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The purpose of this study was to examine the impact of an extracurricular geriatric program on medical students' knowledge of, and attitudes toward, the elderly and their interest in studying geriatric medicine. The participants were first-year medical students (n = 137) who joined the Senior Teacher Education Partnership (STEP) program that partnered medical students with community-dwelling elders. Although results show that the STEP program had minimal effect in changing first-year medical students' knowledge of the aged and aging, it did promote a more positive view of the elderly as being functionally independent and socially active. Statistical analyses also revealed that prior interest and participation in the STEP program are significant indicators of students' interest in pursuing geriatric medicine after completing their first year of medical school. (Contains 4 tables.)

At the University of Missouri-Columbia School of Medicine, we developed a voluntary senior-mentor program, the Senior Teacher Educator Partnership (STEP), for first- and second-year medical students. Using qualitative research methods, we examined the impact of STEP on medical students' attitudes and then assessed the congruence of what is learned through STEP with the knowledge, skills, and attitudes needed to provide care to the elderly patient. STEP was found to be a successful strategy for teaching themes of recognizing the elderly within an ecological context, enhancing sympathy and empathy, emphasizing respect for elderly persons, and gaining an appreciation that aging is an individualized process. New areas identified for student learning experiences included understanding the complexity of the health care system and its impact on elderly patients, understanding the payment system, and developing skills in assessment and care coordination. A model is described for continuous enhancement of educational programs to be used to improve educational experience in geriatrics. (Contains 2 tables.)

Background. Scant information exists about the risk of functional decline following treatment of acute illness in the nursing home (NH) setting. The aim of this study was to determine the incidence of short-term (30-day) functional decline among survivors of NH-acquired lower respiratory tract infection (LRI) and the factors that predict such decline, including the role of initial hospitalization. Methods. We used a prospective cohort design to study 781 episodes of LRI in 1044 NH residents in 36 NHs in central Missouri and the St. Louis metropolitan area. Functional decline was defined as a 3-point increase on the Minimum Data Set (MDS) activities of daily living (ADL) long form scale. Results. Of 781 LRI cases who survived to 30 days, the incidence of ADL decline was 28.8%. In a logistic regression model that used generalized estimating equations to adjust for clustering, variables associated with ADL decline included the following: chronic feeding tube use (AOR = 4.54, 95% confidence interval, or CI, 1.61, 12.80), decubitus ulcer (adjusted odds ratio [AOR] = 2.29, 95% CI 1.35, 3.90), shortness of breath (AOR = 2.18, 95% CI 1.44, 3.30), short-term memory problems (AOR = 2.07, 95% CI 1.33, 3.23), decline in self-performance of toilet use in the 24 hours prior to evaluation (AOR = 1.65, 95% CI 1.29, 2.12), age (AOR = 1.02, 95% CI 1.00, 1.05), and baseline ADL score. Addition of treatment variables to the model showed that initial hospitalization was also associated with ADL decline (AOR = 1.90, 95% CI 1.20, 3.00). Residents with ADL decline at 30 days were less likely to recover to their baseline ADL status at 90 days. Conclusions. Many NH residents who survive to 30 days following LRI develop new functional limitations, and such individuals are at risk for ADL decline at 90 days. A limited number of clinical variables may predict short-term functional decline. Initial hospitalization for acute treatment of LRI may increase the risk of subsequent ADL decline among individuals who survive to 30 days.

Researchers have developed a health status indicator that can identify nursing home patients who have a high risk of death from a respiratory tract infection. The indicator includes blood urea nitrogen, white blood cell count, body mass index, pulse rate, activities of daily living status, absolute lymphocyte count, sex, and mood changes., Context Lower respiratory tract infection (LRI) is a leading cause of mortality and hospitalization in nursing home residents, Treatment decisions may be aided by a clinical prediction rule that identifies residents at low and high risk of mortality. Objective To identify patient characteristics predictive of 30-day mortality in nursing home residents with an LRI. Design, Setting, and Patients Prospective cohort study of 1406 episodes of LRI in 1044 residents of 36 nursing homes in central Missouri and the St Louis, Mo, area between August 15,1995, and September 30, 1998. Main Outcome Measure Thirty-day all-cause mortality. Results Thirty-day mortality was 14.7% (n = 207). In a logistic analysis, using generalized estimating equations to adjust for clustering, we developed an 8-variable model to predict 30-day mortality, including serum urea nitrogen, white blood cell count, body mass index, pulse rate, activities of daily living status, absolute lymphocyte count of less than 800/[micro]L (0.8 X 10(9)/L), male sex, and deterioration in mood over 90 days. In validation testing, the model exhibited reasonable discrimination (c = .76) and calibration (nonsignificant Hosmer-Lemeshow goodness-of-fit statistic, P = 54). A point score based on this model's variables fit to the entire data set closely matched observed mortality. Fifty-two percent of residents had low (score of 0-4) or relatively low (score of 5-6) predicted 30-day mortality, with 2.2% and 6.2% actual mortality, respectively. Conclusions Our model distinguishes nursing home residents at relatively low risk for mortality due to LRI. If independently validated, our findings could help physicians identify nursing home residents in need of different therapeutic approaches for LRI.

Part III. Focuses on the article `Type 2 Diabetes: Patient Education and Home Blood Glucose Monitoring,' published in the May 1998 issue of the `Geriatrics' journal. Most effective treatment for type 2 diabetes; Prevalence of the disease; Information on home glucose monitoring; Comments made by doctors during a discussion relating to type 2 diabetes.

Part II. Focuses on the importance of treatments for type 2 diabetes, which retain weight reduction and physical activity. Treatment of metabolic defects in type 2 diabetes; Highlights of a discussion on the treatment of type 2 diabetes in primary care. INSET: Update on troglitazone and liver toxicity.

Reports on round table discussion between various medical practitioners on type 2 diabetes mellitus and the impact of this disease on the American population. Factors contributing to the development of this disease; Complications associated with this disease; Challenges posed by the disease; Comments from these individuals. INSET: ADA clinical practice recommendations for 1998.

Background and Objectives: Several approaches to merging residency training and medical school education have been attempted over the past 20 years. This study describes and evaluates an integrated family medicine residency programa 4-year program that overlaps with the final year of medical school., Methods: We retrospectively analyzed multiple data sources, including In-Training Examination scores, patient visit profiles, resident demographics, and graduate surveys., Results: Integrated residents (IRs) perform significantly better than traditional residents on In-Training Examinations at each year of residency training, with the difference in mean scores decreasing over time (67.8, 39.6, and 33.0 points better in the first, second, and third residency years). No evidence of increased patient continuity or panel size was noted. A higher proportion of IRs serve as chief residents, rate their residency experience as "excellent," and remain with the program through graduation. Practice characteristics immediately after residency do not significantly differ. Financial benefits are evident for the IRs as well as the hosting department., Conclusions: This integrated program offers several benefits for both the medical student and the residency program, and it is a potential model for academic residencies aiming to recruit and retain a higher percentage of their own schools' students.

Driving is a daily activity for people across the country. Most Americans, including the elderly, consider it a right. Driving, however, is dangerous and can become more challenging as people age. While evaluating the elderly driver is not a simple task, it is a responsibility that must be shared by Missouri physicians. This paper describes the epidemiology of this problem, common mistakes made by elderly drivers, risk factors that can cause unsafe driving, and strategies physicians can use to evaluate their elderly patients' ability to drive.