bluuebunny/crossref_metadata_2025 huggingface dataset:
Race and Stress in the Incidence of Herpes Zoster in Older Adults
Authors: Schmader Kenneth , George Linda K. , Burchett Bruce M. , Hamilton John D. , Pieper Carl F.
Published: April 2015

OBJECTIVES: To examine the effect of black race and acute (negative life events) and chronic (lack of social support) psychological stress on the risk of herpes zoster in late life.

DESIGN: A population‐based, prospective cohort study.

SETTING: Central North Carolina

PARTICIPANTS: Duke Established Populations for Epidemiological Studies of the Elderly, a stratified probability sample of community‐dwelling persons more than 65 years of age.

MEASUREMENTS: Interviewers administered a comprehensive health survey to the participants in 1986–1987 (P1, n = 4162), 1989–1990 (P2, n = 3336), and 1992–1994 (P3, n = 2568). Incident cases of zoster between P1 and P2 and P2 and P3 served as the dependent variable. Hypothesis‐testing variables included race, negative life events, and five measures of social support. Control variables included age, sex, education, cancer, chronic diseases, basic ADLs, instrumental ADLs, depression, self‐rated health, hospitalization, and cigarette smoking. Statistical analyses employed chi‐square tests and proportional hazards model.

RESULTS: At baseline, the sample had a mean age of 73.6 years and was 55% black, 45% white, and 65% female. There were 65 cases of zoster between P1 and P2 and 102 cases of zoster between P2 and P3. From P1 to P2, 1.4% of blacks and 3.4% of whites developed zoster (P <.001). From P2 to P3, 2.9% of blacks and 7.5% of whites developed zoster (P <.001). After controlling for the above variables, blacks were significantly less likely to develop zoster (adjusted risk ratio = 0.35; 95% confidence interval (CI), 0.24–0.51; P <.001). Negative life events increased the risk of zoster, but the result was borderline for statistical significance (adjusted RR = 1.38, 95% CI 0.96–1.97; P =.078). No measures of social support were significantly associated with zoster.

CONCLUSION: Black race decreased the risk of zoster in late life significantly. Measures of stress were not significantly related to zoster, but study limitations preclude definitive conclusions. Future research should focus on these factors in larger samples and different populations. J Am Geriatr Soc 46:973–977, 1998.
Prevalence Estimation of Dementia in a Rural Area of Korea
Authors: Woo Jong Inn , Lee Jung Hie , Yoo Keun‐Young , Kim Chang‐Yup , Kim Yong‐Ik , Shin Young Soo
Published: April 2015

OBJECTIVES: A cross‐sectional survey was conducted to estimate prevalence of dementia and to determine factors related to dementia among residents in a rural area, Yonchon county, Korea, in 1993.

PARTICIPANTS: Of the study population more than 65 years of age (n = 2171), 1674 persons participated in the cross‐sectional survey using the Korean version of the Mini‐Mental State Examination (MMSE‐K).

DESIGN: Subjects were defined as having dementia according to NINCDS‐ADRDA criteria through direct interview by psychiatrists. A total of 436 subjects were selected randomly according to MMSE‐K scores, and cases were confirmed as having either Alzheimer's or vascular dementia.

RESULTS: The adjusted prevalence of dementia was estimated at 9.5%. The prevalence of total dementia was 8.8% for men and 9.9% for women. The prevalence of Alzheimer's disease was 3.2% for men and 5.3% for women and that of vascular dementia 3.1% and 2.1%, respectively. Age‐standardized prevalence of Alzheimer's disease was 4.5%, whereas that of vascular dementia was 2.5%. Using DSM‐III‐R criteria to stratify dementia patients according to severity showed the prevalence of mild, moderate, and severe Alzheimer's disease was 3.4%, 0.7%, and 0.5%, respectively.

CONCLUSION: These results showed that the prevalence of dementia in Korea was similar to its presence in Western countries but different from that previously reported in other Asian countries, e.g., China and Japan. J Am Geriatr Soc 46:983–987, 1998.
Features of Cancer in Nonagenarians and Centenarians
Authors: Saltzstein Sidney L , Behling Cynthia A. , Baergen Rebecca N.
Published: April 2015

OBJECTIVE: To describe the incidence rates and sites of cancer, the causes of death, and gender and ethnic variations in patients with cancer in a population of people 90 years of age and older.

DESIGN: Analysis of the 14,088 cases of cancer in this age group, accessioned by the California Cancer Registry from 1988 through 1993, and comparison with those less than age 90.

MEASUREMENTS: Incidence rates and numbers and percents of cases with various features (gender, ethnicity, site of tumor, stage, causes of death).

RESULTS: The peak age‐specific incidence (ASI) of cancer is in the group 80 to 84 years of age. Those 90 to 94 years of age had a higher ASI than any group except those ages 75 to 89. There are ethnic variations in the sites of cancer in people aged 90 or older. Colorectal cancer accounts for more than one‐fifth of the new cases of cancer in people 90 or older. In women aged 90 or older, the most common sites of cancers are colorectal, breast, and lymphoma/leukemia. In men of the same age, prostate, colorectal, and lung/bronchus are the most common sites. As age increases, fewer people have their cancers staged, and for lung/bronchus, prostate, and breast, more cancers are first diagnosed in the distant stage in people aged 90 and older. Of the people with cancer who die, the proportion dying of cancer decreases as age increases.

CONCLUSION: Cancer is a common disease in nonagenarians and centenarians and will be an increasing healthcare problem. Knowledge of its features is essential to those planning, delivering, and financing health care. J Am Geriatr Soc 46:994–998, 1998.
A Study of Force and Cross‐Sectional Area of Adductor Pollicis Muscle in Female Hip Fracture Patients
Authors: Phillips S.K. , Woledge R.C. , Bruce S.A. , Young A. , Levy D. , Yeo A. , Martin F.C.
Published: April 2015

OBJECTIVES: To determine the extent of muscle weakness in older female hip fracture patients compared with healthy older and young women; to determine the extent to which this weakness is caused by a decline of the force produced per unit area of muscle rather than by a decline in muscle bulk; and to investigate the mechanism of the decline in force per unit area.

DESIGN: This was an open study of three groups of subjects, two age matched older groups and one young group.

SETTING: University College London, Royal Free Hospital, and St. Thomas's Hospital, London.

PARTICIPANTS: Twenty‐nine older female hip fracture patients (mean age 85.6 ± 0.9 SEM), 18 healthy older women (mean age 84.7 ± 1.2 SEM), and 43 young women (mean age 28.9 ± 1.2 SEM).

MEASUREMENTS: Adductor pollicis muscle maximum voluntary force (MVF) during isometric and pliometric contractions and cross‐sectional area (CSA), body weight, height, and demi‐span.

RESULTS: Isometric MVF was lowest in the hip fracture group. In both older groups, isometric MVF and CSA were lower than in the young women. Only part of this weakness in the older groups could be explained by the smaller CSAs. The isometric force per unit area (MVF/CSA) was also lower in both older groups, the hip fracture patients again having the lowest values. Analysis of variance showed a significant difference between groups. The age‐related declines in pliometric force were much less than the declines in isometric force. This resulted in an increase in the pliometric/isometric force ratio both for the hip fracture patients and for the healthy older women compared with that for young women.

CONCLUSION: In comparison with the results from young women, the adductor pollicis muscles of female hip fracture patients were even weaker than those of healthy older women when normalized for muscle size. This decline in isometric MVF/CSA accounted for at least half of the overall weakness in the hip fracture patients. Inasmuch as pliometric force is maintained in situations where weakness is caused by a decline in the force produced per muscle cross‐bridge, this is the likely mechanism of the declines in isometric MVF/CSA observed in this study. J Am Geriatr Soc 46:999–1002, 1998.
The Impact of Urge Urinary Incontinence on Quality of Life: Importance of Patients' Perspective and Explanatory Style
Authors: DuBeau Catherine E. , Levy Becca , Mangione Carol M. , Resnick Neil M.
Published: April 2015

OBJECTIVES: The impact of urinary incontinence (UI) on health‐related quality of life (QoL) is significant yet variable, but little is known about patient‐defined content areas regarding the influence of UI on QoL and whether patient‐specific factors correlate with specific content areas of UI‐related QoL. In order to identify the most valid content areas for a new UI‐related QoL questionnaire, our primary goal was to determine the content areas of greatest concern regarding UI‐related QoL among older persons with urge incontinence. The second goal was to examine the possible role of patients' explanatory style as a mediator of UI impact on health‐related QoL. Data on the questionnaire will be presented elsewhere.

DESIGN: Focus groups comprising urge‐incontinent persons were used to obtain verbatim descriptions of the impact of UI on QoL.

SETTING: A university‐affiliated tertiary hospital.

PARTICIPANTS: Community‐dwelling women (n = 25) and men (n = 5) more than 60 years of age, with urge incontinence, recruited from newspaper, newsletter, and radio advertisements.

MEASUREMENTS: Qualitative content analysis of focus group transcripts was used to determine QoL items. These were compared with previously described UI‐related QoL items obtained from the literature. Subjects' statements regarding causes of UI were evaluated for predominant explanatory style.

RESULTS: Thirty‐two UI‐related QoL items were identified, more than half of which were not described previously. Compared with expert‐defined UI‐related QoL items from the literature, patient‐defined items focused more on coping with embarrassment and interference from UI than on prevention of actual activity performance. Explanatory statements were made frequently by patients talking about their UI. Although positive style explanatory statements were most common, they did not correlate with any QoL items. By contrast, there was a significant correlation between negative explanatory style and six specific UI‐related QoL items.

CONCLUSIONS: Focus groups of older persons with urge incontinence suggest that experts and patients view the impact of urge UI on QoL differently. Whereas experts focus more on functional impact, patients more often cite the impact of UI on their emotional well‐being and on the interruption of activities. In addition, the association between negative explanatory style and specific UI‐related QoL items suggests that explanatory style may be an important mediator of patients' perceptions of UI‐related QoL.
A Two‐Year Follow‐Up of Geriatric Consults in the Emergency Department
Authors: Sinoff G. , Clarfield A.M. , Bergman H. , Beaudet M.
Published: April 2015

OBJECTIVE: To characterize the population and provide a 2‐year follow‐up for those patients for whom a geriatric consult was requested in the emergency department (ED) of an acute care hospital.

BACKGROUND: Older people tend to use health services, including the ED, disproportionately. This phenomenon has implications for medical services as the number of older people continues to increase. To our knowledge, long‐term follow‐up of patients for whom ED geriatric consultation was requested has not been described.

SETTING: The emergency department of a 628‐bed tertiary care university hospital in Montreal, Canada.

SUBJECTS: 326 older patients examined in the ED by a geriatric consult team (GCT).

METHODS: The records kept by the GCT during a 12‐month period were reviewed retrospectively, and the patient cohort was followed for 2 years by telephone or review of hospital charts. Mortality, rate of revisit to ED, readmission to hospital, and final disposition were examined.

RESULTS: The study revealed a particularly high hospital admission rate (63.5%) among those older people consulted by the GCT. The high prevalence rates for the classic geriatric syndromes of falls, incontinence, iatrogenic events, and confusional states suggest a need to address these problems early in their presentation, preferably beginning in the ED. A 2‐year follow‐up exhibited high mortality rates (33.7%) as well as a long‐term institutionalization rate of 52%.

CONCLUSION: The older patients seen in the ED of the acute care hospital for whom multidisciplinary geriatric consult is requested constitute a high‐risk population. Within 2 years after initial consultation, many are dead and more than half have been institutionalized. The results of our follow‐up imply the need for multidisciplinary intervention early on in the course of an older patient's ED visit as well as close follow‐up after hospital discharge.
Underutilization of Angiotensin‐Converting Enzyme Inhibitors in Older Patients with Q‐Wave Anterior Myocardial Infarction in an Academic Hospital‐Based Geriatrics Practice
Authors: Mendelson Gad , Aronow Wilbert S.
Published: April 2015

OBJECTIVE: To investigate the prevalence of angiotensinconverting enzyme (ACE) inhibitors use in older persons without contraindications to ACE inhibitors and with prior Q‐wave anterior myocardial infarction (MI), anterior MI with congestive heart failure (CHF), and with anterior MI and a left ventricular ejection fraction (LVEF) ≥ 40% in an academic hospital‐based geriatrics practice.

DESIGN: A retrospective analysis of charts from all older patients seen from January 1996 through July 1997 at an academic hospital‐based geriatrics practice was performed to investigate the prevalence of ACE inhibitor use in older patients with prior Q‐wave anterior MI, anterior MI with CHF, and anterior MI with LVEF ≤ 40% without contraindications to ACE inhibitors.

SETTING: An academic hospital‐based primary care geriatrics practice staffed by fellows in a geriatrics training program and full‐time faculty geriatricians.

PATIENTS: Ninety‐six women and 65 men, mean age 82 ± 8 years (range 65 to 96), were included in the study.

MEASUREMENTS AND RESULTS: Of 161 patients with Q‐wave anterior MI and no contraindications to ACE inhibitors, LVEF was measured in 58 patients (36%), 56 (35%) of whom were receiving ACE inhibitors. Of 45 patients with Q‐wave anterior MI and CHF, 30 patients (67%) were receiving ACE inhibitors. Of 15 patients with Q‐wave anterior MI and asymptomatic LVEF ≤ 40%, four patients (27%) were receiving ACE inhibitors.

CONCLUSIONS: There is a marked underutilization of use of ACE inhibitors in treating older patients with Q‐wave anterior MI in an academic hospital‐based geriatrics practice.
Association of Electrocardiographic Left Ventricular Hypertrophy with the Incidence of New Congestive Heart Failure
Authors: Aronow Wilbert S. , Ahn Chul
Published: April 2015

OBJECTIVE: To investigate the association of electrocardiographic (ECG) left ventricular hypertrophy (LVH) with the incidence of new congestive heart failure (CHF) in older people.

DESIGN: In a prospective study of 2638 older people, ECGs were obtained at study entry, at 1 month after study entry, when clinically indicated, and at least yearly after study entry. ECG LVH was diagnosed if the point score of Romhilt and Estes was ±5. Persistent LVH was diagnosed if all of the ECGs showed LVH. New LVH was diagnosed if the baseline ECG showed no LVH but LVH was present on the last ECG. Regression of LVH was diagnosed if the baseline ECG showed LVH but no LVH was present on the last ECG. No LVH was diagnosed if all of the ECGs showed no LVH. Persistent LVH, new LVH, regression of LVH, and no LVH were correlated with the incidence of new CHF at follow‐up.

SETTING: A large long‐term health care facility.

PATIENTS: The patients included 1805 women and 833 men, mean age 81 ± 9 years (range 60 to 103).

MEASUREMENTS AND MAIN RESULTS: Of the 2,638 older persons studied, 281 (11%) had persistent ECG LVH, 31 (1%) had new ECG LVH, 12 (0.5%) had regression of ECG LVH, and 2314 (88%) had no ECG LVH. At 42 ± 24 months (range 1 to 154 months) follow‐up, new CHF developed in 168 of 281 persons (60%) with persistent LVH, in 16 of 31 persons (52%) with new LVH, in 4 of 12 persons (33%) with regression of LVH, and in 507 of 2314 persons (22%) with no LVH. Kaplan‐Meier survival curves showed that the development of new CHF was higher in persons with persistent LVH versus regression of LVH (P = .013), in persons with persistent LVH versus no LVH (P = .001), in persons with new LVH versus regression of LVH (P = .039), and in persons with new LVH versus no LVH (P = .001).

CONCLUSION: Older persons with persistent or new ECG LVH have a higher incidence of new CHF and an earlier time to the development of new CHF than older persons without ECG LVH.
Combination Therapy for Early Alzheimer's Disease: What Are We Waiting for?
Authors: Doraiswamy P. Murali , Steffens David C.
Published: April 2015

The practical pharmacological approaches currently available to palliate the cognitive and functional losses in early Alzheimer's disease (AD) include Cholinesterase inhibitors (ChEI), antioxidants (e.g., vitamin E), anti‐inflammatory agents, estrogen, seligiline, vasoactive agents, and ginkgo biloba. Reviewing available data on these therapies and using models from medical illnesses such as cancer and hypertension, we highlight the urgent need for evaluating combination therapies in early AD.
Plasma Antioxidants and Cognitive Performance in Middle‐Aged and Older Adults: Results of the Austrian Stroke Prevention Study
Authors: Schmidt R. , Hayn M. , Reinhart B. , Roob G. , Schmidt H. , Schumacher M. , Watzinger N. , Launer L. J.
Published: April 2015

OBJECTIVES: To study the association between cognitive status and plasma concentrations of various antioxidants in middle‐aged and older individuals without neuropsychiatric disease.

DESIGN: Evaluation of cross‐sectional data from a cohort study.

SETTING: The Austrian Stroke Prevention Study.

PARTICIPANTS: A total of 1769 subjects aged 50 to 75 years, with no history or signs of neuropsychiatric disease, selected randomly from the community register.

MEASUREMENTS: The score on the Mattis Dementia Rating Scale (MDRS) was dichotomized according to age‐and education‐specific lowest quartile cut‐off points. Reversedphase high performance liquid chromatography measurements of the plasma concentrations of lutein/zeaxanthin, cryptoxanthin, canthaxanthin, lycopene, alpha‐carotene, beta‐carotene, retinol, gamma‐tocopherol, alpha‐tocopherol, and ascorbate were measured.

RESULTS: Individuals with MDRS results below the lowest quartile cut‐off point had lower levels of beta‐carotene and alpha‐tocopherol than their counterparts with test performance above this limit (0.44 ± .33 μmol/L vs 0.51 ± .48 μmo/L, P < .001; and 29.50 ± 7.98 μmol/L vs 30.93 ± 11.10 μmol/L, P < .001, respectively). Only alpha‐tocopherol remained significantly associated with cognitive functioning when logistic regression analysis was used to adjust for possible confounders including age, sex, month of blood sampling, years of education, smoking, lipid status, and major risk factors for stroke (P = .019).

CONCLUSION: These observations are compatible with the view that some dietary antioxidants may protect against cognitive impairment in older people.
The Effect of Aging on Bone Mineral Metabolism and Bone Mass in Native American Women
Authors: Perry Horace M. , Bernard Marie , Horowitz Michael , Miller Douglas K. , Fleming Shantiel , Baker Mary Zoe , Flaherty Joseph , Purushothaman Raj , Hajjar Ramzi , Kaiser Fran E. , Patrick Ping , Morley John E.
Published: April 2015

OBJECTIVE: To examine the effect of age on mineral metabolism and bone mineral density (BMD) of the hip and spine in Native American women.

DESIGN: A cross‐sectional study.

SETTING: The Sac and Fox Nation in rural Oklahoma

MEASUREMENTS: Serum measurements were made of 25 hydroxyvitamin D (250HD), osteocalcin, and immunoreactive parathyroid hormone. Bone mineral density of the hip and spine was assessed by dual energy X‐ray absorptiometry.

PARTICIPANTS: A total of 77 Native American women aged 19 to 85 years.

RESULTS: Serum 25 hydroxyvitamin D was related inversely to age (r = −0.32; P < .05) and was less than 15 ng/mL in 7% of the subjects. Serum osteocalcin was higher (P < .001) in postmenopausal than in premenopausal subjects. In postmenopausal subjects, serum osteocalcin was related to age (r = .59, P < .001). BMD was lower (P < .001) in postmenopausal than in premenopausal subjects. There was no evidence of bone loss before age 50 in either the femur or the spine. Age (r > −0.48, P < .001) and body mass index (BMI) (r ≥ 0.41, P < .005) were independent determinants of both femoral and lumbar BMD. Serum 250HD was a significant independent determinant of both lumbar (r = .26, P < .05) and femoral (r = .41, P < .01) BMD. Age, BMI, and serum 250HD together accounted for 70% of the variance in BMD at these sites. The use of t scores indicated femoral bone density was higher (P < .05) in premenopausal Native American women, and lower (P < 0.05) in postmenopausal subjects, compared with white women.

CONCLUSIONS: In Native American women, there is a reduction in bone density and a sustained increase in bone turnover postmenopausally. BMI and serum 250HD are significant determinants of BMD. Peak BMD may be higher, and the postmenopausal rate of bone loss greater, than that in white women.
Management of Older Persons After Myocardial Infarction
Authors: Aronow Wilbert S.
Published: April 2015

OBJECTIVE: To review the management of the older person after myocardial infarction (MI).

DATA SOURCES: A computer‐assisted search of the English language literature (MEDLINE database) followed by a manual search of the bibliographies of pertinent articles.

STUDY SELECTION: Studies on the management of persons after MI were screened for review. Studies in persons older than 60 years and recent studies were emphasized.

DATA EXTRACTION: Pertinent data were extracted from the reviewed articles. Emphasis was on studies involving older persons. Relevant articles were reviewed in depth.

DATA SYNTHESIS: Available data about therapy of persons after MI, including control of risk factors, use of aspirin and beta‐blockers, and indications for use of angiotensin‐converting enzyme inhibitors, long‐term anticoagulant therapy, nitrates, calcium channel blockers, hormone replacement therapy, antiarrhythmic drugs, the automatic implantable cardioverter‐defibrillator, and revascularization, with emphasis on studies involving older persons, were summarized.

CONCLUSIONS: Risk factors for coronary artery disease should be controlled after MI in older persons. A serum low‐density lipoprotein (LDL) cholesterol > 125 mg/dL after MI should be treated with lipid‐lowering drug therapy to decrease the serum LDL cholesterol to < 100 mg/dL. Aspirin in a dose of 160 mg to 325 mg daily should be given indefinitely. Indications for long‐term anticoagulant therapy with warfarin after MI to maintain an international normalized ratio between 2.0 and 3.0 include secondary prevention of MI in persons unable to tolerate daily aspirin, persistent atrial fibrillation, and left ventricular thrombus. Beta‐blockers should be given indefinitely. Angiotensin‐converting enzyme inhibitors should be given to persons who have congestive heart failure, an anterior MI, or a left ventricular ejection fraction ≤ 40%. Calcium channel blockers should not be used unless there is persistent angina pectoris despite beta‐blockers and nitrates. Antiarrhythmic drugs other than beta‐blockers should not be used. An automatic implantable cardioverter‐defibrillator should be used in persons who have a history of ventricular fibrillation or serious sustained ventricular tachycardia or who are at very high risk for developing sudden cardiac death. Until data from the Heart Estrogen/Progestin Replacement Study are available, use of an estrogen/progestin regimen is recommended in the treatment of postmenopausal women after MI unless they are at increased risk for developing breast cancer. The two indications for revascularization in older persons after MI are prolongation of life and relief of unacceptable symptoms despite optimal medical management.
Aging‐Related Clinical and Health Services Research in Canada
Authors: Rockwood Kenneth , Bergman Howard , Hogan David B. , McCracken Peter
Published: April 2015

Research by Canadian geriatricians has grown significantly since the Canadian Society of Geriatric Medicine was founded in 1981. Most research has been clinical or related to health service use. More recently, the Canadian Study of Health and Aging (CSHA) has proved an important focus for population‐based research, and research on dementia.

An increasing number of Canadian geriatricians have undertaken formal research training, and the CSHA study team and other groups are providing opportunities for multicentre, multi‐disciplinary, collaborative studies. These developments point to continued growth in research by Canadian geriatricians, most likely research with a clinical and population focus and employing multicenter designs. J Am Geriatr Soc 46:1469–1472, 1998.
Oral Cobalamin for Pernicious Anemia: Back from the Verge of Extinction
Authors: Lederle Frank A.
Published: April 2015

BACKGROUND: High dose oral cobalamin therapy was shown to be effective for pernicious anemia and other cobalamin deficiency states 30 years ago, and physicians and patients state that they would find oral therapy useful, but a survey conducted in 1989 found that physicians were generally unaware of it.

OBJECTIVE: To assess physician awareness and use of oral cobalamin since 1989.

DESIGN, SETTING, AND PARTICIPANTS: Minneapolis area internists not listed as having subspecialties or academic business addresses were surveyed in 1989 and in 1996.

MEASUREMENTS AND RESULTS: There were 245 responses to the 1989 survey and 223 responses to the 1996 survey for response rates of 68% and 69%, respectively. The percentage of internists who ever used oral cobalamin to treat pernicious anemia increased from 0 in 1989 to 19% in 1996 (P < .001). The percentage who were aware of an effective oral cobalamin preparation for treating cobalamin deficiency states also increased significantly from 4 to 29% (P < .001). The percentage of internists who agreed with the incorrect view that sufficient quantities of cobalamin cannot be absorbed when given orally declined from 91% in 1989 to 71% in 1996 (P < .001).

CONCLUSION: /b Minneapolis internists' awareness and use of oral cobalamin treatment for pernicious anemia increased substantially between 1989 and 1996, but the majority of internists remained unaware of this treatment option.
Exercise‐Induced Silent Myocardial Ischemia and Future Cardiac Events in Healthy, Sedentary, Middle‐Aged and Older Men
Authors: Katzel Leslie I. , Sorkin John D. , Goldberg Andrew P.
Published: April 2015

OBJECTIVES

Before men older than age 45 participate in vigorous exercise programs, the American Heart Association and the American College of Sports Medicine recommend they undergo a screening maximal exercise treadmill test. We examined the predictive value for subsequent cardiac events of exercise‐induced silent myocardial ischemia (SI) during the exercise treadmill test in healthy, sedentary, obese, middle‐aged and older men recruited for research studies.

DESIGN

A cohort study with 7 years of follow‐up

SETTING

Out‐patient research at a tertiary hospital

PARTICIPANTS

170 healthy, sedentary, obese, middle‐aged and older (ages 45–79 years) men with no prior history of coronary artery disease (CAD) recruited for research studies

MEASUREMENTS

Cardiac risk factors, exercise‐induced SI (ST segment depression on the electrocardiogram during a maximal exercise treadmill test), maximal aerobic capacity (V̇O2max), and 7‐ year follow‐up data on incident CAD

RESULTS

At baseline, 37 of the men (22%) had exercise‐induced SI on their treadmill tests. Seven‐year follow‐up data was obtained in 97% of the patients. In the interim, 31 men had cardiac endpoints (sudden cardiac death, myocardial infarction, angioplasty, coronary artery bypass graft surgery, angina), and four had noncardiac deaths. Seventeen of the 37 men (46%) with exercise‐induced SI on their baseline exercise tests had cardiac endpoints compared with 14 of 133 (11%) men with normal exercise tests (P < .001). Compared with the men with no cardiac endpoints, the men with subsequent cardiac endpoints were older (63 ± 1 vs 58 ± 1 years, mean ± SEM, P < .001) and had a lower maximal aerobic capacity (V̇O2max) (24 ± 1 vs 29 ± 1 mL/kg/min, P < .001). In Cox proportional hazards analysis, exercise‐induced SI and a low V̇O2max were independent predictors of subsequent cardiac endpoints.

CONCLUSION

In a healthy population of obese, sedentary, middle‐aged and older men, exercise‐induced SI and low V̇O2max were predictors of incident CAD. This suggests that exercise treadmill testing is beneficial in assessing risk for future cardiac events in obese, sedentary individuals. J Am Geriatr Soc 47:923–929, 1999.
Aging Versus Disease: The Opinions of Older Black, Hispanic, and Non‐Hispanic White Americans About the Causes and Treatment of Common Medical Conditions
Authors: Goodwin James S. , Black Sandra A. , Satish Shiva
Published: April 2015

BACKGROUND

Little is known about how older people interpret disease and how those interpretations might relate to use of medical services.

OBJECTIVE

To assess opinions of older subjects about the cause and treatment of common diseases and how they are related to health behaviors.

DESIGN

In‐home interview of a population‐based sample (n = 601) of noninstitutionalized black, Hispanic, and non‐Hispanic white American men and women aged 75 and older in Galveston County, Texas.

RESULTS

Substantial proportions of the subjects considered heart disease, arthritis, or difficulty sleeping to be a normal part of aging. In multivariate analyses including age, gender, education, marital status, living arrangement, global self‐rating of health, and comorbidity, older black subjects were less likely to view heart disease (OR = 0.41; 95% CI, 0.26–0.64), arthritis (OR = 0.48; 95% CI, 0.31–0.73), or sleep problems (OR = 0.50; 95% CI, 0.32–0.77) as a normal part of aging than were non‐Hispanic whites. Blacks were more than three times as likely to attribute heart disease to overwork or stress than were non‐Hispanic whites. In multivariate analyses, subjects who considered all three of the medical conditions to be a normal part of aging (“fatalistic”) were less likely to have received preventive medical services in the previous year (OR = 0.13; 95% CI, 0.02–0.96), and subjects who felt that nothing could be done to treat any of the conditions (“nihilistic”) were less likely to have a regular physician (OR = 0.24; 95% CI, 0.08–0.74).

CONCLUSIONS

Substantial numbers of older subjects are fatalistic about the cause of disease and/or nihilistic about its treatment. These attitudes are associated with decreased utilization of health services. Attempts to improve the health of underserved groups should employ interventions that are sensitive to the health beliefs of the targeted group.
Quality of Life Impact of Urge Incontinence in Older Persons: A New Measure and Conceptual Structure
Authors: DuBeau Catherine E. , Kiely Dan K. , Resnick Neil M.
Published: April 2015

OBJECTIVE

To develop a condition‐specific measure for assessing the impact of urge urinary incontinence (UI) on the quality of life (QoL) of older persons.

DESIGN

A 32‐item Urge Impact Scale (URIS) was drafted using content area data from focus groups composed of urge incontinent older persons. Pilot testing in 21 urge incontinent persons (mean age 67.7 years) resulted in the elimination of eight items by internal consistency, skew, and patient response criteria. The resulting scale (URIS‐24) was tested for reliability (internal consistency and test‐retest correlation) and construct validity (correlation with UI severity from voiding records) in a separate group of 27 urge incontinent persons (89% women, mean age 72 years). Factor analysis of URIS‐24 data from the combined 48 persons was used to explore the conceptual structure underlying urge UI‐related QoL.

SETTING

University‐affiliated community‐based practice and tertiary hospital.

PARTICIPANTS

Community‐dwelling women and men, older than age 60 and with urge incontinence at least twice weekly, recruited from newspaper, newsletter, and radio advertisements.

RESULTS

Cronbach's alpha for URIS‐32 was 0.84, and for URIS‐24 it was 0.94. When administered (mean ± standard deviation) 9.2 ± 5.1 days apart, URIS‐24 had good test‐retest reliability for total scores (interclass coefficient = .88, concordance coefficient = .88), and individual item scores at time 2 were within 1 point (on a 5‐category Likert scale) of time 1 answers for 89% of responses. URIS‐24 scores had modest but nearly significant correlation with the number of UI episodes (r = −0.39, P = .05). Factor analysis revealed a three component structure corresponding to psychological burden, perception of personal control, and self concept.

CONCLUSIONS

The URIS‐24 is an internally‐consistent, highly reproducible tool for the assessment of the QoL impact of urge UI on older persons. It can be used to evaluate QoL impact by specific items as well as by overall score. Compared with other UI‐specific QoL measures, the URIS‐24 had similar or superior internal consistency, test‐retest reliability, and validity, but it is the first measure designed and tested specifically for older persons with urge UI. These results also highlight the multifactorial structure of urge UI‐related QoL and the importance of its psychological dimensions.
The Validity of Nutritional Status as a Marker for Future Disability and Depressive Symptoms Among High‐Risk Older Adults
Authors: Boult Chad , Krinke U. Beate , Urdangarin Cristina Flood , Skarin Vicki
Published: April 2015

OBJECTIVE

To measure the validity of the DETERMINE Checklist as a marker for future functional disability, depressive symptoms, and mortality among high‐risk older adults.

DESIGN

A Cohort study.

SETTING

An Urban‐suburban Midwestern community.

PARTICIPANTS

Community‐dwelling Medicare beneficiaries at high risk for hospital admission who received geriatric evaluation and management (GEM) (n = 251).

MEASUREMENTS

Demographic, health‐related, functional, psychosocial, survival, and nutritional data were collected through telephone and in‐home interviews.

RESULTS

GEM recipients with baseline Checklist scores of four or higher were found to be significantly more likely than those with lower scores to have functional disability or high levels of depressive symptoms a year later. Checklist scores did not predict mortality.

CONCLUSIONS

The 10‐item Checklist could be used as a secondary screen to identify older persons who, without treatment, are at especially high‐risk to have disability or depression a year later.
Weight, Weight Change, and Mortality in a Random Sample of Older Community‐Dwelling Women
Authors: Reynolds Matthew W. , Fredman Lisa , Langenberg Patricia , Magaziner Jay
Published: April 2015

OBJECTIVE: To evaluate the relationship between measured weight, weight change, and 6‐year mortality risk in a random sample of 648 community‐dwelling women aged 65 and older from Baltimore, Maryland.

MEASUREMENTS: Data were collected using a standardized questionnaire and administered in person by trained interviewers. Questionnaires were completed annually from 1984 to 1986, and body weight was measured at each interview. Weight was defined as body mass index (BMI) of low (<23 kg/m2), average (≥ 23 kg/m2 to ≤ 28 kg/m2), and high (> 28 kg/m2). Four mutually exclusive categories of weight change of at least 4.5% in BMI over the three annual interviews were developed to describe all possible weight change patterns: weight gain, weight loss, no change, and weight cycling.

RESULTS: During the follow‐up period, 106 women (16%) died. Women with low baseline BMI, regardless of weight change, and those who lost weight, regardless of baseline BMI had increased mortality risk. Women with average baseline BMI and weight loss had a very high mortality risk (hazard ratio (HR) 3.84, 95% Confidence interval (CI) 2.14‐6.89). Women who weight cycled had increased mortality risk at low and high baseline weights, and a nonsignificant increased risk at average baseline weight (P = .069). Analyses were adjusted for age, education, smoking, alcohol usage, and pre‐existing illness and included an interaction between weight change and baseline BMI.

CONCLUSIONS: These results suggest that white, older, community‐dwelling women are at an increased risk of mortality if they are underweight, lose weight, or weight cycle. J Am Geriatr Soc 47:1409–1414, 1999.
Atrial Natriuretic Peptide Levels in Geriatric Patients with Nocturia and Nursing Home Residents with Nighttime Incontinence
Authors: Ouslander Joseph , Johnson Theodore , Nasr Samer , Schnelle John , Miller Myron
Published: April 2015

OBJECTIVES: To determine if nocturnal polyuria in geriatric patients with nocturia and nocturnal incontinence is associated with elevated plasma atrial natriuretic peptide (ANP) levels.

DESIGN: Case series.

SETTING: Four nursing homes and two board and care facilities.

PARTICIPANTS: Fifty‐four nursing home residents and 26 board and care residents with a mean age of 86.

MEASUREMENTS: Daytime (7:00 a.m. to 7:00 p.m.) and nighttime (7:00 p.m. to 7:00 a.m.) urine volumes of incontinent nursing home residents were measured over 3 days and 3 nights by reweighing preweighed adults diapers and toileting inserts emptied by research staff for the board and care group. Blood was drawn in the early morning (5:00 a.m. to 7:00 a.m.) before subjects arose and in the evening after an hour of lying in bed (8:00 p.m. to 11:00 p.m.), and plasma ANP levels were determined by radioimmunoassay.

RESULTS: Forty‐nine (61%) of the subjects had nocturnal polyuria as defined by night/total urine volume ratios ≥ 50%. There was no significant difference between those with night/total ratios ≥ 50% versus <50% in plasma levels of ANP in the early morning (44.2 ± 33.3, median 35.7 pg/mL vs 40.9 ± 39.2, median 28.5; P = .36 by Mann Whitney U) or in the evening (43.4 ± 28.8, median 36.4 pg/mL vs 49.6 ± 53.1, median 34.4; P = .58). Nor was there any significant correlation between night/total urine volume ratio and morning or evening ANP levels (r = .01, P = .96 and r = .23, P = .31, respectively).

CONCLUSIONS: In this sample of geriatric patients with nocturia and nursing home residents with nighttime urinary incontinence, ANP levels were elevated, but increased nighttime urine production was not associated with higher levels. Because of the variability in ANP levels, our power to detect such an association was low, and we cannot draw any definitive conclusions. Although high plasma ANP levels are unlikely to be a primary cause of nocturia and nighttime incontinence, they may, when combined with other factors such as low antidiuretic hormone levels, sleep disorders, and low functional bladder capacity, contribute to these symptoms in some geriatric patients. J Am Geriatr Soc 47:1439–1444, 1999.
Smoking and Mortality in an Older Chinese Cohort
Authors: Ho Suzanne C. , Zhan Si Yan , Tang Jin Ling , Chan Sieu Gaen , Woo Jean
Published: April 2015

OBJECTIVES: Only limited data are available regarding smoking and health in later life and, in particular, in the older Chinese population. This paper reports the relationship between smoking and mortality in a Chinese cohort aged 70 years and older.

SETTING: A population‐based study conducted in Hong Kong.

PARTICIPANTS: A cohort comprising 2030 subjects aged 70 and older were assembled in 1991–1992 and followed for 36 months.

DESIGN: A prospective cohort study.

MEASUREMENTS: Baseline information regarding smoking status as well as several social and health variables were obtained through face‐to‐face interview at the respondent's place of residence. The outcome variables were mortality from all causes as well as from cancer and cardiovascular and respiratory diseases. Causes of death were ascertained from death certificates.

RESULTS: The prevalence rates of smoking at baseline were 24.9% in men and 8.2% in women. A total of 534 deaths occurred during the 36‐month follow‐up period. Of these, 447 were attributable to three main causes: cancer, cardiovascular disease, and respiratory disease. Elevated mortality risks from all causes were observed among both male (RR = 1.4; 95% CI, 0.9‐1.9) and female (RR = 1.6; 95% CI, 1.0–2.5) current smokers, but the 95% confidence intervals overlapped. Significant association between current smoking and combined mortality from these three major causes was found in men; it was also found in women after excluding those with these diseases at baseline. More than a 3‐fold increased risk of cancer mortality was found in current smokers of both sexes. Although nonsignificant associations were found between former smokers and mortality risks in men, women who were former smokers had increased mortality risks from all causes as well as from cancer and respiratory diseases.

CONCLUSIONS: This 3‐year prospective study of an older Chinese cohort reveals the impact of smoking on health during later life, especially in women. Smoking cessation, particularly in older men, should be beneficial in reducing mortality. Smoking cessation should begin as early as possible for women. J Am Geriatr Soc 47:1445–1450, 1999.
Higher Systemic Arterial Compliance Is Associated with Greater Exercise Time and Lower Blood Pressure in a Young Older Population
Authors: Cameron J. D. , Rajkumar C. , Kingwell B. A. , Jennings G. L. , Dart A. M.
Published: April 2015

OBJECTIVES: Arterial compliance is an important therapeutic target in older individuals in whom stiffening of the proximal arterial circulation is thought to underlie systolic hypertension and increased cardiac work. We have shown previously that arterial compliance is related to aerobic fitness and that it is increased in young (20 to 35 years old), previously sedentary individuals by a 4‐week period of moderate aerobic training. The extent to which compliance relates to exercise performance in a random selection of young older patients has not been reported previously. Therefore, we examined the interrelationship between systemic arterial compliance (SAC) and time to cessation of exercise during a standard treadmill exercise test in an older population. DESIGN: A cross‐sectional survey.

METHODS: SAC was estimated at rest using simultaneous recordings of ascending aortic flow and carotid applanation tonometry in 43 subjects aged 67 ± 7 years (mean ± SD; 24 men and 19 women). Treadmill exercise testing was performed using a modified Bruce protocol. Aerobic capacity was assessed as Heart Rate‐Blood Pressure product and exercise tolerance as total treadmill time.

RESULTS: SAC and exercise tolerance were related to gender, with men exhibiting greater exercise reserve and higher SAC than women. There was a significant positive correlation between SAC and time to cessation of exercise (r = .34; P = .03), with a negative correlation between SAC and resting heart rate‐blood pressure product (r = ‐.66; P < .001). SAC was correlated with height and blood pressure. Exercise tolerance was related to height (P < .02).

CONCLUSIONS: These data indicate a positive association between SAC and fitness level in healthy older people and an inverse association between SAC and systolic blood pressure. Our findings are consistent with either (1) acquisition of a more compliant circulation and lower blood pressure through more physical activity or (2) that a more compliant arterial circulation and lower blood pressure permit greater athletic performance. J Am Geriatr Soc 47:653–656, 1999.
Lower Incidence of Tardive Dyskinesia with Risperidone Compared with Haloperidol in Older Patients
Authors: Jeste Dilip V. , Lacro Jonathan P. , Bailey Anne , Rockwell Enid , Harris M. Jackuelyn , Caligiuri Michael P.
Published: April 2015

OBJECTIVE: To compare the 9‐month cumulative incidence of tardive dyskinesia (TD) with risperidone to that with haloperidol in older patients.

DESIGN: A prospective longitudinal study.

SETTING: An outpatient psychiatric clinic.

PARTICIPANTS: Subjects were middle‐aged and older (mean age 66 years) patients with schizophrenia, dementia, mood disorders, or other conditions with psychotic symptoms or severe behavioral disturbances. Sixty‐one patients on risperidone were matched with 61 patients from a larger sample of haloperidol‐treated patients in regard to age, diagnosis, and length of preenrollment neuroleptic intake to create clinically comparable groups. The median daily dose of each medication was 1.0 mg.

MEASUREMENTS: Abnormal Involuntary Movement Scale, modified Simpson‐Angus' scale for extrapyramidal symptoms, Brief Psychiatric Rating Scale, and Mini‐Mental State Examination were administered at baseline, 1 month, and 3, 6, and 9 months. The diagnosis of TD was based on specific research criteria. The raters were blind to the patient's medication status.

RESULTS: Life table analysis revealed that patients treated with haloperidol were significantly more likely to develop TD than patients treated with risperidone (P < .05, Peto‐Prentice).

CONCLUSIONS: The atypical antipsychotic risperidone is significantly less likely to result in TD than the conventional neuroleptic haloperidol in a high‐risk group of older patients, at least over a 9‐month period. J Am Geriatr Soc 47:716–719, 1999.
Low Blood Pressure and Incidence of Dementia in a Very Old Sample: Dependent on Initial Cognition
Authors: Guo Zhenchao , Viitanen Matti , Winblad Bengt , Fratiglioni Laura
Published: April 2015

OBJECTIVE: To examine whether initially low blood pressure is related to the incidence of dementia.

DESIGN: A population‐based prospective study.

SETTING: The Kungsholmen district of Stockholm, Sweden

PARTICIPANTS: Three hundred four nondemented subjects aged 75 to 96 years at baseline.

MEASUREMENTS AND MAIN RESULTS: After an average of 3 years, 81 dementia cases were identified (67 with Alzheimer's disease cases). Compared with individuals with baseline systolic pressure of 141 to 179 mm Hg, those with systolic pressure ≤ 140 mm Hg had a significantly higher risk of dementia (relative risk (RR) = 1.9, 95% confidence interval (CI), 1.2–3.2) and Alzheimer's disease (RR = 2.2, 95% CI, 1.2–3.8). However, the RR in relation to systolic pressure ≤ 140 mm Hg was 1.3 (0.8‐2.2) for all dementia and 1.5 (0.8‐2.6) for Alzheimer's disease, when the baseline Mini‐Mental State Examination (MMSE) score was included in the model as a dichotomous variable (< 24 vs ≥ 24). Baseline MMSE <24 significantly predicted the occurrence of dementia (RR = 6.9; 95% CI, 4.3–11.1). Systolic pressure ≤ 140 mm Hg was significantly related to MMSE score < 24 at baseline.

CONCLUSIONS: These data suggest that low blood pressure may be an early correlate of a dementing process although a causative effect cannot be definitely ruled out. J Am Geriatr Soc 47:723–726, 1999.