Aspiration pneumonia is a serious problem for the elderly institutionalized person, often requiring transfer to a hospital and a lengthy stay there. It is associated with a high mortality rate and is very costly to the health care system. The current study sought to determine the key predictors of aspiration pneumonia in a nursing home population with the hope that health care providers could identify those residents at highest risk and focus more efforts on prevention of this serious disease. A cross-sectional, retrospective analysis was done, using the Minimum Data Set (MDS) nursing home assessment data for three states (New York, Mississippi, Maine) from 1993 to 1994 (N = 102842). Nursing home residents were aged 65+. Standardized MDS summary scales and their component items were used, including: the Activities of Daily Living (ADL) scale, the cognitive performance scale (CPS), and the Resource Utilization Groups (RUGs). Results of these analyses showed the prevalence of pneumonia among this population was 3% (n = 3118). Results from the logistic regression models indicated 18 significant predictors of aspiration pneumonia. The strongest to weakest predictors of pneumonia were, respectively, suctioning use, COPD, CHF, presence of feeding tube, bedfast, high case mix index, delirium, weight loss, swallowing problems, urinary tract infections, mechanically altered diet, dependence for eating, bed mobility, locomotion, number of medications, and age, while both CVA and tracheotomy care were inversely predictive of pneumonia. The emergence of these significant predictors suggested a different pathogenesis of pneumonia in the elderly nursing home resident from the acute care patient or the outpatient. Nursing home residents have chronic medical conditions that gradually lead to "decompensation" in functional status, nutritional status, and pulmonary clearance. Dysphagia and aspiration are common complications of their medical conditions and may slowly worsen as their status deteriorates. Alternatively, a sudden adverse event may dramatically increase the amount aspirated or the ability to resist infection and lead to sudden decompensation. Clinical staff must identify residents with dysphagia and aspiration and work to prevent decline in functional status in all residents. They must be aware of the dangers of adverse events that lead to sudden inactivity or illness and increase the risk of aspiration pneumonia. Prevention of this disease whenever possible will reduce costs, improve health outcomes, and improve our quality of care.

Objectives-To examine the role of neighborhood social conditions and walking in communitydwelling older adults. Methods-A multi-level analysis of data from 4,317 older adults (mean age = 74.5; 73% black) from a geographically-defined urban community. Participants completed structured interviews including 14 questions on neighborhood conditions and self-reported walking. The neighborhood questions were summarized into individual-level measures of perceived neighborhood social cohesion and disorder. These measures were aggregated by neighborhood to construct neighborhoodlevel measures of social cohesion and disorder.Results-Neighborhood-level disorder, but not social cohesion, was significantly associated with walking, independent individual-level neighborhood perceptions and other correlates of walking. Further adjustment for race weakened this association to a marginally significant level.Discussion-Neighborhood conditions may shape walking behavior in older adults, especially conditions that reflect physical neglect or social threat. Promotion of walking behavior in older adults may require improvement of the safety and upkeep of the neighborhood environment. Keywordsaging; neighborhood conditions; walking; physical activity; multi-level modelsThe benefits of regular physical activity are well established, and have been documented for health outcomes at all stages of life (Bouchard, Blair, & Haskell, 2007; U.S.Department of Human Services, 1996). Among older adults, regular physical activity is associated with a reduced risk in mortality and aging-related decline in physical and cognitive function (Boyle, Buchman, Wilson, Bienias, & Bennett, 2007;Kramer et al., 1999;Kushi et al., 1997; U.S.Department of Human Services, 1996). Walking is by far the most predominant mode of physical activity among older adults (McPhillips, Pellettera, Barrett-Connor, Wingard, & Criqui, 1989; U.S. Department of Human Services, 1996), and associated with beneficial health Simonsick, Guralnik, Volpato, Balfour, & Fried, 2005;Weuve et al., 2004). In addition, impairments in walking and overall mobility are thought to be a critical early stage of the disablement process in this population (Ferrucci et al., 2000;Lawrence & Jette, 1996;Simonsick et al., 2005).There is a growing recognition that various aspects of the neighborhood environment may account for individual differences in physical activity (Brownson, Baker, Housemann, Brennan, & Bacak, 2001;Humpel, Owen, Iverson, Leslie, & Bauman, 2004. People's perceptions of the neighborhood, such as walkability, safety, and friendliness, have been found to be correlated with overall physical activity and walking (Ball, Bauman, Leslie, & Owen, 2001;Cerin, Saelens, Sallis, & Frank, 2006;Humpel et al., 2004;King et al., 2000;King et al., 2003;Owen, Humpel, Leslie, Bauman, & Sallis, 2004). Features of the built environment related to the design of the urban landscape and land use mix may also be associated with physical activity levels (Atkinson, Sallis, Saelens, Cain, & Black, 2005...

Our results support the hypotheses that high total intakes of vitamins B-6 and B-12 are protective of depressive symptoms over time in community-residing older adults.

Racial disparities in disability have not been eliminated, are greater among women, and have their origins earlier in adulthood.

Findings provide initial evidence of the reliability and construct validity of these neighborhood-level social process measures.