The State of the States in Family Caregiver Support: A 50-State Study is the first to examine publicly funded caregiver support programs in all 50 states and the District of Columbia since the passage of the landmark National Family Caregiver Support Program (NFCSP) in 2000. It highlights key findings, offers state-by-state profiles, pinpoints challenges, identifies issues for the future, and expands recognition of family caregiver needs as distinct from the needs of care receivers. Findings reveal that every state now offers at least some caregiver support services funded by the NFCSP. Still, that support is inconsistent and affected by limited funding. As a companion piece, an interactive database helps families and providers find services in their area. For the report and the database go to: http://www.caregiver.org/

This study examined how positive aspects of caregiving affect adaptation to bereavement among older adults who cared for a relative with dementia. The sample consisted of 217 caregivers involved in the Resources for Enhancing Alzheimer's Caregiver Health Study. Findings show that pre-loss caregiving benefit was associated with higher levels of post-loss depression and grief. This effect was particularly strong for the relation between benefit and grief. Results demonstrate the importance of positive and negative aspects of caregiving and their relation to bereavement outcomes.

Given that physical activity tends to change with age, researchers investigated whether these changes can influence mental function in a study of 295 men aged 70 to 90 from Italy, Finland and the Netherlands. Participants were asked about the intensity and duration of exercise, including activities such as walking, biking, gardening, and playing sports. The researchers followed the men for 10 years, noting who increased or decreased their physical activity. At the outset, Italian men were the most active, typically spending their time on gardening. In Finland, the most popular activity was walking; for Dutch men, it was bicycling. Men who decreased their physical activity by at least one hour each day experienced the largest decline in mental functioning. The more men reduced time spent exercising, the larger was their mental decline.

For the first time, a clinical trial with sufficient rigor, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee. Researchers studied 570 patients age 50 and over with osteoarthritis of the knee. The patients all reported significant pain in their knee the month before joining the study, but had never had acupuncture. Participants were divided into three groups -- 190 received acupuncture, 191 underwent sham acupuncture and 189 followed the Arthritis Foundation's self-help course for managing their condition. Participants also continued to receive standard medical care. By week eight of the study, persons receiving acupuncture began showing a significant increase in function and by week 14 a significant decrease in pain, compared with sham and control groups.

Older adults who get daily social and physical activity -- even for brief periods -- sleep better and have improved cognition. The study of 12 health older men and women between 67 and 86 years old found that 14 weeks of a daily 90-minute social and physical activity program improved cognitive performance by 4 percent to 6 percent, and also improved sleep quality. The daily sessions included 30 minutes of stretching, walking, and stationary upper and lower body exercises. That was followed by 30 minutes of social interaction. The final 30 minutes consisted of mild to moderate physical activity such as rapid walking, calisthenics, or dancing.

This study aimed to identify factors associated with the development of depressive symptoms in outpatients with heart failure. A total of 245 patients without depressive symptoms were enrolled at baseline. One year later, 52 study participants (21.2%) developed depressive symptoms. Living alone, alcohol abuse, perception of care as a substantial economic burden, and health status were independent predictors of developing depression. For patients without these factors, 7.9 percent developed depression by one year. When one factor was present, one-year incidence was 15.5 percent, when two were present the incidence was 36.2 percent, and when three were present the incidence was 69.2 percent.

The percentage of older Americans who were obese doubled to 36 percent during the period from 1980 to 2002. Obesity results in increased risks of developing heart disease, diabetes, certain cancers, and a host disabling conditions. The percentage of merely overweight older adults rose to 73 percent from 55 percent during the same period. Men were more likely than women to be overweight. Annual health costs for persons not within target weight ranges soared to as much as $40 billion. To see the report, visit http://www.agingstats.gov/

Prescription medication use has increased substantially among all Americans, according to the annual report, "Health, United States 2004." Nearly half of Americans age 65 years and older take three or more prescription drugs. More than 44 percent of Americans in general reported taking at least one prescription drug in the month in survey period 1999 and 2000, compared to 39 percent in the previous survey period. Increasing reliance on drugs has increased drug expenditures by at least 15 percent each year since 1998.

It can cost as much as $3,500 to replace a frontline care provider in a long-term care facility. Annual nursing home employee turnover rates averages 45 percent and may cost nursing homes nationwide nearly $4.1 billion, according to the report "The Cost of Frontline Turnover in Long-Term Care." The cost is a result of hiring temporary staff, paying overtime wages to current staff, and recruiting replacement staff. The entire 33-page report can be found at: www.bjbc.org/content/docs/TOCostReport.pdf

Although nursing home residents are at higher-than-average risk from influenza and pneumonia, their vaccination rates for these diseases are less than ideal. This study sampled more than 22,000 residents in 249 facilities in 14 states. Researchers found the average coverage for immunizations was 58 percent for influenza and 34 percent for pneumonia. Rates are far below the goal of 90 percent for nursing home residents, set forth in Healthy People 2010.

Researchers tested 49 nursing home residents who were admitted to a nearby hospital with a high risk of pneumonia and made molecular "fingerprints" of the bacteria found in each patient's mouth before pneumonia developed. Of the 49 patients, 28 had germs known to cause respiratory disease in their dental plaque samples. Of the 14 who eventually developed pneumonia, 10 of them had started out with respiratory disease-causing germs in their teeth. This is the first time research has been able to find a link between dental hygiene and respiratory infection

Data were analyzed from a population-based study of 1,890 Japanese-American men who participated in The Honolulu-Asia Aging Study. The study included 112 men with new onset dementia and 1,778 without dementia. Participants were examined on six occasions over a period of up to 34 years. Weight was measured at each exam and dementia was ascertained at the three most recent exams. Dementia-associated weight loss was shown to begin before the onset of dementia symptoms and accelerates by the time of the diagnosis.

Physicians and family members frequently are asked to provide information about driving ability in persons with Alzheimer's disease (AD), yet there has been little research on the validity of their assessment of driving performance. This study included 75 older adults (17 with mild AD, 33 with very mild AD, and 25 elderly controls). The participant him/herself, an informant, and a neurologist rated each participant's driving ability on a 3-point rating scale (safe, marginal, unsafe). A driving instructor also completed a standardized on-road driving assessment of each participant and then rated driving ability on the 3-point scale. Ratings were compared with the on-road driving score and with each other. Only the neurologist's rating of driving abilities was significantly related to the on-road driving scores of participants.

Increasing prevalence of overweight/obesity and rapid aging of the American population have raised concerns of increasing health care costs, with important implications for Medicare However, little is known about the impact of body mass index (BMI) earlier in life on Medicare expenditures. This study of more than 17,000 men and women examined relationships of BMI in young adulthood and middle age to subsequent health care expenditures at ages 65 years and older. Average annual and cumulative Medicare charges were significantly higher by higher baseline BMI for both men and women.

Over 100 palliative care tools have been posted are now available online for viewing and downloading. These tools were developed or adapted by demonstration projects and national workgroups. The tools fall into four main categories: clinical care, evaluation, educational, and organizational. Go to: www.promotingexcellence.org/tools

A National Institutes of Health draft consensus statement on end-of-life care is now available online. The "state-of-the-science" statement, fresh from the agency's December 6-8 conference on end-of-life care, aims to standardize definitions of the terms "end-of-life," "palliative," and "hospice." The statement addresses problems with current Medicare hospice benefits and identifies "severe limitations" in current end-of-life research. Related conference materials are also available for downloading at http://consensus.nih.gov/

The Seniors Housing & Care Journal publishes evidence-based papers for practitioners in the aging field and researchers conducting applied studies. The Journal is peer-reviewed and guided by our Editorial Board of professionals and academics in the seniors housing and care industry.

We are seeking papers for our upcoming 2005 edition (deadline for papers is June 10, 2005). Papers should have a direct impact on day-to-day operations. The research presented in the Journal covers a wide gamut of issues, all of which have practical implications for today's senior living and community-based practitioners. We look forward to expanding the range of topics and welcome your thoughts.

For more information, contact Managing Editor, David Lindeman, PhD, Mather LifeWays or Bradley R. Fulton, PhD, Mather LifeWays at
(847) 492-6810 or email SHCJ@matherlifeways.com