Early hospital readmission is a predictor of one-year mortality in community-dwelling older Medicare beneficiaries.

Background: Hospital readmission within thirty days is common among Medicare beneficiaries, but the relationship between rehospitalization and subsequent mortality in older adults is not known.

Objective: To compare one-year mortality rates among community-dwelling elderly hospitalized Medicare beneficiaries who did and did not experience early hospital readmission (within 30 days), and to estimate the odds of one-year mortality associated with early hospital readmission and with other patient characteristics.

Design And Participants: A cohort study of 2133 hospitalized community-dwelling Medicare beneficiaries older than 64 years, who participated in the nationally representative Cost and Use Medicare Current Beneficiary Survey between 2001 and 2004, with follow-up through 2006.

Oral healthcare issues in rural residential aged care services in Victoria, Australia.

Objectives: To identify major issues in providing and accessing oral health care in Victorian rural residential aged care services from the perspectives of dentists, aged care staff and residents.

Methods: Structured interviews were conducted with five dentists, nine aged care staff and six residents. Three focus groups were conducted with aged care staff.

Contested surveillance: risk, safety, and cervical screening in Australia.

The expectation of participation in cervical screening programs has become a ubiquitous feature of women's lives; but despite the obvious importance of trying to prevent cervical cancer, both the expression and fulfilment of that expectation are far from straightforward. This is because the actors involved are not always consistent in their interpretation of the risks involved and safety sought. The history of cervical screening in Australia illustrates how the implementation of medical surveillance can be shaped by such interpretations.

Arterial stiffness and cognitive decline in well-functioning older adults.

Background: Stiffness of the central arteries in aging may contribute to cerebral microvascular disease independent of hypertension and other vascular risk factors. Few studies of older adults have evaluated the association of central arterial stiffness with longitudinal cognitive decline.

Methods: We evaluated associations of aortic pulse wave velocity (centimeters per second), a measure of central arterial stiffness, with cognitive function and decline in 552 participants in the Health, Aging, and Body Composition (Health ABC) study Cognitive Vitality Substudy (mean age ± SD = 73.

Hospitalization and change in body composition and strength in a population-based cohort of older persons.

Objectives: To examine the association between hospitalization and annual changes in body composition and strength in older adults.

Design: Cohort study.

Setting: Clinic examinations in Pittsburgh, Pennsylvania, or Memphis, Tennessee.

Ability to walk 1/4 mile predicts subsequent disability, mortality, and health care costs.

Background: Mobility, such as walking 1/4 mile, is a valuable but underutilized health indicator among older adults. For mobility to be successfully integrated into clinical practice and health policy, an easily assessed marker that predicts subsequent health outcomes is required.

Objective: To determine the association between mobility, defined as self-reported ability to walk 1/4 mile, and mortality, functional decline, and health care utilization and costs during the subsequent year.

Arterial stiffness and gait speed in older adults with and without peripheral arterial disease.

Background: Central arterial stiffness is increasingly recognized as an important predictor of cardiovascular events and mortality in older adults; however, few studies have evaluated the association of arterial stiffness with mobility decline, a common consequence of vascular disease.

Methods: We analyzed the association of pulse wave velocity (PWV), a measure of aortic stiffness, with longitudinal gait speed over 7 years in 2,172 participants in the Health, Aging and Body Composition (ABC) Study (mean age ± s.d.

Qualities of fatigue and associated chronic conditions among older adults.

Context: Although fatigue is a common and distressing symptom, a well-specified definition of fatigue is lacking. One of the least well-defined aspects of fatigue is its quality, which might reflect the underlying pathophysiology.

Objective: To identify the qualities of fatigue and assess whether they are associated with distinct chronic conditions.

Biopsychosocial characteristics of community-dwelling older adults with limited ability to walk one-quarter of a mile.

Objectives: To establish nationally representative estimates of the prevalence of self-reported difficulty and inability of older adults to walk one-quarter of a mile and to identify the characteristics independently associated with difficulty or inability to walk one-quarter of a mile.

Design: Cross-sectional analysis of data from the 2003 Cost and Use Medicare Current Beneficiary Survey.

Setting: Community.

Antitumor activity of a selectively replication competent herpes simplex virus (HSV) with enzyme prodrug therapy.

Background: HSV1790 is an oncolytic virus generated by inserting the enzyme nitroreductase (NTR) into the virus HSV1716. NTR converts the prodrug CB1954 into an active alkylating agent.

Materials And Methods: In vitro, 3T6 cells (non permissive to HSV) were used in order to distinguish between virus-induced cytopathic effect and cell death due to activated prodrug.

Methylphenidate for the treatment of depressive symptoms, including fatigue and apathy, in medically ill older adults and terminally ill adults.

Background: Depressive symptoms, fatigue, and apathy are common symptoms among medically ill older adults and patients with advanced disease, and have been associated with morbidity and mortality. Methylphenidate has been used to treat these symptoms because of its rapid effect. Despite the long history of methylphenidate use for the treatment of depressive symptoms, fatigue, and apathy, there is little definitive evidence to support its use.

Missing data: a special challenge in aging research.

Scientific evidence should guide clinical care, but special methodological challenges influence interpretation of the medical literature pertaining to older adults. Missing data, ranging from lack of individual items in questionnaires to complete loss to follow-up, affect the quality of the evidence and are more likely to occur in studies of older adults because older adults have more health and functional problems that interfere with all aspects of data collection than do younger people. The purpose of this article is to promote knowledge about the risks and consequences of missing data in clinical aging research and to provide an organized approach to prevention and management.

Fatigue and function over 3 years among older adults.

Background: Fatigue is a common complaint among older adults, but the association of fatigue with subsequent function is not well known.

Methods: This 3-year longitudinal study of older primary care patients evaluates the association of fatigue, operationalized as feeling tired most of the time, with functional status at baseline and over time.

Results: After adjustment for multiple potential confounders, participants who were tired at baseline had worse Short Form-36 Physical Performance Index scores, activity of daily living scores, and gait speeds.

Fatigue predicts mortality in older adults.

Objectives: To determine the association between fatigue and survival over 10 years in a population of older community-dwelling primary care patients.

Design: Prospective cohort study.

Setting: Medicare health maintenance organization and Veterans Affairs primary care programs.

Explaining the effect of gender on functional transitions in older persons.

Background: Women live longer but experience greater disability than men. The reasons for this gender difference in disability are not well understood.

Objective: Our objectives were to determine if the higher prevalence of disability in women is due to greater incidence of disability, longer duration of disability, or both, and to identify factors that potentially explain these gender differences.

Improvement in usual gait speed predicts better survival in older adults.

Objectives: To estimate the relationship between 1-year improvement in measures of health and physical function and 8-year survival.

Design: Prospective cohort study.

Setting: Medicare health maintenance organization and Veterans Affairs primary care programs.

Depressive symptoms in late life: associations with apathy, resilience and disability vary between young-old and old-old.

Objective: Prior research has found that disability and apathy are associated with late-life depression. However, the effect of age on these associations in "late-life," an ambiguous term encompassing all individuals typically older than 60 years, has not been examined. We investigated the association of depression with disability, apathy and resilience across the age range of late-life.

The effect of prior disability history on subsequent functional transitions.

Background: Many older persons experience multiple transitions between states of disability and independence, but little is known about the effect of prior disability history on subsequent functional transitions. Our objective was to determine the effect of prior disability on subsequent transitions between no disability, mild disability, severe disability, and death.

Methods: For 60 months, 754 persons aged 70 or older underwent monthly assessments of disability in basic activities of daily living.

The dynamic nature of mobility disability in older persons.

Objectives: To determine the rates of clinically meaningful transitions in mobility disability; evaluate how these transitions differ according to age, sex, and physical frailty; and depict the duration of the resulting episodes of mobility disability.

Design: Prospective cohort study.

Setting: General community in greater New Haven, Connecticut, from March 1998 to October 2004.

Estimates of active and disabled life expectancy based on different assessment intervals.

Background: Although disability in activities of daily living (ADLs) is a highly dynamic process, analytic strategies for estimating active and disabled life expectancy have assumed stability in ADL function between periodic surveys spanning 12--24 months or have used interval estimation or instantaneous rates based on long assessment intervals. We performed a prospective cohort study to compare estimates of active and disabled life expectancy based on traditional assessment intervals of 1--2 years with those based on more frequent assessments at 1-month intervals.

Methods: Participants included 754 initially nondisabled community-dwelling persons, aged 70 years or older, who were interviewed monthly for 4 years to ascertain ADL disability.

Transitions between states of disability and independence among older persons.

The objectives of this prospective cohort study, conducted in New Haven, Connecticut, from 1998 to 2004, were to describe disability states experienced by older persons, to evaluate the rate of transitions between states and the duration of disability episodes, and to determine whether these findings differ on the basis of physical frailty--a condition of low physical capacity and vulnerability to adverse functional outcomes. Participants included 754 persons aged 70 years or older who were initially independent in four key activities of daily living: bathing, dressing, walking, or transferring. Disability was assessed during monthly telephone interviews for a median of 60 months, and participants were classified each month according to the following four states: no disability, mild disability (one or two activities), severe disability (three or four activities), and death.

A case study found that a regression tree outperformed multiple linear regression in predicting the relationship between impairments and Social and Productive Activities scores.

Objective: Many important physiologic and clinical predictors are continuous. Clinical investigators and epidemiologists' interest in these predictors lies, in part, in the risk they pose for adverse outcomes, which may be continuous as well. The relationship between continuous predictors and a continuous outcome may be complex and difficult to interpret.