Change in self-reported physical function was examined using baseline and 5 years of follow-up data between 1982 and 1991 from the four Established Populations for Epidemiologic Studies of the Elderly studies. In East Boston, Massachusetts (n = 3,809), Iowa and Washington Counties, Iowa (n = 3,673), New Haven, Connecticut (n = 2,812), and North Carolina (n = 4,163), noninstitutionalized persons aged 65 years and older were asked a series of questions to assess their physical function: a modified Katz Activities of Daily Living (ADL) scale, three items from the Rosow-Breslau Functional Health Scale, and questions on physical performance, adapted from Nagi, as well as information on demographic, social, and health characteristics. Longitudinal statistical analyses (random effects and Markov transition models) were used to evaluate improvement, stability, and deterioration in functional ability at both an individual and a population level over multiple years of data. The average decline in physical function associated with age was found to be greater than previous cross-sectional studies have suggested, and the rate of decline increased with increasing age. Considerable individual variation was evident. Although many people experienced declines, a smaller but substantial portion experienced recovery. Women reported a greater rate of decline in physical function and were less likely to recover from disability.

This finding of a nontransient, perhaps permanent consequence of delirium invites reexamination of the definition of delirium from that of an acute, reversible syndrome to one of acute onset with long-term sequelae.

The authors sought to determine whether subsyndromal delirium is a qualitatively distinct clinical entity or a spectrum of cognitive and behavioral abnormalities. They conducted a prospective, longitudinal study on 325 patients in an acute care hospital with 3- and 6-month follow-ups. Patients were classified into one of three groups: those meeting full DSM criteria for delirium, those with subsyndromal delirium, and those with no symptoms of delirium. There were no differences in risk factors between those developing DSM-defined delirium or subsyndromal delirium. Number of independent risk factors was a significant predictor of delirium. Patients with subsyndromal delirium fall on a continuum between those with DSM-defined delirium and those with no symptoms of delirium. These data suggest that delirium does represent a spectrum of neurobehavioral impairment. Patients with symptoms of subsyndromal delirium are at risk for considerable morbidity; therefore clinicians should attempt to reduce and treat the onset of occurrence of subsyndromal delirium.

There are substantial gaps in the knowledge of older persons about urinary incontinence, especially among men, those age 85 and older, and those with lower levels of education. These knowledge gaps may contribute to misinterpretation of symptoms and underreporting of symptoms to health care professionals. This pattern of findings indicates a greater need for community education on urinary incontinence.