Showing papers in "Journal of Aging and Health in 2012"
TL;DR: The results suggest that global measures of isolation, that fail to distinguish between social isolation and feelings of loneliness, may not detect the impact on physical and mental health in older adults.
Abstract: Objective: To examine the relationship of social isolation, loneliness and health outcomes among older adults. Methods: Using data from the Leave Behind Questionnaire of the Health and Retirement S...
509 citations
TL;DR: This study provides evidence for the validity and reliability of SPPB in diverse populations with increasing limitation of lower limbs, disability, and poor health.
Abstract: Objectives To assess the validity and reliability of the Short Physical Performance Battery (SPPB) in adults 65 to 74 years old, capable in all basic activities of daily living (ADL), in Quebec and Brazil. Methods Participants were recruited in St. Bruno (Quebec) by local advertisements (n = 60) and in Santa Cruz (Brazil) by random sampling (n = 64). The SPPB includes tests of gait, balance, and lower-limb strength. Disability status was categorized as intact mobility, limited mobility, and difficulty in any of ADL. Results There was a graded decrease in mean SPPB scores with increasing limitation of lower limbs, disability, and poor health. Using the test-retest reliability the authors evaluated the intraclass correlation coefficient, which was high in both samples: .89 (95% CI: 0.83, 0.93) in St. Bruno and .83 in Santa Cruz (95% CI: 0.73, 0.89). Discussion This study provides evidence for the validity and reliability of SPPB in diverse populations.
221 citations
TL;DR: Older adults may benefit from special instructions designed to boost Internet trust, for example, learning how to distinguish between high and low quality health-related websites.
Abstract: Objectives: The Internet holds great potential to support information gathering and decision making surrounding health education and self-care. Older adults, however, underutilize the Internet for health information searches relative to younger adults. The goal of the present study was to examine age differences in the role of trust and ease of search in predicting whether or not individuals use (adopters) or do notuse (nonadopters) the Internet to search for health information. Method: We used logistic regressions todetermine whether there were age differences in the extent to which trust and ease of search predicted online health information searches within a nationally-representative sample of 3796 adults from the Health Information National Trends Survey (HINTS). Results: Adopters were more trusting of Internet health informationthan nonadopters. However, a significant age by trust interaction indicated that this difference increased in magnitude with age, a pattern that held even after controlling fo...
182 citations
TL;DR: It is found that indebtedness is common and is associated with more symptoms of depression, anxiety, and anger, and it is weakly associated with other aspects of socioeconomic status (SES), and thus not redundant with them.
Abstract: Objective:This study examines the impact of indebtedness on depressive symptomatology, anxiety, and anger. Method: We use data from a two-wave panel study of adults in Miami-Dade County. The analyt...
156 citations
TL;DR: Results support the HCH model for cognitive outcomes in older women caregivers; however, the relationship may be domain specific.
Abstract: Objectives: Recent findings of better health outcomes in older caregivers than noncaregivers suggest a healthy caregiver hypothesis (HCH) model may be more appropriate than the stress process model for evaluating the health effects of caregiving. In a cross-sectional study, we tested the HCH on two cognitive domains: verbal memory and processing speed. Method: Participants from the Caregiver Study of Osteoporotic Fractures who had a 2-year follow-up interview were categorized as continuous caregivers (n = 194), former caregivers (n = 148), or continuous noncaregivers (n = 574). The Hopkins Verbal Learning Test (HVLT; memory) and Digit Symbol Substitution Task (DSST; processing speed) were administered at the follow-up interview. Results: Continuous caregivers had better memory performance and processing speed than continuous noncaregivers: adjusted mean scores for HVLT were 18.38 versus 15.80 (p < .0001), and for DSST were 35.91 versus 34.38 (p = .09). Discussion: Results support the HCH model for cogniti...
109 citations
TL;DR: This paper investigated whether Whites, Blacks, Latinos, and Asians differ in their rates of advance care planning (ACP; that is, living will, health care proxies, discussions), sources of within-racial group heterogeneity, and racial differences in the explanations offered for not doing ACP.
Abstract: Objectives:The author investigated (a) whether Whites, Blacks, Latinos, and Asians differ in their rates of advance care planning (ACP; that is, living will, health care proxies, discussions), (b) sources of within-racial group heterogeneity, and (c) racial differences in the explanations offered for not doing ACP.Methods:The author estimated logistic regression models with data from a national sample of married and cohabiting adults ages 18 to 64 in the Knowledge Networks study (N = 2,111).Results:Latinos are less likely than Whites to discuss preferences and to have a living will, although the latter gap is fully accounted for by education. Asians are less likely than Whites to have discussions, but more likely to have living wills. Black-White differences emerge only among low SES (socioeconomic status) subgroups. Each group noted distinctive obstacles to planning.Discussion:Public policies should target increasing rates of ACP for all adults prior to onset of major health concerns.
99 citations
TL;DR: Self-report of hearing loss is insensitive to age effects and does not provide a reliable basis for estimating prevalence of age-related hearing loss, although may indicate perceived hearing disability.
Abstract: Objectives: To evaluate a harmonized binary measure of self-reported hearing loss against gold standard audiometry in an older adult population. Method: Seven nationally representative population-b...
96 citations
TL;DR: There is a linear increase in depressive symptoms after age 65, but this occurs in the context of medical comorbidity and is not an independent effect of aging.
Abstract: Objectives: The objective of this study is to examine the relationship between age and depression among people aged 65 and older. Method: The study uses three waves of longitudinal data (1991, 1996, 2001) from a community and institutional sample of Canadians aged 65 and older. The study uses generalized linear mixed-model techniques to estimate the trajectories of depressive symptoms and major depression in late life. Results: There is a linear increase in depressive symptoms after age 65, but this occurs in the context of medical comorbidity and is not an independent effect of aging. There is a significant u-shaped relationship between age and major depression, after adjusting for selected covariates. Discussion: The relationship between age and late-life depression is complex, and it depends on how the dependent variable is measured. Late-life depression develops through a different set of risk factors than it does in earlier stages of the life course. The “fourth age” appears to be a period of psychia...
81 citations
TL;DR: Membership in a trajectory of high and slightly increasing social engagement was related to lower risk of mortality, and the importance of maintaining high levels of social engagement over time for the health of older adults is suggested.
Abstract: Objective: There is a dearth of empirical research examining how patterns of stability and change in social engagement affect mortality. This study uses social integration theory within a life course framework to examine trajectories of social engagement over time and how those patterns relate to mortality. Method: Data are drawn from the Americans’ Changing Lives survey, a nationally representative panel study, with mortality information spanning from 1986 to 2005. Results: Even after controlling for known predictors of mortality, membership in a trajectory of high and slightly increasing social engagement was related to lower risk of mortality. Sociodemographic, health condition, and health behavior variables mediated the impact of the other social engagement trajectories on mortality. Discussion: Findings suggest the importance of maintaining high levels of social engagement over time for the health of older adults.
78 citations
TL;DR: As old age progresses, self-reports of poor health become most closely related to psychological symptoms, which explains some of the paradoxes of past literature and offers important insights for health professionals working with the oldest old.
Abstract: National Health and Medical Research Council (NHMRC); Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR)
76 citations
TL;DR: The authors found that the receipt of emotional support was associated with mental health in women only, whereas the provision of emotional and instrumental support was related to mental health among men and women, but with varying patterns.
Abstract: Objective: The purpose of this study is to examine the association between various aspects of social support and depressive symptoms separately among men and women Method: Using a sample of 6,767 middle-aged adults from one wave of the Wisconsin Longitudinal Study (1992-1993), the authors performed a series of ANCOVAs predicting depressive symptoms and controlling for background variables Results: The authors found that the receipt of emotional support was associated with mental health in women only, whereas the provision of emotional and instrumental support was associated with mental health among men and women, but with varying patterns For example, men who provided instrumental support to nonkin only had the highest levels of depressive symptoms, whereas women who provided instrumental support to kin only had the highest levels of symptoms Discussion: This study helps to clarify if and what types of social support are related to mental health in men and women
TL;DR: The results show loneliness as a major risk factor for hypertension and call for health care professionals to be aware of the negative physiological effects of loneliness in old age.
Abstract: Objective: The present study aims to determine the impact of loneliness on hypertension in later life. Method: Data for this study are derived from a sample of 1,880 older Malaysians via a cross-se...
TL;DR: Higher levels of creativity predict longer survival in a sample of older men which provides preliminary support of the protective role creativity has on health even at advanced ages.
Abstract: Objectives: We examined whether specific facets are more robust predictors of mortality risk than overall trait openness in a sample of older men. Methods: The current investigation used data from ...
TL;DR: Examination of how race and sex affect associations among osteoarthritis pain, disability, and depression in 363 older adults with diagnosed knee OA found significant interactions of race, sex, and disability were driven by a lack of relationship between depression and disability among African American men.
Abstract: Objectives: A cross-sectional study examined how race and sex affect associations among osteoarthritis (OA) pain, disability, and depression in 363 older adults with diagnosed knee OA. Method: Afri...
TL;DR: Results were consistent with the hypothesis that racial disparities in cessation widen with increasing age and should account for social determinants and aim to address social disparities in driving mobility among older adults.
Abstract: OBJECTIVES: To longitudinally examine gender and racial disparities in driving cessation among older adults. METHODS: Data came from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study (N = 1,789). Logistic generalized estimating equations (GEE) were used to identify predictors of driving cessation; stratified analysis and interaction terms were used to determine whether factors differed by gender and race. RESULTS: Two hundred and five (11.5%) participants stopped driving over the study period. Education was associated with increased risk of cessation for men (adjusted odds ratio [AOR] =1.40, 95% confidence interval [CI] =1.10 to 1.78), but decreased risk for women (AOR = 0.90, 95% CI = 0.82-0.98). Being married was associated with lower risk of cessation for men (AOR = 0.18, 95% CI = 0.06-0.56) but was unrelated to cessation for women (AOR = 1.00, 95% CI = 0.56-1.80). Results were consistent with the hypothesis that racial disparities in cessation widen with increasing age. DISCUSSION: Factors predictive of driving cessation vary by gender. Racial disparities in cessation are wider at older ages. Transportation policies and programs should account for social determinants and aim to address social disparities in driving mobility among older adults. Language: en
TL;DR: Self-neglect was clearly prevalent among older adults, especially among those with lower health status and physical and cognitive function.
Abstract: Objectives: To examine the prevalence of self-neglect and its specific behaviors in a community-dwelling population of older adults. Method: A population-based cohort study conducted between 2007 and 2010 rated participant’s personal and home environment, particularly with regard to hoarding, personal hygiene, house in need of repair, unsanitary conditions, and inadequate utility. Prevalence estimates were presented across health-related variables of health status, physical function, and cognitive function. Results: There were 4,627 older adults (1,645 men and 2,982 women). Prevalence of self-neglect in older adults increased with lower health status in both men (4.7% in very good/excellent health, 7.9% in good health, and 14.9% in fair/poor health) and women (4.5% in very good/excellent health, 7.9% in good health, and 10.6% in fair/poor health). For those with ≥3 Katz impairments, the prevalence of self-neglect in older adults was 12.8% in men and 13.8% in women. For those with MMSE (Mini-Mental State E...
TL;DR: A framework of issues to consider when modifying measures for diverse populations is presented, and suggestions are provided on reporting modifications in publications using the measures.
Abstract: Eliminating health disparities among ethnic minorities and vulnerable older populations is a national priority (Smedley, Stith, & Nelson, 2003; US Department of Health and Human Services, 2000) To accomplish this goal, it is essential to understand factors that contribute to these disparities (National Institute on Aging, 2011) Research on health disparities and its determinants among ethnic minorities and vulnerable older populations necessitates use of self-report measures However, many of these widely-used measures were developed and tested on mainly white, young and middle-aged, well-educated samples These measures may have limitations when used in studies of minority or lower-socioeconomic status (SES) older adults included in health disparities and minority aging research
A substantial amount of research has attempted to address these issues over the past 15 years, including systematic efforts by the Resource Centers for Minority Aging Research (RCMARs) (Stahl & Hahn, 2006); also see preface for an overview of RCMAR contributions in measurement in diverse older populations (Teresi, Stewart, & Stahl, 2012) There are published guidelines on methods for examining the conceptual and psychometric adequacy of measures in ethnically diverse populations (Collins, 2003; Hahn & Cella, 2003; Johnson, 2006; AM Napoles-Springer, Santoyo-Olsson, O'Brien, & Stewart, 2006; AM Napoles-Springer & Stewart, 2006; AL Stewart & Napoles-Springer, 2003; Teresi, Stewart, Morales, & Stahl, 2006) There also are systematic reviews examining the conceptual or psychometric adequacy of particular concepts and measures in diverse populations (Coates & Monteilh, 1997; AL Stewart & Napoles-Springer, 2000) including older adults (Mui, Burnette, & Chen, 2001; Mutran, Reed, & Sudha, 2001)
However, when problems are found with measures in diverse population groups, there are no guidelines on what to do next Once a measure has been determined to be inappropriate for minority or lower-SES participants, researchers have three options One is to use the measure “as is” without modification and articulate the limitations This abides by the tenet of administering measures as published which some believe preserves score reliability and validity (Juniper, 2009) However, if a measure is not suitable for a population, scientific inferences derived from it may be compromised
A second option is to create a new measure de novo Developing a new measure is fraught with challenges, including having the expertise, time, and resources to develop and test a new measure, which may not be practical for most health disparities researchers Methods for developing new measures to be culturally sensitive involve a mixed-methods approach that includes concept development, writing items, pretesting, revising, field testing, and conducting psychometric analysis to derive final measures Although there are no general guidelines for developing new measures in minority populations, several publications provide detailed examples of these steps (Jackson, 1996; Krause, 2006; A L Stewart, Napoles-Springer, Gregorich, & Santoyo-Olsson, 2007)
The third option is to modify or adapt an existing measure There is a delicate balance between trying to retain the strength of an existing measure, which may have undergone extensive development and testing, but clearly will be problematic, and making modifications which may or may not work Furthermore, there are very few practical guidelines on how to go about making those modifications In multi-national research, measures developed in English must be translated for use in non-English speaking countries In guidelines for multi-national studies, adaptations are an integral part of the translation process, eg, items may be modified to achieve “semantic” equivalence (Aaronson et al, 1992; Beaton, Bombardier, Guillemin, & Ferraz, 2000; Bullinger et al, 1998) However, these guidelines give little attention to issues in modifying measures when no language translation is needed
This paper attempts to address this gap by providing a framework for modifying measures to improve their reliability and validity in health disparities research involving ethnically and racially diverse populations The goal of such modifications would be to increase the likelihood that the modified measure has comparable meaning, reliability, and validity as the original measure, but in a new population group The issues raised here pertain primarily to addressing differences from mainstream populations (on which original measures were tested) in socioeconomic status, race/ethnicity, language, and literacy Issues of modifications based on these types of group differences are relevant to health disparities studies of adults of all ages Occasionally, modifications are made to adapt a measure specifically to be more appropriate for older adults (Thiamwong, Stewart, & Warahut, 2009; Vanderplas & Vanderplas, 1981) We describe three issues: 1) reasons for considering modifications – why a modification would be needed; 2) the basis for modifications – information that can be used to make the modifications; and 3) possible types of modifications We conclude with recommendations for assessing modified measures and for reporting results of these assessments
TL;DR: Higher levels of mothers’ education and early-life family income were associated with a greater risk of breast cancer incidence and the role of social factors in breastcancer incidence and survival was emphasized.
Abstract: Objectives: We examine (a) how breast cancer onset and survival are affected by various dimensions of early-life socioeconomic status (SES) and (b) the extent to which women’s characteristics in ad...
TL;DR: This study uses longitudinal data from the National Survey of Midlife Development in the United States that first sampled 3,032 respondents aged 25 to 74 during 1995-1996 to address the inconsistent findings on whether childhood misfortune increases adult cancer occurrence.
Abstract: OBJECTIVE: To address the inconsistent findings on whether childhood misfortune increases adult cancer occurrence. METHODS: This study uses longitudinal data from the National Survey of Midlife Development in the United States (MIDUS) that first sampled 3,032 respondents aged 25 to 74 during 1995-1996. A series of logistic regressions were estimated separately for men and women to test whether the effect of childhood misfortune on adult cancer was largely cumulative or specific to the type or profile of misfortune. RESULTS: For men, additive childhood misfortune, physical abuse by father, and frequent abuse by either parent increased cancer risk. For women, physical abuse by mother and frequent abuse by either parent increased cancer risk. DISCUSSION: Analyses reveal the importance of examining alternative specifications of childhood misfortune for men and women. Additive childhood misfortune predicted cancer for men only, whereas child abuse by parent of the same sex predicted cancer for men and women. Language: en
TL;DR: Frailty increases the odds of falls in older Mexican Americans and interventions tailored to reduce fall incidence and improve health care quality for older Mexican American are needed.
Abstract: Objective: Examine the relationship between frailty and falls. Method: A total of 847 Mexican Americans from the Hispanic Established Population for the Epidemiological Study of the Elderly were ev...
TL;DR: In this paper, the authors tested a healthy immigrant effect (HIE) and postimmigration health status changes among late life immigrants, using three waves of the Second Longitudinal Study of A...
Abstract: Objectives: This study tested a healthy immigrant effect (HIE) and postimmigration health status changes among late life immigrants. Methods: Using three waves of the Second Longitudinal Study of A...
TL;DR: DYN/AO older adults might be at greater risk of metabolic alterations than those displaying dynapenia alone or those with neither abdominal obesity nor dynapENia.
Abstract: Objectives: To investigate the additive effect of dynapenia and abdominal obesity on metabolic risk factors in older adults. Method: A total of 3,007 men and women from the National Health and Nutrition Examination Survey (NHANES) study were categorized as follows: (a) non-dynapenic/non-abdominally obese (N-DYN/N-AO), (b) dynapenic/non-abdominally obese (DYN/N-AO), (c) non-dynapenic/abdominally obese (N-DYN/AO), (d) dynapenic/ abdominally obese (DYN/AO) based on waist circumference (WC) and leg muscle strength tertiles. Dependent variables were lipids, glucose, blood pressure, and other chronic conditions. Results: The DYN/AO group had lower plasma HDL-chol and higher triglyceride and glucose levels than N-DYN/N-AO and DYN/N-AO groups (all p ≤ .01). Higher plasma triglyceride was observed in the DYN/AO group compared with N-DYN/AO group (p ≤ .01). The odds of having metabolic syndrome, cardiovascular diseases, and type II diabetes were higher in DYN/AO compared with DYN/N-AO and N-DYN/N-AO. Conclusion: DY...
TL;DR: The results indicate that increases in the levels of physical activity can contribute to improvements in quality of life of older adults.
Abstract: Objective: To investigate the association between physical activity and quality of life in a sample of Brazilian older adults. Method: The Portuguese version of the World Health Organization Qualit...
TL;DR: Findings suggest that racial/ ethnic concordance may not be universally effective for diverse older populations, but perceived interpersonal sensitivity of the provider has a strong influence on older adults’ satisfaction with care regardless of their racial/ethnic background.
Abstract: Objectives: This study examined how patients’ satisfaction with their care is affected by racial/ethnic concordance and patients’ perceived interpersonal sensitivity of their providers. The sample consisted of non-Hispanic Whites, African Americans/Blacks, Hispanics/Latinos, and Asian Americans age 50 and older. Method: Data came from the population-based Commonwealth Fund 2001 Health Care Quality Survey (n = 2,075). A hierarchical regression model of satisfaction was estimated for each racial/ethnic group with a sequential entry of variables: demographic and health-related variables, racial/ethnic concordance between patient and provider, and interpersonal sensitivity. Results: The influence of patient-provider racial/ethnic concordance on satisfaction with care was negligible, but the influence of interpersonal sensitivity was substantial (p < .001) in all racial/ethnic groups. Discussion: Findings suggest that racial/ethnic concordance may not be universally effective for diverse older populations, but...
TL;DR: The process of assessing the appropriateness of existing measures for theory-based research on perceived discrimination and health is illustrated to improve understanding of how perceived discrimination may contribute to racial/ethnic health disparities among older adults.
Abstract: Objectives:Discrimination may contribute to health disparities among older adults. Existing measures of perceived discrimination have provided important insights but may have limitations when used in studies of older adults. This article illustrates the process of assessing the appropriateness of existing measures for theory-based research on perceived discrimination and health.Method:First, we describe three theoretical frameworks that are relevant to the study of perceived discrimination and health—stress-process models, life course models, and the Public Health Critical Race (PHCR) praxis. We then review four widely-used measures of discrimination, comparing their content and describing how well they address key aspects of each framework, and discussing potential areas of modification.Discussion:Using theory to guide measure selection can help improve understanding of how perceived discrimination may contribute to racial/ethnic health disparities among older adults.
TL;DR: Older adults report fewer posttraumatic stress disorder (PTSD) symptoms than younger adults, but the reasons for this age difference are unclear, and the extent to which they may be due to age differences in event centrality is explored.
Abstract: Objective: Older adults report fewer posttraumatic stress disorder (PTSD) symptoms than younger adults, but the reasons for this age difference are unclear. In the current study, the authors explor...
TL;DR: This work states that high-stakes testing may require item removal or separate calibrations to ensure accurate assessment, and guidelines for modification based on DIF analyses and illustrations of the impact of adjustments are presented.
Abstract: Objectives:Measure modification can impact comparability of scores across groups and settings. Changes in items can affect the percent admitting to a symptom.Methods:Using item response theory (IRT) methods, well-calibrated items can be used interchangeably, and the exact same item does not have to be administered to each respondent, theoretically permitting wider latitude in terms of modification.Results:Recommendations regarding modifications vary, depending on the use of the measure. In the context of research, adjustments can be made at the analytic level by freeing and fixing parameters based on findings of differential item functioning (DIF). The consequences of DIF for clinical decision making depend on whether or not the patient’s performance level approaches the scale decision cutpoint. High-stakes testing may require item removal or separate calibrations to ensure accurate assessment.Discussion:Guidelines for modification based on DIF analyses and illustrations of the impact of adjustments are p...
TL;DR: Underweight is a risk factor for mortality among elderly people, whereas overweight and mild obesity are associated with the lowest mortality particularly among men and those with cardiovascular morbidity.
Abstract: Objectives: To describe the relationship of body mass index and mortality in older adults, examining the influence of sex and cardiovascular morbidity. Methods: Sixteen-year cohort of a population sample of 1,008 people aged 65 and over. BMI mortality hazard ratios are estimated controlling for age, sex, education, physical activity, smoking, chronic conditions, and ADL (activities of daily living) disability. Results: At baseline the median BMI is 26.8 (Interquartile range: 24.2-29.7 Kg/m2). Findings show that during 16 years there were 672 deaths. The U-shaped curve of the mortality hazard by BMI is wide. The minimum mortality occur at BMI = 30.5 Kg/m2. Findings show that men had lower mortality risk with increasing BMI and that cardiovascular disease was associated with high mortality in the low-BMI category. Discussion: Underweight is a risk factor for mortality among elderly people, whereas overweight and mild obesity are associated with the lowest mortality particularly among men and those with card...
TL;DR: It is possible to age successfully by adhering to specific clusters of health behaviors, and as the number of adherent behaviors increased so did the likelihood of aging successfully and that adherence to some health behavior clusters was more closely associated with success than adherence to others.
Abstract: Objectives: Analyses examine the extent to which adherence to recommendations regarding health behaviors cluster among older adults, whether people who adhere to multiple health behaviors are more likely to age successfully than those who adhere to fewer health behaviors, and whether some health behavior clusters are more closely associated with successful aging than others. Method: Cross-sectional data were collected using structured telephone interviews from 5,688 persons aged 50 to 74 living in New Jersey. Results: Prevalence odds ratio analyses indicated that differential cluster patterns exist. Logistic regression revealed that as the number of adherent behaviors increased so did the likelihood of aging successfully and that adherence to some health behavior clusters was more closely associated with successful aging than adherence to others. Discussion: Although adherence to more health behaviors was associated with a greater likelihood of successful aging, it is possible to age successfully by adher...
TL;DR: The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes, and the single negative finding suggests that further investigation is needed on possible impact on resident behavior.
Abstract: Objective: To examine the effects of electronic health information technology (HIT) on nursing home residents. Methods: The study evaluated the impact of implementing a comprehensive HIT system on resident clinical, functional, and quality of care outcome indicators as well as measures of resident awareness of and satisfaction with the technology. The study used a prospective, quasi-experimental design, directly assessing 761 nursing home residents in 10 urban and suburban nursing homes in the greater New York City area. Results: No statistically significant impact of the introduction of HIT on residents was found on any outcomes, with the exception of a significant negative effect on behavioral symptoms. Residents’ subjective assessment of the HIT intervention were generally positive. Discussion: The absence of effects on most indicators is encouraging for the future development of HIT in nursing homes. The single negative finding suggests that further investigation is needed on possible impact on reside...