Serum CTX: a new marker of bone resorption that shows treatment effect more often than other markers because of low coefficient of variability and large changes with bisphosphonate therapy.

Serum CrossLaps is a new assay for measuring carboxy-terminal collagen crosslinks (CTX) in serum. This measurement is reported to be more specific to bone resorption than other measurements. However, the utility of this and other markers in monitoring patients on antiresorptive therapy depends on how often changes anticipated with therapy exceed changes attributable to random variability.

Scaling ADLs within the MDS.

Background: Dependency in activities of daily living (ADLs) is a reality within nursing homes, and we describe ADL measurement strategies based on items in the Minimum Data Set (MDS) and the creation and distributional properties of three ADL self-performance scales and their relationship to other measures.

Methods: Information drawn from four data sets for a multistep analysis was guided by four study objectives: (1) to identify the subcomponents of ADLs that are present in the MDS battery; (2) to demonstrate how these items could be aggregated within hierarchical and additive ADL summary scales; (3) to describe the baseline and longitudinal distributional properties of these scales in a large, seven-state MDS database; and (4) to evaluate how these scales relate to two external criteria.

Results: Prevalence and factor structure findings for seven MDS ADL self-performance variables suggest that these items can be placed into early, middle, and late loss ADL components.

Effects of postprandial walking exercise on meal-related hypotension in frail elderly patients.

The purpose of this study was to assess the hemodynamic effects of a postmeal walk in frail elderly patients with postprandial hypotension. We demonstrated that frail elderly patients with postprandial hypotension are able to increase their blood pressure and heart rate in response to a postmeal walking exercise, but this effect is limited to the exercise period only and is not sustained during subsequent rest.

Nursing rehabilitation and exercise strategies in the nursing home.

Background: The purpose of this study was to evaluate how weight training or nursing-based rehabilitative care programs in nursing homes impact on resident performance of Activities of Daily Living (ADL) and objectives tests of physical performance.

Methods: This study involved a quasi-experimental control, longitudinal comparison of functional status over a 10-month period, where baseline status was adjusted through a weighting procedure based on functional status, cognitive status, and age. All residents from six residential care nursing home facilities were eligible except those with a terminal prognosis, a projected stay of less than 90 days, or with health complications that prohibited contact.

Correlates and management of nonmalignant pain in the nursing home. SAGE Study Group. Systematic Assessment of Geriatric drug use via Epidemiology.

Objective: Nonmalignant pain is a common problem among older people. The prevalence of pain in the nursing home is not well studied. We looked at the association between nonmalignant pain, psychological and functional health, and the practice patterns for pain management in the nursing home.

Neural mechanisms of delirium: current hypotheses and evolving concepts.

The purpose of this article is to review current knowledge regarding potential neural mechanisms of delirium. A MEDLINE search for relevant English language articles was undertaken using various combinations of delirium (including cognitive disorders, encephalopathy, and confusion) with pathogenesis and pathophysiology. These articles were scanned for content related to hypotheses concerning the neurobiology of delirium.

Effects of age and gender on autonomic control of blood pressure dynamics.

Both age and gender influence cardiovascular autonomic control, which in turn may influence the ability to withstand adverse cardiac events and respond to orthostatic stress. The purpose of this study was (1) to quantify age- and gender- related alterations in autonomic control of blood pressure (BP) and (2) to examine the impact of these autonomic alterations on BP response to orthostatic stress. We measured continuous BP and R-R intervals and vasoactive peptide levels in the supine and 60 degrees head-up tilt positions during paced respiration (0.

An automated telephone system for monitoring the functional status of community-residing elders.

We tested the reliability and validity of an automated telephone monitoring system for assessing changes in the functional status of disabled elders living in the community. The sample consisted of 20 adults older than 60 years of age enrolled in a home care program due to functional disabilities. Within a 72-hour period, each participant received, in random order, two automated and one personal telephone functional assessment as well as a home visit assessment by a case manager.

Nursing home characteristics and the development of pressure sores and disruptive behaviour.

Objective: To determine how nursing home characteristics affect pressure sores and disruptive behaviour.

Method: Residents (n = 5518, aged > or =60 years) were selected from 70 nursing homes in the National Health Care chain. Homes were classified as high- or low-risk based on incidence tertiles of pressure sores or disruptive behaviour (1989-90).

Blood pressure behavior in the nursing home: implications for diagnosis and treatment of hypertension.

Objectives: To determine patterns of elevated blood pressure (BP) behavior, their clinical correlates, and the relationship to diagnosis and management of hypertension.

Design: A cross-sectional, prevalence survey.

Setting: Forty-five nursing homes owned or managed by a large national chain.

Serum anticholinergic activity changes with acute illness in elderly medical patients.

Background: Elevated serum anticholinergic activity levels have been associated with delirium in cross-sectional studies of ill older persons. This study used serial measures of serum anticholinergic activity levels to determine whether these levels change following illness resolution, and if such changes are specific to those with delirium.

Methods: Twenty-two nursing home residents with a febrile illness had serum specimens drawn and were evaluated for the presence of delirium during the acute illness and at 1-month follow-up.

A patient-centered approach to advance medical planning in the nursing home.

Objective: The objective of this study is to determine whether nursing home residents or their surrogates are willing and able to prioritize their goals for care and to demonstrate how these rankings can form the basis of a specific pattern of medical care.

Design: A prospective, descriptive study.

Setting: A 40-bed nursing unit for residents with mild to moderate impairments in a 725-bed teaching nursing home.

Dementia in the primary care setting.

The first step in assessing behavioral problems in a patient with dementia is to understand why these behaviors occur and what might be causing them. In some instances, new or longstanding problem behaviors may be related to changes occurring within the brain, but in other cases may be related to a physical problem. The second step is to determine if there is a pattern to the patient's behavior.

Complex demodulation of cardiorespiratory dynamics preceding vasovagal syncope.

Background: The dynamic autonomic processes leading to vasovagal syncope are poorly understood.

Methods And Results: We used complex demodulation to continuously assess changes in respiration, R-R interval, and arterial pressure (blood pressure) variability during 60 degree head-up tilt in 25 healthy subjects with tilt-induced vasovagal syncope and 25 age-matched nonsyncopal control subjects. Coherence and transfer function analyses were used to examine the relation between respiration and R-R interval variability before syncope.

A practical approach to identifying mortality-related factors in established long-term care residents.

Objective: Determining prognosis is an important part of medical planning for long-term care residents. Clarifying the resident characteristics associated with increased mortality has received little attention from investigators, and many approaches that have been suggested are unsuitable for widespread use. Using a readily available database, we sought to determine factors associated with 1-year mortality in established long-term care residents.

A computer-mediated intervention for Alzheimer's caregivers.

This article describes the background and development of an automated telecommunications system, REACH for TLC (Telephone Linked Care), for family caregivers of people with Alzheimer's disease. Caregivers press designated keys on the touch-tone keypad of their home telephones to communicate with TLC and the system speaks to caregivers using a human voice controlled by an Interactive Voice Response computer system. REACH for TLC (1) monitors the primary caregiver's stress level on a weekly basis and makes recommendations and referrals if necessary, (2) provides a voice mail caregiver support network, (3) offers access to an Alzheimer's expert panel, and (4) provides an automated distraction conversation individualized for the person with Alzheimer's disease to allow caregivers a minirespite break or to use as a tool to divert troublesome behaviors.

Lack of an association between insulin-like growth factor-I and body composition, muscle strength, physical performance or self-reported mobility among older persons with functional limitations.

Objective: The hypothesis that decreased growth hormone (GH) secretion contributes to the functional decline that occurs with aging is far from substantiated. There have been few studies addressing the distribution and correlates of IGF-I, an indicator of GH activity, in nonclinical populations. As part of a growth hormone intervention trial, we examined the cross-sectional relations between IGF-I levels and multiple measures of physical function, body composition, and strength in a group of older men and women exhibiting mild to moderate reductions in measured physical performance.

Does artificial enteral nutrition prolong the survival of institutionalized elders with chewing and swallowing problems?

Background: There is a lack of prognostic data regarding tube feeding of institutionalized elderly people. The objective of this study was to determine the impact of feeding tubes on the survival of nursing home residents with chewing and swallowing problems, and to follow the course of the tube-fed residents over one year.

Methods: We conducted a cohort study with 12-month follow-up using Minimum Data Set resident assessments from 1991.

Identifying nursing home residents at risk for falling.

Objectives: To develop a fall risk model that can be used to identify prospectively nursing home residents at risk for falling. The secondary objective was to determine whether the nursing home environment independently influenced the development of falls.

Design: A prospective study involving 1 year of follow-up.

Low-frequency arterial pressure fluctuations do not reflect sympathetic outflow: gender and age differences.

Low-frequency arterial pressure oscillations (Mayer waves) have been proposed as an index of vascular sympathetic outflow. However, cross-sectional differences in these pressure oscillations may not reflect different levels of sympathetic nervous outflow in humans. Three groups of healthy subjects with characteristically different sympathetic nervous outflow were studied: young females (n = 10, 18-28 yr), young males (n = 11, 18-29 yr), and older males (n = 13, 60-72 yr).

The effect of specific medical conditions on functional decline.

Objectives: To examine how functional status among older community-dwelling residents differs over time between those with and those without specific medical conditions.

Design: Prospective cohort study.

Participants: A total of 1060 community-dwelling Massachusetts residents aged 65 or older who were not totally functionally dependent at baseline assessment.

Exclusion of elderly subjects from clinical trials for Parkinson disease.

Objectives: To determine whether subjects older than 75 years are included in the randomized controlled trials of antiparkinsonian medications conducted during the last 30 years and to identify study characteristics that are associated with the exclusion of patients of advanced age.

Methods: A systematic search was conducted on MEDLINE from January 1966 until September 1996 of all randomized controlled trials of drugs used to treat the motor symptoms of Parkinson disease. Articles were abstracted for the age of subjects date of publication, geographic location, drug class studied, stage of Parkinson disease of subjects, and the number of subjects in each trial.

Assessing and treating weight loss in nursing home patients.

Any physician who cares for nursing home residents has been confronted with the problem of unintentional weight loss. This can be a particularly vexing problem when the person with weight loss has multiple medical diagnoses, takes many medications, and has some degree of cognitive impairment. Questions raised in such cases include the following: what are normal weights for the old; is some degree of weight loss part of normal aging; what are the causes of weight loss in nursing home residents; and what are the most effective means of reversing the loss.

Longitudinal weight changes, length of survival, and energy requirements of long-term care residents with dementia.

Objective: We hypothesized that institutionalized patients with dementia, who frequently have feeding problems and require supervised and assisted feeding, would lose more weight during their residency than nondemented, independently functioning residents and have compromised survival. To test this hypothesis, we examined the survival and longitudinal changes in weight of two cohorts of institutionalized residents with dementia and compared these cohorts with a cohort of nondemented residents. We also measured the resting energy expenditures of a subset of the subjects with dementia as an indicator of their energy needs.