Depressive Symptoms, Chronic Pain, and Falls in Older Community-Dwelling Adults: The MOBILIZE Boston Study.
J Am Geriatr Soc. 2012 Jan 27;
Authors: Eggermont LH, Penninx BW, Jones RN, Leveille SG
Abstract
OBJECTIVES: To examine whether overall depressive symptoms and symptom clusters are associated with fall risk and to determine whether chronic pain mediates the relationship between depression and fall risk in aging. DESIGN: Prospective cohort study. SETTING: Boston, Massachusetts, and surrounding communities. PARTICIPANTS: Older community-dwelling adults (N = 722, mean age 78.3). MEASUREMENTS: Depressive symptomatology was assessed at baseline using the 20-item Hopkins Revision of the Center for Epidemiologic Studies Depression Scale (CESDR) as overall depression and two separate domains: cognitive and somatic symptoms. Chronic pain was examined at baseline as number of pain sites (none, single site, or multisite), pain severity, and pain interference with activities of daily living. Participants recorded falls on monthly postcards during a subsequent 18-month period. RESULTS: According to negative binomial regression, the rate of incident falls was highest in those with the highest burden of depressive symptoms (according to total CESDR and the cognitive and somatic CESDR domains). After adjustment for multiple confounders and fall risk factors, fall rate ratios comparing the highest three CESDR quartiles with the lowest quartile were 1.91, 1.26, and 1.11, respectively. Similarly graded associations were observed according to the CESDR domains. Although pain location and interference were mediators of the relationship between depression and falls, adjustment for pain reduced fall risk estimates only modestly. There was no interaction between depression and pain in relation to fall risk. CONCLUSION: Depressive symptoms are associated with fall risk in older adults and are mediated in part by chronic pain. Research is needed to determine effective strategies for reducing fall risk and related injuries in older people with pain and depressive symptoms.
PMID: 22283141 [PubMed - as supplied by publisher]
Serum 25-Hydroxyvitamin D, Transitions Between Frailty States, and Mortality in Older Adults: The Invecchiare in Chianti Study.
J Am Geriatr Soc. 2012 Jan 27;
Authors: Shardell M, D’Adamo C, Alley DE, Miller RR, Hicks GE, Milaneschi Y, Semba RD, Cherubini A, Bandinelli S, Ferrucci L
Abstract
OBJECTIVES: To assess whether serum 25-hydroxyvitamin D (25(OH)D) concentrations relate to transitions between the states of robustness, prefrailty, and frailty and to mortality in older adults. DESIGN: The Invecchiare in Chianti (InCHIANTI) Study, a prospective cohort study. SETTING: Tuscany, Italy. PARTICIPANTS: Adults aged 65 and older (N = 1,155). MEASUREMENTS: Serum 25(OH)D concentrations measured at baseline; frailty state (robust, prefrail, frail) assessed at baseline and 3 and 6 years after enrollment; and vital status determined 3 and 6 years after enrollment. RESULTS: The median (interquartile range) 25(OH)D concentration was 16.0 ng/mL (10.4-25.6 ng/mL; multiply by 2.496 to convert to nmol/L). Prefrail participants with 25(OH)D levels less than 20 ng/mL were 8.9% (95% confidence interval (CI) = 2.5-15.2%) more likely to die, 3.0% (95% CI = -5.6-14.6%) more likely to become frail, and 7.7% (95% CI = -3.5-18.7%) less likely to become robust than prefrail participants with 25(OH)D levels of 20 ng/mL or more. In prefrail participants, each 5-ng/mL decrement of continuous 25(OH)D was associated with 1.46 times higher odds of dying (95% CI = 1.18-2.07) and 1.13 higher odds of incident frailty (95% CI = 0.90-1.39) than with recovery of robustness. Transitions from robustness or frailty were not associated with 25(OH)D levels. CONCLUSION: Results provide evidence that prefrailty is an “at risk” state from which older adults with high 25(OH)D levels are more likely to recover than to decline, but high 25(OH)D levels were not associated with recovery from frailty. Thus, 25(OH)D levels should be investigated as a potential therapy to treat prefrailty and prevent further decline.
PMID: 22283177 [PubMed - as supplied by publisher]
OBJECTIVES: To examine whether protein intake is associated with change in muscle strength in older persons. Because systemic inflammation has been associated with protein catabolism, the study also evaluated whether a synergistic effect exists between protein intake and inflammatory markers on change in muscle strength. DESIGN: Longitudinal. SETTING: The Invecchiare in Chianti Study. PARTICIPANTS: Five hundred and ninety-eight older adults. MEASUREMENTS: Knee extension strength was measured at baseline (1998-2000) and during 3-year follow-up (2001-2003) using a handheld dynamometer. Protein intake was assessed using a detailed food frequency questionnaire. The inflammatory markers examined were C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). RESULTS: The main effect of protein intake on change in muscle strength was not significant. However, a significant interaction was found between protein intake and CRP (P = .003), IL-6 (P = .049), and TNF-α (P = .02), indicating that lower protein intake was associated with greater decline in muscle strength in persons with high levels of inflammatory markers. CONCLUSION: Lower protein intake was associated with decline in muscle strength in persons with high levels of inflammatory markers. These results may help to understand the factors contributing to decline in muscle strength with aging and to identify the target population of older persons who may benefit from nutritional interventions aimed at preventing or reducing age-associated muscle impairments and its detrimental consequences.
PMID: 22283208 [PubMed - as supplied by publisher]
Reevaluating the Implications of Recurrent Falls in Older Adults: Location Changes the Inference.
J Am Geriatr Soc. 2012 Jan 27;
Authors: Kelsey JL, Procter-Gray E, Berry SD, Hannan MT, Kiel DP, Lipsitz LA, Li W
Abstract
OBJECTIVES: To compare characteristics of indoor and outdoor recurrent fallers and explore some implications for clinical practice, in which a fall risk assessment for all recurrent fallers has been recommended. DESIGN: Prospective cohort study. SETTING: Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study, a study of falls etiology in community-dwelling older individuals from randomly sampled households in the Boston, Massachusetts, area. PARTICIPANTS: Seven hundred thirteen women and men, mostly aged 70 and older, with at least 1 year of follow-up. MEASUREMENTS: Data at baseline and from an 18-month follow-up examination were collected by questionnaire and comprehensive clinic examination. During follow-up, participants recorded falls on daily calendars. A telephone interview queried location and circumstances of each fall. RESULTS: One hundred forty-five participants reported recurrent falls (≥2) during the first year. Those who had fallen only outdoors had good health characteristics, whereas those who had fallen only indoors were generally in poor health. For instance, 25.5% of indoor-only recurrent fallers had gait speeds of slower than 0.6 m/s, compared with 2.9% of outdoor-only recurrent fallers; the respective percentages were 44.7% and 8.8% for Berg balance score less than 48. Recurrent indoor fallers generally had poor health characteristics regardless of their activity at the time of their falls, whereas recurrent outdoor fallers who fell during vigorous activity or walking were especially healthy. A report of any recurrent falls in the first year did not predict number of positive findings on a comprehensive or abbreviated fall risk assessment at the 18-month follow-up examination. CONCLUSION: Characteristics of community-dwelling older people with recurrent indoor and outdoor falls are different. If confirmed, these results suggest that different types of fall risk assessment are needed for specific categories of recurrent fallers.
PMID: 22283236 [PubMed - as supplied by publisher]
Authors: Davey A, Lele U, Elias MF, Dore GA, Siegler IC, Johnson MA, Hausman DB, Tenover JL, Poon LW,
Abstract
OBJECTIVES: To describe the prevalence of diabetes mellitus (DM) in centenarians. DESIGN: Cross-sectional, population-based. SETTING: Forty-four counties in northern Georgia. PARTICIPANTS: Two hundred forty-four centenarians (aged 98-108, 15.8% male, 20.5% African American, 38.0% community dwelling) from the Georgia Centenarian Study (2001-2009). MEASUREMENTS: Nonfasting blood samples assessed glycosylated hemoglobin (HbA(1c) ) and relevant clinical parameters. Demographic, diagnosis, and DM complication covariates were assessed. RESULTS: 12.5% of centenarians were known to have DM. DM was more prevalent in African Americans (27.7%) than whites (8.6%, P < .001). There were no differences between men (16.7%) and women (11.7%, P = .41) or between centenarians living in the community (10.2%) and in facilities (13.9%, P = .54). DM was more prevalent in overweight and obese (23.1%) than nonoverweight (7.1%, P = .002) centenarians. Anemia (78.6% vs 48.3%, P = .004) and hypertension (79.3% vs 58.6%, P = .04) were more prevalent in centenarians with DM than in those without, and centenarians with DM took more nonhypoglycemic medications (8.6 vs 7.0, P = .02). No centenarians with HbA(1c) of less than 6.5% had random serum glucose levels greater than 200 mg/dL. DM was not associated with 12-month all-cause mortality, visual impairment, amputations, cardiovascular disease, or neuropathy. Thirty-seven percent of centenarians reported onset before age 80 (survivors), 47% between age 80 and 97 (delayers), and 15% aged 98 and older (escapers). CONCLUSION: Diabetes mellitus is a risk factor for cardiovascular disease and mortality but is seen in persons who live into very old age. Aside from higher rates of anemia and use of more medications, few clinical correlates of DM were observed in centenarians.
PMID: 22283370 [PubMed - as supplied by publisher]
Coronary Artery Disease Is Associated with Cognitive Decline Independent of Changes on Magnetic Resonance Imaging in Cognitively Normal Elderly Adults.
OBJECTIVES: To examine in cognitively normal elderly adults whether vascular factors predict cognitive decline and whether these associations are mediated by magnetic resonance imaging (MRI) measures of subclinical vascular brain injury. DESIGN: Prospective multisite longitudinal study of subcortical ischemic vascular diseases. SETTING: Memory and aging centers in California. PARTICIPANTS: Seventy-four participants who were cognitively normal at entry and underwent at least two neuropsychological evaluations and two MRI examinations over an average follow-up of 6.9 years. MEASUREMENTS: Item response theory was used to create composite scores of global, verbal memory, and executive functioning. Volumetric MRI measures included white matter hyperintensities (WMHs), silent brain infarcts (SBIs), hippocampus, and cortical gray matter (CGM). Linear mixed-effects models were used to examine the associations between vascular factors, MRI measures, and cognitive scores. RESULTS: History of coronary artery disease (CAD) was associated with greater declines in global cognition, verbal memory, and executive function. The CAD associations remained after controlling for changes in WMHs, SBIs, and hippocampal and CGM volumes. CONCLUSION: History of CAD may be a surrogate marker for clinically significant atherosclerosis, which also affects the brain. Structural MRI measures of WMHs and SBIs do not fully capture the potential adverse effects of atherosclerosis on the brain. Future longitudinal studies of cognition should incorporate direct measures of atherosclerosis in cerebral arteries, as well as more sensitive neuroimaging measures.
PMID: 22283410 [PubMed - as supplied by publisher]
Age Patterns of Incidence of Geriatric Disease in the U.S. Elderly Population: Medicare-Based Analysis.
J Am Geriatr Soc. 2012 Jan 27;
Authors: Akushevich I, Kravchenko J, Ukraintseva S, Arbeev K, Yashin AI
Abstract
OBJECTIVES: To use the Medicare Files of Service Use (MFSU) to evaluate patterns in the incidence of aging-related diseases in the U.S. elderly population. DESIGN: Age-specific incidence rates of 19 aging-related diseases were evaluated using the National Long Term Care Survey (NLTCS) and the Surveillance, Epidemiology, and End Results (SEER) Registry data, both linked to MFSU (NLTCS-M and SEER-M, respectively), using an algorithm developed for individual date at onset evaluation. SETTING: A random sample from the entire U.S. elderly population (Medicare beneficiaries) was used in NLTCS, and the SEER Registry data covers 26% of the U.S. population. PARTICIPANTS: Thirty-four thousand seventy-seven individuals from NLTCS-M and 2,154,598 from SEER-M. MEASUREMENTS: Individual medical histories were reconstructed using information on diagnoses coded in MFSU, dates of medical services and procedures, and Medicare enrollment and disenrollment. RESULTS: The majority of diseases (e.g., prostate cancer, asthma, and diabetes mellitus) had a monotonic decline (or decline after a short period of increase) in incidence with age. A monotonic increase in incidence with age with a subsequent leveling off and decline was observed for myocardial infarction, stroke, heart failure, ulcer, and Alzheimer’s disease. An inverted U-shaped age pattern was detected for lung and colon carcinomas, Parkinson’s disease, and renal failure. The results obtained from the NLTCS-M and SEER-M were in agreement (excluding an excess for circulatory diseases in the NLTCS-M). A sensitivity analysis proved the stability of the incidence rates evaluated. CONCLUSION: The developed computational approaches applied to the nationally representative Medicare-based data sets allow reconstruction of age patterns of disease incidence in the U.S. elderly population at the national level with unprecedented statistical accuracy and stability with respect to systematic biases.
PMID: 22283485 [PubMed - as supplied by publisher]
Physical Health Conditions Associated with Posttraumatic Stress Disorder in U.S. Older Adults: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.
J Am Geriatr Soc. 2012 Jan 27;
Authors: Pietrzak RH, Goldstein RB, Southwick SM, Grant BF
Abstract
OBJECTIVES: To present findings on past-year medical conditions associated with lifetime trauma exposure and full and partial posttraumatic stress disorder (PTSD) in a nationally representative sample of U.S. older adults. DESIGN: Face-to-face diagnostic interviews. SETTING: Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. PARTICIPANTS: Nine thousand four hundred sixty-three adults aged 60 and older. MEASUREMENTS: Logistic regression analyses adjusting for sociodemographic characteristics and psychiatric comorbidity were used to evaluate associations between PTSD status and past-year medical disorders; linear regression models evaluated associations with past-month physical functioning. RESULTS: After adjustment for sociodemographic characteristics and comorbid lifetime mood, anxiety, substance use, attention-deficit/hyperactivity, and personality disorders, respondents with lifetime PTSD were more likely than respondents who reported experiencing one or more traumatic life events but who did not meet lifetime criteria for full or partial PTSD (trauma controls) to report being diagnosed with hypertension, angina pectoris, tachycardia, other heart disease, stomach ulcer, gastritis, and arthritis (odds ratios (ORs) = 1.3-1.8) by a healthcare professional; they also scored lower on a measure of physical functioning than controls and respondents with partial PTSD. Respondents with lifetime partial PTSD were more likely than controls to report past-year diagnoses of gastritis (OR = 1.7), angina pectoris (OR = 1.5), and arthritis (OR = 1.4) and reported worse physical functioning. Number of lifetime traumatic event types was associated with most of the medical conditions assessed; adjustment for these events reduced the magnitudes of and rendered nonsignificant most associations between PTSD status and medical conditions. CONCLUSION: Older adults with lifetime PTSD have high rates of several physical health conditions, many of which are chronic disorders of aging, and poorer physical functioning. Older adults with lifetime partial PTSD have higher rates of gastritis, angina pectoris, and arthritis and poorer physical functioning.
PMID: 22283516 [PubMed - as supplied by publisher]
Metabolic Complications in Elderly Adults with Chronic Kidney Disease.
J Am Geriatr Soc. 2012 Jan 27;
Authors: Drawz PE, Babineau DC, Rahman M
Abstract
OBJECTIVES: To determine whether elderly adults with a low glomerular filtration rate (GFR) are at risk for anemia, hyperkalemia, acidosis, and hyperphosphatemia. DESIGN: Retrospective study. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: Thirteen thousand eight hundred seventy-four veterans aged 65 and older with chronic kidney disease (CKD) and a GFR between 15 and 60 mL/min per 1.73 m(2) . Their average age was 79. MEASUREMENTS: Anemia was defined as a hemoglobin level of less than 10 g/dL, hyperkalemia as a potassium level greater than 5.5 mEq/L, acidosis as a bicarbonate level of less than 21 mEq/L, and hyperphosphatemia as a phosphorus level greater than 4.6 mg/dL. Multivariable logistic regression was used to evaluate whether age modifies the effect of low GFR on metabolic complications by including an interaction term between age and GFR in each model. RESULTS: The average GFR of participants was 46.5 mL/min per 1.73m(2) , 3.1% had anemia, 2.5% hyperkalemia, 2.3% acidosis, and 4.4% had hyperphosphatemia. Lower GFR was associated with higher rates of metabolic complications across all age groups (odds ratio per 5-mL/min per 1.73 m(2) decrease in GFR in multivariable models was 1.21 for anemia, 1.26 for hyperkalemia, 1.45 for acidosis, and 1.72 for hyperphosphatemia). There was no significant interaction between age and GFR in models including only age and GFR or in multivariable models (P-values for age by GFR interaction term: 0.66 for anemia, 0.19 for hyperkalemia, 0.54 for acidosis, and 0.22 for hyperphosphatemia). CONCLUSION: Elderly adults with CKD are at risk for anemia, hyperkalemia, acidosis, and hyperphosphatemia; age does not modify the relationship between GFR and development of metabolic complications. Elderly adults with low GFR should be monitored for metabolic complications, regardless of age.
PMID: 22283563 [PubMed - as supplied by publisher]
Factors Noted to Affect Breast Cancer Treatment Decisions of Women Aged 80 and Older.
J Am Geriatr Soc. 2012 Jan 27;
Authors: Schonberg MA, Silliman RA, McCarthy EP, Marcantonio ER
Abstract
OBJECTIVES: To identify factors that influence the breast cancer treatment decisions of women aged 80 and older. DESIGN: Medical record review. SETTING: One academic primary care clinic and two community health centers in Boston. PARTICIPANTS: Sixty-five women aged 80 and older diagnosed with breast cancer between 1994 and 2004 and followed through June 30, 2010. MEASUREMENTS: Data were abstracted on breast cancer characteristics, comorbidities, treatments received, and outcomes. Notes from primary care physicians, oncologists, and breast surgeons were reviewed to determine factors involved in treatment decision-making. RESULTS: Median age at diagnosis was 84.0 (interquartile range 82.0-86.3), 55 (84.6%) were non-Hispanic white, and 40 (61.5%) had at least one comorbidity. Nine women were diagnosed with ductal carcinoma in situ, 42 with a new primary invasive breast cancer, eight with a second primary, and six with a breast cancer recurrence. Sixty-three (96.9%) received some type of treatment. Fifty-six (86.2%) had at least one detailed physician note on treatment decision-making in their charts. The main categories found to influence participant, family, and physician treatment decision-making were tumor characteristics, ratio of treatment benefits to risks, logistics (e.g., transportation, finances), and participant age, health (including a concurrent diagnosis), and psychosocial characteristics. Family was involved in treatment discussions for 46 (70.8%) participants. CONCLUSION: The quality of physician documentation about decision-making in these women was high. A great amount of thoughtful and complex decision-making involving patients, family, and physicians occurs after a woman aged 80 and older is diagnosed with breast cancer.
PMID: 22283600 [PubMed - as supplied by publisher]
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