bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Performance Measures in the Clinical Setting
Authors: Studenski Stephanie , Perera Subashan , Wallace Dennis , Chandler Julie M. , Duncan Pamela W. , Rooney Earl , Fox Michael , Guralnik Jack M. 
Published: December 2004

OBJECTIVES:  To assess the ability of gait speed alone and a three‐item lower extremity performance battery to predict 12‐month rates of hospitalization, decline in health, and decline in function in primary care settings serving older adults.DESIGN:   Prospective cohort study.SETTING:   Primary care programs of a Medicare health maintenance organization (HMO) and Veterans Affairs (VA) system.PARTICIPANTS:   Four hundred eighty‐seven persons aged 65 and older.MEASUREMENTS:   Lower extremity performance Established Population for Epidemiologic Studies of the Elderly (EPESE) battery including gait speed, chair stands, and tandem balance tests; demographics; health care use; health status; functional status; probability of repeated admission scale (Pra); and primary physician's hospitalization risk estimate.RESULTS:   Veterans had poorer health and higher use than HMO members. Gait speed alone and the EPESE battery predicted hospitalization; 41% (21/51) of slow walkers (gait speed <0.6 m/s) were hospitalized at least once, compared with 26% (70/266) of intermediate walkers (0.6–1.0 m/s) and 11% (15/136) of fast walkers (>1.0 m/s) (P < .0001). The relationship was stronger in the HMO than in the VA. Both performance measures remained independent predictors after accounting for Pra. The EPESE battery was superior to gait speed when both Pra and primary physician's risk estimate were included. Both performance measures predicted decline in function and health status in both health systems. Performance measures, alone or in combination with self‐report measures, were more able to predict outcomes than self‐report alone.CONCLUSION:   Gait speed and a physical performance battery are brief, quantitative estimates of future risk for hospitalization and decline in health and function in clinical populations of older adults. Physical performance measures might serve as easily accessible “vital signs” to screen older adults in clinical settings.
Strength and Muscle Quality in a Well‐Functioning Cohort of Older Adults: The Health, Aging and Body Composition Study
Authors: Newman Anne B. , Haggerty Catherine L. , Goodpaster Bret , Harris Tamara , Kritchevsky Steve , Nevitt Michael , Miles Toni P. , Visser Marjolein , The Health, Aging, and Body Composition Research Group  
Published: December 2004

OBJECTIVES:  To determine whether lower lean mass and higher fat mass have independent effects on the loss of strength and muscle quality in older adults and might explain part of the effect of age.DESIGN:   Single‐episode, cross‐sectional analyses of a cohort of subjects in the Health, Aging and Body Composition (Health ABC) Study.SETTING:   Ambulatory clinic and research laboratory.PARTICIPANTS:   Two thousand six hundred twenty‐three men and women aged 70 to 79 from the Health ABC Study.MEASUREMENTS:   Upper and lower extremity strength was measured using isokinetic (knee extension) and isometric (grip strength) dynamometers. Body composition (lean mass and fat mass) was determined by measuring lean mass of upper and lower extremities and the total body by dual‐energy x‐ray absorptiometry. Muscle quality was ascertained by taking the ratio of strength to muscle mass for both upper and lower extremities.RESULTS:   Upper and lower extremity strength and muscle quality decreased as age increased. Most of the explained variance in strength was due to differences in muscle mass, but, in those at the extremes of body fat and lower leg muscle quality, the association with body fat was independent of the effect of age. Although blacks had greater muscle strength and mass than whites, leg muscle quality tended to be lower in blacks than in whites. Upper extremity strength adjusted for lean mass and muscle quality were also associated inversely and independently with age, body fat, and black race.CONCLUSION:   In this older cohort, lower strength with older age was predominantly due to a lower muscle mass. Age and body fat also had significant inverse associations with strength and muscle quality. Both preservation of lean mass and prevention of gain in fat may be important in maintaining strength and muscle quality in old age.
A Home‐Based Pedometer‐Driven Walking Program to Increase Physical Activity in Older Adults with Osteoarthritis of the Knee: A Preliminary Study
Authors: Talbot Laura A. , Gaines Jean M. , Huynh Tu N. , Metter E. Jeffrey 
Published: December 2004

OBJECTIVES:  To determine whether a home‐based pedometer‐driven walking program with arthritis self‐management education (Walk +) would increase physical activity, muscle strength, and functional performance in older adults with osteoarthritis (OA) of the knee as opposed to arthritis self‐management education alone (EDU).DESIGN:   A randomized two‐by‐three (group‐by‐time) design with participants assigned to Walk + (n = 17, mean age ± standard deviation = 69.6 ± 6.7) or EDU (n = 17, age = 70.8 ± 4.7).SETTING:   Community located in the Baltimore‐Washington area.PARTICIPANTS:   Thirty‐four community‐dwelling adults, aged 60 and older with symptomatic knee OA and self‐reported functional impairment.INTERVENTIONS:   Both groups received 12 hours of the Arthritis Self‐Management program over 12 weeks and were followed for an additional 12 weeks. In addition, the Walk + group received individualized instruction in the use of a pedometer, with the goal of increasing their step count by 30% of their baseline step count.MEASUREMENTS:   The outcome measures were physical activity (daily step counts and total activity vector magnitude as measured by a pedometer and Tritrac‐R3D accelerometer), quadriceps femoris strength (isometric peak torque), and functional performance tasks (100‐foot walk‐turn‐walk, timed stair climb, timed chair rise, and pain status).RESULTS:   Daily steps walked showed a significant group‐by‐time interaction (P = .04) after controlling for age. From baseline to completion of training, a 23% increase in daily steps occurred in the Walk + group and a 15% decrease in the EDU group. Although steps increased in the Walk + group, total activity vector magnitude was maintained, suggesting a more efficient gait. The Walk + group became quicker than the EDU group in the normal‐pace walk‐turn‐walk (P = .04). An isometric strength gain of 21% postintervention was seen in the Walk + group, compared with a loss of 3.5% in the EDU group.CONCLUSION:   In older adults with symptomatic knee OA, Walk + appears to increase walking, with improvements in muscle strength and walking performance. The use of a home‐based pedometer‐driven program to increase physical activity, strength, and function in this population warrants further research.
Environmental Components of Mobility Disability in Community‐Living Older Persons
Authors: Shumway‐Cook Anne , Patla Aftab , Stewart Anita , Ferrucci Luigi , Ciol Marcia A. , Guralnik Jack M. 
Published: December 2004

OBJECTIVES:  To examine the relationship between characteristics of the physical environment and mobility disability in community‐living older persons.DESIGN:   Cross‐sectional study conducted on three groups of community‐dwelling older adults.SETTING:   Community‐dwelling older people in Seattle, Washington, and Waterloo, Ontario, Canada.PARTICIPANTS:   Fifty‐four older adults (≥70) were recruited from two geographic sites and grouped according to level of physical function (elite, physically able, physically disabled).MEASUREMENT:   Subjects reported on frequency of encounter versus avoidance of 24 features of the physical environment, grouped into eight dimensions, using a five‐point ordinal scale (never, rarely, sometimes, often, always). Never and rarely responses were combined and coded as not encountered or not avoided, whereas the sometimes, often or always responses were combined and coded as encountered or avoided.RESULTS:   Disabled older adults reported fewer encounters with and concomitantly greater avoidance of physical challenges to mobility than nondisabled older adults. However, both encounter and avoidance varied by environmental dimension.CONCLUSION:   Results support the hypothesis that mobility disability results from an interaction of individual and environmental factors. Mobility disability is associated with avoidance of some, but not all, physically challenging features within the environment, suggesting that some environmental features may disable community mobility more than others.
Loss of Independence in Activities of Daily Living in Older Adults Hospitalized with Medical Illnesses: Increased Vulnerability with Age
Authors: Covinsky Kenneth E. , Palmer Robert M. , Fortinsky Richard H. , Counsell Steven R. , Stewart Anita L. , Kresevic Denise , Burant Christopher J. , Landefeld C. Seth 
Published: December 2004

OBJECTIVES: To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function.DESIGN: Prospective observational study.SETTING: The general medical service of two hospitals.PARTICIPANTS: Two thousand two hundred ninety‐three patients aged 70 and older (mean age 80, 64% women, 24% nonwhite).MEASUREMENTS: At the time of hospital admission, patients or their surrogates were interviewed about their independence in five ADLs (bathing, dressing, eating, transferring, and toileting) 2 weeks before admission (baseline) and at admission. Subjects were interviewed about ADL function at discharge. Outcome measures included functional decline between baseline and discharge and functional changes between baseline and admission and between admission and discharge.RESULTS: Thirty‐five percent of patients declined in ADL function between baseline and discharge. This included the 23% of patients who declined between baseline and admission and failed to recover to baseline function between admission and discharge and the 12% of patients who did not decline between baseline and admission but declined between hospital admission and discharge. Twenty percent of patients declined between baseline and admission but recovered to baseline function between admission and discharge. The frequency of ADL decline between baseline and discharge varied markedly with age (23%, 28%, 38%, 50%, and 63% in patients aged 70–74, 75–79, 80–84, 85–89, and ≥90, respectively, P < .001). After adjustment for potential confounders, age was not associated with ADL decline before hospitalization (odds ratio (OR) for patients aged ≥90 compared with patients aged 70–74 = 1.26, 95% confidence interval (CI) = 0.88–1.82). In contrast, age was associated with the failure to recover ADL function during hospitalization in patients who declined before admission (OR for patients aged ≥90 compared with patients aged 70–74 = 2.09, 95% CI = 1.20–3.65) and with new losses of ADL function during hospitalization in patients who did not decline before admission (OR for patients aged ≥90 compared with patients aged 70–74 = 3.43, 95% CI = 1.92–6.12).CONCLUSION: Many hospitalized older people are discharged with ADL function that is worse than their baseline function. The oldest patients are at particularly high risk of poor functional outcomes because they are less likely to recover ADL function lost before admission and more likely to develop new functional deficits during hospitalization
Comorbidity and the Concentration of Healthcare Expenditures in Older Patients with Heart Failure
Authors: Zhang James X. , Rathouz Paul J. , Chin Marshall H. 
Published: December 2004

OBJECTIVES: To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program.DESIGN: Retrospective analysis of older fee‐for‐service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims.SETTING: Variety of clinical settings.PARTICIPANTS: One thousand two hundred sixty‐six older HF patients from a nationally representative survey.MEASUREMENTS: Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure.RESULTS: Medicare spent an average of $16,514 on medical reimbursement for each HF patient in 1996. Eighty‐one percent of patients had one or more comorbid diseases according to a 17‐disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more‐expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure $26,954), myocardial infarction (16% of patients, mean total expenditure $29,867), renal disease (8% of patients, mean total expenditure $33,014), and hemiplegia or paraplegia (5% of patients, mean total expenditure $33,234). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care.CONCLUSION: Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.
Diagnosis and Treatment of Osteoporosis in Patients with Vertebral Compression Fractures
Authors: Neuner Joan M. , Zimmer Jennifer K. , Hamel Mary Beth 
Published: December 2004

OBJECTIVES: To determine whether patients with vertebral compression fractures are diagnosed with or treated for osteoporosis.DESIGN: Retrospective cohort study.SETTING: Two primary care practices in Massachusetts.PARTICIPANTS: Two hundred six patients with vertebral compression fractures noted on routine radiographs in 1997–1998.MEASUREMENTS: Percentage of patients diagnosed with osteoporosis and treated with prescription medications (estrogen, bisphosphonates, raloxifene, or calcitonin). Factors associated with missed osteoporosis diagnosis and treatment, including risk factors for osteoporosis, comorbidities, vertebral fracture severity, and processes of care communication were also examined.RESULTS: The median patient age was 76, 71% of the cohort was female, and 13% of patients had a history of corticosteroid use. Thirty‐eight percent of subjects (46% of women and 19% of men) were diagnosed with osteoporosis and 32% (39% of women and 14% of men) received prescription medications for osteoporosis. Of women who were diagnosed with osteoporosis, 69% received prescription medications. In adjusted analyses women younger than 50 (adjusted odds ratio (AOR) = 0.09; 95% confidence interval (CI) = 0.01–0.71) and 90 and older (AOR = 0.27; 95% CI = 0.08–0.98) were less likely to be diagnosed with osteoporosis, whereas women with a prior hip or radial fracture (AOR = 3.65; 95% CI = 1.28–10.38) or back pain (AOR = 2.84; 95% CI = 1.38–5.85) were more likely to be diagnosed with osteoporosis.CONCLUSIONS: Physicians frequently did not diagnose osteoporosis in primary care patients with vertebral fractures, missing an important preventive opportunity for patients at high risk for future fractures. Efforts targeted to improving diagnosis of osteoporosis could improve patient care.
Cefotaxime‐Resistant Bacteria Colonizing Older People Admitted to an Acute Care Hospital
Authors: Bonomo Robert A. , Donskey Curtis J. , Blumer Jeffery L. , Hujer Andrea M. , Hoyenm Claudia K. , Jacobs Michael R. , Whalen Christopher C. , Salata Robert A. 
Published: December 2004

OBJECTIVES: To determine the frequency of fecal colonization by cefotaxime‐resistant gram‐negative bacilli in older patients living in the community and in long‐term care facilities (LTCFs) admitted to an acute care hospital.DESIGN: Case‐control, point prevalence study.SETTING: Hospital.PARTICIPANTS: One hundred forty‐three patients aged 65 and older.MEASUREMENTS: Rectal swab cultures, antibiotic drug sensitivity, beta lactamase isolation, and clonal identity.RESULTS: Of the 190 surveillance cultures obtained from 143 patients, 26 cefotaxime‐resistant gram‐negative isolates from 22 patients were recovered. The prevalence rate of cefotaxime‐resistant isolates on admission was 13.3% (19/143). A logistic regression model using cefotaxime colonization as the dependent variable found that multiple comorbidities, admission to a surgical service, and having a diagnosis of infection on presentation and a transfusion history were factors associated with the presence of colonization. These four clinical items accurately classified 74% of patients colonized. Antibiotic use and nursing home residence were not associated with the presence of colonization by cefotaxime‐resistant organisms. Twelve of the cefotaxime‐resistant isolates (46%) were identified as Pseudomonas aeruginosa, and 14 (54%) were other gram‐negative bacilli. In six of the 14 isolates that were not P. aeruginosa (36%), it was possible to demonstrate the presence of an AmpC β‐lactamase related to the CMY‐2 β‐lactamase, a plasmid‐borne cephalosporinase.CONCLUSION: These data raise awareness that there are community‐ and LTCF‐dwelling older patients colonized with gram‐negative enteric bacilli resistant to third‐generation cephalosporins on admission to the hospital. The “reservoir of resistant bacteria” in older people is no longer confined to LTCFs.
Comparison of Two Home Care Protocols for Total Joint Replacement
Authors: Weaver Frances M. , Hughes Susan L. , Almagor Orit , Wixson Richard , Manheim Larry , Fulton Bradley , Singer Ruth 
Published: December 2004

OBJECTIVES: To examine the effect of a more‐efficient home care protocol to manage total joint replacement (TJR) patients after surgery.DESIGN: A randomized trial of two home care protocols for TJR management.SETTING: A hospital‐affiliated home healthcare agency in a large midwestern city.PARTICIPANTS: Medicare‐eligible individuals undergoing elective total hip or knee replacement surgery (N = 136).INTERVENTION: A home care protocol that included preoperative home visits by a nurse and a physical therapist and fewer postoperative visits (range of 9–12 visits) to the home than an existing protocol (range of 11–47 visits).MEASUREMENTS: Functional status, lower extremity functioning, health‐related quality of life, satisfaction with care, and use and cost of healthcare services for 6 months postsurgery.RESULTS: There were no differences in functional status, health‐related quality of life, or lower extremity functioning by group at 6 months. A marginally significant gain in satisfaction with access to care (P = .059) was found in the intervention group at 6 months. Home healthcare costs were 55% lower for the streamlined group (P < .001). Other costs did not differ significantly by group.CONCLUSION: TJR patients who received the more‐efficient home care protocol experienced comparable outcomes to those who received the existing protocol. An abbreviated set of home care visits resulted in more‐efficient delivery of care without compromising patient outcomes.
Temporomandibular joint problems and self‐registration of mandibular opening capacity among adults with Ehlers‐Danlos syndrome. A questionnaire study
Authors: Hagberg Catharina , Korpe Lena , Berglund Britta 
Published: December 2004

Structured AbstractAuthors – Hagberg C, Korpe L, Berglund BObjectives – To study maximal mandibular opening capacity and the prevalence of temporomandibular joint (TMJ) problems reported among a larger group of adults with Ehlers‐Danlos syndrome (EDS). Furthermore, to compare proportions of disorders with those in a cohort of randomized population‐ based controls.Design – A questionnaire study with self‐registration of maximal mandibular opening capacity.Setting and Sample Population – One hundred and fourteen persons with EDS and 114 controls in a randomized population‐based cohort.Experimental variables – Self‐registered maximal mandibular opening capacity values that were calculated from the markings of maximal interincisal distance on spatulas and the assessments of overbite with the aid of photos. Questions concerning EDS, TMJ problems and other related questions.Outcome Measure – Mean values of maximal mandibular opening capacity compared between groups. Proportions of affirmative answers about TMJ problems compared between persons with EDS and controls who did not have the syndrome.Results – The EDS persons who reported problems with poor mouth opening capacity when biting into thick pieces of food had a lower mean maximal mandibular opening value compared with the other EDS persons (p < 0.05). The proportions of affirmative answers concerning mobile joints during mouth opening, present TMJ problems, poor mouth opening capacity when biting into thick food, clicking, crepitations and permanent locking were greater compared with the controls (p < 0.05).Conclusion – These data corroborate the reports in literature that persons with EDS are naturally predisposed to TMJ problems. The self‐registration of maximal mandibular opening capacity was a useful diagnostic tool to provide an objective clinical measure of movement capacity of the TMJ. The clinical measure was in line with the affirmative answers on having problems with poor mouth opening capacity among the EDS persons.
Post‐operative optimization of gum‐chewing kinematics in a prognathic patient
Authors: Yashiro Kohtaro , Takada Kenji 
Published: December 2004

AbstractSmooth jaw movements during gum chewing, which are defined as those driven by optimally smooth patterns of temporal change in acceleration/deceleration, have been quantified in subjects with acceptable occlusions. This paper reports a case in which significant improvement of the smoothness of masticatory jaw movement was observed following surgical‐orthodontic treatment. A patient, who demonstrated a mandibular prognathism, underwent the treatment. The irregularity in acceleration/deceleration of jaw closing movement during gum chewing was quantified by the movement jerk‐cost, where the jerk is rate of change in movement acceleration/deceleration. The normalized jerk‐costs and results of maximum‐smoothness model simulation were compared between jaw movements at pre‐ and post‐treatment stages. The correction of mandibular prognathism and crossbite allowed the patient to close the jaw with wider lateral excursion. Furthermore, smoothness of the jaw closing movements increased significantly and the velocity profile was characterized as similar to that predicted by the kinematic model after treatment. These findings for achievement of ‘functional occlusion’ that allows the patient to perform smooth and economical jaw closing movements during chewing demonstrate necessity of orthodontic treatment of mandibular prognathism to improve jaw motor function.