217 results match your criteria: "Hebrew Rehabilitation Center[Affiliation]"

Nonlinearities and asymmetries of the human cardiovagal baroreflex.

Am J Physiol Regul Integr Comp Physiol

May 2005

Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, MA, USA.

To determine whether an approach such as the modified Oxford technique can consistently produce data that reveal the nonlinear nature of the cardiovagal baroreflex and to ascertain whether the model parameters provide unique insight into baroreflex function, we retrospectively examined 91 baroreflex trials (38 subjects, 27 men and 11 women, ages 22-72 yr). The modified Oxford technique (bolus sodium nitroprusside followed by bolus phenylephrine) was used to perturb blood pressure, and the resulting systolic blood pressure-R-R interval responses were plotted and modeled using a linear, a four-parameter symmetric, and a five-parameter asymmetric model. Several issues, such as the effect of data averaging, various approaches to gain estimation, and the predictive value of model parameters, were examined during reflex modeling.

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Background: Many older persons with advanced dementia receive terminal care in nursing homes, others remain in the community with home care services.

Objectives: To describe and compare the end-of-life experience of persons dying with advanced dementia in the nursing home and home care settings.

Design: Retrospective cohort study.

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Objectives: To describe where older Americans with dementia die and to compare the state health system factors related to the location of dementia-related deaths with those of cancer and all other conditions in this population.

Design: Cross-sectional study.

Setting: United States in 2001.

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Background: The goal of this study was to calibrate depressive symptoms collected using different versions of the Centers for Epidemiologic Studies - Depression (CES-D) instrument in different waves of the Health and Retirement Study (HRS).

Method: The HRS is a prospective and nationally representative cohort study. This analysis included a sample of HRS participants, adults aged 23-85 years in 1992 who had complete data on depressive symptoms at initial 2- and 4-year follow-up interviews (N= 5,734).

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Many physicians are reluctant to lower blood pressure to recommended levels in elderly hypertensive patients because of concern about producing cerebral hypoperfusion. Because hypertension is associated with potentially reversible structural and functional alterations in the cerebral circulation that may improve with treatment, we investigated whether long-term pharmacological reduction of systolic blood pressure will improve, rather than worsen, cerebral blood flow and its regulation. Three groups of elderly subjects 65 years of age or older were studied prospectively: normotensive subjects (N=19), treated hypertensive subjects with systolic pressure <140 mm Hg (N=18), and uncontrolled hypertensive subjects with systolic pressure >160 mm Hg at entry into the study (N=14).

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This study assessed the validity of standardized assessment data collected with the Minimum Data Set (MDS) in postacute care settings and used to create performance indicators. Our results show that performance indicators derived from information collected with the MDS demonstrate convergent validity with data collected with other research or standardized assessment instruments. Results were most favorable for areas of physical functioning, cognitive and communicative functioning, and clinical complexity.

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Effect of blood pressure on cognitive functions in elderly persons.

J Gerontol A Biol Sci Med Sci

November 2004

Hebrew Rehabilitation Center for Aged, 1200 Centre St., Boston, MA 02131, USA.

Background: Little is known about what specific cognitive functions are affected by elevated blood pressure (BP) and how orthostatic BP change is related to cognitive impairment. The aim of this study was to determine the effect of BP and its postural change on cognitive functions in otherwise healthy elders.

Methods: In 70 healthy persons (mean age, 72 +/- 4 years), supine systolic BP (SBP) was assessed 3 times using a sphygmomanometer, and the average values were obtained for the analysis.

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Background And Aims: Previous studies have focused on systolic blood pressure (SBP), diastolic pressure (DBP), and more recently pulse pressure (PP) as risk factors for adverse cardiovascular (CV) endpoints in elderly people. However, the relation between these pressures and CV complications in the frail nursing home population has not been well studied. The aims of this project are to determine the value of PP in predicting CV complications in a nursing home population, and to compare its predictive value with SBP, DBP, and mean arterial pressure (MAP).

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The influence of outpatient comprehensive geriatric assessment on survival: a meta-analysis.

Arch Gerontol Geriatr

June 2005

Hebrew Rehabilitation Center for Aged, Research and Training Institute, 1200 Centre Street, Boston, MA 02131, USA.

Although outpatient Comprehensive Geriatric Assessment (CGA) has shown certain benefits in functional status and quality of life by many randomized controlled trials, no survival benefit has been reported. We hypothesized that the lack of survival benefit may be due to insufficient power of individual trials. In order to assess the influence of outpatient CGA on survival of older persons, we performed a meta-analysis of all randomized controlled trials of outpatient CGA.

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The dynamics of the cerebral vascular response to blood pressure changes in hypertensive humans is poorly understood. Because cerebral blood flow is dependent on adequate perfusion pressure, it is important to understand the effect of hypertension on the transfer of pressure to flow in the cerebrovascular system of elderly people. Therefore, we examined the effect of spontaneous and induced blood pressure changes on beat-to-beat and within-beat cerebral blood flow in three groups of elderly people: normotensive, controlled hypertensive, and uncontrolled hypertensive subjects.

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Cerebral white matter changes and geriatric syndromes: is there a link?

J Gerontol A Biol Sci Med Sci

August 2004

Hebrew Rehabilitation Center for Aged, 1200 Centre Street, Boston, MA 02131, USA.

Cerebral white matter lesions (WMLs), also called "leukoaraiosis," are common neuroradiological findings in elderly people. WMLs are often located at periventricular and subcortical areas and manifest as hyperintensities in magnetic resonance imaging. Recent studies suggest that cardiovascular risk factors are associated with the development of WMLs.

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We set out to fully examine the frequency domain relationship between arterial pressure and cerebral blood flow. Oscillatory lower body negative pressure (OLBNP) was used to create consistent blood pressure oscillations of varying frequency and amplitude to rigorously test for a frequency- and/or amplitude-dependent relationship between arterial pressure and cerebral flow. We also examined the predictions from OLBNP data for the cerebral flow response to the stepwise drop in pressure subsequent to deflation of ischaemic thigh cuffs.

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Estimating prognosis for nursing home residents with advanced dementia.

JAMA

June 2004

Hebrew Rehabilitation Center for Aged Research and Training Institute, the Harvard Medical School, Boston, Mass 02131, USA.

Context: Survival varies for patients with advanced dementia, and accurate prognostic tools have not been developed. A small proportion of patients admitted to hospice have dementia, in part because of the difficulty in predicting survival.

Objectives: To identify factors associated with 6-month mortality in newly admitted nursing home residents with advanced dementia and to create a practical risk score to predict 6-month mortality in this population.

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Non-pharmacologic approaches to prevent bone loss are well suited for elderly patients to avoid polypharmacy and medication side effects. One potential treatment is a vibrating platform that delivers low-level mechanical loading stimulating bone remodeling. However, compliance is a major concern with any daily treatment, and is unknown for an elderly group using this device.

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Objectives: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain.

Design: Cross-sectional study.

Setting: Nursing homes from 10 U.

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Background: The increased prevalence of osteoporosis among people with homocystinuria suggests that a high serum homocysteine concentration may weaken bone by interfering with collagen cross-linking, thereby increasing the risk of osteoporotic fracture. We examined the association between the total homocysteine concentration and the risk of hip fracture in men and women enrolled in the Framingham Study.

Methods: We studied 825 men and 1174 women, ranging in age from 59 to 91 years, from whom blood samples had been obtained between 1979 and 1982 to measure plasma total homocysteine.

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Healthy physiological processes require the complex interaction of multiple control systems operating over multiple time scales. The output of these processes (for example, heart rate, blood pressure, hormonal rhythms, or postural sway) demonstrates complex variability that can be quantified using the concept of fractals, derived from the field of nonlinear dynamics. Complex physiological dynamics enable an organism to rapidly respond to the internal and external perturbations of everyday life.

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Background: Delirium is costly, common, and may persist for weeks or months. Therefore, the adverse impact of delirium on loss of independence may occur in the post-acute setting rather than in the hospital. The purpose of this study is to describe the rate of delirium persistence and identify baseline patient characteristics that are associated with delirium persistence at 1 month among newly admitted post-acute facility patients who were admitted with delirium.

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Unlabelled: A study of a polymorphism in the MTHFR gene, plasma folate, and bone phenotypes in 1632 individuals revealed that the genotype effect on BMD and quantitative ultrasound was dependent on the level of folate. Our findings support the hypothesis that the association between an MTHFR polymorphism and bone phenotypes depends on folate status.

Introduction: Genome-wide screens using quantitative ultrasound (QUS) and BMD phenotypes have shown suggestive linkage on chromosome 1pter-1p36.

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Genetic contribution to biological aging: the Framingham Study.

J Gerontol A Biol Sci Med Sci

March 2004

Hebrew Rehabilitation Center for Aged, and Harvard Medical School, Boston, MA 02131, USA.

This study assessed the contribution of genetic and nongenetic factors to biological aging in American Caucasians. The studied sample included 1402 members of 288 pedigrees from the Framingham Heart Study. The original cohort participants received hand radiography in 1967-1969 (mean age, 58.

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Metacarpal cortical area and risk of coronary heart disease: the Framingham Study.

Am J Epidemiol

March 2004

Research and Training Institute, Hebrew Rehabilitation Center for Aged, 1200 Center Street, Boston, MA 02131, USA.

The objective of this study was to determine the relation between bone mass and the incidence of coronary heart disease in women and men. Participants included 2,059 cohort members of the Framingham Study (1,236 women and 823 men aged 47-80 years) who underwent posteroanterior hand radiography and were free from cardiovascular disease at baseline (1967-1970) and who were then followed for 30 years through the end of 1997 for the incidence of coronary heart disease. The incidence of coronary heart disease decreased from 15.

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Laboratory studies have suggested a role for cholesterol in the pathogenesis of both osteoporosis and atherosclerosis. The purpose of this prospective study was to assess whether cholesterol levels, repeatedly measured over three decades in young and middle-aged adult women and men, predicted bone mineral density (BMD) at advanced age. Study participants included 712 women and 450 men enrolled in the Framingham Osteoporosis Study, aged 32-61 years at baseline (1953-55) who underwent bone densitometry 34 years later (1988-1989).

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Genetic factors substantially contribute to variation in bone mass. There is a controversy as to whether shared genetic factors exist for bone mass at different sites. We hypothesize that using a composite phenotypic score of several correlated bone mass measures may provide complementary results for linkage studies.

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Tube-feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison.

J Am Med Dir Assoc

April 2004

Hebrew Rehabilitation Center for Aged Research and Training Institute, Department of Medicine of Beth Israel Deaconess Medical Center, Division on Aging, Harvard Medical School, Boston, MA 02131, USA.

Objective: To compare the costs associated with caring for severely demented residents nursing homes with and without feeding tubes.

Design: Retrospective cohort study.

Setting: A 700-bed long-term care facility in Boston.

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Musculoskeletal aging.

Curr Opin Rheumatol

March 2004

Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, MA 02131, USA.

Purpose Of Review: Chronic conditions associated with musculoskeletal aging contribute to a heavy functional and economic burden for our rapidly aging population. The purpose of this article is to review recent investigations in musculoskeletal epidemiology related to aging.

Recent Findings: Well over half the older adults in the United States report chronic joint symptoms.

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