bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Chlorothiazide on Bone‐Related Biochemical Variables in Normal Post‐Menopausal Women
Authors: Peh C. A. , Horowitz M. , Wishart J. M. , Need A. G. , Morris H. A. , Nordin B. E. C. 
Published: April 2015

ObjectiveTo evaluate the effects of short‐term administration of chlorothiazide on fasting urinary hydroxyproline, an index of bone resorption, and other bone‐related biochemical parameters in normal post‐menopausal women.DesignSubjects served as their own control before and after chlorothiazide treatment.SettingSubjects were recruited by advertisement.ParticipantsThirteen healthy post‐menopausal women with a mean age of 65 years.InterventionEach subject was given chlorothiazide 500 mg bd po for 7 days. Fasting blood and urine samples were obtained immediately before the commencement of chlorothiazide (day 1) and 2 and 7 days after starting chlorothiazide.ResultsChlorothiazide decreased the urinary calcium/creatinine (mean value day 1, 0.267; day 2, 0.143; day 7, 0.135; P < 0.001) and hydroxyproline/creatinine (day 1, 0.0192; day 2, 0.0145; day 7, 0.0139; P < 0.02) molar ratios.ConclusionChlorothiazide decreases fasting urinary hydroxyproline, a marker of bone resorption in post‐menopausal women. This observation supports a potential role for thiazide diuretics in the prevention of osteoporosis. The observed fall in urinary hydroxyproline is of the same order as that seen after treatment with estrogen or calcium supplements.
Pain Complaints and Cognitive Status among Elderly Institution Residents
Authors: Parmelee Patricia A. , Smithy Buster , Katz Ira R. 
Published: April 2015

ObjectiveTo examine the association between self‐reported pain and cognitive impairment among frail elderly institution residents.DesignA cross‐sectional correlational study.SettingA large urban nursing home and congregate apartment complex housing predominantly Jewish elderly.ParticipantsSeven hundred fifty‐eight elderly institution residents (30% in the nursing home, 70% in congregate apartments). The sample was 70% female and averaged 83.3 years of age.MeasurementsRespondent self‐reports tapped pain intensity, number of localized pain complaints, cognitive status, and disability in performance of activities of daily living. Attending physicians or physician assistants rated respondents health status.Main ResultsPain intensity and number of localized pain complaints bore small but significant negative relationships to cognitive impairment. Pain was positively associated with physician‐rated ill health and functional disability. The association between pain and cognitive status remained significant even when controlled statistically for effects of physical health and functional disability. Item‐by‐item examination of localized pain complaints indicated that markedly cognitively impaired individuals were less likely to report pain in the back and joints. However, examination of possible physical causes of reported pain revealed no differences between pain reports of cognitively impaired versus intact individuals in either the presence or the absence of a likely physical cause.ConclusionsThese data provide no evidence for the “masking” of pain complaints by cognitive impairment. They suggest instead that, although cognitively impaired elderly may slightly underreport experienced pain, their self‐reports are generally no less valid that those of cognitively intact individuals. Limitations of the research are acknowledged and implications for treatment of cognitively impaired institution residents are discussed.
Serum Albumin and Prealbumin As Predictors of Clinical Outcomes of Hospitalized Elderly Nursing Home Residents
Authors: Ferguson Robert P. , O'Connor Patrick , Crabtree Benjamin , Batchelor Allison , Mitchell Jeanne , Coppola Devin 
Published: April 2015

ObjectiveTo investigate the prevalence of hypoalburninemia and hypoprealbuminemia in hospitalized, elderly, skilled nursing facility residents and to correlate these findings with clinical outcomes.DesignProspective cohort study.SettingA 300‐bed community hospital.ParticipantsEighty‐one hospitalized, skilled nursing facility patients, average age 83.1 years.InterventionsNone.Outcome MeasuresSerum albumin and prealbumin (transthyretin) were measured at admission, mid‐week, 1 week, and 1 month. Patients were followed for 90 days for the outcomes of length of hospitalization and mortality.ResultsThe prevalence of hypoalbuminemia was 99% and of hypoprealbuminemia, 79%. Both means dropped significantly from admission to midweek nadirs of 25 g/L for albumin and 14 mg/L for prealbumin. Severe hypoalbuminemia at mid‐week predicted mortality (RR = 4.1 95%, CI 2.0–8.5) and extended length of hospitalization (RR = 5.2 95%, CI 2.8–9.8). Severe hypoprealbuminemia predicted extended hospitalization (RR = 3.2, CI 1.5–6.7) but not mortality.ConclusionsHypoalbuminemia and hypoprealbuminemia are very common in this clinical setting and vary in parallel fashion over time. Severe hypoalbuminemia was a stronger predictor than hypoprealbuminemia of 90‐day mortality and extended length of stay. Serum albumin on admission was not as strong a predictor of outcomes as serum albumin at mid‐week.
The Critical Shortage of Geriatrics Faculty
Authors: Reuben David B. , Bradley Thomas B. , Zwanziger Jack , Fink Arlene , Vivell Susan , Hirsch Susan H. , Beck John C. 
Published: April 2015

To estimate the adequacy of current and future supply of geriatrics faculty, we conducted a national survey to determine the current supply of geriatrics faculty in five specialties and compared these estimates to standards for optimal faculty supply in geriatrics. Finally, we generated a model to project future faculty supply based on both current training capacity and differing assumptions regarding future training capacity.Our findings indicate that the current supply of geriatrics physician faculty is less than half the number needed in each specialty. (Existing numbers range from a high of 909 faculty in internal medicine to a low of 86 in physical medicine.) Moreover, given the current capacity for training, there will be a net loss of such faculty each year in each specialty.We conclude that the number of geriatrics faculty currently available is insufficient to provide an appropriate “core” level of geriatrics training for all undergraduate medical students and residents in relevant residency programs. In addition, the current framing capacity for geriatrics faculty cannot even sustain the current level of faculty over the next 10 years. To correct the current and future deficit, substantial increases in both geriatrics fellowship positions and mid‐career training positions will be necessary.
Treadmill Walking in Old Age May Not Reproduce the Real Life Situation
Authors: Greig Carolyn , Butler Felicity , Skelton Dawn , Mahmud Siti , Young Archie 
Published: April 2015

Objective: In a preliminary study in our laboratory, healthy elderly people had a higher heart rate during treadmill walking than during corridor walking at the same speed. The objective of this study was to determine whether this initial observation, (1) persisted after repeated testing, (2) was present in younger adults, (3) was due to wearing a mouthpiece during treadmill walking, or (4) was due to a change in gait.Design: A study of elderly and young volunteers undergoing repeated testing, with comparison of treadmill walking with corridor walking.Setting: The Royal Free Hospital School of Medicine.Participants: Twelve healthy elderly (71–80 years) and 12 healthy young (21–37 years) volunteers.Main Outcome Measures: Heart rate (beats/min) and step rate (steps/min) during comfortable self‐paced corridor walking and during treadmill walking at the same speed.Main Results: The elderly subjects had higher heart rates during treadmill walking than during corridor walking at the same speed (mean difference = 6 beats/min, 95% Confidence Interval (CI) = 1 to 10). This difference increased (to a mean of 11 beats/min, 95% CI = 5 to 16) when a mouthpiece was worn on the treadmill. These differences persisted after repeated testing. The young subjects did not have higher heart rates on the treadmill, (with or without the mouthpiece). In both groups, step rate was lower (95% CI = ‐9 to ‐2, elderly; ‐5 to ‐2, young) during treadmill walking, corresponding to a 3% increase in stride length.Conclusion: The heart rate response to treadmill walking in healthy elderly people may be less representative of the “real life” situation than in younger adults.
What Is Appropriate Health Care for End‐Stage Dementia?
Authors: Daniel J. Luchins MD  , Hanrahan Patricia 
Published: April 2015

Objective: This study sought to determine the kind of health care that professional and family caregivers viewed as appropriate for end‐stage dementia patients.Design: Survey.Participants: All 819 physician members and 1,000 randomly selected non‐physician members of the Gerontological Society of America and 500 families of demented relatives from the Alzheimer's Association.Measures: Respondents chose the appropriate level of care from five choices on a continuum from highly aggressive to palliative.Results: The majority of physicians who cared for elders (61%), gerontologists from other professions (55%), and families (71%) chose palliative care only. Increased age of the respondent and experience with terminal care choices were associated with the choice of palliative care. The majority favored hospice care for patients with end‐stage dementia.Conclusions: Professional and family members of demented individuals, especially if they have experience in terminal care decisions, strongly favor palliative care for end‐stage dementia. These findings may be helpful to professionals and families dealing with these choices.
Alleviation of Sleep Maintenance Insomnia with Timed Exposure to Bright Light
Authors: Campbell Scott S. , Dawson Drew , Anderson Michael W. 
Published: April 2015

Objective: Half of the population over 65 suffers from chronic sleep disturbance. As a consequence, almost 40% of hypnotic medications are prescribed to people over age 60. Yet, hypnotics are often of little benefit in this population. As such, an effective non‐drug alternative could prove important in the management of age‐related sleep maintenance insomnia. The current study sought to evaluate the efficacy of bright light exposure in the treatment of sleep maintenance insomnia.Design: Following baseline sleep and circadian rhythms assessment, subjects with sleep‐maintenance insomnia were treated with timed exposure to either bright white light or dim red light for 12 consecutive days. Sleep and circadian rhythms recordings were subsequently obtained and measures of sleep quality were compared to assess efficacy of the treatments.Setting: Baseline and post‐treatment sleep and circadian rhythms assessments took place in the Laboratory of Human Chronobiology, Department of Psychiatry, Cornell University Medical College. The treatment phase of the study was conducted in participants' homes.Participants: Sixteen men and women between the ages of 62 and 81 years were studied. All subjects were free of hypnotic medication, and all had experienced sleep disturbance for at least 1 year prior to entering the study.Results: Exposure to bright light resulted in substantial changes in sleep quality. Waking time within sleep was reduced by an hour, and sleep efficiency improved from 77.5% to 90%, without altering time spent in bed. Increased sleep time was in the form of Stage 2 sleep, REM sleep, and slow wave sleep. The effects were remarkably consistent across subjects.Conclusions: The findings demonstrate the effectiveness of timed exposure to bright light in the treatment of age‐related sleep maintenance insomnia. With further refinement of treatment regimens, this non‐drug intervention may prove useful in a large proportion of sleep disturbed elderly.
Aggressive Behaviors among the Institutionalized Elderly
Authors: Malone Michael L. , Thompson Lori , Goodwin James S. 
Published: April 2015

Objective: To describe the incidence and characteristics of aggressive behaviors in a group of institutionalized elderly.Design: Retrospective survey.Setting: 350‐bed, urban skilled nursing facility.Patients: All nursing home residents who had an incident report completed after an aggressive behavior.Measurements: Examination of all incident reports of aggressive behavior for 1 year.Results: There were 94 reports of aggressive behaviors. Twenty‐nine residents exhibited one aggressive behavior, 12 residents two, and six residents exhibited three or more aggressive behaviors. These six residents accounted for 44% of all events. The incidence of aggressive behavior was 0.27 per resident per year for the entire facility; on the Alzheimer's unit the incidence was 0.75 per resident per year. Sixty‐two percent of the victims of aggressive behavior were other nursing home residents, 37% were employees, and 1% were visitors. The charts of the six residents with three or more aggressive behaviors were reviewed. These residents received trials of multiple scheduled psychotropic medications, often exhibited several additional agitated behaviors around the time of the attack, were at risk for psychiatric hospitalizations during the study period, and often were noted to have underlying acute medical illnesses near the time of the attack.Conclusion: Approximately two aggressive behaviors per week occurred in a large nursing home. Residents and staff of Alzheimer's units have a higher risk of being victims of aggressive behavior. A small number of patients account for nearly half of the behaviors, even on the Alzheimer's unit. Aggressive behaviors may be clinical indicators of underlying acute medical illnesses.
A Comparison of the Cardiac Safety and Therapeutic Efficacy of Trimipramine versus Doxepin in Geriatric Depressed Patients
Authors: Nair N. P. Vasavan , Amin Mohammed , Schwartz George , Dastoor Dolly , Thavundayil Joseph X. , Mirmiran Jamal , MacDonald Carolyn , Phillips Robert 
Published: April 2015

Objective: To compare the cardiac safety and therapeutic efficacy of trirnipramine and doxepin.Design: A 1‐week single‐blind placebo period followed by a 5‐week randomized double‐blind parallel group clinical trial.Setting: Psychiatric out‐patient clinic of a general hospital.Patients: 37 young‐elderly patients with a diagnosis of Major Depressive Episode (DSM‐III criteria).Interventions: Placebo for 1 week, 2 weeks of titration with either drug in the dosage range of 75 mg/day up to a maximum of 200 mg/day.Measurements: We measured the psychiatric effects with the Hamilton Rating Scale for Depression, the Hamilton Anxiety Rating Scale, and the Clinical Global Impression Scale. Cardiovascular effects were assessed on 12‐lead standard electrocardiograms plus 1‐minute rhythm and high speed recordings; orthostatic (lying/standing) blood pressures were also taken. Physical exams, lab tests, cognitive functions (Buschke Selective Reminding Test, Hierarchic Dementia Scale, Word Fluency) and adverse reactions were also noted.Results: Both drugs were equally effective in relieving symptoms of depression and anxiety. The cardiovascular effects of both drugs were minimal. Trimipramine did lower blood pressure but this was without clinical significance. Three trimipramine patients and five doxepin patients developed occasional premature ventricular or atrial contractions. Of these, two trimipramine patients and one doxepin patient were among those with abnormal ECG's at entry. The doxepin patient was withdrawn from the study after 21 days of treatment when the PVC's became increasingly frequent.Conclusions: Trimipramine and doxepin are equally safe and effective antidepressants in the young‐elderly.
Age‐Related Trends in Cardiovascular Morbidity and Physical Functioning in the Elderly: The Cardiovascular Health Study
Authors: Bild Diane E. , Fitzpatrick Annette , Fried Linda P. , Wong Nathan D. , Haan Mary N. , Lyles Mary , Bovill Edwin , Polak Joseph F. , Schulz Richard 
Published: April 2015

Objective: To describe relationships between age and subclinical cardiovascular disease, manifest chronic disease, and physical functioning and limitations among persons aged 65 years and older, with emphasis on the “oldest old,” those 85 years and older.Design: Observational population‐based study.Setting: Four U.S. communities: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania.Participants: 5,201 men and women aged 65 years and older.Measurements: Demographic data; histories of cardiovascular disease (CVD), chronic lung disease, arthritis, diabetes, and hypertension; measures of subclinical disease including arm and ankle blood pressures, internal carotid wall thickness and stenosis, ejection fraction, left ventricular mass, fractional shortening, and diastolic function, electrocardiographic left ventricular hypertrophy and cardiac injury score, forced expiratory flow and volume; functional status including self‐reported physical functioning, hearing and sight limitations and health status, and performance‐based measures of function. These variables were examined among men and women in three age groups: 65–74 years, 75–84 years, and 85+ years. Subgroups of participants with and without manifest CVD were also examined.Main Results: In women, the prevalence of CVD and other chronic conditions increased with age, and the highest rates occurred among those 85 years and older. In men, prevalence rates increased between the two younger groups, but the oldest group had lower than expected rates for coronary heart disease, cerebrovascular disease, hypertension, and chronic lung disease. In contrast, there were strong age‐related linear trends in most of the subclinical measures of blood pressure, atherosclerosis and pulmonary function and in virtually all measures of functional status in both gender groups across the age range. There was a particularly marked decline in functional status between the two older age groups. While subclinical disease was greater and functional status was poorer among those with manifest CVD, with few exceptions, age‐related trends were not significantly different between the two groups.Conclusions: Lower than expected prevalence rates of CVD among those aged 85 years and older, particularly among men, in this study of community‐dwelling elderly may represent selection bias or a real plateauing in disease prevalence with age. However, subclinical disease appears to increase and functional status to decline across the age range in both men and women regardless of the presence of CVD. The apparent increase in subclinical disease with age indicates potential for CVD prevention after age 65.
Cognitive Impairment and the Use of Health Services in an Elderly Rural Population: The MoVIES Project
Authors: Ganguli Mary , MPH Eric Seaberg , PhD Steven Belle , MPH Lynn Fischer , DrPH Lewis H. Kuller MD 
Published: April 2015

Objective: To describe the patterns of use of health and human services by elderly rural individuals and to determine whether cognitively impaired persons had a distinctive pattern of service utilization.Design: An epidemiological survey and cognitive screening of an age‐stratified random community sample.Setting: The mid‐Monongahela Valley, a rural community in Southwestern Pennsylvania.Participants: 1366 non‐institutionalized persons aged 65 years and older, fluent in English, and with at least a sixth grade education.Measurements: We administered a battery of cognitive screening tests (the Mini‐Mental State Examination; Immediate and Delayed Recall of a Story; Immediate and Delayed Recall of a Word List; CERAD modification of the Boston Naming Test; Verbal Fluency for initial letters P and S and for names of Fruits and Animals; Temporal Orientation; Praxis; Clock Drawing; and Trailmaking Tests A and B.) We also obtained basic demographic information and enquired about the use of health and human services in the previous year.Results: Approximately 10% of the sample was classified (by operational criteria) as cognitively impaired. In univariate analyses, cognitive impairment was found to be significantly associated with the use of certain health services: hospitalization in the previous 6 months (odds ratio, OR = 2.1; 95% CI = 1.3, 3.3), previous nursing home use (OR = 9.3; 95% CI = 3.8, 22.9), home health care (OR = 4.6; 95% CI = 2.7, 8.0), social services (OR = 6.5; 95% CI = 3.4, 12.4), mental health services (OR = 2.8; 95% CI = 1.2, 6.2), and the regular use of prescription medications (OR = 2.0; 95% CI = 1.3, 3.2). Visits to physicians were not significantly different between the impaired and unimpaired groups. In a multiple regression model, which included age and educational level, the use of home health care (OR = 3.4; 95% CI = 1.8, 6.4) and social services (OR = 2.3; 95% CI = 1.1, 4.9) remained significantly associated with cognitive impairment.Conclusions: The association of cognitive impairment with the use of these health and human services underscores the general frailty of the impaired group. These findings also point to potential target groups in the community for further evaluation and services for dementia. The findings support the need for education regarding cognitive impairment and dementia to be made available to providers of these services, particularly informal social services such as those provided by church groups.
Age‐Related Variability in the Use of Cardiovascular Imaging Procedures
Authors: Bearden Donna M. , Allman Richard M. , Sundarum Srini Vasan , Burst Nickie M. , Bartolucci Alfred A. 
Published: April 2015

Objective: To determine if older patients undergo fewer cardiovascular imaging procedures (CIPs) than younger patients when admitted to a tertiary care academic medical center for an acute myocardial infarction (MI), after adjusting for disease severity and comorbidities.Design: Non‐current prospective cohort study.Setting: Urban tertiary care academic medical center.Patients: Medical records of 294 patients admitted and diagnosed with an acute MI between January 1990 and April 1991 were reviewed.Measurements: The total number of different CIPs performed during hospitalization was determined. Cardiac catheterizations, echocardiograms, radionuclide ventriculograms, and thallium scans counted as CIPs. Disease severity was assessed by the Acute Physiology Score (APS) of APACHE II, admission Killip's Classification, and peak creatine phos‐phokinase (CPK) levels. Comorbidities were assessed using a modified Comorbidity Damage Index of Charlson.Results: The mean (± SD) number of different CIPs performed during hospitalization was significantly less for those ≥75 years old (1.3 ± 1.0) than for those <75 years old (1.7 ± 1.0) (P = 0.01), and CIP number negatively correlated with age (Spearman r = −0.178; P = 0.01). Mean CIP number decreased from 2.0 ± 1.1 for those <45 years old to 0.9 ± 0.6 for those >85 years old (P = 0.02). Other factors positively associated (P ≤ 0.10) with CIP number were: CPK values in the highest quartile of the study population (>355 U/L); admission to a cardiology, medical, or family practice service; no CIP performed at an outside hospital prior to transfer; admission Killip's Classification of less than IV, and a Q‐wave MI. After adjusting for these variables in a multiple regression model, age ≥75 remained an independent predictor of decreased CIP use (P = 0.003). The modified comorbidity index score and the APS score, a general measure of severity of illness, were not significantly associated with CIP use. When procedures were examined individually, no significant age‐related differences were noted in the use of thallium scans, radionuclide ventriculograms, or echocardiograms. Older patients did, however, remain less likely to undergo cardiac catheterizations (P < 0.001).Conclusion: Older patients, regardless of underlying disease severity or comorbidities, undergo fewer invasive cardiovascular evaluations than younger patients when admitted to a tertiary care academic medical center for an acute MI.