n-3 Fatty acids, hypertension and risk of cognitive decline among older adults in the Atherosclerosis Risk in Communities (ARIC) study.

Objective: Recent research indicates that n-3 fatty acids can inhibit cognitive decline, perhaps differentially by hypertensive status.

Design: We tested these hypotheses in a prospective cohort study (the Atherosclerosis Risk in Communities). Dietary assessment using a food-frequency questionnaire and plasma fatty acid exposure by gas chromatography were completed in 1987-1989 (visit 1), while cognitive assessment with three screening tools--the Delayed Word Recall Test, the Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale-Revised and the Word Fluency Test (WFT)--was completed in 1990-1992 (visit 2) and 1996-1998 (visit 4).

Sleep problems in primary care: a North Carolina Family Practice Research Network (NC-FP-RN) study.

Background: The prevalence and nature of sleep disorders in primary care has not been widely studied. As part of a survey conducted in 5 family practice offices in North Carolina, we screened adult patients for sleep syndromes and sought to ascertain which demographic status and health status were associated with these disorders.

Methods: We approached 2963 consecutive adults who presented for office visits to the 5 study practices.

Physician communication with family caregivers of long-term care residents at the end of life.

Objectives: To assess family perceptions of communication between physicians and family caregivers of individuals who spent their last month of life in long-term care (LTC) and to identify associations between characteristics of the family caregiver, LTC resident, facility, and physician care with these perceptions.

Design: Retrospective study of family caregivers of persons who died in LTC.

Setting: Thirty-one nursing homes (NHs) and 94 residential care/assisted living (RC/AL) facilities.

Poor nutritional habits: a modifiable predecessor of chronic illness? A North Carolina Family Medicine Research Network (NC-FM-RN) study.

Purpose: To examine associations between personal nutritional patterns and various indicators of health, disease risk, and chronic illness in a diverse, representative sample of adult patients from primary care settings.

Methods: As part of a survey of adult patients conducted in the waiting rooms of 4 primary care practices in North Carolina (recruitment rate 74.8%), a 7-item nutrition screen was administered to 1788 study participants.

Assisted living policies promoting autonomy and their relationship to resident depressive symptoms.

Objective: The objective of this study is to determine the relationship between facility policies regarding autonomy and depression among residents of residential care/assisted living (RC/AL) facilities.

Method: A stratified sample of RC/AL facilities in Florida, Maryland, New Jersey, and North Carolina participated in the study. Patient characteristics for individuals 65 years and older were obtained from medical record reviews and in-person interviews.

Dementia care mapping as a research tool.

Introduction: Dementia Care Mapping (DCM) was originally developed as a clinical tool but has attracted interest as a potential observational measure of quality of life (QOL) and well-being of long-term care residents with dementia. DCM coding involves continuous observation over a 6-h period, with observers recording a Behavior Category Code (BCC, a recording of activity/interaction) and a Well/Ill Being (WIB) score at 5 min intervals.

Method: Descriptive data from several different research teams on the distribution and psychometric properties of DCM data were compiled and summarized.

Survey of osteoporosis preventive care in community family medicine settings.

Objective: This study's objective was to document and describe osteoporosis preventive care for women age 45 years and older in community family medicine practices.

Methods: We conducted a crosssectional mailed survey of 400 women age 45 years and older enrolled in a community-based family medicine research network. Participants responded to 42 items regarding osteoporosis screening and prevention during primary care visits.

Identifying supports and barriers to physical activity in patients at risk for diabetes.

Introduction: Recent clinical trials have demonstrated that increasing physical activity among patients at risk for diabetes can prevent or delay the onset of type 2 diabetes. In this study, we surveyed primary care patients at risk for diabetes to 1) describe physical activity habits, supports, and barriers; 2) identify characteristics associated with increased physical activity; and 3) develop and assess the psychometric properties of an instrument that measures influences on physical activity.

Methods: A cross-sectional sample of 522 high-risk adults who attended 14 North Carolina primary care family practices were mailed a survey about physical activity and supports of and barriers to physical activity.

Assisting cognitively impaired nursing home residents with bathing: effects of two bathing interventions on caregiving.

Purpose: When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing, nursing home caregivers are in a unique position to improve residents' experience. This report addresses whether certified nursing assistants (CNAs) who received training in a person-centered approach with showering and with the towel bath showed improved caregiving behaviors (gentleness and verbal support) and experienced greater preparedness (confidence and ease) and less distress (hassles) when assisting residents with bathing.

Design And Methods: We used a crossover design and randomized 15 nursing homes into two treatment groups and a control group of 5 facilities each.

Effectiveness of mailing "Bathing Without a Battle" to all US nursing homes.

An educational CD-ROM/video program was developed to educate nursing home staff about two research-based techniques for reducing agitation and aggression during bathing of persons with Alzheimer's disease, including person-centered showering and the towel bath. This educational program was distributed free of charge to all 15,453 US nursing homes in the Centers for Medicare and Medicaid Services database. The dissemination, use, and short-term outcomes were evaluated by extrapolating data collected by long-term care surveyors in three states; usage was further assessed by tracking the number of nursing home staff who registered for the continuing education credits associated with the program.

Syndromic surveillance for emerging infections in office practice using billing data.

Purpose: We wanted to evaluate the feasibility of conducting syndromic surveillance in a primary care office using billing data.

Methods: A 1-year study was conducted in a primary care practice; comparison data were obtained from emergency department records of visits by county residents. Within the practice, a computer program converted billing data into de-identified daily summaries of International Classification of Diseases, Ninth Revision (ICD-9) codes by sex and age-group; and a staff member generated daily summaries and e-mailed them to the analysis team.

An empirical typology of residential care/assisted living based on a four-state study.

Purpose: Residential care/assisted living describes diverse facilities providing non-nursing home care to a heterogeneous group of primarily elderly residents. This article derives typologies of assisted living based on theoretically and practically grounded evidence.

Design And Methods: We obtained data from the Collaborative Studies of Long-Term Care, which examined 193 assisted living facilities in four states: Florida, Maryland, New Jersey, and North Carolina.

The bathing of older adults with dementia.

Older adults who need assistance with bathing often find the activity to be both physically and emotionally demanding, as do their caregivers. Research has identified several contributing factors, including pain; fatigue and weakness; confusion; anxiety resulting from being naked in front of strangers, being afraid of falling, and being in a noisy or unfamiliar place; and discomfort from cold or drafty bathing areas or harsh water sprays. The authors of this article make the case for the elimination of forced bathing.

Is hospice associated with improved end-of-life care in nursing homes and assisted living facilities?

Objectives: To examine whether hospice enrollment for nursing home (NH) and residential care/assisted living (RC/AL) residents near the end of life is associated with symptoms and symptom management, personal care, spiritual support, and family satisfaction.

Design: Structured, retrospective telephone interviews with family and staff who attended to NH and RC/AL residents in the last month of life.

Setting: A stratified sample of 26 NH and 55 RC/AL facilities in four states.

Medicare prospective payment and quality of care for long-stay nursing facility residents.

Background: The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities and also cut per-diem rates. Previous studies have found effects on facility-wide staffing but not on quality for short-stay residents. Because facilities may combine revenue streams to be used where needed, spillover effects on quality of care for long-stay residents are possible.

Development of a practice-based patient cohort for primary care research.

Background And Objectives: Efforts to develop "laboratories" for primary care research have largely focused on the development of networks that recruit subjects on a project-specific basis. We sought to develop an alternative model--a representative cohort of adult primary care patients maintained for use in multiple projects.

Methods: In 2001, research assistants in waiting areas of a representative sample of 16 family medicine practices in North Carolina approached all adult patients during a 4-week period.

Dementia care and quality of life in assisted living and nursing homes.

Purpose: There are few empirical studies relating components of long-term care to quality of life for residents with dementia. This study relates elements of dementia care in residential care/assisted living (RC/AL) facilities and nursing homes to resident quality of life and considers the guidance this information provides for practice and policy.

Design And Methods: We used a variety of report and observational measures of the structure and process of care and 11 standardized measures of quality of life to evaluate the care for and quality of life of 421 residents with dementia in 35 RC/AL facilities and 10 nursing homes in four states.

Health and functional outcomes and health care utilization of persons with dementia in residential care and assisted living facilities: comparison with nursing homes.

Purpose: This study compares health and functional outcomes and health care utilization of persons with dementia residing in residential care/assisted living (RC/AL) facilities and nursing homes.

Design And Methods: The study uses data from a longitudinal cohort study of 1,252 residents with dementia in 106 RC/AL facilities and 40 nursing homes in four states.

Results: Rates of mortality; new or worsening morbidity; and change in activities of daily living, cognition, behavioral problems, depressive symptoms, social function, and withdrawal did not differ between the two settings.

Factors associated with nursing assistant quality-of-life ratings for residents with dementia in long-term care facilities.

Purpose: We identify resident, nursing assistant, and facility factors associated with nursing assistant quality-of-life ratings for residents with dementia in long-term care.

Design And Methods: We used a cross-sectional survey of 143 nursing assistants providing care to 335 residents in 38 residential care/assisted living (RC/AL) facilities and nursing homes in four states. We assessed resident quality of life by using the Quality of Life-Alzheimer's Disease Scale (QOL-AD).

Attitudes, stress, and satisfaction of staff who care for residents with dementia.

Purpose: Considering the increasing proportion of residents in long-term care who have dementia, and the important influence that direct care providers have on resident quality of life, this study explores the dementia-related attitudes of residential care/assisted living (RC/AL) and nursing home staff, as well as their work stress and satisfaction.

Design And Methods: Data were derived from interviews with 154 direct care providers from 31 RC/AL facilities and 10 nursing homes who participated in the Collaborative Studies of Long-Term Care.

Results: Stress was more often reported by care providers who had been working for 1 to 2 years (compared with longer); in addition, those who had been working for 1 to 2 years were more likely to espouse hopeful or person-centered attitudes than those who had been working for a longer period of time.

Characteristics associated with lower activity involvement in long-term care residents with dementia.

This article describes the characteristics associated with activity involvement in 400 residents with dementia in 45 assisted living facilities and nursing homes. Activity involvement was related to family involvement in care and staff encouragement, after adjusting for resident age, gender, race, cognitive and functional status, and comorbidity.

Characteristics associated with low food and fluid intake in long-term care residents with dementia.

This article describes the prevalence, assessment, and treatment of, as well as characteristics associated with, the food and fluid intake of 407 residents with dementia in 45 assisted living facilities and nursing homes. Overall, 54% of observed residents had low food intake, and 51% had low fluid intake. Staff monitoring of residents, having meals in a public dining area, and the presence of noninstitutional features were each associated with higher food and fluid intake.

Characteristics associated with pain in long-term care residents with dementia.

This article describes the prevalence, assessment, and treatment of pain, as well as characteristics associated with pain, in 331 residents with dementia in 45 assisted living facilities and nursing homes. Overall, 21% of residents had pain, and pain was more commonly reported in for-profit facilities, and for those receiving professional assessment and treatment.

Characteristics associated with mobility limitation in long-term care residents with dementia.

This article describes the prevalence, assessment, and treatment of, as well as characteristics associated with, mobility limitation in 343 residents with dementia in 45 assisted living facilities and nursing homes. Overall, 89% of residents had some degree of mobility limitation. Mobility limitation was associated with fewer behavioral symptoms, low fluid intake, professional assessment, and professional and informal treatment.

Characteristics associated with behavioral symptoms related to dementia in long-term care residents.

This article describes care for behavioral symptoms related to dementia (BSRD) and identifies their potential correlates among 347 residents with dementia living in 45 assisted living facilities and nursing homes from four states. The prevalence of BSRD was associated with staff training and resident cognition, mood, mobility, and psychotropic use. Attention to staff training and depression management might improve BSRD.