bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visual Risk Factors for Hip Fracture in Older People
Authors: Ivers Rebecca Q. , Optom B , Cumming Robert G. , Mitchell Paul , Simpson Judy M. , Peduto Anthony J. 
Published: December 2004

OBJECTIVES:  To determine the association between poor vision and risk of hip fracture in the Blue Mountains Eye Study.DESIGN:   Prospective population‐based cohort study.SETTING:   Two post code areas in the Blue Mountains, west of Sydney, Australia.PARTICIPANTS:   Three thousand six hundred fifty‐four community‐dwelling Australians aged 49 and older.MEASUREMENTS:   At baseline, subjects had an extensive eye examination, including refraction, contrast sensitivity and visual field testing, photographs of the lens and retina, and an interview. Hip fractures during the 5‐year follow‐up were identified by self‐report and review of medical records and were radiologically confirmed.RESULTS:   For 2‐year follow‐up (17 hip fractures), the adjusted hazard ratio (HR) for risk of hip fracture in those with corrected visual acuity worse than 20/60 was 8.4 (95% confidence interval (CI) = 1.5–48.5, population attributable risk (PAR) = 27%); for presence of posterior subcapsular cataract, the adjusted HR was 5.0 (95% CI = 1.1–23.0, PAR = 24%); and for visual field loss, the adjusted HR was 5.5 (95% CI = 1.0–29.8, PAR = 55%). In those aged 75 and older, visual acuity worse than 20/60 gave an adjusted HR of 40.6 (95% CI = 5.6–292.5, PAR = 49%). Visual impairment of any type did not predict risk of hip fracture after a 2‐year follow‐up.CONCLUSION:   Visual impairment is strongly associated with risk of hip fracture in the next 2 years but not over a longer period of time.
Estimating Hip Fracture Morbidity, Mortality and Costs
Authors: Braithwaite R. Scott , Col Nananda F. , Wong John B. 
Published: December 2004

OBJECTIVES: To estimate lifetime morbidity, mortality, and costs from hip fracture incorporating the effect of deficits in activities of daily living.DESIGN:  Markov computer cohort simulation considering short‐ and long‐term outcomes attributable to hip fractures. Data estimates were based on published literature, and costs were based primarily on Medicare reimbursement rates.SETTING:  Postacute hospital facility.PARTICIPANTS:  Eighty‐year‐old community dwellers with hip fractures.MEASUREMENTS:  Life expectancy, nursing facility days, and costs.RESULTS:  Hip fracture reduced life expectancy by 1.8 years or 25% compared with an age‐ and sex‐matched general population. About 17% of remaining life was spent in a nursing facility. The lifetime attributable cost of hip fracture was $81,300, of which nearly half (44%) related to nursing facility expenses. The development of deficits in ADLs after hip fracture resulted in substantial morbidity, mortality, and costs.CONCLUSION:  Hip fractures result in significant mortality, morbidity, and costs. The estimated lifetime cost for all hip fractures in the United States in 1997 likely exceeded $20 billion. These results emphasize the importance of current and future interventions to decrease the incidence of hip fracture.
Hospital Readmissions After Hospital Discharge for Hip Fracture: Surgical and Nonsurgical Causes and Effect on Outcomes
Authors: Boockvar Kenneth S. , Halm Ethan A. , Litke Ann , Silberzweig Stacey B. , McLaughlin MaryAnn , Penrod Joan D. , Magaziner Jay , Koval Kenneth , Strauss Elton , Siu Albert L. 
Published: December 2004

OBJECTIVES:  To examine the causes of hospital readmission after hip fracture and the relationships between hospital readmission and 6‐month physical function and mortality.DESIGN:   Prospective, multisite, observational cohort study.SETTING:   Four hospitals in the New York City metropolitan area.PARTICIPANTS:   Five hundred sixty‐two patients hospitalized for hip fracture aged 50 and older and discharged alive in 1997–1998.MEASUREMENTS:   Patient demographic characteristics, type of fracture and repair, comorbid conditions, postoperative complications, do not resuscitate status, and active clinical problems at the time of hospital discharge. Prefracture and 6‐month mobility were measured using the Functional Independence Measure. Hospital readmissions and International Classification of Diseases, Ninth Revision principal diagnoses were ascertained from hospital admission/discharge databases, the New York Statewide Planning and Research Cooperative System, medical record review, and patient self‐report.RESULTS:   Eighty‐two percent of participants were women, and 93% were white. Within 6 months after hospital discharge, 178 (32%) patients were readmitted to the hospital, with 45 (8%) readmitted more than once. Forty‐seven of 233 readmissions (20%) occurred within the first 2 weeks after discharge, and 80 (34%) occurred within 4 weeks. Over 6 months, 89% of readmissions were for nonsurgical problems, of which infectious (21%) and cardiac (12%) diseases were the most common. In multivariate analyses, patients who were readmitted were more likely to require total assistance with ambulation at 6 months (odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6–4.6) and to die (OR = 4.0, 95% CI = 2.2–7.3) than those not readmitted.CONCLUSION:   Hospital readmissions after hip fracture are largely due to nonsurgical illness and are associated with increased morbidity and mortality.
Sociodemographic and Health Characteristics of Older Chinese on Admission to a Nursing Home: A Cross‐Racial/Ethnic Study
Authors: Huang Zheng‐Bo , Neufeld Richard R. , Likourezos Antonios , Breuer Brenda , Khaski Albert , Milano Evelin , Libow Leslie S. 
Published: December 2004

OBJECTIVES:  To investigate sociodemographic characteristics (SDCs) and health status of older Chinese newly admitted to a nursing home (NH) and to compare them with the characteristics of residents from other racial/ethnic groups.DESIGN:   Secondary analysis of the admission Minimum Data Set Plus (MDS+).SETTING:   A New York City municipal NH near Chinatown.PARTICIPANTS:   Two hundred fifty‐eight (125 Chinese, 57 white, 53 Hispanic, and 23 black) of 292 residents consecutively admitted from November 1992 to May 1997 were selected after excluding those younger than 60 or transferred from another NH.MEASUREMENTS:   SDCs, health status parameters (cognitive performance, physical functioning, mood/behavior patterns, and psychosocial well‐being), and morbidity information (most‐frequent diagnoses/conditions and medication use) documented in or generated from the MDS+.RESULTS:   The majority of these Chinese were first‐generation immigrants and spoke primarily Cantonese or Mandarin Chinese. Compared with whites, they were more likely to be married, less likely to have lived alone, more likely to be using Medicaid, less likely to make medical decision alone, and more likely to depend on family members for decision‐making. Nearly three‐quarters of Chinese had cognitive impairment. There was an underdiagnosis of dementia in the Chinese subjects on admission. Severe dependence in activity of daily living was identified in more than one‐third of Chinese. Fewer Chinese were using psychotropic medications on admission than the whites. Similar to other groups, many of the Chinese subjects were incontinent of bowel and bladder and had chewing or swallowing problems, hypertension, anemia, and stroke.CONCLUSION:   This is the first systematic report of the SDCs and health status of a group of newly admitted older Chinese to an urban NH in the United States using the Minimum Data Set database. These findings suggest that Chinese residents are as frail as other racial/ethnic residents on admission. NHs care for older Chinese need to be sensitive to the presence of dementia and require a staff that can speak Cantonese and Mandarin Chinese and is comfortable negotiating with families who are more likely to be the designated decision makers.
Association Between Dementia and Midlife Risk Factors: the Radiation Effects Research Foundation Adult Health Study
Authors: Yamada Michiko , Kasagi Fumiyoshi , Sasaki Hideo , Masunari Naomi , Mimori Yasuyo , Suzuki Gen 
Published: December 2004

OBJECTIVES:  To investigate the association between midlife risk factors and the development of vascular dementia (VaD) or Alzheimer's disease (AD) 25 to 30 years later.DESIGN:   A prevalence study within a longitudinal cohort study.SETTING:   Subjects in the Adult Health Study (a prospective cohort study begun in 1958) have been followed through biennial medical examinations in Hiroshima, Japan.PARTICIPANTS:   One thousand seven hundred seventy‐four subjects in Hiroshima, Japan born before September 1932 (1,660 with no dementia, 114 with dementia (51 with AD, and 38 with VaD) diagnosed from 1992 to 1997 according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria).MEASUREMENTS:   The subjects were examined for effect on dementia of sex, age, education, atomic bomb radiation dose, and midlife factors associated with risk (smoking, alcohol intake, physical activity, dietary habits, systolic blood pressure (SBP), body mass index, and history of diabetes mellitus) that had been evaluated in 1965–1970.RESULTS:   VaD prevalence increased significantly with age, higher SBP, and lower milk intake. The odds ratios of VaD for age (in 5‐year increments), SBP (10 mmHg increments), and milk intake (almost daily/less than four times a week) were 1.29, 1.33, and 0.35, respectively. The risk factors for VaD were compatible with the risk factors for stroke in this study population. AD prevalence increased significantly with age and lower education. Other midlife factors and radiation dose did not show any significant association with VaD or AD.CONCLUSION:   Increased SBP and low milk intake in midlife were associated with VaD detected 25 to 30 years later. Early behavioral control of the risk factors for vascular disease might reduce the risk of dementia.
Delirium in Older Emergency Department Patients Discharged Home: Effect on Survival
Authors: Kakuma Ritsuko , Du Fort Guillaume Galbaud , Arsenault Louise , Perrault Anne , Platt Robert W. , Monette Johanne , Moride Yola , Wolfson Christina 
Published: December 2004

OBJECTIVES: To determine whether prevalent delirium is an independent predictor of mortality in older patients seen in emergency departments (EDs) and discharged home without admission.DESIGN: Prospective study with 18 months of follow‐up.SETTING: EDs in two Montreal hospitals.PARTICIPANTS: From a cohort study of prognosis for delirium (107 delirious and 161 nondelirious subjects), 30 delirious and 77 nondelirious subjects aged 66 and older who were discharged home without admission were identified.MEASUREMENTS: Detailed interviews with patients and their proxies and review of medical charts were performed at enrollment. Trained lay interviewers determined delirium status using the Confusion Assessment Method. Subjects were followed up at 6‐month intervals for a total of 18 months. Dates of death were obtained from the Ministère de la Santé et des Service Sociaux (Ministry of Health and Social Services). Survival analysis was performed using the Cox proportional hazards modeling adjusting for potential confounding variables.RESULTS: The analysis revealed a statistically significant association between delirium and mortality after adjustments for age, sex, functional level, cognitive status, comorbidity, and number of medications for the first 6 months of follow‐up (hazard ratio = 7.24; 95% confidence interval = 1.62–32.35). The subjects whose delirium was not detected by the ED physician or nurse had the highest mortality over 6 months (30.8%). The mortality of delirious subjects detected in the ED was similar to that of the nondelirious subjects (11.8 vs 14.3%).CONCLUSION: The results of this study suggests that nondetection of delirium in the ED may be associated with increased mortality within 6 months after discharge. Further research is necessary to examine the effectiveness of improving detection on subsequent prognosis of older patients with delirium.
The Last 2 Years of Life: Functional Trajectories of Frail Older People
Authors: Covinsky Kenneth E. , Eng Catherine , Lui Li‐Yung , Sands Laura P. , Yaffe Kristine 
Published: December 2004

OBJECTIVES: To characterize the functional trajectories during the last 2 years of life of patients with progressive frailty, with and without cognitive impairment, and to assess whether it was possible to identify discrete functional indicators that signal the end of life.DESIGN: A retrospective analysis of functional trajectories during the last 24 months of life.SETTING: Twelve demonstration sites of the Program of All‐inclusive Care for the Elderly (PACE). PACE cares for frail older people who meet criteria for nursing home placement, with the goal of keeping the patient at home.PARTICIPANTS: Nine hundred seventeen patients who died while enrolled in PACE.MEASURES: At PACE entry and every 3 months thereafter, data were collected about the degree of dependence (none, partial, or full) in bathing, eating, and walking and the degree of incontinence (none, bladder, or bowel). Cognitive impairment was defined as six or more errors on the Short Portable Mental Status Questionnaire. To describe the end‐of‐life trajectories of patients, data were analyzed from observational windows of time, beginning with the patients' dates of death and extending backward in time to 24 months before death. Each analytical window was 3 months in duration. For each of the functional measures, the probability of functional deterioration in the last 2 years of life in patients with (64%) and without (36%) cognitive impairment was also compared.RESULTS: The mean age at death was 84; 69% of patients were women. For patients with and without cognitive impairment, a prolonged, steady increase in the rates of functional dependence that were evident at least 1 year before death, rather than sudden increases in functional dependence shortly before death, characterized the functional trajectories. It was not possible for any of the four measures to detect a time point before death at which there was an abrupt decline in function likely to signal impending death.For each measure, patients with cognitive impairment declined earlier, were more likely than patients without cognitive impairment to have the maximal level of dependence in the 0‐ to 3‐month window before death (e.g., 56% vs 30% for mobility, P < .001), and were more likely to decline in the 2 years before death (e.g., 56% vs 36% for mobility, P < .001).CONCLUSION: Patients with advanced frailty, with or without cognitive impairment, have an end‐of‐life functional course marked by slowly progressive functional deterioration, with only a slight acceleration in the trajectory of functional loss as death approaches. Patients with cognitive impairment have particularly high rates of functional impairment at the time of death. These results suggest that end‐of‐life care systems that are targeted toward patients with functional trajectories clearly suggesting impending death (such as the Medicare hospice benefit) are poorly suited to older people dying with progressive frailty.
Prevalence and Correlates of Anxiety Symptoms in Well‐Functioning Older Adults: Findings from the Health Aging and Body Composition Study
Authors: Mehta Kala M. , Simonsick Eleanor M. , Penninx Brenda W. J. H. , Schulz Richard , Rubin Susan M. , Satterfield Suzanne , Yaffe Kristine 
Published: December 2004

OBJECTIVES: To determine the prevalence and correlates of anxiety symptoms in the absence of depression, in older black and white people.DESIGN: Cross‐sectional study.SETTING: Baseline assessment of a biracial cohort of community‐resident well‐functioning men and women aged 70 to 79 participating in the Health Aging and Body Composition study.PARTICIPANTS: Three thousand forty‐one participants (mean age 74, 52% women, 58% white).MEASUREMENTS: Participants were asked about three major anxiety symptoms (feeling fearful, tense/keyed‐up, or shaky/nervous) derived from the Hopkins Symptom Checklist. Participants were considered to have anxiety symptoms if they reported feeling at least two anxiety symptoms “a little” or one symptom “quite a bit” in the past week. Logistic regression models were used to identify demographic, psychosocial, and health‐related correlates of anxiety symptoms.RESULTS: Anxiety symptoms occurred in 15% of older people without depression and 43% of those with depression. Of nondepressed older people, women were more likely to have anxiety symptoms than men (P < .01), especially white women (20% prevalence). After multivariate adjustment, the chronic conditions of urinary incontinence (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.1–1.9), hearing impairment (OR = 1.4, 95% CI = 1.0–2.1), hypertension (OR = 1.3, 95% CI = 1.0–1.7) and poor sleep (OR = 1.7, 95% CI = 1.3–2.4) were associated with a higher prevalence of anxiety symptoms. Persons with poorer psychosocial functioning, low personal mastery (OR = 2.0, 95% CI = 1.6–2.5) and the need for more emotional support (OR = 2.2, 95% CI = 1.7–2.8), also had higher rates of anxiety symptoms.CONCLUSION: Anxiety symptoms are common in depressed and nondepressed older people. Given the high prevalence and coexistence with depressive symptoms, it will be important to conduct longitudinal studies that assess depressive and anxiety symptoms to clarify the direction and influence and disentangle the health‐related consequences of these two conditions.
Prescription and Dosage of Analgesic Medication in Relation to Resident Behaviors in the Nursing Home
Authors: Allen Rebecca S. , Thorn Beverly E. , Fisher Susan E. , Gerstle John , Quarles Karen , Bourgeois Michelle S. , Dijkstra Katinka , Burgio Louis D. 
Published: December 2004

OBJECTIVES: To examine correlates of analgesic medication prescription and administration in communicative, cognitively impaired nursing home residents. Residents' behaviors were assessed using computer‐assisted real‐time observations as potential adjunctive indicators of pain.DESIGN: Cross‐sectional study over a 4‐week period.SETTING: Five nursing homes in the greater Birmingham, Alabama, area.PARTICIPANTS: Ninety‐two residents (mean age ± standard deviation = 83.86 ± 8.55) with a mean Mini‐Mental State Examination (MMSE) score of 13.81 ± 6.34.MEASUREMENTS: Data were obtained via chart review, resident assessments, questionnaire completion by certified nursing assistants familiar with residents' care, and direct observation of residents' daily behaviors.RESULTS: Receipt of analgesic medication was related to self‐report of pain (F2,89 = 9.89, P = .0001), MMSE (F2,88 = 3.98, P = .022), and time spent inactive (F2,89 = 3.04, P = .053). Residents who received analgesic medication reported greater intensity of pain than other residents. Residents who received analgesics had higher MMSE scores than those who did not receive analgesics. Residents who received analgesics spent less time being inactive than those not prescribed analgesics. Receipt of higher dosage of opioid analgesic medication was associated with more time spent with others in verbal interaction (r = .22, P = .03).CONCLUSION: This study refines the methodology of measuring analgesic medication dosage and its effect on resident behavior. Analgesic prescription and administration patterns are related to time residents spend being inactive. Results suggest that opioid analgesics may hold particular promise in alleviating pain, as indicated by resident behaviors.
Consensus Statement on Improving the Quality of Mental Health Care in U.S. Nursing Homes: Management of Depression and Behavioral Symptoms Associated with Dementia
Authors:   American Geriatrics Society and American Association for Geriatric Psychiatry
Published: December 2004

The American Geriatrics Society and American Association for Geriatric Psychiatry Expert Panel on Quality Mental Health Care in Nursing Homes developed this consensus statement.The following organizations were represented on the expert panel and have reviewed and endorsed* the consensus statement:Alzheimer's Association, American Association for Geriatric Psychiatry, American Association of Homes and Services for the Aging, American College of Health Care Administrators, American Geriatrics Society, American Health Care Association, American Medical Directors Association, American Society on Aging, American Society of Consultant Pharmacists, Gerontological Society of America, National Association of Directors of Nursing Administration in Long‐Term Care, National Citizen's Coalition for Nursing Home Reform, National Conference of Gerontological Nurse Practitioners.The following organizations were also represented on the expert panel and reviewed and commented on the consensus statement:American Psychiatric Association: Council on Aging, American Psychological Association.
Does the transition temperature of Cu–NiTi archwires affect the amount of tooth movement during alignment?
Authors: Dalstra Michel , Melsen Birte 
Published: December 2004

Structured AbstractAuthors – Dalstra M, Melsen BObjectives – To examine whether the transition temperature of Cu–NiTi archwires has an effect on the tooth movement during the alignment phase of orthodontic treatment.Design – ‘Split mouth’ design in randomly selected patients.Setting and Sample Population – The Department of Orthodontics, School of Dentistry, University of Aarhus. Fifteen randomly selected patients with identical level of irregularity in the alignment phase of their treatment.Experiment Variable – Specially manufactured Cu–NiTi archwires for the upper arch were inserted. These consisted of two separate halves, each with its own transition temperature, respectively 27° and 40°C, and clamped together in the middle.Outcome Measure – The tooth movement, expressed as two translations and a rotation, in the occlusal plane was measured from the patients’ intraoral photographs taken upon insertion of the archwires and again after 1 month.Results – Tooth movements tended to be larger on the 40°C‐side, however only in case of the total translation of the premolars was this difference significant. In general, patients had not noticed any difference between the two sides of the archwire, although one patient stated the 27°C‐side to be more comfortable as the 40°C‐side had bothered her when drinking hot beverages.Conclusion – The transition temperature of Cu–NiTi archwires has indeed an effect on the amount of tooth movement during alignment. However, the differences are so small though that it is the question whether they can be noticed clinically. The study corroborates the trend towards the use of lower forces within orthodontics.