Key Words public health impact, Alzheimer's disease, Alzheimer's care s Abstract Recent developments in basic research suggest that therapeutic breakthroughs may occur in Alzheimer's disease treatment over the coming decades. To model the potential magnitude and nature of the effect of these advances, historical data from congestive heart failure and Parkinson's disease were used. Projections indicate that therapies which delay disease onset will markedly reduce overall disease prevalence, whereas therapies to treat existing disease will alter the proportion of cases that are mild as opposed to moderate/severe. The public health impact of such changes would likely involve both the amount and type of health services needed. Particularly likely to arise are new forms of outpatient services, such as disease-specific clinics and centers. None of our models predicts less than a threefold rise in the total number of persons with Alzheimer's disease between 2000 and 2050. Therefore, Alzheimer's care is likely to remain a major public health problem during the coming decades.

Using evidence from a number of sources (including the 1981 and 1991 censuses of India, prior research, and NGO reports), this article examines whether bias against girl children persists during periods of development and fertility decline, whether prenatal sex selection has spread in India as elsewhere in Asia, and whether female vs. male child mortality risks have changed. The authors present estimated period sex ratios at birth (SRBs) calculated by reverse survival methods along with reported sex ratios among infants aged 0 and 1, as well as sex ratios of child mortality probabilities (q5), from the two censuses. The ®ndings show an increase in`masculine' SRBs and persistent (or even worsening) female mortality disadvantage, despite overall mortality decline, due to selective neglect and the spread of female infanticide practices in some areas. Research and reports indicate the increasing use of prenatal sex selection in some regions. In India, preference for sons appears to be undiminished by socio-economic development, which interacts with cultural sources of male bias. The increased masculinity of period SRBs in some areas, together with persistent excess female child mortality and female infanticide, creates a`double jeopardy' for girl children. Legislation curbing prenatal sex determination and policy measures addressing societal female devaluation have had little impact, suggesting that female demographic disadvantage is unlikely to improve in the near future.

Factors that promote successful management of persons with severe behavioral problems in special care units (SCUs) for dementia were evaluated. Using qualitative data from staff interviews conducted in 36 nursing home SCUs, the study examined the relationships among demographic and behavioral characteristics of 70 residents, management techniques of the staff, and family participation in the management of persons with severe behavioral problems. Problem behaviors were often managed successfully in SCUs, although unpredictable aggression was particularly difficult to control and was a common reason for discharge. Use of multiple non-pharmacological techniques was associated with a greater likelihood of successful management, and physical restraints were used as a last resort. SCU staff members also reported that large, physically aggressive men and residents with real or suspected psychiatric comorbidity were especially difficult to manage. Finally, family involvement and support were critical to resident success and often buffered against resident discharge.

Elder-proxy concordance is highest among ADL items, followed by medical history items and IADL items. Caregiver depressive symptomotology had no significant impact on elder-proxy response concordance on any of the three outcomes of interest: IADL and medical history bias and ADL disagreement. However, caregiver burden was marginally predictive of bias on the total ADL and IADL scales. Additionally, increased burden was significantly predictive of bias on five of the seven individual items of the IADL scale, suggesting that the more burden a caregiver feels, the greater likelihood that s/he will overstate the older person's disability compared with self-report. These findings suggest that clinicians and researchers who use proxy reports to determine treatment regimens and complete data collection efforts may do so with confidence on ADL individual items and medical history items when the older person's frailty is marginal. However, caregiver burden may result in misleading representation of the older person's functional status, specifically in regard to IADL items.

This article examines the impact of familial social support ties (indicated by marital status, kin availability, sources of economic support, and frequency and quality of emotional interaction) on subjective health perception among a sample of elderly men and women aged 60 and older in South India. We used 1993 survey data from three states of South India: Kerala, Tamil Nadu, and Karnataka. We hypothesized that (a) widowhood would be associated with poorer self-rated health, (b) number of kin ties would be positively associated with self-rated health, (c) economic and emotional support from kin would improve outcomes, and (d) these associations would be stronger among women than among men. Results of logistic regression techniques supported the first hypothesis and partially supported the third. With regard to the second hypothesis, the presence of specific kin rather than the number of each type of family member was important. For the fourth hypothesis, results suggest that men and women in this sample have broadly similar associations between widowhood and self-rated health. For women however, controlling for socioeconomic status did not weaken the association between widowhood and self-rated health, suggesting the symbolic/cultural importance of this status. In general, these findings suggest that theories on the importance of marital status and kin ties for older adults' self-rated health, which were developed and tested in Western societies, need to be refined for Asian societies, where the nature of marriage and widowhood are different.