This application requests renewal of a five-year Teaching Nursing Home Program Project--the Hebrew Rehabilitation Center for Aged (HRCA)/Harvard Research Nursing Home (RNH). This program is a consortium of four principal institutions, all with substantial experience in clinical geriatrics and gerontological research. The institutions include: 1) HRCA, a 725-bed long-term care facility with an on-site clinical research center and computer facility, and administrative responsibility for two community housing projects, providing access to an additional 500 potential research subjects; 2) Beth Israel Hospital, a major Harvard teaching hospital and site of a well-developed clinical and research program in geriatric medicine and a productive NIH-funded Clinical Research Center; 3) Harvard Medical School, site of the Division on Aging; and 4) Boston University School of Nursing, with strong gerontologic components in its graduate and undergraduate curricula. Over the past 3-1/2 years of funding, the RNH has established an effective Core providing successful operational procedures, access to research subjects, and data management resources for six productive research projects focusing on previously neglected problems of institutionalized elderly. The RNH has also supported 15 pilot projects and served as a research training base for eight Fellows in geriatric medicine. Early results of these research activities have led to the development of seven new projects proposed in this application. These include studies of: 1) mechanisms and treatment of postprandial hypotension; 2) the natural history and histopathology of a previously unrecognized cause of urinary incontinence--detrusor hyperreflexia with impaired contractility; 3) the role of atrial natriuretic factor in age- related alterations in extracellular volume regulation; 4) Vitamin D nutritional intake, sunlight exposure, and circulating Vitamin D levels; and 5) DNA repair capacity in lymphocytes from patients with Alzheimer's Disease. These projects share a common focus on important, prevalent geriatric issues and benefit from extensive collaboration among the investigators, Principal Investigators with clinical gerontological research experience and intimate knowledge of the RNH, a supportive program Core, and committed resources from a strong consortium of outstanding academic institutions.
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