bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validity of the Minimum Data Set in Identifying Urinary Tract Infections in Residents of Long‐Term Care Facilities
Authors: Stevenson Kurt B. , Moore James W. , Sleeper Barbara 
Published: April 2004

Objectives: To determine the validity of the Minimum Data Set (MDS) to detect cases of urinary tract infection (UTI) that meet specific evidence‐based criteria.Design: Prospective surveillance.Setting: Sixteen long‐term care facilities (LTCFs) in Idaho.Participants: Residents of participating LTCFs for whom an MDS form was completed.Measurements: Prospective surveillance of all types of infection, including UTI, and data collection on clinical manifestation, microbiology, and treatment; MDS data on identification of UTI.Results: A stratified analysis demonstrated that the validity of MDS was 14% when using the evidence‐based criteria for UTIs as the criterion standard. The estimated sensitivity and specificity of MDS entries were 57.9% and 86.5%, respectively. The estimated positive and negative predictive values for the study population were 13.9% and 98.2%, respectively.Conclusion: MDS has the potential to be an important measure of quality in the long‐term care setting. When used to detect residents with UTIs, it appears to greatly overestimate the number of cases while adequately screening out residents without UTIs. These problems may be overcome by providing more‐explicit definitions for UTIs to be used by providers when completing MDS information on individual residents.
Urinary Incontinence and Its Association with Death, Nursing Home Admission, and Functional Decline
Authors: Holroyd‐Leduc Jayna M. , Mehta Kala M. , Covinsky Kenneth E. 
Published: April 2004

Objectives: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs).Design: A population‐based prospective cohort study from 1993 to 1995.Setting: Community‐dwelling within the United States.Participants: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline.Measurements: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status.Results: The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2‐year follow‐up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02–1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18–2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36–2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39–2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67–1.21), nursing home admission (AOR=1.33, 95% CI=0.86–2.04), or ADL decline (AOR=1.24, 95% CI=0.92–1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05–1.63), although adjustment markedly reduced the strength of this association.Conclusion: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community‐dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.
Anemia Is Associated with Disability and Decreased Physical Performance and Muscle Strength in the Elderly
Authors: Penninx Brenda W. J. H. , Pahor Marco , Cesari Matteo , Corsi Anna Maria , Woodman Richard C. , Bandinelli Stephania , Guralnik Jack M. , Ferrucci Luigi 
Published: April 2004

Objectives: To examine the association between anemia and disability, physical performance, and muscle strength in older persons.Design: Cross‐sectional.Setting: Community‐dwelling older persons in the Chianti area in Italy.Participants: A total of 1,156 persons aged 65 and older participating in the InChianti Study (“Invecchiare in Chianti,” i.e., Aging in the Chianti Area).Measurements:
Anemia was defined according to World Health Organization criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. Disability in six basic and eight instrumental activities of daily living was assessed. Physical performance was assessed using the short physical performance battery (4‐m walk, balance, and chair stands), which yields a summary performance score ranging from 0 to 12 (high). Muscle strength was determined using knee extensor and handgrip strength assessments.Results: Overall, 11.1% of the men and 11.5% of the women had anemia. After adjustment for age, sex, body mass index, Mini‐Mental State Examination score, creatinine level, and presence of various comorbid conditions, anemic persons had more disabilities (1.71 vs 1.04, P=.002) and poorer performance (8.8 vs 9.6, P=.003) than persons without anemia. Anemic persons also had significantly lower knee extensor strength (14.1 vs 15.2 kg, P=.02) and lower handgrip strength (25.3 vs 27.1 kg, P=.04) than persons without anemia. Further adjustment for inflammatory markers (interleukin‐6, C‐reactive protein, tumor necrosis factor‐α) did not change these associations.Conclusion: Anemia is associated with disability, poorer physical performance, and lower muscle strength. Further research should explore whether treating anemia has a beneficial effect on the functional status of older persons.
Differences in End‐of‐Life Preferences Between Congestive Heart Failure and Dementia in a Medical House Calls Program
Authors: Haydar Ziad R. , Lowe Alice J. , Kahveci Kellie L. , Weatherford Wilson , Finucane Thomas 
Published: April 2004

Objectives: To compare end‐of‐life preferences in elderly individuals with dementia and congestive heart failure (CHF).Design: Retrospective case‐control study.Setting: Geriatrician‐led interdisciplinary house‐call program using an electronic medical record.Participants: Homebound individuals who died while under the care of the house‐call program from October 1996 to April 2001.Measurements: Medical records review for demographics, functional status, advance medical planning, hospice use, and place of death.Results: Of 172 patients who died in the program, 29 had CHF, 79 had dementia, 34 had both, and 30 had neither. Patients with CHF were younger (82.6 vs 87.0, P=.011) and less functionally dependent (activities of daily living score 9.1 vs 11.5, P=.001). Time from enrollment to death was not significantly different (mean±standard deviation=444±375 days for CHF vs 325±330 days for dementia, P=.113). A do‐not‐resuscitate (DNR) directive was given in 62% of patients with CHF and 91% with dementia (P<.001). Advance medical planning discussions were not significantly different (2.10 in CHF vs 1.65 in dementia, P=.100). More patients with CHF participated in their advance medical planning than those with dementia (86% vs 17%, P<.001). Hospice was used in 24% of CHF and 61% of dementia cases (P<.001). Finally, 45% of patients with CHF and 18% of patients with dementia died in the acute hospital (P=.006). Multivariate analysis showed that the fact that more patients with CHF were involved in their medical planning was not significant in predicting end‐of‐life preferences. Alternatively, Caucasian ethnicity was an independent predictor of having a documented DNR and death outside of the acute hospital.Conclusion: In the months before death, patients with CHF were more likely to have care plans directed at disease modification and treatment, whereas dementia patients were more likely to have care plans that focused on symptom relief and anticipation of dying. Several factors may contribute to this difference.
Do Rural Elders Have Limited Access to Medicare Hospice Services?
Authors: Virnig Beth A. , Moscovice Ira S. , Durham Sara B. , Casey Michelle M. 
Published: April 2004

Objectives: To examine whether there are urban‐rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries.Design: Observational study using 100% of Medicare enrollment, hospice, and hospital claims data.Setting: Inpatient hospitals and hospices.Participants: Persons aged 65 and older in the Medicare program who died in 1999.Measurements: Rates of hospice use before death and in‐hospital death rates were calculated.Results: In 1999, there were 1.76 million deaths of Medicare beneficiaries aged 65 and older. Hospice services were used by 365,700 of these beneficiaries. Rates of hospice care before death were negatively associated with degree of rurality. The lowest rate of hospice use, 15.2% of deaths, was seen in rural areas not adjacent to an urban area. The highest rate of use, 22.2% of deaths, was seen in urban areas. Rural areas adjacent to urban areas had an intermediate level of hospice use (17.0% of deaths). Hospices based in rural areas had a smaller number of elderly patients each year than hospices based in urban areas (P<.001) and were more likely to have very low volumes (average daily census of three patients or less).Conclusion: The consistently lower use of Medicare hospice services before death and smaller sizes of rural hospices suggest that the combination of Medicare hospice payment policies and hospice volumes are problematic for rural hospices. Adjusting Medicare payment policies might be a critical step to assure availability of hospice services forterminally ill beneficiaries regardless of where they live.
The Quality of Medical Care Provided to Vulnerable Older Patients with Chronic Pain
Authors: Chodosh Joshua , Solomon David H. , Roth Carol P. , Chang John T. , MacLean Catherine H. , Ferrell Bruce A. , Shekelle Paul G. , Wenger Neil S. 
Published: April 2004

Objectives: To assess the quality of chronic pain care provided to vulnerable older persons.Design: Observational study evaluating 11 process‐of‐care quality indicators using medical records and interviews with patients or proxies covering care received from July 1998 through July 1999.Setting: Two senior managed care plans.Participants: A total of 372 older patients at increased risk of functional decline or death identified by interview of a random sample of community dwellers aged 65 and older enrolled in these managed‐care plans.Measurements: Percentage of quality indicators satisfied for patients with chronic pain.Results: Fewer than 40% of vulnerable patients reported having been screened for pain over a 2‐year period. One hundred twenty‐three patients (33%) had medical record documentation of a new episode of chronic pain during a 13‐month period, including 18 presentations for headache, 66 for back pain, and 68 for joint pain. Two or more history elements relevant to the presenting pain complaint were documented for 39% of patients, and at least one relevant physical examination element was documented for 68% of patients. Treatment was offered to 86% of patients, but follow‐up occurred in only 66%. Eleven of 18 patients prescribed opioids reported being offered a bowel regimen, and 10% of patients prescribed noncyclooxygenase‐selective nonsteroidal antiinflammatory medications received appropriate attention to potential gastrointestinal toxicity.Conclusion: Chronic pain management in older vulnerable patients is inadequate. Improvement is needed in screening, clinical evaluation, follow‐up, and attention to potential toxicities of therapy.
Daily Pain That Was Excruciating at Some Time in the Previous Week: Prevalence, Characteristics, and Outcomes in Nursing Home Residents
Authors: Teno Joan M. , Kabumoto Glen , Wetle Terrie , Roy Jason , Mor Vincent 
Published: April 2004

Objectives:To examine the prevalence, correlates, and consequences of nursing home (NH) staff reports of “excruciating” level of pain at some time in the previous week in persons with daily pain reported on the Minimum Data Set (MDS).Design:Cross‐sectional study.Setting:NHs in the United States.Participants:A total 2,138,442 persons who resided in 15,745 nursing homes in the United States.Measurements:Pain reported as daily and at its most excruciating in the previous week on the MDS at initial and follow‐up assessment. Associations were examined with demographic characteristics, functioning, and measures of disease burden reported on the MDS.Results:NH staff noted that 80,512 (3.7%) of residents had daily pain that was at one or more times excruciating in the previous week. This level of pain was more prevalent in younger residents. Nearly two‐thirds (62.1%) of persons with this level of pain were no longer independent in activities of daily living, but 48.8% were rated to have normal cognitive status. In contrast, those without daily pain that was sometimes excruciating were less likely to be cognitively intact (25.7%P<.001) and less likely to have declined in their functioning (30.1%,P=.001). More than one in five with daily pain that was excruciating at times had a cancer diagnosis, and 21.5% experienced weight loss. Of the 24,300 persons with a second assessment, 10,284 (42.3%) still had excruciating pain at some time in the previous week.Conclusion:NH residents with daily pain that was sometimes excruciating were younger and seriously ill with functional decline and weight loss. Too often, persons remain in this level of pain.
Predictors of Varying Levels of Nonadherence to Mammography Screening in Older Women*
Authors: Levy‐Storms Lené , Bastani Roshan , Reuben David B. 
Published: April 2004

Objectives: To identify predictors of varying levels of nonadherence to mammography screening in older women.Design: Cross‐sectional survey.Setting: Sixty community‐based sites where seniors gather.Participants: Consecutive volunteer sample of 499 women aged 60 to 84 who had not received a mammogram within the previous year.Measurements: Three levels of nonadherence (never had a mammogram (never), mammogram more than 2 years before (lapsed), and mammogram in the past 1 to 2 years (due/reference group)). These were based on a Transtheoretical Model and incorporated into the Adherence Model. Bivariate and multivariate multinomial logistic regression analysis was used for variables obtained.Results: Two risk factors, having difficulty getting to a facility and not intending to ask a health provider for a mammogram, were predictive of the never and lapsed levels. Distinct risk factors for being in the never compared with the due level of nonadherence included being concerned about pain, not being enrolled in a health maintenance organization, not getting preventive checkups, and being only somewhat (versus very) likely to ask a physician for mammogram. In contrast, distinct risk factors for the lapsed compared with the due level of nonadherence included perceiving that no friends have routine mammograms and not having a provider referral.Conclusion: Some risk factors for not being up to date with mammography vary by the level of nonadherence. Interventions should be individualized to women's level of nonadherence and include common core strategies that encourage women to ask for a mammogram and to lessen the difficulty of getting to a screening facility.
Depression After Stroke: A Prospective Epidemiological Study
Authors: Whyte Ellen M. , Mulsant Benoit H. , Vanderbilt Joni , Dodge Hiroko H. , Ganguli Mary 
Published: April 2004

Objectives: To elucidate the relationship between stroke and depressive symptoms and to determine whether disability or cerebrovascular risk factors mediate that relationship.Design: A prospective longitudinal epidemiological survey.Setting: The mid‐Monongahela Valley, a rural, nonfarm, low‐socioeconomic‐status community.Participants: Random sample of 1,134 subjects aged 65 and older.Measurements: The dependent variable was clinically significant depressive symptoms, as defined by five or more symptoms on the modified Center for Epidemiological Studies Depression scale. The independent variables were demographics (age, sex, education), stroke, number of impaired instrumental activities of daily living (IADLs), diabetes mellitus, hypertension, atherosclerotic heart disease, and smoking. Logistic regression analyses were conducted for cross‐sectional and longitudinal models examining whether stroke was associated with or predicted depressive symptoms, with other associated factors included as covariates.Results: Clinically significant depressive symptoms were cross‐sectionally associated with stroke (odds ratio (OR)=3.5, 95% confidence interval (CI)=1.4–8.3), diabetes mellitus (OR=2.8, 95% CI=1.7–4.6; P≤.05), and IADL impairment (OR=1.6, 95% CI=1.4–1.8; P<.05). Longitudinal analysis demonstrated that stroke (OR=6.3, 95% CI=1.7–23.2) and depressive symptoms at baseline (OR=15, 95% CI=7.7–29.5) predicted subsequent clinically significant depressive symptoms measured 2 years later, whereas education was protective (OR=0.4, 95% CI=0.2–0.8).Conclusion: Stroke survivors have a greatly elevated risk for clinically significant depressive symptoms even 2 or more years after index stroke, independent of functional disability, cerebrovascular risk factors, and previous depressive symptoms.
The Effect of Raloxifene on Markers of Bone Turnover in Older Women Living in Long‐Term Care Facilities
Authors: Hansdóttir Helga , Franzson Leifur , Prestwood Karen , Sigur∂´sson Gunnar 
Published: April 2004

Objectives: To examine the effect of raloxifene on bone turnover in elderly women.Design: Clinical intervention.Setting: Long‐term care facilities.Participants: Nineteen women completed the study, mean age 85 (range 76–99).Intervention: Raloxifene 60 mg was given daily for 12 weeks.Measurements: Markers of bone turnover were plasma C‐telopeptides of type I collagen (CTx), urine cross‐linked N‐telopeptides of type I collagen (NTx) and serum tartrate–resistant acid phosphatase (TRAP 5b), plasma osteocalcin, and serum bone alkaline phosphatase. Other markers were serum 25‐OH vitamin D, parathyroid hormone, ionized calcium, and phosphate. Markers were measured at baseline, after calcium and vitamin D had been taken for 6 weeks, after raloxifene had been taken for 12 weeks, and 6 weeks after raloxifene had been stopped. Paired sample t test was used to examine changes in markers at each time point.Results: Plasma CTx decreased on average by 31%, urinary NTx by 35%, plasma osteocalcin by 25%, serum bone alkaline phosphatase by 15% (P<.01), and serum TRAP 5b by 10% (P<.05) on treatment.Conclusion: Raloxifene reduces bone turnover in elderly women living in long‐term care facilities. The effect of raloxifene on bone turnover is comparable with that seen in younger postmenopausal women.
Effect of Psychiatric and Other Nonmotor Symptoms on Disability in Parkinson's Disease
Authors: Weintraub Daniel , Moberg Paul J. , Duda John E. , Katz Ira R. , Stern Matthew B. 
Published: April 2004

Objectives: To examine the effect of depression and other nonmotor symptoms on functional ability in Parkinson's disease (PD).Design: A cross‐sectional study of a convenience sample of PD patients receiving specialty care.Setting: The Parkinson's Disease Research, Education and Clinical Center at the Philadelphia Veterans Affairs Medical Center.Participants: One hundred fourteen community‐dwelling patients with idiopathic PD.Measurements: The Unified Parkinson's Disease Rating Scale (UPDRS); Hoehn and Yahr Stage; Mini‐Mental State Examination; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depression module; probes for psychotic symptoms; Hamilton Depression Rating Scale; Geriatric Depression Scale—Short Form; Apathy Scale; and Epworth Sleepiness Scale. Disability was rated using the UPDRS activity of daily living (ADL) score and the Schwab and England ADL score. Multivariate analysis determined effect of depression and other nonmotor symptoms on disability.Results: The presence of psychosis, depressive disorder, increasing depression severity, age, duration of PD, cognitive impairment, apathy, sleepiness, motor impairment, and percentage of time with dyskinesias were related to greater disability in bivariate analyses. Entering these factors into two multiple regression analyses, only the increasing severity of depression and worsening cognition were associated with greater disability using the UPDRS ADL score, accounting for 37% of the variance in disability (P<.001). These two factors plus increasing severity of PD accounted for 54% of the variance in disability using the Schwab and England ADL score (P<.001).Conclusion: Results support and extend previous findings that psychiatric and other nonmotor symptoms contribute significantly to disability in PD. Screening for nonmotor symptoms in PD is necessary to more fully explain functional limitations. Further study is required to determine whether identifying and treating these symptoms will improve function and quality of life.
Interactive Video Specialty Consultations in Long‐Term Care
Authors: Wakefield Bonnie J. , Buresh Kelli A. , Flanagan James R. , Kienzle Michael G. 
Published: April 2004

Objectives: To assess provider and resident satisfaction with and outcomes of specialist physician consultations provided via interactive video to residents of a long‐term care (LTC) center.Design: Cross‐sectional survey.Setting: Two Veterans Affairs Medical Centers (VAMC) and a state LTC center.Participants: Physicians (n=12) at the VAMC and nurses (n=30) and residents (n=62) at the LTC center.Intervention: Interactive video conferencing to provide physician specialty visits to residents at the LTC center.Measurements: Satisfaction ratings and record review to determine changes in treatment plan and follow‐up care.Results: Data were collected on 76 individual consultations in six clinics. The most frequent outcome was a change in treatment plan with the resident remaining at the LTC setting (n=29, 38%) or no change in treatment (n=26, 34%). Physicians' ratings were 78% good to excellent for usefulness in developing a diagnosis, 87% good to excellent for usefulness in developing a treatment plan, 79% good to excellent for quality of transmission, and 86% good to excellent satisfaction with the consult format. Overall, 72% of residents were satisfied with the consult format, and 92% felt that it was easier to obtain medical care via telemedicine. Nurses felt that the telemedicine clinics were a good use of their time and skills (100%).Conclusion: There was a high rate of physician, patient, and nurse satisfaction with interactive video conferencing. Care delivered to residents of LTC settings via video conferencing offers a number of potential advantages, including avoidance of travel for patient and provider and potentially greater continuity of care.