The cost of recruiting Alzheimer's disease caregivers for research.

Objectives: This study examined the cost and outcomes associated with multiple recruitment strategies used to enroll participants in an Alzheimer's disease (AD) caregiver study.

Methods: Recruitment data were collected as part of an AD caregiving intervention study and examined for number of referrals and participants, yield, personnel cost, materials cost, total cost, and cost per participant.

Results: Recruitment rates varied by method implemented and referral source.

Prophylaxis and treatment of influenza virus infection.

Influenza virus infections remain an important cause of morbidity and mortality. Furthermore, a recurrence of pandemic influenza remains a real possibility. There are now effective ways to both prevent and treat influenza.

Estrogen replacement therapy improves baroreflex regulation of vascular sympathetic outflow in postmenopausal women.

Background: Menopausal estrogen loss has been associated with increased cardiovascular disease in postmenopausal women. However, the link between estrogen and cardiovascular disease remains unclear. Some data suggest estrogen mediates its effect through changes in arterial pressure and its regulation.

Quantification of mechanical and neural components of vagal baroreflex in humans.

Traditionally, arterial baroreflex control of vagal neural outflow is quantified by heart period responses to falling and/or rising arterial pressures (ms/mm Hg). However, it is arterial pressure-dependent stretch of barosensory vessels that determines afferent baroreceptor responses, which, in turn, generate appropriate efferent cardiac vagal outflow. Thus, mechanical transduction of pressure into barosensory vessel stretch and neural transduction of stretch into vagal outflow are key steps in baroreflex regulation that determine the conventional integrated input-output relation.

Endogenous anticholinergic substances may exist during acute illness in elderly medical patients.

Background: The purpose of this study was to determine if serum anticholinergic activity (SACA) arises from endogenous substances produced during illness.

Methods: Elderly medical inpatients (N = 612) were screened for anticholinergic medication use in the week prior to the study by interviews of subjects and proxies and review of emergency room, hospital, and nursing home medication administration records. Of 24 subjects without a recent anticholinergic medication history, 15 were recruited and 10 completed the study.

Does reduced vascular stiffening fully explain preserved cardiovagal baroreflex function in older, physically active men?

Background: We measured cardiovagal baroreflex gain and its vascular mechanical and neural components during dynamic baroreflex engagement in 10 young untrained men, 6 older untrained men, and 12 older, physically active men.

Methods And Results: Our newly developed assessment of beat-to-beat carotid diameters during baroreflex engagement estimates the mechanical transduction of pressure into barosensory stretch (diameter/pressure), the neural transduction of stretch into vagal outflow (R-R interval/diameter), and conventional integrated cardiovagal baroreflex gain (R-R interval/pressure). Integrated gain was lower in older untrained men than in young untrained men (6.

Factors affecting the use of a telephone-based intervention for caregivers of people with Alzheimer's disease.

We investigated the usefulness of a computer-mediated interactive voice response (IVR) system integrated with voicemail to help family caregivers manage disruptive behaviours in people with Alzheimer's disease. The randomization procedure resulted in 49 caregivers being assigned to the intervention group and 51 to the control group. Using their ordinary telephone, the caregivers were linked to the four components of the IVR system: monitoring and counselling, an in-home support group, 'ask the expert', and a respite conversation.

Differing perceptions of end-of-life care in long-term care.

Background: Care team members may have different views on end-of-life care, which may influence perceptions of that care.

Methods: Twenty-seven consecutive deaths at a long-term care facility were identified. A structured interview of primary care team members (physician, nurse, and aide) was administered.

Inconsistent link between low-frequency oscillations: R-R interval responses to augmented Mayer waves.

Low-frequency oscillations in arterial blood pressure (Mayer waves) and R-R interval are thought to be linked through the arterial baroreflex. To delve into this relationship, we applied low (10 mmHg) and moderate (30 mmHg) lower body negative pressure (LBNP) in 10-s cycles to 18 healthy young male subjects. They showed no change in average blood pressure with this oscillatory stimulus but did show a significant decrease in R-R interval (P < 0.

Artificial nutrition and hydration in the patient with advanced dementia: is withholding treatment compatible with traditional Judaism?

Several religious traditions are widely believed to advocate the use of life-sustaining treatment in all circumstances. Hence, many believe that these faiths would require the use of a feeding tube in patients with advanced dementia who have lost interest in or the capacity to swallow food. This article explores whether one such tradition--halachic Judaism--in fact demands the use of artificial nutrition and hydration in this setting.

Elderly cohort study subjects unable to return for follow-up have lower bone mass than those who can return.

Longitudinal studies of osteoporosis in older persons may underestimate bone loss because of a lack of follow-up measurements on subjects too frail to return. The authors addressed this possible bias as part of the population-based Framingham Study; in 1996-1997, they used quantitative ultrasound to assess the bone status of elderly subjects regardless of their ability to return to the clinic. Broadband ultrasound attenuation (BUA) and speed of sound of the calcaneus (heel) were measured in 433 subjects at the Framingham, Massachusetts, clinic and in 167 subjects at their homes or nursing homes.

Predicting fractures using bone mineral density: a prospective study of long-term care residents.

Bone mineral density (BMD) has been shown to predict fracture risk in community-dwelling older persons; however, no comparable prospective study has been performed in the long-term care setting where the role of BMD testing is uncertain. To determine the ability of a single BMD measurement to predict the risk of subsequent fracture in long-term care residents, we designed a prospective study in a 725-bed long-term care facility. A total of 252 Caucasian nursing home residents (mean age 88 years, 74% women) were recruited between 1992 and 1998.

Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study.

Few studies have evaluated protein intake and bone loss in elders. Excess protein may be associated with negative calcium balance, whereas low protein intake has been associated with fracture. We examined the relation between baseline dietary protein and subsequent 4-year change in bone mineral density (BMD) for 391 women and 224 men from the population-based Framingham Osteoporosis Study.

The association between orthostatic hypotension and recurrent falls in nursing home residents.

Purpose: Orthostatic hypotension is common among the elderly, but its relation to falls is not certain. We determined whether orthostatic hypotension, including its timing and frequency, was associated with falls in elderly nursing home residents.

Subjects And Methods: We conducted a prospective study of 844 elderly (60 years of age and older), long-stay residents at 40 facilities that were part of a multistate nursing home chain.

Resident characteristics associated with wandering in nursing homes.

Objectives: This retrospective cohort study examined the association between resident characteristics and the development of wandering behavior.

Methods: Subjects included a total of 8982 residents from the states of Mississippi, Texas, and Vermont who had baseline and 3-month follow-up Minimum Data Set assessments between 1 January 1996 and 31 December 1997.

Results: Residents who had a short-term memory problem (Odds Ratio (OR) = 3.

The protective effect of social engagement on mortality in long-term care.

Objectives: To examine the effect of social engagement (SE) on mortality in long-term care.

Design: A retrospective cohort study.

Setting: A 725-bed long-term care facility.

Autonomic and neurohumoral control of postprandial blood pressure in healthy aging.

Background: Postprandial hypotension (PPH) is a common and morbid problem in elderly people that is associated with an impaired vascular response to meal digestion. Healthy aging in the absence of blood pressure elevation is associated with autonomic and neurohumoral changes that may influence the vascular response to meal ingestion. However, it is not known whether these age-related changes are associated with the development of PPH.

Dynamic regulation of middle cerebral artery blood flow velocity in aging and hypertension.

Background And Purpose: Although aging and hypertension may predispose hypertensive elderly subjects to cerebral hypoperfusion during orthostatic stress, their effects on the acute cerebral autoregulatory response to hypotension are not known.

Methods: Continuous middle cerebral artery blood flow velocity (BFV) (transcranial Doppler ultrasound) and mean arterial pressure (MAP, Finapres) were measured in response to (1) acute hypotension during standing, (2) steady-state sitting and standing, and (3) hypercarbia during CO(2) rebreathing in 10 healthy young subjects (age 24+/-1 years), 10 healthy elderly subjects (age 72+/-3 years), and 10 previously treated hypertensive elderly (age 72+/-2 years) subjects. CO(2) reactivity was computed as the slope of cerebrovascular conductance (CVC=BFV/MAP) versus end-expiratory CO(2).

Development of constipation in nursing home residents.

Purpose: Constipation is a common complaint among geriatric patients and may result in significant morbidity, especially among nursing home residents. The prevalence of constipation increases with advancing age and may be a result of the aging process, but the exact cause is unknown. The aim of this study was to describe the prevalence of constipation and to determine risk factors for the development of constipation in a large population of nursing home residents.

Dimensions of the Mini-Mental State Examination among community dwelling older adults.

Background: Little work has been published on the internal structure of the Mini-Mental State Examination (MMSE), one of the most widely used instruments for grading cognitive status in clinical settings and field research.

Methods: MMSE responses from a sample of older adults (50-98 years) in five US sites (N = 8556) were analysed.

Results: A five-factor solution was found to be most appropriate.

Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee.

Objective: To analyze cross sectional data from the National Health and Nutrition Examination Survey (NHANES I) concerning 3 indicators of osteoarthritis (OA) of the knee: radiographic evidence of structural damage, self-reported knee pain, and self-report of a diagnosis of arthritis at any joint by a physician.

Methods: Analysis of NHANES I data for 6880 persons ages 25-74 in the United States.

Results: Radiographic stage 2-4 knee OA was found in 319 subjects (3.

Large neutral amino acid changes and delirium in febrile elderly medical patients.

A hypothesized but unexplored mechanism for delirium in older persons is that changes in plasma large neutral amino acid (LNAA) concentrations alter brain serotonin levels, result in neurotoxicity, or both. Therefore we performed a prospective study of 21 acutely febrile long-term-care residents to study the relationship between LNAA changes and delirium. Plasma LNAA concentrations were evaluated during illness and 1 month later.

Development of a minimum data set-based depression rating scale for use in nursing homes.

Background: depression is common but under-diagnosed in nursing-home residents. There is a need for a standardized screening instrument which incorporates daily observations of nursing-home staff.

Aim: to develop and validate a screening instrument for depression using items from the Minimum Data Set of the Resident Assessment Instrument.

Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study.

Few studies have evaluated risk factors for bone loss in elderly women and men. Thus, we examined risk factors for 4-year longitudinal change in bone mineral density (BMD) at the hip, radius, and spine in elders. Eight hundred elderly women and men from the population-based Framingham Osteoporosis Study had BMD assessed in 1988-1989 and again in 1992-1993.