Progressive supranuclear palsy (PSP) is an uncommon neurodegenerative disease associated with postural instability, falling, and memory loss. Different therapeutic approaches have been suggested for PSP, but their efficacy is unclear. With our growing understanding of Parkinson's-related syndromes, it is likely that PSP will be increasingly diagnosed, so it is even more important now to know the usefulness of the possible therapies. To our knowledge, no systematic review of PSP therapy has been published. Objective: To determine the effectiveness of published PSP treatments.Evidence review: A systematic review of published literature was completed. We searched using PubMed, Scopus, EMBASE, PsychInfo, Cochrane and CINAHL for related articles. To maximize sensitivity, we also searched "gray" literature.Standard exclusion criteria were used: no comparison group; no clear, defined interventions; outcome(s) that were not objective; and outcome assessors not blinded to the intervention.Findings: The initial search obtained 1073 publications. Of these studies, 24 were relevant to the question of therapy efficacy. Fifteen dealt with medications, 4 with intra-or transcranial procedures, 2 with physical therapy, 1 dealt with ophthalmic treatment, and 2 dealt with two simultaneous types of interventions, ophthalmic and physical rehabilitation. Of these studies, 13 remained after application of our exclusion criteria.In this final group, all either showed no benefit, or found changes that were not reflected in any benefit to the subject's quality of life or longevity.Conclusion: At the patient level, effectiveness has not been established for any treatment for PSP. (C) 2016 Elsevier GmbH. All rights reserved.

The knowledge base of nutrition and the brain is steadily expanding. Much of the research is aimed at ways to protect the brain from damage. In adults, the major causes of brain damage are aging and dementia. The most prominent dementia, and the condition that grabs the most public attention, is Alzheimer's disease. The assumption in the field is that possibly some change in nutrition could protect the brain and prevent, delay, or minimize Alzheimer's disease damage. Presented here is a framework for understanding the implications of this research. There is a gap between publishing research results and change in public nutrition behavior. Several influencing elements intervene. These include regulatory agencies and all the organizations and people who advise the public, all with their own perspectives. In considering what advice to give, advisors may consider effectiveness, research model, persuasiveness, and risks, among other factors. Advice about nutrition and Alzheimer's disease today requires several caveats.

Objectives To describe trends in use of emergency departments (EDs) of older adults, reasons for visits, resource use, and quality of care. Design Analysis of the National Hospital Ambulatory Medical Care Survey. Setting U.S. emergency departments from 2001 to 2009. Participants Individuals aged 65 and older visiting U.S. EDs. Measurements Emergency departments (ED) visits by patients aged 65 and older were identified, and demographic, clinical, and resource use characteristics and outcomes were assessed. Results From 2001 to 2009, annual visits increased from 15.9 to 19.8 million, a 24.5% increase. Numbers of outpatients grew less than hospital admissions (20.2% vs 33.1%); intensive care unit admissions increased 131.3%. Reasons for visits were unchanged during the study; the top complaints were chest pain, dyspnea, and abdominal pain. Resource intensity grew dramatically: computed tomography 167.0%, urinalyses 87.1%, cardiac monitoring 79.3%, intravenous fluid administration 59.8%, blood tests 44.1%, electrocardiogram use 43.4%, procedures 38.3%, and radiographic imaging 36.4%. From 2005 to 2009, magnetic resonance imaging use grew 84.6%. The proportion receiving a potentially inappropriate medication decreased from 9.6% in 2001 to 4.9% in 2009, whereas the proportion seen in the ED, discharged, and subsequently readmitted to the hospital rose from 2.0% to 4.2%. Conclusion Older adults accounted for 156 million ED visits in the United States from 2001 to 2009, with steady increases in visits and resource use across the study period. Hospital admissions grew faster than outpatient visits. If changes in primary care do not affect these trends, facilities will need to plan to accommodate increasingly greater demands for ED and hospital services. J Am Geriatr Soc 61:12-17, 2013.

To the Editor: We welcome the contribution by Drs. St. John and Montgomery. Their findings are consistent with ours.1 However, contrary to our findings, when they adjusted for physical function, the association lost significance. In our analyses, we adjusted for activity of daily living (ADL) limitations, which were found to be a significant predictor even while the effect of depressive symptoms remained highly significant. Drs. St. John and Montgomery also used ADLs and included an additional measurement for instrumental activities of daily living (IADLs). It appears that they added both variables into their model concurrently rather than determining the individual effect of each. It is possible that the IADL scale undermined the effect of physical impairment as measured using the ADLs. We adjusted for considerably more variables than Drs. St. John and Montgomery, which also may explain the different results. For example, we adjusted for arthritis and stroke, which may affect function. It may be that the physical function measured in their study was a confounder for these medical conditions Cognition did not significantly affect risk of nursing home admissions in Drs. St. John and Montgomery's model. This is inconsistent with some research.2-4 We believe that this requires more research. As a measure of social support, we included home ownership. Although this is not a comprehensive measure of social support, other research has also shown that those who do not own their own home are far more likely to be admitted to a nursing home4 and that home ownership can serve as a proxy for income. We also adjusted for economic level and marriage, which could possibly explain some differences. Drs. St. John and Montgomery acknowledge differences in the admitting practices for nursing homes in the United States and Canada. In Canada, entering a nursing home requires a panel review. Medicare requires a 3-day prior hospitalization and a physician's note that the individual can show some improvement before reimbursement is approved, which affects many admissions, although for direct admissions to long-term care in a nursing home, U.S. facilities accept anyone based on bed availability and insurance status (i.e., availability of private pay or Medicaid). Therefore, measures of physical function, cognitive status, depression, and physical health may play a different role in the risk of admissions in the United States than in Canada, where residents are only admitted for long-term care. Financial Disclosure: The authors do not have any financial investment in this research. Author Contributions: Dr. Harris performed the analysis with input from Dr. Cooper. Dr. Cooper and Dr. Harris both authored the letter. Sponsor's Role: There was no outside sponsorship of this research.

OBJECTIVES:To evaluate the power of several self-reported depressive symptoms to predict nursing home admission (NHA).DESIGN:A Cox proportional hazards model was used to estimate the risk of NHA.SETTING:Data were from the Health Outcomes Survey (a national random sample of 137,000 Medicare + Choice enrollees aged 65 and older), the Nursing Home Minimum Data Set, and the Medicare Enrollment Database.PARTICIPANTS:Medicare beneficiaries aged 65 and older enrolled in a Medicare Managed Care Plan who were self-respondents to the questionnaire and were not institutionalized at the time of the survey.MEASUREMENTS:Variables were self-reported functional status, chronic health conditions, demographics, and several mood-related questions.RESULTS:After controlling for age, race, sex, marital status, home ownership, functional status, and comorbid conditions, individuals who identified themselves as feeling sad or depressed much of the time over the previous year were at significantly higher risk of NHA.CONCLUSION:A single question about depressive symptoms can be used to identify individuals at higher risk of NHA. There may be benefit from better screening and treatment of depression in community-based older people. Depression and social support may be linked. This study was targeted and did not attempt to explain everything that affects NHA. Investigation of the relationship between social support, depression, and NHA should be considered in future research.

Objective: To determine if a question about symptoms of depression in a mail survey predicts mortality after adjusting for a large number of covariates. Design: National cross-sectional survey of 141,589 enrollees in Medicare, age 65 and older. Analyses used multivariate logistic regression models with death as the outcome. Results: Response to a question about sadness or anhedonia was associated with death in 2 years (OR = 1.32; 95% CI = 1.2, 1.4). Results were consistent across age, gender, and presence/absence of known heart disease. Other responses associated with death were older age, male gender, and self-reported cancers, shortness of breath, heart failure, smoking, and other characteristics. Higher education and being married appeared to protect from death. Discussion: A single survey question about feelings of sadness or anhedonia is predictive of death in 2 years.

BACKGROUND:health status is increasingly used as a measure of healthcare effectiveness. How diseases and symptoms are associated with health status is not completely understood.OBJECTIVES:to find diseases, symptoms and demographic factors associated with physical and mental health status in older Americans.METHODS:we analysed data from a survey of over 100 000 Medicare beneficiaries aged 65 and older. We used the short-form 36 physical and mental summary scores as measures of health status. Other data collected included demographic details, symptoms and diagnoses.RESULTS:age as a single variable explained 4% of variation in physical health status. Adding other demographic information and increased disease burden explained variation to 8% and 27% respectively. Together, shortness of breath, back pain, difficulty getting in and out of chairs, arthritis of hip or knee, a recent change in health and age explained 54% of variation. All available variables explained 59%. The role of age as an independent factor decreased markedly after disease and symptoms were considered. Similar factors were associated with lower mental health status, but age was not.CONCLUSION:these data suggest that heart and lung disease and back pain are the most important factors affecting the average physical health status of older people. Sex, marital status and race have very little independent effect. Efforts to improve average physical health status scores might best be targeted at these conditions rather than demographic characteristics. Mental health status does not decline with age, and similar factors affect it but to a lesser degree.

Objective. A new measurement of health care quality for Medicare beneficiaries has been implemented by the Health Care Financing Administration (HCFA). This paper describes the program, presents baseline data and highlights associated issues.Design. The Health Outcomes Survey (HOS) is a longitudinal cohort mail survey Changes in population health status after 2 years will be evaluated on an individual plan level.Setting. Two-hundred and eighty-seven US Medicare managed care plans.Main outcomes measures. Physical component and mental component summary scales derived from the SF-36.Findings. Baseline data documented lower health status in older populations, while functional limitations and disease prevalence were higher. Among different plans, mean functional levels were found to be similar, although a few plans contained populations with exceptionally low levels. These data do not support the assertion that enrolees in for-profit plans are healthier than non-profit plans.Conclusions/implications. The HOS is the first large-scale program to evaluate health outcomes among older Americans. HCFA recognizes several technical and policy issues. Technical issues include possible biased reporting for subpopulations, the validity of prosy responses and respondent burden. Policy issues concern the appropriateness of using a generic measure such as the SF-36 and how much change in health status can be attributed to quality of health care. HCFA plans to extend the HOS to beneficiaries in traditional Medicare. The HOS project is expected to encourage more efforts to maintain or improve the health status of the Medicare managed care population.

Rural patients who are admitted to hospitals outside their residence county or who travel great distances for hospitalization deprive local rural hospitals of revenue. To provide more information about such rural residents, we studied their characteristics compared to those admitted in the same county. Characteristics studied included illness severity, demographics and county resources. To validate the findings and to provide a different analytic approach, characteristics of residents who travel long distances for admission were also studied. We studied admissions for ambulatory care sensitive conditions, as they might be most responsive to policy changes such as increasing recruitment of local primary-care physicians. Hospital discharges during 1994 for 248,656 New York State residents were studied. We constructed multivariate models using logistic regression and ordinary least squares methods. The models were applied to residents in three types of geographic location along an urban-rural continuum. Outside admissions were associated with younger age, higher illness severity and fewer county hospital resources. Same county admissions were associated with nonwhite race, and lack of insurance. Surprisingly, in rural counties, outside admissions were directly associated with increased primary-care providers. Results from the distance model generally supported findings from the outside admission model.

BACKGROUND:The standard process of obtaining informed consent sometimes prevents physicians or patients from participating in clinical trials, partly because they are concerned about eventual treatment allocation or the physician is concerned the patient might harbor some uncertainty about the best treatment. Alternative randomization methods have been advocated that may address these and other concerns.METHODS:After institutional ethics committee gave its approval, the authors interviewed 770 patients before operation and asked them to consider enrolling in a mock anesthesia trial. Patients were allocated randomly to one of five methods of randomization and consent: one-sided informed consent (the most common approach), prerandomized consent to experimental treatment, prerandomized consent to standard treatment, one-sided physician-modified informed consent, or one-sided patient-modified informed consent. Recruitment rates were compared and sociodemographic and perioperative predictors of recruitment were identified.RESULTS:The randomization method did not result in any significant difference in recruitment rates: one-sided informed consent, 55.6%; prerandomized consent to experimental treatment, 53.3%; prerandomized consent to standard treatment, 53%; one-sided physician-modified informed consent, 60.7%; and one-sided patient-modified informed consent, 56.7% (P = 0.66). Multivariate predictors of recruitment were patient age >45 yr (odds ratio, 1.44; 95% confidence interval [CI], 1.08 to 1.93), English-speaking at home (1.49; 1.0 to 2.21), and male researcher-male patient interaction (1.37; 1.20 to 1.57).CONCLUSIONS:No evidence emerged that alternative randomization and consent designs resulted in increased recruitment rates compared with simple one-sided informed consent for a sham anesthesia trial in patients awaiting elective surgery. Older, male patients were more likely to provide consent.

During the national health care reform debate in the 103rd Congress, all major proposals included specific clinical preventive services as important and explicitly defined benefits. The proposed Health Security Act, for example, carefully defined a benefit package with selected clinical preventive services. Even more modest proposals frequently specified elimination of co-payments for preventive care. While no health care reform legislation was passed by the 103rd Congress, support for preventive services, in one way or another, was one of the few nearly universally accepted goals.