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GENERAL INFORMATION Journal of the American Medical Directors Association (ISSN 1525-8610). Frequency: Published 6 times annually (January/February, March/April, May/June, July/August, September/October, November/December), one volume per year beginning in January, 2000. Correspondence regarding editorial matters should be addressed to the Editor: Dan Osterweil, MD, CMD, Editor-in-Chief, Journal of the American Medical Directors Association, 1685 Sweet Briar Place, Thousand Oaks, CA 91362. For information regarding membership in the American Medical Directors Association, contact the American Medical Directors Association, 10480 Little Patuxent Parkway, Suite 760, Columbia, MD 21044. Tel:1-410-740-9743; Fax: 1-410-740-4572; website address: www.amda.com. Membership dues $180 for medical directors and physicians annually includes subscription to JAMDA and our newspaper Caring for the Ages. Administrators, DONs, and other non- physicians may join as associate members for $90.00. Other rates are available; please contact AMDA. Members also enjoy discounts on meetings and certification courses and on educational tools such as clinical practice guidelines and information kits. Customer service (orders, claims, online, change of address): Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Phone: (800) 654-2452 (U.S. and Canada); (407) 345-4000 (outside U.S. and Canada). Fax: (800) 225-6030 (U.S. and Canada); (407) 363-9661 (outside U.S. and Canada). e-mail: [email protected]. Address changes must be submitted four weeks in advance. Yearly subscription rates: United States and possessions: Individual $154; Institution $200; Student/Resident: $73. All other countries (prices include airspeed delivery): Individual $180; Institution $235; Student/Resident $99. Single Issues $40. To receive student/resident rate, orders must be accompanied by name of affiliated institution, date of term and the signature of program/ residency coordinator on institution letterhead. Orders will be billed at the individual rate until proof of status is received. Current prices are in effect for back volumes and back issues. Further information on this journal is available from the Publisher. Information on other Elsevier products is available through Elsevier’s website (http://www.elsevier.com). Reprints: For queries about author offprints, e-mail authorsupport@ elsevier.com. To order 100 or more reprints for educational, commercial, or promotional use, contact the Commercial Reprints Department, Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Fax: (212) 462-1935; e-mail: [email protected]. Advertising information: Advertising orders and inquiries can be sent to: USA, Canada, and South America, for pharmaceutical advertising sales: James Nagle, Breuning Nagle Associates, 58 Pine Street, New Canaan, CT 06840, phone: (203) 801-9696, fax: (203) 801-0011, e-mail: [email protected]; for equipment advertising sales, Michael Targowski, Elsevier, 360 Park Avenue South, New York, NY 10010, phone: (212) 633-3693, fax: (212) 633-3820, e-mail: m.tar[email protected]. Classified advertising orders and inquiries can be sent to Simone Imbert, Elsevier, 360 Park Avenue South, New York, NY 10010, phone: (212) 462-1908, fax: (212) 633-3820, e-mail: s.imbert@ elsevier.com. Europe and the rest of the world, Julie Toop; phone: 44 (0) 1865 843016; fax: 44 (0) 1865 843976; e-mail: [email protected]. Author inquiries: For inquiries relating to the submission of articles (including electronic submission where available), please visit Elsevier’s Author Gateway at http://authors.elsevier.com. The Author Gateway also provides the facility to track accepted articles and set up e-mail alerts to inform you of when an article’s status has changed, as well as detailed artwork guidelines, copyright information, frequently asked questions, and more. Please see Information for Authors for individual journal. Contact details for questions arising after acceptance of an article, especially those relating to proofs, are provided after registration of an article for publication. The paper used in this publication meets the requirements of ANSI/NISO Z39.48-1992 (Permanence of Paper). English language help service: Upon request, Elsevier will direct authors to an agent who can check and improve the English of their paper (before submission). Please contact [email protected] for further information. © 2005 Amercian Medical Directors Association. All rights reserved. This journal and the individual contributions contained in it are protected under copyright by the American Medical Directors Assocation, and the following terms and conditions apply to their use: Photocopying: Single photocopies of single articles may be made for personal use as allowed by national copyright laws. Permission of the Publisher and payment of a fee is required for all other photocopying, including multiple or systematic copying, copying for advertising or promotional purposes, resale, and all forms of document delivery. Special rates are available for educational institutions that wish to make photocopies for non-profit educational classroom use. Permissions may be sought directly from Elsevier’s Rights Department in Philadelphia, PA, USA: phone (215) 238-7869, fax (215) 238-2239, e-mail healthpermissi[email protected]. Requests may also be completed online via the Elsevier homepage (http://www.elsevier.com/locate/permissions). In the USA, users may clear permissions and make payments through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA; phone: (978) 750-8400, fax: (978) 750-4744, and in the UK through the Copyright Licensing Agency Rapid Clearance Service (CLARCS), 90 Tottenham Court Road, London W1P 0LP, UK; phone: (44) 20 7631 5555; fax: (44) 20 7631 5500. Other countries may have a local reprographic rights agency for payments. Derivative Works: Subscribers may reproduce tables of contents or prepare lists of articles including abstracts for internal circulation within their institutions. Permission of the Publisher is required for resale or distribution outside the institution. Permission of the Publisher is required for all other derivative works, including compilations and translations. Electronic Storage or Usage: Permission of the Publisher is required to store or use electronically any material contained in this journal, including any article or part of an article. Except as outlined above, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the Publisher. Address permissions requests to: Elsevier Rights Department, at the fax and e-mail addresses noted above. Notice: No responsibility is assumed by the Publisher [or The American Medical Directors Association] for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. Although all advertising material is expected to conform to ethical (medical) standards, inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer. Indexing Services: The Journal has been accepted for indexing in the Index Medicus; EMBASE/Excerpta Medica; the Cumulative Index to Nursing and Allied Health Literature database and CINAHL print index; Alzheimer’s Disease Education & Referral Center (National Institute on Aging and National Institutes of Health Combined Health Information Database; Abstracts in Social Gerontology; and AgeLine (AARP).

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GENERAL INFORMATION

Journal of the American Medical Directors Association (ISSN 1525-8610).Frequency: Published 6 times annually (January/February, March/April,May/June, July/August, September/October, November/December), onevolume per year beginning in January, 2000.

Correspondence regarding editorial matters should be addressed to theEditor: Dan Osterweil, MD, CMD, Editor-in-Chief, Journal of the AmericanMedical Directors Association, 1685 Sweet Briar Place, Thousand Oaks, CA91362.

For information regarding membership in the American Medical DirectorsAssociation, contact the American Medical Directors Association, 10480 LittlePatuxent Parkway, Suite 760, Columbia, MD 21044. Tel:1-410-740-9743; Fax:1-410-740-4572; website address: www.amda.com. Membership dues $180 formedical directors and physicians annually includes subscription to JAMDA andour newspaper Caring for the Ages. Administrators, DONs, and other non-physicians may join as associate members for $90.00. Other rates are available;please contact AMDA. Members also enjoy discounts on meetings andcertification courses and on educational tools such as clinical practice guidelinesand information kits.

Customer service (orders, claims, online, change of address): ElsevierPeriodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.Phone: (800) 654-2452 (U.S. and Canada); (407) 345-4000 (outside U.S. andCanada). Fax: (800) 225-6030 (U.S. and Canada); (407) 363-9661 (outside U.S.and Canada). e-mail: [email protected]. Address changes must be submittedfour weeks in advance.

Yearly subscription rates: United States and possessions: Individual $154;Institution $200; Student/Resident: $73. All other countries (prices includeairspeed delivery): Individual $180; Institution $235; Student/Resident $99.Single Issues $40. To receive student/resident rate, orders must be accompaniedby name of affiliated institution, date of term and the signature of program/residency coordinator on institution letterhead. Orders will be billed at theindividual rate until proof of status is received. Current prices are in effect forback volumes and back issues. Further information on this journal is availablefrom the Publisher. Information on other Elsevier products is available throughElsevier’s website (http://www.elsevier.com).

Reprints: For queries about author offprints, e-mail [email protected]. To order 100 or more reprints for educational, commercial, orpromotional use, contact the Commercial Reprints Department, Elsevier Inc.,360 Park Avenue South, New York, NY 10010-1710. Fax: (212) 462-1935;e-mail: [email protected].

Advertising information: Advertising orders and inquiries can be sent to: USA,Canada, and South America, for pharmaceutical advertising sales: James Nagle,Breuning Nagle Associates, 58 Pine Street, New Canaan, CT 06840, phone:(203) 801-9696, fax: (203) 801-0011, e-mail: [email protected]; forequipment advertising sales, Michael Targowski, Elsevier, 360 Park AvenueSouth, New York, NY 10010, phone: (212) 633-3693, fax: (212) 633-3820,e-mail: [email protected]. Classified advertising orders and inquiriescan be sent to Simone Imbert, Elsevier, 360 Park Avenue South, New York, NY10010, phone: (212) 462-1908, fax: (212) 633-3820, e-mail: [email protected]. Europe and the rest of the world, Julie Toop; phone: �44 (0)1865 843016; fax: �44 (0) 1865 843976; e-mail: [email protected].

Author inquiries: For inquiries relating to the submission of articles (includingelectronic submission where available), please visit Elsevier’s Author Gateway athttp://authors.elsevier.com. The Author Gateway also provides the facility totrack accepted articles and set up e-mail alerts to inform you of when an article’sstatus has changed, as well as detailed artwork guidelines, copyrightinformation, frequently asked questions, and more. Please see Information forAuthors for individual journal. Contact details for questions arising afteracceptance of an article, especially those relating to proofs, are provided afterregistration of an article for publication.

�� The paper used in this publication meets the requirements of ANSI/NISOZ39.48-1992 (Permanence of Paper).

English language help service: Upon request, Elsevier will direct authors to anagent who can check and improve the English of their paper (before submission).Please contact [email protected] for further information.

© 2005 Amercian Medical Directors Association. All rights reserved.This journal and the individual contributions contained in it are protectedunder copyright by the American Medical Directors Assocation, and thefollowing terms and conditions apply to their use:

Photocopying: Single photocopies of single articles may be made for personaluse as allowed by national copyright laws. Permission of the Publisher andpayment of a fee is required for all other photocopying, including multiple orsystematic copying, copying for advertising or promotional purposes, resale,and all forms of document delivery. Special rates are available for educationalinstitutions that wish to make photocopies for non-profit educationalclassroom use.

Permissions may be sought directly from Elsevier’s Rights Department inPhiladelphia, PA, USA: phone (215) 238-7869, fax (215) 238-2239, [email protected]. Requests may also be completed online via theElsevier homepage (http://www.elsevier.com/locate/permissions).

In the USA, users may clear permissions and make payments through theCopyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923,USA; phone: (978) 750-8400, fax: (978) 750-4744, and in the UK through theCopyright Licensing Agency Rapid Clearance Service (CLARCS), 90 TottenhamCourt Road, London W1P 0LP, UK; phone: (�44) 20 7631 5555; fax: (�44) 207631 5500. Other countries may have a local reprographic rights agency forpayments.

Derivative Works: Subscribers may reproduce tables of contents or preparelists of articles including abstracts for internal circulation within theirinstitutions. Permission of the Publisher is required for resale or distributionoutside the institution.

Permission of the Publisher is required for all other derivative works, includingcompilations and translations.

Electronic Storage or Usage: Permission of the Publisher is required to store oruse electronically any material contained in this journal, including any article orpart of an article.

Except as outlined above, no part of this publication may be reproduced, storedin a retrieval system or transmitted in any form or by any means, electronic,mechanical, photocopying, recording or otherwise, without prior writtenpermission of the Publisher.

Address permissions requests to: Elsevier Rights Department, at the fax ande-mail addresses noted above.

Notice: No responsibility is assumed by the Publisher [or The AmericanMedical Directors Association] for any injury and/or damage to persons orproperty as a matter of products liability, negligence or otherwise, or from anyuse or operation of any methods, products, instructions or ideas contained inthe material herein. Because of rapid advances in the medical sciences, inparticular, independent verification of diagnoses and drug dosages should bemade.

Although all advertising material is expected to conform to ethical (medical)standards, inclusion in this publication does not constitute a guarantee orendorsement of the quality or value of such product or of the claims made of itby its manufacturer.

Indexing Services: The Journal has been accepted for indexing in the IndexMedicus; EMBASE/Excerpta Medica; the Cumulative Index to Nursing andAllied Health Literature database and CINAHL print index; Alzheimer’s DiseaseEducation & Referral Center (National Institute on Aging and NationalInstitutes of Health Combined Health Information Database; Abstracts inSocial Gerontology; and AgeLine (AARP).