bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obesity Is Associated with Functional Decline in Community‐Dwelling Rural Older Persons
Authors: Jensen Gordon L. , Friedmann Janet M. 
Published: March 2003

OBJECTIVES: This investigation sought to examine potential gender differences in the relationship between body mass index (BMI) and functional decline.DESIGN: Cohort study.SETTING: Rural Pennsylvania.PARTICIPANTS: Medicare managed‐risk program participants (aged ≥65) in the Geisinger Health Plan. Mean age at study baseline was 71. Final analyzable sample was 2,634 participants.MEASUREMENTS: Self‐reported weight, weight change, living and eating habits, alcohol and medication use, depression, dentition, and functional status were obtained upon enrollment and again between 3 and 4 years later. Measured height and weight were also recorded at enrollment. Functional decline was defined as any increase in reported limitations in activities of daily living or instrumental activities of daily living over the study period. Logistic regression was used to evaluate the relationship between BMI, as defined by current National Institutes of Health categories, and risk of functional decline while controlling for age, depression, and polypharmacy. The referent category was BMI 18.5 to 24.9.RESULTS: Women had a higher prevalence of reported functional decline than men at the upper range of BMI categories (31.4% vs 14.3% for BMI ≥40). Women (odds ratio (OR) = 2.61, 95% confidence interval (CI) = 1.39–4.95) and men (OR = 3.32, 95% CI = 1.29–8.46) exhibited increased risk for any functional decline at BMI of 35 or greater. Weight loss of 10 pounds and weight gain of 20 pounds were also risk factors for any functional decline.CONCLUSIONS: Obesity was a risk factor for functional decline in older persons of either gender. Change in body weight did not benefit function for many older persons.
Inappropriate Prescribing Before and After Nursing Home Admission
Authors: Dhalla Irfan A. , Anderson Geoffrey M. , Mamdani Muhammad M. , Bronskill Susan E. , Sykora Kathy , Rochon Paula A. 
Published: March 2003

OBJECTIVES: To compare the prevalence of inappropriate prescribing before and after nursing home admission and to determine which patient and physician characteristics are associated with inappropriate prescribing in the nursing home setting.DESIGN: A pre/post retrospective, cohort study.SETTING: All licensed nursing homes in Ontario, Canada.PARTICIPANTS: Nineteen thousand nine hundred eleven individuals aged 66 and older, newly admitted to nursing homes in Ontario between April 1, 1997, and March 31, 1999.MEASUREMENTS: For each patient in the cohort, a subset of the Beers criteria was used to characterize and compare the prevalence of inappropriate prescribing (as indicated by the prescription of one of 49 inappropriate drugs) before and after nursing home admission. A logistic regression model was used to study the association between inappropriate prescribing and patient and physician characteristics.RESULTS: The proportion of patients receiving a prescription for at least one inappropriate drug decreased from 25.4% before nursing home admission to 20.8% afterward (P < .001). Most patients who had been prescribed an inappropriate agent before nursing home entry had that agent discontinued after admission. The most commonly prescribed inappropriate drugs after nursing home admission were strongly anticholinergic antidepressants (6.4%) and long‐half‐life benzodiazepines (5.9%). Patients younger than 85 were more likely to receive inappropriate drug therapy (odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.15–1.35) than those aged 85 and older. Other significant predictors were having more than one prescriber (OR = 1.40, 95% CI = 1.29–1.51), having a physician aged 50 or older (OR = 1.14, 95% CI = 1.05–1.23), having a male physician (OR = 1.20, 95% CI = 1.05–1.37), having a nonspecialist physician (OR = 1.23, 95% CI = 1.01–1.49), having a nonurban physician (OR = 1.13, 95% CI = 1.03–1.24), and having a physician practicing outside the greater Ontario metropolitan area (OR = 1.31, 95% CI = 1.19–1.51).CONCLUSIONS: Although a substantial number of nursing home residents receive inappropriate drug therapy, the prevalence of inappropriate prescriptions in our cohort declined after nursing home admission despite an overall increase in drug use. Patient and physician characteristics were associated with inappropriate prescribing. Targeted interventions such as regionally based education programs or drug use restrictions may reduce the prevalence of inappropriate prescribing.
Inappropriate Medication Prescribing in Residential Care/Assisted Living Facilities
Authors: Sloane Philip D. , Zimmerman Sheryl , Brown Lori C. , Ives Timothy J. , Walsh Joan F. 
Published: March 2003

OBJECTIVES: To identify the extent to which inappropriately prescribed medications (IPMs) are administered to older patients in residential care/assisted living (RC/AL) facilities and to describe facility and resident factors associated with receipt of one or more IPMs.DESIGN: Cross‐sectional study of a stratified, representative sample of 193 facilities in four states.SETTING: We identified representative geographic regions within Florida, New Jersey, North Carolina, and Maryland and drew from within them a stratified random sample of 193 RC/AL facilities. Three subtypes of facilities were included in the sample: small homes (<16 beds), larger “new‐model” homes, and larger “traditional” homes.PARTICIPANTS: Within each larger home, a random sample of residents aged 65 and older was approached for consent; in smaller homes all residents were approached. The overall enrollment rate was 92%; 2,078 residents were enrolled.MEASUREMENTS: Questionnaires and on‐site observations were used to gather data on facility administration and staffing and resident characteristics. All prescription and nonprescription medications taken at least 4 of the 7 days before data collection were taken from medication administration records and coded for analysis. IPM designation was based on modification of a list developed by Beers et al. and currently used by nursing home surveyors.RESULTS: The majority of RC/AL patients were taking five or more medications; 16.0% of these patients were receiving IPMs. The most common IPMs were oxybutynin, propoxyphene, diphenhydramine, ticlopidine, doxepin, and dipyridamole. In multivariate analyses, using generalized estimating equations, IPM use was associated with the number of medications received, smaller facility bed size, moderate licensed practical nurse turnover, absence of dementia, low monthly fees, and absence of weekly physician visits.CONCLUSIONS: IPMs remain a problem in long‐term care, but rates in these RC/AL settings compare favorably with those reported for other frail older populations, suggesting that use of medications with severe adverse effects may be waning. Regular physician facility visits may improve prescribing, as will attention to high‐risk groups such as individuals on multiple medications.
Prevalence of and Association Between Silent Myocardial Ischemia and New Coronary Events in Older Men and Women with and without Cardiovascular Disease
Authors: Aronow Wilbert S. , Ahn Chul , Mercando Anthony D. , Epstein Stanley , Kronzon Itzhak 
Published: March 2003

OBJECTIVES: To investigate the prevalence of silent ischemia (SI) in older men and women detected by 24‐hour ambulatory electrocardiograms (AECGs) and the association between SI and new coronary events.DESIGN: In a prospective study, the prevalence of SI detected by 24‐hour AECGs and the incidence of new coronary events in 915 older men and 1,874 older women with coronary artery disease (CAD); with hypertension, valvular disease, or cardiomyopathy without CAD; and with no cardiovascular disease were investigated.SETTING: Large long‐term healthcare facility.PARTICIPANTS: Nine hundred fifteen men, mean age 80, and 1,874 women, mean age 81.MEASUREMENTS: The prevalence of SI and the incidence of new coronary events in older men and women.RESULTS: SI was present in 34% of men and 33% of women with CAD; 15% of men and 14% of women with hypertension, valvular disease, or cardiomyopathy without CAD; and 6% of men and 5% of women with no cardiovascular disease. At 45‐month follow‐up in men and 47‐month follow‐up in women, SI significantly increased the incidence of new coronary events by 2.0 times in men and women with CAD (P < .001); by 1.8 times in men and 1.7 times in women with hypertension, valvular disease, or cardiomyopathy without CAD (P < .001); and by 6.3 times in men (P = .018) and 4.4 times in women (P = .008) with no cardiovascular disease.CONCLUSIONS: SI increases the incidence of new coronary events in older men and women with CAD, with hypertension, valvular disease, or cardiomyopathy without CAD, and with no cardiovascular disease.
Improving Medication Use in Newly Admitted Home Healthcare Patients: A Randomized Controlled Trial
Authors: Meredith Sarah , Feldman Penny , Frey Dennee , Giammarco Lisa , Hall Kathi , Arnold Kristina , Brown Nancy J. , Ray Wayne A. 
Published: March 2003

OBJECTIVES: To test the efficacy of a medication use improvement program developed specifically for home health agencies. The program addressed four medication problems identified by an expert panel: unnecessary therapeutic duplication, cardiovascular medication problems, use of psychotropic drugs in patients with possible adverse psychomotor or adrenergic effects, and use of nonsteroidal antiinflammatory drugs (NSAIDs) in patients at high risk of peptic ulcer complications. It used a structured collaboration between a specially trained clinical pharmacist and the patients' home‐care nurses to improve medication use.DESIGN: Parallel‐group, randomized controlled trial.SETTING: Two of the largest home health agencies in the United States.PARTICIPANTS: Study subjects were consenting Medicare patients aged 65 and older admitted to participating agency offices from October 1996 through September 1998, with a projected home healthcare duration of at least 4 weeks and at least one study medication problem.INTERVENTION: Qualifying patients were randomized to usual care or usual care with the medication improvement program.MEASUREMENTS: Medication use was measured during an in‐home interview, with container inspection at baseline and at follow‐up (between 6 and 12 weeks) by interviewers unaware of treatment assignment. The trial endpoint was the proportion of patients with medication use improvement according to predefined criteria at follow‐up.RESULTS: There were 259 randomized patients with completed follow‐up interviews: 130 in the intervention group and 129 with usual care. Medication use improved for 50% of intervention patients and 38% of control patients, an attributable improvement of 12 patients per 100 (95% confidence interval (CI) = 0.0–24.0, P = .051). The intervention effect was greatest for therapeutic duplication, with improvement for 71% of intervention and 24% of control patients, an attributable improvement of 47 patients per 100 (95% CI = 20–74, P = .003). Use of cardiovascular medications also improved more frequently in intervention patients: 55% vs 18%, attributable improvement 37 patients per 100 (95% CI = 9–66, P = .017). There were no significant improvements for the psychotropic medication or NSAID problems. There was no evidence of adverse intervention effects: new medication problems, more agency nurse visits, or increased duration of home health care.CONCLUSIONS: A program congruent with existing personnel and practices of home health agencies improved medication use in a vulnerable population and was particularly effective in reducing therapeutic duplication.
Leptin Levels are Appropriate for Body Mass Index in Older Men Who Experience Involuntary Weight Loss
Authors: Yukawa Michi , McCormick Wayne C. , Rajan Suparna , Matsumoto Alvin M. , Wallace Jeffery I. , Pearlman Robert A. , Weigle David S. 
Published: March 2003

OBJECTIVES: To determine the relationship between leptin and unintentional weight loss in older adults.DESIGN: Prospective cohort study over 2 years.SETTING: University‐affiliated Veterans Affairs Medical Center.PARTICIPANTS: The subjects were 105 community‐dwelling male veterans aged 65 and older who had participated in a prospective cohort study on nutrition and health conducted at the Veterans Affairs Puget Sound Health Care System from 1986 to 1989.MEASUREMENTS: Anthropometric data and fasting blood specimens were collected at baseline and annually for the subsequent 2 years. Stored blood specimens were analyzed for leptin, insulin, glucose, C‐reactive protein, sex hormone binding globulin, and testosterone levels.RESULTS: Over 2 years, 75 men were weight stable (weight loss <4% of baseline) and 30 men had unintentional weight loss (weight loss>4% of baseline). The baseline body mass index (BMI) and leptin levels for the two groups were not statistically different. Positive correlations existed between leptin level and BMI at each time point for weight‐stable and weight‐loss subjects. Furthermore, a significant relationship existed between changes in leptin and changes in BMI over 1 year in multiple regression analysis (r = .436, P < .001 after the first year; and r = .630, P = .027 after the second year).CONCLUSIONS: Like in younger adults, plasma leptin levels remained proportional to BMI, and changes in BMI were accurately reflected by changes in leptin levels in older individuals. Fasting leptin levels did not predict involuntary weight loss over 2 years of follow‐up.
Multifocal Glasses Impair Edge‐Contrast Sensitivity and Depth Perception and Increase the Risk of Falls in Older People
Authors: Lord Stephen R. , Dayhew Julia , Sc B App , Howland Amelia 
Published: March 2003

OBJECTIVES: To determine the extent to which multifocal glasses impair contrast sensitivity and depth perception at critical distances required for detecting hazards in the environment and whether multifocal glasses use increases the risk of falls in older people.DESIGN: One‐year prospective cohort study.SETTING: Falls Laboratory, Prince of Wales Medical Research Institute.PARTICIPANTS: One hundred fifty‐six community‐dwelling people aged 63–90.MEASUREMENTS: Contrast sensitivity, depth perception, accidental falls.RESULTS: Eighty‐seven subjects (55.8%) were regular wearers of multifocal (bifocal, trifocal, or progressive lens) glasses. These subjects performed significantly worse in the distant depth perception and distant edge‐contrast sensitivity tests in conditions that forced them to view test stimuli through the lower segments of their glasses. Multifocal glasses wearers were more than twice as likely to fall in the follow‐up period than nonmultifocal glasses wearers (odds ratio (OR) = 2.29, 95% confidence interval (CI) = 1.06–4.92), when adjusting for age, poor vision, reduced lower limb sensation and strength, slow reaction time, and increased postural sway. Multifocal glasses wearers were also more likely to fall because of a trip (OR = 2.79, 95% CI = 1.08–7.22), when outside their homes (OR = 2.55, 95% CI = 1.14–5.70), and when walking up or down stairs (P < .01). The population attributable risks of regular multifocal glasses use were 35.2% for any falls, 40.9% for falls due to a trip, and 40.9% for falls outside the home.CONCLUSIONS: The study findings indicate that multifocal glasses impair depth perception and edge‐contrast sensitivity at critical distances for detecting obstacles in the environment. Older people may benefit from wearing nonmultifocal glasses when negotiating stairs and in unfamiliar settings outside the home.
The Incremental Effect of Dementia‐Related Problem Behaviors on the Time to Nursing Home Placement in Poor, Frail, Demented Older People
Authors: Phillips Victoria L. , Diwan Sadhna 
Published: March 2003

OBJECTIVES: To examine the incremental effect of dementia‐related problem behaviors (DRPBs) on the risk of and time to nursing home placement (NHP) in poor, frail, demented older people.DESIGN: Client assessments were reviewed retrospectively for clinical, functional, and cognitive information, particularly the presence of DRPBs and the time during enrollment at which they occurred.SETTING: The Georgia Community Care Services Program (CCSP), a Medicaid 1915‐C home and community‐based services program (HCBS).PARTICIPANTS: A random sample of demented clients (n = 204) discharged during fiscal year 1996 from four CCSP regions.MEASUREMENTS: The risk of and time to nursing home placement. Cox proportional hazards models and an extended Cox model with a time‐varying covariate for the presence of DRPBs were used to evaluate the risk factors associated with NHP in demented older people. Kaplan‐Meier survival curves were used to estimate the time to NHP for several risk groups.RESULTS: In demented older people in a HCBS program, having a DRPB was found to increase the hazard rate of NHP. Having a problem behavior shortened average median survival in the community by approximately 2 years.CONCLUSIONS: DRPBs in demented older people shorten the time to NHP. Exploration of effective interventions is warranted.
Induction of additional red cell alloantibodies after intrauterine transfusions
Authors: Viëtor H. E. , Kanhai H. H. H. , Brand A. 
Published: March 2003

BACKGROUND: The aim of this study was to determine the frequency and origin of additional alloantibodies directed against red cells (RBCs) after intrauterine transfusion (IUT).STUDY DESIGN AND METHODS: Between March 1987 and December 1992, fetuses with severe hemolytic disease (n = 91) received a total of 280 ultrasound‐guided IUTs of RBCs from unrelated donors. The specificity of alloantibodies to RBCs in maternal serum was determined both before and after each IUT. If additional alloantibodies directed against RBCs were detected, their origin was determined by phenotyping the fetal, donor, and paternal RBCs for each particular antigen. The study included a control group of 69 pregnant women who underwent either amniocentesis or fetal blood sampling.RESULTS: Production of additional alloantibodies directed against RBC antigens was detected in 24 women (26%). The source of the immunizing antigen, either donor or fetus, was identified in 14 patients. The additional alloantibodies were directed against fetal antigens in 11 women and against donor antigens in 3. One additional alloantibody directed against donor antigen clearly reduced the survival of donor RBCs. The fetus and the donor shared the immunizing antigen in four cases, and in one case, the antibody occurred naturally. In five cases, the source of the immunizing antigen was not determined. In the control group, additional antibodies were detected in two patients.CONCLUSION: IUT therapy is associated with a high incidence of additional alloantibodies. In the majority of patients, the use of maternal RBCs for IUT would not have prevented additional formation of alloantibody to RBCs.
A phase III trial of recombinant human erythropoietin therapy in nonanemic orthopedic patients subjected to aggressive removal of blood for autologous use: dose, response, toxicity, and efficacy
Authors: Goodnough L.T. , Price T.H. , Friedman K.D. , Johnston M. , Ciavarella D. , Khan N. , Sacher R. , Vogler W.R. , Wissel M. , Abels R.I. 
Published: March 2003

BACKGROUND: Previous clinical trials have shown that the use of recombinant human erythropoietin (EPO) can facilitate autologous blood donation and reduce allogeneic blood transfusions in autologous blood donors who are anemic at first donation. However, the role of EPO therapy in nonanemic patients remains undefined. To identify this role, a randomized, controlled, multicenter dose‐escalation trial was conducted in patients whose initial hematocrit was > 39 percent (0.39).STUDY DESIGN AND METHODS: EPO (150, 300, or 600 units/kg) or placebo was administered intravenously at each of six phlebotomy visits over a 3‐week study period. Sixteen (14%) of 116 patients were unable to complete the treatment protocol because of adverse events (n = 11) or for personal reasons (n = 5); 2 patients (1 EPO and 1 placebo) experienced serious adverse events.RESULTS: In 91 evaluable patients, additional red cell production during the study period was 440 +/− 176, 621 +/− 215, 644 +/− 196, and 856 +/− 206 mL (mean +/− SD), respectively, for patients receiving placebo and EPO at 150, 300, and 600 units/kg (p < 0.05 for all EPO groups compared to placebo). However, the percentages of patients in each group who received allogeneic blood did not differ: 2 (9%) of 23 placebo patients and 6 (9%) of 68 EPO patients.CONCLUSION: It is concluded that, while EPO therapy increased preoperative red cell production, no clinical benefit could be demonstrated in autologous blood donors who were not anemic at first blood donation.
Prevalence and risk factors for hepatitis C antibodies in volunteer blood donors in Brazil
Authors: Patin̄o‐Sarcinelli F. , Hyman J. , Camacho L.A.B , Linhares D.B. , Azevedo J.G. 
Published: March 2003

Background: Little is known about the prevalence, risk factors, and transmission of hepatitis C virus (HCV) in a nontransfused population, particularly in developing countries.Study Design and Methods: To investigate the association between HCV seropositivity and some demographic variables, a case‐control study was conducted on 138 seropositive donors among 4762 consecutive volunteer blood donors and 1101 seronegative controls in Rio de Janeiro, Brazil. Donors were initially screened by interview for male homosexuality, use of illicit drugs, tattoos, previous transfusions, venereal diseases, and jaundice. Eligible donors were then tested for HCV antibodies by enzyme‐linked immunosorbent assay. A multivariate analysis was performed on age, ethnic group, gender, and prior donation.Results: The overall prevalence of HCV seropositivity was 2.89 percent. An increased risk of seropositivity was demonstrated for nonwhite donors at an odds ratio of 2.11 (95% CI, 1.43‐3.13), for males at 2.39 (95% CI, 1.01–5.7), and for prior donors at 1.66 (95% CI, 1.09‐2.52). The risk of anti‐HCV positivity increased markedly with age. Those at highest risk were the group 40 to 49 years old, with an odds ratio of 4.37 (95% CI, 2.39‐ 7.99) versus the group 20 to 29 years old. The group under 20 years old showed an odds ratio of 0.50 (95% CI, 0.06‐3.87) compared to the group 20 to 29 years old. These findings were equally significant in a univariate analysis.Conclusion: Our results suggest that HCV seropositivity is strongly associated with male sex, nonwhite ethnicity, and greater age. A significant number of seropositive donors were not detected by screening interview.