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PURPOSE (1) to evaluate objectively changes in cognitive function and electrophysiologic characteristics associated with hypothyroidism of varying severity and duration in primarily older persons; (2) to determine whether these changes are reversible when a euthyroid state has been attained after treatment with thyroid hormone. SUBJECTS AND METHODS We(More)
The mean incidence of falls in nursing homes is 1.5 falls per bed per year (range 0.2-3.6). The most common precipitating causes include gait and balance disorders, weakness, dizziness, environmental hazards, confusion, visual impairment, and postural hypotension. The most important underlying risk factors for falls and injuries include some of these same(More)
OBJECTIVE To develop and validate an instrument measuring attitudes toward older persons and caring for older patients. DESIGN Cross-sectional and longitudinal studies. SETTING An academic medical center. PARTICIPANTS Initial Study: 121 primary care residents (n = 96), fellows (n = 14), and faculty (n = 11) participated in instrument development in(More)
OBJECTIVES To determine whether nursing homes (NHs) that score differently on prevalence of weight loss, according to a Minimum Data Set (MDS) quality indicator, also provide different processes of care related to weight loss. DESIGN Cross-sectional. SETTING Sixteen skilled nursing facilities: 11 NHs in the lower (25th percentile-low prevalence)(More)
To determine the association between blood cytokine levels and body weight loss in elderly patients, serum levels of cachectin/tumor necrosis factor alpha (TNF) and interleukin-1 alpha (IL-1) were measured with specific and sensitive ELISA systems. Of the 19 healthy young subjects, two (10.5%) had detectable levels of serum TNF and one (5.3%) was positive(More)
CONTEXT Assessment and management of pain for nursing home residents is frequently reported to be inadequate, yet few studies have used objective criteria to measure the quality of care related to pain. OBJECTIVE Field test a standardized resident interview and medical record review protocol to assess and score quality indicators relevant to pain. (More)
A study was performed to identify and rank risk factors for falling among populations of institutionalized (fallers, N = 79, nonfallers, N = 70) and noninstitutionalized (fallers, N = 34, nonfallers, N = 34) elderly persons. Fallers were matched by age, sex, and living location to nonfaller control subjects. A nurse practitioner performed a comprehensive(More)
OBJECTIVE To assess the effectiveness of low-air-loss beds for the treatment of pressure ulcers in nursing homes. DESIGN Prospective, randomized, clinical trial. SETTING Three teaching nursing homes in Los Angeles, Calif. SUBJECTS Eighty-four nursing home residents with trunk or trochanter pressure ulcers (Shea stage > or = 2). INTERVENTIONS(More)
OBJECTIVE To measure the effects of a specialized postfall assessment intended to detect causes and underlying risk factors for falls, and to recommend preventive and therapeutic interventions. DESIGN Randomized, controlled trial. SETTING A long-term residential care facility for elderly persons. SUBJECTS Within 7 days of a fall, 160 ambulatory(More)
Previous studies in laboratory animals have shown that tumor necrosis factor-alpha (TNF) may alter thyroid function tests. To determine whether elevated serum TNF levels are associated with altered serum concentrations of T4, T3, free T4, rT3, and TSH, we measured these parameters in 29 nursing home residents with detectable serum TNF levels and compared(More)