bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Lipid Levels and the Risks of Incident Myocardial Infarction, Stroke, and Total Mortality: The Cardiovascular Health Study
Authors: Psaty Bruce M. , Anderson Melissa , Kronmal Richard A. , Tracy Russell P. , Orchard Trevor , Fried Linda P. , Lumley Thomas , Robbins John , Burke Greg , Newman Anne B. , Furberg Curt D. 
Published: September 2004

Objectives: To assess the association between lipid levels and cardiovascular events in older adults.Design: A prospective population‐based study.Setting: Four field centers in U.S. communities.Participants: A total of 5,201 adults aged 65 and older living in U.S. communities, plus a recruitment of 687 African Americans 3 years later.Measurements: Fasting lipid measures included low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein cholesterol (HDL‐C), total cholesterol, and triglycerides.Results: At baseline, 1,954 men and 2,931 women were at risk for an incident myocardial infarction (MI) or stroke. During an average 7.5‐year follow‐up, 436 subjects had a coronary event, 332 had an ischemic stroke, 104 a hemorrhagic stroke, and 1,096 died. After adjustment, lipid measures were not major predictors of the outcomes of MI, ischemic stroke, hemorrhagic stroke, and total mortality. For total cholesterol and LDL‐C, the associations with MI and ischemic stroke were only marginally significant. HDL‐C was inversely associated with MI risk (hazard ratio=0.85 per standard deviation of 15.7 mg/dL, 95% confidence interval=0.76–0.96). For the outcome of ischemic stroke, high levels of HDL‐C were associated with a decreased risk in men but not women. Lipid measures were generally only weakly associated with the risks of hemorrhagic stroke or total mortality.Conclusion: In this population‐based study of older adults, most lipid measures were weakly associated with cardiovascular events. The association between low HDL‐C and increased MI risk was nonetheless strong and consistent.
Risk of Congestive Heart Failure in an Elderly Population Treated with Peripheral Alpha‐1 Antagonists
Authors: Bryson Chris L. , Smith Nicholas L. , Kuller Lewis H. , Chaves Paulo H. M. , Manolio Teri A. , Lewis William , Boyko Edward J. , Furberg Curt D. , Psaty Bruce M. 
Published: September 2004

Objectives: To compare the risk of congestive heart failure (CHF) in elderly individuals treated with any peripheral alpha‐1 antagonist for hypertension with any thiazide, test whether the risk persists in subjects without cardiovascular disease (CVD) at baseline, and examine CHF risk in normotensive men with prostatism treated with alpha antagonists.Design: Prospective cohort study.Setting: Four U.S. sites: Washington County, Maryland; Allegheny County, Pennsylvania; Sacramento County, California; and Forsyth County, North Carolina.Participants: A total of 5,888 community‐dwelling subjects aged 65 and older.Measurements: Adjudicated incident CHF.Results: The 3,105 participants with treated hypertension were at risk for CHF; 22% of men and 8% of women took alpha antagonists during follow‐up. The age‐adjusted risk of CHF in those receiving monotherapy treated with alpha antagonists was 1.90 (95% confidence interval=1.03–3.50) compared with thiazides. In subjects without CVD at baseline receiving monotherapy, women taking an alpha antagonist had a 3.6 times greater age‐adjusted risk of CHF, whereas men had no difference in risk. Adjustment for systolic blood pressure attenuated statistical differences in risk. There were 930 men without hypertension at risk for CHF; 5% used alpha antagonists during follow‐up, with no observed increase in CHF risk.Conclusion: Subjects receiving alpha antagonist monotherapy for hypertension had a two to three times greater risk of incident CHF, also seen in lower‐risk subjects, but differences in blood pressure control partly explained this.
A Matched‐Cohort Study of Health Services Utilization and Financial Outcomes for a Heart Failure Disease‐Management Program in Elderly Patients
Authors: Berg Gregory D. , Wadhwa Sandeep , Johnson Alan E. 
Published: September 2004

Objectives: To investigate the utilization and financial outcomes of a telephonic nursing disease‐management program for elderly patients with heart failure.Design: A 1‐year concurrent matched‐cohort study employing propensity score matching.Setting: Medicare+Choice recipients residing in Ohio, Kentucky, and Indiana.Participants: A total of 533 program participants aged 65 and older matched to nonparticipants.Intervention: Disease‐management heart failure program employing a structured, evidence‐based, telephonic nursing intervention designed to provide patient education, counseling, and monitoring services.Measurements: Medical service utilization, including hospitalizations, emergency department visits, medical doctor visits, skilled nursing facility (SNF) days, selected clinical indicators, and financial effect.Results: The intervention group had considerably and significantly lower rates of acute service utilization than the control group, including 23% fewer hospitalizations, 26% fewer inpatient bed days, 22% fewer emergency department visits, 44% fewer heart failure hospitalizations, 70% fewer 30‐day readmissions, and 45% fewer SNF bed days. Claims costs were $1,792 per person lower in the intervention group than in the control group (inclusive of intervention costs), and the return on investment was calculated to be 2.31.Conclusion:The study demonstrates that a commercially delivered heart failure disease‐management program significantly reduced hospitalizations, emergency department visits, and SNF days. The intervention group had 17% lower costs than the control group; when intervention costs were included, the intervention group had 10% lower costs.
Hyperkyphotic Posture Predicts Mortality in Older Community‐Dwelling Men and Women: A Prospective Study
Authors: Kado Deborah M. , Huang Mei‐Hua , Karlamangla Arun S. , Barrett‐Connor Elizabeth , Greendale Gail A. 
Published: September 2004

Objectives: To determine the association between hyperkyphotic posture and rate of mortality and cause‐specific mortality in older persons.Design: Prospective cohort study.Setting: Rancho Bernardo, California.Participants: Subjects were 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture made at an osteoporosis visit between 1988 and 1991.Measures: Kyphotic posture was measured as the number of 1.7‐cm blocks that needed to be placed under the participant's head to achieve a neutral head position when lying supine on a radiology table. Demographic and clinical characteristics and health behaviors were assessed at a clinic visit using standard questionnaires. Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates.Results: Hyperkyphotic posture, defined as requiring one or more blocks under the occiput to achieve a neutral head position while lying supine, was more common in men than women (44% in men, 22% of women, P<.0001). In age‐ and sex‐adjusted analyses, persons with hyperkyphotic posture had a 1.44 greater rate of mortality (95% confidence interval (CI)=1.12–1.86, P=.005). In multiply adjusted models, the increased rate of death associated with hyperkyphotic posture remained significant (relative hazard=1.40, 95% CI=1.08–1.81, P=.012). In cause‐specific mortality analyses, hyperkyphotic posture was specifically associated with an increased rate of death due to atherosclerosis.Conclusion: Older men and women with hyperkyphotic posture have higher mortality rates.
Geriatric Patients Improve as Much as Younger Patients from Hospitalization on General Psychiatric Units
Authors: Snowden Mark B. , Walaszek Art , Russo Joan E. , Comtois Kate A. , Srebnik Debra S. , Ries Richard K. , Roy‐Byrne Peter P. 
Published: September 2004

Objectives: To determine whether geriatric patients aged 65 and older on general adult psychiatric units improve as much as younger patients, over what duration their improvement occurs, and their risk of readmission.Design: Cohort study.Setting: Inpatient psychiatric unit of an urban, university‐affiliated, county hospital from January 1993 through August 1999.Participants: A total of 5,929 inpatients.Measurements: Standardized, routine assessments by attending psychiatrists included the Psychiatric Symptom Assessment Scale (PSAS) on admission and discharge. Discharge scores, length of stay (LOS), and risk of readmission within 1 year were modeled for the groups using multiple regression analyses.Results: Geriatric patients constituted 5% (n=299) of the 5,929 admissions. In multivariate analysis, geriatric status was not associated with discharge PSAS scores. Median LOS was longer for geriatric patients (16 days) than younger patients (10 days, P<.001), especially in older women (14 days) and geriatric patients with mild medical illness severity (13 days vs 11 days in those with moderate‐to‐severe medical illness). Geriatric patients were as likely to be readmitted within 1 year of discharge as younger patients.Conclusion: Geriatric patients on general inpatient psychiatry units improved as much as younger patients. Their longer LOS was associated with milder medical illness severity. There may be a role for more specialized care of elderly women or geriatric patients with mild to moderate medical illness to improve the efficiency of their care.
Patterns of Presentation, Diagnosis, and Treatment in Older Patients with Colon Cancer and Comorbid Dementia
Authors: Gupta Supriya K. , Lamont Elizabeth B. 
Published: September 2004

Objectives: To estimate patterns of colon cancer presentation, diagnosis, and treatment according to history of dementia using National Cancer Institute (NCI) Surveillance, Epidemiology, and End‐Result (SEER) Medicare data.Design: Population‐level cohort study.Setting: NCI's SEER‐Medicare database.Participants: A total of 17,507 individuals aged 67 and older with invasive colon cancer (Stage I‐IV) were identified from the 1993–1996 SEER file. Medicare files were evaluated to determine which patients had an antecedent diagnosis of dementia.Measurements: Parameters relating to the cohort's patterns of presentation and care were estimated using logistic regressions.Results: The prevalence of dementia in the cohort of newly diagnosed colon cancer patients was 6.8% (1,184/17,507). Adjusting for possible confounders, dementia patients were twice as likely to have colon cancer reported after death (i.e., autopsy or death certificate) (adjusted odds ratio (AOR)=2.31, 95% confidence interval (CI)=1.79–3.00). Of those diagnosed before death (n=17,049), dementia patients were twice as likely to be diagnosed noninvasively than with tissue evaluation (i.e., positive histology) (AOR=2.02 95% CI=1.63–2.51). Of patients with Stage I ‐III disease (n=12,728), patients with dementia were half as likely to receive surgical resection (AOR=0.48, 95% CI=0.33–0.70). Furthermore, of those with resected Stage III colon cancer (n=3,386), dementia patients were 78% less likely to receive adjuvant 5‐fluorouracil (AOR=0.22, 95% CI=0.13–0.36).Conclusion: Although the incidences of dementia and cancer rise with age, little is known about the effect of dementia on cancer presentation and treatment. Elderly colon cancer patients are less likely to receive invasive diagnostic methods or curative‐intent therapies. The utility of anticancer therapies in patients with dementia merits further study.
Breast Cancer Screening in Women Aged 80 and Older: Results from a National Survey
Authors: Schonberg Mara A. , McCarthy Ellen P. , Davis Roger B. , Phillips Russell S. , Hamel Mary B. 
Published: September 2004

Objectives: To estimate the national rates of mammography screening in women aged 80 and older and examine the relationship between health status and screening within the previous 2 years.Design: Population‐based survey.Setting: United States.Participants: Eight hundred eighty‐two women aged 80 and older who responded to the 2000 National Health Interview Survey, representing an estimated 3.83 million noninstitutionalized women nationally.Measurements: Screening mammography, disease burden, and functional status were assessed using a questionnaire.Results: Of the 882 women, 41.5% were aged 85 and older; 19.6% had two or more significant diseases; and 12.1% were dependent in at least one activity of daily living (ADL). More than half (50.8%) had received a screening mammogram within the previous 2 years. Women with two or more significant diseases were less likely to have received screening than those without significant disease, but the difference was not statistically significant (43.9% vs 54.0%, P=.152). Women dependent in at least one ADL were less likely to receive screening mammography than women without functional impairment (37.2% vs 55.9%, P<.001). After adjustment, the likelihood of screening remained lower in women with two or more significant diseases (adjusted odds ratio (AOR)=0.63, 95% confidence interval (CI)=0.40–1.05) and in women with at least one ADL dependency (AOR=0.44, 95% CI=0.22–0.88). Of 294 women likely to have life expectancies of less than 5 years because of poor health, 39.4% received screening mammography.Conclusion: More than half of women aged 80 and older in the United States receive screening mammograms. Nearly 40% of women very unlikely to benefit because of poor health received screening mammography.
Body Weight Change and Mortality in a Cohort of Elderly Patients Recently Discharged from the Hospital
Authors: Sullivan Dennis H. , Liu Longjian , Roberson Paula K. , Bopp Melinda M. , Rees Jacqueline C. 
Published: September 2004

Objectives: To evaluate the prognostic significance of weight change in frail elderly patients.Design: Prospective study.Setting: The general medical or surgical wards of a university‐affiliated Department of Veterans Affairs hospital.Participants: Six hundred sixty randomly selected subjects aged 65 or older.Measurements: At admission and discharge, each subject completed a standardized diagnostic evaluation, including demographic variables, and basic medical, functional, and nutritional assessments. Weights were recorded from hospital or clinic visits in the year before admission, during the current hospitalization, and after discharge for a median of 5.6 years. Average yearly intraindividual weight change was calculated using least‐squares regression. Associations between intraindividual weight change and mortality were identified using Cox proportional hazards regression.Results: During the study, 314 subjects (48%) died. A U‐shaped association between weight change and mortality was observed. Those who were relatively weight stable (±1 kg/y) had the lowest mortality (28%). Compared with this group, the adjusted relative risks (ARR) of death for those who lost 1 or more to less than 3 kg/y and 3 or more kg/y were 2.14 (95% confidence interval (CI)=1.52–3.00) and 3.59 (95% CI=2.58–4.99), respectively. The ARR associated with a weight gain of 1 or more to less than 3 kg/y and 3 or more kg/y was 1.38 (95% CI=0.91–2.10) and 3.73 (95% CI=2.34–5.94), respectively. The amount of bidirectional weight fluctuation (estimated using coefficient of variance) was not significantly associated with mortality.Conclusion: For reasons that are not clear, elderly patients who gain 3 or more kg/y after hospital discharge are at nearly the same risk of mortality as those who lose this amount of weight.
Risk Factors Relating Blood Markers of Inflammation and Nutritional Status to Survival in Cachectic Geriatric Patients in a Randomized Clinical Trial
Authors: Yeh Shing‐shing , Hafner Alice , Chang Chin‐Kuo , Levine Daniel M. , Parker Thomas S. , Schuster Michael W. 
Published: September 2004

Objectives: To evaluate the effect of proinflammatory cytokines, their receptors, and nutritional indicators (at baseline and after 12 weeks of megestrol acetate (MA) treatment) upon long‐term survival in geriatric cachectic patients without active acute infections, inflammation, or cancer.Design: Randomized clinical trial with placebo or MA treatment for 12 weeks and then follow‐up for more than 4 years.Setting: Veterans Affairs nursing home in Northport, New York.Participants: Nursing home patients with weight loss of 5% of usual body weight over the previous 3 months or body weight 20% below ideal body weight.Intervention: Random assignment of placebo or MA oral suspension 800 mg/d to the eligible patients for 12 weeks.Measurements: White blood cell counts, prealbumin, plasma cytokine levels (or their receptors), including tumor necrosis factor receptor (TNFR), soluble subunits (TNFR‐p55 and TNFR‐p75), interleukin (IL)‐6, soluble IL‐2 receptor, and C‐reactive protein at baseline and 12 weeks after treatment.Results: There was no difference in survival between the MA and placebo groups. Considering possible confounders, initial IL‐6, initial TNFR‐p75 levels, and final neutrophil percentage were associated with elevated mortality, whereas higher initial prealbumin, initial albumin, final prealbumin, final albumin, and final weight gain were associated with decreased death.Conclusion: In geriatric weight‐loss patients with cachexia, certain cytokines and nutritional indicators were effective in predicting long‐term mortality, regardless of treatment with MA. Interventions to modify levels of these cytokines or their receptors and improvement in nutritional status by weight gain might be helpful in ameliorating undetected chronic inflammation and thus might prolong the survival of these nursing home residents.
Insulin Resistance and Executive Dysfunction in Older Persons
Authors: Abbatecola Angela M. , Paolisso Giuseppe , Lamponi Marco , Bandinelli Stefania , Lauretani Fulvio , Launer Lenore , Ferrucci Luigi 
Published: September 2004

Objectives: To evaluate the association between insulin resistance (IR) and executive dysfunction in a large, population‐based study of older persons without diabetes mellitus (DM) or dementia.Design: Cross‐sectional study.Setting: Outpatient clinic in Greve in Chianti and Bagno a Ripoli, Italy.Participants: A total of 597 subjects aged 65 to 93 without DM or dementia.Measurements: Anthropometric measurements; plasma fasting levels of glucose, insulin, cholesterol (total cholesterol, high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol), and insulin‐like growth factor‐1 (IGF‐1); homeostasis model assessment (HOMA) to estimate degree of IR; Trail Making Test (TMT) A; TMT‐B; TMT‐B minus TMT‐A (DIFF B–A); and Mini‐Mental State Examination (MMSE).Results: IR (HOMA) was associated with longer TMT‐B (correlation coefficient (r)=0.11; P=.006) and DIFF B–A times (r=0.10; P=.022). Subjects in the upper tertile of IR were older and had longer TMT‐B and DIFF B–A than participants in the lowest tertile. After adjusting for age, sex, and years of formal education, IR was significantly correlated with TMT‐A, TMT‐B, and DIFF B–A. After adjusting for age, sex, education, body mass index, waist:hip girth ratio, HDL‐C, triglycerides, IGF‐1, hypertension, drug intake, and physical activity, the results did not significantly change. After introducing MMSE score into the model, IR continued to be an independent determinant of TMT‐A (β=11.005; P=.021), TMT‐B (β=28.379; P<.001), and DIFF B–A (β=17.374; P=.011).Conclusion: IR is independently associated with frontal cortex function evidenced by poor TMT times in older persons without DM or dementia.
The Relationship Between Number of Medications and Weight Loss or Impaired Balance in Older Adults
Authors: Agostini Joseph V. , Han Ling , Tinetti Mary E. 
Published: September 2004

Objectives: To examine the relationship between cumulative medication exposure and risk of two common manifestations of adverse drug effects: weight loss and impaired balance.Design: Cross‐sectional and longitudinal cohort.Setting: Urban Connecticut community.Participants: Eight hundred eighty‐five community‐dwelling residents aged 72 and older.Measurements: Weight loss (≥10 pounds) and balance, a composite of four balance measures.Results: Participants took a mean±standard deviation of 2.2±1.9 medications (range 0–15). After adjustment for age, depressive symptoms, cognitive impairment, vision and hearing impairments, number of chronic diseases, and number of hospitalizations in the previous year, the adjusted odds ratio (OR) for weight loss was 1.48 (95% confidence interval (CI)=0.85–2.59) for those taking one to two medications, 1.96 (95% CI=1.08–3.54) for three to four medications, and 2.78 (95% CI=1.38–5.60) for five or more medications. For impaired balance, adjusted ORs were 1.44 (95% CI=0.94–2.19), 1.72 (95% CI=1.09–2.71), and 1.80 (95% CI=1.02–3.19), respectively.Conclusion: A greater number of medications were associated with increased risk of adverse drug outcomes, after extensive adjustment for chronic illness. Clinicians should consider the adverse effects of total drug use and not merely the benefits or risks of individual medications for specific diseases.
The Development of a Rapid Screen for Caregiver Burden
Authors: Hirschman Karen B. , Shea Judy A. , Xie Sharon X. , Karlawish Jason H. T. 
Published: September 2004

Objectives: To develop a shortened screen for burden associated with caring for a patient with Alzheimer's disease (AD).Design: Cross‐sectional.Setting: The Memory Disorders Clinic of an AD center.Participants: Two hundred fifty‐one AD patient‐caregiver dyads.Measurements: Screen for Caregiver Burden (SCB), Center for Epidemiologic Studies Depression scale, Medical Outcomes Short Form, Mini‐Mental State Examination, and patient and caregiver characteristics.Results: At least 25% of the sample endorsed eight of the 25 items in the SCB subjective burden (SB) scale. Of these eight items with a prevalence of 25% or greater endorsement, seven items had item‐total correlations of 0.55 or greater. The shortened seven‐item SCB SB had an alpha of 0.86, indicating that the shortened scale has good internal consistency (Full SCB SB α=0.88). The seven‐item SCB SB was highly associated with depression and overall mental health measures.Conclusion: This shortened version of the SCB allows a clinician to rapidly assess the burden associated with caregiving for a person with AD.