Dying with advanced dementia in the nursing home.

Background: Nursing homes are important providers of end-of-life care to persons with advanced dementia.

Methods: We used data from the Minimum Data Set (June 1, 1994, to December 31, 1997) to identify persons 65 years and older who died with advanced dementia (n = 1609) and terminal cancer (n = 883) within 1 year of admission to any New York State nursing home. Variables from the Minimum Data Set assessment completed within 120 days of death were used to describe and compare the end-of-life experiences of these 2 groups.

Advancing the taxonomy of disability in older adults.

Background: Refinement of the traditional task-based classification of disability is needed to advance the field of disability research and to inform clinical practice. We propose an enhancement of the taxonomy of disability that incorporates information about symptoms and impairments that directly contribute to disability. In the first step of this new development, we present evidence to support five categories of disability related to pain, balance, weakness, endurance, and other symptoms.

Geriatrics training in general internal medicine fellowship programs: current practice, barriers, and strategies for improvement.

To ensure its growth and prosperity, general internal medicine will need to embrace care of the elderly, research on aging, and geriatrics education as components of its core mission. Experts agree that general internal medicine fellows could benefit from increased opportunities in research on aging and geriatrics education; however, important barriers will hamper efforts to integrate geriatrics training into general internal medicine fellowship programs. This article reviews the barriers to integration and proposes solutions for overcoming those barriers.

Prevalence and correlates of recognized depression in U.S. nursing homes.

Objectives: To provide descriptive epidemiological information on identified depression in nursing home residents.

Design: Survey of the 1996 Medical Expenditure Panel Survey-Nursing Home Component (MEPS-NHC).

Setting: Nine hundred fifty-one nursing facilities.

Age, gender, and body mass effects on quantitative trait loci for bone mineral density: the Framingham Study.

A genome-wide scan was performed in participants from the Framingham Osteoporosis Study (1557 members of 330 mostly Caucasian pedigrees), with 401 microsatellite markers spaced on average at 10 cM. Bone mineral density (BMD) was measured at the femoral neck, trochanter, Ward's area, and lumbar spine with DXA. Our recent study (J Bone Mines Res 17 (2002), 1718) reported a number of regions with suggestive linkage to possible quantitative trait loci (QTL).

Vigilance. Evolution and definition for caregivers of family members with Alzheimer's disease.

The language of caregiving relies heavily on terms that are frequently negative such as caregiver stress and burden, but these are not universally accepted phenomenon. The purpose of this article is to report on the development of caregiver vigilance and to suggest it offers both neutral terminology and a means to include caregivers' perceptions of their supervisory role. The concept of vigilance emerged from a qualitative study of caregivers of family members with Alzheimer's disease.

Spontaneous indices are inconsistent with arterial baroreflex gain.

Spontaneously occurring, parallel fluctuations in arterial pressure and heart period are frequently used as indices of baroreflex function. Despite the convenience of spontaneous indices, their relation to the arterial baroreflex remains unclear. Therefore, in 97 volunteers, we derived 5 proposed indices (sequence method, alpha-index, transfer function, low-frequency transfer function, and impulse response function), compared them with arterial baroreflex gain (by the modified Oxford pharmacologic technique), and examined their relation to carotid distensibility and respiratory sinus arrhythmia.

Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study.

Purpose: We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response (IVR) intervention designed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer's disease (AD).

Design And Methods: We conducted a randomized controlled study of 100 caregivers, 51 in the usual care control group and 49 in the technology intervention group, who received yearlong access to an IVR-mediated system. The system provided caregiver stress monitoring and counseling information, personal voice-mail linkage to AD experts, a voice-mail telephone support group, and a distraction call for care recipients.

A comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more?

Background: In a clinical study evaluating the functioning of mobility-limited elders, muscle power accounted for more of the variation in function than strength did. There was also evidence that the power-function relationship may be described as curvilinear. However, these findings have never been confirmed in a representative population.

Effect of systolic blood pressure and carotid stiffness on baroreflex gain in elderly subjects.

Background: Aging is associated with diminished baroreflex sensitivity (gain), which predisposes elderly people to orthostatic hypotension, syncope, and cardiovascular morbidity. Aging is also associated with systolic blood pressure (SBP) elevation and carotid artery stiffness, which may both affect baroreflex gain.

Methods: We examined the relation between SBP, carotid artery stiffness, and baroreflex gain in 34 healthy elderly (71 +/- 4 years) and 10 healthy young (31 +/- 3 years) subjects.

Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment.

Context: Empiric data and expert opinion suggest that use of feeding tubes is not beneficial for older persons with advanced dementia. Previous research has shown a 10-fold variation in this practice across the United States.

Objective: To identify the facility and resident characteristics associated with feeding tube use among US nursing homes residents with severe cognitive impairment.

Resident characteristics associated with mortality in long-term care nursing homes: is there a gender difference?

Objective: To examine the gender-specific association between characteristics in established long-term care residents and 1-year risk of mortality.

Design: A retrospective cohort study.

Setting: The Hebrew Rehabilitation Center for Aged, a 725-bed long-term care facility in Boston, Massachusetts.

The protective effect of social engagement on 1-year mortality in a long-stay nursing home population.

We examined the effect of social engagement (SE) on mortality in 30,070 long-stay nursing home residents who were > or =65 years of age and did not have a serious communication problem. Information on SE and resident characteristics were obtained from the Minimum Data Set, and death information was obtained from the National Death Index. Life table analyses show that greater levels of SE are associated with longer survival (P=.

Choosing appropriate medical care for the elderly.

Decisions about what constitutes appropriate medical care are increasingly necessary in an aging society. Neither patient autonomy, physician beliefs, nor health services research alone can adequately define reasonable care for the individual patient. A new framework is proposed for determining reasonable medical care that involves 4 steps: (1) patients prioritize their goals of care (prolongation of life, maintenance of function, and maximization of comfort); (2) physicians assign a pathway of care based on the patient's prioritization of goals (longevous, ameliorative, or palliative); (3) expert panels define a range of feasible interventions for each pathway; and (4) medical problems are treated with interventions consistent with the pathway chosen.

Common and gender specific factors associated with one-year mortality in nursing home residents.

Objectives: To identify common and gender-specific factors associated with mortality in two distinct nursing home (NH) populations: newly admitted (NA), and long-stay (LS) residents.

Design: A retrospective cohort study.

Setting: NH facilities in the state of New York.

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

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 Participants: Nursing home residents aged 65 years and over with advanced dementia and eating problems for whom long-term feeding tube had been discussed as a treatment option.

Racial bias in the assessment of cognitive functioning of older adults.

This study was undertaken to determine if the difference in assessed cognition between Black/African-American and White older adults was due differential item functioning (DIF) and/or differences in the effect of background variables. Participants were 15257 adults aged 50 and older surveyed in the Study of Asset and Health Dynamics of the Oldest Old (AHEAD) and Health and Retirement Study (HRS). The cognitive measure was a modified telephone interview for cognitive status.