bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethnic Differences in the Prevalence and Pattern of Dementia‐Related Behaviors
Authors: Sink Kaycee M. , Covinsky Kenneth E. , Newcomer Robert , Yaffe Kristine 
Published: July 2004

Objectives: To determine the prevalence of dementia‐related behaviors in a large, multiethnic sample of community‐dwelling patients with moderate to severe dementia and to determine whether differences in patient or caregiver characteristics could explain any differences in prevalence of these behaviors between white and nonwhite patients.Design: Cross‐sectional study.Setting: Community‐based.Participants: A total of 5,776 Medicare patients (5,090 white, 469 black, 217 Latino; mean age 78.9) enrolled in the Medicare Alzheimer's Disease Demonstration and Evaluation study at eight sites across the United States between 1989 and 1991.Measurements: Trained interviewers collected information on patient demographic characteristics, cognitive and functional status, and caregiver characteristics such as relationship to patient, functional status, depression, and burden. Ethnicity was obtained by self‐report. Caregivers were asked if the patient typically demonstrated any of eight dementia‐related behaviors. To determine the independent association between ethnicity and dementia‐related behaviors, logistic regression models were developed for each of the behaviors, adjusting for patient and caregiver characteristics.Results: Overall, 92% of patients had one or more dementia‐related behaviors. Sixty‐one percent of black and 57% of Latino patients were reported to have four or more behaviors, compared with 46% of white patients (P<.001). The prevalence of specific behaviors ranged from 24% for combativeness to 67% for wandering. After multivariate adjustment, black patients were significantly more likely than whites to be constantly talkative (odds ratio (OR)=1.41, 95% confidence interval (CI)=1.11–1.80), to have hallucinations (OR=1.89, 95% CI=1.49–2.40) and episodes of unreasonable anger (OR=1.70, 95% CI=1.34–2.15), to wander (OR=1.40, 95% CI=1.08–1.81), and to wake their caregiver (OR=1.33, 95% CI=1.04–1.69). Latinos had a significantly higher likelihood than whites of having hallucinations (OR=1.49, 95% CI=1.10–2.01), episodes of unreasonable anger (OR=1.59, 95% CI=1.18–2.16), combativeness (OR=1.59, 95% CI=1.17–2.17), and wandering (OR=1.59, 95% CI=1.21–2.26). For most behaviors, these adjusted ORs are similar in magnitude of effect and statistical significance to the unadjusted estimates.Conclusion: Black and Latino community‐dwelling patients with moderate to severe dementia have a higher prevalence of dementia‐related behaviors than whites. Therefore, as the aging minority population grows, it will be especially important to target caregiver education, in‐home support, and resources to minority communities.
Government Expenditures at the End of Life for Short‐ and Long‐Stay Nursing Home Residents: Differences by Hospice Enrollment Status
Authors: Miller Susan C. , Intrator Orna , Gozalo Pedro , Roy Jason , Barber Janet , Mor Vincent 
Published: July 2004

Objectives: To examine end‐of‐life government expenditures for short‐ and long‐stay Medicare‐ and Medicaid‐eligible (dual‐eligible) nursing home (NH) hospice and nonhospice residents.Design: A retrospective cohort study.Setting: Six hundred fifty‐seven Florida NHs.Participants: Dual‐eligible NH residents who died in Florida NHs between July and December 1999 (N=5,774).Measurements: Nursing home stays of 90 days or less were considered short stays (n=1,739), and those over 90 days were long stays (n=4,035). Three diagnosis groups were studied: cancer without Alzheimer's disease or dementia, Alzheimer's disease or dementia, and other diagnoses. Eligibility and expenditure claims data for 1998 and 1999 were merged with vital statistics and NH resident assessment data to determine diagnoses, location of death, hospice enrollment, eligibility, and expenditures.Results: Twenty percent of short‐stay (n=350) and 26% of long‐stay (n=958) NH decedents elected hospice; of these, 73% of short‐stay and 58% of long‐stay NH residents had hospice stays of 30 days or less. Overall, mean government expenditures in the last month of life were significantly less for hospice than nonhospice residents ($7,365; 95% confidence interval (CI)=$7,144–7586 vs $8,134; 95% CI=$7,896–8,372), but 1‐month expenditures were only significantly lower for hospice residents with short NH stays, not for those with long NH stays.Conclusion: Overall, hospice care in NHs does not appear to increase government expenditures. Because significantly lower expenditures are observed for short‐stay NH hospice residents, policy restricting access to Medicare hospice for Medicare skilled nursing facility residents may represent a missed opportunity for savings.
Black/White Differences in Pressure Ulcer Incidence in Nursing Home Residents
Authors: Baumgarten Mona , Margolis David , Van Doorn Carol , Gruber‐Baldini Ann L. , Hebel J. Richard , Zimmerman Sheryl , Magaziner Jay 
Published: July 2004

Objectives: To compare black and white nursing home residents with respect to the incidence of nursing home (NH)‐acquired pressure ulcers (PUs) and to examine the role of resident characteristics and facility characteristics in explaining differences between the racial groups.Design: Prospective cohort study conducted between 1992 and 1995.Setting: Fifty‐nine Maryland NHs.Participants: A total of 1,938 residents (301 black, 1,637 white) aged 65 and older newly admitted to participating NHs.Measurements: The outcome variable was the first occurrence of a Stage 2, 3, or 4 PU as determined based on medical record review. The predictor variable was race (black, white). Eight resident characteristics (age, sex, number of activity of daily living dependencies, bedfast, PU on admission to facility, incontinence, dementia, and whether the resident was on Medicaid) and three facility characteristics (number of beds, for‐profit ownership status, and urban/nonurban location) were considered as possible confounding variables.Results: The incidence of PUs was 0.38 per person‐year in the NH. The rate for blacks was significantly higher than for whites (0.56 vs 0.35 per person‐year) (P<.001). In multivariate analysis, controlling for eight resident characteristics and three facility characteristics, race was significantly associated with PU incidence (hazard ratio comparing blacks with whites=1.31, 95% confidence interval=1.02–1.66).Conclusion: Blacks have a higher incidence of NH‐acquired PUs than whites; resident characteristics appear to mediate the higher risk. Future research should aim to identify modifiable factors that explain differences between racial groups in PU risk and to develop solutions to prevent the suffering and cost associated with PUs.
Risk Factors for Deep Vein Thrombosis in Inpatients Aged 65 and Older: A Case‐Control Multicenter Study
Authors: Weill‐Engerer Sébastien , Meaume Sylvie , Lahlou Amina , Piette François , Saint‐Jean Olivier , Sachet Annick , Beinis Jean‐Yves , Gallinari Claude , Grancher Anne‐Sophie , Vincent Jean‐Pierre , Naga Henri , Belmin Joel , Salvatore Rosella , Kazes Marie , Pautas Eric , Boiffin André , Piera Jean‐Bernard , Duviquet Monique , Knafo David , Piau Andrée , Miric Dragoslav , Jean Alain , Bellamy Valérie , Tissandier Olivier , Le Blanche Alain‐Ferdinand 
Published: July 2004

Objectives: To identify independent risk factors of symptomatic deep vein thrombosis (DVT) in geriatric inpatients and to define high‐risk patients likely to benefit from preventive treatment.Design: Hospital‐based case‐control multicenter study with prospective data collection.Settings: Geriatric university hospitals with long‐, intermediate‐, and short‐term care facilities.Participants: All patients aged 65 and older in 19 geriatric departments were submitted to clinical surveillance over a 16‐month period.Measurements: Twenty‐three potential risk factors of phlebitis were screened for. Comparison using logistic regression of 310 consecutive patients with symptomatic DVT versus 310 randomly selected controls was performed. The risk for symptomatic DVT in geriatrics was then scored from the clinical risk factors identified using multivariate analysis. This score is defined by the sum of the odds ratio (OR) of each risk factor present.Results: Six factors were identified as independently related to the development of DVT: restriction of mobility (from OR=1.73, limited mobility without immobilization, to OR=5.64, bedridden during <15 days), aged 75 and older (OR=1.5/10 years), history of DVT or pulmonary embolism (OR=3.38), acute heart failure (OR=2.52), chronic edema of the lower limbs (OR=2.51), and paresis or paralysis of a lower limb (OR=2.06). The defined score of 8 or higher corresponded to an 88.7% probability of having symptomatic DVT.Conclusion: Treatments to prevent symptomatic DVT in hospitalized elderly should be evaluated on patients with these factors.
Providing Nutrition Supplements to Institutionalized Seniors with Probable Alzheimer's Disease Is Least Beneficial to Those with Low Body Weight Status
Authors: Young Karen W. H. , Greenwood Carol E. , Van Reekum Robert , Binns Malcolm A. 
Published: July 2004

Objectives: To examine whether providing a midmorning nutrition supplement increases habitual energy intake in seniors with probable Alzheimer's disease (AD) and to investigate the effects of body weight status and cognitive and behavioral function on the response to the intervention.Design: Randomized, crossover, nonblinded clinical trial.Setting: A fully accredited geriatric teaching facility affiliated with the University of Toronto's Medical School with a home for the aged.Participants: Thirty‐four institutionalized seniors with probable AD who ate independently.Intervention: Nutrition supplements were provided between breakfast and lunch for 21 consecutive days and compared with 21 consecutive days of habitual intake.Measurements: Investigator‐weighed food intake, body weight, cognitive function (Severe Impairment Battery and Global Deterioration Scale), behavioral disturbances (Neuropsychiatric Inventory—Nursing Home Version), and behavioral function (London Psychogeriatric Rating Scale).Results: Relative to habitual intake, group mean analyses showed increased 24‐hour energy, protein, and carbohydrate intake during the supplement phase, but five of 31 subjects who finished all study phases completely compensated for the energy provided by the supplement by reducing lunch intake, and 24‐hour energy intake was enhanced in only 21 of 31 subjects. Compensation at lunch was more likely in subjects with lower body mass indices, increased aberrant motor behavior, poorer attention, and increased mental disorganization/confusion.Conclusion: Nutrition supplements were least likely to enhance habitual energy intake in subjects who would normally be targeted for nutrition intervention—those with low body weight status. Those likely to benefit include those with higher body mass indices, less aberrant motor problems, less mental disorganization, and increased attention.
Plasma Hypertonicity: Another Marker of Frailty?
Authors: Stookey Jodi D. , Purser Jama L. , Pieper Carl F. , Cohen Harvey J. 
Published: July 2004

Objectives: To determine whether plasma hypertonicity might be a marker of early frailty, this study tested the associations between plasma hypertonicity, incident disability, and mortality in nondisabled older adults.Design: Longitudinal, observational study.Setting: Community‐based.Participants: Older adults (≥70), who reported no disability and gave blood in the 1992 Duke Established Populations for Epidemiologic Studies of the Elderly survey (n=705), were re‐interviewed in 1996 for functional status (n=561) and followed for all deaths up to January 1, 2000.Measurements: Plasma tonicity was estimated from plasma glucose, sodium, and potassium measures and used to classify subjects as normo‐ (285–294 mOsm/L) or hypertonic (≥300 mOsm/L). Disability was defined as any impairment on the Rosow‐Breslau, activity of daily living (ADL), and instrumental activity of daily living (IADL) scales. The relative risk (RR) of any new disability and relative hazard of death associated with hypertonicity were estimated using logistic regression models and Cox proportional hazards models, respectively. All models were controlled for age, sex, race, weight status, current smoking, activity level, plasma blood urea nitrogen and creatinine, cognitive impairment, depression, and chronic disease status. To determine whether observed effects were attributable to plasma glucose alone, all models were repeated on a subsample of nondiabetic, normoglycemic subjects.Results: Plasma hypertonicity (observed in 15% of subjects) was associated with increased risk of new Rosow‐Breslau (RR=2.1, 95% confidence interval (CI)=1.2–3.6), IADL (RR=2.3, 95% CI=1.2–4.3), and ADL (RR=2.7 95% CI=1.3–5.6) disability by 1996 and mortality by 2000 (RR=1.4, 95% CI=1.0–1.9). Results were similar for the normoglycemic subgroup (ADL: RR=2.9, 95% CI=1.0–8.0; IADL: RR=2.5, 95% CI=1.0–6.3; Rosow‐Breslau: RR=1.8, 95% CI=0.8–3.9; mortality: RR=1.5, 95% CI=0.9–2.3).Conclusion: Plasma hypertonicity may be a marker of early frailty. It was prevalent in this sample of nondisabled community‐dwelling older adults and predicted incident disability and mortality. Further research to identify its determinants and consequences may help inform interventions against frailty.
A Comparative Study of Clinical Features and Outcomes in Young and Older Adults with Severe Acute Respiratory Syndrome
Authors: Chan Tak Yeung , Miu Ka Ying , Tsui Chung Kan , Yee Kwok Sang , Chan Ming Houng 
Published: July 2004

Objectives: To determine the clinical presentation, findings, and outcomes of older adults (> 60) with severe acute respiratory syndrome (SARS) and compare these with a control group of younger patients (≤60).Design: Retrospective cohort study.Setting: A community‐based, acute hospital in Hong Kong.Participants: All adult inpatients with a clinical diagnosis of SARS.Measurements: Clinical presentations, investigations, treatment, and 30‐ and 150‐day mortality.Results: There were 52 young and 25 older patients with a mean age±standard deviation of 39.5±11.7 and 72.1±7.2, respectively. Fever, chills, and diarrhea were more common in younger patients, whereas decrease in appetite and general condition occurred only in older patients. The prevalence of positive reverse‐transcriptase polymerase chain reaction for SARS‐associated coronavirus (SARS‐CoV) in nasopharyngeal secretions and stool samples was similar in the two groups. The prevalence of positive serological tests for SARS‐CoV was significantly lower in older patients (42% vs 92%, P<.001). This was largely due to incomplete testing in elderly patients. Older patients were more likely to develop secondary nosocomial infection, be admitted to an intensive care unit, and require mechanical ventilation. The cumulative 30‐ and 150‐day mortality rates were 3.8% and 7.6%, respectively, in young patients with SARS and 56% and 60%, respectively, in older patients (P<.001).Conclusion: Older patients with SARS more often presented with nonspecific symptoms, and the prognosis was poor. Reverse‐transcriptase polymerase chain reaction was useful in diagnosing SARS in older patients, but the role of serological tests in individual elderly is limited.
An Analysis of an Older Driver Evaluation Program
Authors: Kantor Bonnie , Mauger Linda , Richardson Virginia E. , Unroe Kathleen Tschantz 
Published: July 2004

Objectives: To identify elements of an older driver evaluation program that predict driving performance in older adults.Setting: Outpatient medical clinic in an academic medical center.Design: A retrospective analysis.Participants: Six hundred sixty‐four older adults who were referred to an older driver evaluation program.Measurements: A physician trained in geriatric medicine and a clinical geriatric nurse specialist oversaw an experienced driving evaluator and an occupational therapist who conducted assessments of older persons' functional status; reaction time; driving skills; and cognitive, hearing, and vision abilities. Self‐report data along with a medical history submitted by patients' primary care physicians supplemented the clinical assessments.Results: A multinomial logistic regression revealed that the Mini‐Mental State Examination (MMSE), cues needed with the Trail Making Test, Part B, grip strength, and an interaction effect between the MMSE and reaction time constituted the most parsimonious model for predicting on‐the‐road performance. A receiver operating characteristic analysis indicated that this index had good sensitivity but low specificity. A binomial regression comparing imperfect and perfect drivers demonstrated the significance of the Traffic Sign and Visual Perception tests.Conclusion: Clinicians should employ a multilevel screening process that includes initial cognitive tests, such as the MMSE and the Trail Making Test, Part B, although more studies of driving evaluation programs in medical settings that include random samples of older drivers are needed.
Hospice Care in Nursing Homes: Is Site of Care Associated with Visit Volume?
Authors: Miller Susan C. 
Published: July 2004

Objectives: To determine factors associated with hospice visit volume and to examine whether visit volume differs by nursing home (NH) versus non‐NH setting.Design: Retrospective cohort study.Setting: Twenty‐one hospices across seven states under the ownership of one parent provider.Participants: Hospice patients from October 1998 through September 1999 in NH (n=9,460) and non‐NH (n=15,484) settings.Measurements: Data were from the provider's centralized information system. Average daily visit volume was the number of visits divided by the number of hospice routine home care days (days not in hospice inpatient or continuous home care). Multivariate logistic regression tested the association between site of care and an individual's probability of having average daily visits above the sample median.Results: Average daily visits±standard deviation were 1.1±1.1 for NH and 1.2±1.3 for non‐NH hospice patients. Site of care was not significantly associated with having an average daily visit volume above the sample median, but patients in NH settings had a lower probability of having a nurse average daily visit volume above the median (adjusted odds ratio (AOR)=0.59, 95% confidence interval (CI)=0.46–0.74) and a greater probability of having social worker (AOR=2.46, 95% CI=1.87–3.24), aide (AOR=1.97; 95% CI=1.11–3.48), and clergy (AOR=3.23, 95% CI=2.21–4.44) average daily visits above the median than those in non‐NH settings.Conclusion: A different mix, not volume, of services appears to be used to address the physical, psychosocial, and spiritual needs of hospice patients/families who reside in NH settings than of those in non‐NH settings.
Outcomes and Characteristics of Patients Discharged Alive from Hospice
Authors: Kutner Jean S. , Meyer Sue A. , Beaty Brenda L. , Kassner Cordt T. , Nowels David E. , Beehler Connie 
Published: July 2004

Objectives: To describe outcomes and characteristics of patients discharged alive from hospice.Design: Prospective cohort study using a telephone survey.Setting: Hospices (n=18) participating in the Population‐Based Palliative Care Research Network during the 1‐year study period.Participants: English‐speaking adults (n=164) who were discharged alive from participating hospices during the 1‐year study period.Measurements: Mortality within 6 months of hospice discharge.Results: Thirty‐five percent (n=48) of the 139 patients with known outcomes died within 6 months of hospice discharge, 15 of whom (31%) died without hospice readmission. There were no significant associations between sex (P=.77), length of hospice service (P=.99), diagnosis (P=.73), discharge disposition (P=.54), admission evidence of prognosis of less than 6 months to live (P=.22–.95), Karnofsky score at admission or change between admission and discharge (P=.39, P=.38, respectively), or duration of hospice care after stabilization (P=.83) and mortality within 6 months after hospice discharge. Age (P=.11), discharge Karnofsky score (P=.17), and reason for discharge being improved or stabilized condition (P=.13) trended toward statistical significance. The strongest predictor of mortality after hospice discharge was a report that the patient's condition had worsened (hazard ratio=10.2, 95% confidence interval 4.5–23.4).Conclusion: One‐third of patients who were discharged from hospice died within 6 months of hospice discharge, indicating ongoing eligibility for hospice care even under the strictest interpretation of hospice eligibility criteria. Patients who are discharged from hospice care should be evaluated frequently, especially within the first weeks to months after discharge, for changes in status, unmet needs, and potential hospice readmission.
Psychometric Comparisons of the Timed Up and Go, One‐Leg Stand, Functional Reach, and Tinetti Balance Measures in Community‐Dwelling Older People
Authors: Lin Mau‐Roung , Hwang Hei‐Fen , Hu Ming‐Hsia , Wu Hong‐Dar Isaac , Wang Yi‐Wei , Huang Fu‐Chao 
Published: July 2004

Objectives: To compare the practicality, reliability, validity, and responsiveness of the timed up and go (TUG), one‐leg stand (OLS), functional reach (FR), and Tinetti balance (TB) performance measures in people aged 65 and older.Design: A prospective study.Setting: Shin‐Sher Township of Taichung County, west‐central Taiwan.Participants: Twelve hundred community‐dwelling older people.Measurements: During an initial assessment at their residences, participants were interviewed for demographics, cognition, fall history, use of a walking aid, and activities of daily living (ADLs), in addition to completing the four balance tests. Falls were ascertained by telephone every 3 months for a 1‐year follow‐up; the four balance measures and ADLs were also reassessed at the end of the follow‐up year.Results: Of the four balance measures, the OLS had the lowest participation rate, and participation of people who were cognitively impaired had fallen in the previous year, used a walking aid, or suffered from an ADL disability was lower than for their counterparts. The time to complete the tests ranged from 58 seconds for OLS, to 160 seconds for the TB. All four balance measures exhibited excellent test‐retest reliability and discriminant validity but poor responsiveness to fall status. The TB showed better discriminant, convergent, and predictive validities and responsiveness to ADL changes than the other three tests.Conclusion: According to psychometric properties, the most suitable performance measure for evaluating balance in community‐dwelling older people was the TB, followed by the TUG.