bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strength, Balance, and the Modifying Effects of Obesity and Knee Pain: Results from the Observational Arthritis Study in Seniors (OASIS)
Authors: Jadelis Kristen , Miller Michael E. , Ettinger Walter H. , Messier Stephen P. 
Published: May 2003

OBJECTIVE: To examine the relationship between muscular strength and dynamic balance in a sample of older adults with knee pain and to determine the role that obesity and severity of knee pain play in the ability to maintain balance.DESIGN: Cross‐sectional study designed to examine the association between strength and balance in a cohort of older adults with chronic knee pain.SETTING: A university health and exercise science center.PARTICIPANTS: A cohort of 480 adults age 65 and older with knee pain.MEASUREMENTS: Force platform dynamic balance measure of the center of pressure excursion during a forward and subsequent backward lean. Isokinetic strength measures of concentric and eccentric knee flexion and extension and concentric ankle plantar flexion and dorsiflexion. Body mass index (BMI) and a knee pain scale were used to measure obesity and knee pain, respectively.RESULTS: A regression model was developed to investigate the relationship between dynamic balance and muscular strength while controlling for gender, BMI, radiographic severity, knee pain, and foot length. Knee strength alone explained 18.4% of the variability in dynamic balance. The addition of knee pain, BMI, radiographic severity, gender, and foot length explained an additional 6.7%. When the knee‐ankle interaction, ankle strength, and knee strength–pain interaction variables were added to the regression model, 28.9% of the variability in dynamic balance was explained.CONCLUSIONS: Strength appears to play a significant role in maintaining balance in an older, osteoarthritic population. We found that mean knee strength accounted for approximately 19% of the variability in dynamic balance. Hence, greater knee strength was associated with better dynamic balance. The best dynamic balance performances occurred in participants that had a combination of strong knees and strong ankles. However, knee osteoarthritic patients with weak knee strength could still maintain high levels of dynamic balance by having strong ankle strength. Moreover, we have shown that obesity is associated with attenuated dynamic balance performance and that poorer balance is associated with higher pain scores in the presence of weaker knees. For stronger knees, however, pain does not appear to be related to balance.
Self‐Reported Social and Emotional Impact of Urinary Incontinence
Authors: Fultz Nancy H. , Herzog A. Regula 
Published: May 2003

OBJECTIVE: Incontinence‐specific and generic measures of well‐being were regressed on potential predictors to identify incontinent respondents at risk for psychosocial distress and to understand the relationship between urinary incontinence (UI) and other determinants of social and emotional status.DESIGN: Survey data were collected May 1994 through April 1996.SETTING: Telephone interviews as a supplement to a nationally representative monthly consumer survey.PARTICIPANTS: Analyses were based on 1,116 continent and 206 incontinent respondents age 40 and older.MEASUREMENTS: Incontinent respondents self‐reported the extent to which urine loss restricted social activities or affected their feelings about themselves. All respondents were asked whether they felt depressed, lonely, or sad. Covariates included sex, age, race, education, social desirability, health status, frequency of urine loss, quantity of loss, and urgency.RESULTS: The majority of incontinent respondents reported that urine loss did not restrict activities or diminish self‐esteem. Incontinent respondents who were younger, male, less educated, lower in social desirability, in poorer health, or losing greater quantities of urine were more likely to report psychosocial distress, although these correlates were not consistently significant. Compared with continent respondents, significantly higher percentages of incontinent respondents reported feeling depressed, lonely, or sad. In the multivariate models, incontinence retained an independent association with loneliness, but not with sadness or depression.CONCLUSION: Even though the direct psychosocial impact of urine loss may be minor in many cases, UI is associated with a constellation of physical and behavioral factors that can impose a social and emotional burden. This suggests that UI cannot be adequately evaluated or treated without consideration of the patient's overall quality of life.
Healthy Centenarians Do Not Exist, but Autonomous Centenarians Do: A Population‐Based Study of Morbidity Among Danish Centenarians
Authors: Andersen‐Ranberg Karen , Schroll Marianne , Jeune Bernard 
Published: May 2003

OBJECTIVE: To assess the prevalence of common illnesses in an unselected population of centenarians.DESIGN: A population‐based survey.SETTING: Denmark.PARTICIPANTS: All Danes who celebrated their 100th anniversary between April 1, 1995 and May 31, 1996: 276 persons.MEASUREMENTS: All participants (including proxies) were visited at their domicile for an interview (sociodemographic characteristics, activities of daily living, living conditions, need of assistance from other people, former health and current diseases, current medication) and a clinical examination (dementia screening test, heart and lung auscultation, neurological assessment, height and weight, electrocardiogram, arm and ankle blood pressure, assessment of hearing and vision capacity, a short physical performance test, bio‐impedance, lung function test, blood test). Further health information was retrieved from medical files and national health registers.RESULTS: Seventy‐five percent (207) of eligible subjects participated in the study. Cardiovascular disease was present in 149 (72%) subjects. Osteoarthritis (major joints) was present in 54%, hypertension (≥140/≥90) in 52%, dementia in 51%, and ischemic heart disease in 28%. The mean number of illness was 4.3 (standard deviation (SD) 1.86). Only one subject was identified as being free from any chronic condition or illness. Sixty percent had been treated for illness with high mortality. In 25 autonomous (nondemented, functioning well physically, living at home) and 182 nonautonomous centenarians, comorbidities were equivalent.CONCLUSION: Because they have a high prevalence of several common diseases and chronic conditions, Danish centenarians are not healthy. However, a minor proportion was identified as being cognitively intact and functioning well.
Disability in the Oldest Old: “Can Do” or “Do Do”?
Authors: Der Wiel Annetje Bootsma‐van , Gussekloo J. , De Craen A. J. M. , Van Exel E. , Knook D. L. , Lagaay A. M. , Westendorp R. G. J. 
Published: May 2003

OBJECTIVE: To investigate the discrepancies between outcomes for competence (can do) and actual performance (do do) in activities of daily living (ADLs).DESIGN: Baseline measurements of a population‐based follow‐up study.SETTING: Leiden 85‐Plus Study, the Netherlands.PARTICIPANTS: Five hundred and ninety‐nine persons, age 85. The response rate was 86%.MEASUREMENTS: Face‐to‐face interviews. Measurements of competence and actual performance were based on the Groningen Activity Restriction Scale. Help received was assessed for several domains. Prevalence rates for disability were assessed according to the concepts of both competence and actual performance. Analysis was performed separately for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs).RESULTS: Seventy‐seven percent of the oldest old were competent to perform all the BADLs and performed them regularly. Fifteen percent were not competent to perform certain BADLs independently but performed them regularly with help from others. The prevalence of disability defined as inability in one or more BADLs was 22% for women and 10% for men. The prevalence of disability defined as inactivity in one or more BADLs was 16% for women and 17% for men. Only 5% of the oldest old were competent to perform all IADLs and performed them regularly. In spite of being competent, 70% did not perform certain IADLs regularly. The prevalence of disability defined as inability in one or more IADLs was 64% for women and 55% for men. The prevalence of disability defined as inactivity in one or more IADLs was 92% for women and 98% for men.CONCLUSION: The structural discrepancies between the outcomes of competence and actual performance have important consequences when estimating disability in old people. Promoting actual performance in IADLs may reduce disability.
The Management of Adverse Clinical Events in Nursing Homes: A 1‐Year Survey Study
Authors: Bellelli Giuseppe , Frisoni Giovanni B. , Barbisoni Piera , Boffelli Stefano , Rozzini Renzo , Trabucchi Marco 
Published: May 2003

OBJECTIVE: In Italian nursing homes (NHs), care delivery at night and during holidays is not regulated by regional laws; some facilities employ staff physicians, others employ physicians engaged from year to year (temporary physicians), and others employ publicly funded National Health System (NHS) physicians. This study was designed to determine whether the use of different kinds of physicians leads to different outcomes with regard to the rate of hospitalization and appropriateness of the management of adverse clinical events.DESIGN: Prospective, nonrandomized‐survey data collection.SETTING: Ten nonprofit nursing facilities in Italy.PARTICIPANTS: Three hundred and fifty‐two NH residents, staff physicians, temporary physicians, and NHS physicians.MEASUREMENTS: Medical intervention during adverse clinical events occurring at night and during holidays.RESULTS: Three hundred and fifty‐two residents experienced 551 adverse clinical events; 78 were hospitalized. The hospitalization rate of NHS physicians was about two times that of the temporary physicians and six times that of the staff physicians. Staff physicians' diagnoses and management were appropriate in the majority of cases; NHS diagnosis and management were doubtful or incorrect in about one‐third of all cases.CONCLUSIONS: NH residents frequently experience adverse clinical events; physician characteristics influence the rate of hospitalization and the quality of medical interventions.
An Intervention to Increase Fluid Intake in Nursing Home Residents: Prompting and Preference Compliance
Authors: Simmons Sandra F. , Alessi Cathy , Schnelle John F. 
Published: May 2003

OBJECTIVE: To evaluate a three‐phase, behavioral intervention to improve fluid intake in nursing home (NH) residents.DESIGN: Controlled clinical intervention trial.SETTING: Two community NHs.PARTICIPANTS: Sixty‐three incontinent NH residents.INTERVENTION: Participants were randomized into intervention and control groups. The intervention consisted of three phases for a total of 32 weeks: (1) 16 weeks of four verbal prompts to drink per day, in between meals; (2) 8 weeks of eight verbal prompts per day, in between meals; and (3) 8 weeks of eight verbal prompts per day, in between meals, plus compliance with participant beverage preferences.MEASUREMENTS: Between‐meal fluid intake was measured in ounces by research staff during all three phases of the intervention. Percentage of fluids consumed during meals was also estimated by research staff for a total of nine meals per participant (3 consecutive days) at baseline and at 8 and 32 weeks into the intervention. Serum osmolality, blood urea nitrogen, and creatinine values were obtained for all participants in one of the two sites at the same three time points.RESULTS: The majority (78%) of participants increased their fluid intake between meals in response to the increase in verbal prompts (phase 1 to 2). A subset of residents (21%), however, only increased their fluid intake in response to beverage preference compliance (phase 3). There was a significant reduction in the proportion of intervention participants who had laboratory values indicative of dehydration compared with the control participants. Cognitive and nutritional status were predictive of residents' responsiveness to the intervention.CONCLUSIONS: A behavioral intervention that consists of verbal prompts and beverage preference compliance was effective in increasing fluid intake among most of a sample of incontinent NH residents. Verbal prompting alone was effective in improving fluid intake in the more cognitively impaired residents, whereas preference compliance was needed to increase fluid intake among less cognitively impaired NH residents.
Cognitive Impairment and Mortality in Older Primary Care Patients
Authors: Stump Timothy E. , Callahan Christopher M. , Hendrie Hugh C. 
Published: May 2003

OBJECTIVE: To assess the impact of cognitive impairment on mortality in older primary care patients after controlling for confounding effects of demographic and comorbid chronic conditions.DESIGN: Prospective cohort study.SETTING: Academic primary care group practice.PARTICIPANTS: Three thousand nine hundred and fifty‐seven patients age 60 and older who completed the Short Portable Mental Status Questionnaire (SPMSQ) during routine office visits.MEASUREMENTS: Cognitive impairment measured at baseline using the SPMSQ, demographics, problem drinking, history of smoking, clinical data (including weight, cholesterol level, and serum albumin), and comorbid chronic conditions collected at baseline; survival time measured during the 5 to 7 years after baseline.RESULTS: Eight hundred and eighty‐six patients (22.4%) died during the 5 to 7 years of follow‐up. Cognitive impairment was categorized as having no impairment (84.3%), mild impairment (10.5%), and moderate‐to‐severe impairment (5.2%) based on SPMSQ score. Chi‐square tests revealed that patients with moderate‐to‐severe impairment were significantly more likely to die compared with patients with mild impairment (40.8% vs 21.5%) and those with no impairment (40.8% vs 21.4%). No significant difference in crude mortality was found between patients with no impairment and those with mild impairment. After analyzing time to death using the Kaplan‐Meier method, patients with moderate‐to‐severe cognitive impairment were at increased risk of death compared with those with no or mild impairment (Log‐rank χ2 = 55.5; P < .0001). Even in multivariable analyses using Cox proportional hazards to control for confounding factors, compared with those with no impairment, moderately‐to‐severely impaired patients had an increased risk of death, with a hazard ratio (HR) of 1.70. Increased risk of death was also associated with older age (HR = 1.03 for each year), a history of smoking (HR = 1.48), having a serum albumin level <3.5 g/L (HR = 1.29), and weighing less than 90% of the ideal body weight (HR = 1.98). Outpatient diagnoses associated with increased mortality risk were diabetes mellitus, coronary artery disease, congestive heart failure, cerebrovascular disease, cancer, anemia, and chronic obstructive pulmonary disease (HR range 1.36–1.67). Factors protective of mortality risk included female gender (HR = 0.67) and black race (HR = 0.73).CONCLUSIONS: Moderate‐to‐severe cognitive impairment is associated with an increased risk of mortality, even after controlling for confounding effects of demographic and clinical characteristics. Mild cognitive impairment is not associated with mortality risk, but a longer follow‐up period may be necessary to identify this risk if it exists.
Acculturation and the Prevalence of Depression in Older Mexican Americans: Baseline Results of the Sacramento Area Latino Study on Aging
Authors: González Hector M. , Haan Mary N. , Hinton Ladson 
Published: May 2003

OBJECTIVE: HTo determine the association between acculturation, immigration, and prevalence of depression in older Mexican Americans.DESIGN: Cross‐sectional analysis from a cohort study.SETTING: Urban and rural counties of the Central Valley of Northern California.PARTICIPANTS: One thousand seven hundred and eighty‐nine Latinos recruited from a population‐based sample (85% Mexican Americans) with a mean age of 70.6 (range 60–100; standard deviation (SD) = 7.13); 58.2% were women.MEASUREMENTS: Depressive symptoms were assessed with the Center for Epidemiologic Studies—Depression scale (CES‐D). Acculturation was measured with the Acculturation Rating Scale for Mexican Americans—II. Psychosocial, behavioral, and medical histories were also obtained.RESULTS: The prevalence of depression (CES‐D ≥ 16) was 25.4%. Women were at greater risk (32.0%) than men (16.3%; male/female odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.90–3.09). The prevalence of depression was higher among immigrants (30.4%, OR = 1.70, 95% CI = 1.36–2.13), bicultural participants (24.2%, OR = 1.66, 95% CI = 1.24–2.24), and less‐acculturated participants (36.1%, OR = 2.95, 95% CI = 2.22–3.93) compared with U.S.‐born (20.5%) and more‐acculturated groups (16.1%). When adjustments for education, income, psychosocial, behavioral, and health‐problem factors were made, the least‐acculturated participants were at significantly higher risk of depression than highly acculturated Mexican Americans (OR = 1.56, 95% CI = 1.06–2.31).CONCLUSIONS: These findings are consistent with previously reported estimates of a higher prevalence of depression for older Mexican Americans than non‐Hispanic Caucasians and African Americans and are the first to report the prevalence and risk of depression for older U.S.‐born and immigrant Mexican Americans. The high prevalence of depression of the least acculturated group may be related to cultural barriers encountered by immigrants and less‐acculturated older Mexican Americans and to poorer health status.
Functional Ability and Oral Health Among Older People: A Longitudinal Study from Age 75 to 80
Authors: Avlund Kirsten , Holm‐Pedersen Poul , Schroll Marianne 
Published: May 2003

OBJECTIVE: To examine whether functional ability at age 75 and age 80 is associated with oral health and use of dental services cross‐sectionally and whether changes in functional ability from age 75 to age 80 are associated with oral health and regular use of dental services at age 80.DESIGN: The study included a random sample of 75‐year‐olds at baseline and a follow‐up study 5 years later. The data are treated as two cross‐sectional studies at age 75 and 80, respectively, and as a longitudinal study from age 75 to 80.SETTING: The western part of Copenhagen County.PARTICIPANTS: The two cross‐sectional studies of 75‐ and 80‐year‐old people included 411 and 321 persons, respectively. The longitudinal study from age 75 to 80 included the 326 persons who participated in both surveys.MEASUREMENTS: Oral health status was measured roughly by number of teeth and chewing ability. Use of dental services was measured by frequency of visits to a dentist or denturist. Functional ability was measured by two scales on mobility in relation to tiredness and need of help. Changes in mobility from age 75 to 80 is described as (1) improved or sustained good, (2) decreased, and (3) sustained poor. Gender, chronic diseases, self‐rated health, socio‐demographic factors, living alone, and social relations were included as possible confounders.RESULTS: The odds ratio of having no or few teeth was 1.7 (1.1–2.6) in 75‐year‐old individuals who felt tired in mobility, 1.7 (1.0–2.9) in 80‐year‐old persons who needed help with mobility, and 2.7 (0.94–7.5) in persons with sustained need of help with mobility from age 75 to 80. The odds ratio of chewing difficulties was 1.7 (1.1–2.8) in 80‐year‐old people in need of help, and 1.8 (1.1–3.0) in persons age 75 to 80 needing sustained help. Dentate 80‐year‐old persons who felt tired in mobility had an odds ratio of 2.0 (0.94–4.2) of not using dental services.CONCLUSIONS: The results indicate that oral impairment (e.g., having no or few teeth), oral functional limitations (e.g., chewing problems), and general functional limitations (e.g., mobility problems) are interrelated and that prevention of disabilities should be aimed at both functional limitations and oral health problems if the intention is to promote a good life in old age. In addition, the results point to the importance of taking problems in mobility seriously in delivering preventive services to old people because people who are tired or dependent on help seem to be at a higher risk of not using dental services regularly.
Physician Confidence and Interest in Learning More About Common Geriatric Topics: A Needs Assessment
Authors: Robinson Bruce E. , Barry Patricia P. , Renick Nancy , Bergen Merlynn R. , Stratos Georgette A. 
Published: May 2003

OBJECTIVE: To assess physicians' confidence in and interest in learning more about 18 specific geriatric topics.DESIGN: Written survey.SETTING: Annual meetings of the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP).PARTICIPANTS: Seven hundred and fifty‐eight physicians (547 ACP members, 211 AAFP members).MEASUREMENTS: For each topic, participants rated their confidence in performance, their peers' need for education, and their interest in learning more, using a five‐point Likert scale.RESULTS: Survey participants were on average 16 years out of medical school and 61% were in a community primary care practice that included many geriatric patients on a primarily fee‐for‐service basis. High levels of interest in learning more about dementia, functional assessment, urinary incontinence, and sensory impairment were found. A substantial correlation (r = .44, P < .0001) between the proportion of seniors reported in the physicians' practice and confidence in performance in the areas surveyed was identified.CONCLUSIONS: These findings provide useful information on the physician‐learner's perception of needs, which is important in the design of effective continuing education efforts in geriatrics.
On the Use of Surrogate Respondents for Controls in a Case‐Control Study of Alzheimer's Disease
Authors: Debanne Sara M. , Petot Grace J. , Li Jingjin , Koss Elisabeth , Lerner Alan J. , Riedel Tatiana M. , Rowland Douglas Y. , Smyth Kathleen A. , Friedland Robert P. 
Published: May 2003

OBJECTIVE: To examine the presence and extent of bias introduced by using surrogate respondents for healthy controls in a case‐control study of Alzheimer's disease (AD).DESIGN: Comparative study of matched responses to questionnaire ascertaining lifestyle issues.SETTING: University Hospitals/Case Western Reserve University Alzheimer Center.PARTICIPANTS: Controls (n = 50) were identified through the Research Registry. Surrogates (n = 50) were their healthy relatives or friends.MEASUREMENTS: Answers in the areas of demographic and occupational history, smoking habits, medical history, dietary intake, and leisure and work activities were recorded. The analysis was based on methods for paired data. Continuous variables were analyzed, focusing on paired differences between self and surrogate responses.RESULTS: For occupations and exposures, over 80% of the surrogates agreed with the subjects on over 80% of the questions. On smoking history, over 90% of the surrogates agreed with the subjects on over 70% of the questions. On leisure and work activities, over 70% of the surrogates agreed with the subjects on over 50% of the questions. There was less agreement regarding medical history. For continuous variables, most paired t‐tests of zero mean difference between self and surrogate responses resulted in nonrejection of this hypothesis. Computed mean differences were not always positive or always negative.CONCLUSION: We did not find systematic under‐ or overreporting by the surrogates of the controls. Therefore, if there are biases in the responses of surrogates of the AD cases in our case‐control study, they would not be canceled out by using surrogates for the controls.