bluuebunny/crossref_metadata_2025_split huggingface dataset:
Needlestick Injuries and Needle Disposal in Minnesota Nursing Homes
Authors: Crossley Kent , Willenbring Karen , Thurn Joseph 
Published: April 2015

We examined needle use and disposal, needlestick injuries and their management, and employee education regarding the acquired immunodeficiency syndrome and needle use by means of a questionnaire sent to all long‐term care facilities certified for skilled care in Minnesota. Responses were received from 297 of 349 (85.1%) homes. Nearly all homes (271 of 293; 92.5%) provided education for new nursing employees about use and disposal of needles. Disposal of needles and sharps was generally consistent with current recommendations for short‐term care hospitals. Needlestick injuries were usually related to recapping and were most common in registered and licensed practical nurses but were infrequent (i.e., <1 injury per home per employee‐year) probably because parenteral therapy is infrequently used in long‐term care settings. Only slightly over half (166 of 286; 58%) of the homes had protocols for management of needlestick injuries.Although Minnesota nursing homes properly dispose of needles and sharps, many of these institutions need to develop policies for management of needlestick injuries that are consistent with current recommendations.
The Accuracy of Medication Histories in the Hospital Medical Records of Elderly Persons
Authors: Beers Mark H. , Munekata Mark , Storrie Michele 
Published: April 2015

Medication histories written in medical records are important sources of information for clinicians and researchers. Medication histories in outpatient records are frequently inaccurate; the accuracy of the histories in hospital records has not previously been studied. We evaluated the accuracy of medication histories recorded in hospital medical records of 122 persons over the age of 65 at three sites, comparing the written record to a structured history obtained from the patient by the research staff. We defined an error as either the failure to record the use of a medication the patient claimed to use or the recording of a medication that the patient denied using.We found that 83% of all patients had at least one such error, and 46% had three or more. We reanalyzed the data excluding over‐the‐counter, topical, and cold medications, and found that 60% of all patients still had at least one error, and 18% had three or more. Failure to record use in the record was more common than recording medications the patient denied using. There were no qualitative differences between hospitals or between the histories obtained by interns and attending physicians.This analysis suggests that medication histories in the hospital medical record are not accurate sources of information in elderly persons. Errors in the history may adversely affect clinical care; researchers relying on hospital medical records to determine medication use at the time of admission should first validate their data.
Long‐Term Enteral Feeding of Aged Demented Nursing Home Patients
Authors: Peck Arthur , Cohen Camille E. , Mulvihill Michael N. 
Published: April 2015

The terminal phase of dementia is initiated by the inability to swallow. New techniques of enteral alimentation permit more effective, longer intubation. To assess the application of these new techniques to late‐stage demented aged patients, all current intubations in a teaching nursing home were reviewed. Of 52 feeding intubations, 26 had been in situ for more than 1 year. A randomly selected comparison group of nonintubated patients was also studied.Weight increased for 48% of the intubated group versus 17% of the nonintubated group (P < .01). Aspiration pneumonia occurred more often in the intubated group (58%) than in the nonintubated group (17%) (P < .01). Decubitus ulcers were also more common in the intubated group (21%) than in the nonintubated group (14%). Restraints were used more in the intubated group (71%) than in the nonintubated group (56%). These differences did not reach statistical significance.All of the intubated patients were severely demented, with MMSE scores of zero. Seventy‐one percent of the nonintubated group were demented, with MMSE scores of < 23.Prolongation of the terminal phase of dementia in the aged by tube feeding is now feasible. The implications of this change in the life‐span of demented nursing home patients need attention by families, nursing homes, and those who make public health policy.
Early Readmission of Elderly Patients With Congestive Heart Failure
Authors: Vinson Janice M. , Rich Michael W. , Sperry Jane C. , Shah Atul S. , McNamara Timothy 
Published: April 2015

Repetitive hospitalizations are a major health problem in elderly patients with chronic disease, accounting for up to one fourth of all inpatient Medicare expenditures. Congestive heart failure, one of the most common indications for hospitalization in the elderly, is also associated with a high incidence of early rehospitalization, but variables identifying patients at increased risk and an analysis of potentially remediable factors contributing to read‐mission have not previously been reported.We prospectively evaluated 161 patients 70 years or older that had been hospitalized with documented congestive heart failure. Hospital mortality was 13% (n = 21). Among patients discharged alive, 66 (47%) were readmitted within 90 days. Recurrent heart failure was the most common cause for readmission, occurring in 38 patients (57%). Other cardiac disorders accounted for five readmissions (8%), and noncardiac illness led to read‐mission in 21 cases (32%). Factors predictive of an increased probability of readmission included a prior history of heart failure, four or more admissions within the preceding 8 years, and heart failure precipitated by an acute myocardial infarction or uncontrolled hypertension (all P < .05). Using subjective criteria, 25 first readmissions (38%) were judged possibly preventable, and 10 (15%) were judged probably preventable. Factors contributing to preventable readmissions included noncompliance with medications (15%) or diet (18%), inadequate discharge planning (15%) or follow‐up (20%), failed social support system (21%), and failure to seek medical attention promptly when symptoms recurred (20%).Thus, early rehospitalization in elderly patients with congestive heart failure may be preventable in up to 50% of cases, identification of high risk patients is possible shortly after admission, and further study of nonpharmacologic interventions designed to reduce readmission frequency is justified.
Taking to Bed
Authors: Clark Linda P. , Dion Denise M. , Barker William H. 
Published: April 2015

The objective of this study was to determine the incidence and selected clinical outcomes of taking to bed among a population of independently ambulating older individuals. It was designed as a retrospective case series and was conducted in the intermediate‐care facility of a not‐for‐profit, teaching nursing home. Our study group was composed of individuals over 65 years of age who became bed bound. Thirty‐six taking‐to‐bed episodes occurred in 36 individuals during one calendar year, giving an incidence of 13 per 1,000 resident‐months (95% CI, 4 to 23 per 1,000). Twelve of the 36 died within 3 months, and 17 within 6 months, but almost all who survived regained ambulation. Survival was significantly shorter for the five without localizing symptoms (P < .05). Orthopedic, neurologic, psychiatric, and iatrogenic conditions were most commonly identified as concurrent medical events. Almost half who took to bed had multiple concurrent medical events, and these residents were more likely to present without localizing symptoms (P < .05). Twenty‐one (58%) of the episodes occurred after a fall.The incidence of taking to bed in this population indicates that clinicians caring for older persons should be alert to its occurrence. The dramatic decline in mobility deserves careful assessment because it initiated a period of relatively rapid change in the health careers of the individuals we studied: almost half died within 6 months, but nearly all who survived regained ambulation. Those without localizing symptoms may have more complex interacting medical problems and a worse prognosis.
Mini‐Mental State Exam Scores Vary with Education in Blacks and Whites
Authors: Murden Robert A. , McRae Thomas D. , Kaner Steven , Bucknam Mary E. 
Published: April 2015

Previous studies have suggested that education and race may affect performance on standardized mental status tests. In order to more clearly define these relationships, a prospective longitudinal study was devised to answer two questions: (1) whether race or level of education affects scores on the Mini‐Mental State (MMS) exam in non‐demented people and (2) what numerical cutpoints maximize the sensitivity and specificity of utilizing the MMS to help diagnose dementia in blacks of varying educational attainment.A total of 100 white and 258 black individuals, recruited from two city hospital primary care geriatric clinics, were evaluated and subsequently followed longitudinally over a 2 1/2 year period in order to assess accurately the presence or absence of dementia. In the non‐demented, total MMS scores and performance on each item of the MMS were analyzed, revealing that people with an 8th grade or less education consistently had significantly (P < .01) worse results than the better educated (9th grade or better) on borough, attention items, recall of table and dog, copying, sentence writing, phrase repeating, and total score. Furthermore, a total of 25% of the lower education group had an MMS score in the 18–23 range, traditionally thought to suggest dementia. There were no consistently significant differences between blacks and whites of equal education. In the better educated groups, using a score of 23 or less to define dementia maximizes the sensitivity and specificity of using the MMS in this diagnosis at 93% and 100%, respectively. In the lower education group, using 17 or less to define dementia maximizes sensitivity and specificity at 81% and 100%, respectively. It is concluded that MMS results are affected by education but not by race, that only certain MMS items are educationally related and perhaps could be modified, and that on the unmodified MMS a score of 17 or less should be used as the outpoint for suggesting the presence of dementia in the poorly educated.
Characteristics and Outcomes of Hospitalized Older Patients Who Develop Hypocholesterolemia
Authors: Noel Margaret A. , Smith Thuy K. , Ettinger Walter H. 
Published: April 2015

ObjectivesThis research project was undertaken to determine the clinical characteristics, lipoprotein abnormalities, and outcomes of older hospitalized patients who develop hypocholesterolemia.MethodsThe project had two parts: (1) a retrospective, case‐control study of 50 hospitalized patients ≥65 years old whose serum cholesterol was normal on admission (≥160 mg/dL) and fell to ≤120 mg/dl during hospitalization; (2) a laboratory study of lipoproteins in 17 hospitalized patients ≥65 years old whose cholesterol was normal on admission but fell to ≤120 mg/dL during hospitalization.ResultsCase‐control Study—Nine percent of patients ≥65 years old developed hypocholesterolemia while in the hospital, and these patients were more likely than controls to have undergone surgery and to have nothing by mouth for 5 days or longer. Cases had a longer length of stay, more complications, and were slightly more likely to die in the hospital than controls.Laboratory Study—Hypocholesterolemic patients had low concentrations of all lipoproteins (VLDL, LDL, HDL), and the LDL and HDL were enriched in triglyceride and depleted of cholesterol ester.ConclusionAcquired hypocholesterolemia is a common finding in hospitalized older patients and is associated with poor outcomes. Patients who became hypocholesterolemic in the hospital had both a low concentration of lipoprotein particles and abnormalities in lipoprotein particle composition.
Underdiagnosis and Poor Documentation of Acute Confusional States in Elderly Hip Fracture Patients
Authors: Gustafson Yngve , Brännström Benny , Norberg Astrid , Bucht Gustav , Winblad Bengt 
Published: April 2015

Study ObjectiveTo determine the accuracy of diagnosis and documentation of acute confusional states (ACS) in the medical records of patients with hip fracture.DesignThe diagnosis of ACS in two prospective clinical studies was compared to its diagnosis in the medical records of the same patients on the same hospitalization. In order to determine if the simultaneous prospective study influences the diagnostic and documentary practices evidenced in the medical records, a further comparison was done by reviewing medical records of two series of patients seen some years prior to the prospective studies.SettingPatients with femoral neck fractures treated at a department of orthopedic surgery in a university hospital and one retrospective control sample from a department of general surgery in a county hospital.SubjectsTwo prospective samples of patients 65 years and older treated for femoral neck fractures (n = 111 and n = 57, respectively) and two earlier retrospective samples (n = 66 and n = 68, respectively).Measurements and Main ResultsAll comparisons showed that both physicians and nurses diagnosed ACS unsatisfactorily and documented the patients' mental status poorly. The analysis of the two retrospective medical record control samples gave the same results. Neither the physicians nor the nurses used any kind of diagnostic instrument to detect cognitive disorders in the patients.ConclusionsACS is a common and severe complication in elderly people treated for femoral neck fractures. Acute confusional states have, by definition, one or more causes that can often be identified and treated. Poor assessment and documentation is a threat to the patients as a correct diagnosis of ACS is a prerequisite for further assessment of its underlying causes and the consequent necessary medical and nursing care.
Geriatrics Faculty in the United States: Who Are They and What Are They Doing?
Authors: Reuben David B. , Bradley Thomas B. , Zwanziger Jack , Vivell Susan , Fink Arlene , Hirsch Susan H. , Beck John C. 
Published: April 2015

Despite increases in geriatrics training at all levels of medical education, there is a nationwide shortage of geriatrics faculty. This shortage may be due in part to demands for clinical responsibilities that preclude adequate time for teaching and research.To learn about the professional activities of geriatrics faculty, we conducted a national survey of a 50% sample of all medical schools and their affiliated residency programs that focused on physician and non‐physician geriatrics faculty in internal medicine, family practice, psychiatry, neurology, and physical medicine and rehabilitation. Although we found minor differences across specialties, in general, approximately one‐third of physician faculty time is spent in teaching, the majority of which is clinical teaching. Less than 15% of physician faculty time is spent in research, and fewer than 10% of physician geriatrics faculty devote over half of their time to research. The percentage of time that non‐physician faculty (other than “Research Only” faculty) spend in research is only slightly higher. These findings suggest that efforts to increase geriatrics education at all levels and promote research advances will be limited unless geriatricians devote substantially more of their time to these responsibilities.
Prevalence of Postural Hypotension at Baseline in the Systolic Hypertension in the Elderly Program (SHEP) Cohort
Authors: Applegate William B. , Davis Barry R. , Black Henry R. , Smith W. McFate , Miller Stephen T. , Burlando Alfredo J. 
Published: April 2015

Objective: The objective of this study was to examine the prevalence and correlates of postural hypotension (defined as a drop in systolic blood pressure of ≥20 mm Hg) in a cohort of elderly persons with isolated systolic hypertension (ISH).Design: Baseline cross‐sectional analysis of the 4,736 persons randomized in the Systolic Hypertension in the Elderly Program (SHEP).Setting: A randomized multi‐center double‐blind outpatient clinical trial of the impact of treating ISH. Participants: Men and women age ≥60 years with the systolic blood pressure (SBP) ≥ 160 mm Hg and diastolic blood pressure (DBP) < 90 mm Hg.Measures: Medical histories were obtained using interviewer‐administered, standardized clinical history forms. At entry into the study, seated and standing BP was measured by certified BP technicians using a random zero sphygmomanometer. Postural hypotension (PH) was assessed at 1 and 3 minutes after the participant arose from a seated position.Main results: PH was found in 10.4% of participants at 1 minute and in 12.0% of participants at 3 minutes. 5.3% of participants demonstrated PH at both time intervals while 17.3% demonstrated PH at either or both of the time intervals. Factors significantly (P < 0.05) associated with the presence of PH were higher mean SBP and a lower mean body mass index.Conclusions: Somewhat different persons were defined as having PH based upon the 1 minute and 3 minute standing measures of BP, and prevalence estimates of PH can vary depending on whether one or more intervals of measurement are used. Cross‐sectional data analysis indicated that PH, in healthy community‐dwelling older persons with ISH, may not be associated with a history of disorders or problems usually thought to be related to PH. However, prospective data are needed to determine the prognostic significance of PH, and whether one or multiple measurements carry more significance.
Effects of Exercise Training on Bone Density in Older Men and Women
Authors: Blumenthal James A. , Emery Charles F. , Madden David J. , Schniebolk Susan , Riddle Margaret W. , Cobb Frederick R. , Higginbotham Michael , Coleman R. Edward 
Published: April 2015

Objectives: To determine the effects of up to 14 months of aerobic exercise on measures of bone density in older adults.Design: Randomized controlled trial with subjects assigned to either an aerobic exercise condition, non‐aerobic yoga, or a wait list non‐exercise control group for 4 months. Aerobic fitness and bone density were evaluated in all subjects at baseline (Time 1) and after 4 months (Time 2). A semi‐crossover design was utilized with all subjects completing 4 months of aerobic exercise, followed by another evaluation (Time 3). All subjects were then given the option of 6 additional months of aerobic exercise, after which they had a fourth evaluation (Time 4).Setting: An outpatient exercise rehabilitation facility at a large, major medical center.Subjects: One‐hundred‐one healthy men (n = 50) and women (n = 51) over age 60 (Mean age = 67.0), recruited from the community.Intervention: The exercise program included stretching, cycle ergometry, and walking three times per week for 60 minutes throughout the course of the study.Outcome Measures: Aerobic fitness (VO2 max) as assessed by cycle ergometry, and bone density (bone mineral content) measured by single photon absorptiometry.Results: Subjects achieved a 10%–15% increase in VO2 max after 4 months of exercise training, and 1%–6% further improvement with additional training. Aerobic fitness was associated with significant increases in bone density in men, but not women, who maintained aerobic exercise for 14 months.
Methicillin‐Resistant Staphylococcus aureus in Minnesota Nursing Homes
Authors: Thurn Joseph R. , Belongia Edward A. , Crossley Kent 
Published: April 2015

Objective: To assess the experience of Minnesota nursing homes with methicillin‐resistant Staphylococcus aureus (MRSA) and the policies and procedures used for its control.Design: A 12‐question survey, with primarily categorical responses, was mailed to the Directors of Nursing of all Minnesota long‐term‐care facilities. A follow‐up mailing was sent to non‐responders 5 weeks later. The mailing included a cover letter, a description of the study and its purposes, and a stamped return envelope. Four weeks after the second mailing, all non‐responding institutions were contacted by telephone and invited to participate by mail or by completing the survey by telephone.Setting: All long‐term‐care facilities in Minnesota licensed for skilled and intermediate care.Participants: The survey was directed to the Directors of Nursing of the long‐term‐care facilities with the request that, if another individual was better able to complete it, the survey be forwarded to them.Results: Completed responses were obtained from 88% (395/445) of all long‐term‐care facilities in Minnesota. Forty‐eight institutions (12%) had residents colonized or infected with MRSA. Only four (8%) of these facilities stated that MRSA was a problem; however, 33 (69%) of facilities with MRSA had sought outside help or consultation from a variety of sources for its control. Few facilities (7%) had cultured residents specifically for MRSA. Policies regarding the admission of colonized or infected persons were reported by 14% and 21% of facilities, respectively, and over 40% of these policies stated that persons with MRSA would not be accepted. Policies regarding the care of MRSA‐colonized or ‐infected persons were not uniform. Both metropolitan and non‐metropolitan facilities had residents with MRSA.Conclusions: Our results suggest that MRSA in long‐term‐care facilities may be a widespread and underrecognized problem. There is a need to develop uniform policies for the control of MRSA in nursing homes. These policies should consider the sources and objectives of long‐term‐care facilities.
Clinical Significance of Primitive Reflexes in Alzheimer's Disease
Authors: Molloy D. William , Clarnette Roger M. , McIlroy William E. , Guyatt Gordon , Rees Linda , Lever Judy 
Published: April 2015

Study Objective: To establish the relationship between cognition, behavior, function, and clinical characteristics on the one hand, and the presence of primitive reflexes (PR) (pout, snout, palmomental and grasp) in patients with Alzheimer's disease (AD).Design: Cross‐sectional survey.Setting: Secondary care geriatric practice specializing in the assessment of cognitive impairment.Subjects: 136 consecutive patients presenting with AD.Measurements: PR were assessed in standardized fashion by a single clinician. Cognitive function was measured using the Standardized Mini‐Mental Status Examination, activities of daily living (ADL) and instrumental activities of daily living (IADL) were measured using the Lawton scale, and behavior was measured using the Behavioural Problem Checklist.Results: There was no difference in age or duration of dementia in those with and without PR, nor was there any difference in cognitive function. Despite this, patients with PR showed a greater degree of functional limitation and dysfunctional behavior. There was also a higher incidence of rigidity, gait abnormalities, and apraxia in patients with PR.Conclusions: Patients with primitive reflexes had more severe impairment in ADL function and dysfunctional behavior for an equal level of cognitive function.