This application requests renewal of the Hebrew Rehabilitation Center for Aged (HRCA)/Harvard Research Nursing Home (RNH), a well-established Program Project committed to the rigorous scientific investigation of highly prevalent, disabling geriatric syndromes relevant to the care of the frail elderly. This program is a consortium of four principal institutions, all with substantial experience in clinical geriatrics and gerontological research, including l) the HRCA -an academic long-term care facility with a strong institutional commitment to excellence in geriatric care, teaching, and research; 2) Beth Israel Hospital, a major Harvard teaching hospital with a well-developed clinical and research program in geriatric medicine; 3) Harvard Medical School, site of the Division on Aging and Claude Pepper Geriatric Research and Training Center; and 4) Boston College School of Nursing, with its strong faculty expertise in gerontologic nursing research. During the past 10 years of funding, the RNH has established an effective Core providing five research laboratories at HRCA (a Clinical Research Center, Urodynamics Facility, Bone Densitometry Unit; Basic Science Laboratory, and computer facility), access to institutionalized and community dwelling research subjects, and data management resources for six productive research projects. The RNH has also supported 25 pilot projects over the past four years alone, and has served as a research training base for 11 fellows in geriatric medicine. Results of previous research activities has led to the development of six new projects proposed in this application, including studies of: 1) alterations in autonomic function associated with aging, gender, and unexplained syncope; 2) the pathophysiology of detrusor hyperreflexia with impaired contractility, a previously unrecognized syndrome of urinary incontinence; 3) angiotensin converting enzyme inhibition for the prevention of congestive heart failure using atrial natriuretic peptide levels and noninvasive monitoring of pulmonary capillary wedge pressure to guide therapy; 4) the role of vitamin D in preventing bone loss in different ethnic groups of elderly people; 5) the perception of affect in Alzheimer's Disease; and 6) the maintenance of improvements in continence and behavior among institutionalized elderly using a nursing intervention. Each of these projects focuses on previously neglected problems of the frail elderly and builds on nearly 10 years of preliminary work. The projects benefit from a decade of successful collaboration among the investigators, extensive gerontological research expertise from a consortium of outstanding academic institutions, a supportive program Core, committed institutional resources from the HRCA, and a principal investigator with a proven track record in managing a project of this size and scope.
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