Terminal care for persons with advanced dementia in the nursing home and home care settings.

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.

A national study of the location of death for older persons with dementia.

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.

Use of an IRT-based latent variable model to link different forms of the CES-D from the Health and Retirement Study.

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).

Is pulse pressure a predictor of cardiovascular complications in a frail elderly nursing home population?

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).

Estimating prognosis for nursing home residents with advanced dementia.

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.

Homocysteine as a predictive factor for hip fracture in older persons.

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.

Genome screen for a combined bone phenotype using principal component analysis: the Framingham study.

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.

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.

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).

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.

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.

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=.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.