bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hearing Impairment as a Determinant of Function in the Elderly
Authors: Bess Fred H. , Lichtenstein Michael J. , Logan Susan A. , Burger M. Candice , Nelson Eugene 
Published: April 2015

This clinical, practice‐based study explores the research question: Is there a relationship between hearing loss and functional disturbance in elderly patients? We analyzed the impact of hearing impairment on 153 patients over 65 years of age screened in primary care practice. Functional and psychosocial impairment were measured using the Sickness Impact Profile (SIP), a standardized measure for assessing sickness related dysfunction. Hearing level was determined with pure tone audiometry.Multiple linear regression was used to adjust for patient case‐mix differences and other clinical variables. After adjustment, a 10 dB increase in hearing loss was found to result in a 2.8 point increase in Physical SIP scores (95% confidence interval = 1.8–3.8), a 2.0 point increase in psychosocial SIP scores (95% confidence interval = 0.8–3.2) and a 1.3 point increase in overall SIP scores (95% confidence interval = 0.1–2.5). Poor hearing was associated with higher SIP scores and increased dysfunction. Thus, hearing impairment is an important determinant of function in the elderly.
An Objective Measure of Physical Function of Elderly Outpatients
Authors: Reuben David B. , Siu Albert L. 
Published: April 2015

Direct observation of physical function has the advantage of providing an objective, quantifiable measure of functional capabilities. We have developed the Physical Performance Test (PPT), which assesses multiple domains of physical function using observed performance of tasks that simulate activities of daily living of various degrees of difficulty. Two versions are presented: a nine‐item scale that includes writing a sentence, simulated eating, turning 360 degrees, putting on and removing a jacket, lifting a book and putting it on a shelf, picking up a penny from the floor, a 50‐foot walk test, and climbing stairs (scored as two items); and a seven‐item scale that does not include stairs. The PPT can be completed in less than 10 minutes and requires only a few simple props. We then tested the validity of PPT using 183 subjects (mean age, 79 years) in six settings including four clinical practices (one of Parkinson's disease patients), a board‐and‐care home, and a senior citizens' apartment.The PPT was reliable (Cronbach's alpha = 0.87 and 0.79, interrater reliability = 0.99 and 0.93 for the nine‐item and seven‐item tests, respectively) and demonstrated concurrent validity with self‐reported measures of physical function. Scores on the PPT for both scales were highly correlated (.50 to .80) with modified Rosow‐Breslau, Instrumental and Basic Activities of Daily Living scales, and Tinetti gait score. Scores on the PPT were more moderately correlated with self‐reported health status, cognitive status, and mental health (.24 to .47), and negatively with age (−.24 and −.18). Thus, the PPT also demonstrated construct validity. The PPT is a promising objective measurement of physical function, but its clinical and research value for screening, monitoring, and prediction will have to be determined.
Electroconvulsive Therapy in Octogenarians
Authors: Cattan Rogelio A. , Barry Patricia P. , Mead Gayle , Reefe William E. , Gay Alix , Silverman Michael 
Published: April 2015

Medical records of 81 older patients (65 years of age and over) who underwent electroconvulsive therapy (ECT) at a university‐affiliated private geriatric hospital were reviewed to evaluate the safety and efficacy of this treatment for depression in the “young‐old” (65 to 80 years) compared with the “old‐old” age group (over 80 years), a group that has not yet been adequately studied.Information was obtained regarding demographics, medical and psychiatric diagnosis, medications, indications for ECT, number and laterality of treatments, outcome, and complications. Thirty‐nine patients 80+ years of age (mean age, 85 ± 3.2) were compared with 42 patients 65 to 80 years of age (mean age, 74 ± 5.2). Statistical analysis was performed using confidence intervals of the difference in proportions of patients in each group. There were no significant differences in the demographics, number and laterality of ECT treatments, indications for ECT treatment, medical diagnosis, medications, or prior history of falls, but psychiatric diagnoses differed slightly. Patients over 80 years had significantly more cardiovascular complications and falls (95% confidence interval) and tended to have a worse ASA (American Society of Anesthesiologists) scale rating and a somewhat less successful outcome.This study confirms the role of ECT as a relatively safe and effective treatment, which may be lifesaving in selected depressed older patients. Prospective studies are needed to understand better the long‐term outcome and to prevent the morbidity and mortality associated with ECT in this frail, high‐risk older group.
The Use of Urethral, Condom, and Suprapubic Catheters in Aged Nursing Home Patients
Authors: Hebel J. Richard , Warren John W. 
Published: April 2015

In this study of 4,259 aged patients in 53 randomly selected nursing homes in Maryland, we found that 10% of women and 15% of men used a urine collection device. Among bedfast patients, 47% of women and 58% of men and, among patients with decubitus ulcers, 37% of women and 33% of men were using a urine collection device.The indwelling urethral catheter was the most commonly used device. Indeed, for women, few other options were available: 93% of women used this device. In women, multiple logistic regression analysis indicated that presence of a decubitus ulcer and occupation of a long‐term care bed were the attributes most strongly associated with the use of the urethral catheter. Of men with urine collection devices, 43% were using the urethral catheter; poor mobility status was the characteristic most strongly associated with its use.Long‐term urethral catheterization has been well studied and is associated with universal bacteriuria and with a number of complications. Options need to be further explored, particularly external urine collection devices for women. Furthermore, because urethral catheterization may be used as a management technique for decubitus ulcers, prevention of the latter may diminish the use of urethral catheters and their subsequent complications.
Pelvic Muscle Exercise for Stress Urinary Incontinence in Elderly Women
Authors: Wells Thelma J. , Brink Carol A. , Diokno Ananias C. , PhD Robert Wolfe , Gillis Grace L. 
Published: April 2015

PurposeTo compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community‐living elderly women.SubjectsConvenience sample of 157 community‐living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation.MethodsEighty‐two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day.Main resultsTreatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125.ConclusionsAmong those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.
Is Age an Independent Risk Factor of Adverse Drug Reactions in Hospitalized Medical Patients?*
Authors: Carbonin Pierugo , Bernabei Roberto , Sgadari Antonio 
Published: April 2015

Objective: To study the incidence and the risk factors of adverse drug reactions.Design: Multicenter survey.Setting: Hospitalized care: 22 internal medicine and 19 geriatric wards.Patients: All patients (n = 9,148) consecutively admitted during two observation periods of 2 months.Main Outcome Measure: Incidence of adverse drug reactions.Results: The mean age was 67.1 ± 0.17 years (median 72); the mean duration of hospital stay was 18.1 ± 0.19 days (median 14). Each patient was administered 5.1 ± 0.03 (median 5) drug prescriptions. The incidence of probable or definite adverse drug reactions was 5.8% (532/9,148). In univariate analysis, the incidence of adverse drug reactions increased from 3.3% at under age 50 to 6.5% at age 70–79 and decreased over age 80 (5.8%). In multivariate logistic regression, taking more than four drugs (OR = 2.94, CI = 2.38–3.62), staying in hospital more than 14 days (OR = 2.82, CI = 2.26–3.52), having more than 4 active medical problems (OR = 1.78, CI = 1.29–2.45), staying in a medical ward instead of geriatric ward (OR = 1.33, CI = 1.09–1.63), and drinking alcohol (OR = 1.28, CI = 1.03–1.58) were positively correlated with adverse drug reactions occurrence (P < 0.05). Age, gender, and smoking cigarettes were not significant predictors of adverse drug reactions.Conclusion: Age is not an independent risk factor of adverse drug reactions, and good geriatric care can reduce the incidence of adverse drug reactions.
The Home Care Practice and Attitudes of Minnesota Family Physicians
Authors: Keenan Joseph M. , Bland Carole J. , Webster Linda , Myers Shepherd 
Published: April 2015

Objective: Assess home care practice and attitudes of Minnesota family physicians (FPs).Design: Mailed survey.Setting: State of Minnesota.Participants: Members of the Minnesota Academy of Family Physicians, 80% of the FPs practicing in the state.Intervention: A 55‐item mailed, self‐complete questionnaire regarding general practice and personal physician characteristics (18 questions), specific questions regarding geriatric and home care practice and related attitudes (37 questions); up to four reminder or follow‐up surveys were sent.Main Outcome Measures: Descriptive summary of FP home care practice and attitudes.Results: Eighty percent of surveys were completed, 76% of responding physicians made at least one home visit in the previous year, and 92% of home visits were to geriatric patients. Discriminant function analysis identified six significant (P < 0.001) variables that explained 52% of the variance (r2 = 0.52, Wilks Lambda = 0.48) in home visiting behavior between frequent home visiting FPs (greater than 24 visits/year) and non‐visiting FPs. FPs most likely to do home visiting were older and tended to have small group or solo practices in rural settings.Conclusion: The survey documented continued decline (from previously published surveys) of physician home visiting behavior and widespread dissatisfaction with reimbursement. However, attitudes regarding home care provided by other professionals were highly positive.
Epidemiology of Asymptomatic Bacteriuria in Elderly Women
Authors: Abrutyn Elias , Mossey Jana , Levison Matthew , Boscia Jerome , Pitsakis Peter , Kaye Donald 
Published: April 2015

We studied asymptomatic bacteriuria in elderly ambulatory women residents without indwelling catheters in self‐contained apartment houses at the Philadelphia Geriatric Center (PGC), in the nursing home at PGC, and in several life‐care communities (LCC). Subjects were studied every 6 months from January 1983 through January 1989, and since enrollment was continuous some participated in more surveys than others. PGC residents were middle class and lived either in a self care apartment house (CL) or nursing home (NH); LCC residents were middle or upper class. Antimicrobial therapy for asymptomatic bacteriuria was not given by the study team.The ages of the 865 women studied averaged 80.3, 82.8, and 83.3 years in LCC, CL, and NH, respectively. On each survey about 11% at LCC, 18% at CL, and 25% at NH sites had positive cultures. Turnover was high. The conversion rate from a negative to a positive culture was 5% at LCC, 11% at CL, and 8% at NH. The reversion rate from a positive to a negative culture was 33% at LCC, 34% at CL and 31% at NH (P > 0.05). Persistent infection with the same organism was uncommon. Infection risk was associated with residence, which was partially explained by a factor evaluating mobility, but was unrelated to age or scores evaluating activities of daily living or mental status. Besides mobility, other more complex factors play a role in the acquisition of infection.
The Interrelationship between Physical Exercise, Muscle Strength and Body Adiposity in a Healthy Elderly Population
Authors: Reed Richard L. , Yochum Kathleen , Pearlmutter Lori , Meredith Keith E. , Mooradian Arshag D. 
Published: April 2015

Objective: To determine the relationship between habitual physical exercise and body adiposity in a healthy elderly population.Research Design and Methods: Physical exercise was measured by a questionnaire previously adapted for use with the healthy elderly. The level of exercise was converted into calories expended over the previous 14 days and was divided into tertiles. Body adiposity was measured at six sites by anthropometry, and overall percent body fat was measured by bioelectric impedence.Participants and Setting: Two hundred and thirteen healthy ambulatory subjects over the age of 60 (116 females and 97 males) were recruited from a large retirement community in Southern Arizona. The mean age of the subjects was 70.0 years.Results: Percent body fat was similar in men with different levels of physical activity (27.9% for lowest fertile of activity, 28.1% for middle tertile of activity, and 28.5% for highest tertile of activity). The corresponding values of percent fat in women was 38.0%, 36.0%, and 37%, respectively. There was a statistically significant increase in muscle strength measured in five muscle groups with a hand‐held dynamometer with increasing levels of activity.Conclusions: These data indicate that level of physical exercise, over the range of 0 to 1,528 Kcal/day, does not predict body adiposity in the healthy elderly population. To decrease body fat without a change in dietary habits would require a more intensive exercise regimen than currently being undertaken by most healthy elderly people.
The Effect of Planned Walking on Communication in Alzheimer's Disease
Authors: Friedman Rita , Tappen Ruth M. 
Published: April 2015

One of the effects of Alzheimer's disease is a diminution in the ability to communicate. A randomized, non‐blinded two‐group experimental study was undertaken to determine if planned walking has the capacity to improve the communication performance of patients with moderate to severe Alzheimer's disease. Thirty subjects meeting NINCDS‐ADRDA diagnostic criteria for probable Alzheimer's disease, selected from two nursing homes, participated in the study. Intervention and comparison groups were each made up of subjects from both nursing homes. Subjects in one group were walked individually for 30 minutes three times a week for 10 weeks. Subjects in the comparison group were engaged in conversation for the same amount of time for 10 weeks.A multivariate analysis of variance (MANOVA) was performed on the communication data. Analysis of the data at post‐testing indicated that communication performance improved significantly in the planned walking group over the conversation‐only group (f = 4.29; df = 2.28; P = 0.024). The results suggest that a planned walking program has the capacity to improve the communication performance of patients with Alzheimer's disease.
Thyroid Stimulating Hormone Elevation without Antithyroid Antibody Elevation in Nursing Home Patients
Authors: Drinka Paul J. , Nolten Wolfram E. , Voeks Susan , Hanger Elizabeth 
Published: April 2015

Objectives: To investigate the relationship between antithyroid antibody elevation and thyrotropin (TSH) elevation.Setting: Large state veterans home.Methods: Seven hundred seventy‐six residents were screened for TSH elevation. Seventy‐two residents with TSH elevation and no history of thyroid disease or recent iodine exposure later had determinations of antithyroglobulin and antimicrosomal antibodies. The relationship between TSH levels and antibody titers was explored.Results: Eleven percent of the residents had TSH elevation. Thirty‐two percent of men and 64% of women with TSH elevation had elevation of antithyroid antibodies. Those residents with the highest antithyroid antibody titers had significantly greater TSH elevation.Conclusion: Previous investigators have found similar percentages of individuals with TSH elevation who lack antithyroid antibody elevation. We hypothesize that TSH elevation without elevated antibody titers may be the result of a previously described involutional histologic lesion of the thyroid.
The Relation of Dizziness to Functional Decline
Authors: Boult Chad , Murphy John , Sloane Philip , Mor Vincent , Drone Corby 
Published: April 2015

Objective: to assess the effect of dizziness on the probability that an older person will die or become functionally disabled within 2 years. Dizziness is a common symptom for which the prognosis is uncertain. This report compares the prognoses for dizzy and not‐dizzy older people in order to assist clinicians who diagnose and treat these patients.Design: a prospective study of a representative sample of elderly (70+) non‐institutionalized Americans. Elderly subjects (n = 3,798) in the Longitudinal Study of Aging (LSOA) were asked questions about the presence of dizziness, medical conditions, and functional disability in 1984. The cohort was reinterviewed about functional disability in 1986.Outcome Measure: transition from functional ability to disability after 2 years.Results: Bivariate analyses showed that dizziness predicts functional decline but not mortality. Multivariate models revealed that age, race, sensory impairment, vascular disease, and other morbidity are independent predictors of becoming disabled. Controlling for these potential confounders, dizziness does not predict an increased probability of becoming disabled.Conclusion: Elderly people who are dizzy should be evaluated for the presence of these related conditions.
Characteristics of Diabetic Ketoacidosis in Older versus Younger Adults
Authors: Malone Michael L. , Gennis Virginia , Goodwin James S. 
Published: April 2015

ObjectiveTo describe how diabetic ketoacidosis in those aged 65 or over differs from that in younger adults.DesignRetrospective chart review of all adult patients with a primary or secondary discharge diagnosis of diabetic ketoacidosis (n = 338).SettingThree urban teaching hospitals in Milwaukee, WI from January 1, 1987 to May 31, 1990.PatientsTwo hundred twenty cases in 150 patients met our criteria for severity of illness to be included in the study. Twenty‐seven cases were in patients ≥ age 65; 193 cases were in patients < age 65.ResultsThe older patients were less likely to have been using insulin before hospitalization (55.6% vs 80.2%, P = 0.004) and less likely to have had a prior episode of diabetic ketoacidosis (8.0% vs 51.4%, P = 0.001). The presenting laboratory data were not significantly different between older and younger subjects. There was a trend toward a higher mean insulin dosage to bring the patient's blood glucose to ≤300 mg/dL for those age 65 or older; 69.1 units vs 44.9 units (P = 0.06). The time required to obtain a glucose <300 mg/dL was greater in older patients (10.5 vs 7.7 hours, P = 0.01). The average length of stay for those age 65 or older was 12.4 days vs 6.7 days (P = 0.001). Thirdly, of those age 65 or older, 7% vs 29% of younger subjects had a blood glucose or Accucheck ≤ 49 mg/dL at some time during their hospital course. The hypoglycemic episodes were more likely to be asymptomatic in older patients (P = 0.03). The mortality rate was 22% for those age 65 or older vs 2% for younger subjects (P = 0.001). The mortality rate for those in age groups 60–69 years, 70–79 years, and ≥ 80 years was 8%, 27%, and 33%, respectively. In patients ≥ 65, mortality was confined to those with coexisting renal disease or infection.ConclusionOlder patients with diabetic ketoacidosis are less likely to have been using insulin before hospitalization. They tend to receive more insulin therapy during their acute management, have a longer average length of hospital stay, and have a higher mortality rate.
A Pilot Study of Anabolic Steroids in Elderly Patients With Hip Fractures
Authors: Sloan John P. , Wing Peter , Dian Larry , Meneilly Graydon S. 
Published: April 2015

ObjectiveTo determine the safety and efficacy of the anabolic steroid nandrolone in elderly patients with hip fractures. Design: A randomized double‐blind placebo‐controlled trial. Setting: The orthopedic ward of a university teaching hospital.Participants29 frail elderly females with hip fractures. Intervention: Subjects received nandrolone 2 mg/kg (n = 15) or placebo (n = 14) by weekly injection for 4 weeks or until discharge.MeasuresBaseline functional status was assessed by the Lawton‐Brody ADL and IADL. Hemoglobin, transferrin, thyroid‐binding prealbumin, albumin, liver function tests, creatinine, weight, MAMC, bioelectric impedance, standard anthropometrics and grip strength were measured at baseline and weekly intervals. Rehabilitation parameters and length of stay were recorded.ResultsThe placebo and nandrolone groups were similar in age, although the control group had slightly higher baseline ADL scores. There was no difference between groups in biochemical parameters, anthropometrics, body composition, grip strength, rehabilitation end points or length of stay. One subject in the nandrolone group had a doubling of AST and was withdrawn from the study.ConclusionsNandrolone can be given safely to frail elderly subjects with hip fractures but is likely to be of minimal benefit at the doses we employed.
The Effect of Aging on Intact PTH and Bone Density in Women
Authors: Flicker L. , Lichtenstein M. , Colman P. , Buirski G. , Kaymakci B. , Hopper J. L. , Wark J. D. 
Published: April 2015

ObjectiveTo determine whether age‐related bone loss is negatively associated with serum intact parathyroid hormone (PTH).DesignSurvey.SettingUniversity hospital outpatient department.Participants100 community‐dwelling women, age 18 to 80, recruited as a convenience sample.MeasurementsDependent variables—bone density at the spine and femoral neck by dual‐energy X‐ray absorptiometry. Independent variables—age, menopausal status (binary) and intact serum PTH by Allegro immunometric assay.ResultsPost‐menopausal women had higher serum PTH and lower bone density of spine and femoral neck than pre‐menopausal women. Bone density at the spine decreased with age, but this effect was accounted for by menopausal state. Bone density at the femoral neck decreased with age even after adjusting for menopause. Log PTH was negatively associated with bone density at the femoral neck but not significantly at the spine. Multiple regression analysis adjusting for age and menopause showed no significant association between intact PTH and bone density at the spine or the femoral neck.ConclusionAlthough this study confirmed the rise in intact PTH with age, there is no evidence that this is the mediator of age‐related bone loss.