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A new method of physical activity monitoring is presented, which is able to detect body postures {sitting, standing, and lying) and periods of walking in elderly persons using only one kinematic sensor attached to the chest. The wavelet transform, in conjunction with a simple kinematics model, was used to detect different postural transitions (PTs) and walking periods during daily physical activity. To evaluate the system, three studies were performed. The method was first tested on 11 community-dwelling elderly subjects in a gait laboratory where an optical motion system {Vicon) was used as a reference system. In the second study, the system was tested for classifying PTs (i.e., lying-to-sitting, sitting-to-lying, and turning the body in bed) in 24 hospitalized elderly persons. Finally, in a third study monitoring was performed on nine elderly persons for 45-60 rain during their daily physical activity. Moreover, the possibility-to-perform long-term monitoring over 12 h has been shown. The first study revealed a close concordance between the ambulatory and reference systems. Overall, subjects performed 349 PTs during this study. Compared with the reference system, the ambulatory system had an overall sensitivity of 99% for detection of the different PTs. Sensitivities and specificities were 93% and 82% in sit-to-stand, and 82% and 94% in stand-to-sit, respectively. In both first and second studies, the ambulatory system also showed a very high accuracy (> 99%) in identifying the 62 transfers or rolling out of bed, as well as 144 different posture changes to the back, ventral, right and left sides. Relatively high sensitivity (> 90%) was obtained for the classification of usual physical activities in the third study in comparison with visual observation. Sensitivities and specificities were, respectively, 90.2 % and 93.4% in sitting, 92.2% and 92.1% in 'standing + walking,' and, finally, 98.4% and 99.7% in lying. Overall detection errors (as percent of range) were 3.9% for 'standing + walking,' 4.1% for sitting, and 0.3% for lying. Finally, overall symmetric mean average errors were 12% for 'standing + walking,' 8.2% for sitting, and 1.3% for lying. Index Terms--Ambulatory system, elderly people, kinematic sensor, long-term monitoring, physical activity, postural transition, wavelet transform.

A program of in-home evaluation of the aged and their living conditions may reduce the risk of disability and long-term stays in nursing homes. A total of 215 people over 75 were enrolled in a three-year assessment program and compared to 199 people over 75 who were not enrolled in the program. The program involved visits from gerontologic nurse practitioners who performed annual physical examinations, evaluated social support and safety in the home, made risk-reducing recommendations, and monitored the implementation of these recommendations. During the program, 9 people in the program and 20 people in the control group were admitted to nursing homes for over 100 days. People in the program were much less likely to require assistance in performing basic activities of life such as bathing, dressing, eating, and moving about the house. However, the program did not affect participants' survival or ability to perform without assistance such tasks such as cooking, shopping, and paying bills. The estimated cost per year of intervention by the nurse practitioners resulting in life without disability was $6,000.

To lay the groundwork for devising, improving and implementing strategies to prevent or delay the onset of disability in the elderly, we conducted a systematic literature review of longitudinal studies published between 1985 and 1997 that reported statistical associations between individual base-line risk factors and subsequent functional status in community-living older persons. Functional status decline was defined as disability or physical function limitation. We used MEDLINE, PSYCINFO, SOCA, EMBASE, bibliographies and expert consultation to select the articles, 78 of which met the selection criteria. Risk factors were categorized into 14 domains and coded by two independent abstractors. based on the methodological quality of the statistical analyses between risk factors and functional outcomes (e.g. control for base-line functional status, control for confounding, attrition rate), the strength of evidence was derived for each risk factor. The association of functional decline with medical findings was also analyzed. The highest strength of evidence for an increased risk in functional status decline was found for (alphabetical order) cognitive impairment, depression, disease burden (comorbidity), increased and decreased body mass index, lower extremity functional limitation, low frequency of social contacts, low level of physical activity, no alcohol use compared to moderate use, poor self-perceived health, smoking and vision impairment. The review revealed that some risk factors (e.g. nutrition, physical environment) have been neglected in past research. This review will help investigators set priorities for future research of the Disablement Process, plan health and social services for elderly persons and develop more cost-effective programs for preventing disability among them. Keywords: Disablement; Disability; Functional decline; Elderly

Presents letters to the editor on issues related to aging. Alzheimer's disease and edentulism; Investigation of occult malignancies in patients with venous thromboembolism; Change in general practitioner prescribing.

Presents letters on medicine, published in the May issue of the periodical 'Archives of Internal Medicine.' Distinction between complementary and alternative medicine (CAM); Informed consent for CAM; Adherence to highly active antiretroviral therapy; Utilization of volunteer health care professionals for the care of the uninsured; Refusal of endoscopy in cirrhotic patients with child-pugh class A.