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Evaluate five different recruitment strategies for their capacity to enroll and retain both healthy and vulnerable older adults as part of a multiyear influenza vaccination study.We analyzed recruitment methods and other characteristics ofindividuals who participated in or were considered for five sequential one-year studies.Of 940 screened individuals, 820 met eligibility criteria with 795 enrolled over the five-year study (307 primary participants). Among these enrollees, 63.4% were female and 95.5% were white, with mean ages of 75.3 (older group) and 30.6 (younger group). More than a half (56.7%) of the participants enrolled more than once, participating an average of 2.56 (SD = 1.6) times. The majority (81.9%) of individuals recruited each year were return participants identified during earlier recruitments. Physician referrals resulted in only 5.3% recruitments.Recruitment and retention of study subjects, especially older adults, was facilitated by the existence ofa database listing past participants.

We report an atypical presentation of sporadic Creutzfeldt-Jakob disease (CJD) in a 74-year-old woman that illustrates the difficulty in diagnosing this rare, but important, cause of rapidly progressive dementia. Despite well-established criteria, this diagnosis is often missed or substantially delayed (Table 1). In this case, a precipitous cognitive decline associated with a urinary tract infection initiallysuggested delirium. Although atypical CJD was considered as a cause when symptoms persisted, a definitive diagnosis was established postmortem when the cerebrospinal fluid (CSF) prion protein 14-3-3 tested positive. Creutzfeldt-Jakob disease must be considered in the differential diagnosis of rapidly progressive dementia as Connecticut accounts for approximately three of the more than 200 cases diagnosed nationally.

Urinary incontinence is a common problem among older women, with a great impact on their quality of life, self-esteem and ability to live independently. Although often neglected by both patients and health-care providers, a variety of behavioral, pharmacologic and surgical interventions are now available to resolve or improve the symptoms of most older women who are incontinent. Since many of the factors which contribute to continence in late life lie outside of the bladder, the assessment of urinary incontinence in older women must extend beyond the genitourinary tract, assessing domains such as mobility, fluid balance and cognition. The primary care physician in uniquely placed in being able to diagnose this problem, to initiate treatment in many patients and to refer those requiring additional specialized expertise.