Journal of the American Geriatrics Society
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Randomized Controlled Trial Comparative Study Clinical Trial
Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study.
The purposes of this pilot study were to determine if a combined dietary and exercise intervention would result in significant weight loss in older obese adults with knee osteoarthritis, and to compare the effects of exercise plus dietary therapy with exercise alone on gait, strength, knee pain, biomarkers of cartilage degradation, and physical function. ⋯ Weight loss can be achieved and sustained over a 6-month period in a cohort of older obese persons with osteoarthritis of the knee through a dietary and exercise intervention. Both exercise and combined weight loss and exercise regimens lead to improvements in pain, disability, and performance. Moreover, the trends in the biomechanical data suggest that exercise combined with diet may have an additional benefit in improved gait compared with exercise alone. A larger study is indicated to determine if weight loss provides additional benefits to exercise alone in this patient population.
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Acute illness causes considerable morbidity and mortality in nursing home residents but is often difficult to recognize early. Nursing assistants often notice early signs of acute illness but do not methodically document or communicate their observations with medical staff. ⋯ A new instrument developed for nursing assistants to document behavioral and functional status changes in nursing home residents demonstrates fair sensitivity and high specificity for acute illness. Close monitoring of patients with a positive instrument might avert morbidity and mortality from acute illness by allowing earlier treatment.
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To examine national variation in use of the Medicare hospice benefit by older individuals before their death, and to identify individual characteristics and local market factors associated with hospice use. ⋯ The wide variation in hospice use suggests that there is great potential to increase the number of users of the Medicare hospice benefit.
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To determine if family members perceive that hospice improves the care of dying nursing home residents during the last 3 months of life. ⋯ Family members believe that nursing home hospice improves quality of care for symptoms, reduces hospitalizations, and adds value and services for dying nursing home residents.