Functional Exercise Improves Mobility Performance in Older Adults With Type 2 Diabetes: A Randomized Controlled Trial.

: Diabetes-related disability occurs in approximately two-thirds of older adults with diabetes and is associated with loss of independence, increased health care resource utilization, and sedentary lifestyle. The objective of this randomized controlled trial was to determine the effect of a center-based functional circuit exercise training intervention followed by a 10-week customized home-based program in improving mobility function in sedentary older adults with diabetes. : Participants (n = 111; mean age 70.

A Case Study in Cross-cultural Health Care and Ethics: Who Decides What Is in the Child's "Best Interest"?

Health care in the United States is increasingly delivered in cross-cultural contexts. Empathy, mutual regard, respect, and compassionate communication are necessary to achieve the highest standard of care for each individual. Moral and ethical perspectives on life and death, health, and health care are not universal but rather have their origins within culture and societal norms.

Diabetes care improvement in pharmacist- versus nurse-supported patient-centered medical homes.

Objectives: In 2009 and 2010, 17 primary care sites within 1 healthcare system became patient-centered medical homes (PCMHs), but the sites trained different personnel (pharmacists vs nurses) to improve diabetes care using self-management support (SMS). We report the challenges and successes of our efforts to: 1) assemble a new multipayer (Medicare, Medicaid, commercial) claims dataset linked to a clinical registry and 2) use the new dataset to perform comparative effectiveness research on implementation of the 2 SMS models.

Study Design: Longitudinal cohort study.

Perceptions and attitudes about hospice and palliative care among community-dwelling older adults.

It is expected that the American geriatric population will have an increased need for hospice and palliative care services over the next few decades. We surveyed 187 community dwelling older adults about several aspects related to end-of-life (EOL) care. Participants were much more familiar with the term hospice than palliative care.

Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study.

Background: Our research group has previously shown that the geriatric syndrome of frailty is associated with features of the metabolic syndrome (MetS) on cross-sectional analysis.

Methods: To test whether MetS and its physiologic determinants-insulin resistance as measured by homeostasis model assessment score (IR-HOMA), increased inflammation and coagulation factor levels, and elevated blood pressure-are associated with incident frailty, we studied a subcohort of participants from the Cardiovascular Health Study observed from 1989/1990 through 1998/1999: 3141 community-dwelling adults, aged 69 to 74 years, without frailty and illnesses that increase inflammation markers or mimic frailty. The association of baseline MetS, IR-HOMA, levels of inflammation and coagulation factors, and systolic blood pressure (SBP) with time to onset of frailty was adjusted for demographic and psychosocial factors and incident events.

Caregiver attitudes and hospitalization risk in michigan residents receiving home- and community-based care.

Objectives: To study a cohort of participants in home- and community-based services (HCBS) in Michigan to evaluate the relationship between (1) caregiver attitudes and participant characteristics and (2) the risk of hospitalization.

Setting: HCBS programs funded by Medicaid or state/local funds in Michigan.

Participants: Five hundred twenty-seven individuals eligible for HCBS in Michigan were studied.