摘要:

OBJECTIVES: The purpose of this study was to determine whether walking is associated with a reduced risk of cardiovascular disease hospitalization and death in community‐dwelling older men and women.DESIGN: A prospective study, with follow‐up time of 4 to 5 years (average 4.2 years).SETTING: A western Washington health maintenance organization.PARTICIPANTS: Men and women aged 65 years and older from a random sample of HMO enrollees invited by mail to participate in a health promotion intervention trial (36% accepted the invitation and completed questionnaires). This report is based on 1645 older adults without severe disability and without history of heart disease. Vital status ascertainment was complete (100%), and only 2.6% did not complete the follow‐up.MEASUREMENTS: Reported frequency and duration of walking for exercise, work, errands, pleasure, and hiking in the 2 weeks before baseline were used to classify hours of walking per week. The two main outcomes were: (1) cardiovascular disease hospitalizations with a discharge diagnosis of coronary (ICD‐9‐CM 410–414) or other cardiovascular diseases (ICD‐9‐CM 390–409, 415–448) documented by computerized hospitalization records and (2) death. Numerous potential confounding factors were considered, including age, sex, treated high blood pressure, current estrogen use and chronic disease score (ascertained by computerized medical and pharmacy records), and ethnicity, education, income, physical function, self‐rated health status, smoking, alcohol intake, and body mass index (ascertained by self‐report on the mailed questionnaire).RESULTS: Walking more than 4 hours/week was associated significantly with a reduced risk of cardiovascular disease hospitalization in both sexes combined compared with walking less than 1 hour/week (age and sex‐adjusted relative risk = 0.69; 95% confidence interval, 0.52–0.90). This association was not altered by adjustment for baseline cardiovascular risk factors and indicators of general health status. The association was present in all age groups, among those with and without physical limitations, and also among those who did and did not also participate in more vigorous physical activities. Walking more than 4 hours/week was also associated with a reduced risk of death (age and sex‐adjusted relative risk = 0.73; 95% confidence interval, 0.48–1.10), however, this association was substantially diminished by adjustment for cardiovascular risk factors and measures of general health status.CONCLUSIONS: Walking more than 4 hours/week may reduce the risk of hospitalization for cardiovascular disease events. The association of walking more than 4 hours/week with reduced risk of death may be mediated by effects of walking on other risk factors. These findings provide much stronger evidence than previously available for advising older men and women to embark on or maintain a sustained program of walking to prevent cardiovascular disease events.J

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02425.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVES: To compare the heart rate and intra‐arterial blood pressure responses during weight lifting, horizontal and uphill walking, and stair climbing in older male subjects.DESIGN: We used intra‐brachial artery catheterization to compare the arterial blood pressure (ABP) and heart rate (HR) responses during 10 repetitions (˜40 s) of single‐arm curl (SAC) and single‐arm overhead military press (SAMP) (70% of the one repetition maximum–1RM); 12 repetitions (˜50 s) of single‐ (SLP) and double‐leg press (DLP) weight‐lifting exercises (80% of 1RM); 10 minutes of horizontal treadmill walking (T10) at 2.5 mph holding a 20‐pound weight in minutes 4 to 6 (T104–6) and 30 pounds in minutes 8 to 10 (T108–10); 4 minutes of treadmill walking (T4) at 3.0 mph up an 8% incline; and 12 flights (192 steps) of stair climbing (STR) at 60 to 65 steps/minute on a Stairmaster 6000 ergometer (˜3 minutes).SETTING: McMaster University, Hamilton, Ontario, Canada.PARTICIPANTS: Seventeen healthy males aged (X̄ ± SE) 64.4 ± 0.6 years.MEASUREMENTS: Continuous intra‐arterial measurements of systolic, diastolic, and mean arterial pressure and heart rate and rate‐pressure product.RESULTS: The peak values of HR, ABP and rate‐pressure product (HR · BPs/1000;(RPP,103)) were not systematically ordered among the various activities. The lowest peak values for all variables were recorded during the initial 4 minutes of horizontal treadmill walking. The STR and T4 walking exercises elicited higher HRs (151 ±3.2 and 121 ± 3.4 bpm) than the weight lifting (range from 100 ± 4.8 (SAC) to 113 ± 3.8 bpm (SAMP)), but the converse was true for diastolic pressure (range from 128 ± 6.3 (SAC) to 151 ± 4.8 mm Hg (SAMP) versus 101 ± 2.5 (T4) to 118 ± 3.4 mm Hg (T108–10) and mean arterial pressure (range from 145 ± 4.5 (SAC) to 158 ± 4.8 mm Hg (SAMP) versus 129 ± 3.4 in T4 to 148 ± 3.8 (T108–10) and 157 ± 4.1 mm Hg (STR)). The peak systolic pressure was greatest in STR (271 ± 9.6 mm Hg) followed by SAMP (261 ± 9.3 mmHg) and T108–10(244 ± 6.4 mm Hg) and was lowest in SAC (224 ± 10.5 mm Hg) and T104–6(220 ± 5.7 mm Hg). The peak RPP descended in sequence from STR (41 ± 1.8), SAMP (29.8 ± 1.7), T4 (28.1 ± 1.3), DLP (27.2 ± 1.3), T108–10(27.1 ± 1.4), SLP (25.4 ± 1.7), T104–6(22.7 ± 1.2) and SAC (22.0 ± 2.2).CONCLUSION: We concluded that older adults who engage in weight lifting with heavy submaximal loads are exposed to no more peak circulatory stress than that created during a few minutes of inclined walking. Moreover, climbing only three to four flights of stairs at a moderate pace (–50–70 s) elicits peak circulatory demands similar to, but at a much more rapid rate of adjustment than, 10 minutes of horizontal walking at 2.5 mph intermittently carrying a 30‐pound weight or 4 mi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02426.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine factors that predict change in walking velocity in older people using a multivariate model.DESIGN: Longitudinal observational study.SUBJECTS: A total of 588 persons older than age 60, including subjects residing in a continuing care retirement community (CCRC) (n = 248), and homebound (n = 79) and ambulatory (n = 261) subjects. Mean age at baseline = 77.MEASUREMENT: Independent variables included demographics, physician measures of lower‐extremity joint impairment and other musculoskeletal and neurological variables, comorbidities derived from physical examination and chart abstract, self‐assessed arthritis pain, depression, and anxiety. The major dependent variables were 2‐ and 4‐year decline in walking velocity below a threshold associated with nursing home placement.MAIN RESULTS: From baseline to Year 4, median walking velocity declined from 61.8 to 53.0 m/min, and the proportion of subjects above a threshold value of 11.5 m/min declined from 95.3% to 80.4%. Age, joint impairment, and weakness of quadriceps, measured at baseline, predicted 2‐year and 4‐year decline in walking velocity.CONCLUSIONS: The findings indicate that joint impairment and quadriceps strength contribute significantly to crossing a clinically significant threshold in walking velocity among older people over time. Future research is needed to determine whether these risk factors can be modified through preventive interventions such as muscle‐strengthening exercises and pain medication.J Am Geriatr Soc 44:

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02427.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To better understand how to differentiate the “in vivo” normal aging brain from pathological conditions, namely dementia of the Alzheimer type (DAT), by means of magnetic resonance imaging (MRI), single photon emission computerized tomography (SPECT), and proton magnetic resonance spectroscopy (1H‐MRS), to show neuroanatomical, perfusional and neurochemical details, respectively.DESIGN:1H‐MRS, MRI‐based hippocampal volumetry and99mTc‐HMPAO SPECT were performed in healthy older subjects as well as patients suffering from age‐associated memory impairment (AAMI) and dementia of Alzheimer type (DAT).SUBJECTS AND SETTING: Eighteen subjects were selected from those referred to an outpatient clinic for diagnostic evaluation of cognitive impairment entered the study. Six patients fulfilled NINCDS‐ADRDA diagnostic criteria for DAT, six subjects were affected by AAMI, and six cognitively healthy subjects, selected from among relatives of the patients, were defined as controls.METHODS: The1H‐MRS and MRI studies were performed on a 1.5 Tesla NMR‐imaging system equipped with a spectroscopy research package. SPECT scans were performed on a Gamma 11 computer system.FINDINGS:1H‐MRS showed significantly lower N‐acetyl‐aspartate concentration in DAT and AAMI compared with controls. Conversely, mean inositol concentration was significantly higher in DAT than in controls, whereas AAMI subjects registered intermediate values. MRI measurements showed significantly reduced volumes of hippocampal formations in DAT and AAMI groups compared with controls. Finally,99mTc‐HMPAO SPECT showed a significant frontal, temporo‐parietal, and occipital hypoperfusion in DAT patients only.CONCLUSIONS: These findings support the hypothesis of a continuum among the three conditions studied, or at least between AAMI and DAT, where AAMI seems to be an early, monosymptomatic stage of Alzheimer disease. Accepting this view, it would be questionable to maintain the term “age‐associated memory impairment” as a discrete entit

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02428.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To investigate the prevalence and characteristics of nocturnal enuresis in community‐dwelling older adults and to identify potential predisposing variables.DESIGN: Interview survey.SETTING: Five rural counties in northwestern Pennsylvania.PARTICIPANTS: Subjects were 3884 community‐dwelling older adults aged 65 to 79 years who volunteered for a health promotion demonstration.MEASUREMENTS: The dependent variable was self‐reported accidental loss of urine during sleep. Independent variables included demographic variables, self‐reported disease history and symptomatology, and standardized screening instruments for depression (CES‐D), dementia (MMSE), and functional status (ADLs).MAIN RESULTS: Prevalence of nocturnal enuresis was 2.1%, and was significantly higher among women (2.9%) compared with men (1.0%;P<.0001). Compared with subjects with daytime incontinence only, those with nocturnal enuresis reported greater severity and impact of incontinence on several parameters. Enuretics were more likely to have received treatment; treatment outcome, however, was significantly less successful. In univariate analyses, enuresis was significantly associated with symptoms of congestive heart failure (CHF), impairment in activities of daily living, depression, and use of sleep medications at least once per week. In stepwise logistic regression modeling, two symptoms of congestive heart failure and regular use of sleep medication entered the model.CONCLUSIONS: Nocturnal enuresis appears to be uncommon among older adults, but it may be associated with i poorer therapeutic outcomes compared with the more common forms of daytime incontinence. The findings are consistent with the hypothesis that daytime fluid accumulation followed at night by mobilization of excess fluid is a contributor to enuresis in older adults.J Am Geriatr Soc 44:139

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02429.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To examine the anticipated decisions to consent to or to forgo life‐sustaining treatment by spouses of patients with Alzheimer's disease and to describe the relationship of spouse and patient characteristics to predicted decisions.DESIGN: Prospective quantitative study.SETTING: The Aging and Dementia Research Center (ADRC), part of an Alzheimer's Disease Center Core Grant, at New York University Medical Center.PARTICIPANTS: Fifty spouse caregivers of Alzheimer's disease patients, evaluated at the ADRC, who had a minimum Stage 4 on the Global Deterioration Scale.MEASUREMENTS: Spouses were presented with two conditions (critical illness and irreversible coma) and rated their agreement with, certainty of, and comfort with four treatments (resuscitation, breathing machine, feeding tube, and antibiotics). Data were also obtained as to patients' current quality of life, spouses' standard of decision‐making, and spouse burden.RESULTS: Eighteen of 50 patients had a durable power of attorney for health care, 20 of 50 had a living will, and 26 of 50 had neither. In the face of critical illness, almost equal numbers of spouses would consent to or forgo CPR, 28 of 50 would forgo a breathing machine, 21 of 50 a would forgo a feeding tube, and 5 of 50 would forgo antibiotics. Five of 50 would forgo all four treatments, and 12 of 50 all but antibiotics. Spouses were significantly more likely to forgo treatment in the face of coma than for critical illness (P<.001). Spouses were more certain about decisions related to coma than to critical illness (P<.001), and there was a positive and significant correlation between certainty and comfort (P= .001). Those consenting to treatment were more comfortable than those forgoing treatment (for CPR and antibioticsP= .001). Spouses of patients with Stage 7 AD were more likely to forgo CPR than those with Stages 4 to 6 AD (P<.001). Only two of 50 spouses selected descriptors congruent with a purely substituted judgment standard of decision‐making. An equal number of spouses rated patient quality of life as good, fair, or poor. For critical illness, the poorer the quality of life rating, the more likely the spouses were to forgo feeding tubes (P<.001). There was a trend for highly burdened spouses to consent to treatment.CONCLUSIONS: The results provide evidence that spouses of patients with AD anticipate forgoing life‐sustaining treatments in the face of coma but are less sure about choices for critical illness. Although preliminary in nature, findings suggest that doctors, nurses, and social workers need to provide additional support to spouses choosing to forgo rather than consent to treatment and need to inquire as to what spouses perceive as the factors that are important to them in making a decision.J Am Geriatr Soc 44:144–

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02430.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine the prevalence and types of dementia in centenarians and to examine whether the ApoE 4 allele has significant impact on the development of Alzheimer's disease (AD) in the population.DESIGN: Cross‐sectional study and a 6‐month prospective study.SETTING: Yamanashi Prefecture, JapanPARTICIPANTS: Forty‐seven centenarians participated in the study to determine the prevalence and types of dementia. Thirty‐three of the 47 participated in the study of ApoE genotyping. As controls, 224 demented older adults participated in the genetic study. Their age at onset was<90 years.OUTCOMES: Prevalence of dementia based on DSM‐III‐R; types of dementia based on NINCDS‐ADRDA and ICD‐10; distribution on ApoE alleles in the centenarians and in the controls; and the 6‐month mortality rate of the subjects.MAIN RESULTS: Of 47 centenarians, 70.2% had dementia, and AD accounted for the majority (75.8%) of the dementia cases. The distribution of ApoE alleles in all the subjects and the AD subjects was ε2: 4.6% vs. 0%; ε 3: 90.1 % vs. 94.1%; ε 4: 4.6% vs. 5.9%. The frequency of the ε 4 allele in the AD patients showed a tendency to decrease with increasing age, ranging from 38% for those with an age at onset of<60 years to 22% for those with an age at onset of ranging from 80 to 89 years. The 6‐month mortality rate was 27% (9/33) for the demented centenarians, whereas none of the 14 nondemented centenarians died.CONCLUSION: This almost‐complete survey, conducted in a prefecture of Japan, revealed a high prevalence of dementia in centenarians. The ApoE ε 4 allele does not have an impact on the development of AD in centenarians.J Am Ge

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02431.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To analyze the mechanisms of falls that result in femoral neck fractures among lucid older people.DESIGN: A cross‐sectional study.SETTING: An orthopedic university hospital department.PARTICIPANTS: A consecutive series of 123 lucid patients, 65 years of age or more, who were admitted for femoral neck fractures.MEASUREMENTS: On admission, the subjects were interviewed about fracture accident characteristics, and falling mechanisms were classified. An arterial blood gas sample was taken from each patient soon after admission. Based on data regarding drug consumption and social and medical characteristics, a fall‐risk index was calculated for each subject.RESULTS: It was ascertained that 95% of the fractures were caused by falls and<2% were spontaneous. Most accidents (68%) took place indoors, 47% of the falls were classified as extrinsic, 24% as intrinsic, 7% as nonbipedal, and 22% remained unclassified. Almost all outdoor falls were extrinsic; however, intrinsic falls were as common as extrinsic falls indoors (P<.001). Extrinsic fallers presented a significantly lower fall‐risk index score than subjects with fractures caused by intrinsic, nonbipedal, and unclassifiable falls. A large proportion of subjects (24%) were hypoxemic (pO2<8 kPa) on admission, and patients who sustained fractures at night had lower oxygen tension than that of daytime fallers (P= .006).CONCLUSIONS: Accidental falls are the primary cause of femoral neck fractures. Preventive actions should be directed toward intrinsic, as well as extrinsic, risk factors for falls. Hypoxemia might be a risk factor for falls, especially those falls that occur at night.J Am Geriatr Soc 44:156–16

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02432.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To determine the effect of an inpatient self‐medication program (SMP) on the ability to self‐medicate, patient medication knowledge, compliance, and patient morale.DESIGN: Randomized controlled clinical trial.POPULATION: One hundred seven consecutive patients admitted to a geriatric assessment and rehabilitation program were randomized to either participate in the SMP or to receive standard care.INTERVENTION: The SMP was a three‐stage program in which patients were given increasing responsibility for the administration of their own medications.MEASUREMENTS: Ability to self‐medicate on discharge from hospital; medication compliance at 1 month; patient medication knowledge; Philadelphia Morale Scale.MAIN RESULTS: Participation in the self‐medication program did not increase the proportion of patients who were able to self‐medicate on discharge from hospital. Compliance was improved by the program. On a proportional basis, the self‐medication group made significantly fewer medication errors than the control group at 1‐month follow‐up (0.045 vs 0.086,P<.001). There were no significant differences in morale or medication knowledge between the SMP and control groups, although both groups made significant gains in knowledge about the names, administration times, and purposes of their medications from admission to follow‐up (P<.001).CONCLUSIONS: A SMP can improve compliance in geriatric patients who are discharged to the community. Participation in a SMP does not improve patients' morale nor does it improve their medication knowledge more than pharmacy counselling alone. Participation in a SMP is unlikely to increase the probability that patients will be able to self‐medicate on discharge. Cognitive factors limit patients' ability to self‐medicate.J Am Geria

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02433.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE: To test the prognostic role of nutritional variables as a component of geriatric multidimensional assessment and to study the effect of hospitalization on nutritional status.DESIGN: Validation cohort study: multidimensional assessment on admission and at discharge and a weekly nutritional assessment.SETTING: General Medicine and Geriatrics wards in an acute‐care university hospital.PATIENTS: A consecutive sample of 302 patients aged 79 ± 6 years, range 70–96 years.MAIN OUTCOME MEASURES: Mortality, longstay (>29 days), loss of lean body mass as expressed by a negative change in mid‐arm muscle circumference (MAMC).RESULTS: Incidence of mortality, longstay, and decreased MAMC was 6.9%, 24.8%, and 64.2%, respectively. According to logistic regression analysis, mortality was independently predicted by preadmission dependency in at least one Activity of Daily Living (odds ratio = 2.08, confidence limits = 1.19–3.65), clinical diagnosis of malnutrition (OR = 1.89, CL= 1.11–3.21), serum albumin<3.5 g/dL (OR = 1.82, CL = 1.06–3.14). This predictive model allowed us to recognize 75% of the patients at risk of death by targeting 23% of the population. Longstay was independently predicted by stroke (OR = 1.54, CL = 1.01–2.35), clinical diagnosis of malnutrition (OR = 1.41, CL = 1.04–1.93), and more than five comorbid diseases (OR = 1.39, CL = 1.01–1.94). Dependency in at least one ADL was the only independent predictor of decreased MAMC (OR = 1.71, CL = 1.27–2.30).CONCLUSIONS: Nutrition variables are a cardinal component of multidimensional assessment in the acute‐care setting. Nutritional status deteriorates during the hospital stay, mostly in physically dependent patients.J Am Geriat

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1996.tb02434.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY