Community-dwelling Elderly Subjects Research Articles

Normal ranges of blood urea nitrogen and serum creatinine levels in the community-dwelling elderly subjects aged 70 years or over--correlation between age and renal function

To estimate normal ranges of blood urea nitrogen (BUN) and serum creatinine (Cr) levels in the aged, we measured BUN and Cr levels in 332 cases of apparent-healthy elderly subjects (male, 152; female, 180) aged 70 years or more. We measured the variables also in 315 cases of sex-matched young control subjects (male, 139; female, 176). This study was a part of the Kahoku Longitudinal Aging Study (KLAS) that aims to reveal the comprehensive functions in the aged. We calculated the mean and the standard deviation (SD) in each group, and excluded subjects with values beyond twice the SD-line. We defined the normal range as range within the single SD-line of the remainder. The estimated normal range of BUN was 14-23 mg/dl both in male and female elderly subjects, and that of Cr was 0.9-1.3 mg/dl in male and was 0.7-1.1 mg/dl in female. The mean BUN level in the elderly subjects was significantly higher than that in the control young subjects. The mean Cr level in the elderly subjects was slightly higher than that in the control subjects. Significant positive correlation was found between BUN levels and age in male elderly subjects. Although Cr levels did not correlate with age in elderly subjects, Cr levels divided by body surface area significantly correlated with age. We concluded that the normal range of BUN and Cr levels differed between young and elderly subjects, and that the decline in renal function correlated with age after the seventh decade.

Short versions of the Timed Manual Performance Test. Development, reliability, and validity.

The Timed Manual Performance test is gaining wider use as a measure of functional status in research and clinical settings. It is a rather lengthy 27-item test, however, requiring the use of a large cumbersome panel of doors. The authors, therefore, studied 1,286 community-dwelling elderly subjects recruited through their primary care provider to: 1) reduce the number of items in the Timed Manual Performance (TMP) test and 2) assess the reliability and validity of the shorter versions of the TMP compared with the 27-item TMP. Using principal components analysis, we identified two shorter measures, TMP (Doors) consisting of five board tasks and TMP (Table) consisting of six table tasks. Timed Manual Performance (Doors) and TMP (Table) involve less equipment than the original TMP and have higher rates of completion. Furthermore, not only are these tests reliable (alpha = 0.79 and 0.82 for TMP [Doors] and TMP [Table], respectively), they appear to be better measures of manual performance compared with the 27-item TMP.

Night Sleep Symptoms in an Elderly Population and Their Relation with Age, Gender, and Education

Night sleep symptoms and their relation with a number of psychic, social and somatic variables were investigated in 453 community dwelling elderly subjects. Multivariate statistics showed that: (a) age in the over 75 elderly is not a risk factor for a poor night sleep quality; b) women report worse sleep quality for the frequent co-existence of depression, anxiety, somatization, disability, loneliness; (c) education can modify the elderly's expectations about their own sleep quality.

A Comparative Study of Monoclonal Gammopathies and Immunoglobulin Levels in Japanese and United States Elderly

To define the prevalence of monoclonal immunoglobulin (Ig) proteins and quantitative serum immunoglobulin levels in elderly Japanese in comparison with elderly Caucasians as possible factors related to the reported lower incidence of multiple myeloma in elderly Japanese than in elderly Caucasians. Survey study Community Center in Yokohama, Japan and Retirement Community in the United States. Convenience sample of community-dwelling elderly subjects (age 63-95) presenting for health screening examinations in each setting. Frozen serum samples were obtained from routine screening from 146 consecutive Japanese subjects and 111 US subjects. None Presence of monoclonal immunoglobulin protein determined by serum protein electrophoresis and immunofixation and quantitative Ig by laser nephelometry. Four (2.7%) of the Japanese cohort had monoclonal gammopathies compared with 11 (10%) of the American cohort. Two of the monoclonal gammopathies were IgG Kappa and two were IgG Lambda. No cases of multiple monoclonal gammopathy were identified in the Japanese group, compared with 25% of the monoclonal gammopathies in the American group. The mean quantitative serum IgG level for the Japanese group was 1,685 +/- 520 mg/dL versus 1,118 +/- 402 mg/dL for the American group; mean quantitative IgA levels were 283 +/- 116 mg/dL versus 226 +/- 116 mg/dL (P < 0.001). Albumin levels were normal in both populations, suggesting that there was not an increase in occult inflammatory disorders in the Japanese population. The low prevalence of monoclonal gammopathy in elderly Japanese is consistent with the reported lower frequency of multiple myeloma. The reason for the higher quantitative immunoglobulin levels in this population is unclear. Further cross-cultural investigation is warranted to explore the genetic influences on altered immune regulation with aging.

A dynamic posturography study of balance in healthy elderly.

Using dynamic posturography, we studied the balance of 234 community-dwelling elderly subjects (mean age, 76 +/- 5 years) as well as 34 young controls (mean age, 34 +/- 12 years). Almost all measures of balance were worse in elderly subjects compared with young controls. The decrements in older persons indicate a diminished capacity to process conflicting sensory input as well as a possible narrowing of the limit of stability (or, alternatively, an increase in sway). We propose that this occurs most likely as a result of biomechanical or central processing changes as opposed to diminished sensory or vestibular input. Furthermore, with difficult tasks sequentially presented, the performance of the older subjects improved, suggesting that balance, at least in the short term, adapts to stressful conditions. In these elderly subjects screened for age-related diseases affecting balance, only small decrements of balance occurred between the ages of 70 and 85 years. This nominal decrease over a 15-year span suggests that clinically significant balance impairment is the result of age-related disease rather than an inevitable consequence of aging and is therefore potentially treatable.

Proposed Factor Structure of the Geriatric Depression Scale

The Geriatric Depression Scale (GDS) is commonly used to measure depression in the elderly. However, there have been no reports of the underlying structure of the GDS. To this end, the GDS was administered to 326 community-dwelling elderly subjects, and the data were subjected to a factor analysis. A five-factor solution was selected and, after a varimax rotation, the factors that emerged could be described as: (1) sad mood, (2) lack of energy, (3) positive mood, (4) agitation, and (5) social withdrawal. This solution accounted for 42.9% of the variance. Knowledge of the factor structure should aid both clinicians and researchers in the interpretation of responses on the GDS.

Successful recruitment of elderly community-dwelling subjects for Alzheimer's disease research.

One hundred seventy-four healthy community-dwelling subjects were recruited for a research project investigating Sleep/EEG measures as biological markers for early-stage Alzheimer's Disease (AD). All subjects were age 55 or older. The subjects were divided into four groups: 46 subjects were diagnosed as having mild, uncomplicated AD, 31 had memory problems but did not meet the research criteria for AD, 43 had uncomplicated major depressive disorder, and 54 were normal controls. Male depressives and mild AD subjects were the groups most difficult to recruit. The ratio of initial inquiries from potential subjects to final study participants in all groups combined was 9 to 1. Successful recruiting strategies for each study group are discussed. News announcements and referrals from other AD researchers accounted for the greater number of study participants.

Postprandial blood pressure reduction in healthy elderly.

Previous studies have identified postprandial systolic blood pressure reductions in old, frail institutionalized subjects, which do not occur in healthy, young subjects, after a morning meal. To evaluate the relative contributions of state of health and time of day to this potentially dangerous abnormality in cardiovascular homeostasis, we measured sitting systolic blood pressure and heart rate before and at intervals after a noon meal, and in identical fashion without a meal, in 21 healthy, community-dwelling elderly subjects (73 +/- 6 years of age) attending a nutrition program. Systolic blood pressure changed a maximum of -11 +/- 9 (SD) mmHg (P = .006, analysis of variance) by 60 minutes after the meal, in contrast to 1 +/- 7 mmHg (NS) by 60 minutes, when no meal was given (P less than .0001, meal versus control studies). There was a highly significant inverse correlation between postprandial and basal sitting systolic blood pressure changes (R = -0.60, P = .004). Healthy community-dwelling elderly demonstrate postprandial reductions in systolic blood pressure which correlate with basal sitting systolic blood pressure. This is consistent with age- and hypertension-related impairment in baroreflex compensation for the hypotensive stress of eating.

Hypovitaminosis D and elevated serum alkaline phosphatase In elderly Irish people

The vitamin D status of 181 elderly Irish community-dwelling and institutionalized subjects was studied during Winter-Spring. The mean serum 25-hydroxyvitamin D level was 10 nmol/L (95% range less than 5.0-59 nmol/L); values were below 25 nmol/L in 79 percent of subjects. A significant seasonal variation of serum 25-hydroxyvitamin D levels was noted in elderly community-dwelling subjects. The previously documented age-related increase in serum alkaline phosphatase activity was significantly less in vitamin D replete subjects than in vitamin D deplete subjects in this study (P less than 0.005). The higher serum alkaline phosphatase values found in the vitamin D deplete subjects may represent mild secondary hyperparathyroidism or osteomalacia. The relationship of vitamin D status to both dietary intake and effective sunlight (latitude) is examined.

Do Functionally Fit Elderly Community-Dwelling Subjects Have Enough Time to Safely Cross the Road?

Elderly people are the most vulnerable group in urban traffic and a large proportion of them are as pedestrians victims of traffic accidents. The majority of these happen while crossing the road. Crossing a busy road at an intersection with traffic lights or without them is a typical dual task condition requiring a motor task i.e. walking and a cognitive task such as monitoring traffic. The purpose of present study was to compare the walking speed and the related spatio-temporal gait variables of fallers and non-fallers in three walking conditions against the speeds required by regulations in Slovenia for safe street crossing. To assess the spatio-temporal characteristics of gait we used a 7m instrumented walkway.The general results showed that the spatio-temporal gait parameters did not differ between the two groups at the self-selected speed. But as soon as a constraint, such as fast walking speed, was imposed on the subjects the differences between the groups became evident. Fallers demonstrated a significantly slower mean gait velocity and shorter stride length while the cadence and the base of support did not differ between the two groups. In dual task conditions the difference between the two groups reached 25 percent. The fallers group gait velocity dropped to 0.99 m/s. The observed walking speed was slower than considered by the guidelines for the design of traffic light equipped road crossing.In conclusion, the results of walking speed under dual task conditions could be a useful parameter for planning of optimal pedestrian crossing in urban areas. These results will serve for the design of a population based study in Ljubljana.