Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity.

Background: Delirium may persist for weeks or months, and discharging elderly patients quickly from acute care facilities is not uncommon. Therefore, the adverse impact of delirium on loss of independence may occur in the postacute setting rather than in the hospital. The purpose of this study is to describe the prevalence of delirium, delirium symptoms, and severity assessed at admission to postacute facilities.

The Caregiver Vigilance Scale: application and validation in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project.

This article reports on the measurement properties of Caregiver Vigilance, a four-item caregiver self-report of perceived oversight demand for Alzheimer's disease and related disorders family caregiving. The self-report uses data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project, a multisite National Institutes of Health (NIH) sponsored study of over 1,200 family caregivers. Results indicate that the items were clearly understood by the racially/ethnically diverse respondents; and, when responses were transformed into a summary scale and analyzed, unidimensionality was evident and internal consistency reliability favorably demonstrated.

Nursing home characteristics associated with tube feeding in advanced cognitive impairment.

Objectives: To identify nursing homes factors associated with the use of tube feeding in advanced cognitive impairment.

Design: Descriptive study.

Setting: The On-line Survey Certification of Automated Records (OSCAR) was used to obtain facility characteristics from 1,057 licensed nursing homes in six states from 1995 to 1996.

Delirium symptoms in post-acute care: prevalent, persistent, and associated with poor functional recovery.

Objectives: To determine the prevalence of delirium symptoms at the time of admission to post-acute facilities, the persistence of delirium symptoms in this setting, and the association of delirium symptoms with functional recovery.

Design: Prospective cohort study.

Setting: Eighty-five post-acute care facilities: 55 rehabilitation hospitals and 30 skilled nursing facilities in 29 states.

Education and sex differences in the mini-mental state examination: effects of differential item functioning.

Years of completed education is a powerful correlate of performance on mental status assessment. This analysis evaluates differences in cognitive performance attributable to level of education and sex. We analyzed Mini-Mental State Examination responses from a large community sample (Epidemiologic Catchment Area study, N = 8,556), using a structural equation analytic framework grounded in item response theory.

Disabling symptoms: what do older women report?

Objective: To answer the question, "What do older disabled women report as the main symptoms causing their disability?"

Design: Cross-sectional study of 876 women aged 65 and older who participated in the second interview of the Women's Health and Aging Study, a longitudinal study of community-living women, representing the one third of older women with at least mild to moderate disability.

Measurements And Main Results: Women were asked to identify the symptom and the condition that was the main cause of disability in basic and instrumental activities of daily living, and lower extremity mobility. Musculoskeletal pain symptoms were reported as the main cause of disability by at least one third of women with each type of disability.

Carotid distensibility characterized via the isometric exercise pressor response.

Distensibility of the large elastic arteries is a key index for cardiovascular health. Distensibility, usually estimated from resting values in humans, is not a static characteristic but a negative curvilinear function of pressure. We hypothesized that differences in vascular function with gender and age may only be recognized if distensibility is quantified over a range of pressures.

Mapping of quantitative ultrasound of the calcaneus bone to chromosome 1 by genome-wide linkage analysis.

Quantitative ultrasound (QUS) may predict the risk of fracture independent of bone density. The aim of this study was to identify, using quantitative trait linkage analysis, chromosomal regions that might contain genes influencing variation in calcaneal ultrasound measures in a set of families from the general population. A genome-wide autosomal scan was conducted in 324 Caucasian families (1270 measured individuals) from the Framingham Osteoporosis Study, using a set of 401 Marshfield microsatellite markers with a 10 cM average density map.

Genome screen for quantitative trait loci contributing to normal variation in bone mineral density: the Framingham Study.

A genome-wide scan was performed in a randomly ascertained set of 330 extended families from the population-based Framingham Study to identify chromosomal regions possibly linked to bone mineral density (BMD). A set of 401 microsatellite markers was typed at a 10-centimorgan (cM) average density throughout the genome. BMD was measured at the femoral neck, trochanter, Ward's area, and lumbar spine in 1557 participants of both Framingham cohorts.

Insulin-like growth factor binding proteins 4 and 5 and bone mineral density in elderly men and women.

Insulin-like growth factor-1 (IGF-I) plays a central role in the maintenance of bone mass. To test whether two major IGF-I binding proteins, IGFBP-4 and IGFBP-5, are related to bone mineral density (BMD), we studied a sample of the Framingham Offspring Cohort participants (99 men and 101 women, ages 60-87). Serum levels of IGF-I, IGFBP-4, and IGFBP-5 were measured by previously validated radioimmunoassays (CVs approximately 10%).

Orthostatic hypotension.

A common problem among elderly people, orthostatic hypotension is associated with significant morbidity and mortality, which may be caused by medications, the cumulative effects of age- and hypertension-related alterations in blood pressure regulation, or age-associated diseases that impair autonomic function. Evaluation requires multiple blood pressure measurements taken at different times of the day and after meals or medications. Central and peripheral nervous system disorders should be sought, and the laboratory evaluation should concentrate on ruling out diabetes mellitus, amyloidosis, occult malignancy, and vitamin deficiencies.

Associating the onset of motor impairments with disability progression in nursing home residents.

Objectives: To evaluate the association between the onset of movement impairments and disability progression in nursing home residents.

Design: Retrospective cohort analysis of data from the State of New York Minimal Data Set, version 2.0, between November 1998 and October 1999.

Effects of a multimedia project on users' knowledge about normal forgetting and serious memory loss.

Objective: The aim of the project was to develop and evaluate the effectiveness of a CD-ROM-based multimedia program as a tool to increase user's knowledge about the differences between "normal" forgetfulness and more serious memory loss associated with Alzheimer's disease.

Design And Measurements: The research was a controlled randomized study conducted with 113 adults who were recruited from the community and who expressed a concern about memory loss in a family member. The intervention group (n=56) viewed a module entitled "Forgetfulness: What's Normal and What's Not" on a laptop computer in their homes; the control group (n=57) did not.

Mental stress response, arterial stiffness, and baroreflex sensitivity in healthy aging.

This study examined the relationship of pressor responses during mental stress to arterial stiffness and baroreflex sensitivity. Hemodynamic responses of 24 healthy individuals (51-86 years old) to two mental stress tasks (math and speech) were compared with common carotid artery mechanical stiffness and autonomic nervous system regulation of blood pressure as measured by using the modified Oxford technique. At the ages studied, no effect of age on stress task responsiveness, carotid stiffness, or baroreflex sensitivity was observed.

Do we need to create geriatric hospitals?

During a single illness episode, the sickest, frailest older patients are often treated in multiple distinct sites, including the emergency room, the intensive care unit, a general medical floor, and a skilled nursing facility. Such frequent transfers involve changes in physician, changes in nursing care, the rewriting of orders, and physical dislocation, all of which can adversely affect outcomes. This system, although efficient, increases the chance of medical errors, promotes delirium, and undermines the doctor-patient relationship.

Inter-relations among declines in arterial distensibility, baroreflex function and respiratory sinus arrhythmia.

Objectives: We hypothesized that structural and neural cardiovascular (CV) deficits may be intimately linked. Specifically, decreased carotid distensibility with age may blunt the arterial baroreflex, thereby reducing resting cardiac vagal tone.

Background: Increased CV risk is associated with lower carotid distensibility, impaired baroreflex function and reduced respiratory sinus arrhythmia (RSA), possibly representing a direct path between structural and neural CV deficits.

Musculoskeletal pain and risk for falls in older disabled women living in the community.

Objectives: To determine whether musculoskeletal pain increased risk for falls in older women with disabilities.

Design: Prospective population-based cohort study.

Setting: The city and county of the eastern area of Baltimore.

Racial and state differences in the designation of advance directives in nursing home residents.

Objectives: To examine racial and state differences in the use of advance directives and surrogate decision-making in a nursing home population.

Design: A retrospective cohort study.

Setting: Nursing homes in the states of California (CA), Massachusetts (MA), New York (NY), and Ohio (OH).

Weight loss and metabolic changes in dementia.

Weight loss is common in elderly people with dementia, particularly those with Alzheimer s disease, and feeding difficulties are major issues in their care in the later stages of their disease. This review summarizes data from cross-sectional and longitudinal studies of weight changes with dementia, physiologic aspects of the metabolic and nutritional changes in dementia, and treatment strategies to minimize weight loss.

Dynamics of stability: the physiologic basis of functional health and frailty.

Under basal resting conditions most healthy physiologic systems demonstrate highly irregular, complex dynamics that represent interacting regulatory processes operating over multiple time scales. These processes prime the organism for an adaptive response, making it ready and able to react to sudden physiologic stresses. When the organism is perturbed or deviates from a given set of boundary conditions, most physiologic systems evoke closed-loop responses that operate over relatively short periods of time to restore the organism to equilibrium.

Education bias in the mini-mental state examination.

Education is correlated with cognitive status assessment. Concern for test bias has led to questions of equivalent construct validity across education groups. Following the work of previous researchers, we submitted Mini-Mental State Examination (MMSE) responses to external validation analyses.

Can metacarpal cortical area predict the occurrence of hip fracture in women and men over 3 decades of follow-up? Results from the Framingham Osteoporosis Study.

The purpose of this study was to determine if a single measurement of metacarpal cortical area could predict the subsequent risk of hip fracture over a long-term follow-up period. Thirteen hundred eighty-six women and 1014 men (mean age [+/- SD] 61 +/- 8 years) underwent posteroanterior hand radiography between 1966 and 1970 as part of the Framingham Study. Measurements of cortical bone width (external width and medullary width) were made at the midpoint of the second metacarpal with a digital caliper to the nearest 0.

Widespread musculoskeletal pain and the progression of disability in older disabled women.

Background: Widespread musculoskeletal pain is a poorly understood but common problem in older adults. Little is known about the progression of disability related to this condition.

Objective: To determine whether widespread musculoskeletal pain increases the risk for worsening disability in older women with disabilities.

Bone loss and the progression of abdominal aortic calcification over a 25 year period: the Framingham Heart Study.

Vascular calcification and osteoporosis are common age-related processes that are prominently displayed on routine lateral lumbar spine radiographs as dense calcium mineral deposits of the aorta that lie adjacent to osteopenic vertebrae. Using a population-based cohort of older men and women, we tested the hypothesis that the progression of vascular calcification of the abdominal aorta should be greatest in those individuals with the greatest amount of bone loss. From the original population-based Framingham Heart Study cohort, 364 women and 190 men had lateral lumbar spine and hand radiographs performed between 1966 and 1970 and repeated between 1992 and 1993.

Automated quantification of sympathetic beat-by-beat activity, independent of signal quality.

Sympathetic nerve activity (SNA) can provide critical information on cardiovascular regulation; however, in a typical laboratory setting, adequate recordings require assiduous effort, and otherwise high-quality recordings may be clouded by frequent baseline shifts, noise spikes, and muscle twitches. Visually analyzing this type of signal can be a tedious and subjective evaluation, whereas objective analysis through signal averaging is impossible. We propose a new automated technique to identify bursts through objective detection criteria, eliminating artifacts and preserving a beat-by-beat SNA signal for a variety of subsequent analyses.