bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preventing Falls in Older People: Outcome Evaluation of a Randomized Controlled Trial
Authors: Stevens Margaret , Holman C. D'Arcy J. , Bennett Nicole , De Klerk Nick 
Published: March 2003

OBJECTIVES: To evaluate the outcome of an intervention to reduce hazards in the home on the rate of falls in seniors.DESIGN: Randomized controlled trial, with follow‐up of subjects for 1 year.SETTING: Community‐based study in Perth, Western Australia.PARTICIPANTS: People age 70 and older.INTERVENTION: One thousand eight hundred seventy‐nine subjects were recruited and randomly allocated by household to the intervention and control groups in the ratio 1:2. Because of early withdrawals, 1,737 subjects commenced the study. All members of both groups received a single home visit from a research nurse. Intervention subjects (n = 570) were offered a home hazard assessment, information on hazard reduction, and the installation of safety devices, whereas control subjects (n = 1,167) received no safety devices or information on home hazard reduction.MEASUREMENTS: Both groups recorded falls on a daily calendar. Reported falls were confirmed by a semistructured telephone interview and were assigned to one of three overlapping categories: all falls, falls inside the home, and falls involving environmental hazards in the home. Analysis was by multivariate modelling of rate ratios and odds ratios for falls, corrected for household clustering, using Poisson regression and logistic regression with robust variance estimation.RESULTS: Overall, 86% of study subjects completed the 1 year of follow‐up. The intervention was not associated with any significant reduction in falls or fall‐related injuries. There was no significant reduction in the intervention group in the incidence rate of falls involving environmental hazards inside the home (adjusted rate ratio, 1.11; 95% CI = 0.82–1.50), or the proportion of the intervention group who fell because of hazards inside the home (adjusted odds ratio, 0.97; 95% CI = 0.74–1.28). No reduction was seen in the rate of all falls (adjusted rate ratio, 1.02; 95% CI = 0.83– 1.27) or the rate of falls inside the home (adjusted rate ratio, 1.17; 95% CI = 0.85–1.60). There was no significant reduction in the rate of injurious falls in intervention subjects (adjusted rate ratio, 0.92; 95% CI = 0.73–1.14).CONCLUSIONS: The intervention failed to achieve a reduction in the occurrence of falls. This was most likely because the intervention strategies had a limited effect on the number of hazards in the homes of intervention subjects. The study provides evidence that a one‐time intervention program of education, hazard assessment, and home modification to reduce fall hazards in the homes of healthy older people is not an effective strategy for the prevention of falls in seniors.
The Impact of Insomnia on Cognitive Functioning in Older Adults
Authors: Cricco Meredith , Simonsick Eleanor M. , Foley Daniel J. 
Published: March 2003

OBJECTIVES:To examine whether self‐reported symptoms of insomnia independently increase risk of cognitive decline in older adults.DESIGN:Longitudinal cohort study.SETTING:The four sites of the Established Populations for Epidemiologic Studies of the Elderly.PARTICIPANTS:Six thousand four hundred forty‐four community‐dwelling men and women age 65 and older who had no more than one error on the Short Portable Mental Status Questionnaire (SPMSQ) at baseline and an in‐person interview at the third annual follow‐up (FU3).MEASUREMENTS:Insomnia was defined as report of trouble falling asleep or waking up too early most of the time. Cognitive decline was defined as two or more errors on the SPMSQ at FU3. Logistic regression was used to determine risk of cognitive decline associated with insomnia, controlling for demographic, behavioral, and health‐related factors. Analyses were stratified by sex and depressed mood.RESULTS:Among nondepressed men, those reporting symptoms of insomnia at both baseline and FU3 had an adjusted odds ratio (OR) of 1.49 (95% CI = 1.03–2.14) for cognitive decline, relative to those with no insomnia at FU3. Men with insomnia at FU3 only were not at increased risk (OR = 1.16, 95% CI = 0.82–1.65). These relationships were not found in women. Men and women with depressive symptoms at FU3 were at increased risk for cognitive decline independent of insomnia.CONCLUSION:Chronic insomnia independently predicts incident cognitive decline in older men. More sensitive measures of cognitive performance may identify more subtle declines and may confirm whether insomnia is associated with cognitive decline in women. J Am Geriatr Soc 49:1185–1189, 2001.
Impact of a New Assessment System, the MDS‐HC, on Function and Hospitalization of Homebound Older People: A Controlled Clinical Trial
Authors: Landi Francesco , Onder Graziano , Tua Ennio , Carrara Benigno , Zuccalá Giuseppe , Gambassi Giovanni , Carbonin PierUgo , Bernabei Roberto ,   on behalf of the Silvernet‐Hc Study Group of Bergamo
Published: March 2003

OBJECTIVES:To evaluate the impact of a new assessment system, the Minimum Data Set for Home Care (MDS‐HC), on the functional status and hospitalization rates of frail, community‐dwelling older people.DESIGN:Single‐blind randomized trial with 1‐year follow‐up.SETTING:Bergamo, Italy.PARTICIPANTS:All 187 subjects who were eligible for home care services delivered by two Health Districts between September 1998 and April 1999.INTERVENTION:Random allocation to an intervention group undergoing MDS‐HC assessment or to a control group receiving conventional geriatric assessment with Barthel, Lawton and Brody, and Mini‐Mental State Examination (MMSE) scales.MEASUREMENTS:Hospitalization, health services use and costs, and variations in functional status.RESULTS:Survival analysis indicated that the intervention group was admitted to the hospital later and less often than were controls (relative risk = 0.49, 95% confidence interval = 0.56–0.97). Health services were used to the same extent, but intervention subjects used more in‐home help services. Total costs for the intervention group were 21% lower than for the control group. The adjusted mean scores of the activities of daily living index (51.7±36.1 vs 46.3±33.7; P = .05) and MMSE (19.9±8.9 vs 19.2±10.7; P = .03) were significantly improved in the intervention group as compared with the control group.CONCLUSIONS:The MDS‐HC assessment instrument may provide a cost‐saving approach to reducing institutionalization and functional decline in older people living in the community. J Am Geriatr Soc 49:1288–1293, 2001.
Illness Representations According to Age and Effects on Health Behaviors Following Coronary Artery Bypass Graft Surgery
Authors: Gump Brooks B. , Matthews Karen A. , Scheier Michael F. , Schulz Richard , Bridges Michael W. , Magoverm George J. 
Published: March 2003

OBJECTIVES: To determine if illness representations differ as a function of age and how these representations, in conjunction with age, predict postoperative health behaviors. DESIGN: Prospective study of patients undergoing coronary artery bypass graft (CABG) surgery. SETTING: A large metropolitan hospital providing regional cardiac care for patients in a tri‐state area, located in Pittsburgh, Pennsylvania. PARTICIPANTS: All consenting patients (N = 309) from a consecutive series of patients scheduled for CABG surgery between January 1992 and January 1994. To be eligible for participation, patients could not be scheduled for any other coincidental surgery (e.g., valve replacement), and could not be in cardiac intensive care or experiencing angina at the time of the referral. Participants were predominantly male (70%) and married (80%), and averaged 62.8 years of age. MEASUREMENTS: Postoperative self‐reported health behaviors. RESULTS: Older participants awaiting CABG surgery were significantly more likely to believe old age to be the cause of their coronary heart disease (CHD) and significantly less likely to believe genetics, health‐damaging behaviors, health protective behaviors, and emotions to be the cause of their CHD than were younger participants awaiting surgery. Furthermore, the older participants were significantly more likely to believe they had no control over the disease and that the disease would be gone after surgery, and reported fewer postoperative health behavior changes than did younger participants. CONCLUSION: These findings demonstrate significant differences in illness representations as a function of age. Furthermore, differences in postoperative health behaviors were consistent with differing illness representations.
Racial Differences in the Cost of Treating Men with Early‐Stage Prostate Cancer
Authors: Brandeis Judson , Pashos Chris L. , Henning James M. , Litwin Mark S. 
Published: March 2003

OBJECTIVE: To compare the cost and resource utilization in the evaluation, treatment, and 6‐month follow‐up of African‐American and White men undergoing either external beam radiation therapy (XRT) or radical prostatectomy (RP) for early‐stage prostate cancer. DESIGN: Retrospective analysis of cost and resource utilization data from encrypted patient‐specific hospital inpatient, hospital outpatient, and physician/supplier data files. SETTING: National Medicare claims data from 1993 through 1996. PARTICIPANTS: A random 5% national sample of Medicare beneficiaries from the Health Care Financing Administration Public Use Files for 1993 through 1996. MEASUREMENTS: Inpatient, outpatient, and physician/supplier Medicare costs. RESULTS: African‐American men undergoing RP for early‐stage prostate cancer had significantly higher costs ($21,878 vs $18,786, P < .0001) than did White men. Most of the difference occurred in the inpatient setting. African‐American men undergoing XRT had significantly greater costs ($18,131 vs $15,734, p < .0001) than did White men. Most of this difference was generated by longer duration of XRT treatments. CONCLUSIONS: In early‐stage prostate cancer, charges for RP and XRT in African‐American men are higher when compared with those for White men.
Advance Care Planning and End‐of‐Life Care for Hospitalized Nursing Home Residents
Authors: Happ Mary Beth , Capezuti Elizabeth , Strumpf Neville E. , Wagner Laura , Cunningham Sarah , Evans Lois , Maislin Greg 
Published: March 2003

OBJECTIVES: To describe advance care planning (ACP) and end‐of‐life care for nursing home residents who are hospitalized in the last 6 weeks of life.DESIGN: Constant comparative analysis of deceased nursing home resident cases.SETTING: A not‐for‐profit Jewish nursing home.PARTICIPANTS: Forty‐three deceased residents hospitalized within the last 6 weeks of life at a tertiary medical center.MEASUREMENTS: Trained nurse reviewers abstracted data from nursing home records and gerontological advanced practice nurse field notes. Clinical and outcome data from the original study were used to describe the sample. Data were analyzed using the constant comparative method and validated in interviews with a gerontological advanced practice nurse and social worker.RESULTS: The analysis revealed distinct characteristics and identifiable transition points in ACP and end‐of‐life care with frail nursing home residents. ACP was addressed by social workers as part of the nursing home admission process, focused primarily on cardiopulmonary resuscitation preference, and reviewed only after the crisis of acute illness and hospitalization. Advance directive forms specifying preferences or limitations for life‐sustaining treatment contained inconsistent language and vague conditions for implementation. ACP review generally resulted in gradual limitation of life‐sustaining treatment. Transition points included nursing home admission, acute illness or hospitalization, and decline toward death. Relatively few nursing home residents received hospice services, with most hospice referrals and palliative care treatment delayed until the week before death. Most residents in this sample died without family present and with little documented evidence of pain or symptom management.CONCLUSION: Limiting discussion of advance care plans to cardiopulmonary resuscitation falsely dichotomized and oversimplified the choices about medical treatment and care at end‐of‐life, especially palliative care alternatives, for these older nursing home residents. Formal hospice services were underutilized, and palliative care efforts by nursing home staff were often inconsistent with accepted standards. These results reinforce the need for research and program initiatives in long‐term care to improve and facilitate individualized ACP and palliative care at end of life.
Low Serum Vitamin D Does Not Predict New Disability or Loss of Muscle Strength in Older Women
Authors: Verreault René , Semba Richard D. , Volpato Stefano , Ferrucci Luigi , Fried Linda P. , Guralnik Jack M. 
Published: March 2003

OBJECTIVES: To determine whether serum levels of 25‐hydroxyvitamin D (25(OH)D) and parathyroid hormone (PTH) predict accelerated decline in muscular strength or onset of new disability in mobility and upper extremity functioning over a 3‐year follow‐up.DESIGN: A community‐based prospective cohort study.PARTICIPANTS: Six hundred twenty‐eight moderately to severely disabled women aged 65 and older living in the community.MEASUREMENTS: Subjects were divided into three groups of baseline 25(OH)D serum levels (deficiency: <25 nmol/L; low normal: 25–52 nmol/L; high normal: ≥53 nmol/L) and into tertiles of PTH levels. Objective performance measures (hip flexor, knee extensor, and grip strengths; walking speed; and time for repeated chair stands) and disability in activities involving mobility and upper extremity function were assessed at baseline and every 6 months for 3 years. Decline in performance measures and onset of new disability were compared between 25(OH)D and PTH groups using random effects models and proportional hazards models, respectively, while adjusting for age, race, education, body mass index, baseline performance, and chronic conditions.RESULTS: The annual rate of decline over 3 years in muscular strength, walking speed, and time to perform repeated chair stands was similar across 25(OH)D groups. We observed a nonsignificantly faster decline in proximal muscle strength and walking speed with increasing PTH levels. There was no association for either measure between serum levels and the risk of incident disability in activities relating to mobility and upper extremity function.CONCLUSION: This study does not support the hypothesis that vitamin D deficiency is associated with loss in muscular strength and decline in mobility and upper extremity functioning over time in older women who were moderately to severely disabled at baseline.
The Use of Life‐Sustaining Treatments in Hospitalized Persons Aged 80 and Older
Authors: Somogyi‐Zalud Emese , Zhong Zhenshao , Hamel Mary Beth , Lynn Joanne 
Published: March 2003

OBJECTIVES: To characterize the use of life‐sustaining treatments in hospitalized patients aged 80 and older.DESIGN: A prospective cohort study.SETTING: Four teaching hospitals in the United States that participated in the Hospitalized Elderly Longitudinal Project (HELP).PARTICIPANTS: Hospitalized patients aged 80 and older.MEASUREMENTS: We report the rates of admissions to intensive and coronary care units and the rates of use of cardiopulmonary resuscitation (CPR), ventilators, right heart catheterization, artificial nutrition and hydration, surgical interventions, hemodialysis, and blood transfusions.RESULTS: Of the 1,266 patients enrolled in HELP, 72 died during the enrollment hospitalization. The median age of those who died was 86 (range 83–89). Of the patients who died, the median number of activities of daily living impairments was two (range 1–4) before hospitalization, and 70% reported their baseline quality of life as fair or poor. Most patients who died had stated that they did not want aggressive care; 70% wanted their care focused on comfort rather than prolonging life, and 80% had a do‐not‐resuscitate order. However, the majority (63%) of the patients received one or more life‐sustaining treatments before they died. Fifty‐four percent were admitted to intensive or coronary care units, 43% were on a ventilator, 18% received CPR, 18% received tube feeding, 17% underwent surgery, 15% had right heart catheterization, 14% received blood transfusions, and 6% had hemodialysis. Intensive care did not affect survival time.CONCLUSION: The use of life‐sustaining treatments was prevalent in very old patients who died in the course of hospitalization, despite the fact that the majority had a preference for comfort care. This lack of congruence warrants further investigation and efforts to provide care that is more consistent with patients' preferences.
Profiles of Older Medicare Decedents
Authors: Lunney June R. , Lynn Joanne , Hogan Christopher 
Published: March 2003

OBJECTIVES: To evaluate the usefulness of a clinical scheme to classify older decedents to better understand the issues associated with healthcare use and costs in the last year of life.DESIGN: We analyzed Medicare claims data for a random sample of 0.1% of all Medicare beneficiaries with expenditures between 1993 and 1998. This sample yielded 7,966 deaths.SETTING: Medicare claims data.PARTICIPANTS: Medicare beneficiaries.MEASUREMENTS: We classified decedents into groups representing four trajectories at the end of life: sudden death, terminal illness, organ failure, and frailty.RESULTS: Ninety‐two percent of decedents were captured by the profiling strategy. The four trajectory groups had distinct patterns of demographics, care delivery, and Medicare expenditures. Frailty was a dominant pattern, with 47% of all decedents, whereas sudden death claimed only 7%; cancer claimed 22%, and organ system failure, 16%.CONCLUSIONS: The clinical scheme to classify decedents appears to fit most decedents and to form groups with substantial clinical differences. Acknowledging the differences among these groups may be a fruitful way to evaluate expenditures and develop strategies to improve care at the end of life.
Racial and Ethnic Differences in Place of Death: United States, 1993
Authors: Iwashyna Theodore J. , Chang Virginia W. 
Published: March 2003

OBJECTIVES: To examine racial and ethnic differences in place of death, adjusting for likely confounders.DESIGN: A retrospective cohort analyzed using multinomial logistic regression.SETTING: United States in 1993.PARTICIPANTS: A nationally representative sample of 22,658 deaths in 1993 from the National Mortality Followback Survey.MEASUREMENTS: Place of death as determined on the death certificate, with controls for age, sex, income, education, and cause of death. The outcomes of interest were death in a hospital during an inpatient stay, death in a nursing home, death in a private residence, or death in some other place.RESULTS: After adjustment, 43% of whites die after an inpatient hospital stay, as do 50% of blacks and 56% of Mexican Americans. Twenty percent of whites, 22% of Mexican Americans, and 14% of blacks die in nursing homes. Twenty‐two percent of whites, 18% of blacks, and 9% of Mexicans die in a private residence.CONCLUSIONS: There are substantial differences between whites, blacks, and Mexican Americans in place of death that cannot be explained by differences in age, sex, income, education, and causes of death between the groups.
Serum Interleukin‐6 and Hemoglobin as Physiological Correlates in the Geriatric Syndrome of Frailty: A Pilot Study
Authors: Leng Sean , Chaves Paulo , Koenig Kathleen , Walston Jeremy 
Published: March 2003

OBJECTIVES: To determine specific physiological correlates of the geriatric syndrome of frailty that warrant further investigation.DESIGN: Population‐based case‐control study.SETTING: General Clinical Research Center at Johns Hopkins Bayview Medical Center.PARTICIPANTS: Community‐dwelling adults aged 74 and older from Baltimore, Maryland.MEASUREMENTS: Frailty status was determined using a recently validated screening tool that consists of weight loss, fatigue, low levels of physical activity, and measurements of grip strength and walking speed. Serum interleukin‐6 (IL‐6) was measured using enzyme‐linked immunosorbent assay, and standard complete blood count was performed using a Coulter counter.RESULTS: Eleven frail and 19 nonfrail subjects with mean age ± standard deviation of 84.9 ± 6.7 vs 81.3 ± 4.1 years, respectively, completed the study. The frail subjects had significantly higher serum IL‐6 levels and significantly lower hemoglobin and hematocrit than the nonfrail subjects (4.4 ± 2.9 vs 2.8 ± 1.6 pg/mL, 12.1 ± 1.1 vs 13.9 ± 1.0 g/dL, and 35.8%± 3.1% vs 40.6%± 2.8%, respectively). No significant difference was observed in mean corpuscular volume, red blood cell distribution width, or white blood cell and platelet counts between the frail and nonfrail groups. Furthermore, there was an inverse correlation between serum IL‐6 level and hemoglobin (Pearson's correlation coefficient: −0.46) and hematocrit (−0.48) in the frail group but not in the nonfrail group.CONCLUSION: These results suggest that frail subjects have evidence of inflammation and lower hemoglobin and hematocrit levels. This subclinical anemia is normocytic and is hence unlikely due to myelosuppression or iron deficiency and is potentially related to the increased chronic inflammatory state marked by serum IL‐6 elevation. Further studies are indicated to better characterize the immune and hematological changes that underlie frailty.
Outcomes of a Community‐Based Dissemination of the Health Enhancement Program
Authors: Phelan Elizabeth A. , Williams Barbara , Leveille Suzanne , Snyder Susan , Wagner Edward H. , LoGerfo James P. 
Published: March 2003

OBJECTIVES: We previously found in an efficacy trial that a health promotion program prevented functional decline and reduced hospitalizations in community‐dwelling older people with chronic conditions. We sought to evaluate the effectiveness of the program in its dissemination phase.DESIGN: Outcome evaluation using a within‐group, pretest‐posttest design.SETTING: Fourteen senior centers located throughout western Washington.PARTICIPANTS: Three hundred four community‐dwelling men and women aged 65 and older.INTERVENTION: A disability‐prevention, chronic disease–self‐management program.MEASUREMENTS: Participant characteristics, risk factors for disability, change in health and functional status, and healthcare use over 1 year of enrollment; participant satisfaction.RESULTS: Participants were 71% female, had a mean age of 76, and reported three chronic health conditions on average. The percentage of participants found to be depressed decreased (28% at time of enrollment vs 17% at 1‐year follow‐up, P = .005). The percentage of physically inactive participants decreased (56% vs 38%, P = .001). Physical activity level and exercise readiness improved (Physician‐based Assessment and Counseling for Exercise mean score 4.3 vs 5.1, P = .001). At follow‐up, 83% rated their health the same as or better than a year ago, compared with 73% at time of enrollment. The proportion with impaired functional status, as measured by bed days and restricted activity days, stayed the same. The proportion hospitalized remained stable (23% at enrollment and follow‐up, P = 1.0).CONCLUSIONS: Under real world conditions, the Health Enhancement Program reaches older people at risk of functional decline. Those enrolled for 1 year experience a reduction in disability risk factors, improvement in health status, no decrements in functional status, and no increase in self‐reported healthcare use.