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Purpose: The purpose of this quality improvement project was to examine the feasibility of rapidly converting a Tai Chi program for older Veterans from face‐to‐face to virtual classes. Methods: Eighteen Veterans attending our face‐to‐face Tai Chi course were invited to transition to virtual classes. Feasibility was defined as the ability of program staff and participants to successfully connect and complete the initial and subsequent classes by VA Video Connect (VVC) with little to no technical difficulties, participant ability to participate in the course without safety concerns, and favorable feedback from participants and program staff. Results: Nine of 18 Veterans agreed to transition to the virtual program and attended a median (interquartile range) of 11 (4–15) classes; they were younger (62.7 + 11.5 vs. 70.5 + 7.0 years, p <.05) and more likely to have the knowledge and equipment needed to participate (78% vs. 0%, p <.01) than nonparticipants. Tai Chi instructors and participating Veterans reported being able to connect to and complete the classes virtually with only minimal technical problems. No adverse events were reported. Feedback from the instructors and Veterans was positive and included comments on ease of use and enjoyability. Conclusion: Results suggest that virtual Tai Chi classes via VVC are feasible for some older Veterans. [ABSTRACT FROM AUTHOR]

Background. Although weight change in older persons has proven prognostic significance, it is not known whether monthly weights obtained by the clinical staff in long-term care institutions are reliable enough to be useful in identifying at-risk residents. The objective of this study was to determine whether an association exists between mortality risk and the intraresident variation in weight in long-term care institutions. Methods. For this study, 900 nursing home residents with a recently identified nutritional problem from 96 long-term care facilities in 8 states were randomly selected. At study entry, nutritional, health status, and demographic data were extracted from the nursing home chart or the Minimum Data Set. Weights obtained by the nursing home staff were recorded at baseline and during each of the subsequent 6 months. Cox proportional hazards regression analysis was used to assess relationships between weight parameters and mortality risk during the 7 months of observation. Results. During the study, 435 (48%) participants had at least 1 monthly weight that differed from the previous month's weight by ≥5%; 163 (18%) participants had this magnitude of a 1-month weight change more than once. By controlling for the linear trend (i.e., slope) of each residents' weight change between the first to the last weight, the average month-to-month residual variability in the resident's weights was calculated. This residual variability or "average random fluctuation" in weight from 1 month to the next was ≥2% in 229 (25%) participants and ≥3% in 82 (9%) participants. Despite the large random fluctuation in the residents' weights, weight loss was an important prognostic indicator. Those who lost ≥5% in any month bed a 10-fold increased risk for death compared with those who gained weight (adjusted relative risk, 10.6; 95% confidence interval, 3.2 to 35.5). The average random fluctuation in weight was associated with an increased risk for death only at the upper 10th percentile for the population. Conclusions. Many nutritionally compromised elderly nursing home residents experience significant bidirectional fluctuations in their weight from month to month. How much of this variability is due to measurement error is not known. However, a weight loss of ≥5% in any month has important prognostic implications. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between serum albumin, prealbumin, various serum inflammation associated-cytokines, and mortality in older geriatric recuperative care patients., Design: A prospective cohort study., Setting: A geriatric rehabilitation unit of a university-affiliated Department of Veterans Affairs hospital., Participants: Participants were 53 geriatric patients (mean age 78 +/- 7.3, 96% male) admitted to a Geriatric Evaluation and Management (GEM) unit. Patients with documented near-terminal medical disorder, overt infections, and any systemic or localized inflammatory disorders were excluded., Measurements: Inflammation-associated cytokines (IL-8, IL-1beta, IL-6, IL-10, TNF-alpha), albumin, prealbumin, and C-reactive protein were measured at hospital discharge and each subject was then tracked for 1 year., Main Results: By Cox Proportional-Hazards Regression analysis, the strongest predictor of mortality within 6 months of study entry was the serum IL-6. For each log increase in IL-6, there was nearly a 9-fold greater 6-month mortality risk (RR 8.99, 95% CI 1.65 to 49.03). The association between albumin and mortality was no longer significant after controlling for IL-6. There was a strong inverse correlation between IL-6 and both albumin (R2 0.39, P < .001) and prealbumin (R2 0.41, P < .001)., Conclusion: Subclinical inflammation appears to be an important factor contributing to low serum albumins in older recuperative care patients and may confound the association between albumin and mortality in this population. More in-depth studies of these associations are warranted.