Laura K. Chiodo

A Randomized Trial of Physical Rehabilitation for Very Frail Nursing Home Residents

BACKGROUND Past studies suggest multidisciplinary interventions that include physical therapy (PT) can improve function of nursing home residents. This trial specifically evaluates effects of PT for frail long-stay nursing home residents. DESIGN Randomized, controlled trial. SETTING One academic nursing home and eight community nursing homes. PATIENTS A total of 194 elderly nursing home residents dependent in at least two activities of daily living residing in the nursing home for at least 3 months. INTERVENTIONS Patients were randomized to individually tailored one-on-one PT sessions or friendly visits (FVs) three times a week for 4 months. Physical therapy included range-of-motion, strength, balance, transfer, and mobility exercises. MAIN OUTCOME MEASURES Performance-based physical function assessed by the Physical Disability Index; self-perceived health status assessed with the Sickness Impact Profile; observer-reported activities of daily living; and falls. RESULTS Eighty-nine percent and 92% of PT and FV sessions, respectively, were attended; 5% and 9% of subjects dropped out in the PT group and FV group, respectively. Compared with the FV group, the PT group experienced no significant improvements in overall Physical Disability Index, Sickness Impact Profile, or activities of daily living scores. A 15.5% improvement in the mobility subscale of the Physical Disability Index was seen (95% confidence interval [CI], 6.4% to 24.7%); no benefits in range-of-motion, strength, or balance subscales were found. Compared with the FV group, the PT group used assistive devices for bed mobility tasks less often (P = .06) and were less likely to use assistive devices and wheelchairs for locomotion (P < .005). There were 79 falls in the PT group vs 60 falls in the FV group (P = .11). Charge for the 4-month PT program was

Declining Executive Control in Normal Aging Predicts Change in Functional Status: The Freedom House Study

1220 per subject (95% CI,

Performance of Case‐Finding Tools for Depression in the Nursing Home: Influence of Clinical and Functional Characteristics and Selection of Optimal Threshold Scores

412 to

Executive control mediates memory's association with change in instrumental activities of daily living: the Freedom House Study.

1832). CONCLUSION This standardized physical therapy program provided modest mobility benefits for very frail long-stay nursing home residents with physical disability due to multiple comorbid conditions.

Medical Treatment Preferences of Nursing Home Residents: Relationship to Function and Concordance with Surrogate Decision-Makers

Objectives: To assess the contribution of executive control function (ECF) to functional status.

Severe Dysosmia Is Specifically Associated with Alzheimer-Like Memory Deficits in Nondemented Elderly Retirees

OBJECTIVE: To compare case‐finding tools for depression in the nursing home setting and to evaluate effects of subject function, cognition, and disease number on test performance.

Misclassification is likely in the assessment of mild cognitive impairment.

Objectives: To assess the relative independent contribution of changes in executive control function (ECF) and memory to changes in functional status.

Depressive symptoms predict longitudinal change in executive control but not memory

Objective: To describe treatment preferences of nursing home residents, concordance with decisions by self‐selected proxies and to establish the relationship of sociodemographic and functional measures to decisions.

Functional status of Mexican American nursing home residents

Objectives: To determine whether or not (1) impaired olfactory function is associated with impaired memory on neuropsychological testing in healthy retirees, and if so then (2) whether memory impairment is most consistent with a mesiotemporal rather than frontal system disorder. Methods: 173 independent residents of a continuing care retirement community were studied. Subjects completed the University of Pennsylvania Smell Identification Test (UPSIT) and a battery of both general and specific cognitive measures that included the Mini-Mental State Examination (MMSE) and the Executive Interview (EXIT25). Subjects were examined twice over 3 years. Results: UPSIT performance was normal in 21% and in the ‘anosmic’ range in 25% of subjects. Anosmic UPSIT performance was associated with significantly worse performance on all cognitive tests. However, only short-term verbal memory was independently associated with UPSIT-defined anosmia. This association remained significant after adjusting for the other cognitive and sociodemographic variables. The memory deficits of anosmic subjects were qualitatively consistent with a cortical type (type 1) dementing illness such as Alzheimer’s disease (AD). Over time, UPSIT-defined ‘anosmic’ cases suffered significantly greater declines on both the MMSE and the EXIT25, independently of baseline age, gender and MMSE score. Conclusions: Impaired odor identification in individuals without overt dementia is associated with an AD-like memory impairment and an increased rate of cognitive decline. The comorbid association of these deficits is consistent with the known hierarchical spread of preclinical AD pathology and may be a specific indicator of future clinical AD dementia.

Function and Medical Comorbidity in South Texas Nursing Home Residents: Variations by Ethnic Group

We estimated the relative frequency of isolated memory impairment versus isolated and comorbid impairment in executive control function (ECF). One hundred and ninety-three noninstitutionalized residents of a single Comprehensive Care Retirement Community (mean age 79.2 years) were investigated. The subjects were tested with multiple measures of memory and ECF. Test scores were standardized to minimize scaling effects. ‘Impairment’ was defined as performance ≤1.5 standard deviations below the mean for the entire sample (i.e., a z score ≤–1.5). Disability was estimated as the sum of self-reported activities of daily living and instrumental activities of daily living. The cognitive test performance was significantly associated with functional impairment, independently of age. ECF and memory measures were significantly intercorrelated. Both were significantly and independently associated with disability ratings. 6–10% of the subjects had memory impairment; 25–35% of the memory-impaired subjects had comorbid ECF impairments. An additional 4–7% of the subjects had isolated ECF impairment. A significant fraction of the cases otherwise meeting the criteria for ‘mild cognitive impairment’ may have comorbid ECF impairment. This raises the issue of whether they might be more properly classified as ‘demented’. In addition, isolated ECF impairment may affect almost as many persons as isolated memory impairment. Isolated ECF impairment is not consistent with the natural history of preclinical Alzheimer’s disease, suggests other conditions, and can be disabling, independently of age and/or memory loss.