bluuebunny/crossref_metadata_2025_split huggingface dataset:
Just Get Out the Door! Importance of Walking Outside the Home for Maintaining Mobility: Findings from the Women's Health and Aging Study
Authors: Simonsick Eleanor M. , Guralnik Jack M. , Volpato Stefano , Balfour Jennifer , Fried Linda P. 
Published: January 2005

Objectives: To determine the association between volitional walking behavior and change in walking ability and lower extremity function over 1 year in functionally limited older women.Design: Longitudinal cohort study.Setting: Data were collected in participant's homes in Baltimore, Maryland.Participants: One thousand two cognitively intact community‐resident female Medicare beneficiaries aged 65 and older enrolled in the Women's Health and Aging Study.Measurements: Reported walking behavior and change in reported walking difficulty, usual and rapid gait speed, and lower extremity physical performance score over 1 year.Results: Of 800 functionally limited women who could walk unassisted at baseline and were alive and contacted 1 year later, 226 (28%) walked regularly, at least eight blocks per week. These women exhibited better health and functioning than nonwalkers (e.g., lower prevalence of depressive and fatigue symptoms and cardiovascular disease and higher mean ankle‐arm index, forced expiratory volume in the first second, and gait speed). One year later, independent of initial functional status, social‐psychological and behavioral factors, and health conditions, walkers were 1.8 times (95% confidence interval=1.2–2.7; P=.002) more likely to maintain reported walking ability and showed less decline in customary walking speed (0.009 m/s vs −0.070 m/s; P=.001) and functional performance score (−0.17 vs −0.73; P=.01) than women who walked less than eight blocks.Conclusion: The strength, consistency, and specificity of the association between walking behavior and maintenance of mobility provide strong evidence that even a small amount of regular walking can confer short‐term protection from further mobility loss in functionally limited women. The observation that most women capable of walking at least eight blocks per week were not doing so indicates the need to get more women “out the door” and to encourage those who walk a little to walk a little more.
Incidence of Cardiovascular Disease in Older Americans: The Cardiovascular Health Study
Authors: Arnold Alice M. , Psaty Bruce M. , Kuller Lewis H. , Burke Gregory L. , Manolio Teri A. , Fried Linda P. , Robbins John A. , Kronmal Richard A. 
Published: January 2005

Objectives: To estimate incidence rates of major cardiovascular disease (CVD) in older Americans.Design: Longitudinal cohort study using prospectively collected data on cardiovascular events.Setting: Four U.S. communities in the Cardiovascular Health Study (CHS).Participants: Five thousand eight hundred eighty‐eight participants in CHS, aged 65 or older at enrollment, including 3,393 women (581 African American) and 2,495 men (343 African American).Measurements: At semiannual contacts, participants reported any occurrence of clinical CVD. Medical records were obtained and adjudicated to confirm diagnosis of CVD.Results: During 10 years of follow‐up, incidence of coronary heart disease (CHD) per 1,000 person‐years was 39.6 (95% confidence interval (CI)=36.4–43.1) in men and 22.3 (95% CI=20.4–24.2) in women. Cumulative event rates for CHD and myocardial infarction for women aged 75 and older at baseline were similar to those for men aged 65 to 74. The overall incidence of stroke was similar for men and women (14.7 (95% CI=13.0–16.6) and 13.7 (95% CI=12.4–15.1) per 1,000 person‐years, respectively), but the risk of stroke increased with age more rapidly in women, resulting in a greater cumulative event rate for stroke in women than in men aged 75 and older. The incidence of congestive heart failure increased 9% with each year of age over 65 and was greater than 6% per year in Caucasian men and women aged 85 and older at baseline. Rates were similar in African Americans and Caucasians.Conclusion: The occurrence of new CVD in older Americans is high, indicating that preventive efforts need to be maintained into older ages.
Relationship Between Plasma Lipids and All‐Cause Mortality in Nondemented Elderly
Authors: Schupf Nicole , Costa Rosann , Luchsinger Jose , Tang Ming‐Xin , Lee Joseph H. , Mayeux Richard 
Published: January 2005

Objectives: To investigate the relationship between plasma lipids and risk of death from all causes in nondemented elderly.Design: Prospective cohort study.Settin: Community‐based sample of Medicare recipients, aged 65 years and older, residing in northern Manhattan.Participants: Two thousand two hundred seventy‐seven nondemented elderly, aged 65 to 98; 672 (29.5%) white/non‐Hispanic, 699 (30.7%) black/non‐Hispanic, 876 (38.5%) Hispanic, and 30 (1.3%) other.Measurements: Anthropometric measures: fasting plasma total cholesterol, triglyceride, high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol (LDL‐C), and non‐HDL‐C, body mass index, and apolipoprotein E (APOE) genotype. Clinical measures: neuropsychological, neurological, medical, and functional assessments; medical history of diabetes mellitus, heart disease, hypertension, stroke, and treatment with lipid‐lowering drugs. Vital status measure: National Death Index date of death. Survival methods were used to examine the relationship between plasma lipids and subsequent mortality in younger and older nondemented elderly, adjusting for potential confounders.Results: Nondemented elderly with levels of total cholesterol, non‐HDL‐C, and LDL‐C in the lowest quartile were approximately twice as likely to die as those in the highest quartile (rate ratio (RR)=1.8, 95% confidence interval (CI)=1.3–2.4). These results did not vary when analyses were adjusted for body mass index, APOE genotype, diabetes mellitus, heart disease, hypertension, stroke, diagnosis of cancer, current smoking status, or demographic variables. The association between lipid levels and risk of death was attenuated when subjects with less than 1 year of follow‐up were excluded (RR=1.4, 95% CI=1.0–2.1). The relationship between total cholesterol, non‐HDL‐C, HDL‐C, and triglycerides and risk of death did not differ for older (≥75) and younger participants (>75), whereas the relationship between LDL‐C and risk of death was stronger in younger than older participants (RR=2.4, 95% CI=1.2–4.9 vs RR=1.6, 95% CI=1.02–2.6, respectively). Overall, women had higher mean lipid levels than men and lower mortality risk, but the risk of death was comparable for men and women with comparable low lipid levels.Conclusion: Low cholesterol level is a robust predictor of mortality in the nondemented elderly and may be a surrogate of frailty or subclinical disease. More research is needed to understand these associations.
Potentially Inappropriate Medication Use by Elderly Persons in U.S. Health Maintenance Organizations, 2000–2001
Authors: Simon Steven R. , Chan K. Arnold , Soumerai Stephen B. , Wagner Anita K. , Andrade Susan E. , Feldstein Adrianne C. , Lafata Jennifer Elston , Davis Robert L. , Gurwitz Jerry H. 
Published: January 2005

Objectives: To determine rates of potentially inappropriate medication use in elderly persons in managed care plans in the United States in 2000–2001.Design: Cross‐sectional study using automated medication‐dispensing data.Setting: Ten geographically distributed health maintenance organizations (HMOs).Participants. One hundred fifty‐seven thousand five hundred seventeen members aged 65 years and older enrolled in one of the HMOs.Measurements: Prevalence of use of 33 potentially inappropriate medications from January 1, 2000 through June 30, 2001.Results: In 2000–2001, 28.8% (95% confidence interval=28.6–29.1) of elderly individuals received at least one of 33 potentially inappropriate medications. This rate ranged from 23.0% to 36.5% across the 10 HMOs. Approximately 5% of elderly patients received at least one of the 11 medications classified by an expert panel as “always avoid,” 13% received at least one of the eight medications that would rarely be considered appropriate, and 17% received at least one of the 14 medications that have some indications but are often misused. Overall, rates of use of these medications were greater in women (32.4%) than in men (24.2%). At least 1% of elderly members received belladonna alkaloids (2.3%), dicyclomine (1.1%), or hyoscyamine (1.2%), each of which multiple expert panels have classified as always inappropriate in patients aged 65 years and older. Seven percent of elderly members received propoxyphene, an analgesic medication considered rarely appropriate in the elderly and a drug that has a long history of limited efficacy and potential for toxicity.Conclusion: Recent rates of potentially inappropriate medication use by elderly HMO members were at least as great as in a 1996 national sample. This study highlights the need to understand more fully the rationale behind the continued use of these medications.
Decreasing Use of Percutaneous Endoscopic Gastrostomy Tube Feeding for Veterans with Dementia—Racial Differences Remain
Authors: Braun Ursula K. , Rabeneck Linda , McCullough Laurence B. , Urbauer Diana L. , Wray Nelda P. , Lairson David R. , Beyth Rebecca J. 
Published: January 2005

Objectives: Percutaneous endoscopic gastrostomy (PEG) tube placement is a widely used method for long‐term enteral feeding of demented patients unable to take sufficient food by mouth. National time trends in PEG tube use over the last decade have not been previously reported. The objective of this study was to determine whether use of PEG tubes for patients with dementia has changed over time and by race.Design: Retrospective cohort study.Setting: All Veterans Affairs hospitals.Participants: Using an administrative database of the Veterans Health Administration, all veterans with dementia and all veterans who received a PEG tube were identified between fiscal years 1990–2001.Measurements: Proportion of PEG tube placement for dementia patients over time and by race.Results: Four hundred thirteen thousand six hundred twenty‐seven dementia patients aged 60 and older were identified, of whom 6,464 (1.6%) received a PEG tube. Use of PEG tubes for dementia patients increased during the first half of the decade but subsequently decreased almost to baseline after peaking in 1996 (1990: 1.2%, 1996: 1.8%, 2001: 1.3%). Time trends in the use of PEG tube feeding for dementia patients varied by race. Specifically, the relative risk for PEG tube placement in African‐American dementia patients increased from 1.65 (95% confidence interval (CI)=1.25–2.17, FY 1990) to 1.97 (95% CI=1.62–2.4, FY 2001).Conclusion: Although the overall use of PEG tube feeding for dementia patients decreased over time, rates in use and changes in use over time varied significantly by race. Reasons for the differential use of this procedure should be explored.
Suboptimal Prescribing in Elderly Outpatients: Potentially Harmful Drug‐Drug and Drug‐Disease Combinations
Authors: Zhan Chunliu , Correa‐de‐Araujo Rosaly , Bierman Arlene S. , Sangl Judy , Miller Marlene R. , Wickizer Stephen W. , Stryer Daniel 
Published: January 2005

Objectives: To assess the prevalence and correlates of potentially harmful drug‐drug combinations and drug‐disease combinations prescribed for elderly patients at outpatient settings.Design: Retrospective analysis of the 1995–2000 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS).Setting: Physician offices and hospital outpatient departments.Participants: Outpatient visits by patients aged 65 and older in the NAMCS and NHAMCS (n=70,203).Measurements: Incidences of six drug‐drug combinations and 50 drug‐disease combinations that can place elderly patients at risk for adverse events according to expert consensus panels.Results: Overall, 0.74% (95% confidence interval (CI)=0.65–0.83) of visits with two or more prescriptions had at least one inappropriate drug‐drug combination, and 2.58% (95% CI=2.44–2.72) of visits with at least one prescription had one or more inappropriate drug‐disease combinations. Of visits with a prescription of warfarin, 6.60% (95% CI=5.46–7.74) were prescribed a drug with potentially harmful interaction. Of patients with benign prostatic hypertrophy, 4.06% (95% CI=3.06–5.06) had at least one of six drugs that should be avoided. The number of drugs prescribed is most predictive of inappropriate drug‐drug and drug‐disease combinations.Conclusion: Potentially harmful drug‐drug and drug‐disease combinations occur in various degrees in outpatient care in the elderly population. Targeting combinations such as those involving warfarin that are high in prevalence and potential harm offers a practical approach to improving prescribing and patient safety.
Prompting Primary Providers to Increase Community Exercise Referrals for Older Adults: A Randomized Trial
Authors: Ackermann Ronald T. , Deyo Richard A. , LoGerfo James P. 
Published: January 2005

Objectives: To determine whether a clinic‐based physical activity promotion intervention can lead to more community‐based exercise referrals by providers and higher exercise motivation in patients.Design: Cluster randomized, controlled trial.Setting: Seattle Veterans Affairs General Internal Medicine Clinic.Participants: Thirty‐one physicians and nurse practitioners were randomized to a physical activity counseling intervention or control condition (counseling about tobacco cessation). Three hundred thirty‐six patients aged 50 and older and visiting a study provider were enrolled.Intervention: Intervention providers were trained to offer referrals to community exercise programs for patients who reported before their clinic visit that they were “contemplative” about regular exercise.Measurements: Process measures of health behavior assessment and provider advice, exercise stage‐of‐change, proportion of participants reporting regular physical activity.Results: At baseline, 172 intervention patients and 164 controls were similar with respect to sex, age, comorbidity score, and exercise motivation level. Forty‐five percent of all intervention patients and 35% of controls reported receiving exercise advice (P=.07). Intervention patients who were contemplative about exercise were even more likely to receive exercise advice than contemplative controls (59% vs 38%; P=.02). After 4 months, 35% of all intervention patients reported regular exercise, compared with 28% of controls (P=.06).Conclusion: Primary providers are more likely to offer exercise advice when informed whether patients are contemplative about exercise. Patients may be more likely to start regular exercise as a result of this advice.
The Effect of a Social Work Intervention to Enhance Advance Care Planning Documentation in the Nursing Home
Authors: Morrison R. Sean , Chichin Eileen , Carter John , Burack Orah , Lantz Melinda , Meier Diane E. 
Published: January 2005

Objectives: To assess the effect of a multicomponent advance care planning intervention directed at nursing home social workers on identification and documentation of preferences for medical treatments and on patient outcomes.Design: Controlled clinical trial.Setting: New York City nursing home.Participants: One hundred thirty‐nine newly admitted long‐term care residents.Intervention: Nursing home social workers were randomized to the intervention or control groups. The intervention consisted of baseline education in advance care planning that incorporated small‐group workshops and role play/practice sessions for intervention social workers; structured advance care planning discussions with residents and their proxies at admission, after any change in clinical status, and at yearly intervals; formal structured review of residents' goals of care at preexisting regular team meetings; “flagging” of advance directives on nursing home charts; and feedback to individual healthcare providers of the congruence of care they provided and the preferences specified in the advance care planning process. Control social workers received an educational training session on New York State law regarding advance directives but no additional training or interventions. Subjects were enrolled from January 9, 2001 through May 25, 2003 and followed for 6 months after enrollment.Measurements: Nursing home chart documentation of advance directives (healthcare proxies, living wills) and do‐not‐resuscitate orders; preferences for artificial nutrition and hydration, intravenous antibiotics, and hospitalization; and concordance of treatments received with documented preferences were compared for residents assigned to intervention and control social workers.Results: Intervention residents were significantly more likely than residents in the control group to have their preferences regarding cardiopulmonary resuscitation (40% vs 20%, P=.005), artificial nutrition and hydration (47% vs 9%, P<.01), intravenous antibiotics (44% vs 9%, P<.01), and hospitalization (49% vs 16%, P<.01) documented in the nursing home chart. Control residents were significantly more likely than intervention residents to receive treatments discordant with their prior stated wishes. Two of 49 (5%) intervention residents received a treatment in conflict with their prior stated wishes (one hospitalization, one episode of intravenous antibiotics), compared with 17 of 96 (18%) control patients (P=.04).Conclusion: This generalizable intervention directed at nursing home social workers significantly improved the documentation and identification of patients' wishes regarding common life‐sustaining treatments and resulted in a higher concordance between patients' prior stated wishes and treatments received.
Underrecognition of Cognitive Impairment in Assisted Living Facilities
Authors: Magsi Homa , Malloy Timothy 
Published: January 2005

Objectives: To determine the prevalence of cognitive impairment (CI), dementia diagnosis and treatment, assistance with medications, and surrogate decision‐makers for residents of assisted living facilities (ALFs).Design: Cross‐sectional study.Setting: Seven ALFs in Omaha, Nebraska, and the surrounding area. None of the ALFs in this study were designated “Alzheimer's” or “dementia” facilities.Participants: Four hundred seven of 455 ALF residents were solicited, and 230 consented. The average age ± standard deviation of participants was 83.3±8.3.Measurements: ALF residents were examined using the Mini‐Mental State Examination (MMSE), and their medical charts were reviewed.Results: Fifty‐eight percent of ALF residents had CI according to the MMSE. Of those with CI, 63% had no diagnosis of dementia, 75% were not treated for dementia, 41% with a documented diagnosis of dementia were not treated for dementia, 22% self‐administered an average of 5.4±3.4 medications daily, and 11% had surrogate decision makers.Conclusion: More than half of ALF residents in this study had CI and a significant percentage was undiagnosed. Even when diagnosed as dementia, CI is significantly undertreated in this setting. These deficits must be addressed to promote quality of care and the need for specialized attention.
A National Study of the Location of Death for Older Persons with Dementia
Authors: Mitchell Susan L. , Teno Joan M. , Miller Susan C. , Mor Vincent 
Published: January 2005

Objectives: To describe where older Americans with dementia die and to compare the state health system factors related to the location of dementia‐related deaths with those of cancer and all other conditions in this population.Design: Cross‐sectional study.Setting: United States in 2001.Participants: All persons aged 65 and older who died from nontraumatic causes in the United States during 2001. The underlying cause of death, as determined by the National Center for Health Statistics from death certificate data, was used to categorize subjects into three decedent groups: dementia (n=88,523, 5.1%), cancer (n=389,754, 22.4%), and all other conditions (n=1,256,873, 72.5%).Measurements: Site of death was identified as the hospital, home, nursing home, or another location as recorded on the death certificate. In each state, the proportion of hospital deaths in the three decedent groups was categorized as high, medium, and low based on terciles of the national distribution. Using multivariate analyses, associations between state‐level variables and the proportion of deaths occurring in the hospital in each state were examined.Results: The majority of dementia‐related deaths in the United States occurred in nursing homes (66.9%). In contrast, most older persons with cancer died at home (37.8%) or in the hospital (35.4%). The hospital was the most common site of death for all other conditions (52.2%). The state‐specific proportion of dementia‐related deaths occurring in hospitals varied from 5.0% to 37.0% across the nation and was in the highest tercile in 18 states. Hospital death rates related to cancer and all other conditions were in the highest tercile in 14 of these 18 states. After multivariate adjustment, states with a greater number of hospital beds per 1,000 persons and a lower percentage of decedents aged 85 and older were more likely to have a higher proportion of hospital deaths in all three decedent groups. Additionally, in the dementia cohort, states with fewer nursing home beds had a greater proportion of hospital deaths.Conclusion: The majority of older Americans whose underlying cause of death is attributable to dementia on their death certificate die in nursing homes. State‐level factors, including the availability of hospital and nursing home beds and the age of decedents in the population, explain, in part, the wide state‐to‐state variability in the proportion of dementia‐related deaths occurring in the hospital.
Self‐Reported Goals of Older Patients with Type 2 Diabetes Mellitus
Authors: Huang Elbert S. , Gorawara‐Bhat Rita , Chin Marshall H. 
Published: January 2005

Objectives: New diabetes mellitus guidelines from the American Geriatrics Society promote the individualization of treatment goals and plans for patients aged 65 and older. Communicating with older patients about such complex medical decisions presents new challenges for providers. The self‐reported healthcare goals, factors influencing these goals, and self‐care practices of older patients with diabetes mellitus were explored.Design: Exploratory study involving semistructured interviews.Setting: Four clinics of a midwestern, urban academic medical center.Participants: Patients aged 65 and older with type II diabetes mellitus (N=28).Measurements: Semistructured, one‐on‐one interviews were conducted. Interviews were audiotaped, transcribed, and evaluated for recurring themes using a grounded theory approach.Results: The majority of patients expressed their healthcare goals in a social and functional language, in contrast to the biomedical language of risk factor control and complication prevention, even when specifically asked about goals for diabetes mellitus care. Patient's predominant healthcare goals centered on maintaining their independence and their activities of daily living (71%). Medical experiences of friends and family (50%), social comparison with peers (7%), and medical professionals (43%) shaped patients' goals. Self‐reported medication adherence and glucose monitoring was high, but more than one‐quarter of patients failed to adhere to any dietary recommendations, and one‐third failed to adhere to their exercise regimens.Conclusion: As diabetes mellitus care recommendations for older patients grow more complex, providers could enhance their communication about such medical decisions by exploring patients' specific circumstances and reframing diabetes mellitus treatment goals in patients' own language. These may be crucial steps to developing successful individualized care plans.