The incidence of chronic wounds is increased among older adults, and the impact of chronic wounds on quality of life is particularly profound in this population. It is well established that wound healing slows with age. However, the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The impact of age and accompanying multi-morbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables, lack of standardization in data collection, and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this paper, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify key research questions to guide future study of age-associated changes in chronic wound healing.

Context: Numerous studies have identified strong correlations between the severity of nutritional deficits and an increased risk of subsequent morbid events among the hospitalized elderly, but whether inadequate nutrient intake during hospitalization contributes to such nutritional deficits or the risk of adverse outcomes is not known. Objectives: To identify the distribution of average daily nutrient intake among the nonterminally ill hospitalized elderly, ascertain what factors contribute to persistently low intakes, and determine whether the adequacy of nutrient intake correlates with the risk of mortality. Design: Prospective cohort study conducted from 1994 to 1997. Setting: University-affiliated Department of Veterans Affairs hospital. Putierzts: A total of497 patients 65 years or older (mean [SDI age, 74 [6] years; 97% male; 86% white) with a length of stay of 4 days or more. Muin Outcome Measures: Daily in-hospital nutrient intake, in-hospital mortality, and 90-day mortality. Results: A total of 102 patients (21%) had a n average daily in-hospital nutrient intake of <50%. of their calculated maintenance energy requirements. Admission illness severity, average length of stay, and admission albumin and prealbumin levels for this low nutrient group did not differ significantly from those of the remaining patients. However, the low nutrient group had lower mean (SD) discharge serum total cholesterol (154 [441 mg/dL [4 11.11 mmol/Ll us 173 [421 mg/dL [4.5 11.11 mmol/Ll; p = .001), albumin (29.1 [6.7] us 33.2 [6.1] g/L,p = .001), and prealbumin (162 [691 rs 205 1681 mg& p = .001) concentrations and a higher rate of in-hos-pita1 mortality (relative risk, 8.0; 95% confidence interval, 2.8 to 22.6) and 90-day mortality (relative risk, 2.9; 95% confidence interval, 1.4 to 6.1). Contributing to the problem of inadequate nutrient intake, patients were frequently ordered to have nothing by mouth and were not fed by another route. Neither canned supplements nor nutrition support mere used effectively. Conclusions: Throughout their hospitalization, many elderly patients were maintained on nutrient intakes far less than their estimated maintenance energy requirements, which may contribute to an increased risk of mortality. Given the difficulties reversing established nutritional deficits in the elderly, greater efforts should be made to prevent the development of such deficits during hospitalization.

To determine whether the level of protein-calorie undernutrition at presentation correlated with the subsequent risk of developing in-hospital complications independently of nonnutrition factors influencing outcomes, a prospective study was conducted of 110 consecutive admissions to a Geriatric Rehabilitation Unit (GRU) of a Veteran's Administration hospital. In total, 54 variables were evaluated as possible predictors of outcomes. The risk of developing at least one complication while on the GRU was studied by using multivariate techniques (discriminant function analysis) and was found to correlate with, in order of significance, functional status as admission, serum albumin concentration at admission, amount of weight lost in the year before admission, and the presence or absence of a renal or pulmonary disease. Nutrition variables also independently correlated with the risk of developing an infectious complication or a major life-threatening complication and dying within the hospital. These data indicate the importance of nutrition status in geriatric rehabilitation patients.

Objectives. To determine the effects on balance and gait of a Wii-Fit program compared to a walking program in subjects with mild Alzheimer's dementia (AD). Methods. A prospective randomized (1 : 1) pilot study with two intervention arms was conducted in an assisted living facility with twenty-two mild AD subjects. In both groups the intervention occurred under supervision for 30 minutes daily, five times a week for eight weeks. Repeated measures ANOVA and paired t-tests were used to analyze changes. Results. Both groups showed improvement in Berg Balance Scale (BBS), Tinetti Test (TT) and Timed Up and Go (TUG) over 8 weeks. However, there was no statistically significant difference between the groups over time. Intragroup analysis in the Wii-Fit group showed significant improvement on BBS (P = 0.003), and TT (P = 0.013). The walking group showed a trend towards improvement on BBS (P = 0.06) and TUG (P = 0.07) and significant improvement in TT (P = 0.06). Conclusion. This pilot study demonstrates the safety and efficacy of Wii-Fit in an assisted living facility in subjects with mild AD. Use of Wii-Fit resulted in significant improvements in balance and gait comparable to those in the robust monitored walking program. These results need to be confirmed in a larger, methodologically sound study.