Journal of the American Geriatrics Society
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Multicenter Study
The impact of insomnia on cognitive functioning in older adults.
To examine whether self-reported symptoms of insomnia independently increase risk of cognitive decline in older adults. ⋯ Chronic insomnia independently predicts incident cognitive decline in older men. More sensitive measures of cognitive performance may identify more subtle declines and may confirm whether insomnia is associated with cognitive decline in women.
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Palliative care is emerging as an important new field. Although programs are developing in hospital environments, little is known about development of programs in outpatient practices or those serving large managed care populations. ⋯ The article addresses guiding principles, the need for obtaining baseline data, how the clinical consultation service was established, development of outcomes measures, and information on current program status. Five themes emerged as key to successful program development, most importantly the close collaboration between administrative and clinical staff in all aspects of program development.