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Nicole Austin, , Ian Dick, Richard Prince,
Published: 1 October 2007
Journal of the American Geriatrics Society, Volume 55, pp 1598-1603; https://doi.org/10.1111/j.1532-5415.2007.01317.x

Abstract:
Objectives: To determine longitudinal predictors of incident and persistent fear of falling (FOF) in older women. Design: Longitudinal study. Setting: Clinical research center based at a university hospital. Participants: One thousand two hundred eighty-two community-dwelling women aged 70 to 85. Measurements: FOF at baseline and after 3 years of follow-up; a range of baseline demographic and clinical variables, including mobility, balance, and depression. Results: FOF was present in 418 subjects (33%) at baseline, developed in 30% of women who had been free of the symptom at baseline, and was reported by a total of 46% of the sample after 3 years of follow-up. In cross-sectional multivariable analysis, baseline FOF was independently associated with a range of variables, including living alone, obesity, cognitive impairment, depression, and impairments in balance and mobility. Baseline predictors of FOF that persisted after 3 years were similar, whereas obesity and slower timed up and go test scores predicted new-onset FOF. Conclusion: FOF in older women is a common and persistent complaint that is caused mainly by impairments of balance and mobility. A range of social, psychological, and physical risk factors for disability are associated with persistence of FOF. These results imply that early intervention may be important for the prevention of persistent FOF
, Gerda G. Fillenbaum, Robert B. Wallace
Published: 1 February 2006
Journal of the American Geriatrics Society, Volume 54, pp 335-338; https://doi.org/10.1111/j.1532-5415.2005.00589.x

Abstract:
To evaluate the prevalence and utility of memory complaint in a geographically representative cohort and, in cases with mild cognitive impairment (MCI), to determine whether memory complaint alters 10-year trajectories of disability in activities of daily living (ADLs), Short Portable Mental Status Questionnaire (SPMSQ) score, and 20-item word recall. Prospective cohort study. Washington and Iowa counties, Iowa. Iowa Established Populations for Epidemiologic Studies of the Elderly (N = 3,673; aged > or =65; 61.3% female; 99.9% white). Age, sex, education, SPMSQ score, 20-item word recall, ADL or instrumental ADL disability, and chronic medical conditions. The prevalence of memory complaint was 34%. Although proportionally more cognitively impaired individuals were in the memory complaint group (34% vs 27%), the pattern of subclassification into cognitively intact and MCI Stage 1 and 2 subgroups was similar for people with and without memory complaint. Median SPMSQ score and number of words recalled at baseline were comparable across memory complaint categories in each subgroup. MCI participants without subjective memory complaint constituted a larger proportion of the overall sample than individuals with subjective memory complaint (460 (14%) vs 295 (8.9%)) and of persons objectively classified as having MCI (61% vs 39%). The distribution of individual 10-year change in ADL disability, SPMSQ score, and word recall were similar for those with and without memory complaint across all subgroups of cognitive impairment. Memory complaint is not necessary for MCI diagnosis and does not distinguish cases with different progression rates in disability or cognitive impairment. 2006.
, David Margolis Md, , Ann L. Gruber-Baldini, J. Richard Hebel, , Jay Magaziner
Published: 19 July 2004
Journal of the American Geriatrics Society, Volume 52, pp 1293-1298; https://doi.org/10.1111/j.1532-5415.2004.52358.x

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, Eva Kiesswetter,
Published: 28 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2746-2748; https://doi.org/10.1111/jgs.15103

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Rafael Lomas‐Vega, , Francisco Javier Molina‐Ortega,
Published: 28 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2748-2749; https://doi.org/10.1111/jgs.15156

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, Renee E. Labor, Nancy E. Freeborne, Robert L. Jayes, Diane E. Campbell, Joanne Lynn
Published: 1 January 2005
Journal of the American Geriatrics Society, Volume 53, pp 66-73; https://doi.org/10.1111/j.1532-5415.2005.53012.x

Abstract:
To study end-of-life care of a representative sample of older people using qualitative interpretation of administrative claims by clinicians and to explore whether this method yields insights into patient care, including continuity, errors, and cause of death. Random, stratified sampling of decedents and all their Medicare-covered healthcare claims in the 3 years before death from a 5% sample of elderly fee-for-service beneficiaries, condensation of all claims into a chronological clinical summary, and abstraction by two independent clinicians using a standardized form. United States. One hundred Medicare fee-for-service older people without disability or end-stage renal disease entitlement who died in 1996 to 1999 and had at least 36 months of continuous Part A and Part B enrollment before death. Qualitative narrative of the patient's medical course; clinician assessment of care continuity and apparent medical errors; cause, trajectory, and place of death. The qualitative narratives developed by the independent abstracters were highly concordant. Clinicians felt that 75% of cases lacked continuity of care that could have improved the quality of life and the way the person died, and 13% of cases had a medical error identified by both abstracters. Abstracters disagreed about assignment of a single cause of death in 28% of cases, and abstracters and the computer algorithm disagreed in 43% of cases. Qualitative claims analysis illuminated many problems in the care of chronically ill older people at the end of life and suggested that traditional vital statistics assignation of a single cause of death may distort policy priorities. This novel approach to claims review is feasible and deserves further study.
Martine T. E. Puts Msc, ,
Published: 22 December 2004
Journal of the American Geriatrics Society, Volume 53, pp 40-47; https://doi.org/10.1111/j.1532-5415.2005.53008.x

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, Jack M. Guralnik, Jeff D. Williamson, Linda P. Fried, Crystal Simpson, Eleanor M. Simonsick, Brenda W. J. H. Penninx
Published: 22 December 2004
Journal of the American Geriatrics Society, Volume 53, pp 34-39; https://doi.org/10.1111/j.1532-5415.2005.53007.x

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Published: 1 September 2004
Journal of the American Geriatrics Society, Volume 52, pp 1430-1434; https://doi.org/10.1111/j.1532-5415.2004.52403.x

Abstract:
To evaluate emergency medical technicians' (EMTs) experiences with the Physician Orders for Life-Sustaining Treatment (POLST) program and learn about attitudes regarding its effectiveness. Anonymous survey mailed to a stratified random sample. Tri-County Portland, Oregon, area. A total of 572 Oregon EMT respondents (out of 1,048 surveys) were included in the analysis. Survey questions about experiences with the POLST form and opinions about POLST. Respondents were mostly male (76%) and paramedics (66%). Most respondents (73%) had treated a patient with a POLST, and 74% reported receiving education about POLST. EMTs reported that POLST, when present, changed treatment in 45% of cases. Seventy-five percent of the respondents agreed that the POLST form provides clear instructions about patient preferences, and 93% agreed that the POLST form is useful in determining which treatments to provide when the patient is in cardiopulmonary arrest. Fewer (63%) agreed that the form is useful in determining treatments when the patient has a pulse and is breathing. Most respondents have experience with the POLST program. EMTs find the POLST form useful and often use it to change treatment decisions for patients.
Published: 25 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2727-2732; https://doi.org/10.1111/jgs.15139

Abstract:
This study aimed to examine the relationship between disability and the American Heart Association metric of ideal cardiovascular health (CVH) in older adults from the 2009-10 Chilean National Health Survey. Data from 460 older adults were analyzed. All subjects were interviewed using the standardized World Health Survey, which includes 16 health-related questions and assesses the domains of mobility, self-care, pain and discomfort, cognition, interpersonal activities, vision, sleep and energy, and affect. A person who responds with a difficulty rating of severe, extreme, or unable to do in at least one of these eight functioning domains is considered to have a disability. Ideal CVH was defined as meeting the ideal levels of four behaviors (smoking, body mass index, physical activity, diet adherence) and three factors (total cholesterol, fasting glucose, blood pressure). Logistic regression analysis suggested that ideal physical activity reduces the odds of disability (odds ratio (OR) = 0.55, 95% confidence interval (CI) = 0.36-0.85). Moreover, participants with intermediate (3-4 metrics) (OR = 0.63, 95% CI = 0.41-0.97) and ideal (5-7 metrics) (OR = 0.51, 95% CI = 0.24-0.97) CVH profiles had lower odds of disability independent of history of vascular events and arthritis disease than those with a poor profile (0-2 metrics). In conclusion, despite the cross-sectional design, this study suggests the importance of promoting ideal CVH because of their relationship with disability.
, , William E. Haley, Virginia J. Howard, David L. Roth, Monika M. Safford, Meredith L. Kilgore
Published: 26 October 2017
Journal of the American Geriatrics Society, Volume 66, pp 133-139; https://doi.org/10.1111/jgs.15166

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, Michael C. Jernigan, Yuchiao Chang, , John Hsu, Joshua P. Metlay Md,
Published: 26 October 2017
Journal of the American Geriatrics Society, Volume 66, pp 100-105; https://doi.org/10.1111/jgs.15150

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Angela M. Abbatecola, Luigi Ferrucci, Rodolfo Grella, , Massimiliano Bonafã¨, , Anna M. Corsi, , ,
Published: 12 February 2004
Journal of the American Geriatrics Society, Volume 52, pp 399-404; https://doi.org/10.1111/j.1532-5415.2004.52112.x

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Published: 1 November 2003
Journal of the American Geriatrics Society, Volume 51, pp 1610-1614; https://doi.org/10.1046/j.1532-5415.2003.51512.x

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Rebekah Harris, Yuefang Chang, Kristen Beavers, , , Karen Johnson, Meryl LeBoff, Catherine Womack, Robert Wallace, Wenjun Li, et al.
Published: 27 September 2017
Journal of the American Geriatrics Society, Volume 65, pp 2673-2678; https://doi.org/10.1111/jgs.15050

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, T. T. Minh Vu, Nathalie Veillette, , Alain Vadeboncoeur, Antonio Ciampi, Deniz Cetin‐Sahin, Eric Belzile
Published: 27 September 2017
Journal of the American Geriatrics Society, Volume 66, pp 394-400; https://doi.org/10.1111/jgs.15137

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Peter A. Boling
Published: 27 September 2017
Journal of the American Geriatrics Society, Volume 65, pp 2557-2558; https://doi.org/10.1111/jgs.15024

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Yun Wang, Erica S. Spatz, Maliha Tariq, Suveen Angraal,
Published: 27 September 2017
Journal of the American Geriatrics Society, Volume 65, pp 2572-2579; https://doi.org/10.1111/jgs.14987

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, , Tobie Olsan, Xeuya Cai, Stuti Dang, Orna Intrator, Jiejin Li, Shan Gao, ,
Published: 27 September 2017
Journal of the American Geriatrics Society, Volume 65, pp 2697-2701; https://doi.org/10.1111/jgs.15126

Abstract:
To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans.
, Yan Yang, , Sharon Tapper, Steve Lai, Peter Yu, , Christine Ritchie
Published: 24 October 2017
Journal of the American Geriatrics Society, Volume 66, pp 327-332; https://doi.org/10.1111/jgs.15145

Abstract:
With the growing public demand for access to critical health data across care settings, it is essential that advance care planning (ACP) information be included in the electronic health record (EHR) so that multiple clinicians can access it and understand individuals' preferences for end-of-life care. Community-based palliative care programs often incorporate ACP services. This study examined whether a community-based palliative care program is associated with digitally extractable ACP documentation in the EHR. Observational study using propensity score-weighted generalized estimation equations to examine patterns of digitally extractable ACP documentation. Palo Alto Medical Foundation (PAMF), a multispecialty ambulatory healthcare system in northern California. Individuals aged 65 and older with serious illnesses between January 1, 2013, and December 31, 2014 (N = 3,444). Community-based palliative care program in PAMF. Digitally extractable ACP in EHR. We found that only 14% (n = 483) of individuals with serious illnesses had digitally extractable ACP in electronic health records. Of the 6% of individuals receiving palliative care, 65% had ACP, versus 11% of those not receiving palliative care. Study results showed a strong positive association between palliative care and ACP. Only a small percentage of individuals with serious illnesses had ACP documentation in the EHR. Individuals with serious illnesses infrequently used palliative care delivered by board-certified palliative care specialists. Palliative care service use was associated with higher rates of ACP after controlling for organizational and individual characteristics using a propensity score weighting method. Scalable interventions targeted at non-palliative care clinicians for universal access to ACP are needed.
, Harold W. Neighbors, Marcia Valenstein, Frederic C. Blow, John F. McCarthy, Rosalinda V. Ignacio, Leah Gillon, Alan M. Mellow, Kiran K.-K. Taylor
Journal of the American Geriatrics Society, Volume 53, pp 777-784; https://doi.org/10.1111/j.1532-5415.2005.53255.x

Abstract:
To examine primary care physician (PCP) contributions toward racial and sex differences in the diagnosis and treatment of late-life depression. Design : Survey using a computerized instrument incorporating video interviews and text, with volunteer PCPs randomly assigned to one of four standardized video vignettes of an elderly patient depicting late-life depression. Vignettes differed only in the patient/actor's race (white/African-American) or sex. Setting : American Academy of Family Physicians meeting, San Diego, California, 2002. Participants : One hundred seventy-eight U.S.-practicing postresidency PCPs who were asked to participate in a clinical decision-making study. Measurements : The computerized survey instrument assessed PCPs' diagnoses, first-line treatment and management recommendations, and judgment of personal characteristics/behaviors for the patients in the vignettes. Results : Eighty-five percent of all PCPs correctly diagnosed the elderly patient(s) with major depression. There were no significant differences in the diagnosis of depression, treatment recommendations, or PCP assessment of most patient characteristics by the race or sex of the patient/actor in the vignette, but PCP characteristics, most notably the location of medical school training (U.S. vs international), affected the likelihood of a depression diagnosis and treatment recommendations. Conclusion : Given standardized symptom-pictures, PCPs are just as likely to diagnose and treat depression in African-American as in white older people, suggesting that bias based simply on apparent patient race is not a likely explanation for the lower rates of depression diagnosis and treatment in older African Americans. PCPs who have trained at international medical schools may benefit from targeted training initiatives on the diagnosis and treatment of late-life depression
, Linda P. Fried, Qian-Li Xue, Jeremy Walston, Sean X. Leng, Richard D. Semba
Journal of the American Geriatrics Society, Volume 53, pp 747-754; https://doi.org/10.1111/j.1532-5415.2005.53250.x

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Sutapa Maiti, Liron Sinvani, Michele Pisano, , Vidhi Patel, Meredith Akerman, Karishma Patel, Christopher Smilios, Christian Nouryan, Guang Qiu, et al.
Published: 20 October 2017
Journal of the American Geriatrics Society, Volume 66, pp 70-75; https://doi.org/10.1111/jgs.15127

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, Fatiha Najioullah, Seendy Bartholet, Sébastien Colas, Sergio Yactayo, , Jean-Luc Fanon, Raymond Césaire, Moustapha Dramé
Published: 21 September 2017
Journal of the American Geriatrics Society, Volume 65, pp 2510-2515; https://doi.org/10.1111/jgs.15004

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, Eric B. Larson, Jane B. Shofer Ms, Paul K. Crane, Laura E. Gibbons, Wayne McCormick, James D. Bowen, Mary Lou Thompson, Ge Li Md, Mph Eric B. Larson Md
Published: 21 September 2017
Journal of the American Geriatrics Society, Volume 65, pp 2627-2633; https://doi.org/10.1111/jgs.15077

Abstract:
Background/Objectives Longitudinal studies have shown an increase in cognitive decline many years before clinical diagnosis of dementia. We sought to estimate changes, relative to “normal” aging, in the trajectory of scores on a global cognitive function test—the Cognitive Abilities Screening Instrument (CASI). Design A prospective cohort study. Setting Community‐dwelling members of a U.S. health maintenance organization. Participants Individuals aged 65 and older who had no dementia diagnosis at baseline and had at least two visits with valid CASI test score (N = 4,315). Measurements Average longitudinal trajectories, including changes in trajectory before clinical diagnosis in those who would be diagnosed with dementia, were estimated for CASI item response theory (IRT) scores. The impact of sex, education level, and APOE genotype on cognitive trajectories was assessed. Results Increased cognitive decline relative to “normal” aging was evident in CASI IRT at least 10 years before clinical diagnosis. Male gender, lower education, and presence of ≥1 APOE ε4 alleles were associated with lower average IRT scores. In those who would be diagnosed with dementia, a trajectory change point was estimated at an average of 3.1 years (95% confidence interval 3.0‐3.2) before clinical diagnosis, after which cognitive decline appeared to accelerate. The change point did not differ by sex, education level, or APOE ε4 genotype. There were subtle differences in trajectory slopes by sex and APOE ε4 genotype, but not by education. Conclusion Decline in average global cognitive function was evident at least 10 years before clinical diagnosis of dementia. The decline accelerated about 3 years before clinical diagnosis.
Published: 21 September 2017
Journal of the American Geriatrics Society, Volume 65, pp 2529-2534; https://doi.org/10.1111/jgs.15104

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, Evelyn Horn, Alex Reyentovich, Victoria Vaughan Dickson, Sean Pinney, Deena Goldwater Md, Nathan E. Goldstein, Omar Jimenez, Sergio Teruya, Jeff Goldsmith, et al.
Published: 21 September 2017
Journal of the American Geriatrics Society, Volume 65, pp 2383-2390; https://doi.org/10.1111/jgs.15124

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, Stavroula A Chrysanthopoulou, Christine M Ulbricht, Anne L Hume, Jennifer Tjia, Kate L Lapane
Published: 21 September 2017
Journal of the American Geriatrics Society, Volume 66, pp 48-55; https://doi.org/10.1111/jgs.15080

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, Sadia Sharmin, Yoojin Lee, Lori A. Daiello, Nishant R. Shah, W. John Boscardin, , Sei J. Lee,
Published: 17 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2397-2404; https://doi.org/10.1111/jgs.15144

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, Mary Geda, Terrence E. Murphy, Sui Tsang, Mary E. Tinetti, Sarwat I. Chaudhry
Published: 18 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2391-2396; https://doi.org/10.1111/jgs.15102

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Ailian Hei,
Published: 17 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2720-2726; https://doi.org/10.1111/jgs.15147

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, Priscilla Gazarian, Neil Alexander, Katy Araujo, Dorothy Baker, Jonathan F. Bean, Chad Boult, Peter Charpentier, Pamela Duncan, Nancy Latham, et al.
Published: 17 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2733-2739; https://doi.org/10.1111/jgs.15121

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, Kala M. Mehta, , W. John Boscardin, Richard H. Fortinsky, Robert M. Palmer, C. Seth Landefeld
Published: 23 November 2012
Journal of the American Geriatrics Society, Volume 60, pp 2254-2262; https://doi.org/10.1111/jgs.12008

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Richard A. Dennis, Larry E. Johnson, Paula K. Roberson, Muhannad Heif, Melinda M. Bopp, Kimberly K. Garner, Kalpana P. Padala, , Patricia M. Dubbert, Dennis H. Sullivan
Published: 23 November 2012
Journal of the American Geriatrics Society, Volume 60, pp 2246-2253; https://doi.org/10.1111/jgs.12007

Abstract:
To determine the relationships between physical function, systemic inflammation, and nutrient intake in elderly adults who are deconditioned or recovering from medical illness. Prospective observational study. Recuperative care and rehabilitation setting of a Veterans Affairs hospital. Older adults assessed to be in need of and likely to benefit from specialized inpatient care (N = 336, aged 78.9 ± 7.5, median length of stay 24 days). Functional assessments and plasma analyses for albumins and inflammatory markers were performed at admission and discharge. Complete nutrient intake assessments were performed daily. Katz (independence in activities of daily living) and walking endurance (distance capability and summation of need for assistive device and human help) scores were based on direct observation and provider query. Data were analyzed using least-squares and logistic regression analyses. Changes in physical function between admission and discharge were positively correlated with change in nutrient intake and inversely correlated with inflammation at admission and its change. Participants in the upper quartile of change for nutrient intake (particularly improved protein intake) were two to three times as likely to experience a clinically significant change in functional status during the hospitalization. Similarly, the odds of experiencing an improvement in physical function were two to four times as great for participants whose C-reactive protein levels declined as for those whose levels increased. These relationships remained significant after controlling for age, length of stay, and other baseline indicators of health status. Protein intake and inflammation are significantly correlated with functional recovery for aging individuals undergoing recuperative care and rehabilitation. Future studies should investigate whether combined interventions that target these factors improve recovery during hospitalization for this population.
, Sophie Austin, Lauren Cohen, David Reed, Patricia Poole, Kimberly Ward, Philip D. Sloane
Published: 12 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2516-2521; https://doi.org/10.1111/jgs.15061

Abstract:
The poor oral hygiene of nursing home (NH) residents is a matter of increasing concern, especially because of its relationship with pneumonia and other health events. Because details and related risk factors in this area are scant and providers need to be able to easily identify those residents at most risk, this study comprehensively examined the plaque, gingival, and denture status of NH residents, as well as readily available correlates of those indicators of oral hygiene, including items from the Minimum Data Set (MDS). Oral hygiene assessment and chart abstract conducted on a cross-section of NH residents. NHs in North Carolina (N = 14). NH residents (N = 506). Descriptive data from the MDS and assessments using three standardized measures: the Plaque Index for Long-Term Care (PI-LTC), the Gingival Index for Long-Term Care (GI-LTC), and the Denture Plaque Index (DPI). Oral hygiene scores averaged 1.7 (of 3) for the PI-LTC, 1.5 (of 4) for the GI-LTC, and 2.2 (of 4) for the DPI. Factors most strongly associated with poor oral hygiene scores included having dementia, being on hospice care, and longer stay. MDS ratings of gingivitis differed significantly from oral hygiene assessments. The findings identify resident subgroups at especially high risk of poor oral health who can be targeted in quality improvement efforts related to oral hygiene; they also indicate need to improve the accuracy of how MDS items are completed.
Comment
Elizabeth C. Gundersen, Mandi M. Sehgal, Joseph G. Ouslander
Published: 9 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2452-2454; https://doi.org/10.1111/jgs.15010

, Dominique Bonnet‐Zamponi, , , Sandra Laribe‐Caget, Patrick Frémont, Eric Pautas, Christiane Verny, ,
Published: 9 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2713-2719; https://doi.org/10.1111/jgs.15081

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, Eilidh E. C. Ferguson, Amanda J. Barugh, , Alasdair M. J. MacLullich, ,
Published: 9 October 2017
Journal of the American Geriatrics Society, Volume 66, pp 161-169; https://doi.org/10.1111/jgs.15101

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Ana Carmen Dos Santos Ribeiro Simoe Juliano, , Jéssica Teixeira Santos Da Silva, Letícia Gomes Santos, Jéssica Borges Taranto Nunes, Guilherme Cortes Fernandes,
Published: 4 October 2017
Journal of the American Geriatrics Society, Volume 66, pp 383-388; https://doi.org/10.1111/jgs.15138

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Chanunya Srihawan, Onaizah Habib, Lucrecia Salazar,
Published: 4 October 2017
Journal of the American Geriatrics Society, Volume 65, pp 2646-2650; https://doi.org/10.1111/jgs.15099

Abstract:
Healthcare-associated meningitis or ventriculitis (HCAMV) is a serious and life-threatening complication of invasive neurosurgical procedures or penetrating head trauma. Older adults are at higher risk of adverse outcomes in community-acquired meningitis but studies of HCAMV are lacking. Therefore, we perform the study to define the differences in clinical outcomes between older and younger adults with HCAMV.Retrospective study.A large tertiary care hospital in Houston, Texas, from July 2003 to November 2014.Adults with a diagnosis of HCAMV (N = 160) aged ≥65 (n = 35), aged 18-64 (n = 125).Demographic characteristics, clinical presentation, laboratory results, treatments, and outcomes (Glasgow Outcome Scale).Older adults had more comorbidities and CSF abnormalities [pleocytosis, high cerebrospinal fluid (CSF) protein, low CSF glucose) and were more likely to have altered mental status than younger adults (P < .05). An adverse clinical outcome was seen in 142 participants (89%) (death (n = 18, 11%), persistent vegetative state (n = 26, 16%), severe disability (n = 68, 43%), moderate disability (n = 30, 19%). There was no difference in adverse outcomes between older (97%) and younger (86%) adults (P = .13). On logistic regression analysis, abnormal neurological examination (adjusted odds ratio (aOR) = 7.13, 95% confidence interval (CI) = 2.15-23.63, P = .001) and mechanical ventilation (aOR = 11.03, 95% CI = 1.35-90.51, P = .02) were associated with adverse clinical outcomes.Older adults with HCAMV have more comorbidities and CSF abnormalities and are more likely to have altered mental status than younger adults but have similar high rates of adverse clinical outcomes.
Marzena Gieniusz, Liron Sinvani, , , Christian Nouryan, , Nina Kohn, , Gisele Wolf‐Klein
Published: 4 October 2017
Journal of the American Geriatrics Society, Volume 66, pp 64-69; https://doi.org/10.1111/jgs.15125

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