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Demographic and health characteristics of residents choosing to use on-site medical care in a newly opened continuing care retirement community (CCRC).

OBJECTIVE: To determine demographic and health characteristics of older adults choosing to use on-site medical care in a continuing care retirement community (CCRC). DESIGN: A descriptive study of residents moving into a newly opened CCRC. Residents responded to a self-report mail survey composed of questions related to reasons for moving to a CCRC, health and functional status,health care use during the previous 5 years. RESULTS: Of 942 residents, 642 (68%) completed the survey. Medical center users and nonusers were similar demographically and reported similar reasons for moving to the CCRC including desire for a low maintenance apartment (49% vs. 48%; P = 0.806), concern about health or spouse's health (67% vs. 63%; P = 0.345), and desire for social activities (63% vs. 58%; P = 0.151). However, on-site medical center users versus nonusers reported increased rates of fair/poor health (31% vs. 18%; P = 0.0001), fair/poor vision (27% vs. 15%; P = 0.0003),difficulty walking in the home (13% vs. 8%; P = 0.53), using the toilet (6% vs. 2%; P = 0.044), shopping (29% vs. 20%; P = 0.007), using transportation (19% vs. 10%; P = 0.005), doing laundry (13% vs. 7%; P = 0.016), using the telephone (8% vs. 3%; P = 0.002), and taking medication (5% vs. 1%; P = 0.022). CONCLUSION: For both users and nonusers of the medical center, the most frequently cited reason for moving to the CCRC was concern about health. On-site medical center users had lower perceived health, were functionally more disabled, and had health characteristics that made them at higher risk for high health care utilization. The challenges to provide high quality medical care and enhance quality of life for CCRC residents will continue to increase. Physicians should play an active role not only in providing medical care to CCRC residents, but also in providing medical leadership for these institutions.

Journal Article↗

Quality of preventive clinical services among caregivers in the health and retirement study.

We examined the association between caregiving for a spouse and preventive clinical services (self-reported influenza vaccination, cholesterol screening, mammography, Pap smear, and prostate cancer screening over 2 years and monthly self-breast exam) for the caregiver in a cross-sectional analysis of the Health and Retirement Study, a nationally representative sample of U.S. adults aged > or = 50 years (N = 11,394). Spouses engaged in 0, 1-14, or > or = 14 hours per week of caregiving. Each service was examined in logistic regression models adjusting for caregiver characteristics. After adjustment for covariates, there were no significant associations between spousal caregiving and likelihood of caregiver receipt of preventive services.

Aged↗

The longitudinal occurrence and impact of comorbid chronic pain and chronic depression over two years in continuing care retirement community residents.

OBJECTIVE: To describe the longitudinal course of depressive symptoms and pain experienced by continuing care retirement community (CCRC) residents and to investigate the impact of comorbid chronic activity-limiting pain and chronic high depressive symptoms on physical functioning and health service use. METHODS: This longitudinal study of 169 CCRC residents involved five assessments (baseline and four in-person interviews at 6-month intervals). The Geriatric Depression Scale (GDS), questions drawn from the McGill Pain Questionnaire, and self-report data on physical functioning and health care use were assessed. Individuals reporting activity-limiting pain and those with GDS scores > or =11 at three or more assessments were considered to have chronic pain or chronic depression, respectively. The analysis sample included 169 CCRC residents. Multivariate logistic regression was used to test hypotheses. RESULTS: Pain and depressive symptoms were characterized by longitudinal stability. Of the sample, 37% met the criteria for chronic activity-limiting pain, 21% met the criteria for chronic high depressive symptoms, and 13% were comorbid. Adjusting for age and health conditions, those with chronic activity-limiting pain were five times more likely than those in the lowest pain group to persistently be in the worst two quartiles of physical functioning, as were those with even one GDS score >5. The odds of poor physical functioning were 11.2 times greater in those with comorbid chronic pain and depression. Comparable greater odds were seen in this sample for frequency of medical care visits (adjusted odds ratio AOR]=12.4) and consistently high use of all medical services (AOR=3.5). CONCLUSIONS: Pain and depressive symptoms were both common and appeared remarkably stable over time. Depressive symptoms contributed significantly to the prediction of impairment associated with pain, and identification and treatment of such symptoms, even minor symptoms, could reduce pain-related impairment and health care costs in the elderly.

Activities of Daily Living↗

Self-reported functional status predicts change in level of care in independent living residents of a continuing care retirement community.

OBJECTIVE: To test the hypothesis that self-reported functional status predicts change in level of care from independent to dependent in residents of a continuing care retirement community (CCRC). DESIGN: Two-year longitudinal descriptive study of change in level of care and survival. SUBJECTS: One hundred fifty-two residents in the independent-living unit of a non-profit CCRC. Mean age at initial evaluation was 82.3 years, SD 6.2. MEASUREMENT: Predictor variables assessed at baseline were age, sex, physician estimate of functionally significant disease, self-reported functional status, and performance-based hand function. Criterion variables collected at 2-year follow-up were level of care (independent/dependent) and survival (alive/dead). MAIN RESULTS: Self-reported functional status (P less than 0.01) and age (P less than 0.05) were significant predictors of change in level of care in a logistic regression analysis containing all predictor variables. No variable predicted survival. CONCLUSIONS: Self-reported functional status may help to predict dependency in older adults in good health who have few markers of dependency risk.

Activities of Daily Living↗

Efficacy and feasibility of a novel tri-modal robust exercise prescription in a retirement community: a randomized, controlled trial.

OBJECTIVES: To test the feasibility and efficacy of current guidelines for multimodal exercise programs in older adults. DESIGN: Randomized, controlled trial. SETTING: Retirement village. PARTICIPANTS: Thirty-eight subjects (14 men and 24 women) aged 76.6 +/- 6.1. INTERVENTION: A wait list control or 10 weeks of supervised exercise consisting of high-intensity (80% of one-repetition maximum (1RM)) progressive resistance training (PRT) 3 days per week, moderate-intensity (rating of perceived exertion 11 to 14/20) aerobic training 2 days per week, and progressive balance training 1 day per week. MEASUREMENTS: Blinded assessments of dynamic muscle strength (1RM), balance, 6-minute walk, gait velocity, chair stand, stair climb, depressive symptoms, self-efficacy, and habitual physical activity level. RESULTS: Higher baseline strength and psychological well-being were associated with better functional performance. Strength gains over 10 weeks averaged 39+/-31% in exercise, versus 21+/-24% in controls (P=.10), with greater improvements in hip flexion (P=.01), hip abduction (P=.02), and chest press (P=.04) in the exercise group. Strength adaptations were greatest in exercises in which the intended continuous progressive overload was achieved. Stair climb power (12.3+/-15%, P=.002) and chair stand time (-7.1+/-15%, P=.006) improved significantly and similarly in both groups. Reduction in depressive symptoms was significantly related to compliance (attendance rate r=-0.568, P=.009, PRT progression in loading r=-0.587, P=.02, and total volume of aerobic training r=-0.541, P=.01), as well as improvements in muscle strength (r=-0.498, P=.002). CONCLUSION: Robust physical and psychological adaptations to exercise are linked, although volumes and intensities of multiple exercise modalities sufficient to cause significant adaptation appear difficult to prescribe and adhere to simultaneously in older adults.

Aged↗

Therapy of cutaneous squamous cell carcinoma in two retirement home residents.

The incidence of cutaneous squamous cell carcinomas (SCC) has been increasing by about 5% per year of the past 40 years in a population which is growing continuously older and as such presents a growing therapeutic challenge. We report on two elderly female residents of a retirement home with histologically confirmed SCC on the back of the hand. In one case the tumor was completely excised and covered with a graft. In the second case the patient refused all surgical and radiotherapeutic procedures. We sought an adequate therapeutic alternative considering the extent and thickness of the tumor. Topical application of the immune response modifier imiquimod appeared to represent an alternative solution because of its unique antineoplastic mode of action, even though there was no published experience with this approach. She has remained tumor-free for four years, justifying our decision. In both cases, a comparable cosmetic result with full functional capacity of the hands was obtained. Imiquimod 5% cream was approved last year for the treatment of superficial basal cell carcinoma.

Adjuvants, Immunologic↗

Serum creatinine concentrations in retired racing Greyhounds.

BACKGROUND: Greyhounds frequently have laboratory values that are outside reference intervals established for dogs. Our recognition of increased serum creatinine concentrations in several Greyhounds posed a problem when evaluating a Greyhound with suspected renal disease. OBJECTIVE: The purpose of this study was to compare serum creatinine concentrations between Greyhound and non-Greyhound dogs. METHODS: Thirty retired racing Greyhounds and 30 age- and gender-matched control non-Greyhound dogs were evaluated. Serum creatinine concentrations in both groups were measured using a standard biochemical method and compared statistically using a Kruskal-Wallis test. RESULTS: Creatinine concentration was significantly higher in the Greyhounds (P <.01) than in the control group. CONCLUSION: Greyhounds have a higher serum creatinine concentration than do non-Greyhound dogs. This idiosyncrasy should be taken into account when evaluating healthy Greyhounds and those with suspected renal disease.

Animals↗

Mortality in retired coke oven plant workers.

A previous study on 536 retired coke oven plant workers in Lorraine Collieries (France) reported an excess of deaths from lung cancer (standardised mortality ratio (SMR) = 251) compared with the French male population. Occupational exposures during working life were retraced for each subject, but the number of deaths during the observation period (1963-82) was small, and smoking habits were known only for dead subjects. In 1988, the cohort was re-examined (182 deaths occurred between 1963 and 1987) and smoking habits were determined for all the subjects. This study confirmed the excess of lung cancer (SMR = 238, p < 0.001). It showed an excess of mortality from all causes (SMR = 141, p < 0.001), overall cancers (SMR = 133, p < 0.05), and cardiovascular diseases (SMR = 133, p < 0.05). A significant excess of deaths was found for subjects who worked near the ovens for all causes (145, p < 0.01), lung cancer (SMR = 252, p < 0.01), colon cancer (SMR = 381, p < 0.05), and cardiovascular diseases (SMR = 155, p < 0.05). A significant excess mortality was also found from all causes (176, p < 0.05) and stomach cancer (SMR = 538, p < 0.01) in subjects who worked in byproducts, from lung cancer (SMR = 433, p < 0.001) in those in the workshops, and from cirrhosis of the liver and alcoholism (SMR = 360, p < 0.01) in those underground; but, due to small numbers, these figures were not robust. An excess of mortality from all causes (SMR = 163, p<001), lung cancer (SMR = 228, p<0.05) and cardiovascular diseases (SMR = 179, p<0.01) was shown also for non-exposed or slightly exposed subjects. The fact that, on the whole, mortality of various exposed groups was similar to that of non-exposed or slightly exposed workers may be explained in part by the selection at hiring and the healthy worker effect. As an increased risk of lung cancer was noted among subjects who worked in the old generations of plant compared with the other workers (although the relative risk was not significant) it is concluded that the role of occupational hazards could not be excluded.

Cardiovascular Diseases↗

Evaluation of the quality of coding of job episodes collected by self questionnaires among French retired men for use in a job-exposure matrix.

BACKGROUND: and AIMS: The ESPACES study was intended to identify retirees who may have been, according to their job descriptions, exposed to asbestos during their working lives. As part of this study, we analysed the quality of the occupation and activity sector coding as well as its effect on the subjects' exposure status. METHODS: The occupation and activity sector for a sample of 450 retired men were coded twice (with the second coder blinded to the first result), according to the international codes for industries (ISIC-1975) and occupations (ISCO-1968). For each series, linking the information about a job episode (dates, ISIC code, ISCO code) with the matrix allowed attribution of a probability of asbestos exposure to each episode and each subject. The asbestos exposure in the two series was compared by the kappa reproducibility coefficient. RESULTS: The analysis concerned 425 questionnaires. There was at least one difference in the code for either activity sector (ISIC) or occupation (ISCO) in half the episodes (50.2%). The exposure status estimated by the job-exposure matrix did not change between the series for 84.7% of the subjects. The kappa coefficient was 0.64 for all questionnaires, 0.70 when the questionnaire was coded twice by the same coder, and 0.62 when coded by two different coders. CONCLUSIONS: Despite intra- and inter-differences between coders, the coding of job episodes for the ESPACES study appears satisfactory and hence indicates that the assessment of the subjects' asbestos exposure was assessed without major distortions. This study underlines the usefulness of employing coders specifically trained for this technique.

Asbestos↗

Retirement.

Retirement should be carefully thought through and sensible plans made for the future. It is a time of challenge for what lies ahead not disappointment at what has been. As you shut one door another will open and it is up to each individual to ensure that this will lead to a productive, satisfying and enjoyable way of life.

Pensions↗

60 years of chemical carcinogens: Sir Ernest Kennaway in retirement.

1992 marks the sixtieth anniversary of the publication of the first paper on the production of cancer by pure hydrocarbons, by the team at the Chester Beatty Research Institute headed by Professor Kennaway. Studies on polycyclic aromatic hydrocarbons and other chemical carcinogens continued to thrive under his leadership in succeeding years at the Chester Beatty and beyond, into his 'retirement' in 1946. He played a key role in stimulating research on factors contributing to the epidemic of lung cancer that became apparent by then, and with the support of the Medical Research Council (MRC) and other organizations he directed a small team working on analytical and epidemiological studies in a makeshift laboratory at St Bartholomew's Hospital. Published work included the identification and determination of benzo(a)pyrene in domestic soot, urban air pollution, motor vehicle exhausts and cigarette smoke, also arsenic in urban air and cigarette smoke, radon in indoor air and carbon deposits in human lungs. Such studies have been pursued in other laboratories around the world since then, and many of the lines of enquiry are traceable back to the pioneering work of the team at the Chester Beatty 60 years ago.

Air Pollutants↗

State unit on aging involvement with continuing care retirement community (CCRC) legislation.

State units on aging (SUAs) from 29 states with continuing care retirement community (CCRC) legislation were surveyed to (a) assess staff familiarity with CCRC legislation, (b) examine interdepartmental working relationships surrounding such legislation and ask what role(s) ombudspersons are playing in CCRC oversight, (c) determine what role(s) aging units have had in developing legislation, and (d) gain insights regarding legislative impact. Results indicate that SUAs have been active in legislative development but vary greatly in the intensity of their involvement with the implementation and enforcement of CCRC regulation and in their perception of legislative impact.

Aged↗

A prediction model of aerobic exercise in older adults living in a continuing-care retirement community.

OBJECTIVES: The purpose of this study was to test a model of exercise behavior in older adults. It was hypothesized that gender, marital status, chronic illness, mental and physical health, self-efficacy and outcome expectations, fear of falling, and past exercise behavior were directly and/or indirectly associated with current exercise behavior. METHODS: In this descriptive study, interviews were conducted with 201 older adults living in a continuing-care retirement community. RESULTS: Twelve paths were significant, and the model accounted for 40% of the variance in exercise behavior. Self-efficacy expectations, outcome expectations, and prior exercise were directly associated with current exercise; health status, gender, and marital status were indirectly associated with current exercise behavior through self-efficacy and outcome expectations. DISCUSSION: Recognizing and treating mental and physical health problems may directly influence self-efficacy and outcome expectations related to exercise. Moreover, interventions that strengthen self-efficacy and outcome expectations related to exercise may improve exercise behavior.

Aged↗

The effect of spousal mental and physical health on husbands' and wives' depressive symptoms, among older adults: longitudinal evidence from the Health and Retirement Survey.

OBJECTIVE: To estimate the effect of spousal depressive symptoms and physical health on respondents' depressive symptoms in a national sample of older married couples. METHOD: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents' depressive symptoms. RESULTS: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p < .001). Controlling for spousal depressive symptoms, a decline in the spouses' physical health was associated with a significant reduction in respondent depressive symptoms (p < .05). DISCUSSION: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.

Aged↗

Retired registered nurses' stories about being in ethically difficult care situations.

Twelve retired nurses were asked to narrate a care situation in which it had been difficult for them as nurses to know what was the right and good thing to do. The transcribed interviews were examined by content analyses. Physicians were the central coactors in the nurses' stories. Colleagues were seldom mentioned. Other ward staff were mainly called "the girls". The patient was central and referred to with respect. All the nurses focused on experiential learning. Guiding ethical principles are listed.

Conflict, Psychological↗

A cognitive and physical performance assessment of retirees entering a continuing care retirement community: the Moorings Assessment Protocol.

Moorings Park Continuing Care Retirement Community (CCRC) screened 267 applicants (115 males; 152 females; mean age 80.22 years) using the Mini-Mental State Examination (MMSE), the 7-Minute Screen, the Geriatric Depression Scale (GDS), and the Physical Performance Test (PPT). They compared mean scores across admission/nonadmission groups to determine the extent to which cognitively impaired persons were effectively redirected from independent living settings inadequate for their needs. Groups differed (p < .05) on 21 test items/scores, including subscales of the 7-Minute Screen. The nonadmission group underperformed the admission group and healthy controls from earlier research, and outscored persons with Alzheimer's disease on all 7-Minute Screen subscales. Researchers concluded that geriatricians had effectively identified those with dementia and mild cognitive impairment (MCI) and placed them into supervised settings more appropriate to their clinical and social needs.

Age Factors↗

Racial differences in influenza vaccination among older Americans 1996-2000: longitudinal analysis of the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey.

BACKGROUND: Influenza is a common and serious public health problem among the elderly. The influenza vaccine is safe and effective. METHODS: The purpose of the study was to determine whether frequencies of receipt vary by race, age group, gender, and time (progress from 1995/1996 to 2000), and whether any racial differences remain in age groups covered by Medicare. Subjects were selected from the Health and Retirement Study (HRS) (12,652 Americans 50-61 years of age (1992-2000)) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (8,124 community-dwelling seniors aged 70+ years (1993-2000)). Using multivariate logistic regression, adjusting for potential confounders, we estimated the relationship between race, age group, gender, time and the main outcome measure, receipt of influenza vaccination in the last 2 years. RESULTS: There has been a clear increase in the unadjusted rates of receipt of influenza vaccination for all groups from 1995/1996 to 2000. However, the proportions immunized are 10-20% higher among White than among Black elderly, with no obvious narrowing of the racial gap from 1995/1996 to 2000. There is an increase in rates from age 50 to age 65. After age 70, the rate appears to plateau. In multivariate analyses, the racial difference remains after adjusting for a series of socioeconomic, health, and health care related variables. (HRS: OR = 0.63 (0.55-0.72), AHEAD: OR = 0.55 (0.44-0.66)) CONCLUSIONS: There is much work left if the Healthy People 2010 goal of 90% of the elderly immunized against influenza annually is to be achieved. Close coordination between public health programs and clinical prevention efforts in primary care is necessary, but to be truly effective, these services must be culturally appropriate.

Age Distribution↗

Chimpanzees and retirement.

The subject of sanctuaries for chimpanzees has lately become the topic of a great deal of discussion (Brent, Butler, & Haberstroh, 1997; Committee on Long-Term Care of Chimpanzees, 1997; Dyke, Williams-Blangero, Mamelka, & Goodwin, 1995; Peterson & Goodall, 1993). In the United States, laboratories that use chimpanzees in research are facing a housing crisis. An increase in captive births caused by the initiation of the National Chimpanzee Breeding and Research Program in 1986 (Hobson, Graham, & Rowell, 1991), coupled with the diminished use of chimpanzees as experimental subjects, have led to a large population of chimpanzees considered to be surplus to demand (Blood, Wolfle, & Whitney, 1992). These chimpanzees, as well as an unknown number from the private sector, are candidates for what is currently being called retirement.

Journal Article↗