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Background/Study Context: Previous research on triathlon performance analyzed age trends for the Top Ten or Top Five finishers in world championship or national races at Olympic, Half-Ironman, and Ironman distances. The findings indicated higher age declines and/or earlier onset of decline in swimming and running than cycling. However, the designs of those studies took no account of possible differences between cross-sectional and longitudinal trends (i.e., cohort differences versus age changes). METHODS: This study analyzed performance times over the inaugural 5 years of the Half-Ironman world championship held in Clearwater, Florida, from 2006 to 2010. Only one previous study is known that examined age trends in performance for this triathlon distance. The data from the official race results showed 5549 age class competitors that provided 6541 sets of observations. Analyses by mixed linear modeling (MLM) partitioned the data to compare discrete and interactive cross-sectional and longitudinal trends for swimming, cycling, and running, respectively. RESULTS: The findings showed an historical decrease in cycling and running but not swimming times. Performance times were lower by men than women, with the gender discrepancy higher in some older age classes. Comparable to earlier findings for the Half-Ironman triathlon, cross-sectional performance decline was apparent for all triathlon activities from an early cohort age (i.e., 35-39 years). Although longitudinal trend showed significant gains for swimming, running, and overall times, interactions between cohort age and age change showed longitudinal decline that began at a younger cohort age for running (35-39 years) than swimming (50-55 years), but the interaction was nonsignificant for cycling. These interactions add to the knowledge about cohort differences and age changes in triathlon performance. CONCLUSIONS: Practical applications of the findings suggest that conservation of effort might explain the absence of longitudinal change in cycling performance at older cohort ages. The authors reason that increased effort in cycling might benefit overall times of older triathletes.

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PURPOSE OF THE STUDY: This study was initiated to forecast the number of older drivers and passengers who may be fatally injured in traffic crashes in future years. DESIGN AND METHODS: The study was based on data from the U.S. Fatality Analysis Reporting System covering the period from 1975 to 1998. Projections were based on least squares regression models. RESULTS: About 35,000 drivers and passengers died in traffic crashes each year from 1975 to 1998. Older adults (65 and older) accounted for 10% of all fatalities in 1975, 17% in 1998, and a projected 27% by 2015, the same proportion predicted for drivers and passengers aged younger than 30. On the basis of these projections, the number of fatally injured women and men aged 65 and older will increase respectively by 373% and 271% between 1975 and 2015. IMPLICATIONS: If current trends continue, the number of fatalities among older drivers and passengers and those aged younger than 30, may be equivalent early in this century. These projections call for further research into conditions that may lead to crashes involving older drivers and for the development and implementation of initiatives to curb traffic-related fatalities among older adults.

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Considerable burden is reported by informal caregivers of older individuals with cognitive impairment. Significant progress in the understanding of determinants of this burden has been achieved. However, further progress could be attained if we considered important methodological issues that may have limited our understanding of caregiver burden. These issues include subgroups of care recipients and caregivers, measurement issues, research design, and statistical techniques. Fifty-three studies published between 1980 and 1997 (inclusive) that focused on caregiver burden were abstracted to determine the extent to which the methodological issues discussed above were considered. Overall, we found considerable variability among the studies surveyed. Further understanding of the caregiving process and reductions in caregiver burden will depend on the attention to methodological issues and understanding of burden across the whole caregiving career.

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BACKGROUND: Previous research on risk of delirium in acute hospital settings identified mainly patient variables (e.g., age) that are not amenable to intervention. The purpose of this study was to develop a model for new delirium in hospitalized older patients that included process of care and social variables. METHODS: A prospective cohort study was undertaken in a community hospital in Ontario, Canada. Research participants included 156 hospitalized patients age 65+ years and without delirium on admission who were admitted to a medical or surgical unit. The measures included daily appraisal of delirium using a standardized and validated tool, and assessment of patient, process of care, and social variables. RESULTS: Delirium developed in 28 of the 156 patients (17.9%). Older age and cognitive impairment were significant patient variables. Significant process of care variables included a high number of medications administered during hospitalization, surgery, a high number of procedures during early hospitalization (e.g., x-rays, blood tests), and intensive care treatment. CONCLUSIONS: Approximately one older patient in five developed delirium after admission to a medical or surgical unit. Risks not easily amenable to intervention included age, cognitive dysfunction, surgery, and intensive care requirements. Risk factors that are potentially modifiable included number of medications and number of procedures. Future research might focus on the efficacy of such intervention to reduce new-onset delirium in acute hospital settings.

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OBJECTIVES: The purpose of this study was to investigate the predictors of caregiver burden and depression, including objective stressors and mediation forces influencing caregiving outcomes. METHODS: This investigation is based on the 1994 Canadian Study of Health and Aging (CSHA) database. Participants were 613 individuals with dementia, living in either the community or an institution, and their informal caregivers. Participants for the CSHA were identified by screening a large random sample of elderly persons across Canada. Structural equation models representing four alternative pathways from caregiving stressors (e.g., functional limitations, disturbing behaviors, patient residence, assistance given to caregiver) to caregiver burden and depression were compared. RESULTS: The data provided the best fit to a model whereby the effects on the caregiver's well-being are mediated by appraisals of burden. A higher frequency of disturbing behavior, caring for a community-dwelling patient, and low informal support were related to higher burden, which in turn led to more depressive symptomatology. Caregivers of patients exhibiting more disturbing behaviors and functional limitations received less help from family and friends, whereas those whose care recipients resided in an institution received more informal support. DISCUSSION: Our findings add to the preexisting literature because we tested alternative models of caregiver burden using an unusually large sample size of participants and after overcoming methodological limitations of past research. Results highlight the importance of the effective management of disturbing behaviors, the provision of formal services for caregivers with highly impaired patients and no informal support, and the improvement of coping skills in burdened caregivers.

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There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals with similar needs may be cared for in a variety of different settings. Moreover, as people make transitions from one sector of the healthcare system to another, there is a need for comparable information to ensure continuity of care and reduced assessment burden. The RAI/MDS series of assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.

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Reductions in healthcare spending and current demographic trends will result in increasing demands to care for aging relatives, especially those with cognitive impairment (e.g., Alzheimer's disease). Taking care of older individuals with cognitive impairment can be very challenging and burdensome. Caregiver burden is associated with negative outcomes such as caregiver depression and increased likelihood of patient institutionalization. One hundred eleven patients and their spousal caregivers were studied using a pre-post design. All subjects received a comprehensive medical intervention that included medical management of patients' problems and education of caregivers. We examined changes in patients' function and caregiver burden. At follow-up, patients' cognition and independence in activities of daily living had continued to deteriorate whereas their mood was improved. Regression analyses showed that changes in caregiver burden were positively associated with changes in the frequency of dysfunctional behaviors but not with changes in cognition. Gender was also related to changes in caregiver burden; male caregivers were more likely than female caregivers to report reductions in burden at follow-up. These data suggest medical interventions may provide some relief to caregivers of cognitively impaired older patients, but more research is required to identify the causal agents of this effect.

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Literacy is defined in the Oxford English Dictionary as the ability to read and write, and illiteracy as an inability to read. Hardy, Segatore and Edge (1993) suggest a serious problem of illiteracy among student nurses that endangers patient safety. Their evidence is entirely anecdotal, some of which is misclassified as literacy errors. They provide no substantive or statistical evidence to support their claims. Educators making serious and provocative charges on such flimsy grounds ought either to recant or obtain evidence that is more convincing.

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OBJECTIVE: To study the acute effects of non-strenuous physical exercise on memory retrieval and visuo-motor performance in old-old nursing home residents. DESIGN: A randomized control trial. SETTING: A nursing home. PARTICIPANTS: Ambulatory volunteers from the nursing home, with all 20 shown to be normal on mental status. Three were male and 17 female, with a means of 84.5 years for age and 9.3 years for education. They were divided at random into an exercise and a control group. INTERVENTION: A single 15-minute standardized bout of non-strenuous exercise administered independently to each participant in the exercise group. Control group participants watched a video of similar exercises for 15 minutes. MEASUREMENTS: Two measures requiring the retrieval of category instances with semantic or initial consonant cues. Retrieval time was 60 seconds for each of four categories per measure. Visuo-motor performance was measured by Symbol Digit coding. Testing sessions were held before exercise, immediately post-exercise and 30 minutes post-exercise. RESULTS: The group-by-time interaction was significant only for semantically cued memory (P < 0.01), with higher retrieval at post-testing only in the exercised group. The higher retrieval was mainly attributable to more new items retrieved by the exercise group at the immediate post-test (P < 0.05). CONCLUSIONS: This study provides preliminary support for the hypothesis that non-strenuous physical exercise has positive acute effects on meaningfully cued memory.

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Two performance models relating age, physical activity, and physical performance were evaluated on 5 age cohorts involving more than 6,000 persons ranging in age from 20 to 69 years. Significant age and activity main effects, without 1 Age X Activity interaction, were obtained on 5 fitness measures and 2 activity indexes. These results are inconsistent with predictions from the moderation model, but they fit predictions from a recently formulated tonic and overpractice model of physical performance.

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In this randomized study, we compared the psychological well-being of elderly nursing home residents who participated in reminiscence and current topics group discussions with a control group of residents. We rated participants happiness/depression, activity, mood, and functional levels before and after the group interventions. The intervention had a significant effect only on the happiness/depression measure, with both intervention groups showing positive changes compared to the control group.

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We investigated the effects of exercise on the coding performance of young and older subjects. Hypotheses were tested that exercise either facilitates spatial localization or reduces susceptibility to distraction in older subjects. In a balanced design, we administered Digit Symbol and Symbol Digit coding tasks to exercisers and nonexercisers at two age levels under conditions of low or high within-task interference. The findings showed higher performance by the exercisers than by the nonexercisers only at the older age level and only with the Symbol Digit task. These findings support the hypothesis that exercise compensates for a loss of spatial localization skills with age. We found no evidence that susceptibility to distraction either increased with age or was affected by chronic exercise.

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The relationship between activity and mortality has been examined mainly in middle-aged and elderly community residents. This study investigated the prediction of five-year mortality in 156 institution residents, including a subsample (n = 121) retested one year after the initial assessment. The measures included demographic variables, three health indexes, happiness, quality of life ratings, personality and life stress indexes, cognitive function, and activity level. The strongest predictors of survival beyond five years from initial testing were a younger age and a high activity level. The relationships of age and activity to survival were mutually independent and were not secondary to the effects of any other variable. Health was not related to activity level and did not emerge as a strong predictor of survival. After a consideration of methodological issues, the findings were interpreted as providing support for an activity theory formulation of mortality prediction.

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We compared the psychometric adequacy of a multidimensional self-report battery for use with cognitively able, elderly adults under conditions of microcomputer and interviewer administration. The SENOTS battery contains scales of Happiness/Depression, Financial Hardship, Physical Symptoms, Activity Limitation, and Activity Propensity. The SENOTS microcomputer program contains sequential phases intended to (a) select out respondents incapable of interacting adequately with the microcomputer, (b) train respondents to make appropriate keyboard responses. (c) administer the program, and (d) store and process the responses. The SENOTS battery was administered to 80 community residents and 80 institution residents by either a microcomputer or an interviewer. Results indicated a comparable psychometric adequacy to the SENOTS battery under both administration conditions. Internal consistencies were all at acceptable levels, and the scales differentiated the community residents from the institution residents.

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This study evaluated the usefulness of a balance test with eyes open and closed to index postural control capability. Experiment 1 was a one-year longitudinal study of 225 subjects aged 50 to 82 years. Comparing the two conditions, balance with eyes open had higher reliability, had greater sensitivity to aging effects, correlated stronger with functional age indices (vital capacity and forced expiratory volume), and showed greater sensitivity to the effects of physical fitness training. Experiment 2 included 22 visually impaired subjects aged 19 to 84 years. Minimally sighted subjects balanced for longer than fully blind subjects, but no differences in balance were found between subjects blind from birth versus those with acquired vision loss. The findings demonstrate the importance of vision to balance and indicate that balance with eyes open is a valid and sensitive test for clinical and research purposes.

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The present investigation addressed the problem of a social desirability response bias in measures of psychological well-being. Data on 150 people, between the ages of 50 and 82, yielded high correlations between three measures of well-being (the MUNSH, the LSI-Z, and the PGC) and the Edwards Social Desirability Scale, but only moderate ones between well-being scales and the Marlowe-Crowne Social Desirability Scale. Part correlations between well-being measures and an external criterion of happiness, controlling for social desirability, failed to improve on the zero-order criterion/well-being relationship. Controlling for social desirability, therefore, does not enhance the construct validity of well-being scales. These and related results suggest that the high zero-order correlations between measures of well-being and the Edwards scale are more readily attributed to content similarity between the Edwards scale and measures of well-being than to a social desirability response bias in well-being measures.

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The research proceeded in two stages. The intention at the first stage was to develop a comprehensive activities inventory (i.e., the Memorial University of Newfoundland Activities Inventory, or MUNAI) that reflected recurrent content themes in interview data obtained from elderly adults. The intention at the second stage was to test a reactivity model and a propensity model of happiness-activity relationships in an 18-month longitudinal design. The reactivity model asserts that happiness, in part, is determined by activity levels. The claim of the propensity model is that both happiness and activity indices are reflections of different underlying propensities. The results supported the propensity model in that (a) activity structure retained stability over the longitudinal interval, (b) the relative standing of individuals on both happiness and the structural activity indices retained stability and, (c) the happiness-activities relationship was of a limited order.

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