""To examine the association between 25-hydroxyvitamin D (25(OH)D) and physical function in adults of advanced age. Cross-sectional and longitudinal analysis of physical function over 3?years of follow-up in the Cardiovascular Health Study All Stars. Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania. Community-dwelling adults aged 77 to 100 (N?=?988). Serum 25-hydroxyvitamin D 25(OH)D), Short Physical Performance Battery (SPPB), and grip and knee extensor strength assessed at baseline. Mobility disability (difficulty walking half a mile or up 10 steps) and activities click here
of daily living (ADLs) disability were assessed at baseline and every 6?months over 3?years of follow-up. Almost one-third (30.8%) of participants were deficient in 25(OH)D (<20?ng/mL). SPPB scores were lower in those with deficient 25(OH)D (mean (standard error) 6.53?(0.24)) than in those with sufficient 25(OH)D (��30?ng/mL) (7.15?(0.25)) after adjusting for sociodemographic characteristics, season, health behaviors, and chronic conditions (P?=?.006). Grip strength adjusted for body size was also lower in those with deficient 25(OH)D than in those with sufficient 25(OH)D (24.7?(0.6)?kg vs 26.0?(0.6)?kg, P?=?.02). Participants with deficient 25(OH)D were more likely <a href="http://www.selleckchem.com/products/ABT-737.html
">selleck kinase inhibitor to have prevalent mobility (OR?=?1.44, 95% confidence interval (CI))?=?0.96�C2.14) Temozolomide
and ADL disability (OR?=?1.51, 95% CI?=?1.01�C2.25) at baseline than those with sufficient 25(OH)D. Furthermore, participants with deficient 25(OH)D were at greater risk of incident mobility disability over 3?years of follow-up (hazard ratio?=?1.56, 95% CI?=?1.06�C2.30). Vitamin D deficiency was common and was associated with poorer physical performance, lower muscle strength, and prevalent mobility and ADL disability in community-dwelling older adults. Moreover, vitamin D deficiency predicted incident mobility disability. ""To determine how well healthcare proxies (HCPs) understand do-not-hospitalize (DNH) orders and why they may or may not initiate them. Semistructured qualitative interviews. Two nursing homes in western Massachusetts. HCPs of nursing home residents with advanced dementia. In-depth interviews were audiotaped and transcribed verbatim. Data were qualitatively analyzed in an iterative process, and emergent concepts were conceptually ordered into explanatory categories. Pertinent demographic and clinical information was collected from the Minimum Data Set (MDS) and patient charts. Sixteen of 31 eligible HCPs were interviewed. Major findings included barriers to and facilitators of initiating DNH orders. Barriers included a perceived lack of physician involvement in decision-making and limited understanding of DNH orders and the resident's prognosis.