bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly from the Emergency Department—The DEED II Study
Authors: Caplan Gideon A. , Williams Anthony J. , Daly Barbra , Abraham Ken 
Published: August 2004

Objectives: To study the effects of comprehensive geriatric assessment (CGA) and multidisciplinary intervention on elderly patients sent home from the emergency department (ED).Design: Prospective, randomized, controlled trial with 18 months of follow‐up.Setting: Large medical school–affiliated public hospital in an urban setting in Sydney, Australia.Participants: A total of 739 patients aged 75 and older discharged home from the ED were randomized into two groups.Intervention: Patients randomized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital‐based multidisciplinary outreach team. The team implemented or coordinated recommendations. The control group received usual care.Measurements: The primary outcome measure was all admissions, to the hospital within 30 days of the initial ED visit. Secondary outcome measures were elective and emergency admissions, and nursing home admissions and mortality. Additional outcomes included physical function (Barthel Index (total possible score=20) and instrumental activities of daily living (/12) and cognitive function (mental status questionnaire (/10)).Results: Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit (16.5% vs 22.2%; P=.048), a lower rate of emergency admissions during the 18‐month follow‐up (44.4% vs 54.3%; P=.007), and longer time to first emergency admission (382 vs 348 days; P=.011). There was no difference in admission to nursing homes or mortality. Patients randomized to the intervention group maintained a greater degree of physical and mental function (Barthel Index change from baseline at 6 months: −0.25 vs −0.75; P<.001; mental status questionnaire change from baseline at 12 months: −0.21 vs −0.64; P<.001).Conclusion: CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital. Patients aged 75 and older should be referred for CGA after an ED visit.
Use of the Physician Orders for Life‐Sustaining Treatment Program in Oregon Nursing Facilities: Beyond Resuscitation Status
Authors: Hickman Susan E. , Tolle Susan W. , Brummel‐Smith Kenneth , Carley Margaret Murphy 
Published: August 2004

Objectives: Program was designed to communicate resident/surrogate treatment preferences in the form of medical orders. To assess statewide nursing facility use of the Physician Orders for Life‐Sustaining Treatment (POLST) and to identify the patterns of orders documented on residents' POLST forms.Design: Telephone survey; on‐site POLST form review.Setting: Oregon nursing facilities.Participants: One hundred forty‐six nursing facilities in the telephone survey; 356 nursing facility residents aged 65 and older at seven nursing facilities in the POLST form review.Measurements: A telephone survey; onsite POLST form reviews.Results: In the telephone survey, 71% of facilities reported using the POLST program for at least half of their residents. In the POLST form review, do‐not‐resuscitate (DNR) orders were present on 88% of POLST forms. On forms indicating DNR, 77% reflected preferences for more than the lowest level of treatment in at least one other category. On POLST forms indicating orders to resuscitate, 47% reflected preferences for less than the highest level of treatment in at least one other category. The oldest old (≥85, n=167) were more likely than the young old (65–74, n=48) to have orders to limit resuscitation, medical treatment, and artificial nutrition and hydration.Conclusion: The POLST program is widely used in Oregon nursing facilities. A majority of individuals with DNR orders requested some other form of life‐extending treatment, and advanced age was associated with orders to limit treatments.
The Physician Orders for Life‐Sustaining Treatment Program: Oregon Emergency Medical Technicians' Practical Experiences and Attitudes
Authors: Schmidt Terri A. , Hickman Susan E. , Tolle Susan W. , Brooks Heather S. 
Published: August 2004

Objectives: To evaluate emergency medical technicians' (EMTs) experiences with the Physician Orders for Life‐Sustaining Treatment (POLST) program and learn about attitudes regarding its effectiveness.Design: Anonymous survey mailed to a stratified random sample.Setting: Tri‐County Portland, Oregon, area.Participants: A total of 572 Oregon EMT respondents (out of 1,048 surveys) were included in the analysis.Measurements: Survey questions about experiences with the POLST form and opinions about POLST.Results: Respondents were mostly male (76%) and paramedics (66%). Most respondents (73%) had treated a patient with a POLST, and 74% reported receiving education about POLST. EMTs reported that POLST, when present, changed treatment in 45% of cases. Seventy‐five percent of the respondents agreed that the POLST form provides clear instructions about patient preferences, and 93% agreed that the POLST form is useful in determining which treatments to provide when the patient is in cardiopulmonary arrest. Fewer (63%) agreed that the form is useful in determining treatments when the patient has a pulse and is breathing.Conclusion: Most respondents have experience with the POLST program. EMTs find the POLST form useful and often use it to change treatment decisions for patients.
Effect of Vascular Lesions on Cognition in Alzheimer's Disease: A Community‐Based Study
Authors: Riekse Robert G. , Leverenz James B. , McCormick Wayne , Bowen James D. , Teri Linda , Nochlin David , Simpson Kate , Eugenio Charisma , Larson Eric B. , Tsuang Debby 
Published: August 2004

Objectives: To investigate whether clinical and neuropathological differences exist between Alzheimer's disease (AD) cases with and without vascular lesions neuropathologically diagnosed using Consortium to Establish a Registry for Alzheimer's Disease (CERAD) criteria.Design: Descriptive observational study.Setting: A community‐based registry that identified incident dementia cases.Participants: Of the 124 subjects with available clinical and neuropathological assessments, 30 had AD lesions alone, and 18 had AD with vascular lesions. Patients with other neuropathological findings were excluded.Measurements: Dependent measures included demographic, clinical, and neuropathological characteristics. Neuropathological diagnoses were made using the CERAD criteria and Braak and Braak staging.Results: Of the 124 autopsied cases, 85 cases were diagnosed with neuropathological AD. Of these, 30 had pathology consistent with “pure” AD, whereas 18 had AD pathology with significant vascular lesions (AD/V). There were no differences in age, sex, or education between groups. AD/V cases had higher baseline and final Mini‐Mental State Examination (MMSE) scores than pure AD cases, but after adjusting for education, differences in MMSE scores were not statistically significant. The AD/V group had significantly lower Braak staging than the pure AD group, after adjusting for education and final MMSE scores.Conclusion: In this comparison study of AD cases with and without vascular lesions, AD/V cases had less severe AD pathology than those with AD alone, indicating that cerebrovascular disease likely contributes to the severity of cognitive impairment in those with AD. Controlling for vascular risk factors in patients with AD may have a significant effect on severity of dementia.
The Effect of Risperidone on Nursing Burden Associated with Caring for Patients with Dementia
Authors: Frank Lori , Kleinman Leah , Ciesla Gabrielle , Rupnow Marcia F. T. , Brodaty Henry 
Published: August 2004

Objectives: To compare risperidone treatment with placebo for the burden to nursing staff of older nursing‐home residents with dementia.Design: Randomized, double‐blind, placebo‐controlled trial.Setting: Long‐term care institutions in Australia and New Zealand.Participants: Two hundred seventy‐nine residents had evaluable data for comparison of oral risperidone with placebo treatment at 4 weeks, 8 weeks, and endpoint across the 12‐week trial.Measurements: The Modified Nursing Care Assessment Scale (M‐NCAS) is a 28‐item instrument that measures behavior occurrence in patients (patient outcome) and difficulty of those behaviors for nursing staff as rated by nurse carers (nurse outcome). Treatment groups were compared via analysis of covariance (ANCOVA). To aid score interpretation, M‐NCAS effect sizes were examined by response category, with response defined as subjects with mean Cohen‐Mansfield Agitation Inventory total aggression subscale score change of 4 points or greater, a clinical outcome for patients.Results: Between‐group ANCOVAs showed statistically significant reductions in nurse‐rated M‐NCAS scores from baseline to endpoint for the patients randomized to risperidone relative to placebo (P<.05). Effects were evident at 4 weeks and maintained over time. Effect sizes were moderate to large for responders and near zero for nonresponders.Conclusion: Risperidone treatment was associated with an early and sustained reduction in nursing staff burden as measured using the M‐NCAS compared with placebo treatment for older nursing home residents with dementia.
Cognitive Decline in High‐Functioning Older Persons Is Associated with an Increased Risk of Hospitalization
Authors: Chodosh Joshua , Seeman Teresa E. , Keeler Emmett , Sewall Ase , Hirsch Susan H. , Guralnik Jack M. , Reuben David B. 
Published: August 2004

Objectives: To examine hospital use for patients with evidence of cognitive decline indicative of early cognitive impairment.Design: Medicare Part A hospital utilization data were linked to data from the MacArthur Research Network on Successful Aging Community Study to examine the association between baseline cognition and decline in cognitive function over a 3‐year period and any hospitalization over that same period.Setting: New Haven, Connecticut, and East Boston, Massachusetts.Participants: Subjects (N=598) were from two sites of the MacArthur Research Network on Successful Aging Community Study, a 7‐year cohort study of community‐dwelling older persons with high physical and cognitive functioning.Measurements: Multivariate logistic regression was used to determine the association between any hospitalization over 3 years (1988–91) as the outcome variable and baseline cognitive function and decline in cognition over 3 years as primary predictor variables. Decline was based upon repeated (1988 and 1991) measures of delayed verbal recall and the Short Portable Mental Status Questionnaire (SPMSQ).Results: Of 598 subjects, 48 died between 1988 and 1991. No baseline (1988) delayed recall scores or change in recall scores (1988–91) were associated with hospitalization. Although 48.2% declined on verbal memory scores, decline was not associated with risk of hospitalization. Of 494 subjects with complete 3‐year data, 31.2% declined at least one point on the SPMSQ, and 4.7% declined more than two points. Among individuals aged 75 and older at baseline, the adjusted odds ratio for hospitalization for those who declined more than 2 points compared with those who declined less was 7.8 (95% confidence interval=2.0–30.8).Conclusion: Although specific memory tests were not associated with hospitalization, high‐functioning older persons who experienced decline in overall cognitive function were more likely to be hospitalized. Variation in baseline cognitive function in this high‐functioning cohort did not affect hospitalization, but additional research is needed to evaluate associations with other healthcare costs.
Effectiveness of a Group Outpatient Visit Model for Chronically Ill Older Health Maintenance Organization Members: A 2‐Year Randomized Trial of the Cooperative Health Care Clinic
Authors: Scott John C. , Conner Douglas A. , Venohr Ingrid , Gade Glenn , McKenzie Marlene , Kramer Andrew M. , Bryant Lucinda , Beck Arne 
Published: August 2004

Objectives: To compare the effectiveness of Cooperative Health Care Clinic ((CHCC) group outpatient model for chronically ill, older health maintenance organization (HMO) patients) with usual care.Design: Two‐year, randomized, controlled trial conducted with recruitment from February 1995 through July of 1996.Setting: Nonprofit group model HMO.Participants: Two hundred ninety‐four adults (145 intervention and 149 usual care), aged 60 and older (mean age 74.1) with 11 or more outpatient visits in the prior 18 months, one or more self‐reported chronic conditions, and expressed interest in participating in a group clinic.Intervention: Monthly group meetings held by patients' primary care physicians.Measurement: Differences in clinic visits, inpatient admissions, emergency room visits, hospital outpatient services, professional services, home health, and skilled nursing facility admissions; measures of patient satisfaction, quality of life, self‐efficacy, and activities of daily living (ADLs).Results: Outpatient, pharmacy services, home health, and skilled nursing facility use did not differ between groups, but CHCC patients had fewer hospital admissions (P=.012), emergency visits (P=.008), and professional services (P=.005). CHCC patients' costs were $41.80 per member per month less than those of control patients. CHCC patients reported higher satisfaction with their primary care physician (P=.022), better quality of life (P=.002), and greater self‐efficacy (P=.03). Health status and ADLs did not differ between groups.Conclusion: The CHCC model resulted in fewer hospitalizations and emergency visits, increased patient satisfaction, and self‐efficacy, but no effect on outpatient use, health, or functional status.
Group Treatment Improves Trunk Strength and Psychological Status in Older Women with Vertebral Fractures: Results of a Randomized, Clinical Trial
Authors: Gold Deborah T. , Shipp Kathy M. , Pieper Carl F. , Duncan Pamela W. , Martinez Salutario , Lyles Kenneth W. 
Published: August 2004

Objectives: To assess whether group exercise and coping classes reduce physical and psychological impairments and functional disability in older women with prevalent vertebral fractures (VFs).Design: Randomized, controlled trial (modified cross‐over) with site as unit of assignment; testing at baseline and 3, 6, 9, and 12 months.Setting: Nine North Carolina retirement communities.Participants: One hundred eighty‐five postmenopausal Caucasian women (mean age 81), each with at least one VFs.Intervention: The intervention group had 6 months of exercise (3 meetings weekly, 45 minutes each) and coping classes (2 meetings weekly, 45 minutes each) in Phase 1, followed by 6 months of self‐maintenance. The control group had 6 months of health education control intervention (1 meeting weekly, 45 minutes) in Phase 1, followed by the intervention described above.Measurements: Change in trunk extension strength, change in pain with activities, and change in psychological symptoms.Results: Between‐group differences in the change in trunk extension strength (10.68 foot pounds, P<.001) and psychological symptoms (−0.08, P=.011) were significant for Phase 1. Changes in pain with activities did not differ between groups (−0.03, P=.64); there was no change in the pain endpoint. In Phase 2, controls showed significant changes in trunk strength (15.02 foot pounds, P<.001) and psychological symptoms (−0.11, P=.006) from baseline. Change in pain with activities was not significant (−0.03, P=.70). During self‐maintenance, the intervention group did not worsen in psychological symptoms, but improved trunk extension strength was not maintained.Conclusion: Weak trunk extension strength and psychological symptoms associated with VFs can be improved in older women using group treatment, and psychological improvements are retained for at least 6 months.
Long‐Term Prediction of Incident Hip Fracture Risk in Elderly White Women: Study of Osteoporotic Fractures
Authors: Taylor Brent C. , Schreiner Pamela J. , Stone Katie L. , Fink Howard A. , Cummings Steven R. , Nevitt Michael C. , Bowman Paula J. , Ensrud Kristine E. 
Published: August 2004

Objectives: To identify independent risk factors for first hip fracture over 10 years of follow‐up.Design: Prospective cohort study.Setting: Four U.S. clinical centers.Participants: A total of 6,787 women aged 66 and older in the Study of Osteoporotic Fractures.Measurements: Total hip bone mineral density (BMD) using dual‐energy x‐ray absorptiometry and a comprehensive set of potential risk factors were collected. Incident hip fractures were identified prospectively and confirmed using radiographic report.Results: Six hundred two women (8.9%) had a hip fracture during a mean ±standard deviation (SD) follow‐up of 10.1±3.2 years. Older age, previous self‐reported fracture after age 50, maternal history of hip fracture after age 50, greater height at age 25, impaired cognition, slower walking speed, nulliparity, type II diabetes mellitus, Parkinson's disease, and depth perception each independently predicted a 1.17‐ to 1.83‐fold increase in hip fracture risk, whereas each SD (0.13 g/cm2) decrease in hip BMD was independently associated with a 1.84‐fold increase in risk. Lower body mass index also was associated with an increased risk of hip fracture, although lower hip BMD largely explained this association.Conclusion: Although hip BMD is strongly related to hip fracture risk in elderly white women, other clinical risk factors also are independent predictors of long‐term risk and provide additional insight into the prevention of fracture in high‐risk women. Clinicians should be alert to factors other than BMD that place older women at a high risk of hip fracture.
The Effectiveness of a Community‐Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial
Authors: Clemson Lindy , Cumming Robert G. , Kendig Hal , Swann Megan , Heard Robert , Taylor Kirsty 
Published: August 2004

Objectives: To test whether Stepping On, a multifaceted community‐based program using a small‐group learning environment, is effective in reducing falls in at‐risk people living at home.Design: A randomized trial with subjects followed for 14 months.Setting: The interventions were conducted in community venues, with a follow‐up home visit.Participants: Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling.Intervention: The Stepping On program aims to improve fall self‐efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower‐limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two‐hour sessions were conducted weekly for 7 weeks, with a follow‐up occupational therapy home visit.Measurements: The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant.Results: The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50–0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community‐residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17–0.59).Conclusion: The results of this study renew attention to the idea that cognitive‐behavioral learning in a small‐group environment can reduce falls. Stepping On offers a successful fall‐prevention option.
Footwear Style and Risk of Falls in Older Adults
Authors: Koepsell Thomas D. , Wolf Marsha E. , Buchner David M. , Kukull Walter A. , LaCroix Andrea Z. , Tencer Allan F. , Frankenfeld Cara L. , Tautvydas Milda , Larson Eric B. 
Published: August 2004

Objectives: To determine how the risk of a fall in an older adult varies in relation to style of footwear worn.Design: Nested case‐control study.Setting: Group Health Cooperative, a large health maintenance organization in Washington state.Participants: A total of 1,371 adults aged 65 and older were monitored for falls over a 2‐year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex.Measurements: Standardized in‐person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall.Results: Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4–51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3‐fold increase in the risk of a fall (95% CI=0.9–1.9), varying somewhat by style.Conclusion: Contrary to findings from gait‐laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes.
Alcohol Screening Results in Elderly Male Veterans: Association with Health Status and Mortality
Authors: Bridevaux Isabelle Peytremann , Bradley Katharine A. , Bryson Chris L. , McDonell Mary B. , Fihn Stephan D. 
Published: August 2004

Objectives: To evaluate the association between alcohol screening results and health status or mortality in elderly patients.Design: Cross‐sectional and longitudinal cohort studies.Setting: Primary care clinics at seven Veterans Affairs medical centers.Participants: A total of 16,958 male patients aged 65 and older.Measurements: Alcohol screening questionnaires were used to divide patients into four mutually exclusive groups: drinkers who screened negative or positive for problem drinking and nondrinkers (in the previous year) who screened negative or positive for problem drinking. A subset of patients (n=12,491) completed a measure of health status, the Medical Outcomes Study Short Form (SF‐36). All‐cause mortality was ascertained using Veterans Affairs data over a mean follow‐up of 2.8 years.Results: Forty‐eight percent of participants reported drinking in the previous year. Half of the drinkers and nondrinkers screened positive for problem drinking. The SF‐36 item scores were consistently higher for drinkers than for nondrinkers and for patients who screened negative for problems than for those who screened positive. Similarly, survival was consistently better in drinkers than nondrinkers (mortality hazard ratio (HR)=0.74, 95% confidence interval (CI)=0.68–0.82) and in patients who screened negative for problem drinking than in those who screened positive (mortality HR=0.87, 95% CI=0.80–0.95). Nondrinkers who screened positive for problem drinking had the poorest health status and survival, whereas drinkers who screened negative for problem drinking had the best health status and survival.Conclusion: Elderly patients who reported drinking alcohol and those who screened negative for problem drinking had consistently better health status and survival than those who did not drink and those who screened positive.