Community-living Women Research Articles

Quality of diet and potential renal acid load as risk factors for reduced bone density in elderly women

Background Bone mineral density (BMD) may be influenced by the general dietary pattern and the potential renal acid load (PRAL). Methods We compared the dietary intake (estimated using the European Prospective Investigation into Cancer and nutrition questionnaire) of 497 community-living women (60 years of age and older) grouped according to tertiles of baseline total, trabecular and cortical BMD estimated using tibial peripheral quantitative computed tomography (pQCT), and of BMD variation over 6 years. Results None of the nutrients taken into account nor PRAL was associated with total BMD, with the exception that the intake of polyunsaturated fatty acids (PUFA) was slightly higher among women with the highest total BMD. Similar results were found for trabecular BMD. Cortical BMD was associated with serum 25-OH vitamin D (38.8, 43.2, and 49.5 nmol/L in the first, second, and third tertiles, respectively; P = 0.042). In the longitudinal analysis, a lower BMI was associated with greater loss of total BMD, while lower serum 25-OH vitamin D at baseline was associated with smaller loss of cortical BMD. Conclusions We found no relationship between dietary acid load and BMD. We also confirmed the role of well-recognized risk factor for osteoporosis.

Poster 55: Spinal Cord Injury in Ontario: An Investigation of Cervical Screening Rates Among Women (Aged 18 to 69) With and Without Traumatic Injury

Objective: To determine whether cervical screening rates differ between age and geography matched community-living women with and without traumatic spinal cord injury (SCI) in Ontario. Design: Case-control (1:4) study using administrative data. Setting: Not provided. Participants: Incident cases of SCI were identified using the Discharge Abstract Database for the fiscal years 1995–96 to 2001–02. Cases were female residents of Ontario, between the ages of 18 and 69, admitted to an acute care facility with a traumatic SCI (ICD-9-CM code 806 or 952).

Knowledge and Attitudes About HIV/AIDS Among Community-Living Older Women: Reexamining Issues of Age and Gender

ABSTRACT Although older women face unique risks related to HIV/AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.

Construct and Predictive Validity of a Self-Reported Measure of Preclinical Mobility Limitation

Mänty M, Heinonen A, Leinonen R, Törmäkangas T, Sakari-Rantala R, Hirvensalo M, von Bonsdorff MB, Rantanen T. Construct and predictive validity of a self-reported measure of preclinical mobility limitation. Objectives To validate self-reported preclinical mobility limitation concept and self-report assessment method against muscle power and walking speed, and to study the predictive validity of preclinical mobility limitation with respect to future risk of manifest mobility limitation. Design Observational prospective cohort study and cross-sectional analysis. Setting Research laboratory and community. Participants A total of 632 community-living (age range, 75−81y) women and men took part in the baseline assessments and 302 persons in the semi-annual interviews on mobility limitation over 2 years. Interventions Not applicable. Main Outcome Measures Walking speed, muscle power, and self-reported preclinical and manifest mobility limitation. Preclinical mobility limitation was defined as self-reported tiredness or modification of task performance without task difficulty. At baseline, 4 subgroups were created according to self-reported preclinical mobility limitation in any of 3 mobility tasks (walking 2km, walking 0.5km, climbing up stairs): no limitation, preclinical limitation, and minor and major manifest limitation. Results At baseline, participants with preclinical mobility limitation showed intermediate levels of walking speed and muscle power, compared with those with no limitation or manifest mobility limitation. Participants reporting baseline preclinical mobility limitation had 3- to 6-fold higher age- and sex-adjusted risk of progressing to major manifest mobility limitation during the 2-year follow-up compared with participants with no limitation at baseline, whereas the risk among those with minor limitation at baseline was 14- to 18-fold higher compared with those with no limitation. Conclusions The self-report assessment tool proved to be a valid measure to capture the early signs of disability and may serve as an inexpensive tool for identifying those nondisabled persons at high risk for future disability.

A Comparison Study of Coping, Family Problem-Solving and Emotional Status in Victims of Domestic Violence

Domestic violence research has been limited by lack of appropriate comparison groups. In the present study, shelter-living, abused women were compared to community-living, abused women, maritally distressed women, and non-distressed non-abused women on relationship characteristics, emotional status, and family problem solving and coping. Shelter-living abused women reported more physical violence in the past year than community-living abused women. Both abused groups reported higher levels of depression and anxiety than non-abused groups. Community-living women reported greater use of aggressive solutions to family problems than other groups. Differences between community-living and shelter-living abused women point to the utility of including appropriate comparison groups in studies of abused women.

Milk Supplementation and Bone Health in Young Adult Chinese Women

Milk is potentially beneficial for bone health, particularly for Chinese populations where consumption of dairy products is low. There are few data about milk consumption by Chinese women aged 20-35 years. This study examines whether milk supplement over 2 years caused increased bone mineral density (BMD) in Chinese women aged 20-35 years. Four hundred forty-one community-living women living in Hong Kong SAR (221) and Beijing (220) China were randomized to receive milk supplement or nothing. The supplement consisted of two sachets of milk powder (1000 mg calcium, 80 microg vitamin K(1)), for 24 months. BMD at total hip, total spine, and whole body was measured at baseline and at 6, 12, 18, and 24 months; blood specimens were analyzed at baseline and at 3 and 24 months for biochemical indices of bone turnover and vitamin K. Urine samples also were collected. Analysis was by intention to treat as well as per protocol. Differences in change from baseline between the milk and control groups were analyzed using the mixed models approach to repeated measures, including the baseline value as a covariate. Both groups had an increase in BMD and a decrease in bone turnover markers over time, as an indicator of the process of attainment of peak bone mass during this period. Apart from a higher total spine BMD at 6 months in the milk group using per protocol analysis, there was little significant difference observed between the milk group and the control group. Age-related bone metabolism and lack of compliance most likely explain the lack of consistent changes in BMD or bone biochemical measures in response to milk supplementation for 2 years in Chinese women aged 20-35 years.

Stress self-management: An intervention for women with physical disabilities

We sought to develop and evaluate the efficacy of an innovative, theory-driven, group stress self-management intervention designed to ameliorate stress and promote health among women with physical disabilities such as spinal cord injury, multiple sclerosis, and arthritis. We recruited a voluntary sample of 78 community-living women with disabilities who were randomly assigned to either the group stress management intervention or the wait-listed control group, and we used a within- and between-groups pretest/posttest design with a 3-month follow-up. Group differences in changes over time on measures of perceived stress and mental health offer support for the efficacy of the intervention. At the 3-month follow-up assessment, the intervention group also showed greater improvement on measures of pain and role limitations owing to physical health when compared the wait-listed control group. Perceived stress was supported as a mediator of the effect of the intervention on mental health. We found support for social connectedness and self-efficacy as mediators of the relation between the intervention and perceived stress; however, there was relatively weak evidence for differential change over time in those proposed mediators. This study provides the first of its kind, that is, an evaluation of the efficacy of a stress self-management intervention designed specifically for women with physical disabilities. The results are consistent with a model in which the stress management intervention enhances self-efficacy and social connectedness, which leads to reduced stress, which then contributes to improved mental health.

Physical activity and nutritional behaviors of women with physical disabilities: Physical, psychological, social, and environmental influences

We examined predictors of 2 important health behaviors, namely, physical activity and nutritional behaviors, in a sample of community-living women with physical disabilities (N = 386). We conducted a cross-sectional survey with regression analysis. Our regression model accounted for 33.5% of the variance in physical activity. Women with joint problems or multiple sclerosis tended to engage in less physical activity than those with stroke-related disabilities. Those who had lived with their disability longer and those experiencing greater pain tended to report less physical activity. Consistent with the literature, women with greater self-efficacy for physical activity tended to engage in more physical activity. The regression model for nutritional behaviors accounted for 37.9% of the variance. Women with better mobility, greater self-efficacy for nutrition, and more vitality had better nutritional behaviors while those who needed assistance with activities of daily living, had lower social functioning scores, and were engaged in more productive activities reported poorer nutritional behaviors. Our findings highlight the importance of self-efficacy for improving health behaviors. Further research is needed to develop a new paradigm for the measurement of health behaviors, one that focuses on individual improvement rather than comparison to a norm, and health promoting interventions that are responsive to the needs and life circumstances of women with physical disabilities.

Diet Strategies Used by Women to Manage Fecal Incontinence

Fecal incontinence occurs in community-living women who are elderly, as well as younger women, particularly after vaginal childbirth. Little is known about how women manage fecal incontinence in their everyday lives. Ten women who had fecal incontinence for at least 1 year participated in an audio-taped interview in a phenomenological study. Diet modification was identified as a key strategy for managing fecal incontinence. Various food types were avoided, restricted, or used as remedies. The meanings that the women applied to the diet strategies for managing fecal incontinence had 4 themes: restricting diet and eating patterns, eating and dealing with the consequences, treating fecal incontinence with foods and fluids, and lacking therapeutic guidance regarding diet modifications for fecal incontinence. The results of this study suggest that the continence nurse specialist recognize the important role and meaning of diet as a self-care strategy for women with fecal incontinence and address diet in their assessment and management recommendations.

Conjugated Equine Estrogens and Incidence of Probable Dementia and Mild Cognitive Impairment in Postmenopausal Women: Women???s Health Initiative Memory Study

Previous findings from the Women’s Health Initiative Memory Study (WHIMS) have suggested an increased risk of dementia, but not mild cognitive impairment (MCI), in women given conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA). The present report presents data from the WHIMS, a randomized, double-blind, placebo-controlled trial, when assessing the effects of CEE alone and CEE plus MPA on the risk of dementia and MIC in community-living women 65 to 79 years of age. The participants, including 4532 women given estrogen plus progestin and 2947 given estrogen only, entered the trial in the years 1995–2002. Women received a daily tablet of 0.625 mg CEE or matching placebo, or else a combination of 0.625 mg CEE and 2.5 mg MPA daily with matching placebos. The women were screened annually using the Modified Mini-Mental State Examination and, if indicated, underwent a battery of neuropsychologic tests and standardized interviews. The risk of probable dementia during follow up was 49% greater in women assigned to CEE compared with placebo recipients (37 vs. 25 per 10,000 person-years). Comparable rates of probable dementia were recorded for women in the CEE alone and CEE plus MPA group, and the hazard ratios (HRs) did not differ significantly. The risk of MCI was 34% higher in women taking CEE alone than in their matched placebo recipients (HR, 1.34). There was no significant increase in risk in the combined medication trial. The hazard ratio for either probable dementia or MCI in women given CEE alone, compared with placebo women, was 1.38. These findings from the WHIMS indicate that older women who take CEE alone or CEE plus MPA are at increased risk of dementia or MCI. The investigators recommend that women aged 65 and older not be given hormone therapy with the goal of preventing dementia or MCI.

Social class and mortality in older women

In middle-aged people, social class is one of the strongest predictors of mortality. However, to date, research prospectively evaluating the relationship between social class and mortality in the older persons has produced conflicting results. This may be due to the lack of clinical covariates in many analyses. The objective of this study was to determine the relationship between social class markers—education, income, husband's work history, and personal work history—and mortality in a cohort of older women, after adjusting for clinical and behavioral factors. The participants were 737 ambulatory, community-living women, age 72 and older, followed from 1989 to 1993. In addition to education attained, present income, husband's work history, and personal work history, proportional hazard models adjusted for age, race, marital status, number of chronic conditions, number of medications used, Activities of Daily Living status, Mini-Mental State Exam score, physical activity, and alcohol use. In multivariable models personal work history was the only social class marker that remained significantly associated with mortality. Compared with managers and professionals, women who never worked outside the home had a 3.5 greater risk of death (95% CI, 1.6–7.5), while women who had worked in partly/unskilled or skilled professions were over two and a half times more likely to die; the adjusted hazard ratios were 2.7 (95% CI, 1.2–6.4) and 2.7 (95% CI, 1.3–5.7), respectively. In this population of older women, personal work history was the only social class marker predictive of mortality.

Disabling symptoms: what do older women report?.

To answer the question, "What do older disabled women report as the main symptoms causing their disability?" Cross-sectional study of 876 women aged 65 and older who participated in the second interview of the Women's Health and Aging Study, a longitudinal study of community-living women, representing the one third of older women with at least mild to moderate disability. Women were asked to identify the symptom and the condition that was the main cause of disability in basic and instrumental activities of daily living, and lower extremity mobility. Musculoskeletal pain symptoms were reported as the main cause of disability by at least one third of women with each type of disability. Other symptoms that were less frequently reported as main causes of disability were weakness, fatigue, and unsteadiness. Fear of falls was reported by 14% (95% confidence interval, 11.2% to 17.6%) of 472 women with disability in bathing. When asked to report on the main condition causing their disability, many women responded, "old age" or "no specific disease," but were able to identify symptoms causing their disabilities. Musculoskeletal pain was the most common cause of disability reported by older women, followed by weakness and balance difficulties. Greater attention to symptoms that interfere with daily activities of older persons may reduce the burden of disability.

Urinary Free Cortisol Is Similar in Older and Younger Women

The increased cortisol secretion that occurs with aging is associated with characteristics of frailty. In this study we investigated whether healthy elderly women excrete increased amounts of urinary free cortisol (UFC) when compared to younger women. Twenty-four-hour UFC levels were measured in 25 elderly (70 to 87 years of age; median: 74) and 24 younger (19 to 59 years of age; median: 46) community-living women. All subjects were healthy and cognition was unimpaired. No differences in 24-hr UFC were observed between elderly and younger women (54.2 - 28.0 and 45.1 - 15.6 µg/24hr, respectively) and no correlation was found between 24-hr UFC and age. Also, elderly and younger women had similar 24-hr urinary volumes (1366 - 531 and 1514 - 412 ml 24hr, respectively) that did not correlate with UFC. In conclusion, older and younger healthy women have similar 24-hr UFC levels, possibly reflecting a comparable adrenocortical secretion of cortisol.

How well are community-living women treated for osteoporosis after hip fracture?

To examine whether women with recent hip fracture are receiving adequate treatment for osteoporosis. To examine patient and physician characteristics associated with adequate treatment for osteoporosis. Cross-sectional study with prospective and retrospective data collection. Hartford County, Connecticut. Sixty community-living women age 65 and older identified from hospital databases with an International Classification of Diseases, Ninth Revision, code for nontraumatic hip fracture. Treatment for osteoporosis, healthcare utilization, primary care physician's specialty, Katz activities of daily living scale, Lawton instrumental activities of daily living scale, Short Portable Mental Status Questionnaire, Medical Outcomes Study Short Form 12, and Physical Activity Scale for the Elderly. Only 13% of participants were receiving adequate treatment for osteoporosis as defined by the National Osteoporosis Foundation (NOF) guidelines for osteoporosis, 47% reported partial treatment that did not meet NOF guidelines, and 40% were receiving no treatment for osteoporosis. No patient or physician characteristics were associated with the adequacy of treatment for osteoporosis in this small sample. Few of the women in our study were receiving adequate treatment for osteoporosis after hip fracture. There exists an opportunity to educate postmenopausal women and physicians about the importance of treatment for osteoporosis to increase the number of women offered and receiving osteoporosis treatment, especially older postmenopausal women with established, severe osteoporosis as evidenced by recent hip fracture.

Occult vitamin D deficiency in postmenopausal US women with acute hip fracture.

Low vitamin D levels may contribute to hip fractures in women, although limited data are available on vitamin D levels in US women admitted with acute hip fractures. To determine whether postmenopausal women with hip fractures have low vitamin D and high parathyroid hormone levels compared with nonosteoporotic and osteoporotic women admitted for elective joint replacement. Comparative case series conducted between January 1995 and June 1998. Ninety-eight postmenopausal community-dwelling women with no secondary causes of bone loss admitted for hip replacement, of whom 30 women had acute hip fractures and 68 women were admitted for elective joint replacement. Of the women admitted for elective joint replacement, 17 had osteoporosis and 51 did not. Women with comorbid conditions or who were taking medications that affect bone density and turnover were excluded. Primary measures were levels of vitamin D and parathyroid hormone; secondary measures were body composition and markers of bone turnover. Women with hip fractures had lower levels of 25-hydroxyvitamin D than women without osteoporosis admitted for elective joint replacement (P = .02) and than women with osteoporosis admitted for elective joint replacement (P = .01) (medians, 32.4, 49.9, and 55.0 nmol/L, respectively; comparisons adjusted for age and estrogen intake). Parathyroid hormone levels were higher in women with fractures than women in the nonosteoporotic control group (P<.001) or than elective osteoporotic women (P = .001) (medians, 5.58, 3.26, and 3.79 pmol/L, respectively; comparisons adjusted for age and estrogen intake). Fifteen patients (50.0%) with hip fractures had deficient vitamin D levels (< or =30.0 nmol/L) and 11 (36.7%) had a parathyroid hormone level greater than 6.84 pmol/L. Levels of N-telopeptide, a marker of bone resorption, were greater in the women with hip fractures than in the elective nonosteoporotic controls (P = .004). Postmenopausal community-living women who presented with hip fracture showed occult vitamin D deficiency. Repletion of vitamin D and suppression of parathyroid hormone at the time of fracture may reduce future fracture risk and facilitate hip fracture repair. Because vitamin D deficiency is preventable, heightened awareness is necessary to ensure adequate vitamin D nutrition, particularly in northern latitudes.

Posthospital setting, resource utilization, and self-care outcome in older women with hip fracture

Objective: To compare posthospital rehabilitation resource utilization and self-care outcome of women with hip fracture discharged to three types of setting (home, inpatient rehabilitation, skilled nursing). Design: Prospective cohort study. Patient interviews in the hospital, 2 and 6 months after fracture; hospital record reviews. Setting: Two general community and two teaching hospitals. Patients: Consecutive sample of community-living women with hip fracture, aged 65 and over. Of 179 eligible, 130 patients enrolled and 123 completed study. Interventions: Prospective observational study. Main Outcome Measures: Posthospital institutional days, cumulative sessions of physical and occupational therapy within 6 months after fracture, and 2- and 6-month Barthel Index. Results: For patients discharged to home, inpatient rehabilitation, and skilled nursing, respectively, mean posthospital institutional days were 1, 16, and 50; mean sessions of physical therapy were 15, 35, and 50; mean sessions of occupational therapy were 0, 11, and 16; mean 2-month Barthel Index was 93, 89, and 80; mean 6-month Barthel Index was 89, 88, and 86. Differences in posthospital institutional days and physical and occupational therapy sessions, but not 2- and 6-month Barthel Index, were statistically significant after controlling for patient characteristics. Conclusions: Type of posthospital setting is associated with resource utilization, but not self-care outcome after hip fracture.

Impact of a 12-month exercise program on the physical and psychological health of osteopenic women

OBJECTIVE: To describe the effect of a supervised physical activity program on the physical and psychological health of osteopenic women. DESIGN: A randomized controlled trial. SETTING: Sherbrooke, Quebec, Canada. PARTICIPANTS: A total of 124 community-living postmenopausal women, between 50 and 70 years of age, with low bone mass took part in the study. INTERVENTION: Subjects allocated to the experimental group performed weight-bearing exercises (walking, stepping up and down from benches), aerobic dancing, and flexibility exercises for 60 minutes, three times a week, over a period of 12 months. All subjects were invited to attend bi-monthly educational seminars covering topics related to osteoporosis. OUTCOME MEASURES: Spinal and femoral bone mineral density (BMD), functional fitness (flexibility, coordination, agility, strength/endurance, cardiorespiratory endurance), psychological well-being, back pain intensity, and self-perceived health. RESULTS: Spinal BMD stabilized in the exercisers while decreasing significantly in the controls (P = .031). No change in femoral BMD was observed in either group (P = .597). Four of the five parameters chosen to evaluate functional fitness, namely flexibility, agility, strength, and endurance, were affected positively by the exercise program (all P < .01). Adjusting for prescores by means of an analysis of covariance revealed a significant difference between the groups in psychological well-being, which favored the exercisers (P = .012). After 12 months, back pain reported by exercisers was lower than that reported by controls (P = .008). Finally, self-perceived health increased in the exercise group, whereas no difference was observed in the control group (P = .790). CONCLUSION: These results suggest that after 12 months, exercising can produce a significant increase above initial levels in the functional fitness, well-being, and self-perceived health of osteopenic women. Intensity of back pain can also be lowered by exercise. The exercise program succeeded in stabilizing spinal BMD but had no effect on femoral BMD.

Early outcomes after hip fracture among women discharged home and to nursing homes

In a prospective design, early outcomes after hip fracture were compared in three groups of formerly community-living women: those discharged home from the hospital (n = 58), those discharged to a nursing home (NH) and staying there < or = 1 month (n = 23), and those staying > 1 month (n = 39). Data were collected on mobility and mood states prior to hospital discharge and at 2, 8, and 14 weeks. Overall recovery ratings were obtained at the latter three times; readiness for discharge from hospital and nursing home also was examined. The short-stay group did as well in regaining mobility as the home-discharge group and both rated their overall recovery similarly. Affective mood distress was associated with discharge destination site. The short-stay NH group had a greater proportionate lack of designated caregivers than either of the other two groups. Research is needed to identify features of nursing homes as well as characteristics of patients that contribute to positive outcomes in the large number of hip fracture patients currently discharged to these institutions.

The Functional Fitness Assessment Battery: Reliability and Validity Data for Elderly Women

A battery of field tests was recently developed to assess five fitness parameters in elderly persons. The present study examined the test-retest reliability of each item in the battery and tested the validity of the cardiorespiratory endurance item. Reliability and validity data were obtained from two convenience samples. The 29 subjects in the reliability study were community-living women enrolled in seniors’ exercise classes. The validity of the cardiorespiratory endurance item was tested by comparing it with maximal work capacity on a treadmill test. The 52 women in that part of the study were all participants in a study to assess the effect of weight-bearing exercises on women with low bone mass. Both samples were combined for a principal component analysis. Low reproducibility was observed for coordination (0.54) and strength/endurance (0.56). After slightly modifying the test protocol for these two items, reproducibility reached 84 and 94%, respectively. The correlation between the cardiorespiratory endurance score and maximal work capacity was −0.65, while that between the composite score and maximal work capacity was −0.64. Given these minor modifications, then, the Functional Fitness Assessment battery is a reliable and valid tool for assessing functional fitness in elderly women.

Pelvic Muscle Exercise for Stress Urinary Incontinence in Elderly Women

To compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community-living elderly women. Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation. Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day. Treatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125. Among those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.