ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06579.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To study the relationship between estrogen hormone replacement therapy and recall of proper names and words in cognitively intact older women.DESIGN: A case‐control study using subjects matched on age and education.PARTICIPANTS: From a group of 278 older (age range 55 to 93 years) community‐dwelling women volunteers for memory research, 72 older women taking estrogen replacement therapy were matched on age and education with a group of 72 women not taking estrogen.MEASUREMENTS: Dependent measures were performances on: a proper name recall test and a word recall test.RESULTS: Proper name recall was significantly better in those receiving estrogen (mean = 4.3; SD = 3.3) than in those not receiving estrogen (mean = 3.1; SD = 2.5),P= 0.01. There was also significantly greater variance in the name recall scores of the group taking estrogen than in the group not taking estrogen. For word recall, there was no significant difference between those subjects taking estrogen (mean = 6.4; SD 3.8) and those not taking estrogen (mean = 5.8; SD 3.7),P>0.10.CONCLUSIONS: Estrogen use was associated with enhanced recall of proper names. Previous failures to find differences associated with estrogen use may reflect the memory measures used or an increased inter‐individual variability of the estrogen‐taking group, as was observed in the present study. Interpretation of these results should be tempered by their retrospective

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06580.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To investigate the relationship between lower extremity arterial disease, functional status, and mobility among elderly women.DESIGN: Cross‐sectional study.SETTING: Community.PARTICIPANTS: 1492 healthy white women, 65 years of age or older, residing in a rural community, able to walk without the assistance of another person, and enrolled in the Pittsburgh clinic of the multicenter Study of Osteoporotic Fractures. Those with bilateral hip replacement were excluded.MEASUREMENTS: Ankle/arm index (AAI); instrumental activities of daily living (IADLs); measures of recent physical activity, muscle strength, gait and balance; general demographic, lifestyle, and physical variables.RESULTS: Women with lower extremity arterial disease (defined as an AAI of 0.9 or less) were more likely to report difficulty with one or more IADLs than were women free of this disease. After adjusting for age and other potential confounders, only difficulty with walking 2–3 blocks remained highly correlated with disease (relative risk (RR) 2.8, 95% confidence interval (CI) 1.6, 4.8). Several measures of physical activity were inversely and independently related to a low AAI. Muscle strength in the hip, arm, knee, and hand and measures of static and dynamic balance were correlated with low AAI in the univariate analysis, but most of these trends were not statistically significant after adjustment for age and other confounders. Exclusion of women with symptomatic arterial disease did not substantially affect the results obtained.CONCLUSION: Women with mild, predominantly subclinical, lower extremity arterial disease living in the community have decreased functional status and mobil

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06581.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To present baseline data from a prospective study of postprandial hypotension in 499 elderly persons in a long‐term health care facility.DESIGN: Analyses of baseline data for a prospective study.SETTING: A large long‐term health care facility where 499 ambulatory or wheelchair‐bound residents were studied.PATIENTS: The 499 residents were ≥ 62 years of age, mean age 80 ± 9 years (range 62–100), 71% female, 29% male, 66% white, 27% black, 7% Hispanic, 68% ambulatory, and 32% wheelchair‐bound.MEASUREMENTS AND MAIN RESULTS: The mean maximal decrease in postprandial systolic and diastolic blood pressures was 15 ± 6 mm Hg/6 ± 2 mm Hg. The mean maximal decrease in postprandial systolic blood pressure occurred 15 minutes after eating in 13% of residents, 30 minutes after eating in 20% of residents, 45 minutes after eating in 26% of residents, 60 minutes after eating in 30% of residents, and 75 minutes after eating in 11% of residents. Of 499 residents, 118 (24%) had a maximal decrease in postprandial systolic blood pressure of ≥20 mm Hg. The mean maximal decrease in postprandial systolic blood pressure was 24 ± 5 mm Hg in residents with syncope in the prior 6 months and 14 ± 5 mm Hg in residents without syncope (P<0.0001). The mean maximal decrease in postprandial systolic blood pressure was 21 ± 5 mm Hg in residents with falls in the preceding 6 months and 13 ± 4 mm Hg in residents without falls (P<0.0001). The mean maximal decrease in postprandial systolic blood pressure was significantly greater in residents treated with angiotensin‐converting enzyme inhibitors, calcium channel blockers, diuretics, nitrates, digoxin, and psychotropic drugs than in residents not treated with these drugs. The mean maximal decrease in postprandial systolic and diastolic blood pressures was not significantly different in elderly blacks, Hispanics, and whites.CONCLUSIONS: A more severe reduction in postprandial systolic blood pressure correlates with a history of syncope or falls in the previous 6 months. Long‐term follow‐up is being planned to determine whether a marked reduction in postprandial systolic blood pressure in elderly persons correlates with a higher incidence of falls, syncope, new coronary events, new s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06582.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To determine whether low serum B12levels are associated with an increased incidence of dementing illness.DESIGN: Longitudinal cohort study, 5‐year follow‐up.PARTICIPANTS: Volunteer cohort of 410 nondemented ambulatory subjects aged 75 to 85 years.MEASUREMENTS: Annual serum B12determinations and neuropsychological assessments including the Blessed Test of Information, Memory and Concentration (BIMC) and the Fuld Object Memory Evaluation (FOME). If subject met criteria for a major cognitive change (as defined by an increase of 4 or more points on the BIMC), a work‐up that included CT, EEG, and neurologic assessment was performed. Clinical diagnoses were made according to established criteria.RESULTS: Mean serum B12level of entire sample was 558 pg/mL. Twenty‐two subjects had low B12levels defined as values<150 pg/mL. Three of these 22 subjects (13.6%) became demented, compared with 57 of 388 subjects (14.7%) with higher levels. The incidence of Alzheimer disease among the low B12group was 4.5% compared with 7.5% in the higher B12group. The mean B12level at time of diagnosis in subjects who did develop Alzheimer disease was 551 pg/mL. There was no evidence of hematologic disorder among the 22 subjects with low B12. Of the 3 low B12subjects who did become demented, none responded to monthly B12injections.CONCLUSION: A low B12level may not be a risk factor for dementia in general or Alzheimer disease in par

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06583.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To determine the safety and efficacy of 3 months of resistive training of multiple lower extremity muscle groups compared with balance training in persons over 75 years.DESIGN: Randomized 3‐month clinical trial. Subjects (n= 110, mean age 80) were randomized to 4 groups in a 2 × 2 design (control, resistive, balance, combined resistive/balance).INTERVENTIONS: Resistive training involved knee extension and flexion, hip abduction and extension, and plantar and dorsiflexion using simple resistive machines and sandbags. Balance training consisted of exercises to improve postural control. The control group attended 5 health‐related discussion sessions.MEASUREMENTS: Summed isokinetic moments (N m) of 8 leg movements: hip, knee and ankle flexion/extension, and hip abduction/adduction. Secondary outcomes were gait velocity and chair rise time.MAIN RESULTS: Summed peak moment increased in both resistive exercise‐trained groups (13% increase in the resistive group and 21% in the combined training group,P<0.001). The effect of resistance training was significant (MANOVA F = 21.1,P<0.001), but balance training did not improve strength, and there was no interaction (positive or negative) between balance and resistive training. Maximal gait velocity and chair rise time did not improve. Eleven subjects (20%) had musculoskeletal complaints related to resistive training, but all were able to complete the program with modifications.CONCLUSION: Resistive training using simple equipment is an effective and acceptable method to increase overall leg strength in older persons. Resistive or balance training did not improve maximal gait velocity or chair rise time in this sample of relatively healthy older p

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06584.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVES: To examine prescribing and utilization patterns of laxatives, stool softeners, and enemas in a large, long‐term care facility, to compare self‐reports of constipation with specific, bowel‐related symptoms in residents of this facility, and to examine concordance between bowel symptoms reported by residents and the assessments of the nursing staff.DESIGN: Cross‐sectional study.SETTING AND SUBJECTS: All individuals residing in an academically oriented long‐term care facility in the United States for at least 1 month (n= 694).MEASUREMENTS: Clinical, functional, and medication data were abstracted from the medical and nursing records. Individual interviews regarding bowel‐related symptoms were conducted with all able participants (n= 456 (66%)) and their respective primary nurses, and concordance was determined. The study definition ofsymptom‐specific constipationwas no more than 2 bowel movements per week and/or straining on more than 1 in 4 bowel movements.RESULTS: Fifty percent (n= 367) of all residents used at least 1 daily laxative, stool softener or enema during a 1‐month study period. Over half of all laxative users (n= 200) took more than 60 doses per month. Stool softeners were most commonly prescribed, followed by saline laxatives, stimulant laxatives, hyperosmolar laxatives, and bulk laxatives. Forty‐seven percent (n= 213) of the 456 interview responders reported constipation (“self‐reporters”), but only 62% of self‐reporters met the study criteria for symptom‐specific constipation. Concordance between resident's and nurse's report regarding specific bowel symptoms was only fair to slight (kappa 0.12–0.38). Self‐reporters of constipation took almost twice as many laxatives, stool softeners, and enemas as residents who did not report constipation.CONCLUSION: Our findings emphasize the need for a more systematic approach to the assessment of constipation in the long‐term care setting, particularly when pharmacolo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06585.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: In Western society, aging is often associated with adoption of a sedentary lifestyle and associated disuse muscle atrophy and weakness. Recent studies suggest a relationship between quadriceps muscle weakness and falls in elderly residents of US nursing homes (NHs). We hypothesized that fall rates would be lower in Japanese NHs, where lifestyle differences such as squatting to toilet or sleeping on the floor may maintain quadriceps strength and result in fewer falls. Therefore, we examined the relationships between falls, muscle strength, lifestyle, and other clinical characteristics in residents of a Japanese and an American NH.DESIGN: Cross‐culture, prospective, cohort study.MEASUREMENTS: We evaluated disease histories and current medications, quadriceps strength, and mobility of ambulatory American (n= 76) and Japanese (n= 89) NH residents, then followed these residents prospectively for the development of falls. Project staff from both sites trained together to assure uniform data ascertainment.MAIN RESULTS: During a 6‐month follow‐up period, fall rates were nearly 4‐fold higher in the American than in the Japanese residents (49% vs 13%, respectively;P<0.0001). In the American sample, fall rates declined with increasing muscle strength, while in Japan there was no relationship between fall rates and quadriceps strength. Residents also differed in number of medical diagnoses and use of medications, which were greater among American residents. The Japanese had slower gait speeds. Very few Japanese residents practiced squatting behaviors while living in the NH.CONCLUSIONS: The relationship between muscle weakness and falls is probably modified by multiple characteristics of the individual, their culture, and their environment. Information from cross‐cultural studies may provide new insights into effective fall prevention strategies for nursing home

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06586.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To examine changes in the rate of falling of an experimental group of restrained subjects who underwent restraint reduction, and to compare their rate of falling with a group of subjects who did not have restraint orders during the study period.DESIGN: A quasi‐experimental, multiple time‐series study utilizing the principles of single‐subject design. Each subject was followed for 25 weeks before and 25 weeks after initiation of the intervention.SETTING: Seven nursing homes.INTERVENTION: Formal programs aimed at reducing all bed and chair restraints were initiated in all sites after staff received education and training. Multidisciplinary teams implemented the restraint reduction process on a case‐by‐case basis, beginning with 1 unit/floor at a time in each site. Most experimental subjects reached their optimum restraint‐elimination/reduced status within 2 weeks of intervention initiation. The implementation periods ranged from 4 months to more than a year.PARTICIPANTS: Subjects with chart orders for restraints at the start of the study comprised the experimental group and participated in the restraint reduction program (184 subjects). Subjects with no orders for restraints during the study period comprised the nonequivalent control group (111 subjects) and, therefore, did not undergo the intervention.MEASUREMENTS: Incident reports documenting all falls during the study period were examined. Falls, the dependent variable, were classified as serious or nonserious. The independent variable (intervention) was the restraint reduction program offered to experimental subjects. Based on the principles of single subject design, the impact of the intervention on falls was calculated before and after the date the restraint reduction process was initiated for an individual (experimental group) subject. For the control group, the pre‐ and posttest period was calculated from the start date of the restraint reduction program on the unit on which each subject resided.RESULTS: Serious falls did not increase, but nonserious falls increased significantly after restraints were removed or reduced in experimental subjects. The total mean weekly fall rate for this group increased from 1.87% of residents falling per week during preintervention to 3.01% during postintervention. The mean weekly fall rate of the control group was 3.18% at pretest and did not change statistically over time.CONCLUSIONS: The increase in nonserious falls among the experimental group may be attributed to restraint reduction. The mean weekly fall rate in the experimental group postintervention (25 weeks) became comparable to the mean weekly fall rate for the control group during the entire study period (50 weeks). In light of such findings, policy makers have to confront the ethical choice between tying some frail, elderly subjects to beds and chairs versus exposing them to the risks of freedom in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06587.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

OBJECTIVE: To assess whether serum lipoprotein(a) is a risk factor for diabetic retinopathy in the elderly.DESIGN: A cross‐sectional study.SETTING: Outpatient diabetic clinic.PATIENTS: One hundred four noninsulin‐dependent diabetic patients (35 males, 69 females). Twenty‐three were less than 60 years of age (middle‐aged), and 81 were 60 years or older (elderly).MEASUREMENT: Levels of lipoprotein(a) (Lp(a)) and lipids were measured in fasting serum. HbA1c was also measured as an indicator of diabetic control. Other indicators possibly related to retinopathy were also checked. Retinopathy was estimated by photographs of fundi.RESULTS: Significantly higher indicators in the group with retinopathy than in the group without were: HbA1c, Lp(a), duration of diabetes, and systolic blood pressure (BP) in the total cases; HbA1c, duration of diabetes, and Lp(a) in the middle‐aged; HbA1c, systolic BP, and Lp(a) in the elderly. Multiple logistic regression analysis showed that only HbA1c and Lp(a) were independent risk factors for retinopathy in all cases and in the elderly. The incidence of retinopathy was positively correlated to serum Lp(a) levels.CONCLUSION: Lp(a) is an independent risk factor for diabetic re

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1994.tb06588.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY