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PubMed2006

Physicians' expectations regarding registered nurses caring for older people living in sheltered housing, retirement homes and group dwellings.

The aim of this study was to illuminate the meaning of the physicians' expectations regarding registered nurses who are responsible for the care of older people living in sheltered housing, retirement homes and group dwellings. A phenomenological-hermeneutic method was used for the analysis. Twelve physicians from two municipalities in Sweden were interviewed. The naive reading of the interviews characterizes the physicians' expressed views of nurses by using metaphors such as "the extended arm", "gatekeeper" and "belonging to a no-man's land". In the structural analysis, explanations of the metaphors are given. The new understanding was that the physicians also expect registered nurses to be able to switch between keeping a distance and being close to older people. When registered nurses have this skill, the physicians have a "we" feeling towards the nurse. The paper provides insights into the physician-nurse relationship, in the context of residential care in Sweden.

Aged↗
PubMed2006

An outbreak of Pneumococcal pneumonia among residents of a retirement home in France during October 2003.

We describe an outbreak of pneumonia due to Streptococcus pneumoniae in a French retirement home. Eleven residents developed pneumonia. Eight patients had positive results of urinary antigen tests. There were no further cases after the implementation of control measures, which involved isolation of and receipt of antibiotic therapy by symptomatic residents. No risk factors for transmission of S. pneumoniae were identified in this population.

Aged↗
PubMedDate not supplied

Number of children associated with obesity in middle-aged women and men: results from the health and retirement study.

OBJECTIVE: To study associations between number of children and obesity in middle-aged women and men. METHODS: In the Health and Retirement Study, a national survey of households, we tested the association between increasing number of children and obesity (body mass index [BMI] >or= 30) in 9046 middle-aged women and men (4523 couples). RESULTS: Women (n = 4523) who were obese were more frequently nonwhite, reported lower household income, were more frequently employed outside the home, were less frequently covered by health insurance, and were more frequently less educated compared with nonobese women. Men (n = 4523) who were obese were younger, were more frequently African American, and were more frequently less educated and poorer compared with nonobese men. Among women, a 7% increase in risk of obesity was noted for each additional child, adjusting for age, race, household income, work status, physical activity, tobacco use, and alcohol use. Among men, a 4% increase in risk of obesity was noted for each additional child, adjusting for the same covariates. These sex differences were not significantly different. CONCLUSIONS: Previous research has demonstrated an association between number of children and obesity among women. These results suggest a similar association among men. Public health interventions focused on obesity prevention should target both parents, especially those parents with several children.

Adult↗
PubMed1989

Ovariectomy, dietary zinc, and bone metabolism in retired breeder rats.

Bone mineral turnover was studied in sham and ovariectomized (ovax) retired breeder rats after 16 wk of dietary treatment. Rats were fed either a commercial rat diet (CRD) containing high calcium and cholecalciferol or egg-white diets (EWD) containing 2 g Ca/kg, 1,25-(OH)2cholecalciferol (5 micrograms/kg), and either 10 or 200 mg zinc/kg. In rats fed EWD, high Zn enhanced femoral Zn deposition and concentration but did not affect serum Ca levels, bone mineral content (BMC), or turnover. Serum Ca levels and BMC were greater in sham rats and there was a gain in femoral Ca and phosphorus compared with the loss of these minerals in ovax rats. In CRD-fed ovax rats, values for these variables were similar to those of CRD-fed shams and there was no bone mineral loss. These data suggest that ovarian function may be a prerequisite for the beneficial effects of diets containing 1,25-(OH)2cholecalciferol and low Ca on bone metabolism.

Animals↗
PubMed2001

Design and serendipity in establishing a large cohort with wide dietary intake distributions : the National Institutes of Health-American Association of Retired Persons Diet and Health Study.

In 1995-1996, the authors mailed a food frequency questionnaire to 3.5 million American Association of Retired Persons members who were aged 50-69 years and who resided in one of six states or two metropolitan areas with high-quality cancer registries. In establishing a cohort of 567,169 persons (340,148 men and 227,021 women), the authors were fortunate in that a less-than-anticipated baseline response rate (threatening inadequate numbers of respondents in the intake extremes) was offset by both a shifting and a widening of the intake distributions among those who provided satisfactory data. Reported median intakes for the first and fifth intake quintiles, respectively, were 20.4 and 40.1 (men) and 20.1 and 40.0 (women) percent calories from fat, 10.3 and 32.0 (men) and 8.7 and 28.7 (women) g per day of dietary fiber, 3.1 and 11.6 (men) and 2.8 and 11.3 (women) servings per day of fruits and vegetables, and 20.7 and 156.8 (men) and 10.5 and 97.0 (women) g per day of red meat. After 5 years of follow-up, the cohort is expected to yield nearly 4,000 breast cancers, more than 10,000 prostate cancers, more than 4,000 colorectal cancers, and more than 900 pancreatic cancers. The large size and wide intake range of the cohort will provide ample power for examining a number of important diet and cancer hypotheses.

Aged↗
PubMed2005

The clock drawing test is an independent predictor of incident use of 24-hour care in a retirement community.

BACKGROUND: It is unclear how early cognitive impairment affects future care needs. Furthermore, the Mini-Mental State Examination (MMSE), a commonly used screening tool in the clinical setting, tends to have a ceiling effect for early cognitive decline. One of the earliest changes in cognitive function is executive impairment. We examined the relationship between executive function, measured with a clock drawing protocol (CLOX1) designed to capture executive impairment, and incident need for increased level of care and total mortality. METHODS: Residents (n = 230) in independent living at a continuing care retirement community were followed for incident need for 24-hour care (mean 2.5 years). Baseline assessment included health status and physical and cognitive function. Time to event analysis was performed to determine the association of the CLOX1 score with the outcomes. RESULTS: Forty percent of residents had a CLOX1 score <12, and 10% had an MMSE score <26. The event rate for a CLOX1 score <12 was 30 per 100 person-years (p-y) and 13 per 100 p-y for a score > or =12. Similarly, the event rate was 34 per 100 p-y versus 17 per 100 p-y for MMSE <26 and MMSE > or =26, respectively. A CLOX1 score <12 was associated with a twofold higher risk of incident use of 24-hour care (hazard ratio 2.2; 95% confidence interval: 1.5-3.4) and death (hazard ratio 2.3; 95% confidence interval: 1.1-4.8) even after controlling for age, sex, comorbidity, and MMSE scores. The MMSE score was not an independent predictor of incident use of 24-hour care or mortality. CONCLUSION: The clock drawing test, scored for executive impairment, but not the MMSE, predicted incident use of 24-hour care and mortality in this cohort of independent older adults.

Aged↗
PubMed2005

Social status and risky health behaviors: results from the health and retirement study.

OBJECTIVES: We focus on a hypothesized mechanism that may underlie the well-documented link between social status and health-behavioral health risks. METHODS: We use longitudinal data from representative samples of 6,106 middle-aged and 3,636 older adults from the Health and Retirement Study to examine the relationships between social status-including early life social status (e.g., parental schooling), ascribed social status (e.g., sex, race-ethnicity), and achieved social status (e.g., schooling, economic resources)-and behavioral health risks (e.g., weight, smoking, drinking, physical activity) to (1) assess how early life and ascribed social statuses are linked to behavioral health risks, (2) investigate the role of achieved factors in behavioral health risks, (3) test whether achieved status explains the contributions of early life and ascribed status, and (4) examine whether the social status and health risk relationships differ at midlife and older age. RESULTS: We find that early life, achieved, and ascribed social statuses strongly predict behavioral health risks, although the effects are stronger in midlife than they are in older age. DISCUSSION: Ascribed social statuses (and interactions of sex and race-ethnicity), which are important predictors of behavioral health risks even net of early life and achieved social status, should be explored in future research.

Aged↗
PubMed1980

The effect of oxandrolone on low and high density lipoprotein profiles in retired breeder rats.

The retired breeder rat, an animal known to undergo premature aging and to develop hypercholesterolemia, was studied to determine the effect of oxandrolone, a synthetic hypolipidemic steroid, on serum lipoprotein subfractions. The methods utilized for this study included density ultracentrifugation, electron microscopic lipoprotein particle sizing, and disc gel electrophoresis. The data confirmed the cholesterol-lowering ability of oxandrolone and demonstrated that its effect on total serum cholesterol was limited to the low and high density lipoprotein subclasses. The drug-treated group had 50% less LDL cholesterol and 25% less HDL cholesterol. Though there was an absolute decrease in total serum cholesterol in both these fractions, there was a re-distribution of cholesterol, such that post-treatment LDL carried less cholesterol and HDL more cholesterol on a percentage basis than found in pre-treatment values. In the light of current concepts of atherogenicity these alterations are of interest and potentially of considerable value.

Aging↗
PubMed1988

The risk factors of nursing home entry among residents of six continuing care retirement communities.

We identified client characteristics related to nursing home entry for 3,316 residents of six continuing care retirement communities with a longitudinal dataset that follows an initially healthy entry cohort for up to 15 years. The Cox Proportional Hazards Model was used for the analysis of survival data that includes censored data. We calculated hazard indices for residents with different characteristics to show the independent effect of these variables on the probability of nursing home entry. Seven variables emerged as statistically significant covariates: sex, marital status, roommate status, entry year into the community, entry age into the community, number of hospitalizations, and community of residence. The community of residence, which in large part reflects system effects on nursing home entry, was found to be the single most important variable explaining variance in the data. Tobit analysis was used to examine the factors associated with multiple nursing home entries and total days per year spent in a nursing home. With a few exceptions, most of the variables listed above were also significant correlates of multiple entries and total days per year spent in a nursing home.

Age Factors↗
PubMed1989

Patterns of nursing home use in a prepaid managed care system: the continuing care retirement community.

The use of nursing home services among 3,316 residents of six continuing care retirement communities (CCRCs) was compared with that of the general elderly population. CCRC residents have a greater lifetime risk of nursing home entry and repeat entries. CCRC resident's length of stay per admission, however, is shorter. Findings from this comparative analysis provided insight into nursing home use in an insured and managed long term care program for a closed population.

Aged↗
PubMed2000

Patterns of service use in a continuing care retirement community.

The authors analyzed the use of 16 onsite services reported by 91 residents of a new continuing care retirement community (CCRC). The most frequently used services appear to be those of convenience to the residents, including an onsite pharmacy, insurance billing, and a bank, as well as health and fitness services. Perceived health and multiple illnesses were associated with greater use of health and auxiliary health/fitness services, whereas age and marital status were not. In addition, respondent reports of spouse service use predicted respondent service use, whereas measures of social connectedness and friendship did not. Community service use before relocation to the CCRC was predictive of total CCRC service use only in unmarried respondents, demonstrating the complex nature of the relationship between informal support and the use of formal services. The behavioral model appears to be applicable to the study of CCRCs.

Activities of Daily Living↗
PubMed2005

Use of complementary medicine in older Americans: results from the Health and Retirement Study.

PURPOSE: The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy. DESIGN AND METHODS: A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices). RESULTS: Of respondents over 65 years of age, 88% used CAM, with dietary supplements and chiropractic most commonly reported (65% and 46%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases. IMPLICATIONS: The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers.

Activities of Daily Living↗
PubMed1991

Accommodation and relocation decision making in continuing care retirement communities.

Accommodations and relocations in continuing care retirement communities (CCRCs) affect the lives of staff and residents. This article defines the CCRC concept and reviews the literature relevant to accommodation and relocation changes within CCRCs. Implications for health and human services practitioners who work with older CCRC residents, along with specific issues, are discussed.

Aged↗
PubMed1999

Dear author--advice from a retiring editor.

This commentary, detailing the handling of a manuscript by the editor and guiding authors on preparing manuscripts and responding to reviews, provides parting advice to authors from a retiring editor. A close reading of this commentary will give some insight into the editorial process at the American Journal of Epidemiology through the observations of one of its editors.

Periodicals as Topic↗
PubMed1990

Foodborne Snow Mountain agent gastroenteritis with secondary person-to-person spread in a retirement community.

A variety of small round-structured viruses are being recognized with increasing frequency as a cause of gastroenteritis in the community, but have rarely been reported to cause outbreaks in hospitals or extended-care facilities. From March 20 through April 15, 1988, an outbreak of gastroenteritis occurred in a retirement facility in the San Francisco Bay area. Illness was characterized by diarrhea, nausea, and vomiting; two residents died. Attack rates were 46% (155 of 336) in residents and 37% (28 of 75) in employees. During the initial outbreak period, illness among residents was associated with two shrimp meals served in the facility dining hall (odds ratio = 6.7). Person-to-person transmission probably occurred: The risk of becoming ill one or two days after a roommate became ill was significantly greater than that of becoming ill at other times during the outbreak (risk ratio = 6.5). Microbiologic examinations for bacterial and parasitic enteric pathogens were negative; however, 27-nm viral particles were detected by immune electron microscopy and by blocking enzyme immunoassay to Snow Mountain agent in stools obtained at the onset of illness from one of six ill residents. Seroconversion (greater than fourfold antibody rise) to Snow Mountain agent was detected in acute- and convalescent-phase serum specimens from five of six ill residents as measured by enzyme immunoassay, but not for Norwalk agent as measured by radioimmunoassay. This report of an outbreak of Snow Mountain agent gastroenteritis in an extended-care facility documents that these difficult-to-identify 27-nm viruses can cause outbreaks in inpatient settings.

Aged↗
PubMed1990

The emerging relationship between academic health centers and continuing care retirement communities.

A survey of the 96 member-institutions of the Association of Academic Health Centers was conducted by the authors during the 1988-89 academic year to determine the number and types of contractual ties with continuing-care retirement communities (CCRCs). Of the 88 academic health centers that responded, 24% had an existing relationship with a CCRC; 26% were in the process of developing such a relationship; 7% had considered but decided against such a relationship; and 43% had not considered developing such a relationship. The authors document a rapid increase in the number of such relationships in the latter half of the 1980s and suggest that this trend is comparable to the increase in formal relationships with nursing homes begun by academic health centers in the early 1980s. Issues raised by those institutions that responded are presented, levels of possible involvement with a CCRC are described, and the contractual agreement between the University of North Carolina School of Medicine's Program on Aging and a local CCRC is presented as an example of the benefits that can be gained from such a relationship.

Academic Medical Centers↗
PubMed2001

Studying coronary artery disease in the retirement community.

A study was conducted to identify the prevalence of heart disease and associated health-related behaviors among continuing care retirement community (CCRC) residents; researchers also sought to identify management strategies for heart disease. Study results indicated that self-reported heart disease is prevalent among CCRC residents: 60% reported three or more health risk behaviors. The CCRC environment lends itself to providing various management advantages, including access to on-site clinicians, group education, and exercise and dining facilities to promote adherence to exercise, nutrition, and medical management plans.

Aged↗
PubMedDate not supplied

The pain management knowledge of nurses practicing in a rural midwest retirement community.

Pain is a significant health issue, especially among hospitalized patients and elders. Nurses are the key to effective pain management; however, several studies over the past 20 years have demonstrated that nurses lack the knowledge necessary to manage pain effectively. Staff development educators have used a number of education methods to address this deficit. Additionally, educators in staff development have the task of providing education in an effective and cost-efficient manner. The purpose of this study was to assess the pain knowledge scores of a group of nurses practicing in a rural Midwest retirement community before and at two points after a pain education intervention to determine the effectiveness of Knowles' Adult Learning Theory in increasing and sustaining rural nurses' pain knowledge scores.

Analysis of Variance↗