This proposal requests support to continue the Teaching Nursing Home, a multi-site, multi-institutional program project. This TNH represents a reorganization of resources relating to geriatric research into a structure which crosses institutional, departmental and disciplinary lines. Participating organizations include: the Albert Einstein College of Medicine, Montefiore Medical Center, and their four associated long term care facilities, and the College of Mt. St. Vincent Nursing Program. Five research protocols are organized around a strong service core, which includes a common subject pool, shared assessment personnel, shared assessments, a shared database, shared data management and analysis, and shared neuropathologic correlation. The five component research projects study: dementia, osteoarthritis, motor-control impairment, age-associated memory impairment, and congestive heart failure, and include clinical and laboratory investigations. By the end of the next five years, we should have developed a comprehensive database on more than 1000 research subjects and: 1) determined which factors in history, neurologic exam, neuropsychological profile, neuro-imaging, or biochemical markers improve diagnostic accuracy in Alzheimer's disease (AD), and evaluated pathological criteria which differentiate AD from normal aging; 2) described gait and balance in normal elderly; described the natural history of fallers; identified predictors of falling; and defined pathophysiologic mechanisms of motor control and implications for intervention; 3) identified biological markers in synovial fluid and described Osteoarthritis in a spectrum of persons with joint complaints; 4) delineated the syndrome of Age- Associated Memory Impairment and its course, and 5) clarified the syndrome of congestive heart failure in a cohort of old . In short, we will have conducted research on conditions which severely affect the quality of life of older persons, and this project will, hopefully, have an important impact on geriatric practice and care.
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