Journal Of Gerontology[JOURNAL]
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200 papers
Age-sensitive T cell phenotypes covary in genetically heterogeneous mice and predict early death from lymphoma.
Miller RA, Turke P, Chrisp C … +6 more , Ruger J, Luciano A, Peterson J, Chalmers K, Gorgas G, VanCise S
J Gerontol · 1994 Nov · PMID 7525689 · Full text
We have assessed several age-sensitive indicators of immune status in young (i.e., 6 to 11-month-old) mice of a genetically heterogeneous population to see if these varied in parallel and to determine if one or more of t...
We have assessed several age-sensitive indicators of immune status in young (i.e., 6 to 11-month-old) mice of a genetically heterogeneous population to see if these varied in parallel and to determine if one or more of the status indices predicted life span or cancer incidence. We report that the number of memory (i.e., CD44hi) T cells within the CD8 subset is correlated with number of memory cells in the CD4 population, and inversely correlated with the number of naive (i.e., CD45RBhi) CD4 cells at both 6 and 11 months of age, suggesting that the conversion of naive to memory cells may occur at similar rates in both T cell subsets. Mice that ranked high in the proportion of memory T cells (within the CD4 and CD8 pools) at 6 months of age tended to retain their ranking at 11 months, suggesting that the pace or extent of memory cell formation may be a consistent trait that distinguishes mice at least within a genetically heterogeneous population. Mice that at 6 months of age exhibited high levels of CD4 or CD8 memory T cells, low levels of naive CD4 cells, or low levels of T cells able to proliferate in response to Con A and IL-2 were found to be significantly more likely than their littermates to die within the first 18 months of life. Cases of follicular cell lymphoma, lymphocytic and lymphoblastic lymphoma, and hepatic hemangiosarcoma were seen within the group of mice dying at early ages.(ABSTRACT TRUNCATED AT 250 WORDS)
Exploring the validity of the Affect Balance Scale with a sample of family caregivers.
Perkinson MA, Albert SM, Luborsky M … +2 more , Moss M, Glicksman A
J Gerontol · 1994 Sep · PMID 8056955 · Full text
Open-ended responses of caregiving daughters and daughters-in-law were generated by a modified random probe technique to investigate the construct validity of the two subscales of the Affect Balance Scale (ABS), i.e., th...
Open-ended responses of caregiving daughters and daughters-in-law were generated by a modified random probe technique to investigate the construct validity of the two subscales of the Affect Balance Scale (ABS), i.e., the 5-item Positive Affect Scale (PAS) and the 5-item Negative Affect Scale (NAS). A set of criteria were developed to distinguish between responses that did and did not correspond to Bradburn's assumptions concerning affect. While most responses met at least one of the criteria, very few met all. In exploring the nature of affect, we found that positive affect was based to a large extent on personal accomplishments and the recognition of others. The assessment of negative affect was a more interior, or self-focused process. For a significant subset of the sample, a negative response to a closed-ended PAS or NAS item implied disagreement or discontent with the wording or the implications of the item itself, rather than an absence of affect. Not all of the ABS items were equally valid measures of affect.
Structural barriers to the use of formal in-home services by elderly Latinos.
Wallace SP, Campbell K, Lew-Ting CY
J Gerontol · 1994 Sep · PMID 8056954 · Publisher ↗
We examined data on elderly Latinos to identify structural barriers that influence the use of a visiting nurse, home health aide, and/or homemaker, and to investigate possible cultural influence on use. Data are from the...
We examined data on elderly Latinos to identify structural barriers that influence the use of a visiting nurse, home health aide, and/or homemaker, and to investigate possible cultural influence on use. Data are from the 1988 Commonwealth Fund Commission's national survey of 2,299 Latinos age 65 and over. Logistic equations are estimated for all elderly Latinos, those with a hospitalization in the past year, and those without a hospitalization. Need factors consistently increase the odds of using services. The significance of Medicaid and poverty income demonstrates income barriers to community-based care. Living arrangements improve our models only for those with a hospitalization in the past year. Acculturation has no independent effect, although some other findings can be interpreted as cultural preferences. We conclude that a universal, public long-term care program would substantially reduce barriers faced by elderly Latinos, but that nonfinancial barriers are likely to continue.
Hospital resource consumption among older adults: a prospective analysis of episodes, length of stay, and charges over a seven-year period.
Wolinsky FD, Culler SD, Callahan CM … +1 more , Johnson RJ
J Gerontol · 1994 Sep · PMID 8056953 · Publisher ↗
After linking their administrative records and interview data, the consumption of Medicare-reimbursed hospital resources during 1984 through 1990 by the 7,527 LSOA respondents was prospectively assessed using a two-part...
After linking their administrative records and interview data, the consumption of Medicare-reimbursed hospital resources during 1984 through 1990 by the 7,527 LSOA respondents was prospectively assessed using a two-part design. First, logistic regression was used to model whether a hospital episode occurred. Second, among those having had hospital episodes, OLS regression was used to model the number of episodes, as well as the natural logarithms of the total length of stay and the total charges. The risk of hospitalization was mostly associated with being male, prior hospital and physician utilization, and lower body limitations. Among those hospitalized: (a) greater numbers of episodes were mostly associated with prior hospital and physician utilization, and poorer perceived health; (b) longer lengths of stay were mostly associated with prior hospital and physician utilization, and poorer perceived health; and, (c) higher charges were mostly associated with population density, poorer perceived health, and prior physician and hospital utilization. Decedents consistently consumed substantially more hospital resources than survivors.
Women's labor force participation in later life: the effects of early work and family experiences.
Pienta AM, Burr JA, Mutchler JE
J Gerontol · 1994 Sep · PMID 8056952 · Publisher ↗
The purpose of this study was to develop and evaluate a model of labor force participation among a group of older women in the United States. A comprehensive measure of women's combined work and family experiences across...
The purpose of this study was to develop and evaluate a model of labor force participation among a group of older women in the United States. A comprehensive measure of women's combined work and family experiences across the adult life course was created. Employing data from the 1984 Survey of Income and Program Participation, we applied multinomial logistic regression techniques to examine the association between work-family experiences and later life labor supply. Our findings generally support an attachment hypothesis, showing that women who were the most work-oriented throughout the life course were more likely than women who experienced family-related spells of nonlabor-market activity to participate in the labor force, either full-time or part-time, later in life.
The relationship between retirement life cycle changes and older men's labor force participation rates.
Hayward MD, Crimmins EM, Wray LA
J Gerontol · 1994 Sep · PMID 8056951 · Publisher ↗
This study probes the utility of older men's labor force participation rates (LFPRs) as indicators of the work-to-retirement transition. Specific attention is directed at how shifts in the retirement life cycle are relat...
This study probes the utility of older men's labor force participation rates (LFPRs) as indicators of the work-to-retirement transition. Specific attention is directed at how shifts in the retirement life cycle are related to LFPRs. Based on Current Population Survey data for the 1970s, a life table modeling approach showed that LFPRs are relatively weak indicators of the work-to-retirement transition. This was demonstrated by the relative stability in older men's age profiles of LFPRs despite significant changes in the timing and "organization" of the work-to-retirement transition. The 1970s evidenced a contraction of the main career and the expansion of both post-retirement work activity and retirement, yet none of these changes substantially altered the age profiles of older men's labor force participation rates.
Attachment among adult children and their institutionalized parents.
Pruchno RA, Peters ND, Kleban MH … +1 more , Burant CJ
J Gerontol · 1994 Sep · PMID 8056950 · Publisher ↗
Structural equation analysis using data from 424 adult children with parents living in long-term care facilities indicated that the attachment experienced by adult children for their institutionalized parents was predict...
Structural equation analysis using data from 424 adult children with parents living in long-term care facilities indicated that the attachment experienced by adult children for their institutionalized parents was predicted from child's report of parent's mood and child's sense of guilt regarding his/her parent. Parent's mood was predicted by parent's health, and child's sense of guilt was predicted by the amount of help provided to the parent by the adult child. Results are interpreted in the context of theories of attachment.
Stereotypes of the elderly held by young, middle-aged, and elderly adults.
Hummert ML, Garstka TA, Shaner JL … +1 more , Strahm S
J Gerontol · 1994 Sep · PMID 8056949 · Publisher ↗
This two-part study extended the research on multiple stereotypes of elderly adults by examining the perceptions of young, middle-aged, and elderly adults. First, one set of participants engaged in a trait generation tas...
This two-part study extended the research on multiple stereotypes of elderly adults by examining the perceptions of young, middle-aged, and elderly adults. First, one set of participants engaged in a trait generation task which yielded a trait list for use in the second part of the study. Second, other participants sorted the set of traits into groups representing different types of elderly individuals. Trait groupings were analyzed with hierarchical cluster analysis. Results supported the hypothesis that older adults have more complex representations of aging than do middle-aged and young ones, and that middle-aged adults have more complex representations than do young ones. For example, middle-aged and elderly adults reported more stereotypes of the elderly than did young adults, and elderly adults reported more stereotypes than did middle-aged adults. Results also showed, as expected, that these differences in complexity exist against a background of general agreement about the nature of aging: Trait lists produced by those in the three age groups were significantly correlated, and the stereotype sets of the three age groups included seven shared stereotypes. Results are interpreted in terms of their support for two alternative explanations of the complexity differences: ingroup/outgroup and developmental.
Studying disruptive vocalization and contextual factors in the nursing home using computer-assisted real-time observation.
Burgio LD, Scilley K, Hardin JM … +4 more , Janosky J, Bonino P, Slater SC, Engberg R
J Gerontol · 1994 Sep · PMID 8056948 · Publisher ↗
Disruptive vocalization (DV) is both a prevalent and disturbing problem in nursing homes. We developed a computer-assisted data collection system for real-time observation and recording of DV and various environmental co...
Disruptive vocalization (DV) is both a prevalent and disturbing problem in nursing homes. We developed a computer-assisted data collection system for real-time observation and recording of DV and various environmental contextual factors. Both frequency and duration of DV were recorded for 11 residents along with their location in the nursing home, their activity, environmental sound, the social environment, and whether or not the resident was physically restrained. The actual time of all events was also recorded. Measures of cognitive and ADL status were administered. The average occurrence of DV was 22 per hour and the average duration per occurrence was 26 seconds. The results show a significant upward linear trend in the occurrence of DV across the day. This is consistent with the "sundowning" hypothesis. A Cox Proportional Hazards Regression model indicates that another person present in the setting (p = .004) and resident presence at the nursing home hairdresser (p = .07) were associated with shorter duration episodes of DV. Correlational analyses indicate that both higher frequency and longer duration DV are related to greater cognitive impairment, and higher frequency DV is related to greater ADL impairment. We conclude that this computer-assisted real-time observational system is a useful and promising tool for studying disruptive behavior in its environmental context.
Speech accommodations to dementia.
Kemper S, Anagnopoulos C, Lyons K … +1 more , Heberlein W
J Gerontol · 1994 Sep · PMID 8056947 · Publisher ↗
This study investigated whether spouses would adopt a specialized speech register when communicating with adults with probable Alzheimer's disease. A picture description task was used so that the effectiveness of such sp...
This study investigated whether spouses would adopt a specialized speech register when communicating with adults with probable Alzheimer's disease. A picture description task was used so that the effectiveness of such speech accommodations could be assessed. The AD subjects did not vary the syntactic complexity, semantic complexity, or content of their descriptions when they were describing individual pictures versus directing their spouse to choose one of four pictures in a barrier task. The spouses' picture descriptions were more complex syntactically and semantically than the AD subjects' and included more highly salient elements. The spouses also varied the complexity and content of their descriptions, reducing syntactic and semantic complexity and increasing references to highly salient picture elements during the barrier task. These accommodations appeared to facilitate the AD subjects' performance on the picture description task.
Adult age differences in attention: filtering or selection?
Allen PA, Weber TA, Madden DJ
J Gerontol · 1994 Sep · PMID 8056946 · Publisher ↗
We examined the effect of target letter redundancy for target-only (TO) and target-plus-noise (TPN) trials on a visual search, divided attention task where target letters were presented in one or two corners of a two-cor...
We examined the effect of target letter redundancy for target-only (TO) and target-plus-noise (TPN) trials on a visual search, divided attention task where target letters were presented in one or two corners of a two-corner display. Half of the two-letter displays also included a noise letter. In both Experiment 1 (two-choice vs go/no-go) and Experiment 2 (all go/no-go), older adults showed larger redundancy gains than did young adults, and this effect did not interact with task type or visual similarity. However, for the "no-go" trials in both experiments, there were no age differences in overall errors. These results suggest that there are age differences in the activation of selective attention rather than age differences in inhibitory control. In Experiment 2, young adults under lower-luminance presentation conditions (18 cd/m2) showed a smaller redundancy gain than did older adults under higher-luminance presentation conditions (40 cd/m2). These results provided further support of the age differences in activation interpretation, as well as indicating that older adults' larger redundancy gain was not due to an age decrement in retinal illuminance.
Contributions of working memory and evaluation and regulation of understanding to adults' recall of texts.
Zabrucky K, Moore D
J Gerontol · 1994 Sep · PMID 8056945 · Publisher ↗
We examined evaluation and regulation in adults and the relative contributions of working memory, components of working memory (storage and processing efficiency), and evaluation and regulation to text recall. Younger an...
We examined evaluation and regulation in adults and the relative contributions of working memory, components of working memory (storage and processing efficiency), and evaluation and regulation to text recall. Younger and older adults' sentence reading times, sentence rereadings, and memory for texts containing inconsistent information were assessed in an on-line analysis. Older adults detected inconsistent information during reading but failed to selectively regulate understanding by rereading problematic information. Failure to regulate understanding was related to poorer memory for problematic information, overall text recall, and ability to report text inconsistencies. Age differences in selective rereading were substantially reduced when processing efficiency was controlled, and age-related variance in passage recall was substantially reduced when differences in processing efficiency and selective rereading were controlled. Results indicate that processing efficiency and selective rereading contribute to adult age differences in text recall, and highlight the importance of distinguishing between a global strategy of rereading and selective rereading in response to comprehension problems.
The effects of information load and speech rate on younger and older aircraft pilots' ability to execute simulated air-traffic controller instructions.
Taylor JL, Yesavage JA, Morrow DG … +3 more , Dolhert N, Brooks JO, Poon LW
J Gerontol · 1994 Sep · PMID 8056944 · Publisher ↗
In this applied study of memory for orally presented information, 15 younger and 15 older pilots heard recorded air-traffic controller (ATC) messages in the context of six simulated flights. The ATC messages varied in le...
In this applied study of memory for orally presented information, 15 younger and 15 older pilots heard recorded air-traffic controller (ATC) messages in the context of six simulated flights. The ATC messages varied in length (3 vs 4 items), speech rate (235 vs 365 wpm), and type of command (course commands consisting of headings and altitudes vs radio/transponder commands consisting of radio frequencies and transponder codes). Older pilots made more execution errors on average and the age difference was greater for the radio/transponder commands, which contained more unique digits than the course commands. Although longer message lengths and faster speech rates led to higher error rates, the increases were not more marked in the older group. Backward digit span was correlated with communication performance, but the older group's lower level of accuracy was not explainable in terms of differences in digit span.
Age-related changes in visual tracking.
Moschner C, Baloh RW
J Gerontol · 1994 Sep · PMID 8056943 · Publisher ↗
BACKGROUND: To reassess conflicting findings in earlier studies on the effect of aging on smooth pursuit and saccadic eye movements, we compared visual tracking in a large number of elderly normal subjects aged 75 to 93...
BACKGROUND: To reassess conflicting findings in earlier studies on the effect of aging on smooth pursuit and saccadic eye movements, we compared visual tracking in a large number of elderly normal subjects aged 75 to 93 years and a group of young adults aged 18 to 43 years. METHODS: Saccades and smooth pursuit were induced by a laser target projected onto a screen. Eye movements were recorded with electrooculography and analyzed with a digital computer. RESULTS: Smooth pursuit gain was significantly decreased at all target velocities in the older subjects, and the difference between young and old increased with increasing target velocity and acceleration. Peak saccade velocity was significantly slower for amplitudes exceeding 20 degrees, and saccadic reaction times were prolonged in older subjects compared with younger subjects. Mean saccade accuracy was not significantly different between age groups. Within tests, variability increased with aging for smooth pursuit, saccadic reaction time, and saccadic accuracy measurements. CONCLUSION: The increased intratest variability in older subjects probably resulted from nonspecific changes in alertness and attention commonly occurring with aging, whereas the decreased gain of smooth pursuit and saccades with increasing stimulus magnitude most likely resulted from age-related neural degeneration in specific visuomotor pathways.
Effects of age and available response time on ability to step over an obstacle.
Chen HC, Ashton-Miller JA, Alexander NB … +1 more , Schultz AB
J Gerontol · 1994 Sep · PMID 8056942 · Publisher ↗
BACKGROUND: Falls during walking are often triggered when a foot contacts an obstacle in its path. Yet little is known about the ability of individuals of any age to successfully negotiate obstacles, especially under tim...
BACKGROUND: Falls during walking are often triggered when a foot contacts an obstacle in its path. Yet little is known about the ability of individuals of any age to successfully negotiate obstacles, especially under time-critical conditions. METHODS: The gait of 24 young and 24 old healthy adults (mean ages 23 and 73 years) was studied as they approached and tried to avoid stepping on a band of light, not knowing when or where it might appear on an 8 m-long walkway. This virtual obstacle was placed at the predicted location of the next footfall with available response times (ART) before heel strike that were varied randomly in 50 ms increments from 200 to 450 ms. In addition, their gait was observed as they stepped over a fixed virtual obstacle and over an obstacle that appeared with approximately a 1000 ms ART. RESULTS: The old had an increased risk of obstacle contact while negotiating obstacles under time-critical conditions (p = .082). Mean rates-of-success (RS) in obstacle avoidance for the young ranged from .205 at a 200 ms ART to .969 at a .450 ms ART. Corresponding mean RS for the old were .157 and .920. Lower extremity simple reaction time (SRT) test made under static conditions showed that the mean SRT of the old were approximately 80 ms longer than those of the young. Regression analyses suggested that the old in fact would have needed only 30 ms additional ART to achieve RS equal to that of the young for obstacles appearing with ART from 300 to 450 ms. CONCLUSIONS: Reductions in ART significantly decreased RS. Delays as small as 50 or 100 ms in observing or reacting to obstacles in real-life situations may significantly lower the rate of success that subjects of any age have in avoiding them. Age differences in SRT do not always reliably indicate age differences in obstacle avoidance under time-critical situations.
Measurement of severity in advanced Alzheimer's disease.
Volicer L, Hurley AC, Lathi DC … +1 more , Kowall NW
J Gerontol · 1994 Sep · PMID 8056941 · Publisher ↗
BACKGROUND: In late stages of dementia of the Alzheimer type (DAT), most scales measuring only cognitive or functional deficits lose their sensitivity to detect further disease progression. METHODS: By combining ratings...
BACKGROUND: In late stages of dementia of the Alzheimer type (DAT), most scales measuring only cognitive or functional deficits lose their sensitivity to detect further disease progression. METHODS: By combining ratings of cognitive (speech, eye contact) and functional deficits (dressing, eating, ambulation) with occurrence of pathological symptoms (sleep-wake cycle disturbance, muscle rigidity/contractures), a scale was developed (BANS-S) which does not lose its sensitivity until the patient reaches a vegetative state. BANS-S was tested on three Special Care Dementia Units. RESULTS: Data from 74 patients with the clinical diagnosis of DAT indicated that BANS-S has good reliability and reproducibility. BANS-S scores correlated with scores of Mini-Mental State Examination, Katz ADL, Test for Severe Impairment, and Language Assessment. In 25 patients with the diagnosis of DAT confirmed by autopsy, BANS-S scores determined within 3 months of death correlated with density of neurofibrillary tangles in CA2 and CA3 areas of the hippocampus. CONCLUSION: BANS-S may be a useful tool for the evaluation of different treatment strategies in severe DAT and for the correlation of clinical and pathological findings.
Assessing patient dependence in Alzheimer's disease.
Stern Y, Albert SM, Sano M … +6 more , Richards M, Miller L, Folstein M, Albert M, Bylsma FW, Lafleche G
J Gerontol · 1994 Sep · PMID 8056940 · Publisher ↗
BACKGROUND: While cognitive and functional deficits are the hallmark of Alzheimer's disease (AD), loss of social function (and the dependence this implies) is also critical, especially in early stages of disease. Little...
BACKGROUND: While cognitive and functional deficits are the hallmark of Alzheimer's disease (AD), loss of social function (and the dependence this implies) is also critical, especially in early stages of disease. Little attention has been directed to this facet of dementing disease. We describe a scale for assessing dependency in AD and present a baseline profile of dependency in a cohort of AD patients. METHODS: In a study of the predictors of the course of AD, 233 patients in early stages of disease (modified MMS > or = 30) were assessed. Psychometric properties of the dependence scale were established. To validate the scale, dependence scores at baseline were correlated with a series of measures assessing cognition and function. The course of dependency over 18 months of follow-up was also analyzed. RESULTS: The scale shows adequate reliability (test-retest, intraclass correlation). Dependence stage was related to other measures of disease severity. Scalogram analysis shows that the dependence scale is consistent with the course of functional loss established for dementing disease. Prospective data indicate sensitivity of the scale to disease progression. CONCLUSION: Dependency is a distinct, measurable component of dementing disease and should be considered an important outcome in studies of AD.
Predictors of patient refusal to participate in ambulatory-based comprehensive geriatric assessment.
Reuben DB, Posey E, Hays RD … +1 more , Lim ME
J Gerontol · 1994 Sep · PMID 8056939 · Publisher ↗
BACKGROUND: Comprehensive Geriatric Assessment (CGA) in ambulatory settings can be effective only if patients who need this intervention are willing to participate in the evaluation and follow the indicated therapy. METH...
BACKGROUND: Comprehensive Geriatric Assessment (CGA) in ambulatory settings can be effective only if patients who need this intervention are willing to participate in the evaluation and follow the indicated therapy. METHODS: To learn whether older persons' health beliefs and perceptions influence participation in ambulatory-based CGA, we studied subjects who failed a screening assessment offered through a community-based outreach program and were deemed appropriate for CGA. All subjects were interviewed in person following a structured sequence including questions from the RAND Current Health (CH) and Health Worry/Concern (HWC) scales, the Health Locus of Control Scale (HLC), and scales developed to measure health risks and perceived benefits of geriatric assessment. RESULTS: In univariate analysis, the following variables were associated with refusal to participate in CGA status at the p < .05 level: increased worry on HWC and higher scores on three new scales constructed to measure Global Health Risk (GHR), Perceived Global Health Benefits (PGHB), and Perceived Specific Health Benefits (PSHB). For GHR, higher scores indicate greater risk; for PGHB and PSHB, higher scores indicate greater perceived benefit. In multivariate analysis, only educational level, GHR, PGHB, and PSHB scores were independently predictive of refuser status. Correlations with other established health perceptions scales provided support that global health risk and perceived global and specific health benefits are unique constructs. Furthermore, high scores on these scales predicted participation in health improvement programs. CONCLUSIONS: Patients' beliefs about perceived risk and benefit can be measured and predict willingness to participate in ambulatory-based CGA.
Differences between young and old females in the five levels of body composition and their relevance to the two-compartment chemical model.
Mazariegos M, Wang ZM, Gallagher D … +5 more , Baumgartner RN, Allison DB, Wang J, Pierson RN, Heymsfield SB
J Gerontol · 1994 Sep · PMID 8056938 · Publisher ↗
BACKGROUND: Body composition differs between young and old females, although the magnitude of these age-related changes remains uncertain. This uncertainty persists because methodology applied in earlier studies required...
BACKGROUND: Body composition differs between young and old females, although the magnitude of these age-related changes remains uncertain. This uncertainty persists because methodology applied in earlier studies required assumptions that may be age-dependent and also because studies included young and old subjects who differed substantially in body size and health status. METHODS: To resolve these earlier concerns we examined components at the atomic, molecular, cellular, tissue-system, and whole body levels of body composition in 19 weight- and height-matched pairs of young (age 19-35 yrs) and old (age > 65 yrs) healthy White females. Isotope dilution, dual photon, whole-body counting, hydrodensitometry, and anthropometric methods were used either alone or in combination to produce multicomponent models. RESULTS: Old females had significantly more fat, greater truncal skinfolds and circumferences, and significantly less fat-free body mass (FFM), total body potassium (TBK), total body water (TBW), and bone mineral than did their young matched counterparts. Skeletal muscle mass was less in the old females, although the magnitude of the difference from young females varied between the three indices examined. The main assumptions (i.e., TBW/FFM = 0.73 kg/kg and density of FFM = 1.100 g/cc) which the widely used two-compartment TBW and hydrodensitometry methods are based on were not significantly different in young and old females. In contrast, the main assumed steady-state value for the two-compartment TBK method (TBK/FFM = 64.2 mmol/kg) was significantly lower (p < .001) in the old females. CONCLUSION: New approaches thus allow for a critical reexamination of body composition in elderly subjects, and these methods also give new insight into less complex widely used body composition techniques.
Inpatient geriatric evaluation and management units (GEMs) in the veterans health system: diamonds in the rough?
Wieland D, Rubenstein LZ, Hedrick SC … +2 more , Reuben DB, Buchner DM
J Gerontol · 1994 Sep · PMID 8056937 · Publisher ↗
BACKGROUND: Research suggests that inpatient geriatric evaluation and management units (GEMs), which undertake interdisciplinary diagnosis to improve the health of frail elderly patients, are effective. The Department of...
BACKGROUND: Research suggests that inpatient geriatric evaluation and management units (GEMs), which undertake interdisciplinary diagnosis to improve the health of frail elderly patients, are effective. The Department of Veterans Affairs (VA) helped pioneer U.S. GEMs and mandates that every facility shall have a GEM by 1996. We conducted a population survey of VA GEMs in 1991 to assess their dissemination. METHODS: Various organizational and performance characteristics of GEMs were entered in a data base derived from a piloted questionnaire and administrative records. Basic criteria from consensus reports were used to classify and compare "standard" and "nonstandard" GEMs. The criteria covered performance of assessment, team structure, patient selection, GEM location, and treatment functions. We analyzed the effect of GEM type and other factors on length of stay and placement. Reasons for closure of GEMs inactive in 1991 were recovered, and GEMs active in 1991 but later closed are described. RESULTS: As of 1991, 41 of 73 GEMs were classified as standard, and 32 nonstandard. Standard compared to nonstandard GEMs had shorter stays (25.4 vs 69.9 days; p < .001), higher home discharge rates (63.4% vs 40%; p < .001), and lower nursing home placement rates (19.1% vs 40.3%; p < .001). Eleven hospitals had closed their programs by 1991. By 1993, 6 additional GEMs had closed; all were nonstandard in 1991. CONCLUSIONS: Most VA GEMs are organized according to basic consensus standards, and appear to be discharging most patients back to the community after reasonably short stays. However, various resource constraints are common, apparently reflected in nonstandard organization and GEM closure. Additional work is needed to monitor GEM proliferation, implementation, and performance in and out of the VA system.
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