Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale.

BACKGROUND: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. HYPOTHESIS: Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. STUDY DESIGN: REHAB-HF is a multi-center clinical trial in which 360 patients ≥60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. CONCLUSIONS: REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities

Fertility, Living Arrangements, Care and Mobility

There are four main interconnecting themes around which the contributions in this book are based. This introductory chapter aims to establish the broad context for the chapters that follow by discussing each of the themes. It does so by setting these themes within the overarching demographic challenge of the twenty-first century – demographic ageing. Each chapter is introduced in the context of the specific theme to which it primarily relates and there is a summary of the data sets used by the contributors to illustrate the wide range of cross-sectional and longitudinal data analysed

When is a family a family? Evidence from survey data and implications for family policy

This article examines the correspondence between common assumptions about the American family and actual patterns. The assessment is based on national data on individuals, households, and families. Findings indicate that the coresident nuclear model should be considered a model rather than the model of family. Past as well as current marital ties need to be considered in defining “family,” and divorce rather than death should be the expected cause of losing the main breadwinner in the family, except among elderly women. Parent-child ties to either young or adult children often span separate households. Coresidents can include individuals other than nuclear family members, and change rather than stability is the modal pattern in living arrangements. Rather than shaping concepts of the family from a single mold, policy makers and researchers are better advised to recognize the diversity and fluidity in family and household structures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44653/1/10834_2006_Article_BF02353666.pd

What’s a (Childless) Man Without a Woman? The Differential Importance of Couple Dynamics for the Wellbeing of Childless Men and Women in the Netherlands

Using rich couple data from the Netherlands Kinship Panel Study, we investigated to what extent there were gender differences in couple dynamics within childless couples (N = 163). Though the childless partners reported similar relationship satisfaction, we found gender differences in the link between relationship conflict and relationship satisfaction - the childless men were more strongly affected by the negative aspects of the partnership. This gender difference was not evident for the association between partner support and relationship satisfaction - the positive aspects of the partnership were equally important for the male and the female childless partners. Furthermore, the association between relationship satisfaction and health was stronger for the childless men than for the childless women and this difference was particularly evident when the levels of relationship satisfaction were low. These results indicate that when they are in unsatisfying romantic relationships, childless men are at a greater risk than childless women of physical and mental ill health

Determinants of Minority-White Differentials in Child Poverty

This paper uses data from the 1993-2001 March Current Population Survey to estimate the extent to which child living arrangements, parental work patterns, and immigration attributes shape racial and ethnic variation in child poverty. Results from multivariate analyses and a standardization technique reveal that parental work patterns as well as child living arrangements are especially consequential for black and Puerto-Rican economic circumstances. Child immigration generation and parental length of residence seem to play a detrimental role in shaping poverty among Asian, Mexican, and Central/South American children. We also found that the extent to which differences in the composition of and returns to parental resources determine white-minority economic gaps varies substantially across racial and ethnic lines. The social and economic implications of the findings for understanding racial and ethnic inequality are discussed in the final section of the article

The Effects of Cooperation; A Structural Model of Siblings’ Caregiving Interactions

Hervorming Sociale Regelgevin