摘要:

OBJECTIVE:To determine whether older persons with hypertension who use specific calcium antagonists and ACE inhibitors have a different risk of mortality than those using β‐blockers.DESIGN:A prospective cohort study continuing from 1988 through 1992.SETTING:Three communities of the Established Populations for Epidemiologic Studies of the Elderly.PARTICIPANTS:Hypertensive participants aged s 71 years (n = 906) who had no evidence of congestive heart failure and who were using either /3‐blockers (n = 515), verapamil (n = 77), diltiazem (n = 92), nifedipine (n = 74), or ACE inhibitors (n = 148). Nifedipine was of the short acting variety.MEASUREMENTS:The main outcome measure was all‐cause mortality. Age, gender, smoking, HDL‐cholesterol, blood pressure, intake of digoxin and diuretics, physical disability, self‐perceived health, and comorbid conditions were examined as confounders.RESULTS:During 3538 person‐years of follow‐up, 188 participants died (53 deaths per 1000 person‐years). Compared with j3‐blockers, after adjusting for age, gender, comorbid conditions and other health‐related factors, the relative risks (95% confidence interval) for mortality associated with use of verapamil, diltiazem, nifedipine, and ACE inhibitors were 0.8 (0.4‐1.4), 1.3 (0.8‐2.1), 1.7 (1.1–2.7), and 0.9 (0.6‐1.4), respectively. The results were unchanged after excluding participants with other potential contraindications to /3‐blockers and after stratifying on coronary heart disease and use of diuretics. Higher doses of nifedipine were associated with higher mortality.CONCLUSION:Compared with /3‐blockers, use of short acting nifedipine was associated with decreased survival in older hypertensive persons. However, selective factors influencing the use of specific drugs in higher risk patients could not be completely discounted, and final conclusion

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07393.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To determine whether a 12‐month program of regular exercise can improve balance, reaction time, neuromuscular control, and muscle strength and reduce the rate of falling in older women.DESIGN:A randomized, controlled trial of 12 months duration.SETTING:Conducted as part of the Randwick Falls and Fractures Study in Sydney, Australia.PARTICIPANTS:One hundred ninety‐seven women aged 60 to 85 years (mean age 71.6, SD = 5.4) who were randomly recruited from the community.OUTCOME MEASURES:Accidental falls, postural sway, reaction time, neuromuscular control, and lower limb muscle strength.MAIN RESULTS:Exercise and control subjects were tested before, midway through, and at the end of the trial. At initial testing, exercisers and controls performed similarly in all tests and were well matched in relevant health and lifestyle factors. The mean number of classes attended for the 75 exercise subjects who completed the program was 60.0 (range 26–82). At the end of the trial, the exercise subjects showed improved performance in all five strength measures, in reaction time, neuromuscular control, body sway on a firm surface with the eyes open, and body sway on a compliant surface with the eyes open and closed. In contrast, there were no significant improvements in any of the test measures in the controls. In one test measure, hip flexion strength, the exercisers showed continued improvement throughout the study year. There was no significant difference in the proportion of fallers between the exercise and control subjects. Interesting trends were evident, however, between falls frequency and adherence to the exercise program.CONCLUSIONS:These findings show that exercise can produce long‐term benefits with regard to improving sensorimotor function in older persons. The findings also suggest that high compliance to an exercise program may reduce falls frequency, although further studies are required to conclusively demonstrate that exercise offers an effective means of preventin

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07394.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES:The objectives were to identify situational risk factors associated with suffering a serious fall injury and to determine whether, and to what extent, predisposing and situational risk factors contributed independently to risk of suffering a serious fall injury.DESIGN:Nested cohort study.SETTING:General community.PARTICIPANTS:568 members of a representative sample of community‐living persons 72 years of age or older who fell during a median follow‐up of 36 months.MEASUREMENTS:Candidate predisposing factors, identified during a baseline face‐to‐face home assessment, were the demographic, cognitive, medical, and physical performance measures associated with an increased risk of serious injury among fallers in a previous analysis of the cohort. Acute host, behavioral, and environmental factors present at the time of the participants' first reported fall constituted potential situational risk factors. The primary outcome was occurrence of a serious fall injury, defined as a fracture, joint dislocation, or head injury resulting in loss of consciousness and hospitalization, during the first fall recorded during follow‐up.RESULTS:Sixty‐nine subjects (12%) suffered a serious injury during their first reported fall. No acute host factor was associated with increased risk of injury. The environmental and activity factors associated independently with serious injury in multivariate analysis included falling on stairs (adjusted relative risk 2.0; 95% confidence intervals 1.1 – 3.5), during displacing activity (1.8; 1.0 – 3.0), and from at least body height (2.1; 1.0 – 4.7). The independent predisposing factors included female gender (2.1; 1.0 – 4.4), low body mass index (1.8; 1.2 – 2.9), and cognitive impairment (2.8; 1.7 –4.7). Although 12% of first falls resulted in a serious injury overall, this percentage ranged from 0% to 36% as the number of predisposing risk factors increased from zero to three and from 5% to 40% as the number of situational risk factors increased from zero to three. Further, for any given number of predisposing risk factors, the percentage of fallers suffering a serious injury increased with the number of situational risk factorsCONCLUSIONS:Several environmental and behavioral factors contributed to the risk of serious fall injury; this contribution was independent of the effect of chronic predisposing risk factors. Preventive programs that address both predisposing and situational risk factors may result in the greatest injury reduction. These findings support previously recommended multicomponent intervention programs that combine medical, rehabilitative, and environmental components. J Am Geriat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07395.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

BACKGROUND:Serious fall injury represents a little studied, yet common and potentially preventable, cause of morbidity and mortality among older persons. We determined the frequency of, and risk factors for, experiencing serious fall injury events among older persons in the community.SUBJECTS:A representative sample of 1103 community‐living persons aged 72 years and older underwent comprehensive baseline and 1‐year evaluations.MAIN OUTCOME MEASURES:During a median 31 months of follow‐up, fall data were obtained using fall calendars. Injury data were obtained from telephone interviews and from surveillance of emergency room and hospital records.RESULTS:At least one fall was experienced by 546 (49%) participants. A total of 123 participants, representing 23% of fallers and 12% of the cohort, experienced 183 serious fall injury events. The factors independently associated with experiencing a serious injury during a fall included cognitive impairment (adjusted odds ratios 2.2; 95% confidence interval 1.5,3.2); presence of at least two chronic conditions (2.0; 1.4,2.9); balance and gait impairment (1.8; 1.3,2.7); and low body mass index (1.8; 1.2,2.5). In a separate analysis, including only subjects who fell, female gender (1.8; 1.1, 2.9) as well as most of the above factors were associated with experiencing a fall injury.CONCLUSIONS:Several readily identifiable factors appeared to distinguish the subgroup of older fallers at risk for suffering a serious fall injury. These factors should help guide who and what to target in prevention ef

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07396.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To evaluate the training effects of Chinese shadow boxing, Tai Chi Chuan (TCC), on the maintenance of cardiorespiratory function in older individuals.DESIGN:Prospective study of a cohort of TCC practitioners and a group of sedentary controls examined 2 years after initial examination.SETTING:Research project at a hospital‐based exercise physiology laboratory.PARTICIPANTS:Eighty‐four community‐dwelling older adults (mean age: 64 ± 9 years) with no significant cardiovascular, pulmonary, and musculoskeletal disease completed this study. The TCC group, 23 male and 22 female subjects, had been practicing TCC regularly for 6.7 ± 3.3 years. The control group included 21 male and 18 female sedentary subjects with age and body size matched to the TCC group.INTERVENTION:During the period of the study, the TCC practitioners practiced TCC 5.0 ± 1.1 times per week. Each session included 20 minutes of warm up, 24 minutes of TCC training, and 10 minutes of cool down. The baseline cardiorespiratory function was recorded in the initial exercise test. The same measurements were repeated 2 years later to determine the rate of decline of cardiorespiratory function. Furthermore, heart rates (HR) were monitored in 18 men and 16 women during the performance of TCC to determine the exercise intensity of TCC.MAIN OUTCOME MEASURE:The study measured 2‐year trends of cardiorespiratory function in both groups.RESULTS:In the TCC group, the males showed a 2.8% decrease in maximal oxygen uptake (O2max) from 31.6 ± 7.6 mL × kg.−1× min−1to 30.7±7.1 mL × kg.−1× min−1; the females showed a 2.9% decrease in O2max from 20.7±2.3 mL × kg.−1× min−1to 20.1±2.5 mL × kg.−1× min.−1In contrast, the male control group showed a 6.6% decrease in O2max from 24.4±4.4 mL × kg1× min1to 22.8 ± 4.4 mL × kg1× min1; the females showed a 7.4% decrease in O2max from 16.2±2.3 mL × kg.−1× min−1to 15.0 ±2.7 mL × kg.−1× min.−1At the ventilatory threshold (Vet), the sedentary group also showed a significant decrease in O2. During the steady‐state performance of TCC, subjects' mean HR was approximately the HR at the Vet(53–57% of HRmax reserve).CONCLUSION:The data substantiate that practicing Tai Chi Chuan regularly may delay the decline of cardiorespiratory function in older individuals. In addition, TCC may

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07397.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES:To detect subtle cognitive dysfunction in non‐demented patients with either cerebral (cAD) or peripheral (pAD) arteriosclerotic disease, and to evaluate in these patients the effects on cognitive functions of carotid endarterec to my and bypass surgery, respectively.DESIGN:Case‐control study.SETTING:Tertiary care referral center.PARTICIPANTS:Eighty consecutive patients with moderate to high‐grade stenosis of the internal carotid artery (ICA) (mean ageplusmnSD, 62plusmn8 years), 53 patients with stenoses of the peripheral arteries (60plusmn10 years), and 80 healthy volunteers (58plusmn15 years) enrolled in a study on healthy aging. Cerebral and peripheral arteriosclerotic disease was verified by digital subtraction angiography, and all patients were screened for confounding effects of concomitant diseases.MAIN OUTCOME MEASURES:Cognitive functions by event‐related visual P300 potentials.RESULTS:Patients withcAD showed prolonged P300 latencies and reduced P300 amplitudes, whereaspAD patients had reduced P300 amplitudes only. On an individual scale, 25% ofcAD patients, but only 6% ofpAD patients, revealed P300 abnormalities. In thecAD, but not in thepAD patients, the P300 latencies were especially prolonged in the older patients, but other factors such as sex, cerebral symptoms, degree of ICA stenosis, and premorbid intelligence did not play any role in either group. Within 1 to 2 weeks of surgery, the P300 latencies shortened in bothcAD andpAD patients with high initial values.CONCLUSIONS:As demonstrated by P300 potentials, even nondemented arteriosclerotic patients reveal signs of subtle cognitive dysfunction affecting especially the oldercAD patient. In the short‐term, carotid endarterectomy presumably improves cognitive functions unspecifically in nondemented patients with a higher initial degree of P300 ab

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07398.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To examine the change in fall rates after relocation of nursing home residents from one facility to another and to identify resident risk factors for changes in falls following relocation.DESIGN:Retrospective review of incident reports to identify falls, followed by chart review of a longitudinal cohort.SETTING:An academic nursing home whose residents and programs moved from a 125‐ year‐old, 233‐bed facility to a newly constructed 255‐bed facility.PATIENTS:A total of 210 nursing home residents were moved from one facility to the other. Of these, 133 individuals who lived in the old facility for 9 months before the move and in the new facility for 6 months after the move formed the longitudinal cohort.RESULTS:In the 3 months after the move, the fall rate increased from 0.34 to 0.70 falls per resident per quarter in the entire nursing home population (P<.001) and subsequently returned to baseline. In the longitudinal subgroup the fall rate went from 0.26 to 0.60 (P<.005). Fall‐related injuries in the longitudinal subgroup went from 0.058 injuries per resident per quarter at baseline to 0.15 (P<.001). However, the injury rate per fall did not change. There were no characteristics associated with being a faller in the quarter before the move. Dementia and not being bedbound were associated with being a faller after the move. Individuals who were ambulatory or wheelchair mobile had a significant risk of increasing the number of falls after the move, and individuals with dementia had a strong but insignificant trend in this direction.CONCLUSIONS:The incidence of falling doubled after relocation of nursing home residents to a new facility. An increase in falls was seen in individuals who were not bed‐bound. Although nursing home relocation may be a relatively uncommon occurrence, it is reasonable to infer that older individuals who change their living environments are at increased risk for falls and fall‐rel

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07399.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

BACKGROUND:The clinical diagnosis of dementia continues to be flawed. Although the diagnosis of Alzheimer's disease (AD) is better than 90% at research centers in highly selected patients, the diagnosis of patients with non‐AD dementias and atypical AD patients is poor. Single photon emission computed tomography (SPECT) is a functional imaging technique touted as a diagnostic technique for the degenerative disorders. However there have been few clinicopathological studies using SPECT.METHODS:Twenty‐seven consecutive dementia patients were evaluated clinically at a University‐based specialty dementia clinic, and a diagnosis of a specific dementia was made. SPECT imaging was used in helping to select a clinical diagnosis. The correlations between clinical, SPECT and autopsy diagnoses were analyzed.RESULTS:Single photon emission computed tomography predicted pathologic diagnosis in 25 of 27 patients with dementia (92.6%), compared with clinical diagnosis, which was confirmed in 20/27 (74.1%). Distinct patterns were associated with dementia caused by AD, Fronto‐Temporal Dementia (FTD), and Jakob‐Creutzfeldt Disease (JCD). Vascular insults not seen with computerized tomography (CT) or magnetic resonance imaging (MRI) were found with SPECT. Three different pathologies were found in patients with Par‐kinsonian‐Dementias (PD): Lewy‐Body Variant of AD, Diffuse Lewy‐bodies without plaques, and substantia nigra neu‐ronal loss without plaques or Lewy‐bodies. All showed a temporal‐parietal pattern with SPECT that was similar to AD.CONCLUSION:SPECT provides useful positive information in dementia, particularly the differentiation of AD, FTD, and JCD. However, it does not

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07400.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To define the natural history of Alzheimer's Disease (AD), from time of clinical (presumptive) diagnosis and/or onset of symptoms to death and to describe demographic and clinical characteristics of patients with AD.DESIGN:Retrospective medical records review.SETTING:Regional brain bank operated by a university hospital.PARTICIPANTS:One‐hundred randomly selected, autopsy‐confirmed Alzheimer's Disease patients.MEASUREMENTS:All information pertaining to family and clinical history (diagnoses, office visits, hospitalizations), medication use, nutritional status, and clinical testing (laboratory testing, imaging, diagnostics, and psychometric testing) was abstracted. Time of onset for behavioral symptoms (e.g., anxiety, wandering, agitation) and deficits in cognitive function (e.g., recent memory, concentration, language) and activities of daily living (ADL) were also abstracted. Data was collected on‐site using a laptop computer and a series of customized data entry spreadsheets. Upon completion of the data abstraction process, data was converted to a database program for query and analysis.For editorial comments see p 1314RESULTS:A complete natural history timeline was constructed based on the mean values observed in order to demonstrate important clinical endpoints, namely, diagnosis, institutionalization, and death. The mean time between onset of symptoms and clinical diagnosis was 32.1 months (standard deviation = 37.9 months). The interval between symptom onset and AD diagnosis was longer for patients who were less than 65 at time of diagnosis (mean = 37.6 months), female patients (mean = 34.9 months), and patients with a positive family history of dementia (mean = 37.5 months). The mean age at diagnosis was 74.7 years (standard deviation = 8.6 years), with a range of 52 to 89 years. Most patients were diagnosed between the ages of 70 and 79. Males were diagnosed at an earlier age, 72.8 years, on average, than females, 75.4 years. The mean time to institutionalization from time of clinical diagnosis was 23.9 months (standard deviation = 33.6 months). The average age at institutionalization was 77.6 years, with a minimum of 60 years and a maximum of 92.5 years. Institutionalization occurred 56.5 months after symptom onset, on average. This interval was shorter among patients with a negative family history (mean = 53.1 months) and patients diagnosed after age 65 (mean = 51.6 months). Patients diagnosed before age 65 experienced a significantly greater average time to institutionalization, 94 months (P = .01). Disease duration was measured as time from symptom onset until death. Mean disease duration was 101.3 months, or nearly 8.5 years (standard deviation = 59.2 months). Subgroup analysis showed that disease duration was prolonged in younger onset patients (mean = 129.1 months), females (mean = 107.9 months), and patients with a positive family history of dementia (mean = 106.3 months).CONCLUSIONS:These data suggest that the typical AD patient is diagnosed 32 months after symptom onset, at the age of 75 years. This patient is institutionalized 25 months after diagnosis, or approximately 57 months after symptom onset at age 78. The patient remains institutionalized for 44 months or, in actuality, until death. Total disease duration for this typical AD patient is just over 101 months, or approximately 8.5

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07401.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To evaluate the usefulness of standardized neuropsychological tests in the psychometric differentiation of patients with very mild or mild Alzheimer's Disease (AD) and/or major depression presenting in a tertiary clinic with memory/attention complaints.DESIGN:Controlled prospective clinicoexperimental design.SETTING:Multidisciplinary Memory Clinic at Addenbro‐oke's Hospital, Cambridge, England.PARTICIPANTS:Twenty‐four patients with a clinical diagnosis of Alzheimer's disease (12 with major depression and 12 without), 12 patients with major depressive illness but without AD, and 12 healthy control subjects, all matched for age, sex, education levels, and estimates of premorbid intellectual potential.MEASUREMENTS:Mini‐Mental State Examination (MMSE), Wechsler's Logical Memory (WLM) and Visual Reproduction (WVR), immediate and delayed reproduction, Wechsler's paired Associate Learning (WPAL), including the Easy and Hard subsets. Warrington's Recognition Memory for Faces (WRMF), Kendrick's Object Learning (KOLT) and Digit Copying (KDCT)Tests.OUTCOME MEASURES: Minimum 2‐year follow‐up diagnosis.RESULTS:Statistically, patients with very mild AD were distinguished clearly from those without AD on most tests of memory functions. Psychometrically, only KOLT and an index of retention on WLM and WVR were specific enough to avoid false positives, a requirement for second‐stage tools. They also proved sensitive enough to suggest their role as first‐stage instruments when screening for primary dementia in high‐functioning patients scoring above the cut‐point on MMSE.CONCLUSIONS:As efforts intensify to develop more powerful means to identify patients with Alzheimer's disease in its earliest stages, inclusion of specialist tests posing greater cognitive challenge than standard mental status scales has been one strategy. Our study explored how some of these neuropsychological tools behave psychometrically when analyzed on a single‐case basis, and the results suggest a few are sensitive enough to boost detection above base rates alone while also being specific enough to reduce false alarms. Retention on Wechsler's Logical Memory and Visual Reproduction tasks and scores on Kendrick's Object Learning Test helped decrease the degree of ambiguity when cognitive profiles were used to distinguish depressed patients with Alzheimer disease

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07402.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY