bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cognitive Deficits and the Course of Major Depression in a Cohort of Middle‐Aged and Older Community‐Dwelling Adults
Authors: Mojtabai Ramin , Olfson Mark 
Published: June 2004

Objectives:To examine associations between cognitive deficits and persistent significant depressive symptoms at baseline and 2‐ and 4‐year follow‐ups in a sample of community‐dwelling middle‐aged and older adults.Design:Prospective cohort study.Setting:A U.S. national prospective cohort study of middle‐aged and older adults, the Health and Retirement Study.Participants:A sample of 661 participants of the 1996 wave of the Health and Retirement Study who met criteria for 12‐monthDiagnostic and Statistical Manual of Mental Disorders, Third Edition, Revisedmajor depression (MD).Measurements:MD was assessed using the World Health Organization Composite International Diagnostic Interview—Short Form. Persistent significant depressive symptoms were assessed using an eight‐item version of the Center for Epidemiological Studies Depression scale.Results:Cognitive deficits were associated with persistent significant depressive symptoms at follow‐up. In a latent state‐trait analysis, two stable and strongly correlated traits best explained variations in cognitive functioning and depressive symptoms across assessment points.Conclusion:Trait‐like cognitive deficits commonly complicate the course of MD in community‐dwelling middle‐aged and older adults and may help to explain the persistent course of depressive symptoms in a large subgroup of adults with MD in this age range.
Galantamine Maintains Ability to Perform Activities of Daily Living in Patients with Alzheimer's Disease
Authors: Galasko Douglas , Kershaw Paul R. , Schneider Lon , Zhu Young , Tariot Pierre N. 
Published: June 2004

Objectives: To examine the effect of galantamine on activities of daily living (ADLs) with respect to baseline dementia severity, correlation with cognitive and global function, specific ADLs affected, and maintenance of ADL independence.Design: Secondary analysis of a 5‐month randomized, placebo‐controlled trial.Setting: Multiple U.S. clinical centers.Participants: Six hundred fifty‐nine patients with mild to moderate Alzheimer's disease (AD) who completed 5 months of treatment.Intervention: Galantamine at a maintenance dose of 16 or 24 mg/d.Measurements: The AD Cooperative Study ADL Inventory (ADCS/ADL).Results: Galantamine resulted in more improvement in ADCS/ADL scores than placebo regardless of baseline dementia severity, with the greatest differences occurring in patients with more severe disease. Changes in ADCS/ADL scores correlated significantly with change scores on the cognitive subscale of the AD Assessment Scale (r=−0.24). Galantamine treatment resulted in maintenance or improvement of basic and instrumental ADLs, and change from baseline to Month 5 in scores for each individual ADL item favored galantamine over placebo in three of six basic ADLs and six of 17 instrumental ADLs.Conclusion: Galantamine has a favorable effect on ADL performance in patients with AD, detectable after 5 months of treatment, regardless of dementia severity. The ADCS/ADL appears to better measure distinct abilities that may be relevant not only in clinical trials but also in individual patients than do cognitive assessments. J Am Geriatr Soc 52:000–000, 2004.
A Clinical Trial of the Effectiveness of Regularly Scheduled Versus As‐Needed Administration of Acetaminophen in the Management of Discomfort in Older Adults with Dementia
Authors: Buffum Martha D. , Sands Laura , Miaskowski Christine , Brod Meryl , Washburn Allyson 
Published: June 2004

Objectives: To determine in a sample of nursing home patients with dementia and a painful condition whether the regularly scheduled administration of acetaminophen (650 mg four times a day (qid)) was more or less effective than as‐needed (prn) administration of acetaminophen in reducing discomfort.Design: Double‐blind, double‐dummy, placebo‐controlled, crossover study. One arm consisted of 650 mg of acetaminophen administered qid with placebo prn; the other arm consisted of placebo administered qid with acetaminophen prn.Setting: Two community and one Veterans Affairs nursing homes in the San Francisco Bay area.Participants: Thirty‐nine nursing home patients with a mean±standard deviation Mini‐Mental State Examination score of 4.3±5, a mean Global Deterioration Scale score of 5.7±0.4, and a mean Discomfort Scale score of 10.7±6.8. Approximately 84% had degenerative joint disease.Results: Mean Discomfort Scale scores of 7.4±3.7 during the prn arm and 7.2±2.1 during the qid arm (t=0.249, nonsignificant) were within the range previously shown to indicate substantial discomfort. No significant differences in discomfort scores were found between the trial arms after controlling for baseline discomfort and prn use of acetaminophen.Conclusion: Although this trial was negative in terms of the analgesic effects of acetaminophen, the findings have important implications for clinical practice. Prn administration of acetaminophen is sometimes the standard of care for pain management in nursing homes or is offered as an intervention to assess effectiveness. Findings from this study suggest that a 2,600‐mg/d dose of acetaminophen is inadequate for elderly nursing home patients with degenerative joint disease, fractures, or back pain who have significant discomfort.
Physical Activity, Exercise, and Inflammatory Markers in Older Adults: Findings from The Health, Aging and Body Composition Study
Authors: Colbert Lisa H. , Visser Marjolein , Simonsick Eleanor M. , Tracy Russell P. , Newman Anne B. , Kritchevsky Stephen B. , Pahor Marco , Taaffe Dennis R. , Brach Jennifer , Rubin Susan , Harris Tamara B. 
Published: June 2004

Objectives: To examine the association between physical activity and inflammatory markers, with consideration for body fatness and antioxidant use.Design: Cross‐sectional study, using baseline data from the Health, Aging and Body Composition Study.Setting: Metropolitan areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee.Participants: Black and white, well‐functioning men and women (N=3,075), aged 70 to 79.Measurements: Interviewer‐administered questionnaires of previous‐week household, walking, exercise, and occupational/volunteer physical activities. Analysis of covariance was used to examine the association between activity level and serum C‐reactive protein (CRP), interleukin‐6 (IL‐6), and plasma tumor necrosis factor alpha (TNFα) with covariate adjustment. Antioxidant supplement use (multivitamin, vitamins E or C, beta carotene) was evaluated as an effect modifier of the association.Results: Higher levels of exercise were associated with lower levels of CRP (P<.01), IL‐6 (P<.001), and TNFα (P=.02) (e.g., CRP=1.95 mg/L for no exercise and 1.72 for >180 min/wk). Adjustment for body fatness attenuated the associations somewhat. Use of antioxidant supplements modified the CRP (Pinteraction=.01) and IL‐6 (Pinteraction=.08) associations such that concentrations were low in those taking supplements (e.g., CRP=1.79–1.84 across exercise levels) and higher in nonsupplement users who did no exercise (2.03) than in those who did the most (1.72). Among nonexercisers, higher levels of other physical activity were related to lower levels of CRP (P<.01) and IL‐6 (P=.02) but not TNFα (P=.36), even after accounting for body fat.Conclusion: Inflammatory markers are lower in older adults with higher levels of exercise and nonexercise activity and in antioxidant supplement users regardless of exercise level.
Inflammatory Markers and Incident Mobility Limitation in the Elderly
Authors: Penninx Brenda W. J. H. , Kritchevsky Stephen B. , Newman Anne B. , Nicklas Barbara J. , Simonsick Eleanor M. , Rubin Susan , Nevitt Michael , Visser Marjolein , Harris Tamara , Pahor Marco 
Published: June 2004

Objectives: To examine the relationship between indicators of inflammation and the incidence of mobility limitation in older persons.Design: Prospective cohort study: the Health, Aging and Body Composition Study.Setting: Pittsburgh, Pennsylvania, and Memphis, Tennessee.Participants: A total of 2,979 men and women, aged 70 to 79, without mobility limitation at baseline.Measurements: Serum levels of interleukin (IL)‐6, tumor necrosis factor alpha (TNFα), and C‐reactive protein (CRP) and soluble cytokine receptors (IL‐2sR, IL‐6sR, TNFsR1, TNFsR2) were measured. Mobility limitation was assessed and defined as reporting difficulty or inability to walk one‐quarter of a mile or to climb 10 steps during two consecutive semiannual assessments over 30 months.Results: Of the 2,979 participants, 30.1% developed incident mobility limitation. After adjustment for confounders (demographics, prevalent conditions at baseline, body composition), the relative risk (RR) of incident mobility limitation per standard deviation (SD) increase was 1.19 (95% confidence interval (CI)=1.10–1.28) for IL‐6, 1.20 (95% CI=1.12–1.29) for TNFα, and 1.40 (95% CI=1.18–1.68) for CRP. The association between inflammation and incident mobility limitation was especially strong for the onset of more severe mobility limitation and when the levels of multiple inflammatory markers were high. When persons with baseline or incident cardiovascular disease events or persons who were hospitalized during study follow‐up were excluded, findings remained similar. In a subset (n=499), high levels of the soluble receptors IL2sR and TNFsR1 (per SD increase: RR=1.23 (95% CI=1.04–1.46) and RR=1.28 (95% CI=1.04–1.57), respectively) were also associated with incident mobility limitation.Conclusion: Findings suggest that inflammation is prognostic for incident mobility limitation over 30 months, independent of cardiovascular disease events and incident severe illness.
Physical Therapy and Mobility 2 and 6 Months After Hip Fracture
Authors: Penrod Joan D. , Boockvar Kenneth S. , Litke Ann , Magaziner Jay , Hannan Edward L. , Halm Ethan A. , Silberzweig Stacey B. , Sean Morrison R. , Orosz Gretchen M. , Koval Kenneth J. , Siu Albert L. 
Published: June 2004

Objectives: To examine the relationship between early physical therapy (PT), later therapy, and mobility 2 and 6 months after hip fracture.Design: Prospective, multisite observational study.Setting: Four hospitals in the New York City area.Participants: Four hundred forty‐three hospitalized older patients discharged after surgery for hip fracture in 1997–98.Measurements: Patient demographics, fracture type, comorbidities, dementia, number of new impairments at discharge, amount of PT between day of surgery and postoperative day (POD) 3, amount of therapy between POD4 and 8 weeks later, and prefracture, 2‐, and 6‐month mobility measured using the Functional Independence Measure.Results: More PT immediately after hip fracture surgery was associated with significantly better locomotion 2 months later. Each additional session from the day of surgery through POD3 was associated with an increase of 0.4 points (P=.032) on the 14‐point locomotion scale, but the positive relationship between early PT and mobility was attenuated by 6 months postfracture. There was no association between later therapy and 2‐ or 6‐month mobility.Conclusion: PT immediately after hip fracture surgery is beneficial. The effects of later therapy on mobility were difficult to assess because of limitations of the data. Well‐designed randomized, controlled trials of the effect of varying schedules and amounts of therapy on functional status after hip fracture would be informative.
Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta‐Analysis
Authors: Moreland Julie D. , Richardson Julie A. , Goldsmith Charlie H. , Clase Catherine M. 
Published: June 2004

Objectives: To evaluate and summarize the evidence of muscle weakness as a risk factor for falls in older adults.Design: Random‐effects meta‐analysis.Setting: English‐language studies indexed in MEDLINE and CINAHL (1985–2002) under the key words aged and accidental falls and risk factors; bibliographies of retrieved papers.Participants: Fifty percent or more subjects in a study were aged 65 and older. Studies of institutionalized and community‐dwelling subjects were included.Measurements: Prospective cohort studies that included measurement of muscle strength at inception (in isolation or with other factors) with follow‐up for occurrence of falls.Methods: Sample size, population, setting, measure of muscle strength, and length of follow‐up, raw data if no risk estimate, odds ratios (ORs), rate ratios, or incidence density ratios. Each study was assessed using the validity criteria: adjustment for confounders, objective definition of fall outcome, reliable method of measuring muscle strength, and blinded outcome measurement.Results: Thirty studies met the selection criteria; data were available from 13. For lower extremity weakness, the combined OR was 1.76 (95% confidence interval (CI)=1.31–2.37) for any fall and 3.06 (95% CI=1.86–5.04) for recurrent falls. For upper extremity weakness the combined OR was 1.53 (95% CI=1.01–2.32) for any fall and 1.41 (95% CI=1.25–1.59) for recurrent falls.Conclusion: Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle‐strengthening exercises are effective in preventing falls.
A Population‐Based Osteoporosis Screening Program: Who Does Not Participate, and What Are the Consequences?
Authors: Buist Diana S. M. , LaCroix Andrea Z. , Brenneman Susan K. , Abbott Thomas 
Published: June 2004

Objectives: To describe differences in osteoporosis risk factors and rates of fracture and antiresorptive therapy use in women who did and did not participate in an osteoporosis screening program.Setting: Group Health Cooperative, a health maintenance organization in western Washington state.Participants: A total of 9,268 women (aged 60–80) who were not using any antiresorptive therapy were invited to participate in an osteoporosis screening program. This study compares the 35% who participated with the 65% who did not.Design: This observational cohort study of women invited to participate in a randomized, controlled trial of an osteoporosis screening program provided all participants with personalized feedback on their risk of osteoporosis. Some participants also received bone density testing. Automated administrative data were used to examine differences between participants and nonparticipants in fracture outcomes and medication initiation before and after invitation.Results: Baseline fracture rates did not differ between participants and nonparticipants. After age adjustment, nonparticipants had a higher hip fracture rate (14.1 vs 8.3 per 1,000) and a lower rate of initiating any antiresorptive therapy (10.3 vs 17.9 per 100) than participants after an average of 28 to 29 months of follow‐up.Conclusion: Participants had reduced hip fracture rates and increased initiation of antiresorptive therapy compared with nonparticipants. It was not possible to determine whether participating in the screening program, unmeasured confounding, or selection bias accounted for differences in hip fracture or therapy initiation rates. These results suggest that women who do not participate in osteoporosis screening should be pursued to idenepsy individuals who could benefit from primary and secondary osteoporosis prevention.
Clock Drawing, Clock Reading, Clock Setting, and Judgment of Clock Faces in Elderly People with Dementia and Depression
Authors: Bodner Thomas , Delazer Margarete , Kemmler Georg , Gurka Peter , Marksteiner Josef , Fleischhacker W. Wolfgang 
Published: June 2004

Objectives: To assess patient performance on different clock tasks.Design: Group comparisons.Setting: A hospital‐based memory clinic; inpatient and outpatient memory clinic.Participants: Patients with dementia (n=30), patients with depression (n=30), and healthy controls (n=30).Measurements: General neuropsychological tests, clock drawing tests, and three additional clock tasks: clock reading, clock setting, and judgment of clock faces (each comprising 12 items).Results: Demented patients differed significantly from the control and depression groups on all clock tasks; controls and depressed patients differed only in the clock‐setting task. A comparison between tasks showed that clock setting was the most difficult, which differentiated best between diagnostic groups. Groups differed not only in overall performance scores, but also in error characteristics.Conclusion: Overall, study results indicate that clock setting is a sensitive task that may prove to be a valuable tool when screening for dementia.
Anticoagulant Use for Atrial Fibrillation in the Elderly
Authors: Brophy Mary T. , Snyder Kerri E. , Gaehde Stephan , Ives Charlene , Gagnon David , Fiore Louis D. 
Published: June 2004

Objectives: To determine the influence of advanced age on anticoagulant use in subjects with atrial fibrillation and to explore the extent to which risk factors for stroke and contraindications to anticoagulant therapy predict subsequent use.Design: Retrospective cohort study.Setting: The Veterans Affairs Boston Healthcare System.Participants: A total of 2,217 subjects with nonvalvular atrial fibrillation.Measurements: Administrative databases were use to identify subject's age, anticoagulant use, and the presence of a diagnosis of atrial fibrillation, cerebrovascular accident, hypertension, diabetes mellitus, congestive heart failure, or gastrointestinal or cerebral hemorrhage.Results: Unadjusted analysis showed no difference in warfarin use between those aged 75 and older and younger subjects regardless of the presence (33.9% vs 35.7%, P=.37) or absence (33.4% vs 34.7%, P=.58) of contraindications to anticoagulant therapy. Multivariate modeling demonstrated a 14% reduction (95% confidence interval (CI)=4–22%) in anticoagulant use with each advancing decade of life. Intracranial hemorrhage was a significant deterrent (odds ratio (OR)=0.27 95% CI=0.06–0.85). History of hypertension (OR=2.90, 95% CI=2.15–3.89), congestive heart failure (OR=1.70, 95% CI=1.41–2.04), and cerebrovascular accident (OR=1.54, 95% CI=1.25–1.89) were significant independent predictors for anticoagulant use.Conclusion: Despite consensus guidelines to treat all atrial fibrillation patients aged 75 and older with anticoagulants, advancing age was found to be a deterrent to warfarin use. Better estimates of the risk:benefit ratio for oral anticoagulant therapy in older patients with atrial fibrillation are needed to optimize decision‐making.
Concordance of Proxy‐Perceived Change and Measured Change in Multiple Domains of Function in Older Persons
Authors: Yasuda Nobufumi , Zimmerman Sheryl , Hawkes William G. , Gruber‐Baldini Ann L. , Hebel J. Richard , Magaziner Jay 
Published: June 2004

Objectives: To compare proxy perceptions about change over 6 months in physical, instrumental, affective, and cognitive functioning of older persons with computed change in patient self‐report and performance and patient's own perceptions about change.Design: Prospective study.Setting: Recovery from hip fracture that occurred in community‐dwelling persons in Baltimore, Maryland, in 1990–91. The recovery from the sixth to the 12th month postfracture was observed.Participants: One hundred forty‐one hip fracture patients aged 65 and older and a self‐designated proxy for each.Measurements: For specific tasks of physical and instrumental functioning, proxy perception of change over the previous 6 months asked in the 12th month postfracture was compared with change in criterion measures (subject self‐report and observed performance) from the sixth to the 12th month postfracture. For global change over the previous 6 months in each area of functioning, proxy perception was compared with the subject's own perception in the 12th month postfracture.Results: Agreement between proxy perceptions of change and change in criterion measures was poor. There was a general pattern for proxies to overstate improvement and understate deterioration in comparison with change observed in criterion measures for specific tasks of physical and instrumental functioning. Proxies' global perceptions reported subjects improving less and deteriorating more than patients' own perceptions.Conclusion: Proxy perceptions about task‐specific and global changes in subjects' functional health over a short period of time are systematically different from patient report and observed performance.
The Personal and Social Context of Planning for End‐of‐Life Care
Authors: Kahana Boaz , Dan Amy , Kahana Eva , Kercher Kyle 
Published: June 2004

Objectives: To examine the potential facilitators of or deterrents to end‐of‐life planning for community‐dwelling older adults, including personal (health‐related and sociodemographic) and social (physician and family) influences.Design: In‐person interviews with older adults, telephone interviews with physicians and family members.Setting: Cleveland, Ohio.Participants: Two hundred thirty‐one adults aged 65 to 99 who were aging in place, 99 of their primary care physicians, and 127 of their family members.Measurements: Questions assessing older adults' discussions with others about end‐of‐life plans, implementation of advance directives, and physical (Older American Resources and Services) illness index and mental (Short Portable Mental Status Questionnaire) health status.Results: Just fewer than half of older adults had executed an advance directive and discussed their wishes with others. Only personal characteristics of elderly individuals were related to end‐of‐life plans, with whites, unmarried individuals, and younger adults more likely to have made preparations. Older adults' health status, as evaluated by the patient, physician, and caregiver, did not relate to the tendency to have made advance care plans. Older adults' family members were much more likely to report knowledge of advance care plans than were physicians.Conclusion: These findings suggest that many physicians are not talking with their patients about their end‐of‐life wishes. Furthermore, the propensity to have such discussions may relate more to the personal preferences and level of comfort of patients, physicians, and family members than on the health status of the older adult.