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Retornaz F, Grino M, Mari L, Oliver C. Assessment of Glycemic Control in Nursing Home Residents with Diabetes. J Nutr Health Aging 2017; 21:457-463. [PMID: 28346573 DOI: 10.1007/s12603-016-0776-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe glycemic control in nursing home residents with diabetes and to evaluate the relevance of HbA1c in the detection of hypoglycemia risk. DESIGN AND METHODS Diabetes treatment, geriatric assessment, blood capillary glucose (n= 24,682), and HbA1c were collected from medical charts of 236 southern France nursing home residents during a 4-month period. Glycemic control was divided into four categories: tight, fair, and moderate or severe chronic hyperglycemia using the High Blood Glucose Index or the analysis of blood glucose frequency distribution. Hypoglycemia episodes were identified by medical or biological records. RESULTS Glucose control was tight in 59.3 % and fair in 19.1 % of the residents. Chronic exposure to hyperglycemia was observed in 21.6 % of the residents (severe in 9.7 % and moderate in 11.9 %). Hypoglycemia was noticed in 42/236 (17.8%), in all categories of glycemic control. Relative hypoglycemia risk was significantly (P = 0.0095) higher in residents with moderate chronic hyperglycemia compared with those with tight control. The majority of residents with hypoglycemia (39/42) or chronic hyperglycemia (45/51) were insulin-treated. The relative risk of hypoglycemia was not significantly associated with HbA1c values. CONCLUSION Hypoglycemia risk in nursing home residents is observed in all categories of glycemic control. In tight control, the potency of antidiabetic treatment should be reduced. In chronic hyperglycemia, diet and treatment should be reevaluated in order to reduce glucose variability. HbA1c is not sufficient for hypoglycemia risk detection; capillary blood glucose monitoring is warranted for nursing homes residents with diabetes.
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Affiliation(s)
- F Retornaz
- Dr Charles Oliver, Division of Geriatric Medicine, State Geriatric Centre, 176 Avenue de Montolivet, 13012 Marseille, Tel: 04 91 12 75 49, Fax: 04 91 12 75 52, e-mail:
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Sieng S, Thinkamrop B, Laohasiriwong W, Hurst C. Comparison of HbA1c, blood pressure, and cholesterol (ABC) control in type 2 diabetes attending general medical clinics and specialist diabetes clinics in Thailand. Diabetes Res Clin Pract 2015; 108:265-72. [PMID: 25737034 DOI: 10.1016/j.diabres.2015.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 11/04/2014] [Accepted: 02/06/2015] [Indexed: 11/21/2022]
Abstract
AIMS The aim of this study was to compare the achievement of clinical targets for patients with type 2 diabetes mellitus (T2DM) in general medical clinics (GMCs) and specialist diabetes clinics (SDCs) for different hospital types (regional, provincial and community) in Thailand. METHODS We used the medical records of patients (n=26,860) with T2DM from 595 hospitals (26 regional, 70 provincial and 499 community) across all 77 provinces in Thailand. Generalized linear mixed models were used to conduct multi-level modeling to evaluate the achievement of individual outcomes (A - glycated hemoglobin (HbA1c) <7.0% (53 mmol/mol), B - Blood Pressure (BP) <140/80 mmHg and C - LDL-Cholesterol <100mg/dL) and aggregated outcomes (AllABC - achieved all three of the targets, AnyABC - achieved at least one target, ABCcount - the number of targets achieved: 0, 1, 2 or 3). RESULTS Neither clinic types (SDCs or GMCs) were consistency superior across all hospital types. For regional hospitals, SDCs were associated with higher odds of achieving BP, AnyABC, and ABCcount (OR=1.55, 95%CI: 1.25-1.92, p<0.001; OR=1.35, 95%CI: 1.02-1.79; p=0.04; RR=1.10, 95%CI: 1.01-1.20, p=0.03, respectively). For provincial hospitals, SDCs exhibited higher achievement of BP and LDL-C (OR=1.52, 95%CI: 1.23-1.87, p<0.001; OR=1.28, 95%CI: 1.04-1.58, p=0.02, respectively). For community hospitals, however GMCs demonstrated higher achievement of BP and AnyABC (OR=0.81, 95%CI: 0.67-0.98, p=0.03; OR=0.74, 95%CI: 0.56-0.97, p=0.03, respectively). CONCLUSIONS In larger (regional and provincial) hospitals, SDCs outperform GMCs in several (but not all) clinical targets. In contrast, in community hospital, where most patients with T2DM are serviced, GMCs were shown to have superior performance.
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Affiliation(s)
- Sokha Sieng
- Faculty of Public Health, Khon Kaen University, Thailand; Ministry of Education, Youth and Sport, Cambodia
| | | | | | - Cameron Hurst
- Faculty of Public Health, Khon Kaen University, Thailand.
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Sanford A, Morley JE. Are the New Guidelines for Cholesterol and Hypertension Age Friendly? J Am Med Dir Assoc 2014; 15:373-5. [DOI: 10.1016/j.jamda.2014.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 01/08/2023]
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How to Manage Diabetes Mellitus in Older Persons in the 21st Century: Applying These Principles to Long Term Diabetes Care. J Am Med Dir Assoc 2013; 14:777-80. [DOI: 10.1016/j.jamda.2013.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 12/25/2022]
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Hager KK, Loprinzi P, Stone D. Implementing diabetes care guidelines in long term care. J Am Med Dir Assoc 2013; 14:851.e7-15. [PMID: 23910151 DOI: 10.1016/j.jamda.2013.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 05/23/2013] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objectives of this article are to (1) describe the outcomes of a diabetes care program in a long term care facility dedicated to diabetes excellence and (2) compare the relevant outcome variables of research published between 2007 and 2012 with the results found in the studied facility. DESIGN Three-year retrospective chart review of the facility's residents with comparison to extant literature. PARTICIPANTS A total of 224 resident charts within the studied facility were reviewed. Residents with a diagnosis of diabetes, or who were on diabetes medications, or whose fasting blood sugars exceeded 126 mg/dL on 2 occasions, and whose length of stay exceeded 6 months, were tracked for adherence to diabetes guidelines (n = 48). Participant outcomes from relevant studies in the literature were compared to these 48 participants' outcomes. INTERVENTION All levels of staff in the studied facility were educated in general diabetes care. A nurse practitioner was contracted to provide medical care for all diabetic residents (with primary care provider approval). A scorecard for adherence to diabetes guidelines was completed by the nurse practitioner. Over a 3-year period following the education program and scorecard implementation, a chart review of all residents was completed by a consulting diabetes educator/nurse practitioner/nurse faculty member and 6 undergraduate nursing students. RESULTS In general, the nursing home in the present study compared favorably with other relevant studies, demonstrating lower A1C levels, tracking blood sugars more regularly, monitoring blood pressure and lipids more regularly, having a greater percentage of patients on lipid-lowering medications among those in need, more appropriate use of sliding scale insulin, greater adherence to recommendations regarding diet, and had more patients who fit criteria on preventive anticoagulation. DISCUSSION The results for the studied facility were very similar, often better, when compared with the most current nursing home literature. Areas of weakness provided focused strategic planning for the facility. Regrettably, the research is sparse, and evidence supporting guideline adherence data is often missing, making data comparison difficult. This model of care, linking health care agencies with academia, could offer a supportive and affordable method for identifying responses to evidence-based care guidelines. CONCLUSION This narrative review points to the need for continued work in the application of evidence-based guidelines in long term care, specifically in the area of interventions that must be adjusted to the needs of the nursing home population, with increased awareness in maintaining or improving quality of life.
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Affiliation(s)
- Kathy K Hager
- Signature Healthcare, Louisville, KY; Bellarmine University, Louisville, KY.
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Morley JE. Diabetes Mellitus: “The Times They Are A-Changin”. J Am Med Dir Assoc 2012; 13:574-5. [DOI: 10.1016/j.jamda.2012.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/08/2012] [Indexed: 12/27/2022]
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Tracking outpatient continuity and chronic disease indicators-a novel use of the new innovations clinic module. Am J Ther 2012; 19:76-80. [PMID: 22354126 DOI: 10.1097/mjt.0b013e31822119eb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Accreditation Council for Graduate Medical Education common program requirements for Practice-based Learning and Improvement in Internal Medicine specify that trainees must "systematically analyze [his/her] practice using quality improvement methods, and implement changes with the goal of practice improvement" and that the training program "must include use of performance data" in the assessment of the resident's practice. Before implementation of an electronic health record at our academic medical center, we found meeting these requirements to be challenging. This prompted us to set up the New Innovations (New Innovations, Inc, Uniontown, OH) Software Suite's Patient Continuity module to permit analysis and tracking of both quality of care indicators and patient continuity. By using the system, our residents were better able to monitor their patient panel sizes and composition and to correlate their practices with quality of care data. Residency programs, which currently utilize New Innovations software but lack an electronic health record, may find the continuity clinic module useful for engaging their house staff in structured practice improvement initiatives and in satisfying the Accreditation Council for Graduate Medical Education's common program requirements for practice-based learning.
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Basso A, Peruzzi P, Carollo MC, Improta G, Fedeli U. Assessment of glycemic control among diabetic residents in nursing homes. Diabetes Res Clin Pract 2012; 96:e80-3. [PMID: 22445232 DOI: 10.1016/j.diabres.2012.02.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/17/2012] [Accepted: 02/27/2012] [Indexed: 12/20/2022]
Abstract
We assessed hemoglobin A1c (HbA1c) among 88 diabetic residents in three Italian nursing homes, and compared figures with current guidelines and reports in the literature. Mean HbA1c was 6.5%; this paper from Southern Europe confirms recent findings in nursing homes on HbA1c values well below recommended targets.
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[Prevalence of diabetes mellitus in geriatric patients in nursing homes of Cádiz. Diagerca study]. Rev Esp Geriatr Gerontol 2012; 47:114-8. [PMID: 22578323 DOI: 10.1016/j.regg.2011.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 10/17/2011] [Accepted: 11/07/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine prevalence and clinical characteristics of elderly diabetic patients in nursing homes. MATERIAL AND METHOD Observational and multicentre study in 14 nursing homes in Cádiz (Spain). STUDY VARIABLES age, sex, prevalence of diabetes, duration of diabetes, complications, macrovascular complications, retinopathy, nephropathy, and neuropathy. Metabolic control: frequency of baseline blood glucose and HbA1c determinations. Metabolic complications suffered. TREATMENT oral and type of antidiabetics, insulinisation. Diabetes education. Functional and mental assessment using Barthel index and MMT. Data was analysed using SPSS v17.0. RESULTS A total of 1952 elderly institutionalised patients were studied, with a diabetes prevalence of 26.44%. The study included 312 patients with a mean age of 79.7 years, of whom 57.4% were women, and 66.9% knew of their diagnosis of diabetes for over 10 years. Vascular events were suffered by 55.1%, with the most common being ischaemic stroke (55.2%), followed by myocardial infarction (18%) and 14.5% with peripheral arterial disease. There were 29.6% with retinopathy, 21.3% diabetic nephropathy, and 25.6% suffering from distal symmetric polyneuropathy. HbA1c analysis was performed in 90.1% of patients, with 50% levels between 7 and 9%, with a six-monthly assessment rate of 63.4%. Metabolic complications: diabetic ketoacidosis 7.1%, hyperosmolar syndrome 2.9%, and 15.7% symptomatic hypoglycaemia. Oral hypoglycaemic agents were being taken by 66% of patients, with the most frequently used being metformin (55.3%) followed by gliclazide and repaglinide (10.2%, 3.4%, respectively). 50.2% were insulinised. 45.6% functional dependence. Barthel Index average of 48.4 points, with 46.1% diagnosed with dementia, moderate state, 36.7%. CONCLUSIONS Diabetic prevalence in nursing homes is high, and institutionalised patients are elderly, long-standing diabetics, with both macro- and microvascular complications, and have a significant level of mental and functional disabilities.
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Zekry D, Frangos E, Graf C, Michel JP, Gold G, Krause KH, Herrmann FR, Vischer UM. Diabetes, comorbidities and increased long-term mortality in older patients admitted for geriatric inpatient care. DIABETES & METABOLISM 2011; 38:149-55. [PMID: 22115993 DOI: 10.1016/j.diabet.2011.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/05/2011] [Accepted: 10/05/2011] [Indexed: 12/25/2022]
Abstract
AIMS To study the specific impact of diabetes on long-term mortality in very old subjects with multiple comorbidities and functional disabilities. METHODS The prevalence of vascular disorders, global comorbidity load (cumulative illness rating scale [CIRS]) and functional disabilities (activities of daily living [ADL] and Lawton's instrumental ADL [IADL] scores) were determined according to diabetes status in a cohort of 444 patients (mean age 85.3±6.7 years; 74.0% women) admitted to our geriatric service. Also, the specific impact of diabetes on 4-year mortality was analyzed using Cox proportional-hazards models. RESULTS Diabetic patients had higher BMI scores (27.1±4.9 vs. 23.4±4.7 kg/m(2) in controls; P<0.001), and higher prevalences of hypertension (81.9% vs. 65.1%, respectively; P=0.003) and ischaemic heart disease (33.7% vs. 22.2%, respectively; P=0.033), but not of stroke and renal insufficiency. They also had more comorbidities (CIRS score excluding diabetes: 15.1±4.5 vs. 13.8±4.8, respectively; P=0.016) and functional disabilities. Diabetes was associated with mortality (HR: 1.42, 95% CI: 1.02-1.99; P=0.041) after adjusting for age, gender and BMI, and this persisted after adjusting for individual vascular comorbidities, but disappeared after adjusting for CIRS, ADL or IADL scores. CONCLUSION Diabetes was associated with 4-year mortality after adjusting for the inverse relationship between mortality and BMI. This association was better accounted for by the global comorbidity load and functional disabilities than by the individual vascular comorbidities. These findings suggest that the active management of all--rather than selected--comorbidities is the key to improving the prognosis for older diabetic patients.
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Affiliation(s)
- D Zekry
- Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, 3 chemin du Pont-Bochet, Thônex, Switzerland
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Messinger-Rapport BJ, Morley JE, Thomas DR, Gammack JK. Clinical Update on Nursing Home Medicine: 2011. J Am Med Dir Assoc 2011; 12:615-626.e6. [DOI: 10.1016/j.jamda.2011.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 08/17/2011] [Indexed: 12/30/2022]
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Migdal A, Yarandi SS, Smiley D, Umpierrez GE. Update on Diabetes in the Elderly and in Nursing Home Residents. J Am Med Dir Assoc 2011; 12:627-632.e2. [DOI: 10.1016/j.jamda.2011.02.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 02/17/2011] [Accepted: 02/17/2011] [Indexed: 01/25/2023]
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Dybicz SB, Thompson S, Molotsky S, Stuart B. Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents. ACTA ACUST UNITED AC 2011; 9:212-23. [PMID: 21659006 DOI: 10.1016/j.amjopharm.2011.05.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the reported prevalence of diabetes in nursing home residents varies greatly among studies, there remains a common trend: increasing prevalence. Diabetes in the elderly is often associated with the presence of multiple comorbid conditions. However, limited data exist regarding the characteristics, symptom severity, disease management, and outcomes of care for residents of nursing homes with diabetes. OBJECTIVE Our aim was to estimate the prevalence of diabetes in a national sample of skilled nursing facility (SNF) residents over a 12-month period and to examine differences in the burden of comorbidities between elderly residents with and without diabetes, including prevalence and severity of comorbidities, pharmacotherapy associated with these conditions, and cost. METHODS This was a multicenter, observational, medical utilization evaluation study in 23 geographically representative SNFs in the United States. Comorbidities, cognition, physical activity, utilization of health services, and medications were obtained from medical chart audits, minimum data set records, and prescription claims files. Chart abstraction was performed between June 2006 and March 2007. Residents eligible for inclusion in the prevalence analysis were aged ≥65 years, did not receive hospice care, and were not in a persistent vegetative condition. RESULTS A total of 2317 residents met the inclusion criteria and were included in the prevalence analysis; 761 (32.8%) had diabetes. Residents with a full minimum data set assessment within 12 months before chart abstraction (n = 2095) were included in the comorbid burden analysis. Compared with those without diabetes, a greater proportion of residents with diabetes were younger, male, Hispanic or African American, and were overweight or obese. Residents with diabetes had a greater comorbidity burden (Hierarchical Condition Category, 1.90 vs 1.58), including more prescribed medications for certain common comorbid conditions (including angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers [46% vs 24%], diuretics [44% vs 34%], statins [40% vs 18%], or antiplatelets/antithrombotics [43% vs 37%]), and experienced more hospitalizations (37% vs 18% at 6 months) than residents without diabetes. CONCLUSION Nearly one third of elderly SNF residents had diabetes. These patients, compared with SNF residents without diabetes, had a greater comorbid burden, were prescribed more medications to treat these conditions, and had more hospitalizations.
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Affiliation(s)
- Sharon B Dybicz
- Omnicare Senior Health Outcomes LLC, King of Prussia, Pennsylvania, USA
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Aronow WS. Prognostic Value of Cardiac Troponins and Natriuretic Peptides in Hospitalized Nursing Home Residents. J Am Med Dir Assoc 2010; 11:386-8. [PMID: 20627177 DOI: 10.1016/j.jamda.2010.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
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Morley JE. JAMDA Improves Impact Factor. J Am Med Dir Assoc 2010. [DOI: 10.1016/j.jamda.2010.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Aging male. Clin Geriatr Med 2010; 26:171-84. [PMID: 20497839 DOI: 10.1016/j.cger.2010.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There are several special issues that confront the physician when dealing with the older male. Physicians need to pay attention to these issues and recognize their importance to their patients. This article briefly reviews these unique challenges.
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Abstract
Many elderly patients have hypertension, although it is more likely to go untreated in this population. Treatment goals are the same in elderly patients as in younger patients, but elderly patients are more likely to have multiple comorbidities, which must be factored into treatment plans. This article highlights the unique challenges in treating this population.
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Affiliation(s)
- Wilbert S Aronow
- Department of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Valhalla, NY 10595, USA.
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Morley JE. Hypertension: Is It Overtreated in the Elderly? J Am Med Dir Assoc 2010; 11:147-52. [DOI: 10.1016/j.jamda.2009.12.081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 02/07/2023]
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Prevalence of Appropriate Management of Diabetes Mellitus in an Academic General Medicine Clinic. Am J Ther 2010; 17:42-5. [PMID: 19262367 DOI: 10.1097/mjt.0b013e3181822e78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Morley JE. Polypharmacy in the nursing home. J Am Med Dir Assoc 2009; 10:289-91. [PMID: 19497538 DOI: 10.1016/j.jamda.2009.03.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 03/23/2009] [Indexed: 12/11/2022]
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Morley JE. Citation Indexing and JAMDA. J Am Med Dir Assoc 2009. [DOI: 10.1016/j.jamda.2009.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Morley JE. Phronesis and the Medical Director. J Am Med Dir Assoc 2009; 10:149-52. [DOI: 10.1016/j.jamda.2008.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 10/24/2008] [Indexed: 12/15/2022]
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Abstract
Diabetes mellitus has long been recognized as a cause of accelerated aging. As the understanding of the metabolic syndrome has evolved, it has been recognized that the interaction of a panoply of factors in the presence of insulin resistance results in accelerated aging. This article explores the increasing prevalence of diabetes mellitus with aging and how insulin resistance leads to accelerated frailty, disability, hospitalization, institutionalization, and death.
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Affiliation(s)
- John E Morley
- Geriatric Research Education and Clinical Center, St. Louis VA Medical Center, 1 Jefferson Barracks Drive, 11G, St. Louis, MO 63125, USA.
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Aronow WS. Hypertension in the Nursing Home. J Am Med Dir Assoc 2008; 9:486-90. [PMID: 18755421 DOI: 10.1016/j.jamda.2008.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 03/27/2008] [Indexed: 01/13/2023]
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Messinger-Rapport BJ, Thomas DR, Gammack JK, Morley JE. Clinical Update on Nursing Home Medicine: 2008. J Am Med Dir Assoc 2008; 9:460-75. [DOI: 10.1016/j.jamda.2008.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 07/07/2008] [Indexed: 12/11/2022]
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Morley JE. Diabetes. Preface. Clin Geriatr Med 2008; 24:xi-xiii. [PMID: 18672178 DOI: 10.1016/j.cger.2008.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- John E Morley
- Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St. Louis, MO 63104, USA.
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Aronow WS. Commentary on a Potential Correlation Between Demographic Variables and Efficacious Outcomes Among Academic Nursing Home Patients. J Am Med Dir Assoc 2008. [DOI: 10.1016/j.jamda.2008.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Acharya U. A Potential Correlation Between Demographic Variables and Efficacious Outcomes Among Academic Nursing Home Patients. J Am Med Dir Assoc 2008; 9:284-5; author reply 285. [DOI: 10.1016/j.jamda.2008.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 01/24/2008] [Accepted: 01/24/2008] [Indexed: 11/16/2022]
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Prevalence of Moderate and Severe Renal Insufficiency in Older Persons With Hypertension, Diabetes Mellitus, Coronary Artery Disease, Peripheral Arterial Disease, Ischemic Stroke, or Congestive Heart Failure in an Academic Nursing Home. J Am Med Dir Assoc 2008; 9:257-9. [PMID: 18457801 DOI: 10.1016/j.jamda.2008.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Revised: 12/25/2007] [Accepted: 01/04/2008] [Indexed: 10/22/2022]
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Aronow WS. Reply to Letter to the Editor: Treatment of Hyperlipidemia in the Nursing Home. J Am Med Dir Assoc 2008. [DOI: 10.1016/j.jamda.2007.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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