bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Infection in Nursing Home Residents with and without Early Hospital Transfer
Authors: Boockvar Kenneth S. , Gruber‐Baldini Ann L. , Burton Lynda , Zimmerman Sheryl , May Conrad , Magaziner Jay 
Published: March 2005

Objectives: To compare outcomes of infection in nursing home residents with and without early hospital transfer.Design: Observational cohort study.Setting: Fifty‐nine nursing homes in Maryland.Participants: Two thousand one hundred fifty‐three individuals admitted to nursing homes between 1992 and 1995.Measurements: Incident infection was recorded when a new infectious diagnosis was documented in the medical record or nonprophylactic antibiotic therapy was prescribed. Early hospital transfer was defined as transfer to the emergency department or admission to the hospital within 3 days of infection onset. Infection, resident, and facility characteristics were entered into a multivariate model to create a propensity score for early hospital transfer. Association between early hospital transfer and outcomes of infection, namely pressure ulcers and death between Days 4 and 34 after infection onset, were examined, controlling for propensity score.Results: Four thousand nine hundred ninety infections occurred in 1,301 residents. Genitourinary (28%), skin (19%), upper respiratory (13%), and lower respiratory (12%) were the most common types. Three hundred seventy‐five episodes in which residents survived 3 days (7.6%) resulted in early hospital transfer. In multivariate regression, individuals with early hospital transfer had higher mortality (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.04–1.99) and, in 1‐month survivors, a greater occurrence of pressure ulcers (OR 1.61, 95% CI=1.17–2.20) than those without, after adjusting for propensity score.Conclusion: Using observational data and propensity score methods, outcomes were worse in nursing home residents transferred to the hospital within 3 days of infection onset than in those who remained in the nursing home.
The Association Between Specific Nurse Case Management Interventions and Elder Health
Authors: Schein Constance , Gagnon Anita J. , Chan Lisa , Morin Isabelle , Grondines Justin 
Published: March 2005

Objectives: To describe the association between specific nursing interventions performed in the context of nurse case management and older people's quality of life and functional ability.Design: Longitudinal.Setting: Nurse case management through a university hospital and two community health centers.Participants: One hundred seventy‐five community‐dwelling frail older persons (≥70 and at risk for repeated hospitalizations).Measurements: Specific groups of nursing interventions provided in the context of nurse case management over a 10‐month period—coping assistance, lifespan care, risk management, and physical comfort promotion—were focused on. These interventions were recorded using a standardized nursing language. Outcomes were measured using telephone and home interview and medical record review using the 36‐item Short Form and the Older American Resources and Services Multidimensional Functional Assessment Questionnaire.Results: Older people receiving coping assistance interventions demonstrated an increase in instrumental activity of daily living functioning although they had lower general health, role‐emotional, and mental health scores.Conclusion: Coping assistance is one nursing intervention of several provided in the context of nurse case management that is independently associated with improving the functional status of frail older persons even in the presence of declining health normally associated with aging over several months. Examining the relationships between specific nursing activities and health outcomes of frail older persons may be useful in furthering understanding of the results of randomized trials of nurse case management in this population.
Purchasing or Providing Nursing Home Care: Can Quality of Care Data Provide Guidance
Authors: Berlowitz Dan R. , Rosen Amy K. , Wang Fei , Tsilimingras Dionyssios , Tariot Pierre N. , Engelhardt Joe , Kader Boris , Mukamel Dana B. 
Published: March 2005

Objectives: To examine whether quality of care differed for veterans in Department of Veterans Affairs (VA) nursing homes and those on contract in community nursing homes and whether the VA was contracting with nursing homes providing better quality of care than other nursing homes.Design: Observational study using administrative databases from 1997 to 1999.Setting: Ten VA and 650 community nursing homes in New York state.Participants: Four thousand seven hundred sixty‐three veteran and 195,438 nonveteran residents of these nursing homes.Measurements: Risk‐adjusted rates of pressure ulcer development, functional decline, behavioral decline, and mortality.Results: Veterans in VA nursing homes were significantly (P<.05) less likely to develop a pressure ulcer (odds ratio (OR)=0.63) but more likely to experience functional decline (OR=1.6) than veterans in community nursing homes. Residents of community nursing homes with VA contracts were significantly (P<.05) less likely to develop a pressure ulcer (OR=0.91) but more likely to die than residents in noncontract homes. Few nursing homes were consistently among the best or worst performers on all measures; only seven of 650 nursing homes were in the top or bottom decile and 34 in the top or bottom quartile for each measure.Conclusion: Large purchasers and providers of nursing home care such as the VA are unlikely to find information on quality of care useful in making decisions on whether they should “make” or “buy” care. Nursing homes performing well on one quality measure may perform poorly on another, and it is difficult to identify nursing homes that are consistently among the best or worst. Other consumers may encounter similar difficulties when using data on nursing home quality.
Coronary Artery Calcium: Associations with Brain Magnetic Resonance Imaging Abnormalities and Cognitive Status
Authors: Rosano Caterina , Naydeck Barbara , Kuller Lewis H. , Longstreth William T. , Newman Anne B. 
Published: March 2005

Objectives: To evaluate the association between coronary atherosclerosis and subclinical brain magnetic resonance imaging (MRI) abnormalities and between coronary atherosclerosis and abnormal cognitive function (dementia/mild cognitive impairment).Design: Cross‐sectional.Setting: The Cardiovascular Health Study (CHS), an epidemiological study of risk factors for cardiovascular disease in older adults.Participants: Four hundred nine men and women, mean age 79, recruited from the Pittsburgh center of the CHS.Measurements: Coronary atherosclerosis was defined according to the level of coronary artery calcification (CAC), as measured using electronic beam tomography. Subclinical brain MRI abnormalities included ventricular enlargement, white matter hyperintensities, and number of subcortical brain infarcts. Brain MRI and CAC measurements were performed between 1998 and 2000 at the Pittsburgh center of the CHS. Prevalence of brain MRI abnormalities and abnormal cognitive status were examined across quartiles of the CAC score, before and after controlling for age. Multivariate logistic regression models were used to assess whether CAC level was associated with abnormalities of brain MRI or abnormal cognitive status.Results: Older adults with high CAC scores were more likely to have more‐severe brain MRI abnormalities, including subcortical infarction and high white matter hyperintensities. The associations between CAC and ventricular enlargement showed a similar but not significant trend. The presence of any of the MRI abnormalities attenuated the association between CAC and abnormal cognitive status.Conclusion: Older adults with higher levels of CAC were more likely to have more‐severe brain MRI abnormalities and abnormal cognitive status.
Subjective Cognitive Complaints and Cognitive Decline: Consequence or Predictor? The Epidemiology of Vascular Aging Study
Authors: Dufouil Carole , Fuhrer Rebecca , Alpérovitch Annick 
Published: March 2005

Objectives: To explore whether more cognitive complaints are associated with previous or future cognitive decline.Design: Longitudinal; epidemiology vascular aging study.Setting: Community in Nantes, France.Participants: Seven hundred thirty‐three subjects, aged 59 to 71.Measurements: Subjective cognitive complaints were recorded at 4‐year follow‐up examination in a prospective study of people aged 59 to 71 at study entry. Participants' cognitive performances were assessed repeatedly at each wave (baseline, 4 years, and 6 years) of the study using a series of neuropsychological tests including the Mini‐Mental State Examination. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale. Subjects also had a cerebral magnetic resonance imaging scan at 4‐year follow‐up to evaluate presence and severity of white matter hyperintensities (WMHs).Results: Subjects with more cognitive complaints had greater cognitive decline. This significant relationship persisted after adjusting for potential confounders, including depressive symptoms. Multivariate analysis also showed that, in subjects without measured cognitive decline between study entry and 4‐year follow‐up, those with more cognitive complaints at 4‐year follow‐up had significantly greater measured cognitive decline during the subsequent 2 years. In the presence of severe WMH, more cognitive complaints were an even stronger predictor of future cognitive decline.Conclusion: Cognitive complaints reflect measured cognitive decline, but they also predict cognitive decline at an earlier stage than objective tests that are not able to detect cognitive deficits. They need to be taken into account in clinical practice.
Sex Steroid Level, Androgen Receptor Polymorphism, and Depressive Symptoms in Healthy Elderly Men
Authors: T'Sjoen Guy G. , De Vos Sara , Goemaere Stefan , Van Pottelbergh Inge , Dierick Michel , Van Heeringen Cees , Kaufman Jean‐Marc 
Published: March 2005

Objectives: To determine the prevalence of depression in a cohort of elderly men as assessed using a 30‐item Geriatric Depression Scale (GDS) score and to describe the association between this score and sex steroids, androgen receptor (AR) polymorphism, and general health status.Design: Observational study on the relationship between sex steroid status and health‐related parameters.Setting: Community‐based.Participants: Ambulatory men (n=236 in 1997, n=192 in 2000) aged 70 and older at inclusion in 1996, interviewed in 1997 and 2000.Measurements: Serum levels of testosterone, estradiol, sex hormone binding globulin (SHBG), dehydroepiandrosterone‐sulfate (DHEAS), cortisol, and the AR gene cytosine, adenine, guanine (CAG)‐repeat length polymorphism were determined. Free testosterone and free estradiol were calculated. Questionnaires included GDS, 36‐item Short Form, and Rapid Disability Rating Scale—2.Results: Median age was 75.3 years (interquartile range=73.5–78.5). A GDS score of 11 or greater was found in 30 (12.7%) men. Age and GDS score were significantly interrelated (P<.01), as were all health‐assessment scores. GDS scores were not related to (free) testosterone or AR polymorphism in 1997 or 2000. In 1997 only (n=236), higher GDS scores were related to higher estradiol, free estradiol, and DHEAS levels.Conclusion: The data did not support a role for testosterone in depression in elderly community‐based men as assessed using the GDS.
Comparison of Brain Natriuretic Peptide and Probrain Natriuretic Peptide in the Diagnosis of Cardiogenic Pulmonary Edema in Patients Aged 65 and Older
Authors: Ray Patrick , Arthaud Martine , Birolleau Sophie , Isnard Richard , Lefort Yannick , Boddaert Jacques , Riou Bruno ,   the EPIDASA Study Group
Published: March 2005

Objectives: Differentiating cardiogenic pulmonary edema (CPE) from respiratory causes of dyspnea is difficult in elderly patients. The aim of this study was to compare the usefulness of B‐type natriuretic peptide (BNP) and amino‐terminal fragment BNP (proBNP), to diagnose CPE in patients aged 65 and older.Design: Prospective study.Setting: Medical emergency department of a 2,000‐bed urban teaching hospital.Participants: Patients aged 65 and older presenting with acute dyspnea and a respiratory rate of 25 breaths/min or greater, a partial pressure of oxygen of 70 mmHg or less, or an oxygen saturation of 92% or less were included.Measurements: Rapid BNP and proBNP assays, performed blind at admission, were compared with the final diagnosis (CPE or no CPE) as defined by an expert team.Results: Two hundred two patients (mean age±standard deviation 80±9) were included; 88 (44%) had CPE. There was a strong correlation between proBNP and BNP values (correlation coefficient=0.91, P<.001). The median BNP and proBNP were higher in the group of patients with CPE (377 vs 74 pg/mL, P<.001, and 3,851 vs 495 pg/mL, P<.001, respectively). The best threshold values of BNP and proBNP were 250 pg/mL and 1,500 pg/mL, respectively. The area under the receiver operating characteristic curve was greater with BNP than with proBNP (0.85 vs 0.80, P<.05). BNP assay was more accurate in diagnosis than the emergency physician, whereas proBNP was not. Higher values of BNP and proBNP were associated with greater in‐hospital mortality.Conclusion: BNP assay is a more useful diagnostic indicator for CPE than proBNP in patients aged 65 and older.
Subclinical Brain Magnetic Resonance Imaging Abnormalities Predict Physical Functional Decline in High‐Functioning Older Adults
Authors: Rosano Caterina , Kuller Lewis H. , Chung Hyoju , Arnold Alice M. , Longstreth William T. , Newman Anne B. 
Published: March 2005

Objectives: To determine whether severity of subclinical brain magnetic resonance imaging (MRI) abnormalities predicts incident self‐reported physical impairment or rate of decline in motor performance.Design: Longitudinal analysis, average follow‐up time: 4.0 years.Setting: Cardiovascular Health Study (CHS).Participants: CHS participants with modified Mini‐Mental State Examination (3MS) score of 80 or greater, no self‐reported disability, no history of stroke, and at least one assessment of mobility (n=2,450, mean age=74.4).Measurements: Brain MRI abnormalities (ventricular enlargement, white matter hyperintensities, subcortical and basal ganglia small brain infarcts), self‐reported physical impairment (difficulty walking half a mile or with one or more activities of daily living), and motor performance (gait speed, timed chair stand).Results: After adjusting for demographics, cardiovascular risk factors, and diseases, risk of incident self‐reported physical impairment was 35% greater for those with severe ventricular enlargement than for those with minimal ventricular enlargement, 22% greater for those with moderate white matter hyperintensities than for those with minimal white matter hyperintensities, and 26% greater for participants with at least one brain infarct than for those with no infarcts. Those with moderate to severe brain abnormalities experienced faster gait speed decline (0.02 m/s per year) than those with no MRI abnormalities (0.01 m/s per year). Further adjustment for incident stroke, incident dementia, and 3MS score did not substantially attenuate hazard ratios for incident self‐reported physical impairment or coefficients for decline in gait speed.Conclusion: Subclinical structural brain abnormalities in high‐functioning older adults can increase the risk of developing physical disabilities and declining in motor performance.
People Aged Over 75 in Atrial Fibrillation on Warfarin: The Rate of Major Hemorrhage and Stroke in More Than 500 Patient‐Years of Follow‐Up
Authors: Johnson Christina E. , Lim Wen K. , Workman Barbara S. 
Published: March 2005

Objectives: To determine the incidence of major hemorrhage and stroke in people aged 76 and older with atrial fibrillation on adjusted‐dose warfarin who had been recently been admitted to hospital.Design: A retrospective observational cohort study.Setting: A major healthcare network involving four tertiary hospitals.Participants: Two hundred thirty‐five patients aged 76 and older admitted to a major healthcare network between July 1, 2001, and June 30, 2002, with atrial fibrillation on warfarin were enrolled.Measurements: Information regarding major bleeding episodes, strokes, and warfarin use was obtained from patients, relatives, primary physicians, and medical records.Results: Two hundred twenty‐eight patients (42% men) with a mean age of 81.1 (range 76–94) were included in the analysis. Total follow‐up on warfarin was 530 years (mean 28 months). There were 53 major hemorrhages, for an annual rate of 10.0%, including 24 (45.3%) life‐threatening and five (9.4%) fatal bleeds. The annual stroke rate after initiation of warfarin was 2.6%.Conclusion: The rate of major hemorrhage was high in this old, frail group, but excluding fatalities, resulted in no long‐term sequelae, and the stroke rate on warfarin was low, demonstrating how effective warfarin treatment is.
Comorbidity and 1‐Year Mortality Risks in Nursing Home Residents
Authors: Van Dijk Pieter T. M. , Mehr David R. , Ooms Marcel E. , Madsen Richard , Petroski Greg , Frijters Dinnus H. , Margriet Pot Anne , Ribbe Miel W. 
Published: March 2005

Objectives: To investigate the effect of chronic diseases and disease combinations on 1‐year mortality in nursing home residents.Design: Retrospective cohort study using electronically submitted Minimum Data Set (MDS) information and Missouri death certificate data.Setting: Five hundred twenty‐two nursing homes in Missouri.Participants: Forty‐three thousand five hundred ten nursing home residents with a full MDS assessment in 1999.Measurements: Information about chronic diseases, age, sex, and performance in activities of daily living (ADLs) available from the first full MDS 2.0 assessment in 1999; death within 1 year after the first full MDS‐assessment in 1999.Results: After adjustment for age and sex, eight variables were predictive for 1‐year mortality: seven chronic diseases (dementia, cancer, heart failure, renal failure, emphysema/chronic obstructive pulmonary disease, diabetes mellitus, and anemia) and an interaction variable containing age and cancer. Adding terms for disease combinations (e.g., diabetes mellitus and heart failure) did not enhance survival prediction. When there was also adjustment for ADL performance as measured using the MDS‐ADL Short Form, dementia and anemia were not included, because they had no prognostic value above that of the other variables.Conclusion: Several chronic diseases were associated with 1‐year mortality in the institutionalized elderly after adjustment for ADL performance, age, and sex. Evidence of a synergistic effect of disease combinations on mortality is lacking.
Near Vision Impairment Predicts Cognitive Decline: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly
Authors: Reyes‐Ortiz Carlos A. , Kuo Yong‐Fang , DiNuzzo Anthony R. , Ray Laura A. , Raji Mukaila A. , Markides Kyriakos S. 
Published: March 2005

Objectives: To estimate the association between sensory impairment and cognitive decline in older Mexican Americans.Design: A prospective cohort study.Setting: The Hispanic Established Populations for Epidemiologic Studies of the Elderly from five southwestern states.Participants: The sample consisted of 2,140 noninstitutionalized Mexican Americans aged 65 and older followed from 1993/1994 until 2000/2001.Measurements: The outcome, cognitive function decline, was assessed using the Mini‐Mental State Examination blind version (MMSE‐blind) at baseline and at 2, 5, and 7 years of follow‐up. Other variables were near vision, distance vision, hearing, demographics (age, sex, marital status, living arrangements, and education), depressive symptoms, hypertension, diabetes mellitus, stroke, heart attack, and functional status. A general linear mixed model was used to estimate cognitive decline at follow‐up.Results: In a fully adjusted model, MMSE‐blind scores of subjects with near vision impairment decreased 0.62 points (standard error (SE)=0.29, P=.03) over 2 years and decreased (slope of decline) 0.13 points (SE=0.07, P=.045) more per year than scores of subjects with adequate near vision. Other independent predictors of cognitive decline were baseline MMSE‐blind score, age, education, marital status, depressive symptoms, and number of activity of daily living limitations.Conclusion: Near vision impairment, but not distance vision or hearing impairments, was associated with cognitive decline in older Mexican Americans.
Identifying the Activities Affected by Chronic Nonmalignant Pain in Older Veterans Receiving Primary Care
Authors: Duong Bao D. , Kerns Robert D. , Towle Virginia , Reid M. Carrington 
Published: March 2005

Objectives: To identify the specific types of activities affected by chronic pain in older persons and the extent to which older individuals modify, perform less frequently, or terminate activities because of pain.Design: Cross‐sectional survey.Setting: Primary care practice at a Veterans Affairs Medical Center in New England.Participants: Two hundred forty‐four patients (aged 65–90) with chronic nonmalignant pain.Measurements: Open‐ended questions were used to identify the activities affected by pain; participants' responses were subsequently organized into distinct categories (e.g., climbing stairs under higher‐order physical activities and going out to dinner under social/recreational activities). Participants were also asked to indicate whether they had modified, performed less frequently, or terminated these activities because of pain.Results: Participants had a mean age±standard deviation of 75.4±5.2, were mostly male (84%), and had an average pain intensity score of 6.2±1.9 on a 0‐ to 10‐scale. Two hundred three participants (83%) reported that pain affected one or more higher‐order physical activities, and the corresponding percentages for the categories of social/recreational activities, instrumental activities of daily living, and basic activities of daily living were 74%, 57%, and 3%, respectively. The proportions of participants who modified, performed less frequently, or terminated one or more activities because of pain were 71%, 69%, and 22%, respectively.Conclusion: Assessing the effects of chronic pain across multiple functional domains is indicated in older primary care patients, particularly higher‐order physical and social/recreational activities. Inquiring about whether the activities are modified, reduced, or terminated may also help to expand understanding of pain‐related disability in older persons.
The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment
Authors: Nasreddine Ziad S. , Phillips Natalie A. , Bédirian Valérie , Charbonneau Simon , Whitehead Victor , Collin Isabelle , Cummings Jeffrey L. , Chertkow Howard 
Published: March 2005

Objectives: To develop a 10‐minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first‐line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia.Design: Validation study.Setting: A community clinic and an academic center.Participants: Ninety‐four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini‐Mental State Examination (MMSE) score≥17), and 90 healthy elderly controls (NC).Measurements: The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD.Results: Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively).Conclusion: MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.