Deer Lodge Centre

The tension of carbon dioxide in the cells of the medullary respiratory center stimulates it to transmit efferent nervous impulses to the muscles of respiration. These, in turn, perform mechanical work upon the lung and thorax, and result in the complex movement of air known as ventilation. Ideally, therefore, the stimulus (tissue carbon dioxide tension) and the response (efferent impulses) should be measured in order to assess the response of the respiratory center to carbon dioxide. Arterial carbon dioxide tension is generally considered to be a satisfactory approximation of the stimulus delivered to the respiratory center, but the response is far more difficult to measure. While most investigations have reported the response in terms of ventilation (1-3), this may be modified by the ventilatory capacity and the degree of airway obstruction (4). The response of the respiratory muscles, therefore, should be a more accurate measure of respiratory center activity. This can be assessed by measuring the total amount of mechanical work done by these muscles.

Introduction: Type 2 Diabetes (T2D) has reached epidemic proportions in North America. Recent evidence suggests that prebiotics can modulate the gut microbiome, which then plays an important role in regulating lipid metabolism, blood glucose, and insulin sensitivity. As such, prebiotics are appealing potential therapeutic strategies for pre-diabetes and T2D. The key objectives of this study were to determine the tolerability as well as the glucose and insulin modulating ability of MSPrebiotic® digestion resistant starch in healthy middle aged and elderly adults. Materials and Methods: This was a prospective, blinded, placebo controlled study. Pre-diabetes and diabetes were among the exclusion factors. Elderly (>70 years) and mid-age (30 to 50 years) Canadian adults were recruited and, after 2 weeks of consuming placebo, they were randomized to consume 30 grams of either MSPrebiotic® or placebo per day for 12 weeks. In total, 42 elderly and 42 mid-age participants completed the study. Blood samples were collected over the 14 week study and analyzed for glucose, lipid profile, and CRP, lipid particles, TNF-α, IL-10, insulin and insulin resistance. Results: At baseline, the elderly population had a significantly higher percentage (p <0.01) with elevated glucose and significantly higher TNF-α (p < 0.01) compared to mid-age adults. MSPrebiotic® digestion resistant starch was well tolerated in both mid-age and elderly adults. There was a significant difference over time in blood glucose (p = 0.0301) and insulin levels (p = 0.009), as well as insulin resistance (HOMA-IR; p = 0.009) in elderly adults who consumed MSPrebiotic® compared to placebo. No significant changes were found in mid-age adults. Conclusions: Our results suggest that dietary supplementation with prebiotics such as MSPrebiotic® may be part of an effective strategy to reduce insulin resistance, a major risk factor for developing T2D, in the elderly.

Drawing on Māori (Aotearoa-New Zealand), First Nations (Canada), and Navajo Nation (U.S.), case studies and practitioners’ experiences, this article addresses a gap in our understanding of the role of volunteers in emergencies and disasters in Indigenous communities. Enablers and challenges to effective volunteering in these Indigenous communities are discussed. Cultural enablers of volunteering include building capacity during non-emergency times, using all senses when volunteering, and supporting locally emergent psychosocial recovery institutions that are based on cultural understanding and trust. Resolving systemic barriers to volunteering would require institutional and organisational changes through governance, coordination and training. Practical recommendations for supporting volunteer management in Indigenous communities are made.

Nady el-Guebaly, MD, DPH, DPsych, FRCPC1; Jitender Sareen, MD, FRCPC2; Murray B Stein, MD, MPH, FRCPC3 Can J Psychiatry. 2010;55(11):709-714. The Prevalence of Prescriptions and Their Indications Benzodiazepines are reportedly the most frequently prescribed psychotropic medication. Among adults in the United States and Canada, 3% to 4% are using BDZs at any one time.1 About 100 million prescriptions are written per year. The European Study of the Epidemiology of Mental Disorders (commonly referred to as ESEMeD) investigated the use of ADs and BDZs in 2 1 425 respondents from 6 countries. In the nonhelp-seeking population, BDZs were used more commonly than ADs, while in the help-seeking population, with a 12-month prevalence of major depressive disorder or anxiety disorder, BDZs were used as commonly as ADs. In an Australian study/ 16% of the adults aged 65 years and older (n = 3970) had at least 1 BDZ prescription and the prescription prevalence increased with age. BDZs' sedative, hypnotic, and anxiolytic properties are used for various psychiatric and medical conditions including anxiety disorders, sleep disorders, seizure disorders, movement disorders, and muscle spasticity. They are used in anaesthesiology and for the symptomatic treatment of agitation associated with other psychiatric and neurological disorders including psychotic, mood, and cognitive disorders.4 In emergencies they are the preferred treatment of withdrawal from alcohol and sedative-hypnotics as well as agitation from stimulants. Tolerance to sedative effects usually develops among people receiving maintenance therapy with a stable dose of BDZs; by contrast, the memory-impairing effects can persist after several years of daily administration.5 Overdoses are almost never fatal unless occurring in combination with other sedative agents such as alcohol or opiates. The reinforcing effects of BDZs may not only be mediated through binding of the alpha 1 or lambda 2 subtypes of GABA receptors but also via an opioid mechanism. A partial mu receptor antagonist such as naltrexone may reduce anxiolytic and positive subjective effects of BDZs. This may explain the high level of co-occurrence of BDZs and opioid dependence. Of interest, BDZs are the only major class of drugs with abuse liability that decrease dopamine levels in the mesolimbic system.6 From Physiologic Dependence to Loss of Control The dose and duration of exposure to BDZs determines the development of physiological dependence. It is almost never seen in patients treated for less than 2 weeks but occurs in about 50% of patients treated daily for more than 4 months. Short- and long-acting BDZs produce comparable severity of withdrawal. The development of physiological dependence is reduced with intermittent, compared with continuous, exposure to BDZs. Among people exposed to BDZs, a small subset, likely among those who have abused other substances, will develop compulsive drug-seeking behaviour with loss of control and an inability to stop. The same may apply to people with a positive family history of drug or alcohol dependence, given that some of the risk may be hereditary.7 Most patients treated chronically with BDZs, who presumably may have physiological dependence, do not develop compulsive substance use,8 and some patients present with compulsive substance use without physiological dependence. The abuse potential of BDZs depends not only on the drug receptor selectivity but also on the characteristics of the individual and environmental circumstances. BDZs as a primary substance of abuse in people admitted for addiction treatment make up less than 1 % of all admissions. Most of these people report abuse of alcohol or opioids in addition to BDZs.9 The presence of another co-occurring psychiatric disorder (mood, anxiety, and Cluster C personality) occurs in up to 50% of these admissions. Among patients on methadone maintenance treatment, 40% to 50% abuse BDZs. …

OBJECTIVE: To systematically review the literature on the association between deployment to a peacekeeping mission and distress, mental disorders, and suicide. METHODS: Peer-reviewed English publications were found through key word searches in MEDLINE, PsycINFO, Scopus, and Embase, and by contacting authors in the field. Sixty-eight articles were included in this review. RESULTS: Some studies have found higher levels of postdeployment distress and posttraumatic stress disorder (PTSD) symptoms. Most studies have not shown an increased risk of suicide in former peacekeepers. Correlates of distress and PTSD symptoms included level of exposure to traumatic events during deployment, number of deployments, predeployment personality traits or disorder, and postdeployment stressors. Perceived meaningfulness of the mission, postdeployment social supports, and positive perception of homecoming were associated with lower likelihood of distress. CONCLUSIONS: Most peacekeepers do not develop high levels of distress or symptoms of PTSD. As postdeployment distress is consistently shown to be associated with high levels of exposure to combat during deployment, targeted interventions for peacekeepers who have been exposed to high levels of combat should be considered.

BACKGROUND: Past research on the association between insomnia and suicidal ideation (SI) has produced mixed findings. The current study explored the relationship between insomnia, SI, and past-year mental health status among a large Canadian Forces (CF) sample. METHOD: Data was obtained from the 2013 Canadian Forces Mental Health Survey (CFMHS), and included a large representative sample of Canadian Regular Forces personnel (N = 6700). A series of univariate logistic regressions were conducted to test individual associations between past-year mental health status, insomnia, and potential confounds and SI. Mental health status included three groups: 0, 1, or two or more probable diagnoses of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD) and alcohol abuse/dependence. Stepwise multivariate logistic regression was used to assess the relationship between insomnia and SI with mental health status as a moderator. RESULTS: 40.8% of respondents reported experiencing insomnia. Both insomnia and number of mental health conditions incrementally increased the risk of SI. However, past-year mental health status was a significant moderator of this relationship, such that for CF personnel with either no (AOR = 1.61, 1.37-1.89) or only one past-year mental health condition (AOR = 1.39, 1.12-1.73), an incremental increase in insomnia was associated with an increased likelihood of SI. However, in personnel with two or more past-year mental health disorders, insomnia was no longer significantly associated with SI (AOR = 1.04, 0.81-1.33). CONCLUSIONS: Insomnia significantly increased the odds of SI, but only among individuals with no or one mental health condition. Findings highlight the importance of assessing insomnia among CF members in order to further suicide prevention efforts.

BACKGROUND: Occupational therapists working in hospitals are confronted with increasingly complex discharge decisions. However, the relationship of discharge-planning strategies to the professional concepts of client-centred practice and enabling occupations has been unclear. PURPOSE: This study explored the relationship between the models of decision-making used by occupational therapists, and the professional issues of enabling occupation and client-centred practice. METHODS: Qualitative interviews were conducted with 10 occupational therapists. Data were analyzed for the presence and emergence of themes. RESULTS: Therapists try to balance the sometimes competing issues of safety and autonomy. Therapists often engage in negotiated decision-making. However, clients are sometimes excluded, despite therapists' commitment to client-centred processes. Consideration of occupations is often neglected. PRACTICE IMPLICATIONS: Client-defined models of decision-making are insufficient for frail, cognitively- impaired people. A new, client-centred Negotiated Model of Decision-Making is proposed, which facilitates decisions to enable older people with their occupations.

Episodes of bacteremia identified in a long term care facility over a seven and a half-year period from July 1984 to December 1991 were reviewed. Twenty-nine episodes of bacteremia were identified, a rate of 4.35/100,000 patient-days. The most common infecting organisms were Escherichia coli (11 episodes), Streptococcus pneumoniae (four), Proteus mirabilis (three), Staphylococcus aureus (three) and Bacteroides species (two). The source of bacteremia was urinary in 45% of patients, gastrointestinal in 17%, pneumonia in 14%, skin in 14% and unknown in 10%. The overall case fatality rate was 24%, but for the final six years of the review the case fatality rate was only 9.5%. These observations report a rate of bacteremia 10-fold lower than reported from other North American long term care facilities and, potentially, a lower case fatality rate. The primary site of bacteremia, however, in long term care facilities is the urinary tract.

Two hundred and forty-three urine specimens from 76 elderly institutionalized residents were obtained for urine culture, quantitative leukocyte count and urinalysis. Significant bacteriuria was present in 153 specimens (63%), including 33 (22%) with more than one organism. Pyuria (greater than or equal to 10 leukocytes/mm(3)) was present in 214 specimens (88%), including 116 (97%) with single organism bacteriuria, 27 (82%) with multiple organism bacteriuria, and 71 (80%) without significant bacteriuria. The leukocyte esterase test had a positive predictive value of 99% for pyuria but a negative predictive value of only 30%. The quantitative level of pyuria was associated with the level of proteinuria and inversely with pH. A relatively constant level of pyuria tended to persist over months to years in a given individual if bacteriuria persisted. Pyuria is significantly associated with bacteriuria in the institutionalized elderly, but is also common in the nonbacteriuric. The clinical significance of pyuria requires further assessment.

OBJECTIVE: Our study examines the association between suicidal ideation and and self-reported symptoms of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and alcohol use disorder (AUD) in a sample of treatment-seeking Canadian combat and peacekeeping veterans; and identifies potential predictors of suicidal ideation. METHODS: Actively serving Canadian Forces and Royal Canadian Mounted Police members and veterans seeking treatment at the Parkwood Hospital Operational Stress Injury Clinic (n = 250) completed measures including the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, the Alcohol Use Disorder Identification Test, and the PTSD Checklist-Military Version (PCL-M) between January 2002 and December 2010. Regression analyses were used to determine the respective impact of PTSD, and self-reported symptoms of MDD, GAD, AUD, and anxiety on suicidal ideation. RESULTS: Most people met PCL-M screening criteria for PTSD (73.6%, n = 184), while 70.8% (n = 177) screened positively for a probable major depressive episode. PTSD symptom was significantly associated with suicidal ideation (β = 0.412, P < 0.001). After controlling for self-reported depressive symptom severity, AUD severity, and generalized anxiety, PTSD severity was no longer significantly associated with suicidal ideation (β = 0.043, P = 0.58). CONCLUSIONS: Although PTSD alone is associated with suicidal ideation, after controlling for common comorbid psychiatric illnesses, self-reported depressive symptom severity emerged as the most significant predictor of suicidal ideation. These findings support the importance of screening for comorbidities, particularly an MDD, as potentially modifiable conditions that are strongly related to suicidal ideation in military personnel's endorsing criteria for PTSD.

Established following the Reed Report (1991) recommendations, Redford Lodge is an independent psychiatric hospital offering medium secure provision for mentally ill patients and offenders. For this study social and behavioural data were collected on admission and discharge for the 166 patients admitted over the three years 1995‐1998 and 49 discharged patients were reassessed at six‐month follow‐up. Predictors of length of stay, discharge and success at follow‐up were examined in relation to social and demographic factors and engagement in therapy programmes.Patients' socio‐demographic variables were not significantly related to their length of stay, place of discharge or success at follow‐up. One predictor of progress after discharge was employment. Contact with family was identified as a significant factor associated with shorter stay and positive place of discharge but not associated with success at follow‐up. Engagement in psychological therapies and/or group activities was directly related to length of stay, general progress and improvement in mental state but not to subsequent involvement in community services or general success in independent living at follow‐up.Although the findings suggest treatment is successful, further research is needed to identify specific treatment variables that have a positive long‐term effect.

For millennia, Indigenous Peoples around the world have prepared for, coped with, and survived disasters and environmental change, and human-induced events. Along the way, these experiences – and a keen understanding of the environment in which they live – have borne what we refer to today as Indigenous Knowledges. Among the most significant of the human-induced events, colonization has disrupted Indigenous strategies of self-determination and resilience. Indigenous-led climate change adaptation holds a transformative potential for addressing the impacts of the unnatural disasters of colonialism, land dispossession, and the climate change crisis. Yet, community-led research in this urgent research area remains limited. To ensure that Indigenous Peoples’ right to self-determination is protected and the horrific legacy of government-forced relocations is not repeated, communities must lead and define research on climate-forced displacement and planned relocation.

Objective: Posttraumatic stress disorder (PTSD) is often accompanied by other mental health conditions, including major depressive disorder (MDD), substance misuse disorders, and anxiety disorders. The objective of the current study is to delineate classes of comorbidity and investigate predictors of comorbidity classes amongst a sample of Canadian Armed Forces (CAF) Regular Force personnel. Methods: Latent class analyses (LCAs) were applied to cross-sectional data obtained between April and August 2013 from a nationally representative random sample of 6700 CAF Regular Force personnel who deployed to the mission in Afghanistan. Results: MDD was the most common diagnosis (8.0%), followed by PTSD (5.3%) and generalized anxiety disorder (4.7%). Of those with a mental health condition, LCA revealed 3 classes of comorbidity: a highly comorbid class (8.3%), a depressed-only class (4.6%), and an alcohol use–only class (3.1%). Multinomial logit regression showed that women (adjusted relative risk ratio [ARRR] = 2.77; 95% CI, 2.13 to 3.60; P &lt; 0.01) and personnel reporting higher trauma exposure (ARRR = 4.18; 95% CI, 3.13 to 5.57; P &lt; 0.01) were at increased risk of membership in the comorbid class compared to those without a mental health condition. When compared to those with no mental health condition, experiencing childhood abuse increased the risk of being in any comorbidity class. Conclusions: Results provide further evidence to support screening for and treatment of comorbid mental health conditions. The role of sex, childhood abuse, and combat deployment in determining class membership may also prove valuable for clinicians treating military-related mental health conditions.

PURPOSE: To identify and compare perceptions of the geriatric care environment among nurses in three different urban hospital types in one health authority in a Midwestern Canadian province. DESIGN: The Geriatric Institutional Assessment Profile developed by the Nurses Improving Healthsystem Elders (NICHE) program was administered to staff in eight urban hospitals between 2005 and 2006: two geriatric-chronic care hospitals, four community hospitals, and two tertiary hospitals. The study focused on 1,189 nurses who completed the survey (n= 298 for geriatric-chronic care hospitals; n= 387 for community hospitals, n= 504 for tertiary hospitals). METHODS: Analyses focused on items related to the concept of the geriatric nursing practice environment, including a composite measure of overall perceptions and three subscales (institutional values regarding older adults and staff, resource availability, and capacity for collaboration). Nurses' perceptions of the extent to which facilities supported the provision of aging-sensitive or aging-relevant care to older adults and their families was also examined. Univariate analysis of variance was performed to determine significant group differences among nurses in the three hospital types. FINDINGS: Perceptions of the geriatric nurse practice environment (both in terms of the composite scale and the three subscales) were least positive among nurses in community hospitals relative to the other two hospital types. Perceptions in tertiary hospitals were significantly more positive than those in community hospitals in terms of institutional values and resource availability, albeit not capacity for collaboration. Perceptions were most positive in the geriatric-chronic care hospitals. Perceptions of aging-sensitive care delivery were also less positive in community and tertiary hospitals, relative to geriatric-chronic care hospitals; perceptions in community and tertiary hospitals did not differ from each other. CONCLUSIONS: In this Canadian study, nurses' perception of the care environment varied by hospital type, with nurses in community hospitals expressing the most concern and nurses in geriatric-chronic care hospitals being the most positive. This research highlights the importance of the hospital setting in understanding nurses' ability to provide quality geriatric care. CLINICAL RELEVANCE: Enhancing the quality of care for older patients requires an understanding of the challenges and obstacles experienced by nurses. Assessing their perceptions of the care environment they work in, therefore, becomes a key issue in targeting policy and programs.

REASONS FOR PERFORMING STUDY: While surgical arthrodesis is the treatment of choice for osteoarthritis of the proximal interphalangeal joint, some clients are unable to pursue surgery due to costs. A more economical technique was sought using intra-articular ethyl alcohol injections to facilitate ankylosis. OBJECTIVES: To describe the technique and outcome of intra-articular ethyl alcohol injections for facilitated ankylosis of proximal interphalangeal joints with osteoarthritis. METHODS: As a retrospective case series, the medical records (2006-2012) of clinical cases diagnosed with proximal interphalangeal joint osteoarthritis treated with intra-articular ethyl alcohol injections were reviewed. Cases with follow-up of at least 6 months were included. Technique and outcome were determined. Evaluation of outcome was assessed using return to previous performance or intended use and owner satisfaction as the indicators of success. Soundness and level of work are also reported. RESULTS: Thirty-four horses were included in the study. At the time of follow-up, 17 horses (50%) were sound, while 13 horses (38%) were improved but not sound. One horse's lameness was unchanged, and 3 horses were lost to follow-up. The median time until horses became sound or returned to work was 8 months. Six horses had complications, 4 of which were mild and transient. CONCLUSIONS AND POTENTIAL RELEVANCE: The use of intra-articular ethyl alcohol in the proximal interphalangeal joint in horses affected by osteoarthritis appears to be a viable method for facilitated ankylosis if surgical management is not an option.

Modification of the Cyanmethemoglobin Reagent for Analysis of Hemoglobin in Order to Avoid Precipitation of Globulins Get access Paul Green, M.D., Paul Green, M.D. Pathology Laboratories, Deer Lodge Hospital, Department of Veterans Affairs, Winnipeg, Manitoba, Canada Search for other works by this author on: Oxford Academic Google Scholar C. F. J. Teal C. F. J. Teal Pathology Laboratories, Deer Lodge Hospital, Department of Veterans Affairs, Winnipeg, Manitoba, Canada Search for other works by this author on: Oxford Academic Google Scholar American Journal of Clinical Pathology, Volume 32, Issue 3, 1 September 1959, Pages 216–217, https://doi.org/10.1093/ajcp/32.3.216 Published: 01 September 1959 Article history Received: 11 March 1959 Accepted: 12 May 1959 Published: 01 September 1959

Military-related posttraumatic stress disorder (PTSD) is a significant psychiatric condition associated with severe psychosocial dysfunction. This study examined the predictors of treatment outcome in a group of veterans with military-related PTSD. Participants were 102 Canadian combat and peacekeeping veterans who received treatment at a specialized outpatient clinic for veterans with psychiatric disorders resulting from military operation. Analysis demonstrated a significant decrease in PTSD severity during the 1-year period (Yuan-Bentler χ [86, N = 99] = 282.45, p < 0.001). We did not find chronicity, alcohol use, and anxiety or depression severity as significant predictors for PTSD symptom decline. However, initial depression significantly predicted anxiety symptom decline, and initial anxiety predicted depression symptom decline. This study demonstrated that, despite considerable comorbidity, significant treatment gains, including remission of PTSD, can be achieved in an outpatient setting in veterans with chronic military-related PTSD.

Background: Potentially morally injurious experiences (PMIEs) are common during military service. However, it is unclear to what extent PMIEs are related to well-established adverse mental health outcomes.Objective: The objective of this study was to use a population-based survey to determine the associations between moral injury endorsement and the presence of past-year mental health disorders in Canadian Armed Forces (CAF) personnel and Veterans.Methods: Data were obtained from the 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS). With a sample of 2,941 respondents, the weighted survey sample represented 18,120 active duty and 34,380 released CAF personnel. Multiple logistic regressions were used to assess the associations between sociodemographic characteristics (e.g. sex), military factors (e.g. rank), moral injury (using the Moral Injury Events Scale [MIES]) and the presence of specific mental health disorders (major depressive episode, generalized anxiety disorder, panic disorder, social anxiety disorder, PTSD, and suicidality).Results: While adjusting for selected sociodemographic and military factors, the odds of experiencing any past-year mental health disorder were 1.97 times greater (95% CI = 1.94–2.01) for each one-unit increase in total MIES score. Specifically, PTSD had 1.91 times greater odds (95% CI = 1.87–1.96) of being endorsed for every unit increase in MIES total score, while odds of past-year panic disorder or social anxiety were each 1.86 times greater (95% CI = 1.82–1.90) for every unit increase in total MIES score. All findings reported were statistically significant (p < .001).Conclusion: These findings emphasize that PMIEs are robustly associated with the presence of adverse mental health outcomes among Canadian military personnel. The results of this project further underscore the necessity of addressing moral injury alongside other mental health concerns within the CAF.

BACKGROUND: A series of recent articles has reported on well-designed studies examining base rates of posttraumatic stress disorder (PTSD) screenings within the Operation Enduring Freedom (Afghanistan conflict)/Operation Iraqi Freedom (Iraq conflict) (OEF/OIF) military population. Although these studies have a number of strengths, this line of research points out several key areas in need of further examination. OBJECTIVE: Many OEF/OIF Veterans do not use available Veterans Affairs (VA) services, especially mental health care. This highlights the need to understand the differences between those who use and do not use the VA, especially as research with pre-OEF/OIF Veterans suggests that these two groups differ in significant ways. The high rates of PTSD-related concerns in non-VA users also points to a need to understand whether-and where-Veterans are seeking care outside the VA and the accessibility of evidence-based, trauma-focused treatments in the community and private sectors. Careful examination of relationship status is also paramount as little research has examined relationship status or other relationship context issues. Social support, especially from a spouse, can buffer the development of PTSD; however, relationship discord has the potential to greatly exacerbate PTSD symptomatology. Furthermore, given the additional risk factors for sexual minority Veterans to be exposed to trauma, the 2011 repeal of the US Military "Don't Ask, Don't Tell" policy, and the emergence of the VA as likely the largest health care provider for sexual minority Veterans, it will be critically important to study the trauma and mental health experiences of this group. CONCLUSIONS: Studies that examine prevalence rates of PTSD in the returning cohort contribute significantly to our understanding of the US OEF/OIF military population. Further study of PTSD in relation to demographic variables such as VA and non-VA use, relationship status, and sexual orientation will provide rich data that will enhance our ability to develop policy and practice to provide the best care to this population.

OBJECTIVE: In a previous study, elevated urine antibody levels in institutionalized subjects with asymptomatic bacteriuria were associated with decreased survival. This study was undertaken to confirm the previous observation in a prospective study in a larger cohort and to explore selected other variables that may be associated with survival. DESIGN: A prospective, 24-month, observational cohort study. SETTING: Three large nursing homes in Winnipeg, Manitoba. PARTICIPANTS: Permanent residents were identified by initial screening urine cultures and subjects with bacteriuria were enrolled. The median age of subjects was 76 years, 51% were women, and the median duration of residence before enrollment was 26 months. Subjects were highly functionally impaired. MEASUREMENTS: Monthly urine specimens were collected for culture, leukocyte count, and urine antibody. Serum specimens for antibody to uropathogens and IL6 were obtained at enrollment and every 6 months. Anthroporphometric tests of nutritional status and functional and mental status were also measured every 6 months. Residents were stratified as having elevated or not elevated urine antibody, based on the initial urine specimen. The mean urine antibody for all of each subject's specimens was also calculated, and subjects were stratified as low, intermediate, or elevated urine antibody. Outcomes measured included mortality, infection and antibiotic use, and functional, mental, and nutritional decline. RESULTS: Ninety-eight bacteriuric subjects were enrolled in the study; 34 (35%) had elevated urine antibody and 64 (65%) had not elevated urine antibody. The two groups did not differ in demographic features, co-morbidities, functional status, medication use, or infecting organisms. Survival was significantly (P < .001) poorer in the group with elevated urine antibody. At 24 months, 35% of subjects with an elevated urine antibody were alive compared with 75% with a low urine antibody level. This survival difference was consistent when the two groups were stratified by sex, institution, and presence of a chronic indwelling catheter. Subjects with elevated urine antibody had no evidence for accelerated functional or nutritional decline during the study period compared with the group with low urine antibody. These subjects did, however, have an increased incidence of episodes of symptomatic urinary infection and infections at non-urinary sites. CONCLUSIONS: Older, bacteriuric, institutionalized subjects with elevated urine antibody had decreased survival rates compared with subjects with lower urine antibody levels. There is no clinical evidence to support accelerated decline caused by chronic infection to explain this observation. Urine antibody may be a marker for immune dysregulation, which precedes death in older impaired subjects.