Effects of restriction of activities and social isolation on risk of dementia in the community.

Objective: Social isolation and emotional isolation, i.e. loneliness, have been associated with dementia or cognitive decline.

Development of a Short-Form of the Medication Management Test: Evaluation of Dimensionality, Reliability, Information and Measurement Equivalence Using Latent Variable Models.

Background And Purpose: The Medication Management Test (MMT) measures higher cognitive functioning. The aim of the analyses presented was to reduce assessment burden by developing a short-form version, and describe its psychometric properties.

Methods: Factor analyses, item response theory (IRT), and differential item functioning (DIF) were performed to examine the dimensionality, reliability information, and measurement equivalence.

A Link between Subjective Perceptions of Memory and Physical Function: Implications for Subjective Cognitive Decline.

Subjective impairment in memory is a frequently defining feature of subjective cognitive decline (SCD), a state hypothesized to precede objectively apparent cognitive symptoms of Alzheimer's disease (AD) and to hold promise as a non-invasive, inexpensive, preclinical indicator of AD. However, a full model of the factors that contribute to subjective memory (SM), and therefore to SCD, has yet to be articulated. While SM impairment is widely known to be associated with negative affect, the extent to which SM functioning may also reflect other factors, particularly subjective beliefs or perceptions about one's health, is not known.

Methodological issues in measuring subjective well-being and quality-of-life: Applications to assessment of affect in older, chronically and cognitively impaired, ethnically diverse groups using the Feeling Tone Questionnaire.

Quality of life assessment includes measurement of positive affect. Methods artifacts associated with positively and negatively worded items can manifest as negative items loading on a second factor, despite the conceptual view that the items are measuring one underlying latent construct. Negatively worded items may elicit biased responses.

Heritability of Health and Aging Limitations on Personally Desired Activities.

The aim of this study is to estimate heritability of incident limitations on personally desired activities within the eighth decade of life. We measured self-rated ability to perform ten personally desired activities in 1606 male veteran twin pairs at baseline and four years later. At follow-up, 33% of the cohort reported more limitations in desired activities.

Management of persistent pain in the older patient: a clinical review.

Importance: Persistent pain is highly prevalent, costly, and frequently disabling in later life.

Objective: To describe barriers to the management of persistent pain among older adults, summarize current management approaches, including pharmacologic and nonpharmacologic modalities; present rehabilitative approaches; and highlight aspects of the patient-physician relationship that can help to improve treatment outcomes. This review is relevant for physicians who seek an age-appropriate approach to delivering pain care for the older adult.

Quality of life impacts on 16-year survival of an older ethnically diverse cohort.

Objective: The objective of this study is to examine the prediction of mortality, over 16 years, by the domains and domain elements underlying generic measures of quality of life (QoL).

Methods: The method used was an analysis of mortality in an older (65 + years) representative sample (N = 2130) of a multicultural community in North Manhattan. Five conventional QoL domains were measured by in-home, rater-administered, and computer-assisted questionnaire: depressed mood, pain, self-perceived health, and function and social relationships.

Prevalence and characteristics of anergia (lack of energy) in patients with acute coronary syndrome.

Anergia, a commonly occurring syndrome in older adults and patients with cardiovascular diseases, is associated with functional and clinical limitations. To date, the prevalence and clinical-demographic characteristics of anergia in patients with acute coronary syndrome (ACS) have not been elucidated. We examined the prevalence and clinical-demographic characteristics of anergia in a multiethnic sample of patients with ACS.

Health-related restrictions of choices and choosing: implications for quality of life and clinical interventions.

Background: The process of "accessing choices and choosing among them" (c-c) has been proposed as a model for understanding, evaluating, and assisting a patient's management of quality of life. If desired choices are freely accessible, and the act of choosing is efficient and unconstrained, then the outcome is optimized quality of life. The c-c model fits many clinical situations where improved quality of life is a goal, and interventions may be aimed at relieving health-related restrictions of the patient's desired activities.

The Stroud/ADI dementia quality framework: a cross-national population-level framework for assessing the quality of life impacts of services and policies for people with dementia and their family carers.

Objectives: To generate an internationally applicable framework for the systematic assessment of the quality of life impacts of services and policies for people with dementia and their family carers.

Design: A qualitative analysis of text.

Setting: Open groups at six consecutive Alzheimer's Disease International (ADI) Conferences (1999-2005) lasting between 1.

The choices, choosing model of quality of life: clinical evaluation and intervention.

Two previous papers presented a conjectured model of quality of life featuring the personal management of accessing choices and choosing among them (the c-c process). Those papers made the case that this model unifies the pathways leading to impaired quality of life, especially with regard to age associated multiple co-morbidities, changes in perception and functioning, and the effects of long term care environments; it also introduces a science base for understanding and guiding interventions that can assist people to achieve their quality-of-life goals. Our aim in this paper is to outline interprofessional strategies that could relieve restrictions or distortions of the c-c process imposed by aging, ill-health, or a restricting environment.

The choices, choosing model of quality of life: description and rationale.

Aim: This introductory paper offers a critical review of current models and measures of quality of life, and describes a choices and choosing (c-c) process as a new model of quality of life.

Method: Criteria are proposed for judging the relative merits of models of quality of life with preference being given to explicit mechanisms, linkages to a science base, a means of identifying deficits amenable to rational restorative interventions, and with embedded values of the whole person.

Result: A conjectured model, based on the processes of gaining access to choices and choosing among them, matches the proposed criteria.

The choices, choosing model of quality of life: linkages to a science base.

Background: A previous paper began with a critical review of current models and measures of quality of life and then proposed criteria for judging the relative merits of alternative models: preference was given to finding a model with explicit mechanisms, linkages to a science base, a means of identifying deficits amenable to rational restorative interventions, and with embedded values of the whole person. A conjectured model, based on the processes of accessing choices and choosing among them, matched the proposed criteria. The choices and choosing (c-c) process is an evolved adaptive mechanism dedicated to the pursuit of quality of life, driven by specific biological and psychological systems, and influenced also by social and environmental forces.

Self-reported lack of energy (anergia) among elders in a multiethnic community.

Background: Lack of energy, "anergia," is a possible central feature for identifying, evaluating, and treating elders with health-related problems in quality of life.

Methods: A survey was conducted on a randomly selected stratified sample (N = 2130) of three ethnic groups of community-residing elders in a defined urban geographic area: the Northern Manhattan Aging Project (NMAP). The participants were Medicare beneficiaries living north of 150(th) Street in Manhattan.

Differential item functioning (DIF) and the Mini-Mental State Examination (MMSE). Overview, sample, and issues of translation.

Background: Various forms of differential item functioning (DIF) in the Mini-Mental State Examination (MMSE) have been identified. Items have been found to perform differently for individuals of different educational levels, racial/ethnic groups, and/or of groups whose first language is not English. The articles in this section illustrate the use of different methods to examine DIF in relation to English and Spanish language administration of the MMSE.

The Columbia Cooperative Aging Program: an interdisciplinary and interdepartmental approach to geriatric education for medical interns.

Although there is a critical need to prepare physicians to care for the growing population of older adults, many academic medical centers lack the geriatric-trained faculty and dedicated resources needed to support comprehensive residency training programs in geriatrics. Because of this challenge at Columbia University, the Columbia Cooperative Aging Program was developed to foster geriatric training for medical interns. For approximately 60 interns each year completing their month-long geriatric rotations, an integral part of this training now involves conducting comprehensive assessments with "well" older people, supervised by an interdisciplinary team of preceptors from various disciplines, including cardiology, internal medicine, occupational therapy, geriatric nursing, psychiatry, education, public health, social work, and medical anthropology.

A twin study of the genetic contribution to age-related functional impairment.

Background: A key element in the quality of later life is the prevalence of age-related functional impairments. The objective of this study was to quantify the genetic and environmental influences on age-related functional impairment in a population of white male twin elders who were fit in young adulthood when entering military service. The extent of genetic influence on functioning in later life affects the role of public health, personal initiative, and service interventions.

Use of a cane for ambulation: marker and mitigator of impairment in older people who report no difficulty walking.

Objectives: To measure disability, patients are often asked whether they have difficulty performing daily tasks. However, recent work suggests that functional problems may be detected earlier by inquiring about modifications in the way tasks are performed. We sought to describe the characteristics of older people who deny difficulty walking but nevertheless have modified the manner in which they walk, by use of a cane.

Operating Characteristics of Brief Screens for Dementia in a Multicultural Population.

Operating characteristics of seven screens for dementia were compared across various groups for 795 persons who had received a criterion diagnostic evaluation. Area under the curve (AUC), based on receiver operating characteristics, was compared between and within scales as an indication of their efficiency. Differences in AUC were only 5% across all the scales for the entire sample, but increased to 11% across sociocultural groups and scales and to 20% across education groups and scales.

Relative Rates of Dementia By Multiple Case Definitions, Over Two Prevalence Periods, In Three Sociocultural Groups.

The North Manhattan Aging Project registry, using both Reporting and Survey Components, identifies dementia cases among Latino, African-American, and non-Latino white sociocultural groups (9,349 persons 65 years of age or older) in contiguous census tracts. During a 2-year prevalence period of the reporting component, 1,592 persons were reported to the Registry and screened with five widely used brief cognitive measures; 844 were evaluated in a "clinical core," and 452 met research criteria for dementia, covering all subtypes, according to DSM-III-R criteria. Thirteen different case definitions for dementia were applied to the sociocultural groups at three levels of educational achievement, examining for associations with rates of dementia cases and controlling for age.