摘要:

OBJECTIVE: To determine whether the weight loss associated with Alzheimer's disease precedes or follows the dementia.DESIGN: Older community‐dwelling men (n = 134) and women (n = 165) were followed for 20 years before they were diagnosed as cognitively intact or demented. A repeated measures analysis was used to compare weight change in those who developed Alzheimer's Disease (AD) with those who remained cognitively intact.MEASUREMENTS: Weight was measured at three clinic visits between 1972‐74, 1984‐87, and 1990‐93. Participants were classified as having probable or possible AD or being cognitively intact at the 1990‐93 evaluation. Diagnoses were made by two neurologists and a neuropsychometrist, based on neuropsychological tests and physical examination, using NINCDS‐ADRDA criteria.RESULTS: There were 36 men and 24 women diagnosed with probable or possible AD; they were considered to have mild to moderate dementia based on their test scores and community‐dwelling status. Those who developed dementia were older than those diagnosed as cognitively intact. In age‐adjusted analyses, both men and women who were later diagnosed with AD had a significant decrease in weight after the baseline visit (P<.001 andP<.003, respectively), but there was no significant weight loss in the men and women who remained cognitively intact. These differences were not explained by lifestyle, depression, or other illness.CONCLUSION: Weight loss precedes mild to moderate dementia; early weight loss is, therefore, unlikely to be a consequence of AD patients being unable or u

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01362.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To describe the sequential occurrence of influenza A and B in a nursing home, and to determine the efficacy of influenza vaccine and/or amantadine treatment with respect to incidence and sequelae.SETTING: The Jewish Home and Hospital for Aged, a skilled‐care nursing facility.PARTICIPANTS: Of 499 frail older nursing home residents, 139 contracted influenza during the study period (mean age 87.5 years; SD = 6.7). The residents were followed from February through April 1988.INTERVENTION: Influenza vaccine and/or amantadine.MEASUREMENTS: Episodes of influenza and their sequelae, i.e., pneumonia, hospitalization, and death.RESULTS: The vaccine had no effect on the incidence of influenza‐like illness, length of illness, or the associated death rate. It reduced the rate of pneumonia secondary to influenza A and B (relative risk = .57; 95% CI: .37 to .89;P= .023). Amantadine did not affect the attack rate of influenza nor the rate of pneumonia secondary to influenza. It was associated with decreased mortality (relative risk = 0;P= .001), and shorter length of influenza A illness (PWilcoxon= .082). Although the combination of amantadine and vaccine did not affect length of influenza (A or B) illness, it was associated with a significantly lower rate of sequelae (relative risk = .58; 95% CI: .36 to .95;P= .024).CONCLUSION: In this epidemic, the combination of amantadine and vaccine was most effective in reducing the rate of influenza‐associated sequelae. The possibility of a “biphasic” epidemic prompts consideration of vaccinating nonimmunized nursing home residents, even though it may be late in the influen

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01363.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To report on moderate alcohol consumption and measurements of cognitive function and activities of daily living in an older, urban, community‐dwelling sample of black Americans.DESIGN: As part of a community prevalence study of dementia, information on alcohol consumption and cognitive performance was collected on 2040 randomly selected black subjects living in Indianapolis.MEASUREMENTS: From questions in the screening interview, alcohol consumption was grouped into four categories: lifetime abstainers, regular drinkers less than 4 drinks per week, 4 to 10 drinks per week, and more than 10 drinks per week. Current and past drinkers were analyzed separately. Three measurements were used: (1) a total cognitive score; (2) the delayed recall score from the East Boston Memory Test; (3) a score for daily functioning based upon information from the informant. Multiple regression models were fitted with drinking variables as the major predictor, including covariates of age, gender, education, history of stroke, hypertension, being treated for depression, and a family history of dementia.MAIN RESULTS: In all analyses, there was a very consistent pattern for both current and past drinkers. There was a small but significant dose effect of drinking for the drinkers, with subjects in the heaviest drinking category scoring poorest, i.e., lowest scores in cognitive tests and highest scores in scales of daily functioning indicating more impairment. The scores of abstainers were worse than those of subjects in the lightest drinking category. The pattern of scores for cognitive performance and daily functioning was similar between current and past drinkers. These patterns remained the same even after potential confounders were included.CONCLUSIONS: Previous research on effects of alcohol on health indices have suggested a J‐shaped relationship between amounts of alcohol consumption and measurements of heart disease, stroke, and mortality rates. Our study provides some support for the concept of a similar J‐shaped relationship between cognitive performance and alcohol consumption, but the differences between drinking categories were modest and the clinical significance of these findings unce

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01364.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: To describe the frequency and severity of functional problems in two groups of noninstitutionalized inner‐city blacks aged 70 years and older contrasted with results from appropriate groups of white and black older adults and with the goals of the Healthy People 2000 program.DESIGN: Cross‐sectional descriptive study.SETTING: Community‐based samples.PARTICIPANTS: A population‐based sample of 416 older adults living in a 3.5‐square mile catchment area in north St. Louis (NSL), Missouri, and a sample of 197 older residents living in public housing in East St. Louis (ESL), Illinois.MEASUREMENTS: Health status, preventive health activities, health services utilization, and risks for progressive frailty were assessed by self report and observation using well validated, standardized instruments. Whenever possible, comparison data were derived from national datasets, original samples used to validate the measures, and other useful comparison groups.RESULTS: The NSL sample had somewhat better health status and risk for progressive disability than the ESL sample. However, compared with national or regional reference groups using age‐gender adjustments, both study groups demonstrated increased levels of dependence in intermediate activities of daily living, restricted activity days, inability to walk one‐half mile without assistance, reported poor vision, living alone, and limited income compared with both older whites and blacks, and increased levels of worsening health, inability to perform heavy work around the house, never walking a mile or more, and currently unmarried versus whites with variable decrements versus blacks. Contrasted with other comparison groups, the two samples had increased body fat; consistent decrements in gait speed, timed chair stands, timed one‐leg balance, and frequency of preventive exercise; and lower levels of dental care; results relative to physician visits and hospital days were mixed. They also had high levels of measured visual and hearing impairments, unmet needs for home delivered meals, and problems with false teeth. Deficiencies compared with the goals of Healthy People 2000 were large.CONCLUSIONS: The special attributes of inner‐city blacks, including poverty and access to and acceptance of remedial programs, will have to be considered if the goals of Healthy People 2000 are to be met in this important and growing segment o

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01365.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine sex differences in survival after myocardial infarction in older individuals.DESIGN: Prospective cohort study based on a community sample of older individuals. All patients were followed for 1 year after hospital admission.SETTING: Two hospitals in New Haven, Connecticut.PARTICIPANTS: The study included 103 women and 120 men who were participants in the New Haven, CT cohort of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) program and who were diagnosed with myocardial infarction between the inception of the community study in 1982 and December 31, 1992. The mean age of women was 79.3 and of men, 77.3.MEASUREMENTS: Data on clinical characteristics were abstracted from medical records. Sociodemographic, psychosocial, and physical function information was derived from the EPESE interview preceding the infarction. The main outcome measure was all‐cause mortality, for which three end points were used: early mortality (first 30 days), late mortality (1‐year mortality among survivors of the first 30 days), and overall mortality (1‐year mortality from admission in the whole sample).RESULTS: Mortality in the first 30 days did not differ significantly in the two sexes. The relative risk (RR) of death in women compared with men was 0.85 (95% confidence interval [CI], 0.49‐1.47) before multivariable adjustment; this was unchanged after adjustment for demographic factors, comorbidity, functional status, psychosocial factors, and clinical severity (RR, 0.85, 95% CI, 0.41‐1.76). Among survivors of 30 days, women were almost two times more likely to survive at 1 year compared with men, both before multivariable adjustment (RR, 0.56,95% CI, 0.31‐1.02) and after controlling for demographic factors, comorbidity, physical function, psychosocial factors, clinical severity on admission, and hospital complications (RR, 0.44; 95% CI, 0.20‐0.99). Analyses involving 1‐year follow‐up from admission for the entire sample yielded intermediate results.CONCLUSION: There was little difference in mortality in the first 30 days after myocardial infarction between older men and women, but when the early deaths were excluded, women showed an increased survival compared with men in the first year after the myoc

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01366.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: To examine the distribution and correlates of the classes of antihypertensive medications taken by persons aged 60 to 80.DESIGN: Cross‐sectional screening.SETTING: Four academic medical centers in the southern and eastern United States.PARTICIPANTS: Volunteers (N = 2601) entering a clinical trial testing the value of nonpharmacologic approaches to control blood pressure who were either taking one or two (single or combined) medications for the treatment of hypertension and expressed willingness to be withdrawn from these medications according to a standardized protocolMEASUREMENTS: Medication use, blood pressure, and data from self‐administered questionnaires collected during standardized clinic visits.RESULTS: Calcium channel blockers (23.9%) were the most frequent single agent antihypertensive medications used by cohort members, followed by diuretics (17.9%) and angiotensin‐converting enzyme (ACE) inhibitors (17.5%). The most common combination agents were composed of diuretics with either calcium channel blockers (5.4%), ACE inhibitors (4.0%), or β‐blockers (3.7%). Women were twice as likely to be taking diuretics, and less likely to be taking ACE inhibitors and β‐blockers, than men. Blacks were more likely to be taking diuretics and calcium channel blockers, and less likely to be taking β‐blockers and ACE inhibitors, than others. These relationships could not be attributed to differences in geographical area, other demographic factors, age, or medical history.CONCLUSIONS: These usage patterns appear to mirror those in the population of the United States as a whole, which has trended toward greater usage of calcium channel blockers and ACE inhibitors with declining use of diuretics. The distribution of antihypertensive medications among older hypertensives is markedly different between women and men and between black Americ

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01367.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: The purpose of this investigation is to explore the relationship of patient gender and age on coronary artery disease diagnostic evaluation and to assess the impact of noninvasive testing results on coronary revascularization rates and cardiac event‐free survival.STUDY DESIGN: Retrospective observational cohort.PARTICIPANTS: From a series of 5322 consecutively tested patients from a Midwestern university tertiary medical center, a hospital cohort of 1345 patients with clinically suspected coronary artery disease was enrolled from 1988 through 1989.MEASUREMENTS AND RESULTS: Cardiac risk factor and symptom profiles were worse in women, whereas rates of positive test results were similar in both sexes. Multivariable‐adjusted risk for follow‐up diagnostic testing was 1.8 and 1.9 times greater, respectively, for men ≤ and>65 years of age than for women (P.20). Overall cardiac event rates were 2.3, 7.4, 16.7, and 20.2% for young men, young women, older women, and older men, respectively. Initial screening was delayed 2 to 7 times longer for older and younger women compared with men (P<.001); the greatest delays were observed for younger women. Diagnostic follow‐up and subsequent cost of total care from initial evaluation through 2 years of follow‐up were higher for men than for women (P<.0001), with older women having the lowest rate of subsequent diagnostic and interventional follow‐up. In the highest risk patients, subsequent utilization rates were 40 and 20% higher for younger and older men than for similarly aged women. In particular, diabetics were less likely to undergo follow‐up diagnostic testing and revascularization (67% younger women).CONCLUSIONS: Age appears to significantly and differently influence decisions regarding noninvasive and invasive medical service utilization in men and women and may partially account for variable outcomes in this and previous gender‐

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01368.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To identify factors in a medical examination that distinguish convicted older drivers with traffic violations from other drivers.DESIGN: Matched case‐control study.SETTING: Two counties in Sweden.SUBJECTS: Thirty‐seven drivers older than age 65, whose driving licenses have been temporarily suspended, each matched to one control subject based on age, sex, type of driving license, year of first license, living area, educational level, and annual distance driven.MEASUREMENTS: Case and control subjects were compared with respect to medical history, medication use, blood tests, drawing and memory tests, Mini‐Mental State Examination, medical status findings, visual acuity, and brain imaging procedures.MAIN RESULTS: The group of drivers with suspended driving licenses did not differ from matched controls with respect to visual acuity or presence of cardiovascular diseases. However, persons with suspended driving licenses were more likely than control subjects to have suspected or mild dementia (P<.010) and to perform less well on two easily administrated screening tests: copying a cube (P<.010) and 5‐item recall (P<.010). Case subjects with crashes had significantly more cardiovascular diseases than case subjects with other moving violations (P<.050). These case subjects with crashes also had significantly more cognitive impairments than control subjects without crashes as shown by a higher clinical dementia rating score (CDR) (P<.001), lower score on the Mini‐Mental State Examination (MMSE) (P<.050), and lower level of performance in the copying task (cube) (P<.050) and 5‐item recall test (P<.010). They also had evidence of greater cognitive impairment than those case subjects with other moving violations.CONCLUSIONS: Visual acuity and common medical examination did not distinguish convicted older drivers with crashes or other moving violations from controls. There was evidence that even mild cognitive impairment contributed to the risk of losing a driving license because

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01369.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To describe the prevalence and sociodemographic and clinical correlates of suicidal ideation among older primary care patients.DESIGN: Baseline screening for depressive symptoms, functional status, and suicidal ideation, with prospective assessment of mortality.SETTING: An academic primary care group practice at an ambulatory care clinic.PARTICIPANTS: 301 patients who screened positive for depression and a random sample of 101 patients who screened negative from among 3767 patients aged 60 and older who completed screening for depression during routine office visits.MEASUREMENTS: Centers for Epidemiologic Studies Depression (CES‐D) scale, Hamilton Depression Rating (HAM‐D) scale, Sickness Impact Profile (SIP), structured psychiatric interview, sociodemographic and clinical variables, and mortality.RESULTS: Among the 301 patients with CES‐D scores ≥16, 14 (4.6%) reported suicidal ideation and received urgent evaluation by mental health professionals. The estimated prevalence of suicidal ideation in this cohort of older primary care patients was 0.7 to 1.2%. All patients with suicidal ideation had evidence of a current affective disorder, and nearly all had moderate to severe functional impairment. However, even though all 14 patients endorsed suicidal ideation, corresponding HAM‐D scores ranged from 3 to 40, and only four of 14 met diagnostic criteria for major depression. The most common suicide plan involved use of a hand gun. Depressed patients with suicidal ideation did not differ significantly from depressed non‐suicidal patients on any of the following variables: age, gender, race, education, alcohol abuse, cognitive impairment, or mean CES‐D, HAM‐D, or SIP scores. None of the suicidal patients had died within 12 months of the screening date.CONCLUSION: The prevalence of suicidal ideation was about 1% among this cohort of older primary care patients, and the prevalence approaches 5% among those older adults who report significant symptoms of depression. However, asking patients directly about the presence of active suicidal ideation appears to be the only effective means of identifyin

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01370.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: To identify patient factors that influence physicians' decisions to recommend screening mammograms for older women.DESIGN: A cross‐sectional survey including clinical case vignettes.PARTICIPANTS: Random sample of Massachusetts internists, obstetrician/gynecologists, family/general practice physicians, and geriatricians.OUTCOME MEASURE: Proportion of screening mammograms recommended for women in different versions of each case vignette.RESULTS: A total of 482 (65%) of the eligible participants responded to a mailed survey of questions about breast cancer screening practices, attitudes toward ACS guidelines, and four clinical vignettes. Vignettes tested the impact of patient's age, cognitive function, nursing home residence, functional limitations, and comorbidity on the physician's decision to recommend a mammogram.Ninety‐four percent of physicians reported often performing periodic clinical breast exams and mammograms for women aged 65 to 74. For women aged 75 to 84, 89% of physicians reported often performing periodic clinical breast exams, and 79% recommend mammograms. Only 48% strongly agreed with ACS guidelines for annual mammography for women over 65.Age, dementia, and nursing home residence were patient factors associated with decreased mammogram use, but limited mobility and chronic medical problems were not. Physicians were more likely to recommend a mammogram for a woman aged 65 to 74 than for a woman 75 to 84. (P= .002) Physicians were more likely to recommend a mammogram for a woman without dementia than for a woman with mild dementia (P<.05) and for a woman living with her daughter than a for a woman living in a nursing home (P<.001).CONCLUSIONS: Age older than 75, mild dementia, and nursing home residence are factors that negatively influence physicians' decisions to recommend mammography. Presence of chronic medical problems and functional limitations do not. Physicians appear to be using implicit judgments about quality of life and age rather than life expectancy based on comorbidity to determine breast cancer screening practi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb01371.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY