bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Age and Daytime Activities Are Related to Insomnia in the General Population: Consequences for Older People
Authors: Ohayon Maurice M. , Zulley Jurgen , Guilleminault Christian , Smirne Salvatore , Priest Robert G. 
Published: March 2003

OBJECTIVES: To determine the role of activity status and social life satisfaction on the report of insomnia symptoms and sleeping habits.DESIGN: Cross‐sectional telephone survey using the Sleep‐EVAL knowledge base system.SETTING: Representative samples of three general populations (United Kingdom, Germany, and Italy).PARTICIPANTS: 13,057 subjects age 15 and older: 4,972 in the United Kingdom, 4,115 in Germany, and 3,970 in Italy. These subjects were representative of 160 million inhabitants.MEASUREMENTS: Clinical questionnaire on insomnia and investigation of associated pathologies (psychiatric and neurological disorders).RESULTS: Insomnia symptoms were reported by more than one‐third of the population age 65 and older. Multivariate models showed that age was not a predictive factor of insomnia symptoms when controlling for activity status and social life satisfaction. The level of activity and social interactions had no influence on napping, but age was found to have a significant positive effect on napping.CONCLUSIONS: These results indicate that the aging process per se is not responsible for the increase of insomnia often reported in older people. Instead, inactivity, dissatisfaction with social life, and the presence of organic diseases and mental disorders were the best predictors of insomnia, age being insignificant. Healthy older people (i.e., without organic or mental pathologies) have a prevalence of insomnia symptoms similar to that observed in younger people. Moreover, being active and satisfied with social life are protective factors against insomnia at any age.
Visual Risk Factors for Falls in Older People
Authors: Lord Stephen R. , Dayhew Julia 
Published: March 2003

OBJECTIVES: To determine the tests most predictive of falls in community‐dwelling older people from a range of visual screening tests (high and low contrast visual acuity, edge contrast sensitivity, depth perception, and visual field size). To determine whether one or more of these visual measures, in association with measures of sensation, strength, reaction time, and balance, can accurately predict falls in this group.DESIGN: Prospective cohort study of 12 months duration.SETTING: Falls and Balance Laboratory, Prince of Wales Medical Research Institute.PARTICIPANTS: 156 community‐dwelling men and women age 63 to 90 (mean age 76.5, standard deviation = 5.1).MEASUREMENTS: Screening tests of vision, sensation, strength, reaction time and balance, falls.RESULTS: Of the 148 subjects available at follow‐up, 64 (43.2%) reported falling, with 32 (21.7%) reporting multiple falls. Multiple fallers had decreased vision, as indicated by all visual tests, with impaired depth perception, contrast sensitivity, and low‐contrast visual acuity being the strongest risk factors. Subjects with good vision in both eyes had the lowest rate of falls, whereas those with good vision in one eye and only moderate or poor vision in the other eye had elevated falling rates—equivalent to those with moderate or poor vision in both eyes. Discriminant analysis revealed that impaired depth perception, slow reaction time, and increased body sway on a compliant surface were significantly and independently associated with falls. These variables correctly classified 76% of the cases, with similar sensitivity and specificity.CONCLUSION: The study findings indicate that impaired vision is an important and independent risk factor for falls. Adequate depth perception and distant‐edge‐contrast sensitivity, in particular, appear to be important for maintaining balance and detecting and avoiding hazards in the environment.
Genetic and Environmental Influences on Self‐Reported Reduced Hearing in the Old and Oldest Old
Authors: Christensen Kaare , Frederiksen Henrik , Hoffman Howard J. 
Published: March 2003

OBJECTIVES: The aim of the present twin study was to estimate the relative importance of genetic and environmental factors in variation in self‐reported reduced hearing among the old and the oldest old.DESIGN: Self‐reported hearing abilities of older twins assessed at intake interview in a population‐based longitudinal survey.SETTING: Denmark.PARTICIPANTS: Twins age 75 and older identified in the population‐based Danish Twin Registry in 1995. An interview was conducted with 77% of 3,099 individuals in the study population. In 1997 and 1999, a follow‐up contact to the survivors was made and an additional 2,778 twins, age 70–76, were included in the study.MEASUREMENTS: Reduced hearing was assessed by the same question in all interview waves. Heritability (proportion of the population variance attributable to genetic variation) was estimated using structural‐equation analyses.RESULTS: The prevalence of self‐reported reduced hearing corresponded to previous studies and showed the expected age and sex dependence. Concordance rates, odds ratios, and correlations were consistently higher for monozygotic twin pairs than for dizygotic twin pairs in all age and sex categories, indicating heritable effects. Structural‐equation analyses revealed a substantial heritability for self‐reported reduced hearing of 40% (95% CI = 19–53%). The remaining variation could be attributed to individuals' nonfamilial environments.CONCLUSION: We found that genetic factors play an important role in self‐reported reduced hearing in both men and women age 70 and older. Because self‐reports of reduced hearing involve misclassification, this estimate of the genetic influence on hearing disabilities is probably conservative. Hence, genetic and environmental factors play a substantial role in reduced hearing among the old and oldest old. This suggests that clinical epidemiological studies of age‐related hearing loss should include not only information on environmental exposures but also on family history of hearing loss and, if possible, biological samples for future studies of candidate genes for hearing loss.
Problem Behavior in the Last Year of Life: Prevalence, Risks, and Care Receipt in Older Americans
Authors: Bedford Susan , Melzer David , Guralnik Jack 
Published: March 2003

OBJECTIVES: To estimate the prevalence of problem behavior in the last year of life in older people and to explore risk factors and assess the effect of behaviors on access to care.DESIGN: Retrospective analysis of data from the 1993 National Mortality Followback Survey, conducted by the National Center for Health Statistics (NCHS).SETTING: Persons who resided and died in the United States (except South Dakota) in 1993.PARTICIPANTS: Seven thousand six hundred and eighty‐four deaths in people age 65 and older were included, from which full informant interview data were available for 6,748 decedents (88%).MEASUREMENTS: Informant data were collected on frequency of complaints about behavior from family members, complaints from others in the community, bizarre behavior, destroying property, violent threats or attempts, and temper tantrums.RESULTS: Overall, 20% of decedents were reported as having any of the problem behaviors sometimes or often in the last year of life. Rates differed little by age at death or gender. Risks of having problem behaviors were higher for those with clinically diagnosed dementia, mental illness, alcohol abuse, and bronchitis or emphysema. A diagnosis of dementia had been made in 27% of those with behavior problems. Nursing homes or healthcare facilities were the usual residence of 32% of people with any behavior problems sometimes or often during their last year of life. Informants for decedents who had destroyed property or made violent threats were 2.3 times (95% confidence interval (CI) = 1.2–4.4) more likely to report that the subject had not received the care they had needed during the last year of life.CONCLUSION: Problem behavior is relatively common in older people in the last year of life and is not confined to nursing home residents or people suffering from dementia.
Secular Trends in Self‐Reported Functioning, Need for Assistance and Attitudes Towards Life: 10‐Year Differences of Three Older Cohorts
Authors: Pitkala K. H. , Valvanne J. , Kulp S. , Strandberg T. E. , Tilvis R. S. 
Published: March 2003

OBJECTIVES: To compare the self‐reported functional status of cohorts, born 10 years apart, when they were at equivalent ages: 75, 80, or 85.DESIGN: Cross‐sectional mailed survey of three birth cohorts in 1989 and 1999.PARTICIPANTS: Random samples of older home‐dwelling residents from birth cohorts 1904, 1909, and 1914 in 1989 (N = 685) and the birth cohorts 1914, 1919, and 1924 in 1999 (N = 2,047) were asked the same questions.MEASUREMENTS: Self‐reported physical functioning, need for assistance in daily living, and attitudes toward life.RESULTS: Among 85‐year‐olds born in 1914 there was a significantly larger proportion able to go outdoors compared with 85‐year‐olds born in 1904 (72.9% vs 60.6% in women (P < .01) and 84.6% vs 63.6 % in men (P < .01), respectively). Similar trends were observed between the oldest cohorts concerning the need for assistance. The amount of publicly funded domestic help had reduced in the two oldest cohorts in 1999 compared with 1989 (20.3% vs 29.8% in 85‐year‐old women born in 1914 vs 1904 (P < .05); and 10.2 % vs 25.0% in 85‐year‐old men born 1914 vs 1904 (P < .05), but at the same time 75‐year‐old women born in 1924 had increased the use of private domestic help compared with 75‐year‐old women born in 1914. Significantly larger proportions of both men and women had plans for the future in all the cohorts in 1999 than in 1989.CONCLUSIONS: Consistent yet small differences between the corresponding cohorts suggest that physical functioning and more‐optimistic attitude toward life have increased and need for assistance has decreased over 10 years in the older population up to the age of 85.
Does Behavioral Improvement with Haloperidol or Trazodone Treatment Depend on Psychosis or Mood Symptoms in Patients with Dementia?
Authors: Sultzer David L. , Gray Kevin F. , Gunay Ibrahim , Wheatley Muriel V. , Mahler Michael E. 
Published: March 2003

OBJECTIVES:Several previous studies have examined the effects of pharmacological interventions for agitated behavior in patients with dementia. However, the choice of medication in clinical practice continues to be directed largely by local pharmacotherapy culture rather than empirical treatment guidelines. We examined the relationship between behavioral improvement and co‐occurring delusions and mood symptoms in patients with dementia who were treated with haloperidol, an antipsychotic medication, or trazodone, a serotonergic antidepressant.DESIGN:Randomized, double‐blind, parallel‐group, 9‐week treatment trial.SETTING:Inpatient geropsychiatry unit.PARTICIPANTS:Twenty‐eight patients with dementia and agitated or aggressive behaviors.INTERVENTION:Haloperidol 1 to 5 mg/day or trazodone 50 to 250 mg/day.MEASUREMENTS:Cohen‐Mansfield Agitation Inventory (CMAI), Hamilton Depression Rating Scale (Ham‐D), and delusional thoughts subscale and hallucinations subscale of the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE‐AD).RESULTS:CMAI scores improved in each treatment group over the 9 weeks of treatment (P < .001 in each group). Within the haloperidol treatment group, CMAI improvement was not associated with baseline delusional thoughts score or with change in delusional thoughts score over the course of treatment. Within the trazodone treatment group, CMAI improvement was associated with baseline score on total Ham‐D (r = −0.60, P = .02), Ham‐D items measuring subjective mood symptoms (r = −0.50, P = .07), and Ham‐D items measuring neurovegetative signs (r = −0.49, P = .08). CMAI improvement was also associated with improvement in Ham‐D total score over the course of treatment (r = 0.62, P = .02).CONCLUSIONS:Mild depressive symptoms in patients with dementia and agitated behavior are associated with greater behavioral improvement by trazodone‐treated patients. In contrast, the presence of delusions in concert with behavioral disturbance does not necessarily predict greater behavioral improvement with haloperidol treatment than in subjects without signs of psychosis. J Am Geriatr Soc 49:1294–1300, 2001.
Racial and State Differences in the Designation of Advance Directives in Nursing Home Residents
Authors: Kiely Dan K. , Mitchell Susan L. , Marlow Aimee , Murphy Katharine M. , Morris John N. 
Published: March 2003

OBJECTIVES:To examine racial and state differences in the use of advance directives and surrogate decision‐making in a nursing home population.DESIGN:A retrospective cohort study.SETTING:Nursing homes in the states of California (CA), Massachusetts (MA), New York (NY), and Ohio (OH).PARTICIPANTS:Nursing home residents: 130,308 in CA, 59,691 in MA, 112,080 in NY, and 98,954 in OH.MEASUREMENTS:Minimum Data Set information concerning resident race and whether or not residents have a living will (LW), a do not resuscitate (DNR) order, or a surrogate decision‐maker (SDM).RESULTS:The proportion of LWs, DNR orders, and SDMs varied significantly (P < .0001) by racial categories in each state. In general, whites were distinctly different from other racial categories. Whites were significantly more likely to have a LW (odds ratio (OR) = 1.9 (CA), OR = 2.2 (NY), OR = 4.9 (OH)), a DNR order (OR = 2.4 (CA), OR = 2.4 (MA), OR = 3.3 (NY), OR = 3.2 (OH)), and a SDM (OR = 1.1 (CA), OR = 1.2 (NY), OR = 1.6 (OH)) than were nonwhites, after adjusting for potentially confounding factors. Significant state differences (P < .0001) were observed in LWs, DNR orders, and SDMs and were most pronounced in residents of Ohio, who were significantly more likely to have a LW than were residents in other states (OR = 9.3).CONCLUSIONS:Various resident characteristics explain some of the racial differences, although whites are still more likely to have a LW, a DNR order, or an SDM independent of various resident characteristics included in the adjusted analyses. This pattern is observed in all states, although the ORs varied by state. Some of these differences may be due to distinct cultural approaches to end‐of‐life care and lack of knowledge and understanding of advance directives. The distinctly higher rates of LWs among all racial groups in Ohio than in other states suggest that states can potentially increase the use of advance directives through intervention. J Am Geriatr Soc 49:1346–1352, 2001.
Impact of Geographic Barriers on the Utilization of Mammograms by Older Rural Women
Authors: Engelman Kimberly K. , Hawley Daniel B. , Gazaway Rona , Mosier Michael C. , Ahluwalia Jasjit S. , Ellerbeck Edward F. 
Published: March 2003

OBJECTIVES: To examine whether geographic proximity to mammography facilities influences mammogram utilization.DESIGN: Retrospective cohort analysis.SETTING: Rural state.PARTICIPANTS: Female Kansas Medicare beneficiaries aged 65 to 79 (N = 117,901).MEASUREMENTS: Using Medicare claims data, we measured county‐level mammography rates for beneficiaries in Kansas. We calculated mammography rate differences for beneficiaries according to age, race, distance from permanent and mobile mammography sites, and county characteristics including county mammography service availability.RESULTS: Of 105 counties, 37% had only permanent mammography facilities, 22% had both permanent and mobile sites, 29% had only mobile facilities, and 11% had neither, representing 44%, 44%, 9%, and 3% of the 117,901 beneficiaries, respectively. Of the beneficiaries, 91% lived less than 20 miles from a permanent facility; of the remaining 9%, 67% lived less than 20 miles from a mobile site. In 30 counties with only mobile sites, 90% of the 10,439 beneficiaries residing in the counties had access to the sites fewer than 2 days per month. County‐level mammography rates ranged from 37% to 72%. Mammography utilization was 57% in counties with permanent facilities only, 55% in counties with both permanent and mobile sites, 53% in counties with only mobile sites, and 53% in counties with neither (P = 0.12). After adjusting for age, race, and county education level, the odds of receiving a mammogram was slightly lower for persons residing longer distances from a permanent facility (odds ratio = 0.97 for each 5‐mile increase in distance, 95% confidence interval = 0.95–0.99).CONCLUSION: The majority of Kansans live near a mammography facility. Although there is a large variation in county‐level mammography rates across Kansas, this disparity is not well explained by proximity to mammography facilities.
Distal Radius Fractures in Older Women: A 10‐Year Follow‐Up Study of Descriptive Characteristics and Risk Factors. The Study of Osteoporotic Fractures
Authors: Vogt Molly T. , Cauley Jane A. , Tomaino Matthew M. , Stone Katie , Williams James R. , Herndon James H. 
Published: March 2003

OBJECTIVES: To determine the incidence of distal radius fractures and the characteristics of those fractures and to identify the key risk factors.DESIGN: Prospective cohort study, mean follow‐up of 9.8 years.SETTING: Four clinical centers, one each in Baltimore, Maryland; Minneapolis, Minnesota; Pittsburgh, Pennsylvania; and Portland, Oregon.PARTICIPANTS: Nine thousand seven hundred four white women aged 65 and older, enrolled in the multicenter Study of Osteoporotic Fractures.METHODS: Five hundred twenty‐seven distal radius fractures were confirmed by physician review of radiology reports; characteristics of the fractures were noted. Information was also collected on lifestyle, demographics, bone mineral density (BMD), and clinical and performance measures.RESULTS: The overall incidence of fracture was 7.3/1,000 person‐years. Twenty‐seven percent of the fractures were intra‐articular; 73% were extra‐articular. The independent predictors of fracture were decreased BMD (per 0.1 g/cm2) at the distal radius (

relative risk (

RR) = 1.8, 95%confidence interval (

CI) = 1.6–2.1), a history of recurrent falls (

RR = 1.6, 95%CI = 1.2–2.0), and having had a previous fracture since age 50 (

RR = 1.3, 95%CI = 1.1–1.6). Current use of oral estrogen was protective (

RR = 0.6, 95%CI = 0.4–0.8). For women aged 75 and older, poor cognitive status was also a predictor of wrist fracture. Intra‐articular fractures occurred more than twice as frequently in women with diabetes mellitus.CONCLUSIONS: This is the first large long‐term comprehensive study of distal radius fractures in older people. The results indicate that factors predictive of distal radius fractures can easily be assessed in routine clinical practice and can identify women at high risk for fracture. Selected preventive strategies could be designed to reduce the incidence of these fractures.
Reduced Mortality in Treating Acutely Sick, Frail Older Patients in a Geriatric Evaluation and Management Unit. A Prospective Randomized Trial
Authors: Saltvedt Ingvild , Mo Ellen‐Sofie Opdahl , Fayers Peter , Kaasa Stein , Sletvold Olav 
Published: March 2003

OBJECTIVES: Documentation of treatment effects in acutely sick frail older patients in geriatric evaluation and management units (GEMUs) is scarce. The present study evaluated whether treatment in a GEMU would reduce mortality as compared to traditional treatment delivered in the Department of Internal Medicine.DESIGN: Prospective randomized trial.SETTING: GEMU or general medical wardPARTICIPANTS: Acutely sick frail patients aged 75 and older who had been admitted to the Department of Internal Medicine were randomly assigned to treatment in the GEMU (n = 127) or to the general medical wards (n = 127). The following inclusion criteria were used to target frail patients: chronic disability, acute impairment of single activity of daily living, mild/moderate dementia, confusion, depression, imbalance/dizziness, falls, impaired mobility, urinary incontinence, malnutrition, polypharmacy, vision or hearing impairment, social problems, or prolonged bedrest.INTERVENTION: In the GEMU, the treatment strategy emphasized interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilization/rehabilitation, and comprehensive discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow‐up.MEASUREMENTS: Mortality and causes of death.RESULTS: Mortality in the intervention and control groups, respectively, was 12% and 27% at 3 months (P = .004), 16% and 29% (P = .02) at 6 months, and 28% and 34% (P = .06) at 12 months. The hazard ratio was 0.39 (95% confidence interval = 0.21–0.72) at 3 months. The main cause of death was cardiovascular disease.CONCLUSION: Treatment of acutely sick, frail, older patients in a GEMU substantially reduced mortality.
Tai Chi Chuan Training is Associated with Enhanced Endothelium‐Dependent Dilation in Skin Vasculature of Healthy Older Men
Authors: Wang Jong‐Shyan , Lan Ching , Chen Ssu‐Yuan , Wong May‐Kuen 
Published: March 2003

OBJECTIVES: The vascular endothelium modulates vascular tone by synthesizing and metabolizing vasoactive substances. Endothelium‐dependent vasodilation declines with age. This study investigated whether Tai Chi Chuan (TCC) training could enhance endothelial function in the skin vasculature of older men.SETTING: Community setting.DESIGN: Basic hemodynamic characteristics and skin vascular response to endothelium‐dependent and ‐independent vasodilators were studied.PARTICIPANTS: Ten older men who practiced TCC, 10 older healthy sedentary men, and 12 younger healthy sedentary men. The older TCC subjects had practiced classical Yang TCC for a mean ± standard deviation of 11.2 ± 3.4 years; mean attendance was 5.1 ± 1.8 times weekly. Sedentary subjects had not participated in any regular exercise training for at least 5 years.MEASUREMENTS: Different doses of 1% acetylcholine (ACh) and 1% sodium nitroprusside (SNP) were iontophoretically applied to the skin of subjects' lower legs, and cutaneous microvascular perfusion responses were determined by laser doppler measurements. Additionally, arterial and venous hemodynamic variables were measured by impedance plethysmograph.RESULTS: The older TCC group had higher lower leg arterial blood flow (LABF); LABF in response to reactive hyperemia; and lower leg venous capacity, tone and blood flow than their sedentary counterparts, but the older TCC group displayed similar arterial and venous hemodynamic variables to the younger sedentary group. The younger sedentary group had a higher ACh‐induced cutaneous perfusion and a higher ratio of ACh‐ to SNP‐induced cutaneous perfusion than the two older groups. The older TCC group showed a higher ACh‐induced cutaneous perfusion and a higher ratio of ACh‐ to SNP‐induced cutaneous perfusion than the older sedentary group. Skin vascular responses to SNP did not differ significantly between the three groups.CONCLUSIONS: Regular practice of TCC is associated with enhanced endothelium‐dependent dilation in skin vasculature of older individuals. Moreover, TCC training may delay the age‐related decline of venous compliance and hyperemic arterial response.