bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Hospice Have a Role in Nursing Home Care at the End of Life?
Authors: Casarett David J. , Hirschman Karen B. , Henry Michelle R. 
Published: March 2003

OBJECTIVES:To assess the possible benefits and challenges of hospice involvement in nursing home care by comparing the survival and needs for palliative care of hospice patients in long‐term care facilities with those living in the community.DESIGN:Retrospective review of computerized clinical care records.SETTING:A metropolitan nonprofit hospice.PARTICIPANTS:The records of 1,692 patients were searched, and 1,142 patients age 65 and older were identified. Of these, 167 lived in nursing homes and 975 lived in the community.MEASUREMENTS:Patient characteristics, needs for palliative care, and survival.RESULTS:At the time of enrollment, nursing home residents were more likely to have a Do Not Resuscitate order (90% vs 73%; P < .001) and a durable power of attorney for health care (22% vs 10%; P < .001) than were those living in the community. Nursing home residents also had different admitting diagnoses, most notably a lower prevalence of cancer (44% vs 74%; P < .032). Several needs for palliative care were less common among nursing home residents, including constipation (1%vs 5%; P = .02), pain (25% vs 41%; P < .001), and anticipatory grief (1% vs 9%; P < .001). Overall, nursing home residents had fewer needs for care (median 0, range 0–3 vs median 1, range 0–5; rank sum test P < .001). Nursing home residents had a significantly shorter survival (median 11 vs 19 days; log rank test of survivor functions P < .001) and were less likely to withdraw from hospice voluntarily (8%vs 14%; P = .03). However, there was no difference in the likelihood of becoming ineligible during hospice enrollment (6% for both groups).CONCLUSIONS:These results suggest that hospices identify needs for palliative care in a substantial proportion of nursing home residents who are referred to hospice, although nursing home residents may have fewer identifiable needs for care than do community‐dwelling older people. However, the finding that nursing home residents' survival is shorter may be of concern to hospices that are considering partnerships with nursing homes. An increased emphasis on hospice care in nursing homes should be accompanied by targeted educational efforts to encourage early referral. J Am Geriatr Soc 49:1493–1498, 2001.
Urban‐Rural Differences in a Memory Disorders Clinical Population
Authors: Wackerbarth Sarah B. , Johnson Mitzi M. S. , Markesbery William R. , Smith Charles D. 
Published: March 2003

OBJECTIVES: To compare patient characteristics and family perceptions of patient function at one urban and one rural memory disorders clinic.DESIGN: Secondary, cross‐sectional data analyses of an extant clinical database.SETTING/PARTICIPANTS: First time visits (n = 956) at two memory disorders clinics.MEASUREMENTS: Patient and family‐member demographics and assessment results for the Mini‐Mental State Examination (MMSE), instrumental activities of daily living (IADLs), activities of daily living (ADLs), the Memory Change and Personality Change components of the Blessed Dementia Rating Scale, and the Revised Memory and Behavior Problems Checklist.RESULTS: In both clinics, patients and family members were more likely female. The typical urban clinic patient was significantly more likely to be living in a facility and more educated than the typical rural patient. Urban and rural patients did not show significant differences in age‐ and education‐adjusted MMSE scores or raw ADL/IADL ratings, but the urban family members reported more memory problems, twice as many personality changes, more‐frequent behavior problems, and more adverse reactions to problems.CONCLUSION: Physicians who practice in both urban and rural areas can anticipate differences between patients, and their families, who seek a diagnosis of memory disorders. Our most important finding is that despite similarities in reported functional abilities, urban families appear to be more sensitive to and more distressed by patients' cognitive and behavioral symptoms than rural families. These differences may reflect different underlying needs, and should be explored in further research.
Delirium Before and After Operation for Femoral Neck Fracture
Authors: Edlund Agneta , Lundström Maria , Brännström Benny , Bucht Gösta , Gustafson Yngve 
Published: March 2003

OBJECTIVES:The aim of this study was to investigate the differences between preoperative and postoperative delirium regarding predisposing, precipitating factors and outcome in older patients admitted to hospital with femoral neck fractures.DESIGN:A prospective clinical assessment of patients treated for femoral neck fractures.SETTING:Department of orthopedic surgery at Umeå University Hospital, Sweden.PARTICIPANTS:One hundred one patients, age 65 and older admitted to the hospital for treatment of femoral neck fractures.MEASUREMENTS:The Organic Brain Syndrome (OBS) Scale.RESULTS:Thirty patients (29.7%) were delirious before surgery and another 19 (18.8%) developed delirium postoperatively. Of those who were delirious preoperatively, all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, had been treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium, and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and had more postoperative complications such as infections. Male patients were more often delirious both preoperatively and postoperatively. Patients with preoperative delirium were more often discharged to institutional care and had poorer walking ability both on discharge and after 6 months than did patients with postoperative delirium only.CONCLUSIONS:Because preoperative and postoperative delirium are associated with different risk factors it is necessary to devise different strategies for their prevention. J Am Geriatr Soc 49:1335–1340, 2001.
Factors Associated with Healthy Aging: The Cardiovascular Health Study
Authors: Burke Gregory L. , Arnold Alice M. , Bild Diane E. , Cushman Mary , Fried Linda P. , Newman Anne , Nunn Cathy , Robbins John ,   for the CHS Collaborative Research Group
Published: March 2003

OBJECTIVES: To identify factors associated with remaining healthy in older adults. DESIGN: Longitudinal cohort study. SETTING: Data were collected at the four Cardiovascular Health Study field centers. PARTICIPANTS: 5,888 participants age 65 years and older in the Cardiovascular Health Study. MEASUREMENTS: Presence of chronic disease was assessed at baseline and over a maximum 7‐year followup period. Participants who were free of chronic disease (no cardiovascular disease (CVD), chronic obstructive pulmonary disease, or self‐reported cancer, except nonmelanoma skin cancer) at the baseline examination were then monitored for the onset of incident cancer, cardiovascular disease, and fatal outcomes. RESULTS: A high proportion of these older adults was healthy at the initial examination and remained healthy over the follow‐up period. Numerous behavioral factors were associated with continued health, including physical activity, refraining from cigarette smoking, wine consumption (women), higher educational status, and lower waist circumference. A number of CVD risk factors and subclinical disease measures were associated with continued health, including higher high‐density lipoprotein (HDL) cholesterol, lack of diabetes, thinner common carotid intimal medial thickness, lower blood pressure, lower C‐reactive protein, and higher ankle‐arm blood pressure ratio. Among the behavioral factors, exercise, not smoking, and not taking aspirin remained significant predictors of health even after controlling for CVD risk factors and subclinical disease in older adults. CONCLUSIONS: These data suggest that a number of modifiable behavioral factors (physical activity, smoking, and obesity) and cardiovascular risk factors (diabetes, HDL cholesterol, and blood pressure) are associated with maintenance of good health in older adults.
Vascular Risk and Cognitive Impairment in an Older, British, African‐Caribbean Population
Authors: Stewart Robert , Richards Marcus , Brayute Carol , Mann Anthony 
Published: March 2003

OBJECTIVES: In an older, British, African‐Caribbean population with high prevalence rates of hypertension and diabetes mellitus, we ascertained clinical vascular disease (stroke or ischemic heart disease) and vascula; risk (including hypertension, diabetes, and lipid profile) and investigated their associations with cognitive impairment. DESIGN: Cross‐sectional community‐based study. SETTING: The sample was drawn from registration lists for seven primary care services in south London, United Kingdom. PARTICIPANTS: 278 individuals, age 55 to 75, who were born in a Caribbean nation. MEASUREMENTS: Participants were interviewed and examined for cardiovascular risk factors, including a blood test for lipid profile and fibrinogen. A battery of 11 psychometric tests was administered blind to medical status. Cognitive impairment was defined on the basis of a composite measure derived from individual test scores. RESULTS: Seventy‐nine (28%) subjects were classified as having relative cognitive impairment and were compared with the remainder of the sample. Marked differences were seen between low and normal/high educational levels in the strength of associations between measures of vascular risk and cognitive impairment. Hypertension, diabetes, and raised triglycerides were significant factors in those with lower levels of education. Low fibrinogen (negatively associated), high cholesterol, and manual occupation were significant factors in those with normal/high levels of education. Physical exercise was negatively associated with adjustment for age, occupation, depression, and physical disability and after excluding subjects with the most severe impairment. CONCLUSION: Measures of vascular risk were associated with relative cognitive impairment in this population. These associations were modified by previous educational attainment. Physical activity was negatively associated with cognitive impairment.
Incidence of Dementia, Alzheimer's Disease, and Vascular Dementia in Italy. The ILSA Study
Authors: Di Carlo Antonio , Baldereschi Marzia , Amaducci Luigi , Lepore Vito , Bracco Laura , Maggi Stefania , Bonaiuto Salvatore , Perissinotto Egle , Scarlato Guglielmo , Farchi Gino , Inzitari Domenico , For The ILSA Working Group  
Published: March 2003

OBJECTIVES:To estimate the incidence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in older Italians and evaluate the relationship of age, gender, and education to developing dementia.DESIGN:Cohort incidence study in the context of the Italian Longitudinal Study on Aging.SETTING:Population sample from eight Italian municipalities.PARTICIPANTS:A dementia‐free cohort of 3,208 individuals (aged 65–84), individuated after a baseline evaluation performed in 1992  /  93, aimed at detecting prevalent cases.MEASUREMENTS:The dementia‐free cohort was reexamined in 1995 to identify incident cases. The Mini‐Mental State Examination (cutoff 23 /  24) was employed to screen for dementia. Trained neurologists evaluated the individuals who screened positive. Final diagnoses had to meetDiagnostic and Statistical Manual of Mental Disorders, Third Edition, Revisedcriteria for dementia, National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders Association criteria for AD, andInternational Classification of Diseases, Tenth Revisioncriteria for VaD.RESULTS:Before the follow‐up examination, 382 individuals had died (232 had reliable information). Of the 2,826 survivors, 2,266 completed the study. Overall, 127 new dementia cases were identified. Average incidence rates per 1,000 person‐years were 12.47 (95% confidence interval (CI) = 10.23–14.72) for dementia, 6.55 (95% CI = 4.92–8.17) for AD, and 3.30 (95% CI = 2.14–4.45) for VaD. Both AD and VaD showed age‐dependent patterns. Education was protective against dementia and AD. Women carried a significantly higher risk of developing AD (hazard ratio = 1.67, 95% CI = 1.02–2.75), and men of developing VaD (hazard ratio = 2.23, 95% CI = 1.06–4.71).CONCLUSIONS:Incidence of dementia in Italy paralleled that in most industrialized countries. About 150,000 new cases per year are expected. A significant gender effect was evidenced for major dementia subtypes. The burden of VaD, especially in men, offers opportunities for prevention.
Recreational Physical Activity Levels in Healthy Older Women: The Importance of Fear of Falling
Authors: Bruce David G. , Devine Amanda , Prince Richard L. 
Published: March 2003

OBJECTIVES: To examine whether fear of falling is a probable cause of reduced recreational physical activity levels in healthy older women.DESIGN: Cross‐sectional analysis of baseline data from a longitudinal study.PARTICIPANTS: One thousand five hundred older, ambulatory women (aged 70–85), selected at random from the electoral roll.MEASUREMENTS: Self‐reported recreational physical activity levels and fear of falling, demographic variables, anthropometric variables and measures of disability, and physical and cognitive function.RESULTS: The study subjects had low levels of physical and cognitive impairments; 24.1% of the group was obese (body mass index> 30). Twenty‐six percent of the women did not participate in recreational physical activity; 39% participated in sufficient activity to gain probable health benefits. Although the women who did not participate in recreational activities were most likely to report fear of falling (45.2%), it was common in the group as a whole (33.9%), including the most active women (27.0%). Independent risk factors for nonparticipation in physical activity were fear of falling (odds ratio (OR) = 0.70, 95% confidence interval (CI) = 0.54–0.90, P = .006), obesity (OR = 0.50, 95% CI = 0.38–0.66, P = .001), and slower times on the timed up‐and‐go test (OR = 0.88, 95% CI = 0.84–0.92, P = .001). Fear of falling was also independently associated with lower recreational physical activity levels in women who were active (β = −0.09, P = .003). Subgroup analysis suggested that fear of falls affected activity levels at a predisability stage in women with mildly impaired mobility.CONCLUSIONS: Fear of falling is common in healthy, high‐functioning older women and is independently associated with reduced levels of participation in recreational physical activity. Fear of falling is an important psychological barrier that may need to be overcome in programs attempting to improve activity levels in older women.
A Randomized, Double‐Blind, Placebo‐Controlled Study of Oral Vitamin B12 Supplementation in Older Patients with Subnormal or Borderline Serum Vitamin B12 Concentrations
Authors: Seal Eric C. , Metz Jack , Flicker Leon , Melny Joy 
Published: March 2003

OBJECTIVES: To determine the effect of small doses of oral cyanocobalamin supplements in older patients with low or borderline serum vitamin B12 concentrations but no other evidence of pernicious anemia (PA).DESIGN: Randomized, double‐blind, placebo‐controlled study assessing the efficacy of oral cyanocobalamin 10 μg and 50 μg daily for 1 month.SETTING: Two geriatric hospitals in the North Western Health Care Network, Melbourne, Australia.PARTICIPANTS: Thirty‐one inpatients with serum vitamin B12 levels between 100 and 150 pmol/L, without PA, other malabsorption disorders, or progressive neurological or terminal illness. The mean age was 81.4 years.INTERVENTION: After informed consent, a medical and drug history was taken and the Mini‐Mental State Examination (MMSE) completed. A dietitian made assessment of oral cobalamin intake. Blood was taken for serum vitamin B12, serum and red cell folate assay, full blood examination, fasting serum gastrin, parietal and intrinsic factor antibodies, fasting serum homocysteine, and creatinine. Patients were then randomized to receive 10 μg oral cyanocobalamin, 50 μg oral cyanocobalamin, or placebo treatment for 1 month, after which the investigations and clinical examinations were repeated.MEASUREMENTS: Percentage change in the level of vitamin B12, homocysteine, folate, and red cell parameters and absolute changes in MMSE were calculated and compared between groups. The groups were compared on the number of responders who improved their level of B12 by 20%. Chi‐square calculations on changes in serum vitamin B12 concentration were also performed.RESULTS: Mean serum vitamin B12± standard deviation improved by 51.7 ± 47.1% in the 50‐μg group, 40.2 ± 34.4% in the 10‐μg group, and 11.7 ± 24.5% in the placebo group. The change in the 50‐μg cyanocobalamin group was significantly greater than that in the placebo group (P = .044). The change in the 10‐μg cyanocobalamin group was not significantly different from that in the placebo group (P = .186). Eight of 10 subjects in each treatment group were classified as responders, compared with two of 11 in the placebo group (P = .004). Homocysteine levels fell in patients receiving cyanocobalamin, but this fall failed to reach statistical significance. There were no significant changes in the other parameters measured.CONCLUSION: Cyanocobalamin supplementation of 50 μg but not 10 μg daily produced a significant increase in serum vitamin B12. This result has implications for the management of patients with subnormal or borderline serum vitamin B12 concentrations and for food fortification with vitamin B12.
Effects of a Care Protocol on Care Outcomes in Older Nursing Home Patients with Chronic Obstructive Pulmonary Disease
Authors: Lee Diana T. F. , Lee Iris F. K. , Mackenzie Ann E. , Ho Rosalie N. L. 
Published: March 2003

OBJECTIVES:To evaluate the effects of a care protocol used by community nurses to support nursing home staff in the care of patients with chronic obstructive pulmonary disease (COPD).DESIGN:Matched, randomized case‐control trial.SETTING:Forty‐five nursing homes of the New Territories South (NTS) cluster of Hong Kong.PARTICIPANTS:Eighty‐nine older people (≥65, present resident of a nursing home in the NTS region, main diagnosis of COPD, at least one hospital admission in previous 6 months) discharged to the nursing homes from the geriatric units of two hospitals.INTERVENTION:Using a care protocol, community nurses followed up older patients in the experimental group for 6 months after their discharge from the hospitals to the nursing homes.MEASUREMENTS:Data on functional, respiratory, and psychological parameters were collected at entry to study and 6 months later with standard measures. Data on hospital service utilization, nursing home staff, and patient satisfaction were also collected at 6 months.RESULTS:Experimental group participants had significant (P= .008) improvements in psychological well‐being. Nursing home staff and experimental group patients were highly satisfied with the use of the protocol. There was no significant difference between the two groups in functional and respiratory outcomes or hospital service utilization.CONCLUSION:Psychological well‐being as an important factor in rehabilitation in chronic illness has been much neglected in the literature. Supporting nursing home staff in the care of COPD patients through community nursing visits can enhance older residents' psychological well‐being. Psychological aspects of care should be emphasized and incorporated into the delivery of regular nursing home care.
Pain in Cognitively Impaired Nursing Home Residents: How Well Are Physicians Diagnosing It?
Authors: Cohen‐Mansfield Jiska , Lipson Steven 
Published: March 2003

OBJECTIVES: This study examined the reliability and validity of geriatricians' assessments of pain in cognitively impaired nursing home residents.DESIGN: Cross‐sectional analysis.SETTING: A large suburban nursing home.PARTICIPANTS: Seventy‐nine nursing home residents participated in the study. Of these, 31 had mild/moderate cognitive impairment (average Mini‐Mental State Examination (MMSE) = 16.04) and 48 were severely cognitively impaired (average MMSE = 1.91). More than 80% of the participants were female, and the average age was 87.MEASUREMENTS: Two geriatricians from outside the nursing home examined laboratory results, performed a physical examination, and completed a detailed assessment of pain. The personal geriatricians of 42 of the participants also completed the same assessment.RESULTS: Intergeriatrician agreement rates were statistically significant and moderate in magnitude. When examined by subgroup, the correlations were significant only for those with mild/moderate impairment. Some of the geriatricians' ratings of pain correlated significantly with residents' self‐reports. All relationships were weaker in the severely cognitively impaired group. Ratings of greater pain were significantly correlated with higher cognitive functioning.CONCLUSIONS: The results validate geriatricians' evaluations of pain during a medical examination for moderately impaired persons and question their ability to evaluate pain in the severely cognitively impaired. There is a need for increased awareness of pain in this population and a need for improved methodologies to identify it.