Annals of Long Term Care

Breast Cancer Screening in Women Aged 80 and Older: Results from a National Survey
Mara A. Schonberg, MD, MPH, Ellen P. McCarthy, PhD, MPH, Roger B. Davis, ScD, Russell S. Phillips, MD, and Mary B. Hamel, MD, MPH

Objectives: To estimate the national rates of mammography screening in women aged 80 and older and examine the relationship between health status and screening within the previous 2 years.

Design: Population-based survey.

Setting: United States.

Participants: Eight hundred eighty-two women aged 80 and older who responded to the 2000 National Health Interview Survey, representing an estimated 3.83 million noninstitutionalized women nationally.

Measurements: Screening mammography, disease burden, and functional status were assessed using a questionnaire.

Results: Of the 882 women, 41.5% were aged 85 and older; 19.6% had two or more significant diseases; and 12.1% were dependent in at least one activity of daily living (ADL). More than half (50.8%) had received a screening mammogram within the previous 2 years. Women with two or more significant diseases were less likely to have received screening than those without significant disease, but the difference was not statistically significant (43.9% vs 54.0%, P=.152). Women dependent in at least one ADL were less likely to receive screening mammography than women without functional impairment (37.2% vs 55.9%, P<.001). After adjustment, the likelihood of screening remained lower in women with two or more significant diseases (adjusted odds ratio (AOR)=0.63, 95% confidence interval (CI)=0.40-1.05) and in women with at least one ADL dependency (AOR=0.44, 95% CI=0.22-0.88). Of 294 women likely to have life expectancies of less than 5 years because of poor health, 39.4% received screening mammography.

Conclusion: More than half of women aged 80 and older in the United States receive screening mammograms. Nearly 40% of women very unlikely to benefit because of poor health received screening mammography. J Am Geriatr Soc 2004;52(10):1688-1695.

The Relationship Between Number of Medications and Weight Loss or Impaired Balance in Older Adults
Joseph V. Agostini, MD, Ling Han, MD, MS, and Mary E. Tinetti, MD

Objectives: To examine the relationship between cumulative medication exposure and risk of two common manifestations of adverse drug effects: weight loss and impaired balance.

Design: Cross-sectional and longitudinal cohort.

Setting: Urban Connecticut community.

Participants: Eight hundred eighty-five community-dwelling residents aged 72 and older.

Measurements: Weight loss (≥10 pounds) and balance, a composite of four balance measures.

Results: Participants took a mean±standard deviation of 2.2±1.9 medications (range 015). After adjustment for age, depressive symptoms, cognitive impairment, vision and hearing impairments, number of chronic diseases, and number of hospitalizations in the previous year, the adjusted odds ratio (OR) for weight loss was 1.48 (95% confidence interval (CI)=0.85-2.59) for those taking one to two medications, 1.96 (95% CI=1.08-3.54) for three to four medications, and 2.78 (95% CI=1.38-5.60) for five or more medications. For impaired balance, adjusted ORs were 1.44 (95% CI=0.94-2.19), 1.72 (95% CI= 1.09-2.71), and 1.80 (95% CI=1.02-3.19), respectively.

Conclusion: A greater number of medications were associated with increased risk of adverse drug outcomes, after extensive adjustment for chronic illness. Clinicians should consider the adverse effects of total drug use and not merely the benefits or risks of individual medications for specific diseases. J Am Geriatr Soc 2004;52(10):1719-1723.

Comparison of Routine Glove Use and Contact-Isolation Precautions to Prevent Transmission of Multidrug-Resistant Bacteria in a Long-Term Care Facility
William E. Trick, MD, Robert A. Weinstein, MD, Patricia L. DeMarais, MD, Wanda Tomaska, RN, Catherine Nathan, MS, Sigrid K.