bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Utility of an Admission Assessment to Predict In‐Hospital Nutrient Intake
Authors: Sullivan Dennis H. 
Published: April 2015

Objective: To determine if pre‐complication nutrient intake can be predicted based on an admission assessment.Design: Survey (cross‐sectional study).Setting: Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.Patients: Three‐hundred‐twelve randomly selected admissions to the GRU.Measurements: At admission, each patient completed a comprehensive medical, neuropsychological, functional, and nutritional assessment. While remaining hospitalized, each subject was monitored on a daily basis for the development of complications. Complete calorie counts were obtained at least every other day, and the average pre‐complication daily volitional nutrient intake was expressed as a percent of predicted requirements as determined using the Harris‐Benedict equation.Results: Based on a stepwise linear regression analysis, the strongest predictor of pre‐complication volitional intake was the first day calorie count, followed by waist circumference, the percent of weight lost in the 6 months prior to admission, supra‐iliac skinfold thickness, and admission Katz ADL score. The model R2 = 0.66.Conclusions: It is possible to predict pre‐complication nutrient intake with a fair degree of accuracy based on an admission assessment, which includes a 1‐day calorie count.
Correlates of Impaired Function in Older Women
Authors: Ensrud Kristine E. , Nevitt Michael C. , Yunis Carla , Cauley Jane A. , Seeley Dana G. , Fox Kathleen M. , Cummings Steven R. 
Published: April 2015

Objective: To determine the factors associated with impaired function in older women.Design: Cross‐sectional analysis of baseline data collected for a multicenter, prospective study of risk factors for osteoporotic fractures.Setting: Four clinical centers in Portland, Oregon, Minneapolis, Minnesota, Baltimore, Maryland, and the Monongahela Valley, Pennsylvania.Participants: A total of 9,704 ambulatory, non‐black women, aged 65 years and older, recruited from population‐based listings.Measurements: Independent variables, including demographic and historical information (medical conditions, health habits, and medications) and physiologic measures (anthropometry, blood pressure, mental status, vision, and neuromuscular performance) were obtained from a baseline questionnaire, interview, and examination. Measurement of function was assessed by self‐reported ability to perform six physical and instrumental activities of daily living (ADL) and impaired function (dependent variable) was defined as difficulty performing three or more physical and instrumental ADLs.Results: In order of decreasing strength of association, hip fracture, osteoarthritis, parkinsonism, slower walking speed, lower hip abduction force, back pain, greater Quetelet index, osteoporosis, former alcohol use, stroke, never drinking alcohol, lower mental status, use of anxiolytics and/or sleeping medications, inability to hold the tandem position, postural dizziness, cataracts, greater waist to hip ratio, lower physical activity in the past year, greater lifetime cigarette consumption, and lower grip strength were independently associated with impaired function in multivariate analyses. Age, low educational level, diabetes, current heavy alcohol use, postural hypotension, depth perception, and contrast sensitivity were not independent predictors. A combination of neuromuscular performance measures, including decreased muscle strength and impaired balance and gait, appeared to account for the effect of age on disability.Conclusion: A combination of many factors, including medical conditions, health habits such as obesity, smoking, alcohol abstinence, and physical inactivity, and direct measures of neuromuscular performance are associated with impaired function in older women.
Validating the GDS Depression Screen in the Nursing Home
Authors: McGivney Shawn A. , Mulvihill Michael , Taylor Brian 
Published: April 2015

Objective: The GDS (Geriatric Depression Scale) has demonstrated validity among ambulatory elderly but is less useful in nursing home (NH) populations, probably because of high rates of cognitive impairment. We, therefore, sought the lowest level of Mini‐Mental Status Exam (MMSE) score for which the GDS would remain valid.Design: Validation Study.Setting: Nursing Homes in New York City.Participants: A total of 66 of 168 newly admitted residents to the NH were able to complete psychiatric assessment, undergo an MMSE, and complete the GDS. The psychiatrists and testers (all non‐MDs) were blinded to each others' results. Using a cutoff of 10 or greater on the GDS to indicate depression, the GDS's validity (when compared with the psychiatric diagnoses) was sought at ever decreasing levels of cognitive function as measured by the MMSE.Results: The results of all participants (n = 66) revealed a sensitivity of 63% and a specificity of 83%. When only those with an MMSE score ≥15 (the best cutoff score) were included, 44 (64%) participants were selected, with a sensitivity and specificity of 84% and 91%, respectively.Conclusions: The two‐step procedure of first selecting those with MMSE scores ≥15 and then giving the GDS significantly increases the utility of the GDS in detecting depression in NH residents and should improve the diagnostic process for this widely underdetected problem.
Age‐Related Therapeutic Response to Antithyroid Drug in Patients with Hyperthyroid Graves' Disease
Authors: Yamada Takashi , Aizawa Toru , Koizumi Yoichi , Komiya Ichiro , Ichikawa Kazuo , Hashizume Kiyoshi 
Published: April 2015

Objective: To determine whether there is an age‐related difference in the therapeutic response to antithyroid drugs in hyperthyroid Graves' disease.Design: Retrospective analysis of treatment duration and recurrence rate.Patients: Two hundred and twenty‐two patients who have triiodothyronine‐suppressible thyroids within 4 years of methimazole treatment.Measurements: Serum thyroid hormone levels, serum thyrotropin receptor antibody titer, and thyroidal radioiodine uptake.Main results: A longer period of methimazole treatment was needed to normalize serum thyroid hormone levels and to restore normal thyroidal triiodothyronine suppressibility in young than in aged patients. There was an average 10‐month lag between normalization of thyrotropin receptor antibody titer and restoration of thyroidal triiodothyronine suppressibility in both young and aged patients. Recurrence after discontinuation of methimazole was more frequent in young than in aged patients.Conclusions: Aged patients with hyperthyroid Graves' disease show a more favorable response to antithyroid drugs than young counterparts.
Case Managers and Physicians: Communication and Perceived Problems
Authors: Feltes Michael , Wetle Terrie , Clemens Elizabeth , Crabtree Benjamin , Dubitzky Deborah , Kerr Myra 
Published: April 2015

Objective: To describe case managers' perceptions of the physician‐case manager relationship.Design: A qualitative field study using in‐depth open‐ended interviews was used to elicit case managers' experiences and practices. A muladisciplinary team analyzed transcripts using an adaptation of the “grounded theory” approach of Glaser and Strauss.Participants/Setting: Case managers were selected for interview using a maximum variation sampling strategy within an established state‐wide case management agency.Main Outcome Measures: Transcript analysis allowed for the organization of observations into themes, which were merged across interviews to generate theses.Results: Case managers report that: (1) The case manager role is poorly understood by physicians. (2) Physicians lack insight into the social and environmental aspects of home‐bound elderly people. (3) Access to physician services is often difficult to obtain. (4) Power struggles occasionally surface in care planning. (5) Decisions by physicians and case managers regarding the care of frail elderly are often made from different agenda.Conclusions: From the perspective of case managers, gaps in interprofessional communication may hinder the optimal care of frail elderly individuals. J Am Geriatr Soc 42:5–10, 1994
Influence of Diagnostic Classification on Outcomes and Charges in Geriatric Assessment and Rehabilitation
Authors: Miller Stephen T. , Applegate William B. , Elam Janet T. , Graney Marshall J. 
Published: April 2015

Objective: To determine if diagnostic classification is associated with different outcomes from treatment on a geriatric assessment unit (GAU) compared with usual care for elderly patients with acute illnesses.Study Design: Reanalysis after post‐hoc diagnostic classification of a randomized clinical trial with one year follow up.Setting: Community hospital with rehabilitation facility.Subjects: A total of 155 subjects, mean age 78 years and 78% female, of whom 58 subjects had a rehabilitation classification of their diagnoses and 97 had a medical or surgical classification.Outcome Measures: Mortality, nursing home use, activities of daily living, and charges for subsequent medical services.Results: Mortality was decreased in persons with a rehabilitation classification who had received the GAU intervention. The GAU increased point‐prevalence residence in the community for persons with a rehabilitation classification. For persons with a medical‐surgical classification, the GAU intervention was associated with decreased cumulative use of nursing homes. However, GAU intervention was also associated with trends for increased charges in both diagnostic classification groups, even when adjusted for differential survival.Conclusion: Greater benefit from the GAU intervention on mortality and maintenance of residence in the community was observed in a group with a rehabilitation classification when compared with a group with a medical‐surgical classification. These improved outcomes in the rehabilitation group were not accompanied by decreased charges for later medical services that could compensate for initial rehabilitation charges. J Am Geriatr Soc 42:11–15, 1994
Longitudinal Study on Oral Health in Subjects with Alzheimer's Disease
Authors: Ship Jonathan A. , Puckett Scott A. 
Published: April 2015

Objective: To examine longitudinal oral health changes in unmedicated, generally healthy subjects with Alzheimer's disease (AD) and compare them to age‐ and gender‐matched healthy, unmedicated control subjects.Design: Oral health parameters were evaluated over 2 to 3 years and the results compared between subjects with AD and controls.Setting: Clinical Center of the National Institutes of Health, Bethesda, Maryland.Participants: Twenty‐one community‐dwelling subjects with a clinical diagnosis of AD and 21 age‐ and gender‐matched control subjects. Neither population was being treated for any other systemic condition nor taking any prescription medications.Measurements: Unstimulated and stimulated major salivary gland flow rates were measured, and gingival, periodontal, dental, and oral mucosal tissues assessed.Main Results: In general, subjects with AD demonstrated decreased salivary flow rates and diminished oral health, but most longitudinal changes in oral health status were not significantly different than controls.Conclusions: Patients with AD are susceptible to a variety of oral health problems, and progression of AD can lead to a deterioration in oral health and function. These patients require aggressive preventive care to maintain function for as long as possible, which necessitates close cooperation among numerous health care professionals. J Am Geriatr Soc 42:57–63, 1994
Performance of Case‐Finding Tools for Depression in the Nursing Home: Influence of Clinical and Functional Characteristics and Selection of Optimal Threshold Scores
Authors: Gerety Meghan B. , Williams John W. , Mulrow Cynthia D. , Cornell John E. , Kadri Abdulhay A. , Rosenberg Jeff , Chiodo Laura K. , Long Marci 
Published: April 2015

OBJECTIVE: To compare case‐finding tools for depression in the nursing home setting and to evaluate effects of subject function, cognition, and disease number on test performance.DESIGN: Cross‐sectional survey.SETTING: One academic and four community homes.SUBJECTS: One hundred thirty‐four randomly selected, mildly cognitively impaired, functionally dependent residents.METHODS AND MEASURES: The Geriatric Depression Scale (GDS), Short Geriatric Depression Scale (SGDS), Center for Epidemiologic Studies Depression Scale (CES‐D), and Brief Carrol Depression Rating Scale (BCDRS) were administered. The Structured Clinical Interview for DSM‐III‐R diagnoses was administered independently. Operating characteristics and the effects of subject characteristics on test performance were evaluated using McNemar's test and logistic regression. Selection of “optimal” threshold scores was guided by Kraemer's quality indices and clinical judgment.RESULTS: Thirty‐five subjects (26%) had major depression. No differences were found among the instruments in sensitivity (range 0.74–0.89), specificity (range 0.62–0.77), or area under the receiver operating curve (ROC) (range 0.85–0.91). Resident characteristics did not affect test performance. Quality indices showed the GDS and BCDRS met criteria for moderate to substantial agreement with the criterion standard, whereas the SGDS and the CES‐D achieved only fair agreement. No change in threshold scores was warranted.CONCLUSIONS: The GDS and BCDRS performed well in the nursing home. As the GDS can serve as a both a case‐finding and severity instrument, it is preferred. Use of brief, interviewer‐administered tools may improve detection of depression in the nursing home.
Physiological Factors Associated with Falls in Older Community‐Dwelling Women
Authors: Lord Stephen R. , Ward John A. , Williams Philippa , Anstey Kaarin J. 
Published: April 2015

OBJECTIVE: To determine the prevalence of impaired vision, peripheral sensation, lower limb muscle strength, reaction time, and balance in a large community‐dwelling population of women aged 65 years and over, and to determine whether impaired performances in these tests are associated with falls.DESIGN: One‐year prospective study.SETTING: Conducted as part of the Randwick Falls and Fractures Study, in Sydney, Australia.PARTICIPANTS: Four hundred fourteen women aged 65 to 99 years (mean age 73.7 years, SD = 6.3) were randomly selected from the community; 341 of these women were included in the 1‐year prospective study.MAIN RESULTS: The prevalence of impairment in all tests increased with age. In the year following assessment, 207 subjects (60.7%) experienced no falls, 63 subjects (18.5%) fell one time only, and 71 subjects (20.8%) fell on two or more occasions. After controlling for age, multiple falling was associated with low contrast visual acuity and contrast sensitivity, poor vibration sense and proprioception, reduced lower limb strength, slow reaction time, and impaired balance, as indicated by four sway tests and two clinical stability measures. Discriminant function analysis identified visual contrast sensitivity, proprioception in the lower limbs, quadriceps strength, reaction time, and sway on a compliant (foam rubber) surface with the eyes open as the variables that significantly discriminated between subjects who experienced multiple falls and subjects who experienced no falls or one fall only (Wilks' lambda = 0.73 (P < 0.001), canonical correlation = 0.52). This procedure correctly classified 75% of subjects into multiple faller or nonmultiple faller groups.CONCLUSIONS: These findings support previous results conducted in retirement village and institutional settings and indicate that the test procedure aids in the identification of older community‐dwelling women at risk of falls.
Incidence of Complications After Carotid Sinus Massage in Old er Patients with Syncope
Authors: Munro Neil C. , Mclntosh Shona , Lawson Joanna , Morleyf Chris A. , Sutton Richard , Kenny Rose Anne 
Published: April 2015

OBJECTIVE: To review the incidence of neurological complications occurring after carotid sinus massage performed for diagnostic purposes.DESIGN: Case review and comparison with previously published work.SETTING: Syncope Clinic, Royal Victoria Infirmary, Newcastle‐upon‐Tyne, and Chelsea and Westminster Hospital, London.PARTICIPANTS: Patients undergoing investigation of dizziness, syncope, or unexplained falls.METHODS: Carotid sinus massage performed for 5 seconds in both supine and erect postures, both before and after atropine. Contraindications to carotid sinus massage were the presence of carotid bruits, recent myocardial or cerebral ischemia, or previous ventricular tachyarrhythmias.RESULTS: Two cases of neurological complications were reported from a total of 500 patients (2000 massage episodes) investigated in one center, giving an incidence of 0.1%. Combining this data with another center performing investigations in a similar fashion, seven neurological complications arose from a total of 5000 massage episodes, an incidence of 0.14%. Reported complications were pyramidal signs in five cases and visual field defects in two. Pyramidal weakness persisted in one case with a pre‐existing stroke on the same side, and a visual field loss was permanent in one.CONCLUSIONS: Neurological complications following carotid sinus massage for diagnosis of the carotid sinus syndrome are uncommon and usually transient. Contraindications to carotid sinus massage should be respected and the standardized technique used.
Urinary Incontinence Knowledge Among Community‐Dwelling People 65 Years of Age and Older
Authors: Branch Laurence G. , Walker Laura A. , Wetle Terrie T. , DuBeau Catherine E. , Resnick Neil M. 
Published: April 2015

OBJECTIVES: We determined elderly persons' knowledge about the epidemiology and treatment of urinary incontinence (UI) as part of a preintervention survey for the Educational Demonstration of Urinary Continence Assessment and Treatment for the Elderly (EDUCATE).DESIGN: An intact‐group pretest—posttest design was employed to measure the effects of multimethod educational interventions on the knowledge, attitudes, and practices of physicians and older people concerning UI.PARTICIPANTS: A random sample of community‐dwelling people aged 65 years and older from two counties in Massachusetts was selected (n = 1,140).MEASUREMENT: A 14‐item urinary incontinence quiz was developed from information presented in the AHCPR UI Guideline Panel's recommendations. Participant answers to the quiz were part of a 20‐minute telephone interview.RESULTS: For nine of the fact items, the elderly respondents were more likely to give the correct answer than the incorrect answer. However, for only four of those nine did the percentage of correct responses exceed 50% (there were substantial proportions of “don't know” responses). For several fact items, those who were younger, female, or had more formal education were more likely to provide correct responses.CONCLUSIONS: There are substantial gaps in the knowledge of older persons about urinary incontinence, especially among men, those age 85 and older, and those with lower levels of education. These knowledge gaps may contribute to misinterpretation of symptoms and underreporting of symptoms to health care professionals. This pattern of findings indicates a greater need for community education on urinary incontinence.
Prostaglandin E1 as Treatment for Erectile Failure in Elderly Men
Authors: Godschalk Michael F. , Chen Juza , Katz P. Gary , Mulligan Thomas 
Published: April 2015

OBJECTIVE: To determine the efficacy of intracavernosal injection of prostaglandin E1(alprostadil) in elderly men with erectile failure.DESIGN: Prospective study.SETTING: Outpatients at a university‐affiliated VA Medical Center.PARTICIPANTS: Ten subjects aged 65 years and older with duration of erectile failure of 6 months or longer.INTERVENTIONS: Subjects received intracavernosal injections of prostaglandin E1in the office and self‐administered intracavernosal prostaglandin E1at home.MEASUREMENTS: Penile rigidity was measured by palpation and by the Rigiscan rigidity monitor.RESULTS: Intracavernosal injection of prostaglandin E1produced erections adequate for intercourse in 9 of the 10 subjects. Attempts at intercourse were rated satisfactory by two‐thirds of the subjects and their spouses.CONCLUSIONS: Intracavernosal injection of prostaglandin E1is safe and effective for erectile failure in elderly men.
The Neglected Half of Alzheimer Disease: Cognitive and Functional Concomitants of Severe Dementia
Authors: Auer Stefanie R. , Sclan Steven G. , Yaffee Robert A. , Reisberg Barry 
Published: April 2015

OBJECTIVE: Traditional mental status and psychometric assessments bottom out in the late stages of Alzheimer disease (AD). A method adapted from cognitive testing in infants, the Ordinal Scales of Psychological Development was modified (M‐OSPD) and applied to a severely demented population. The concurrent validity of this method was tested in comparison with Functional Assessment Staging (FAST). Internal consistency as a measure for reliability was also determined.DESIGN: Cross sectional study.SETTING: Subjects were generally evaluated in their residence, usually a nursing home or a private home.PATIENTS: Severely cognitively impaired subjects who fulfilled criteria for probable AD were studied.MEASUREMENTS: Evaluation consisted of clinical global, mental status, functional, and cognitive assessments including the Global Deterioration Scale (GDS) and the Mini‐Mental State Examination (MMSE).RESULTS: Seventy patients were evaluated. Traditional mental status assessments (eg, the MMSE) manifested virtually uniform bottom scores in all GDS stage 7 subjects (n = 46), and GDS stage 6 subjects had MMSE scores within one standard deviation unit of zero. In contrast, the M‐OSPD scale continued to show results in the last stages of the disease. The Spearman correlation coefficient between the M‐OSPD total score and the 11 FAST substages represented in this sample was −0.77 (P < 0.001).CONCLUSIONS: The results indicate that patients who are functionally more impaired also show continuing increments in cognitive loss. These cognitive and functional assessments for measuring the magnitude of deterioration in AD can be applied to the estimated half‐million nursing home residents presently labeled “untestable” with the goal of optimization of care and residual capacities.
A Multi‐Center Analysis of the Use of Enalapril and Lisinopril in Elderly Hypertensive Patients
Authors: Hawkins David W. , Hall W. Dallas , Douglas Margaret B. , Cotsonis George 
Published: April 2015

OBJECTIVE: To evaluate the clinical use and adverse effects of enalapril and lisinopril in elderly hypertensive subjects.DESIGN: A multi‐center, retrospective, drug use evaluation survey.SETTING: Ambulatory care clinics at 14 VA and 14 academic medical centers.PATIENTS: 422 elderly (>60 years of age) patients with hypertension and no clinical evidence of congestive heart failure.INTERVENTION: At least 3 consecutive months of anti‐hypertensive therapy with either enalapril or lisinopril.MEASUREMENTS: Blood pressure, serum creatinine, serum potassium, concomitant disease states, concurrent medications, and documentation of any adverse event that might be related to ACE inhibitor therapy.RESULTS: There were no significant differences in systolic and diastolic blood pressures, serum creatinine, or serum potassium between enalapril‐ and lisinopril‐treated patients at baseline and after 3 months of therapy. Both treatments resulted in a significant reduction in diastolic blood pressure. There was no significant difference in the incidence of adverse effects between the two treatments. Significantly more patients were dosed on a twice daily regimen of enalapril than lisinopril.CONCLUSION: The data from this retrospective study confirm the safe and effective use of enalapril and lisinopril, two long‐acting ACE inhibitors, in elderly hypertensive patients.