摘要:

OBJECTIVES: To describe the incidence, anthropometric parameters, and clinical significance of weight loss in older outpatients.DESIGN: Four‐year prospective cohort study.SETTING: University‐affiliated Veterans Affairs Medical Center.PATIENTS: Two hundred forty‐seven community‐dwelling male veterans 65 years of age or older.MEASUREMENTS: Anthropometrics (weight, height, skinfolds, and circumferences), health status measures (Sickness Impact Profile scores, health care utilization, self‐reported ratings of health), and bloodwork (cholesterol, albumin, others) were obtained at baseline and followed annually for 2 years. Outcome measures (hospitalization, nursing home placement, and mortality rates) were followed for a minimum of 2 years after any identified weight change.MAIN RESULTS: The mean annual percentage weight change for the study population was −0.5% (SD: ± 4.0%; range: −17% to +25%). Four percent annual weight loss was determined to be the optimal cutpoint for defining clinically important involuntary weight loss using ROC curve analysis. The annual incidence of this degree of involuntary weight loss was 13.1%. At baseline, involuntary weight losers were similar to nonweight losers in age (73.9 ± 7.9 vs 73.3 ± 6.7 years), body mass index (26.8 ± 3.9 vs 26.9 ± 4.1 kg/m2), and all other anthropometric, health status, and laboratory measures. Relative to nonweight losers, involuntary weight losers had significantly (P≤ .05) greater decrements in central skinfold and circumference measures (subscapular skinfolds, −2.9 vs −0.4 mm; suprailiac skinfolds, −4.2 vs −0.2 mm; and waist to hip ratio, −.01 vs + .00). Both groups had significant decreases in their triceps skinfolds (an estimate of peripheral subcutaneous fat), whereas arm muscle area and albumin levels did not decline significantly in either group. Over a 2‐year follow‐up period, mortality rates were substantially higher (RR = 2.43; 95% CI = 1.34–4.41) among involuntary weight losers (28%) than among nonweight losers (11%). Of interest, a similar increase in 2‐year mortality (36%) was also observed among subjects with voluntary weight loss (by dieting). Survival analyses adjusting for differences between weight losers and nonweight losers in baseline age, BMI, tobacco use, and other health status and laboratory measures yielded similar results.CONCLUSIONS: These results indicate that involuntary weight loss occurred frequently (13.1% annual incidence) in this population of older veteran outpatients. When involuntary weight loss occurred, the predominant anthropometric changes were decrements in measures of centrally distributed fat (trunkal skinfolds and circumferences). Finally, involuntary weight loss greater than 4% of body weight appears to be clinically important as an indepe

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05803.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To describe the differences between healthy young and older women in regards to trunk elevation and hip pivot motions when rising from a supine to a seated position.DESIGN: Cross‐sectional comparison.SETTING: University laboratory.PARTICIPANTS: Two groups of healthy female volunteers: young adult female controls (n = 22, mean age 23.5 years) and community‐dwelling older female adults (n = 17, mean age 73.8 years).MEASUREMENTS: Subjects were videotaped as they performed three controlled bed mobility tasks, starting from a supine position: (1) rising to a seated position at the edge of a firm plinth surface (SS); and rising to a seated position without moving to the edge of the bed while either (2) using hands (SUH) or (3) not using hands (SUNH). A series of movements involving the trunk were identified as subjects performed the SS task.RESULTS: The older women were more likely to rotate and laterally flex their trunks, particularly in the later phases of the SS task. In addition, during the SS task, the older group was more likely to bear weight on their hip/gluteal area, particularly in the later phases, and more likely to use a broad pivot base, consisting of the hip and the elbow. While all young and old performed the SUH task, less than half of the older group could complete the SUNH task. Moreover, the subgroup of older adults who could not complete the SUNH task may have accounted for much of the differences between the young and the old on the SS task.CONCLUSION: Healthy young and older women differ in their ability to rise from a supine to sitting position, primarily in the strategies used to elevate the trunk and facilitate a pivot. Trunk flexion ability likely contributes to the age group differences noted in rising. These data provide the basis for a biomechanical analysis of the critical body segment motions and the strengths required to perform bed mobility ta

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05804.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To evaluate (1) the nutrient content of menus planned for regular consistency meals and pureed meals in a long‐term care facility and (2) to assess nutrient intakes of women consuming these meals.DESIGN: A descriptive survey.SETTING: A nursing home facility in central Pennsylvania.PARTICIPANTS: Fifty‐one female nursing home residents were chosen randomly. Thirty‐one received a regular diet and 20 received a pureed diet.MEASUREMENTS: Demographic and health variables were collected from medical records. Nutrient variables were calculated for regular and pureed consistency meals, as served. Nutrient intake data for each woman were based on seven consecutive days of food intake and nutrient supplement use.MAIN RESULTS: Energy and nutrient values for regular diet menus (i.e., food served) were higher than for pureed menus, but both had values exceeding recommended allowances for most nutrients. Average energy and nutrient intakes were similar for both groups of women (ttest,P<0.05). Data showed that many women in both groups had lower than the recommended intakes of iron, zinc, calcium, and Vitamin D.CONCLUSIONS: Both regular and pureed consistency diets provided to residents met current recommended allowances. Diet consistency did not affect nutrient intakes. Intakes were adequate overall; however, a low intake of the same nutrients generally occurred in both g

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05805.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: The goal of this study was to estimate the prevalence and correlates of difficulty holding urine among a population of community‐dwelling older people.DESIGN: Population‐based cross‐sectional study.SUBJECTS: A population census identified all residents aged 65 years and older residing in East Boston, Massachusetts, in 1982.MEASURES: Data collected via in‐home interviews were used to estimate the prevalence of difficulty holding urine and to provide information regarding potential correlates of urinary difficulty.RESULTS: Of the 3809 study participants (85% response rate), 28% reported having “difficulty holding urine until they can get to a toilet” at least some of the time, and 8% reported difficulty “most” or “all of the time.” Difficulty was associated with age and sex; 44% of women and 34% of men reported some difficulty (P<.001), and 9% of women and 6% of men (P<.001) reported difficulty most or all of the time. For respondents aged 65 to 74 years, 40% reported some difficulty, compared with 47% of those aged 85 and older (Ptrend<.001); difficulty most or all of the time was reported by 6% of those aged 65 to 74 and 12% of those aged 85 and older (Ptrend<.001). Difficulty holding urine was associated with important health and functional measures including depression, stroke, chronic cough, night awakening, fecal incontinence, problems with activities of daily living, decreased frequency and ease in getting out of the house, and poor self‐perception of health.CONCLUSIONS: Difficulty holding urine is a prevalent condition among older people living in the community and is associated highly with a number of health conditions an

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05806.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To characterize medication use in a “well” very old population and relate the quantity and type of medication use to 10‐year mortality.DESIGN AND SUBJECTS: A longitudinal, 10‐year, follow‐up study involving 488 healthy, community‐dwelling volunteers aged 75 to 85 years. The subjects underwent a detailed baseline evaluation and annual assessments that included comprehensive physical exams, laboratory and diagnostic tests, and related interviews. Prescription and nonprescription drug use was determined by self report, confirmation through hospital records, and reports by subjects and significant others.RESULTS: At study baseline, the mean number of prescription and nonprescription medications used was 2.3 and 1.5, respectively. Female subjects (n = 315), those older than 80 years, or those who reported themselves to be in fair or poor health on initial health self‐report were found to show significantly increased use of prescription medications. The most commonly used classes of medications were cardiovascular drugs and analgesics. Subjects who were consuming a greater number of prescription and nonprescription medications did not have higher mortality rates. After correcting for differences in cardiovascular health status between users and nonusers, only digoxin approached significance as an independent predictor of death (P<.08).CONCLUSION: This study confirmed that medication use in an ambulatory, old old population is not excessive. The oldest subjects in the cohort consumed more medications than did the younger subjects. Women used more prescription drugs than men. Increased medication use was associated with worse ratings on health self report. Medication use alone, however, was not a predictor of 10‐year mortality in this population. Questions are raised about the inappropriate prescription of digoxin in

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05807.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To develop an instrument that will facilitate and focus the assessment of a patient's capacity to adhere to a medication regimen before its initiation.DESIGN: This is a crossectional study that compares medical inpatients and outpatients to an age‐matched, community‐living, independent and relatively healthy group on their ability to adequately understand and implement hypothetical but realistic medication regimens.SETTING: Department of Veterans Affairs Medical Center, Sepulveda, California.PARTICIPANTS: Fifty‐five older subjects (65 years or older) were divided into three groups: (1) generally healthy comparisons (standard group) (n = 20); (2) medical outpatients (n = 15); and (3) medical inpatients ready for discharge (n = 20).MEASUREMENTS: Older subjects were first tested on their capacity to comply with a difficult medication regimen presented in scenario form. If scores on the first scenario did not meet a standard group‐derived cutoff point, further testing was conducted with a simpler scenario to identify greater levels of impairment.RESULTS: The outpatient group had significantly lower scenario scores than did the healthy comparison group (P<.03). The simpler scenario also showed a trend toward outpatient impairment (P= .06). In the comparison group, only 5% failed Scenario 1, and none failed Scenario 2. The outpatient group had the most difficulty, with 40% failing Scenario 1 and one‐third of those failing Scenario 2. This differed significantly from the comparison groups (Fisher's ExactP<.03). In the inpatient group 20% failed Scenario 1 and 75% of those failing Scenario 2. The sensitivity and specificity of the Folstein Mini‐Mental State Examination in identifying scenario‐impaired subjects were 73% and 80%, respectively. Question types were analyzed to determine which questions were most frequently missed. Memory and judgment questions were found overall to be the most frequently missed. Healthy controls missed some judgment questions; however, the outpatient group was significantly worse in this category (X2= 5.08;P= .01). All three groups improved their scenario performance significantly with question cueing.CONCLUSION: A significant number of medically ill outpatients encountered difficulty in understanding or remembering correctly hypothetical but realistic medication regimens. This suggests that an older medical patient's cognitive and functional capacity to comply with medication regimens of differing complexity can be specifically assessed before the start of the regimen and probably should be assessed in patients whose compliance capacity is in question. The assessment instrument under development in this study may be helpful in detecting those who need assistance with medications, thus identifying the need for intervention before poor compliance can lead to increased morbidity, rehospitalization, and increased

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05808.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES: To determine the prevalence of Alcohol Use Disorders (AUDs) among residents of a Veterans Affairs (VA) nursing home (NH) using DSM‐III‐R criteria for alcohol abuse and dependence, and to examine the demographic variables associated with AUDs among NH residents. A third objective was to assess the sensitivity, compared with DSM‐III‐R criteria, of three screening tests for AUDs in the NH: the CAGE, the MAST‐G, and the two‐question instrument developed by Cyr and Wartman.DESIGN: A cross‐sectional design, with DSM‐III‐R criteria determined by the alcohol module of the Diagnostic Interview Schedule (DIS) as the criterion standard.PATIENTS: Patients older than age 50 admitted consecutively to a VA NH, n = 117.MAIN OUTCOME MEASURES: Sensitivities, specificities, positive predictive values for the CAGE, MAST‐G, and Cyr and Wartman Screening questionnaires; receiver operating characteristic (ROC) curves for the CAGE and MAST‐G.MAIN RESULTS: Forty‐nine percent of study participants met DSM‐III‐R criteria for lifetime alcohol abuse or dependence (18% active, 31% inactive). The sensitivities and specificities of the three screening questionnaires were as follows: CAGE‐82% and 90%; MAST‐G‐93% and 65%; Cyr and Wartman‐70% and 92%, respectively. The area under the ROC curve was 0.94 for the CAGE and 0.90 for the MAST‐G.CONCLUSIONS: The prevalence of lifetime alcohol abuse and dependence was high in this VA NH population. Both the CAGE and MAST‐G are sensitive to AUDs in this setting. The areas under the ROC curves were not significantly different and indicate both tests discriminated well bet

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05809.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To determine the predictive validity of a mailed questionnaire designed to measure older adults' risk of repeated hospitalization.DESIGN: Prospective cohort study.SETTING: Ramsey County, Minnesota.PARTICIPANTS: Medicaid recipients aged 70 and older who completed the questionnaire.MEASUREMENTS: Responses were used to calculate the subjects' probability of repeated admission (Pra) to hospitals within 4 years. Subjects were classified as low‐risk (Pra<0.5) or high risk (Pra≥ 0.5). One year later, Medicaid claims data were analyzed to determine the subjects' actual use of hospitals.RESULTS: One‐fifth of the respondents (20.6%) were classified as high‐risk at baseline. During the following year, the high‐risk subjects used hospitals at approximately twice the rate of the low‐risk subjects (4.5 vs 2.4 days/person‐year,P= .009).CONCLUSIONS: The instrument, which was previously found to be valid in a national sample of Medicare beneficiaries, appears to be valid also in a local sample of Medicaid beneficiaries. Older adults at risk of heavy hospital use can be identified prospectively through their responses to this brief, mailed, self‐administered questionnaire. The instrument may be useful in targeting older persons for interventions designed to prevent the need fo

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05810.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: To describe the prevalence of activities of daily living (ADL) dependence and medical conditions and the relationship between illnesses and ADL performance in the older population of Shanghai, China.DESIGN: Probability sample survey of community residents.SETTING: The Jing An district of Shanghai, China. The interviews were carried out at the homes of the older persons.PARTICIPANTS: There were 3763 noninstitutionalized elders screened, 3745 of whom completed the interview.MEASUREMENTS: The dependent variables were the five basic ADL items: eating, dressing, transferring, toileting, and bathing. The independent variables were dementia and 19 self‐reported medical conditions, along with age, gender and education level.MAIN RESULTS: Of those in Shanghai aged 65 and older, 8.28% (6.52% of males, 9.17% of females) were functionally dependent in one or more ADLs. The most prevalent self‐reported illness was cardiovascular disease, including hypertension (29.12%) and heart disease (26.65%). ADL performance was associated with dementia and a number of medical conditions in univariate analysis. The best predictors of functional dependence in both age groups (65–74 years; 75 years and older), based on the multiple logistic regression analysis and after controlling for age, gender, and education, were stroke, dementia, Parkinson's disease, diabetes, and emphysemaCONCLUSIONS: The authors have successfully applied five ADL items selected and culturally adapted from Older Americans Resources and Services to the study of older Chinese. A consistent and reliable estimate of functional dependence among older persons is obtained. The prevalence of dementia and many self‐reported illness, as well as the ADL status by medical condition, are reported. The findings reveal certain patterns of relationship between illness conditions and ADL performance.J Am Geriatr Soc 43:378–

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05811.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE: The purpose of this paper is to describe factors affecting wheelchair mobility in nonambulatory nursing home (NH) residents.DESIGN: Prospective descriptive study of a convenience sample of nonambulatory NH residents.SETTING: Seven nursing homes.PARTICIPANTS: Sixty‐five nonambulatory residents.MEASUREMENTS: One‐minute, time‐sampled observations of behavior for each resident were made every 15 minutes for 8 to 11 hours across 2 days, noting wheelchair propulsion activity for the dependent variable; independent variables included measures of wheelchair level of assistance, speed, endurance, handgrip strength, and balance.MAIN RESULTS: A stepwise Multiple Regression analysis found wheelchair speed to be the single best predictor of the percentage of time residents were behaviorally observed wheelchair propelling (Multipler= .45,P<.02). Handgrip strength and wheelchair endurance measures were highly intercorrelated with wheelchair speed. Wheelchairs that were either dysfunctional or inappropriately fitted to the residents' size were a major barrier to wheelchair use, affecting 46% of residents using wheelchairs.CONCLUSION: Improving wheelchair skills with targeted intervention programs, along with making chairs more “user friendly” (e.g., grip extensions on brakes, foot pedals that one can move without bending over), could result in more wheelchair propulsion with resultant improvements in the NH resident's independence, freedom of movement, and qualit

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb05812.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY