Repeatability of the questionnaire for the aging level indices.
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The purpose of the study is to confirm repeatability of the series of self-administrating questions, which can be applied in large community populations. In 1994 and 1995, two surveys were conducted for the residents at Minamikawachi, Japan with a same questionnaire. The number of respondents for the both surveys was 887. Kappa statistics of all items of the series of questions for aging level indices were significantly high. Kappa statistics were over 0.4, and repeatability is good or excellent in 28 items of all the 45 items. The statistics of the items for medical treatments of chronic diseases were high, in such as diabetes (0.846) and hypertension (0.604). For activity of daily livings, such as shopping (0.619), kappa statistics were also high, but that of eating (0.162) was low. The statistics of subjective symptoms were moderate, however, that of impairment of hearing (0.672) was high, and that of decline of interest in opposite sex (0.256) were low. On the other hand, kappa statistics of acute diseases were low, in such as bone fracture (0.073). Correlation coefficients of the comprehensive aging level indices are around 0.6 among the people of 65 years old or older. In conclusion, the repeatability of the questions and indices were good, and they are appropriate to apply to communities. (+info)
Contribution of chronic conditions to aggregate changes in old-age functioning.
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OBJECTIVES: This study explored the role of various chronic conditions in explaining recent improvements in functioning among older Americans. METHODS: We used the Supplements on Aging to the 1984 and 1994 National Health Interview Surveys to examine changes among Americans 70 years and older in reports of chronic conditions and functional limitations. We decomposed functioning changes into condition-related components, controlling for demographic shifts. RESULTS: The percentage of older Americans with upper- and lower-body limitations declined from 5.1% and 34.2%, respectively, in 1984 to 4.3% and 28.5% in 1995, and the average number of lower body limitations decreased. During the same period, reports of 8 of 9 chronic conditions increased, but many of these conditions had less debilitating effects on functioning. Reductions in the debilitating effects of various chronic conditions--particularly arthritis--are important in explaining declines in limitations experienced by older Americans. CONCLUSIONS: Earlier diagnosis and improved treatment and management of chronic conditions, rather than prevention, may be important contributing factors to improvements in upper- and lower-body functioning among older Americans. (+info)
Turning difficulty characteristics of adults aged 65 years or older.
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BACKGROUND AND PURPOSE: Falls that occur while walking have been associated with an increased risk of hip fracture in elderly people. This study's purpose was to describe movement characteristics in older adults that serve as indicators of difficulty in turning while walking. SUBJECTS: Three groups were assessed: young adults who had no difficulty in turning (age range=20-30 years, n=20) (YNDT group), elderly adults who had no difficulty in turning (age range=65-87 years, n=15) (ENDT group), and elderly adults who had difficulty in turning (age range=69-92 years, n=15) (EDT group). METHODS: All subjects were videotaped performing a self-paced 180-degree turn during the Timed "Up & Go" Test. Movement characteristics of each group were identified. Four characteristics were used to identify difficulty in turning: (1) the type of turn, (2) the number of steps taken during the turn, (3) the time taken to accomplish the turn, (4) and staggering during the turn. RESULTS: In general, the EDT group took more steps during the turn and more time to accomplish the turn than the YNDT and ENDT groups. Although the only turning strategy used by the YNDT group was a pivot type of turn, there was an almost total absence of a pivot type of turn in the EDT group. No differences were found among the groups on the staggering item, yet the EDT group was the only group in which staggering was present. We believe these changes observed in the 4 characteristics only in the EDT group are indicators of difficulty in turning while walking. CONCLUSION AND DISCUSSION: These indicators of difficulty may be useful for the early identification of individuals aged 65 years or older who are having difficulty in turning and may well serve as the basis for the development of a scale for difficulty in turning in older adults. Preliminary findings indicate the need for further study into the reliability, validity, and sensitivity of measurements obtained with such a scale. (+info)
Adherence to recommendations of community-based comprehensive geriatric assessment programmes.
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BACKGROUND: non-adherence to the recommendations of short-term community-based consultative comprehensive geriatric assessment programmes is a threat to the effectiveness of these programmes. OBJECTIVE: to synthesize the literature on patient and physician adherence to recommendations of community-based comprehensive geriatric assessment programmes. METHOD: I identified papers cited by an English language literature search of MEDLINE, Health Star and CINAHL databases from January 1980 to November 1999. This search was supplemented with literature identified from the reference sections of these publications. RESULTS: patient adherence rates ranged from 46 to 76%, which approximates to the rates for the consulting physician adherence (49-79%). I identified many characteristics of patient, treatment, care provider and clinical setting which influenced adherence. Understanding these factors has led to the development of adherence-enhancing strategies. However, without systematic evaluations it is difficult to evaluate the relative effectiveness of these interventions. CONCLUSION: further research which targets more representative samples and uses validated assessment tools and multiple data collection methods is needed to expand our knowledge of patterns and predictors of adherence and to evaluate the relative effectiveness of adherence-enhancing intervention strategies. (+info)
Complications of carotid sinus massage--a prospective series of older patients.
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BACKGROUND: there is a causal association between carotid sinus hypersensitivity, falls and syncope in elderly subjects. Neurological complications during carotid sinus massage have been reported in case studies and two retrospective series. Our aim was prospectively to ascertain the incidence of complications occurring after carotid sinus massage performed for diagnostic purposes in a consecutive series of patients. METHODS: 1000 consecutive subjects aged 50 years or over who attended the accident and emergency department with syncope or 'unexplained' falls had carotid sinus massage. Carotid sinus massage was performed for 5 s on the right and then left sides both supine and upright (70 degrees head-up tilt) with continuous heart rate and phasic blood pressure recording. Contraindications to carotid sinus massage were the presence of a carotid bruit, recent history of stroke or myocardial infarction or previous ventricular tachyarrhythmia. RESULTS: complications occurred in nine patients immediately after cessation of carotid sinus massage. Eight had transient neurological complications possibly attributable to carotid sinus massage: visual disturbance, 'pins and needles' and sensation of finger numbness in two cases each, leg weakness in one and sensation of 'being drunk' in one. All transient complications resolved within 24 h. In one patient mild weakness of the right hand persisted. CONCLUSIONS: no subjects had cardiac complications and 1% had possible neurological symptoms, which resolved in most cases. Persistent neurological complications are uncommon, occurring in 1:1000 patients (0.1%) or 1: 3805 episodes of carotid sinus massage (0.03%). (+info)
Nutritional supplementation of elderly hip fracture patients. A randomized, double-blind, placebo-controlled trial.
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BACKGROUND: undernourishment is common in elderly hip fracture patients and has been linked to poorer recovery and increased post-operative complications. OBJECTIVE: to determine whether a nutritional supplement may (i) help elderly patients return to pre-fracture functional levels 6 months post-fracture and (ii) decrease fracture-related complications and mortality. DESIGN: a double-blind, randomized, placebo-controlled clinical trial. SETTING: a county hospital near Barcelona. SUBJECTS: 171 patients, aged 70 and older, hospitalized for hip fracture between July 1994 and July 1996. METHODS: we randomized patients to intervention (n = 85) or control (n = 86) group. Patients received a nutritional supplement containing 20 g of protein and 800 mg of calcium or placebo for 60 days. We determined functional levels by the Barthel index, the mobility index and by the use of walking aids. We performed assessments during hospitalization and at 2 and 6 months post-fracture. FINDINGS: the two groups were comparable at study entry. We observed no differences in return to functional status 6 months post-fracture (61% intervention group vs 55% in control group) nor in fracture-related mortality (13% in intervention group vs 10% in control group). The intervention group suffered fewer in-hospital [odds ratio 1.88 (95% CI 1.01 - 3.53), P = 0.05] and total complications [odds ratio 1.94 (95% CI 1.02-3.7), P = 0.04] than the control group. CONCLUSION: based on our results, we cannot recommend routine nutritional supplementation of all elderly hip fracture patients. While nutritional supplementation may be useful in decreasing complications, this reduction does not result in improvement in functional recovery and nor does it decrease fracture-related mortality. Selected patients may, however, benefit from nutritional supplementation. (+info)
Low-intensity physical activity benefits blood lipids and lipoproteins in older adults living at home.
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OBJECTIVE: to examine the influence of low-intensity, habitual physical activity on blood lipids and lipoproteins and other cardiovascular risk factors in older adults living at home. DESIGN: cross-sectional observational study. PARTICIPANTS: a convenience sample of healthy, older adults (n = 155) who were mainly non-Hispanic, white (96.8%), female (65.2%) and on medications for cardiometabolic-related disorders (60.6%) and had an average age of 74.2 +/- 0.5 years. METHODS: we used a question from the Yale Physical Activity Survey to assess the typical number of hours per day spent in motion during the past month, collapsing responses into <5 and > or = 5 h/day. We determined blood lipids, lipoproteins and glucose with Kodak Ektachem serum oxidase assays or finger stick using the Cholestech LDX system enzymatic technique, and measured blood pressure by auscultation. Waist circumference was the indicator of abdominal fat distribution and body mass index the measure of overall adiposity. RESULTS: after adjusting for age, sex, adiposity, postprandial state, medication use and method of blood sampling, greater amounts of daily accumulated movement were associated with more favourable blood lipid-lipoprotein profiles. Subjects reporting > or = 5 h of daily movement had higher levels of high-density lipoprotein cholesterol [mean difference (95% confidence interval): 0.23 mmol/l (0.07, 0.39); P = 0.002] and a lower ratio of total to high-density lipoprotein cholesterol [average difference: -0.92 (-1.36, -0.48); P = 0.003]. They had lower levels of low-density lipoprotein cholesterol [mean difference: -0.39 mmol/l (-0.80, 0.03); P = 0.074)] and a lower ratio of triglyceride to high-density lipoprotein cholesterol [mean difference: -1.31 (-2.50, -0.12); P = 0.059]. Total cholesterol was similar in the two groups (P > 0.05). The mean blood glucose was 1.49 mmol/l lower (-2.67, -0.31) in the more active group (P = 0.02), independent of age, sex, adiposity, medication use and postprandial state. CONCLUSIONS: low-intensity, habitual physical activity is a sufficient stimulus to enhance blood lipids/lipoproteins and glucose in older adults, independent of abdominal and overall adiposity. (+info)
Walking speed as a good predictor for the onset of functional dependence in a Japanese rural community population.
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OBJECTIVE: to investigate and compare the predictive values of four physical performance measures for the onset of functional dependence in older Japanese people living at home. DESIGN: a population-based prospective cohort study. SETTING: Nangai village, Akita Prefecture, Japan. METHODS: out of the population aged 65 years and older living in Nangai (n = 940) in 1992, we measured hand grip-strength, one-leg standing, and usual and maximum walking speeds in 736 subjects who were independent in the five basic activities of daily living. Their functional status was assessed each year for the subsequent 6 years. The outcome event was the onset of functional dependence, defined as a new disability in one or more of the five basic activities of daily living, or death of a subject who had shown no disability at the previous follow-up. RESULTS: even after controlling for age, sex and a number of chronic conditions, lower scores on each baseline performance measure showed increased risk for the onset of functional dependence. Maximum walking speed was most sensitive in predicting future dependence for those aged 65-74 years, while usual walking speed was most sensitive for people aged > or = 75 years. CONCLUSION: walking speed was the best physical performance measure for predicting the onset of functional dependence in a Japanese rural older population. (+info)