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Int J Geriatr Psychiatry. 2000 Nov;15(11):1013-20.
Resident characteristics associated with wandering in nursing homes.

Kiely DK, Morris JN, Algase DL.

Hebrew Rehabilitation Center for Aged, HRCA Research and Training Institute, Boston, MA 02131, USA. kielail.hrca.harvard.edu

OBJECTIVES: This retrospective cohort study examined the association between resident characteristics and the development of wandering behavior. METHODS: Subjects included a total of 8982 residents from the states of Mississippi, Texas, and Vermont who had baseline and 3-month follow-up Minimum Data Set assessments between 1 January 1996 and 31 December 1997. RESULTS: Residents who had a short-term memory problem (Odds Ratio (OR) = 3.05), had pneumonia (OR = 3.15), asked repetitive questions (OR = 2.19), had a long-term memory problem (OR = 2.06), exhibited dementia (OR = 19.4), constipation (OR = 1.82), expressed sadness or pain (OR = 1.65), and used antipsychotic medication (OR = 1.70), were at an increased risk for developing wandering behavior compared to residents without these characteristics. Residents with functional impairment (OR = 0.28) and women (OR = 0.61) were less likely to develop wandering behavior. CONCLUSIONS: Results of this study may be useful in constructing causal theories for the development of wandering behavior. 2000 John Wiley & Sons, Ltd.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11113981&dopt=Abstract

Exp Cell Res. 2003 May 1;285(2):196-207.
Exocytotic "constipation" is a mechanism of tubulin/lysosomal interaction in colchicine myopathy.

Kuncl RW, Bilak MM, Craig SW, Adams R.

Department of Biology, Bryn Mawr College, Bryn Mawr, PA 19010, USA. rkuncrynmawr.edu

Colchicine, a known microtubule disrupting agent, produces a human myopathy, characterized by accumulation of lysosomes. We have created a reliable animal model of colchicine myopathy that replicates the subacute myopathy seen in humans, reproducing the chronic proximal weakness and vacuolar changes in nonnecrotic myofibers. If a microtubule network plays a role in lysosomal function in muscle, disturbance of it could alter degradation of intrinsic membrane receptors, presumably at some intracellular processing site or at exocytosis. Thus, we examined, as a possible cellular pathogenesis of colchicine myopathy, how the muscle cytoskeleton affects the degradation of membrane proteins, which are processed through the endosomal/lysosomal pathway. We used the acetylcholine receptor as a model membrane component in cultured myotubes allowed to preincubate with colchicine. We tested at which step colchicine interferes with receptor trafficking by accounting for internalization, delivery to lysosomes, hydrolysis, or exocytotic release of debris. We report that colchicine significantly decreases the exocytosis of AChRs but does not affect receptor internalization, lysosomal hydrolysis, or the number of surface membrane receptors. Further, our immunofluorescence observations revealed a morphologic tubulin network in rat skeletal muscle that is more densely distributed in white (mitochondria-poor) muscle fibers than in red (mitochondria-rich) fibers but is present in both. Ultrastructurally, immunogold labeling localized tubulin in the intermyofibrillar region in a long and linear fashion, unassociated with myofibers or mitochondria. Taken together, our findings suggest the following: (1) Microtubules likely play a functional role in the pathway of lysosomal degradation in normal adult skeletal muscle; (2) The observed decrease in overall apparent degradation of membrane receptors by colchicine must be due primarily to inhibition of exocytosis. These data indicate that lysosomal "constipation" underlies colchicine myopathy. (3) An animal model faithful to the human disorder will allow further pathogenetic studies.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12706115&dopt=Abstract

J Am Geriatr Soc. 1978 Dec;26(12):544-9.
Review of laxative utilization in a skilled nursing facility.

Lamy PP, Krug BH.

Laxatives are the most frequently prescribed drugs in long-term care facilities. Of all nursing home patients, 58 percent receive laxatives--often more than one, and usually on a "prn" basis. This pattern of dosage is probably used in an effort to prevent constipation. Selection of a laxative should be based on careful evaluation of the cause of constipation, with due consideration being given to differences in drug effectiveness and the incidence of side effects. A review of laxative utilization among 73 elderly patients in a large metropolitan skilled nursing facility showed a rational use of these drugs. However, more attention should have been paid to the dietary management of constipation.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=101574&dopt=Abstract

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