bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management and Outcome of Acute Myocardial Infarction in Older Patients in the Thrombolytic Era
Authors: Mahon Niall G. , Codd Mary B. , O'Rorke Cliona , Egan Bernadette , McCann Hugh A. , Sugrue Declan D. 
Published: April 2015

OBJECTIVE: Acute myocardial infarction (AMI) is an important cause of mortality and morbidity in older patients. The aim of this study was to determine the proportion of unselected admissions with AMI that is older than 75 years and to examine management and outcomes in this group.DESIGN: An historical cohort study of consecutive unselected admissions with AMI identified using the Hospital In Patient Enquiry (HIPE) database and validated according to MONICA criteria for definite or probable AMI.SETTING: An acute cardiac unit in a university teaching hospital/cardiac tertiary referral center.RESULTS: Of 1059 patients, 606 (57%) were older than 65 years and 309 (29.2%) were older than 75 years. Mean age in this group was 80.5 years. Hospital mortality was almost twice as high as in patients younger than 75 years (28% vs 15%, P < .001), and age was an independent predictor of short‐ and long‐term mortality following AMI. Women constituted a significantly higher proportion of older patients. Family history of AMI and cigarette smoking were less prevalent in older patients. Mean cholesterol was lower and comorbidities were higher. Other baseline characteristics, including previous AMI, did not differ. However older patients were less likely to receive thrombolysis (13% vs 36%, P < .001), aspirin (76% vs 86%, P < .01), or beta‐blockers (25% vs 51%, P < .001) and were less likely to undergo cardiac catheterization or revascularization. Only 53% were admitted to coronary care.CONCLUSION: Patients more than age 75 comprise almost one‐third of patients with AMI and have a poor prognosis. Although age is an independent predictor of mortality following AMI, suboptimal management may contribute to the high mortality in these patients.
Prognostic Value of Dipyridamole Thallium Imaging After Acute Myocardial Infarction in Older Patients
Authors: Jain Sudhir , Baird John B. , Fischer Keith C. , Rich Michael W. 
Published: April 2015

OBJECTIVE: To assess the utility of intravenous dipyridamole thallium testing for predicting major cardiac events following acute myocardial infarction in older patients.DESIGN: Prospective cohort study with a median follow‐up of 18 months.SETTING: A university teaching hospital.PARTICIPANTS: 73 patients aged 65 years and older with enzymatically confirmed acute myocardial infarction (mean age 75 years, 56% male, 71% white).MEASUREMENTS: All patients underwent a detailed clinical assessment, an echocardiogram, and an intravenous dipyridamole thallium stress test before hospital discharge. The study endpoint was death or nonfatal reinfarction during the follow‐up period.RESULTS: Overall, 24 patients (33%) died or developed recurrent myocardial infarction during follow‐up. Among 44 patients with a reversible thallium defect, 19 (43%) reached the study endpoint, compared with only five of 29 patients (17%) without reversible ischemia (P = .04). On multivariate analysis, independent prognostic variables included non‐use of aspirin at hospital discharge (P = .002), decreased left ventricular systolic function (P = .009), non‐use of a beta‐blocker at hospital discharge (P = .013), and reversible ischemia on thallium scintigraphy (P = .025). The relative risks for death or reinfarction associated with non‐use of aspirin, non‐use of a beta‐blocker, left ventricular dysfunction, and reversible ischemia were 2.65, 2.39, 2.01, and 2.51, respectively. Patients with three or four of these risk factors had an 83% probability of death or reinfarction, compared with 41 % in patients with two risk factors and 6% in patients with one or no risk factor (P < .001).CONCLUSION: Intravenous dipyridamole thallium imaging provides independent prognostic information in older patients with acute myocardial infarction. Moreover, the combination of clinical, echocardiographic, and dipyridamole thallium variables effectively stratifies older postinfarction patients into high‐, intermediate‐, and low‐risk categories for death or recurrent myocardial infarction.
The Driving Habits of Adults Aged 60 Years and Older
Authors: Gallo Joseph J. , Rebok George W. , Lesikar Sandra E. 
Published: April 2015

OBJECTIVES: We describe the driving habits of adults aged 60 years and older who were interviewed in the context of a community survey focused on mental disturbances. Our goal was to identify clinical cues that might signal driving difficulty in older adults who might present to the primary care physician for health care.DESIGN: A population‐based survey.SETTING: Continuing participants in a follow‐up study of community‐dwelling adults who were living in East Baltimore in 1981.PARTICIPANTS: Subjects were 1920 continuing participants of the Baltimore sample of the Epidemiologic Catchment Area Program; 589 were aged 60 years and older and provided information on driving habits.MEASUREMENTS: Respondents were asked about their driving status: had they made adaptations to driving and had they experienced any adverse driving events in the 2 years before the interview. Driving behaviors were assessed in relation to chronic disease, sensory impairment, functional status, and mental status.RESULTS: Former drivers were more likely to be older, female, and nonwhite. Diabetes, vision impairment, functional impairment, and making an error on the copy design task of the Mini‐Mental State Examination (MMSE) were associated with no longer driving. Women were more likely to report having made adaptations to driving, as were persons with heart disease, arthritis, vision impairment, and those who made an error on the copy design task of the MMSE. Heart disease and hearing impairment were associated with report of an adverse driving event. In multivariate models that included terms for potentially influential characteristics such as age, gender, and miles driven, only the copy design task was associated with driving status, and only heart disease was associated with driving adaptation and adverse driving events.CONCLUSION: Simple tests that tap visuospatial ability, such as the copy design task of the MMSE, may warrant additional study for use in driving assessment of older adults in primary care. The results underscore the importance of making an inquiry about driving as a separate and independent component of functional assessment.
Survival After Percutaneous Endoscopic Gastrostomy Among Older Residents of Quebec
Authors: Fisman David N. , Levy Adrian R. , Gifford David R. , Tamblyn Robyn 
Published: April 2015

CONTEXT: Percutaneous endoscopic gastrostomy has become a mainstay of nutritional support for individuals with swallowing dysfunction. There is little population‐based data to guide the use of this intervention in older individuals.OBJECTIVE: To describe the use of percutaneous endoscopic gastrostomy among older residents of Quebec and to evaluate patient characteristics associated with subsequent survival and hospital discharge.DESIGN: A population‐based cohort study.SETTING: Quebec, Canada.PATIENTS: 175 individuals with a billing claim for percutaneous endoscopic gastrostomy performed in 1993.MEASUREMENTS: Billing and hospitalization databases were used to collect patient characteristics, medical diagnoses, discharge destinations, and dates of death. The relationships between demographic and diagnostic variables before gastrostomy, and subsequent survival and discharge home, were evaluated using survival analysis.RESULTS: Median survival after gastrostomy was 210 days. Mortality at 30 days was 18.3%. Decreased survival was associated with a previous diagnosis of malignancy (risk ratio (RR) = 1.71; 95% CI, 1.09–2.68); mortality did not increase with increasing age. Of 163 individuals hospitalized at the time of gastrostomy, 42 (26%) were discharged home. Individuals with a previous diagnosis of stroke (RR = 2.80; 95% CI 1.01–7.77) were more likely to be discharged home than other individuals.CONCLUSIONS: Survival after percutaneous endoscopic gastrostomy is poor; the requirement for such a procedure appears to be a marker for severe underlying disease. The greater likelihood of return home after gastrostomy among individuals with stroke suggests that the use of this intervention as an adjunct to rehabilitation is appropriate in these individuals.
Secondary Hyperparathyroidism in Patients from Western Australia with Hip Fracture: Relationship to Type of Hip Fracture, Renal Function, and Vitamin D Deficiency
Authors: Bruce David G , St John Andrew , Nicklason Frank , Goldswain Peter R.T. 
Published: April 2015

OBJECTIVES: To determine the frequency of vitamin D deficiency and secondary hyperparathyroidism in Australian hip fracture patients living in the community.PATIENTS: A total of 283 consecutive patients with hip fracture admitted over a 15‐month period to a university teaching hospital in Western Australia. Included were residents of hostels for the elderly, and excluded were nursing home residents and those with malignant fractures.METHOD: Data collected included biochemistry (25 hy‐droxyvitamin D, parathyroid hormone and creatinine levels), measurements of function and disability (Barthel Index, Frenchay Activity Index), sunshine exposure, and basic demographics.RESULTS: Vitamin D deficiency occurred in 31.7% and secondary hyperparathyroidism occurred in 17.7% of cases. The major determinants of vitamin D deficiency were outdoor sunshine exposure, ambient daily sunshine, and disability (low Frenchay Activity Index or ADL difficulty). Secondary hyperparathyroidism was related to older age, renal dysfunction, and vitamin D deficiency. Secondary hyperparathyroidism was associated with an excess of trochanteric over subcapital hip fractures.CONCLUSIONS: Secondary hyperparathyroidism appears to be a heterogeneous condition, caused in approximately equal proportions by vitamin D deficiency and renal dysfunction, that may confer increased cortical bone fragility and trochanteric fractures. Renal dysfunction in old age may be an important additional determinant of senile osteoporosis, which has implications for preventive therapy. Vitamin D deficiency occurs in disabled and, presumably, housebound older people despite near optimal climactic conditions.
A Randomized Trial of a Combined Physical Activity and Environmental Intervention in Nursing Home Residents: Do Sleep and Agitation Improve?
Authors: Alessi Cathy A. , Yoon Eun J. , Schnelle John F. , Al‐Samarrai Nahla R. , Cruise Patrice A. 
Published: April 2015

OBJECTIVES: The purpose of this study was to test whether an intervention combining increased daytime physical activity with improvement in the nighttime environment improves sleep and decreases agitation in nursing home residents.DESIGN: A randomized trial.SETTING: One community nursing home in the Los Angeles, California area.PARTICIPANTS: Twenty‐nine incontinent residents (mean age 88.3 years, 90% female).INTERVENTION: Subjects were randomized to receive either (1) an intervention combining increased daytime physical activity (14 weeks in duration) plus a nighttime program (5 nights in duration) to decrease noise and sleep‐disruptive nursing care practices (intervention group), or (2) the nighttime program alone (control group). MEASUREMENTS: Daytime physical activity monitors and structured physical function assessments; nighttime wrist activity monitors to estimate nighttime sleep; and timed day time behavioral observations of sleep versus wakefulness, either in or out of bed, and agitation.RESULTS: Physical function measures did not change significantly (MANOVA for repeated measures, group by time effect). Wrist actigraphy estimation of nighttime percent sleep (time asleep over time monitored in bed at night) increased in intervention subjects from 51.7% at baseline to 62.5% at follow‐up compared with 67.0% at baseline to 66.3% at follow‐up in controls (MANOVA, group by time, F = 4.42, P =. 045, df = 27). At follow‐up, intervention subjects averaged a 32% decrease in the percent of daytime observations in bed compared with baseline, with essentially no change in controls (MANOVA, group by time, F = 5.31, P =. 029, df = 27). Seven of 15 intervention subjects had a decrease in observed agitation at follow‐up, compared with baseline, versus only 1 of 14 controls with a decrease in observed agitation.CONCLUSIONS: This study provides preliminary evidence that an intervention combining increased physical activity with improvement in the nighttime nursing home environment improves sleep and decreases agitation in nursing home residents.
Risk Factors for Falls and for Serious Injuries on Falling Among Older Japanese Women In Hawaii
Authors: Davis James W. , Ross Philip D. , Nevitt Michael C. , Wasnich Richard D. 
Published: April 2015

OBJECTIVES: To evaluate if similar constellations of factors underlie the risks of falls and injuries on falling for Japanese women as reported for predominately white populations.DESIGN: A prospective cohort studySETTING: The island of OahuPARTICIPANTS: The older Japanese women who participated in the Hawaii Osteoporosis Study (mean age = 74 ± 5 (SD) years).MEASUREMENTS: As outcomes: falls and serious injuries on falling. As predictors: anthropometric measurements, measurements of neuromuscular performance, activities of daily living (ADLs), past falls, and other suspected risk factors for falls and serious injuries.RESULTS: In multivariable models, four subject characteristics were positively associated with having a fall (having a fall in the past year (RR = 2.0 (95% CI, 1.5–2.8)), slow chair stands (RR = 1.4 (95% CI, 1.0–1.9), a short height (RR = 1.5 (95% CI, 1.1–2.1)), difficulties with five or more ADLs (RR = 1.5 (95% CI, 1.1–2.1))). Two subject characteristics were negatively associated with having a fall (ability to perform a full tandem balance with eyes closed (RR =. 7 (95% CI,. 5–1.0)) and having a long functional reach (RR =. 7 (95% CI,. 5–1.0))). The RRs represent as nearly as possible comparisons of the upper (or lower) quartile and the remaining quartiles. In multivariable models, long times for chair stands (odds ratio (OR) = 3.0 (95% CI, 1.5–6.1)) and a low BMI (OR = 3.1 (95% CI, 1.5–6.4)) were positively associated with having a serious injury among women who had a fall. Among the same women, taking part in an activity they did frequently (OR =. 3 (95% CI,. 1−.8)) and slow foot reaction times (OR =. 3 (95% CI,. 1−.8)) were associated negatively with having a serious injury. CONCLUSIONS: The results from this Japanese cohort support the conclusion that women at high risk of falling and serious fall injuries can be identified using a questionnaire and simple, performance‐based tests of neuromuscular function. The risk factors for falling overlapped, but were distinct from, those for suffering a serious injury once a fall had occurred.
The Treatment and Prevention of Coronary Heart Disease in Canada: Do Older Patients Receive Efficacious Therapies?
Authors: McAlister Finlay A. , Taylor Laurel , Teo Koon K. , Tsuyuki Ross T. , Ackman Margaret L. , Yim Rita , Montague Terrence J. ,   The Clinical Quality Improvement Network (CQIN) Investigators
Published: April 2015

OBJECTIVES: To review the evidence for clinical efficacy and cost‐effectiveness of proven medications in the treatment and prevention of myocardial infarction (MI) in older patients; to summarize Canadian data on treatment patterns and clinical outcomes for younger and older patients with coronary heart disease; to explore the reasons for gaps between best care, based on the evidence of efficacy from trials, and usual care, based on the population effectiveness audits; and to explore potential approaches to closing the care gaps.DESIGN: Review of the recent clinical trial literature on the management of MI, highlighting results in older patients. Review of medication utilization and outcomes data from a series of large, consecutively enrolled patient cohorts with acute MI (N = 7070) in a variety of cardiac care settings (10 centers in five Canadian provinces, including university‐ based teaching hospitals, community hospitals, cardiologist and family physician out‐patient clinics) from 1987 to 1996.RESULTS: There is no qualitative interaction of cardiac therapies: thrombolytics, beta‐blockers, acetylsalicylic acid (ASA), and statins are efficacious in all clinically relevant patient subgroups, including older people. However, there are consistent gaps between usual care and best care, particularly among older patients (in whom there is also a concomitantly higher mortality risk). Repeated multivariate analyses confirm older age to be an independent contributor to increased risk. Use of efficacious medications is, in contrast, consistently associated with increased survival. Analysis of temporal trends suggests beneficial changes in practice patterns and outcomes are possible to achieve. However, “best care” has not been rapidly or completely achieved. Review of strategies to close these care gaps suggests that audit and feedback, critical pathways, and multifactorial interventions involving patients and other members of the healthcare team as well as physicians may be the most efficacious strategies for change.CONCLUSIONS: Despite equal or enhanced efficacy, there is consistently less prescription of proven drugs among older cardiac patients. These care patterns may contribute to their enhanced risk. The causes underlying these practice patterns are complex, and their population impact may be undervalued by clinicians and managers. Improvement of these patterns is difficult, but ultimately it would be beneficial for this presently disadvantaged, readily identified, high risk patient population. J Am Geriatr Soc 47: 811–818, 1999.
Prevalence of Combined Fecal and Urinary Incontinence: A Community‐Based Study
Authors: Roberts Rosebud O. , Jacobsen Steven J. , Reilly W. Terence , Pemberton John H. , Lieber Michael M. , Talley Nicholas J. 
Published: April 2015

OBJECTIVE: To assess the prevalence of combined fecal and urinary incontinence.DESIGN: A cross‐sectional, community‐based study.SETTING: Olmsted County, Minnesota.PARTICIPANTS: Men (n = 778) and women (n = 762), aged 50 years or older, selected randomly from the population.MEASUREMENTS: Participants completed a previously validated self‐administered questionnaire that assessed the occurrence of fecal and urinary incontinence in the previous year.RESULTS: The age‐adjusted prevalence of incontinence was 11.1% (95% Confidence Interval (CI), 8.8–13.5) in men and 15.2% (95% CI, 12.5–17.9) in women for fecal incontinence; 25.6% (95% CI, 22.5–28.8) in men and 48.4% (95% CI, 44.7–52.2) in women for urinary incontinence; and 5.9% (95% CI, 4.1–7.6) in men and 9.4% (95% CI, 7.1–11.6) in women for combined urinary and fecal incontinence. The prevalence of fecal incontinence increased with age in men but not in women, from 8.4% among men in their fifties to 18.2% among men in their eighties (P for trend =. 001). For women, the prevalence increased from 13.1% among 50‐ year‐old women to 20.7% among women 80 years or older (P for trend =. 5). Among persons with fecal incontinence, the prevalence of concurrent urinary incontinence was 51.1% among men and 59.6% among women (P =. 001 and P =. 003, respectively). Cross‐sectionally, the age‐adjusted, relative odds of fecal incontinence among persons with urinary incontinence was greater in men than in women (Odds Ratio (OR) = 3.0; 95% CI, 1.9–4.8 in men and OR = 1.8; 95% CI, 1.2–2.7 in women, P =. 04).CONCLUSIONS: These findings suggest that persons with one form of incontinence are likely to have the other form as well. Despite the higher prevalence of urinary and fecal incontinence among women, the association between fecal incontinence and urinary incontinence was stronger among men than women. This finding, and the significant association between fecal incontinence and age observed in men but not in women, suggest that the etiologies may be more closely linked in men than in women.
Gender Differences in the Sequelae of Hospitalization for Acute Myocardial Infarction Among Older Adults
Authors: Wolinsky Fredric D. , Wyrwich Kathleen W. , Gurney James G. 
Published: April 2015

OBJECTIVE: To examine the effect of gender differences among older adults hospitalized for an acute myocardial infarction (AMI) on subsequent health outcomes.DESIGN: Secondary analysis of the Longitudinal Study on Aging. Data from baseline interviews (1984) and three biennial (1986, 1988, and 1990) re‐interviews were linked to Medicare hospitalization and National Death Index records for 1984–1991.PARTICIPANTS: A total of 6071 community‐dwelling adults aged 70 years or older at baseline.METHODS: Pooled and stratified multivariable models were used to examine gender differences in the independent effects of being hospitalized for an AMI on all‐ cause mortality, the risk and volume of subsequent hospitalization, and increases in the number of functional limitations. Two comparison groups were used.RESULTS: Three hundred fifty‐seven AMI cases (6%; 172 women and 185 men) were compared with 3976 hospitalized controls and 1738 nonhospitalized controls. The risk of all‐cause mortality for AMI cases was greater than that for either hospitalized controls or nonhospitalized controls (referent), and this increased risk was significantly (P < .001) stronger for women (adjusted hazards ratio (AHR) = 14.24, 95%CI = 10.99, 18.46) than for men (AHR = 9.91, 95%CI = 7.75, 12.67). Overall, AMI cases were also more likely to be hospitalized subsequently than the hospitalized controls (referent; adjusted odds ratio (AOR) = 1.47, 95%CI = 1.17, 1,85), although in the stratified analysis this association held for men (AOR = 1.73, 95%CI = 1.25, 2.41) but not for women (AOR = 1.25, 95%CI = .90, 1.73). Among those subsequently hospitalized, both women and men AMI cases consumed more hospital resources than the hospitalized controls, and there were gender differences suggesting that the effects on total charges and length of stay were greater for women than for men with AMI. Finally, although the AMI cases had greater adjusted mean increases in the number of instrumental activities of daily living limitations and lower body limitations than the nonhospitalized controls, they were no worse off than the hospitalized controls, and there were no gender differences in those effects.CONCLUSION: Relative to the appropriate comparison groups, hospitalization for an AMI increases the risk of death and the total costs and lengths of stay of subsequent hospitalizations for women more than for men. Therefore, increased primary prevention, diagnosis, and treatment efforts should be directed toward women. J Am Geriatr Soc 47:151–158, 1999.