To compare the effects of oral vs. transdermal estrogens on GH secretion and levels of circulating insulin-like growth factor I (IGF-I) and IGF-binding protein-3 (IGFBP-3) in younger vs. older postmenopausal women, we conducted a placebo-controlled, cross-over trial of 6 weeks of oral conjugated estrogen (1.25 mg daily) or transdermal estradiol (100 micrograms/day) administered in random order and separated by an 8-week, treatment-free interval. Sixteen healthy postmenopausal women, ages 49-75 yr, were studied on an NIH-funded General Clinical Research Center grant. Data were analyzed for the combined group as well as in the younger ( 62 yr, n = 8). Spontaneous GH secretion, as assessed by 12-h overnight blood sampling at 20-min intervals; GH responsiveness to i.v. bolus injection of GHRH; and levels of serum IGF-I and IGFBP-3, before and after GHRH stimulation, were measured at enrollment and after 6 weeks of each estrogen treatment. Before estrogen treatment, spontaneous nocturnal GH secretion and morning IGF-I levels tended to be lower, IGFBP-3 levels did not differ, and GHRH-stimulated GH levels were significantly reduced in older vs. younger postmenopausal women. Oral estrogens increased spontaneous GH secretion, decreased serum IGF-I levels, and did not alter IGFBP-3 levels, whereas transdermal estrogens did not alter nocturnal GH secretion or morning IGF-I levels and decreased IGFBP-3 levels only in the older women. GHRH-stimulated GH levels were similar before and after oral or transdermal estrogen treatment. In contrast, after, GHRH administration, IGF-I levels were decreased only with oral estrogens, whereas IGFBP-3 levels were decreased with both oral (younger women only) and transdermal (younger and older women) estrogens. We conclude that, in postmenopausal women, oral and transdermal estrogens exert differing effects on the GH/IGF-I axis, but neither form of estrogen completely reverses the known age-related reductions in spontaneous or GHRH-stimulated GH and IGF-I.

CDAD remains a problem in the long-term care setting, and importation from the acute care setting accounts for a large proportion of the C. difficile seen LTCFs. As the population continues to age, issues of disease and infection in long-term care are expected to increase. New prevention and control strategies are needed to control the spread of CDAD in LTCFs.

Background Hip fracture is a serious injury for older adults, usually requiring surgical repair and extensive therapy. Informal caregivers can help older adults make a successful recovery by encouraging them to adhere to the therapy plans and improve their health behaviors. Few resources, however, are available for these caregivers to learn about how to assist their care receivers and cope with their unique caregiving situations. Objective To develop a comprehensive theory-based online hip fracture resource center for caregivers, Caring for Caregivers, and conducted a feasibility trial. Method The resource center included self-learning modules, discussion boards, Ask the Experts, and a virtual library. The feasibility of the intervention was assessed by usage and usability. The feasibility of the future trial was tested using a one-group pre-post design on 36 caregiving-care receiver dyads recruited from six hospitals. The caregivers used the resource center for 8 weeks. The impact of the intervention was assessed on both caregivers (primary) and care receivers (secondary). The data were analyzed by descriptive statistics, paired t-tests, and content analyses. Results On average, caregivers reviewed five modules and used the discussion board 3.1 times. The mean perceived usability score for the resource center was 74.04 ± 7.26 (range = 12–84). Exposure to the resource center significantly improved caregivers’ knowledge about the care of hip fracture patients (t = 3.17, p = .004) and eHealth literacy (t = 2.43, p = .002). Changes in other caregiver outcomes (e.g., strain, coping, social support) and care receiver outcomes (e.g., self-efficacy for exercise, osteoporosis medication adherence) were favorable but not significant. Discussion The findings suggest that the resource center was user-friendly and could be beneficial for caregivers. Additional larger scale trials are needed to assess the effectiveness of the intervention on outcomes.

The ability to walk under normal and cognitive dual task conditions is essential for safe mobility in older adults. However, while assessments of gait provide important health information, they have been limited to laboratory settings. We aimed to create an easy-to-use smartphone App enabling remote dual task walking assessments, and to demonstrate its reliability and validity in relatively healthy younger and older adults. The iPhone-based App utilized multi-media instructions and the phone's internal motion sensors to record movements during normal walking and walking with simultaneous serial-subtractions, with the phone placed in the user's pants pocket. Fourteen younger and 12 older adults completed two lab visits, during which data were acquired by the App and GAITRite mat over multiple normal and dual task walking trials. Participants also used the App to complete assessments in their homes on three separate days. Outcomes included average stride time and the dual-task cost to stride time. Across all detected strides in laboratory trials, derived outcome measures from the App were highly correlated with those derived from the GAITRite mat (Stride Time: p<0.001, r2 =0.99. Dual-task cost: p<0.001, r2 =0.98). These correlations were unaffected by age group, walking condition, and pocket tightness. Moreover, across trials, gait metrics demonstrated excellent test-retest reliability, both within and between laboratory visits and home-based assessments (ICC: 0.79-0.90). These results suggest that dual task walking assessments are valid and can be reliably administered in remote settings in relatively healthy younger and older adults.