This proposal requests support to continue the Teaching Nursing Home (TNH), a multidisciplinary program project entering its tenth consecutive year of funding. This TNH grant represents a further coordination of resources relating to research on health problems of the aged in the nursing home and in the community, and crosses institutional and disciplinary lines. Participating organizations include: the Albert Einstein College of Medicine, Montefiore Medical Center, the four associated long term care facilities, and College of Mount Saint Vincent School of Nursing. Six research protocols are organized around a service core, which includes a shared database, shared data management and analysis, and shared pathology resources. Of the six component research projects three are current: dementia, age-associated memory impairment, and congestive heart failure; three are new: exercise, a community survey, and event-related potentials. the core populations from which these projects will derive their subjects consist of individuals within the TNH system itself, those from the community enrolled in an earlier balance and gait study, and the Bronx Aging Study. A new source of community subjects will be the Norwood- Montefiore Aging Study. These core populations will provide an interactive group for the study of prevalent aging health issues: (a) dementia (projects 1,2,5): the vascular contribution compared to traditional Alzheimer's disease, detection of early dementia, and role of evoked potentials; (b) diastolic cardiac dysfunction (project 3): its relationship to congestive heart failure; (c) aging in community dwellers (project 4): factors affecting transitions in life events; (d) exercise in the very old (project 6): evaluating cardiac stress testing for entry into an exercise program in the nursing home. Insights gained from fundamental research and clinical studies on these major health issues could modify geriatric practices and improve quality of life in the very old.
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