bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic Value of Usual Gait Speed in Well‐Functioning Older People—Results from the Health, Aging and Body Composition Study
Authors: Cesari Matteo , Kritchevsky Stephen B. , Penninx Brenda W. H. J. , Nicklas Barbara J. , Simonsick Eleanor M. , Newman Anne B. , Tylavsky Frances A. , Brach Jennifer S. , Satterfield Suzanne , Bauer Douglas C. , Visser Marjolein , Rubin Susan M. , Harris Tamara B. , Pahor Marco 
Published: December 2009

Objectives: To define clinically relevant cutpoints for usual gait speed and to investigate their predictive value for health‐related events in older persons.Design: Prospective cohort study.Setting: Health, Aging and Body Composition Study.Participants: Three thousand forty‐seven well‐functioning older persons (mean age 74.2).Measurements: Usual gait speed on a 6‐m course was assessed at baseline. Participants were randomly divided into two groups to identify (Sample A; n=2,031) and then validate (Sample B; n=1,016) usual gait‐speed cutpoints. Rates of persistent lower extremity limitation events (mean follow‐up 4.9 years) were calculated according to gait speed in Sample A. A cutpoint (defining high‐ (<1 m/s) and low risk (≥1 m/s) groups) was identified based on persistent lower extremity limitation events. The predictive value of the identified cutpoints for major health‐related events (persistent severe lower extremity limitation, death, and hospitalization) was evaluated in Sample B using Cox regression analyses.Results: A graded response was seen between risk groups and health‐related outcomes. Participants in the high‐risk group had a higher risk of persistent lower extremity limitation (rate ratio (RR)=2.20, 95% confidence interval (CI)=1.76–2.74), persistent severe lower extremity limitation (RR=2.29, 95% CI=1.63–3.20), death (RR=1.64, 95% CI=1.14–2.37), and hospitalization (RR=1.48, 95% CI=1.02–2.13) than those in the low‐risk group.Conclusion: Usual gait speed of less than 1 m/s identifies persons at high risk of health‐related outcomes in well‐functioning older people. Provision of a clinically meaningful cutpoint for usual gait speed may facilitate its use in clinical and research settings.
Universal Bone Densitometry Screening Combined with Alendronate Therapy for Those Diagnosed with Osteoporosis Is Highly Cost‐Effective for Elderly Women
Authors: Schousboe John T. , Ensrud Kristine E. , Nyman John A. , Melton L. Joseph , Kane Robert L. 
Published: December 2009

Objectives:To investigate the cost‐effectiveness of universal bone densitometry in women aged 65 and older combined with alendronate treatment for those diagnosed with osteoporosis (femoral neck T‐score ≤−2.5).Design:A Markov model with a lifetime time horizon and eight health states (no fracture, distal forearm fracture, radiographic (but clinically inapparent) vertebral fracture, clinical vertebral fracture, hip fracture, hip and vertebral fracture, and other fractures), using the societal perspective.Setting:Women living independently and those in nursing homes.Participants:Caucasian women aged 65, 75, 85, or 95.Intervention:Bone densitometry of the hip, with 5 years of alendronate therapy for those found to have osteoporosis versus no intervention (densitometry or drug therapy).Measurements:Lifetime accumulated quality adjusted life years (QALYs), costs, and incremental cost‐effectiveness ratios.Results:The cost per QALY gained for the screen‐and‐treat strategy was $43,000 per QALY gained for 65‐year‐old women and $5,600 per QALY gained for 75‐year‐old women. For 85‐ and 95‐year‐old women, the screen‐and‐treat strategy was cost saving. Sensitivity analyses showed that the screen‐and‐treat strategy was cost‐effective even under assumptions of reduced adherence to drug therapy, reduced fracture reduction benefit from alendronate therapy, or reduced QALYs saved by preventing fracture.Conclusion:Universal bone densitometry combined with alendronate therapy for those found to have osteoporosis is highly cost‐effective for women aged 65 and older and may be cost saving for ambulatory women aged 85 and older (whether independently living or residing in nursing homes).
Physicians “Missing in Action”: Family Perspectives on Physician and Staffing Problems in End‐of‐Life Care in the Nursing Home
Authors: Shield Renée R. , Wetle Terrie , Teno Joan , Miller Susan C. , Welch Lisa 
Published: December 2009

Objectives: To understand the roles of physicians and staff in nursing homes in relation to end‐of‐life care through narrative interviews with family members close to a decedent.Design: Qualitative follow‐up interviews with 54 respondents who had participated in an earlier national survey of 1,578 informants.Setting: Brown University interviewers conducted telephone interviews with participants throughout the United States.Participants: The 54 participants agreed to a follow‐up qualitative interview and were family members or close to the decedent.Measurements: A five‐member, multidisciplinary team to identify overarching themes taped, transcribed, and then coded interviews.Results: Respondents report that healthcare professionals often insufficiently address the needs of dying patients in nursing homes and that “missing in action” physicians and insufficient staffing create extra burdens on dying nursing home residents and their families.Conclusion: Sustained efforts to increase the presence of physicians and improve staffing in nursing homes are suggested to improve end‐of‐life care for dying residents in nursing homes.
The National Pressure Ulcer Long‐Term Care Study: Outcomes of Pressure Ulcer Treatments in Long‐Term Care
Authors: Bergstrom Nancy , Horn Susan D. , Smout Randall J. , Bender Stacy A. , Ferguson Maree L. , Taler George , Sauer Abby C. , Sharkey Siohban S. , Voss Anne Coble 
Published: December 2009

Objectives: To identify resident, wound, and treatment characteristics associated with pressure ulcer (PrU) healing in long‐term care residents.Design: Retrospective cohort study with convenience sampling.Setting: Ninety‐five long‐term care facilities participating in the National Pressure Ulcer Long‐Term Care Study throughout the United States.Participants: Eight hundred eighty‐two residents, aged 18 and older, with length of stay of 14 days or longer, who had at least one Stage II to IV PrU.Measurements: Data collected for each resident over a 12‐week period included resident characteristics, treatment characteristics, and change in PrU area. Data were obtained from medical records, Minimum Data Set, and other records.Results: Two multiple regression models, one for each stage grouping (Stage II, Stage III and IV), were completed. The area of Stage II PrU was reduced more with moist (F=21.91, P<.001) than with dry (F=13.41, P<.001) dressings. PrUs cleaned with saline or soap showed less decrease in area (F=12.34, P<.001) than PrUs cleaned with other cleansers such as antiseptic, antibiotic, or commercial cleansers. Change in area of Stage III and IV PrUs was related to sufficient enteral feeding (F=5.23, P=.02), enteral feeding without higher acuity levels (F=3.94, P=.048), size of PrU (very large (F=120.89, P=.001) and large (F=27.82, P=.001)), and type of dressing (moist (F=14.70, P<.001) and dry (F=5.88, P=.02)). Stage III and IV PrUs increased in area when debrided (F=5.97, P=.02). The overall models were significant (Stage III and IV, F=20.30, coefficient of determination (R2)=0.06, P<.001; Stage II, F=40.28, R2=0.13, P<.001) but explained little of the variation in change in PrU area.Conclusion: In this sample of nursing facility residents, use of moist dressings (Stage II, Stage III and IV) and adequate nutritional support (Stage III and IV) are strong predictors of PrU healing.
Interrater Reliability and Accuracy in Identifying Ischemic Strokes Using Computed Tomography Scans in People with Dementia
Authors: Bowen James D. , Kamin Richard , Leverenz James B. , Fishel Mark A. , McCormick Wayne C. , Kukull Walter A. , Larson Eric B. 
Published: December 2009

Objectives: To assess the reliability and interobserver agreement of stroke identification on neuroimaging in patients presenting with dementia.Design: Comparison study between neurologists, radiology reports, and autopsy.Setting: Dementia registry within a health maintenance organization.Participants: Dementia patients with computed tomography (CT) scans obtained near the time of diagnosis and postmortem neuropathological examinations (N=99).Measurements: Three neurologists independently read CT scans for the presence and locations of strokes. Radiology reports from these scans were reviewed. The results from neurologists, radiologists, and autopsies were compared.Results: The positive predictive value for CT‐observed strokes compared with their presence on autopsy was 0.44 to 0.49, regardless of the specialty of the observer. Strokes were present at autopsy in 46 of 99 cases. Agreement between neurologists on the presence of strokes was fair to moderate (kappa=0.27–0.56). Less agreement was found between neurologists and radiologists (kappa=0.00–0.11). Results improved slightly when each case was evaluated as any stroke present versus no stroke on imaging (kappa=0.34–0.75) or for the presence of multiple strokes (kappa=0.17–0.69).Conclusion: There is only fair to moderate agreement between observers regarding the identification of strokes on CT scans in patients presenting with dementia. Furthermore, strokes identified on imaging were present on pathology only half the time.
The Beneficial Effects of Group‐Based Exercises on Fall Risk Profile and Physical Activity Persist 1 Year Postintervention in Older Women with Low Bone Mass: Follow‐Up After Withdrawal of Exercise
Authors: Liu‐Ambrose Teresa Y. L. , Khan Karim M. , Eng Janice J. , Gillies Graham L. , Lord Stephen R. , McKay Heather A. 
Published: December 2009

Objectives: To determine whether exercise‐induced reductions in fall risk are maintained in older women 1 year after the cessation of three types of interventions—resistance training, agility training, and general stretching.Design: One‐year observational study.Setting: Community.Participants: Ninety‐eight women aged 75 to 85 with low bone mass.Measurements: Primary outcome measure was fall risk, measured using the Physiological Profile Assessment tool. Secondary outcome measures were current physical activity level, assessed using the Physical Activity Scale for the Elderly, and formal exercise participation, assessed using an interview.Results: At the end of the follow‐up, the fall risk of former participants of all three exercise programs was maintained (i.e., still reduced) from trial completion. Mean fall risk value at the end of follow‐up was 43.3% lower than mean baseline value in former participants of the resistance‐training group, 40.1% lower in the agility‐training group, and 37.4% lower in the general stretching group. Physical activity levels were also maintained from trial completion. Specifically, there was a 3.8% increase in physical activity from baseline for the resistance‐training group, a 29.2% increase for the agility‐training group, and a 37.7% increase for the general stretching group.Conclusion: After three types of group‐based exercise programs, benefits are sustained for at least 12 months without further formal exercise intervention. Thus, these 6‐month exercise interventions appeared to act as a catalyst for increasing physical activity with resultant reductions in fall risk profile that were maintained for at least 18 months in older women with low bone mass.
Two‐Minute Mental Health Care for Elderly Patients: Inside Primary Care Visits
Authors: Tai‐Seale Ming , McGuire Thomas , Colenda Christopher , Rosen David , Cook Mary Ann 
Published: December 2009

OBJECTIVES: To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients.DESIGN: Mixed‐method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health.SETTINGS: Three types of settings: an academic medical center, a managed care group, and fee‐for‐service solo practitioners.PARTICIPANTS: Thirty‐five primary care physicians and 366 of their elderly patients.MEASUREMENTS: Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk.RESULTS: Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients.CONCLUSION: Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits “during which a mental health problem is discussed” may need to be supplemented with guidelines about what should happen during the visit. System‐level interventions are needed.
Effects of Change in Physical Activity on Physical Function Limitations in Older Women: Mediating Roles of Physical Function Performance and Self‐Efficacy
Authors: McAuley Edward , Morris Katherine S. , Doerksen Shawna E. , Motl Robert W. , Liang Hu , White Siobhan M. , Wójcicki Thomas R. , Rosengren Karl 
Published: December 2009

OBJECTIVES: To examine the hypothesis that changes in self‐efficacy and functional performance mediate, in part, the beneficial effect of physical activity on functional limitations over time.DESIGN: Prospective, observational study.SETTING: Community‐based.PARTICIPANTS: Two hundred forty‐nine community‐dwelling older women.MEASUREMENTS: Participants completed measures of self‐reported physical activity, functional limitations, and self‐efficacy. Four measures of physical function performance were also assessed. Measures were completed at baseline and 24 months. Data were analyzed using a panel model within a covariance modeling framework.RESULTS: Results indicated that increases in physical activity over time were associated with greater improvements in self‐efficacy, which was associated in turn with improved physical function performance, both of which mediated the association between physical activity and functional limitations. Fewer functional limitations at baseline were also associated with higher levels of self‐efficacy at 24 months. Age, race, and health status covariates did not significantly change these relationships.CONCLUSION: The findings support the mediating roles of self‐efficacy and physical function performance in the relationship between longitudinal changes in physical activity and functional limitations in older women.
After‐Hours Calls from Long‐Term Care Facilities in a Geriatric Medicine Training Program
Authors: Hastings S. Nicole , Whitson Heather E. , White Heidi K. , Sloane Richard , MacDonald Heather , Lekan Deborah A. , McConnell Eleanor S. 
Published: December 2009

OBJECTIVES: To describe after‐hours telephone calls from nurses in long‐term care (LTC) facilities to doctors in a geriatric medicine training program.DESIGN: Evaluation of 1,928 after‐hours calls from LTC facilities over a 10‐month period in 2005/06.SETTING: Geriatrics fellowship program and three affiliated LTC facilities.PARTICIPANTS: Eight geriatrics fellows and 40 medicine interns.MEASUREMENTS: Data were collected on call characteristics (such as reason for call and call outcome) and physician attitudes about the call, scored using a 5‐point Likert scale.RESULTS: Clinical problems were the focus of 70.4% of the calls. The range of clinical problems was broad; most common reasons for calls were falls (n=377), pain (n=138), and agitation (n=100). The majority of calls resulted in medical intervention, including new medications or treatments (43.4%), diagnostic tests (10.2%), or more‐extensive medical evaluation in the emergency department (9.1%) or by an on‐site physician (2.4%). Overall, physician trainees had favorable attitudes about most after‐hours calls, although medicine interns taking calls had a less‐favorable impression and felt less prepared to manage them.CONCLUSION: After‐hours telephone calls from LTC facilities are common, reflect the heterogeneity of geriatric health concerns, and typically result in intervention. As the LTC population grows, more study is needed on telephone care and optimal strategies for training physicians in this important aspect of LTC.
Volume of Home‐ and Community‐Based Medicaid Waiver Services and Risk of Hospital Admissions
Authors: Xu Huiping , Weiner Michael , Paul Sudeshna , Thomas Joseph , Craig Bruce , Rosenman Marc , Doebbeling Caroline Carney , Sands Laura P. 
Published: December 2009

OBJECTIVES: To evaluate whether type and volume of Medicaid Home‐ and Community‐Based Services (HCBS) waiver program are associated with risk of hospitalization and whether this association changes over time.DESIGN: Prospective.SETTING: Indiana Medicaid claims data from June 2001 to December 2004.PARTICIPANTS: Medicaid recipients (N=1,354) who enrolled in the Aged and Disabled waiver program between January 2002 and June 2004.MEASUREMENTS: Time to hospital admission since enrollment in the HCBS waiver program, adjusted for demographics, comorbidities, prior use of health services, and volume of HCBS received, including attendant care, homemaking, and home‐delivered meals.RESULTS: A greater volume of attendant care, homemaking services, and home‐delivered meals was associated with a lower risk of hospitalization. This effect diminished over time for attendant care and homemaking. The risk of hospitalization for subjects receiving 5 hours of attendant care per month was 54% (hazard ratio (HR)=0.46, 95% confidence interval (CI)=0.38–0.57) lower during the first month of enrollment and 20% lower by Month 10 (HR=0.80, 95% CI=0.73–0.88) than for those receiving no attendant care.CONCLUSION: Greater volume of HCBS services was associated with lower risk of hospitalization. The findings highlight the potential importance of assessing and monitoring the volume of HCBS patients receive.
The Poor Outcome of Ischemic Stroke in Very Old People: A Cohort Study of Its Determinants
Authors: Denti Licia , Scoditti Umberto , Tonelli Claudio , Saccavini Marsilio , Caminiti Caterina , Valcavi Rita , Benatti Mario , Ceda Gian Paolo 
Published: December 2009

OBJECTIVES: To assess how much of the excess risk of poor outcome from stroke in people aged 80 and older aging per se explains, independent of other prognostic determinants.DESIGN: Cohort, observational.SETTING: University hospital.PARTICIPANTS: One thousand five hundred fifty‐five patients with first‐ever ischemic stroke consecutively referred to an in‐hospital Clinical Pathway program were studied.MEASUREMENTS: The relationship between age and 1‐month outcome (death, disability (modified Rankin Scale 3–5), and poor outcome (modified Rankin Scale 3–6)) was assessed, with adjustment for several prognostic factors.RESULTS: Six hundred twelve patients aged 80 and older showed worse outcome after 1 month than those who were younger, in terms of mortality (19% vs 5%, hazard ratio (HR)=3.85, 95% confidence interval (CI)=2.8–5.4) and disability (51% vs 33%, odds ratio (OR)=3.16, 95% CI=2.5–4.0), although in multivariate models, the adjusted HR for mortality decreased to 1.47 (95% CI=1.0–2.16) and the ORs for disability and poor outcome decreased to 1.76 (95% CI=1.32–2.3.) and 1.83 (95% CI=137–2.43), respectively. Stroke severity, the occurrence of at least one medical complication, and premorbid disability explained most of the risk excess in the oldest‐old.CONCLUSION: Stroke outcome is definitely worse in very old people, and most of the excess risk of death and disability is attributable to the higher occurrences of the most‐severe clinical stroke syndromes and of medical complications in the acute phase. These represent potential targets for preventive and therapeutical strategies specifically for elderly people.
An Evaluation of an Adapted U.S. Model of Pharmaceutical Care to Improve Psychoactive Prescribing for Nursing Home Residents in Northern Ireland (Fleetwood Northern Ireland Study)
Authors: Patterson Susan M. , Hughes Carmel M. , Crealey Grainne , Cardwell Chris , Lapane Kate L. 
Published: December 2009

OBJECTIVES: To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI).DESIGN: Cluster randomized controlled trial.SETTING: Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).PARTICIPANTS: Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control).INTERVENTION: Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care.MEASUREMENTS: The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI.RESULTS: The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14–0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups.CONCLUSION: Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.