Exercise and the Elderly
For more on this topic please also see our article: Benefits and Contra-indications of Exercise Training in the Elderly
(4/25/18)- Can exercise help overcome a genetic disposition for heart disease? The results of a large study, the results of which were published in a recent edition of the journal Circulation, evaluated 482,702 men and women between the ages of 40 through 69 at the start of the Biobank clinical study in 2006 in England.
All the participants had provided blood and saliva samples for genetic testing, filled out a questionnaire about their exercise and other health habits., and performed some form of physical exercise.
The researchers from Stanford University concluded that those men and women with the highest aerobic fitness, halved their statistical likelihood of developing heart disease, even if their genetic disposition for having heart disease was likely.
(9/20/17)-The results of a study that was published in the Annals of Internal Medicine (http://annals.org/aim) , scientists from Columbia University and other institutions reported on data that they had gathered on thousands of Caucasians and African Americans who were 45 years or older that merely rising from their desk every 30 minutes may have healthful long term benefits to their well-being.
The study was funded primarily by the National Institute of Health
About 8,000 of the participants had undergone health tests and wore accelerometers for a week to track their daily movements. The scientists found a strong correlation between sitting and mortality. Keith Diaz, an assistant professor of behavioral medicine at Columbia University led the study
Please keep in mind that whenever you take a long plane trip or car ride, you should rise from your seat frequently to prevent blood clots.
(10/2/16)- We received the following email from our own Sam Rubin, and want to thanks him for sending it along with a link to an ongoing study being conducted on the benefit of exercise for the elderly.
This article from Yale may be of interest for therubins.com:
(1/28/15)- Whatever exercise an individual chooses to participate in, from just plain walking to playing basketball, your sense of balance has to be there, for you to perform properly. As we age, our balance gets thrown askew to some extent. You can judge for yourself when your “balance isn’t what it should be”.
We don’t recommend you try this unless you have someone close by to watch you, but put the heel of one foot directly in front of the toe of the other foot. Then, close your eyes and cross your hands on your shoulders and see how long you can maintain your balance.
If you feel your balance isn’t what it should be, make an appointment to see an eye, nose and throat specialist for a vestibular canal test. The test is performed by a technician, who does computerized testing of your eyes and ears.
Each ear has a vestibular canal that has nerves that send impulses to the brain to coordinate the data it receives, and in turn uses the data to maintain proper balance for you. These nerves may be damaged by illness, or the aging process deterioration.
If you have vestibular imbalance your doctor can prescribe treatment by a physical therapist. Physical therapy can in turn help you to “lead a balanced life”.
(1/5/15)- The start of the New
Year brings more evidence that healthier living involves getting off the couch
and doing moderate exercise as a helpful firewall to enhance well-being. Note
the article below.
Have a healthy New Year.
As millions of Americans resolve to live healthier lives in 2015, research from the University of the Missouri School of Medicine shows just how important diligent, daily physical activity is. The researchers found that reducing daily physical activity for even a few days leads to decreases in the function of the inner lining of blood vessels in the legs of young, healthy subjects causing vascular dysfunction that can have prolonged effects.
Paul Fadel, associate professor of medical pharmacology and physiology, and John Thyfault, associate professor of nutrition and exercise physiology, also found that the vascular dysfunction induced by five days of inactivity requires more than one day of returning to physical activity and taking at least 10,000 steps a day to improve.
"We know the negative consequences from not engaging in physical activity can be reversed," said Fadel. "There is much data to indicate that at any stage of a disease, and at any time in your life, you can get active and prolong your life. However, we found that skipping just five days of physical activity causes damage to blood vessels in the legs that can take a prolonged period of time to repair."
"Inactivity is typically
going to lead to people being overweight and obese," said Fadel. "The next step after that is insulin resistance
which leads to Type 2 diabetes and cardiovascular disease."
According to the Centers for Disease Control and Prevention, more than 29 million Americans are living with diabetes. That number is expected to continue to increase: the CDC estimates one-third of people born after 2000 will have Type 2 diabetes in their lifetimes.
"The best treatment is to become more active, and our research lends proof to that concept," Fadel said. "If you do not realize how harmful sitting around all day and not doing any activity is to your health, this proves it."
The researchers studied the early effects on the body's blood vessels when someone transitions from high daily physical activity -- 10,000 or more steps per day -- to low daily physical activity, less than 5,000 steps per day. Five thousand steps is the national average, but only half of the daily recommendation from the U.S. Surgeon General. The researchers found going from high to low levels of daily physical activity for just five days decreases the function of the inner lining of the blood vessels in the legs.
"The impairment we saw in just five days was quite striking," Fadel said. "It shows just how susceptible the vascular system is to physical inactivity."
For several years, Fadel and Thyfault have studied inactivity and glycemic control as well as how inactivity affects blood flow and vascular function through the body. A decrease in blood vessel function has been shown in previous studies to be linked to early cardiovascular death and hypertension. Now, this research shows that even an acute period of inactivity of five days changes the measure that is already known to be important for long-term cardiovascular health. Also, although blood flow responses to glucose ingestion were not affected by five days of inactivity, impairments in glycemic control and insulin sensitivity are also a consequence of reduced daily physical activity.
Counting steps and daily physical activity is different than defined exercise, such as working out at the gym. While there are significant benefits to defined exercise, Thyfault and Fadel's research is based on what amounts to 30 minutes of moderate activity per day.
"We need to teach and explain to people about the physiology of their bodies and the physiology of the disease process and help them understand that inactivity plays a foundational role in the disease process," said Thyfault. "Then we give them behavioral tools, like pedometers, to monitor and help them achieve higher physical activity so they start to see and feel health improvements. These studies are proof we need to get people to understand their activity every day plays a role in their health, and that their health is not simply a matter of body weight and how they look in the mirror."
The research was published in
September in Medicine and Science in Sports and Exercise
(5/29/14)- The results of the Lifestyle Interventions and Independence for Elders (LIFE) study that was published a recent edition of the Journal of the American Medical Association concluded that regular exercise will significantly reduce the chance that a frail older person will become physically disabled. Dr. Marco Pahor, the director of the Institute on Aging at the University of Florida in Gainsville was the lead author of the study.
Scientists at eight universities and research centers around the country recruited 1,635 sedentary men and women ages 70 to 89 that scored below a nine on a 12-point scale of physical functioning often used to assess older people. All were able to walk about a quarter-mile on their own.
The men and women were randomly assigned to either an exercise or an education group. Those in the education group were asked to visit the research center once a month or so to learn about nutrition, health-care and other topics related to aging.
The exercise group started a program of walking and light, lower body weight training with ankle weights, going to the research center twice a week for supervised group walks on a track, with the walks growing progressively longer.
They were also asked to complete 3 or 4 more exercise sessions at home, aiming for a total of 150 minutes of walking and about three 10-minute sessions of weight-training exercises each week.
The study followed the participants for an average of 2.6 years. The researchers determined that the exercising volunteers were about 18% less likely to have experienced any episode of physical disability, and 28% less likely to have become permanently disabled (being unable to walk 400 meters by themselves).
(8/16/12)- Federal guidelines recommend that adults get at least 150 minutes of moderate-intensity exercise (like brisk walking) or 75 minutes of vigorous exercise (like running) each week.
The proportion of people who met federal guidelines for aerobic exercise grew to 48% in 2010 from 42% in 2005 according to figures from the Centers for Disease Control and Prevention.
The proportion of adults who said they went on a 10-minute walk at least once a week increased to 62% in 2010 from 56% in 2005.
In the C.D.C.'s National Health Interview Survey, more than 20,000 people were asked to recall how much they had walked in the previous 7 days.
Dr. Dianna Carroll, a CDC epidemiologist, who contributed to the study went on to say; "We have this increase in walking, but less than half of adults are getting enough activity to show substantial health benefits."
(2/15/11)- Aerobic exercise training that gets sedentary older adults up and walking for 40 minutes 3 times a week has been shown to increase the size of the hippocampus and improve memory after 1 year.
The findings appear in the January 31 issue of the Proceedings of the National Academy of Sciences of the United States of America. "There are 2 very important messages to take home from this study," lead investigator Kirk Erickson, PhD, professor of psychology at the University of Pittsburgh in Pennsylvania, told Medscape Medical News.
"The first is that the brain remains modifiable until late adulthood, and this gives us a lot of promise for interventions and treatments that could prevent or delay or even reverse atrophy of the brain. The second major message is that it's never too late to start exercising."
Dr. Erickson and his colleagues recruited 60 adults aged 60 to 80 years who got 30 minutes or less of physical activity per week to embark on a course of aerobic training that involved a program of brisk walking. A similar number of sedentary adults who served as controls were randomized to stretching and toning exercises.
"They were fairly inactive individuals, which is unfortunately very common in society, but nonetheless, we brought them in and started them walking. We first started them walking 10 to 15 minutes at a time because they were not used to exercise, and eventually we progressed them to about 40 minutes a day for 3 days a week and that lasted for a year," he explained.
The participants were supervised, accompanied by trained personnel who monitored their heart rate and level of exertion. All had experienced some degree of brain atrophy although this had not yet progressed to a diagnosis of dementia, and were otherwise healthy, albeit with the usual complement of aches and pains typical for a population of this age, Dr. Erickson said.
In addition, all had to get approval from their personal physicians to participate in the study. Magnetic resonance images (MRIs) were collected before the intervention, after 6 months, and again after the completion of the program.
MRI allowed us to get very high-resolution, detailed images of their brain, and then we were able to use some algorithms to segment out certain brain regions and calculate the size of the hippocampus," Dr. Erickson said.
In addition, participants were given a memory test that measured their spatial memory at the same 3 time points in the study.</P><P>Both groups were similar with regard to their hippocampal volume and memory at baseline.
At the end of 1 year, participants in the aerobic exercise training group increased the volume of the left hippocampus by 2.12% and the right hippocampus by 1.97%, whereas the control group actually displayed a 1.40% and 1.43% decline in the left and right hippocampus, respectively.
The study also found that those in the aerobic exercise group showed improved memory function compared with their performance at the start of the study. This improvement was associated with the increased size of the hippocampus. Increased hippocampal volume was also associated with greater levels of brain-derived neurotrophic factor, a small molecule involved in learning and memory.
"Up to now, we have never demonstrated that if we take people who are previously sedentary and give them exercise that we can actually increase the size of this region of the brain," said Dr. Erickson.
"Clinicians should really try to get their older patients moving. It's easy for us to think that exercise only exerts its effects on our bodies from the neck down, but clearly that's not the case. Our brains are parts of our bodies, and we see the same types of benefits on our brains as we do our bodies. I think that is easily overlooked and something we don't often think about."
Cyrus Raji, MD, PhD, a researcher at the University of Pittsburgh who has conducted research on the benefits of exercise for Alzheimer's disease, commented that the study is important because it shows in a very concrete way how beneficial exercise can be for seniors.
This is a randomized clinical trial, which is the highest form of clinical investigation you can have. What was most exciting to me about the study is that they showed that the specific part of the hippocampus, the anterior part of the hippocampus, benefits the most from exercise training," Dr. Raji, who was not part of the current study, told Medscape Medical News,"This is important because Alzheimer's disease is known to start in and target that part of the hippocampus. The finding helps explain how exercise can reduce the risk for Alzheimer's disease and is another reason why everybody of all age groups, but especially the elderly, should, based on this study, engage in regular forms of physical activity."
Dr. Erickson and Dr. Raji have disclosed no relevant financial relationships.
(10/13/09)- For the elderly, the easiest exercise for those with healthy legs is walking. Some health experts say that "speed walking" is the healthest form of walking exercise that an individual can do to improve one'e health. We at therubins think that walking, at whatever pace you are comfortable with, is the best exercise to keep you healthy. Yes, the walking should be for at least a half hour a day, but even if you walk for only 10 minutes a day, it won't take too long before you feel the benefit for your effort.
It is estimated that the average person will walk the equivalent of three times around the earth in a lifetime. Can you imagine the wear and tear this puts on the 26 bones, 33 joints and over 100 tendons, ligaments and muscles that make up the foot?
A survey for the American Podiatric Medical Association reported 53 percent of respondents had foot pain so severe that it hampered their daily function. On average, people develop pain in their 60s, but it can start as early as the 20s and 30s. Yet, except for women who get regular pedicures, most people do not take care of their feet.
(9/14/09)- People who added about 60 minutes of mild exercise or 30 minutes of moderate exercise per week had increased levels of heart-healthy HDL, according to a study of more than 15,000 middle-aged black and white men and women. Researchers also found that whites had significant decreases in harmful triglycerides, women had improved levels of LDL cholesterol and black women had lower total cholesterol levels. The study was published in the Journal of Lipid Research
(1/17/09)- People with peripheral artery disease (PAD), with or without intermittent claudication, can benefit from regular supervised treadmill exercise and resistance training that targets their lower extremities.
Writing in the January 14, 2008 issue of the Journal of the American Medical Association, Dr Mary M McDermott (Northwestern University, Chicago, IL) and colleagues report that PAD patients randomized to supervised treadmill exercise experienced significant improvements in six-minute-walk test, treadmill walking performance, brachial-artery flow-mediated dilation, and quality of life, as compared with control patients.
"Based on findings reported in this trial, physicians should recommend supervised treadmill exercise programs for PAD patients, regardless of whether they have classic symptoms of intermittent claudication," McDermott and colleagues write. "Our findings regarding brachial-artery flow-mediated dilation suggest that supervised treadmill exercise improves global vascular health in patients with PAD." (See: JAMA 2009 Jan 14;301(2):165-74.)
(12/13/08)- Physical activity guidelines are spelled out in the updated publication "2008 Physical Activity Guidelines for Americans" published Oct. 7, 2008 by the Dept. of Health and Human Services. It suggests that adults should participate in 2 1/2 hours of exercise per week.
(9/17/08)- Results of a randomized trial in older adults with subjective memory impairment but without dementia show a "modest" but lasting improvement in cognitive function after a 6-month program of physical activity (PA).
The study is published in the September 3 issue of the Journal of the American Medical Association.
The benefits of physical activity were apparent after 6 months and persisted for at least another 12 months after the intervention had been discontinued according to Nicola T. Lautenschlager, MD, from the University of Melbourne and St. Vincent's Hospital, in Australia.
(12/8/07)- New guidelines of minimal recommended exercise for maintaining health and lowering the risk of disease in older adults have been issued by the American College of Sports Medicine and the American heart Association. The guidelines make allowances for individualized physical activity levels for those with functional limitations or chronic conditions.
The activity should involve the large muscle groups (e.g., walking, running, cycling, and swimming). The level of intensity (target heart rate) for this physical activity should be at least 55% to 65% of your maximum heart rate. (You can estimate your maximum heart rate by subtracting your age from 220.) You can quickly determine if your intensity is too high by taking the "talk test"; if you cannot maintain a conversation with your exercise partner while exercising, then your intensity is too high.
The Surgeon General has determined that lack of physical activity is detrimental to your health and recommends moderate activity: 150 calories per day or 1000 calories per week. Cardiovascular fitness improvement is dependent upon the exercise program (mode, frequency, duration, and intensity of exercise) as well as the individual participant (fitness level, age, and health status). "Regular exercise can provide tremendous health benefits, but more than half of Americans don’t get enough physical activity," said AMA President Ronald M. Davis, M.D., FACPM. "We encourage patients and physicians to work together to incorporate physical activity into a patient’s daily routine and better protect their health."
The minimum recommendations are divided into 5 categories: moderate intensity, vigorous intensity, muscle strengthening, flexibility activity and balance exercise. The latter is for those persons who have substantial risks of falls. Moderate intensity activity is defined as those exercises that noticeably accelerate heart rate and cause one to break a sweat while still being able to carry on a conversation. Moderate exercise should be done for 30 minutes 5 days per week. It could be broken up into 10-minute periods.
Vigorous intensity physical activity guidelines indicate they need to be done for 20 minutes at least 3 days per week. The vigorousness of the activity is relative to the fitness level of the individual. The perceived exertion is rated on a scale of 1 (resting) to 10 (all-out effort).
The guidelines provide various exercises that can be used for muscle strengthening that can be done 2-3 non-consecutive days per week, doing 8-10 exercises with 10-15 repetitions each. The goal of these exercises is to prevent loss of muscle mass and bone as well as balance for older adults at risk for falling.
If you are not currently exercising, please consult your physician before beginning any exercise program. Consistency is the key to success in any exercise program; choose an activity that you enjoy and are likely to continue throughout your adult life.
(2/17/07)-The National Heart, Lung and Blood Institute (NHLBI) has published a guide offering information on physical activity to maintain a healthy heart. The guide can be downloaded free from the NHLBI Web site at http://www.nhlbi.nih.gov or ordered from its Information Center by calling 301-592-8573.
(11/17/06) P.K. Garg and his group in a multisite study appearing in the journal Circulation 2006; 114:242-248 indicate that exercise reduces functional decline in those with peripheral artery disease (PAD) and furthermore that it increases longevity. Participants were 460 men and women with PAD (mean age 71.9±8.4 years) followed up for 57 months. At 57-month follow-up, 134 participants (29%) had died, including 75 participants (33%) who wore accelerometers. In conclusion, the researchers state: " PAD patients with higher physical activity during daily life have reduced mortality and cardiovascular events compared with PAD patients with the lowest physical activity, independent of confounders. Further study is needed to determine whether interventions that increase physical activity during daily life are associated with improved survival in patients with PAD."
(10/14/06) The literature continues to support the maxim that exercise can be a buffer to handle the aging process. Venkatra and Fernandes (Aging Clin Exp res 1997; 9:42-46) analyzed epidemiological studies and showed that life-long exercise has a positive effect on life-expectancy by decreasing total mortality, while overweight has opposite effect.
Siebens and colleagues "designed a study to test whether a hospital initiated exercise program could improve hospital outcomes in medical and surgical patients aged 70 years and older." They tested the primary hypothesis "that the hospital program would help patients recover more quickly and thereby reduce their length of hospital stay. They also "expected that the additional prescribed home program would yield better functional and physical health outcomes at one month after discharge. They found that "an exercise program started during hospitalization and continued for one month did not shorten length of stay but did improve functional outcome at one month. (Siebens, H, Aronow DE, Ghesemi Z. A Randomized Controlled Trail of Exercise to Improve Outcomes of Acute Hospitalization in Older Adults. J. Am. Geriatr. Soc. 2001;48:1545-1552.)
Researchers have shown that the multiple effects of disease on muscle include muscle atrophy, with loss of myofibrillar protein, inability of motor center in the brain to recruit motor neurons and increased fatigability of these motor units that remain functional. The mechanism of this loss in strength may be decreased muscle protein synthesis. This decreased protein synthesis can be inhibited with resistance training.
The MacArthur Study of Successful Aging followed 1186 healthy individuals between 70 and 79 years of age for 7 years looking for factors that could account for successful aging. The selected subjects underwent a 90-minute personal interview that included a detailed assessment of physical and cognitive capabilities, overall health status, and social, lifestyle, and psychological characteristics. The subjects were then followed for an average of seven years, from 1988/89 through 1995/96, through periodic interviews, to monitor their status as they aged.
Lung function (peak flow) proved important in impeding physical decline in older age. Also, those who followed a schedule of regular physical activity, either moderate or strenuous, were only half as likely to show physical decline as those who were inactive. Lung function and lung capacity are influenced by physical activity. Most interesting was the finding that the benefit of moderate walking and strenuous physical activities was equal.
Also good news is the fact that even participants who had chronic conditions when they began the study experienced the protective effects of exercise and socialization. So it truly never is too late to adapt healthy life habits.
(12/27/03)- Recent studies have determined that exercise improves the health of both older and younger individuals. According to a study published in the Journal of Gerontology "Elderly men not only can tolerate these very high workloads, but will exhibit muscular changes similar to their younger counterparts." Scientists at Ohio University in Athens, Ohio performed some tests on healthy men who kept active, but did not perform regular weight training exercises.
The men did 10 repetitions at 50% of the maximum they could lift at one time. They then performed three sets of six to eight repetitions at 80% to 85% of their one-time maximums. The men did this twice a week. Another group of healthy men did no weight training exercises at all. The exercise capabilities of both groups were similar at the beginning. After 16 weeks the group that did the weight training exercises averaged 50% better on extension, 72% better on the press and 84% better on the half squats. The hearts of the men who performed the weight training had to work less hard at a given intensity in the treadmill test. Leg muscle strength increased up to 84% over 16 weeks among men ages 60 to 75 that did weight-training exercises.
A free, 100 page illustrated exercise guide for persons age 50 and older is
obtainable from National Institute of Aging. Its called "Exercise: A guide from the
NIA". You can call toll free 1-800-222-2225 or
order by email <NIAinfo@access.digix.net.>
Peripheral Arterial Disease (PAD) affects nearly nine million Americans and
is a potentially dangerous condition. It is estimated that only 12% of the
people with this disorder are being treated. It effects primarily the peripheral
circulation in the legs and feet, causing pain and tingling during physical
activities. Fatty deposits, not allowing for oxygen-rich blood to get to the
leg and feet muscles, are blocking arterial circulation. The result is painful
leg cramps (claudation) generally in the calf of the
PAD can be prevented, reduced or even eliminated by exercising, modifying your diet or stopping smoking. Physician should be consulted at the first signs of these symptoms and therapeutic steps to be taken. This is one of those disorders where exercise may prove helpful.
Remember that people vary in terms of the kinds and amount of exercise needed to maintain a healthy status. You have to consider your needs, your medical status as well as physiological status. Physical fitness is an adaptive state, composed of three different components: cardiovascular fitness, musculoskeleton function and body composition (body fatness and metabolic factors). There are four components to a physical fitness program: warm-up, muscle conditioning, aerobics and cool down. Warm-up includes stretching and walking. Muscular conditioning includes calisthenics and weight training. Aerobics include walking, jogging, swimming, dancing, stair stepping. Cool down includes walking and stretching.
Always start an exercise program at a low level and use slow to moderate progression making for gradual adaptation. By setting up intermediary goals that are obtainable, you usually can motivate yourself to continue in a exercise program. Make it as enjoyable and refreshing as possible. By cultivating a positive attitude toward exercise, you enhance the probability of long-term adherence. Consult your physician before starting any exercise program.
Research in the area of exercise suggests that the initial exercise program emphasize stretching and low level muscle conditioning exercises. Recommended is a combination of walking and jogging or fast and slow walking performed on a regular basis three to five times per week.
For those individuals who have not exercised in a long time, the recommendation is to restrict your initial exercise to 5 to 15 minutes per session, and so it twice per day until you begin to feel comfortable with the exercise program.
It is known that physical activity protects against the development of coronary heart disease, stroke, hypertension, obesity, non-insulin dependent diabetes mellitus, osteoporosis, some cancer and even clinical depression.
Exercise involves the transformation of chemical energy stored in muscles into mechanical energy. As this stored chemical energy is used up, new sources of this chemical energy must be tapped to regenerate the energy. This involves muscular glycogen and triglycerides as well as circulatory glucose and fatty acids from adipose tissue. The result is improved functional capacity of your body that can delay the infirmities of disabilities of old age. All this improvement can be measured and is reflected in functional improvement of the enzyme system, augmented blood flow in skeletal muscles due to increased diameters of blood supplying arteries, as well as increased numbers of capillary vessels.
Behaviorally, you don't tire as easily as you did before exercising and you have more energy, thus enabling the body to maintain, repair and improve itself.
Recent studies indicate the importance of physical exercise in the elderly as a way of retarding the process of physical degeneration and enhancing the quality of life of the elderly. The goal is to maintain muscle tone as well as retard the development of chronic diseases. A study appearing in the Archives of Internal Medicine (2003; 161: 2565-2571) is a prime example of the role of physical exercise in maintaining functioning.
What was especially significant about this study was that it followed a group of women over 14 years (prospective study), while most studies do not extend out more than one year. The population studied consisted of 229 women, mean age 74.2, who were involved in a randomized controlled walking intervention (about 7 miles per week) from 1982 to 1985 and were subsequently followed up until 1999. The researchers were able to complete an evaluation of 171 women in person and 17 over the phone (total 188 out of the original 225).
The researchers evaluated data collected at three
points over the 14 years (1985, 1995, and 1999). This involved a physical
activity questionnaire and a physical activity monitor. At the end point of the
study, 1999, the functional status of the women was assessed by self-report and
performance based measures. The findings were: "Women who were always
active had the best functional status and women who were always inactive had
the worst functional status." This study, done by Jennifer S. Brach and
her group, concluded: "There exists a significant relationship between
physical activity during a 14 year period and current functional status in
older women thus suggesting that physical activity plays a role in maintaining
Before starting any physical exercise program, consult your medical doctor. Set reasonable goals for yourself. Be consistent in your exercise program. It may help to have a companion do the exercise with you.
Brach JS., Fitzgerald S., Newman AB., Kelsey S., et al. Physical Activity and Functional Status in Community Dwelling Older Women: A 14 year Prospective Study. 2003; 163:2565-2571.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"
Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated April 25, 2018