ACTIVE cognitive training and rates of incident dementia.

Systematic cognitive training produces long-term improvement in cognitive function and less difficulty in performing activities of daily living. We examined whether cognitive training was associated with reduced rate of incident dementia. Participants were from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (n = 2,802).

Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: study protocol.

Background: Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings.

A comparison of item response theory-based methods for examining differential item functioning in object naming test by language of assessment among older Latinos.

Object naming tests are commonly included in neuropsychological test batteries. (DIF) in these tests due to cultural and language differences may compromise the validity of cognitive measures in diverse populations. We evaluated 26 object naming items for DIF due to Spanish and English language translations among Latinos (=1,159), mean age of 70.

Cognitive decline in the elderly: an analysis of population heterogeneity.

Background: studies of cognitive ageing at the group level suggest that age is associated with cognitive decline; however, there may be individual differences such that not all older adults will experience cognitive decline.

Objective: to evaluate patterns of cognitive decline in a cohort of older adults initially free of dementia.

Design, Setting And Subjects: elderly Catholic clergy members participating in the Religious Orders Study were followed for up to 15 years.

A life course model of cognitive activities, socioeconomic status, education, reading ability, and cognition.

Objectives: To cross-sectionally quantify the contribution of proxy measures of cognitive reserve reflective of the lifespan, such as education, socioeconomic status (SES), reading ability, and cognitive activities, in explaining late-life cognition.

Design: Prospective observational cohort study of aging.

Setting: Retirement communities across the Chicago metropolitan area.

Improving disposition outcomes for patients in a geriatric skilled nursing facility.

Objectives: To evaluate an intervention to improve discharge disposition from a skilled nursing unit (SNU).

Design: Historical control comparison of discharge disposition before and after implementation.

Setting: Fifty-bed SNU.

The nonlinear relationship between gait speed and falls: the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study.

Objectives: To examine the relationship between gait speed and falls risk.

Design: Longitudinal analysis of the association between gait speed and subsequent falls and analysis of gait speed decline as a predictor of future falls.

Setting: Population-based cohort study.

Factor structure of the National Alzheimer's Coordinating Centers uniform dataset neuropsychological battery: an evaluation of invariance between and within groups over time.

The neuropsychological battery from the National Alzheimer's Disease Coordinating Center is designed to provide a sensitive assessment of mild cognitive disorders for multicenter investigations. Comprising 8 common neuropsychological tests (12 measures), the battery assesses cognitive domains affected early in the course of Alzheimer disease. We examined the factor structure of the battery across levels of cognition [normal, mild cognitive impairment, dementia] based on Clinical Dementia Rating scores to determine cognitive domains tapped by the battery.

Multiple, correlated covariates associated with differential item functioning (DIF): Accounting for language DIF when education levels differ across languages.

Differential item functioning (DIF) occurs when a test item has different statistical properties in subgroups, controlling for the underlying ability measured by the test. DIF assessment is necessary when evaluating measurement bias in tests used across different language groups. However, other factors such as educational attainment can differ across language groups, and DIF due to these other factors may also exist.

Conceptual and measurement challenges in research on cognitive reserve.

Cognitive reserve, broadly conceived, encompasses aspects of brain structure and function that optimize individual performance in the presence of injury or pathology. Reserve is defined as a feature of brain structure and/or function that modifies the relationship between injury or pathology and performance on neuropsychological tasks or clinical outcomes. Reserve is challenging to study for two reasons.

Hypertension, orthostatic hypotension, and the risk of falls in a community-dwelling elderly population: the maintenance of balance, independent living, intellect, and zest in the elderly of Boston study.

Objectives: To investigate the relationships between uncontrolled and controlled hypertension, orthostatic hypotension (OH), and falls in participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study (N=722, mean age 78.1).

Design: Prospective population-based study.

Development and validation of a brief cognitive assessment tool: the sweet 16.

Background: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

Implications of Lifecourse Epidemiology for Research on Determinants of Adult Disease.

Many diseases commonly associated with aging are now thought to have social and physiologic antecedents in early life. Understanding how the timing of exposure to early life risk factors influences later-life health may illuminate mechanisms driving adult health inequalities and identify possible points for effective interventions. Recognizing chronic diseases as developing across the lifecourse also has implications for the conduct of research on adult risk factors for disease.

Race-related cognitive test bias in the active study: a mimic model approach.

The present study investigated evidence for race-related test bias in cognitive measures used in the baseline assessment of the ACTIVE clinical trial. Test bias against African Americans has been documented in both cognitive aging and early life span studies. Despite significant mean performance differences, Multiple Indicators Multiple Causes (MIMIC) models suggested most differences were at the construct level.

Depressive symptoms impair everyday problem-solving ability through cognitive abilities in late life.

Background: The association between depression and functional disability in late life remains unclear. This study aimed to explore the relationship between depressive symptoms and daily functioning through the mediation of cognitive abilities, measured by memory, reasoning, and speed of processing.

Methods: The authors recruited 2,832 older adults (mean age = 73.

Survival and comfort after treatment of pneumonia in advanced dementia.

Background: Pneumonia is common among patients with advanced dementia, especially toward the end of life. Whether antimicrobial treatment improves survival or comfort is not well understood. The objective of this study was to examine the effect of antimicrobial treatment for suspected pneumonia on survival and comfort in patients with advanced dementia.

Hospitalization in community-dwelling persons with Alzheimer's disease: frequency and causes.

Objectives: To examine the rates of and risk factors for acute hospitalization in a prospective cohort of older community-dwelling patients with Alzheimer's disease (AD).

Design: Longitudinal patient registry.

Setting: AD research center.

Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples.

This study examined the associations among chronic health conditions, sociodemographic factors, and depressive symptomatology in older married couples. Data from the 2004 wave of the Health and Retirement Study (n = 2,184 couples) were analyzed. Results indicated a reciprocal relationship in depressive symptoms between spouses.

Randomized trial of a delirium abatement program for postacute skilled nursing facilities.

Objectives: To determine whether a delirium abatement program (DAP) can shorten duration of delirium in new admissions to postacute care (PAC).

Design: Cluster randomized controlled trial.

Setting: Eight skilled nursing facilities specializing in PAC within a single metropolitan region.

The 4Cs (crash history, family concerns, clinical condition, and cognitive functions): a screening tool for the evaluation of the at-risk driver.

Objectives: To evaluate the effectiveness of crash history, family concerns, clinical condition, and cognitive function (the 4Cs, an interview-based screening tool for health providers working with older drivers) in identifying at-risk older drivers.

Design: Retrospective cohort study.

Setting: Clinical driving evaluation program at a teaching hospital in the United States.

Development of a unidimensional composite measure of neuropsychological functioning in older cardiac surgery patients with good measurement precision.

The objective of this analysis was to develop a measure of neuropsychological performance for cardiac surgery and to assess its psychometric properties. Older patients (n = 210) underwent a neuropsychological battery using nine assessments. The number of factors was identified with variable reduction methods.

Prevalence of delirium on admission to postacute care is associated with a higher number of nursing home deficiencies.

Objective: To examine the association between the prevalence of delirium among patients admitted to postacute care and the quality of nursing home care as reflected in deficiency counts.

Design: Analysis of screening data from a randomized controlled trial (RCT) of a delirium abatement program.

Setting And Participants: We screened 4744 of 6352 RCT-eligible persons admitted to 1 of 8 skilled nursing facilities in the Boston area over a 3-year period.

Adjustment of nursing home quality indicators.

Background: This manuscript describes a method for adjustment of nursing home quality indicators (QIs) defined using the Center for Medicaid & Medicare Services (CMS) nursing home resident assessment system, the Minimum Data Set (MDS). QIs are intended to characterize quality of care delivered in a facility. Threats to the validity of the measurement of presumed quality of care include baseline resident health and functional status, pattern of comorbidities, and facility case mix.

Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston Study.

Tracking falls among elders is challenging. In this reliability study, which took place between October 2007 and February 2008, the authors compared participants' daily recordings of falls on calendars with a telephone survey of recall of falls over the previous 3 months within the population-based MOBILIZE Boston Study cohort, a cohort of 765 elders. From the cohort, 218 participants were randomly selected.

Delirium: an independent predictor of functional decline after cardiac surgery.

Objectives: To determine whether patients who developed delirium after cardiac surgery were at risk of functional decline.

Design: Prospective cohort study.

Setting: Two academic hospitals and a Veterans Affairs Medical Center.