Effects In Older Women Research Articles

Effects of exercise and/or β-hydroxy-β-methylbutyrate supplementation on muscle mass, muscle strength, and physical performance in older women with low muscle mass: a randomized, double-blind, placebo-controlled trial

The interaction between exercise and nutritional supplementation is unclear among older adults at risk of sarcopenia. We aimed to examine if β-hydroxy-β-methylbutyrate (HMB) supplementation enhances the effects of exercise on muscle mass, strength, and physical performance and observe potential residual effects in older women with low muscle mass. This 12-wk, randomized, double-blind, placebo-controlled, 2×2 factorial design (exercise-only, HMB-only, both, and none) trial included 156 women aged 65-79 y with skeletal muscle index <5.7 kg/m2, and was followed by a 12-wk observational period. Resistance training twice weekly or education programs every 2 wk and calcium-HMB (1500 mg) or placebo supplements daily were provided. The primary outcome was the change in muscle mass from baseline to postintervention. Secondary outcomes included changes in muscle strength and physical performance. In total, 149 and 144 participants completed the assessment at weeks 12 and 24, respectively. ANOVAs based on the intention-to-treat principle showed no significant interactions between exercise and HMB on any primary outcomes. The main-effect analyses revealed that exercise improved the usual and maximal gait speed by 0.16 m/s (95% CI: 0.10, 0.21 m/s) and 0.15 m/s (95% CI: 0.09, 0.22 m/s), respectively; the knee extensor and hip adductor strength by 22.0 N (95% CI: 10.1, 33.9 N) and 21.8 N (95% CI: 12.9, 30.7 N), respectively; and timed up-and-go and sit-to-stand time by -0.5 s (95% CI: -0.7, -0.3 s) and-1.7 s (95% CI: -2.1, -1.3 s), respectively, relative to education. HMB improved usual gait speed by 0.06 m/s (95% CI: 0.01, 0.11 m/s) relative to placebo. Most improvements disappeared during the subsequent 12-wk observation period. HMB additively improved gait performance with negligible benefit and provided no enhancements in the effects of exercise on other outcomes. Exercise appeared to be the only effective intervention to improve outcomes in older women with low muscle mass.This trial was registered at www.umin.ac.jp/ctr/as UMIN000028560.

Temporal effects of corrected female homicide mortality estimates in Northeast Brazil

This study aimed to analyze the temporal effects (age, period, and cohort) on female homicide mortality in the states of Northeast Brazil from 1980 to 2017. This ecological time trend study used APC with a Bayesian approach and the deterministic method Integrated Nested Laplace Approximations (INLA) in the parameters' inference. The female homicide rates for each state of the Northeast were standardized by the direct method after correction of the death records for quality of information and underreporting. Data were also obtained on race/color, place of death, and means of perpetration. During the period analyzed, after correcting the death records, the Northeast region showed a mean rate of 5.40 female homicide deaths per 100,000 women, with a significant increase in all the states in the 2000s. In all the states, there was an increase in relative risk (RR) of homicide death in the second and third decades of life and a protective effect in older women. Except for the state of Sergipe, there was an increase in the risk of death in all five-year periods in the 2000s. The Northeast region as a whole and the states of Paraíba, Pernambuco, and Piauí showed a protective effect for women from older generations. There were also higher proportions of deaths in black women, homicides committed at home, and those perpetrated with firearms. The current study's findings may correlate with the spread of violence in Brazil in the 2000s and the Brazilian State's failure to protect women from violence.

Energy replacement diminishes the postprandial triglyceride-lowering effect from accumulated walking in older women.

Dietary replacement of an acute exercise-induced energy deficit offsets the postprandial triglyceride (TG)-lowering effect of exercise in young boys and middle-aged men. It is unclear whether these findings are observed when exercise is accumulated in older adults. This study examined the effect of accumulating short bouts of exercise, with and without dietary replacement of an exercise-induced energy deficit, on postprandial TG in older women. Seventeen older women (≥ 65years) underwent three, 8-h trials: (1) control, (2) accumulated walking and (3) accumulated walking with energy replacement. During the control trial, participants rested for 8h. The accumulated walking trials comprised twenty 1.5min brisk walking bouts performed at a pre-determined self-selected pace separated by 15min seated rest. In each trial, participants consumed a standardised breakfast and lunch. The breakfast in the accumulated walking with energy replacement trial included replacement of the energy deficit (0.62MJ, 149kcal) induced by exercise. Venous blood samples were collected fasted and at 2, 4, 6 and 8h after breakfast. Time-averaged postprandial serum TG concentrations over 8h were lower after accumulated walking than control and accumulated walking with energy replacement (mean ± SD: 1.46 ± 0.93 vs 1.71 ± 1.01 vs 1.60 ± 0.98mmol/L, respectively: main effect of trial p = 0.017). There was little difference between control and accumulated walking with energy replacement. Replacing the energy expenditure induced by accumulating 30min of brisk walking in short (1.5min) bouts diminishes the postprandial TG-lowering effect in older women.

Associations between sleep and obesity indices in older adults: results from the HELIAD study.

Short sleep duration and low sleep quality are negatively associated with obesity in young adults, but in older people the results are inconsistent. The aim of the present study was to examine the associations between sleep duration and quality with both body mass index (BMI) and waist circumference (WC) and to investigate sex- and age-specific associations in a population-representative cohort of older adults. 1781 participants ≥ 65years old from the HELIAD study were included. Sleep duration and quality were based on self-report, whereas BMΙ and WC were evaluated clinically. Sleep duration was inversely related to WC, only in women, even after adjustment for age, sex, years of education, total energy intake and level of physical activity. Furthermore, sleep quality was negatively related to both BMI and WC in women. In men, however, no significant relationships were observed between these variables. Associations between sleep and weight did not differ between those aged < 73 and ≥ 73years old. To the best of our knowledge, this is the first study examining both sleep duration and quality with BMI and WC in older adults, performing by-sex analysis. Although additional studies are needed, improvements in sleep habits should be considered in weight management of older individuals. Our results suggest that poor sleep is associated to adverse weight effects in older women, but not men.

Calcium and linoleic acid supplements in the prevention of pre-eclampsia.

Alzate et al.1, conducted a nested case-control study to (quote) “estimate the protective effect from calcium [supplement] alone [CC], compared to calcium plus conjugated linoleic acid [CC+CLA] in nulliparous women at risk of preeclampsia”. Based on a crude analysis of the data in Table 3,1 they concluded that neither CC nor CC+CLA reduced the risk of preeclampsia in the whole sample, but that CC+CLA significantly decreased risk among women 13-18 years old. A quick look analysis of the data in this table shows this conclusion is mostly based on the fact that none of the cases in 13-18 year old women was treated with CC+CLA. Contrary to the authors’ interpretation, this does not point to a protective effect of CC+CLA, it simply indicates that the assumption of positivity has being violated and, consequently, that an effect for this age group cannot be estimated2. In fact, the probability of getting no treated cases in this age-group was 28%, since only 15.5% of all women received CC+CLA. Also, accurate estimates of effect in women 34-45 years old were not possible, because there were only seven women who used CC+CLA in this age group. In spite of the limited sample size, the authors restricted their attention to the apparent protective effect of CC+CLA in 13-19 year old women, while ignoring apparent harmful effects in older women. I estimated age-specific rate ratios (RR) by fitting a saturated conditional complementary log-log3 to the data in Table 3 and found that CC+CLA was protective among women 13-19 (RR= 0.61, 95% CI: 0.41- 0.90), but harmful in women 19-34 (RR= 1.74, 95% CI: 1.21- 2.50) and 35-45 years old (RR= 4.98, 95% CI= 1.74-14.30). Of course, this approach is an improvement over a naive crude analysis, but does not solve the problem of violation and near violation of positivity described above. An overall age-adjusted RR was 1.02 (95% CI= 0.89-1.17; p= 0.756). Thus, this study provides no evidence of a beneficial effect of CC+CLA in preventing preeclampsia in any age group.

Cost-Effectiveness of Chemotherapy for Breast Cancer and Age Effect in Older Women

BackgroundPrevious economic evaluations compared specific chemotherapy agents using input parameters from clinical trials and resource utilization costs. Cost-effectiveness of treatment groups (drug classes) using community-level effectiveness and cost data, however, has not been assessed for elderly patients with breast cancer. ObjectiveTo assess the cost-effectiveness of chemotherapy regimens by age and disease stage under “real-world” conditions for patients with breast cancer. MethodsThe Surveillance Epidemiology and End Results-Medicare data were used to identify patients with breast cancer with American Joint Committee on Cancer stage I/II/IIIa, hormone receptor–negative (estrogen receptor–negative and progesterone receptor–negative) patients from 1992 to 2009. Patients were categorized into three adjuvant treatment groups: 1) no chemotherapy, 2) anthracycline, and 3) non–anthracycline-based chemotherapy. Median life-years and quality-adjusted life-years (QALYs) were measured using Kaplan-Meier analysis and were evaluated against average total health care costs (2013 US dollars). ResultsA total of 4575 patients (propensity score–matched) were included for the primary analysis. The anthracycline group experienced 12.05 QALYs and mean total health care costs of $119,055, resulting in an incremental cost-effectiveness ratio of $7,688 per QALY gained as compared with the no chemotherapy group (QALYs 7.81; average health care cost $86,383). The non–anthracycline-based group was dominated by the anthracycline group with lower QALYs (9.56) and higher health care costs ($122,791). Base-case results were found to be consistent with the best-case and worst-case scenarios for utility assignments. Incremental cost-effectiveness ratios varied by age group (range $3,790–$90,405 per QALY gained). ConclusionsAnthracycline-based chemotherapy was found cost-effective for elderly patients with early stage (stage I, II, IIIa) breast cancer considering the US threshold of $100,000 per QALY. Further research may be needed to characterize differential effects across age groups.

Assessing treatment effects in older breast cancer patients: systematic review of observational research methods.

Solid evidence of treatment effects in older women with breast cancer is lacking, as they are generally underrepresented in randomized clinical trials on which guideline recommendations are based. An alternative way to study treatment effects in older patients could be to use data from observational studies. However, using appropriate methods in analyzing observational data is a key condition in order to draw valid conclusions, as directly comparing treatments generally results in biased estimates due to confounding by indication. The aim of this systematic review was to investigate the methods that have been used in observational studies that assessed the effects of breast cancer treatment on survival, breast cancer survival and recurrence in older patients (aged 65 years and older). Studies were identified through systematic review of the literature published between January 1st 2009 and December 13th 2013 in the PubMed database and EMBASe. Finally, 31 studies fulfilled the inclusion criteria. Of these, 22 studies directly compared two treatments. Fifteen out of these 22 studies addressed the problem of confounding by indication, while seven studies did not. Nine studies used some form of instrumental variable analysis. In conclusion, the vast majority of observational studies that investigate treatment effects in older breast cancer patients compared treatments directly. These studies are therefore likely to be biased. Observational research will be essential to improve treatment and outcome of older breast cancer patients, but the use of accurate methods is essential to draw valid conclusions from this type of data.

A protocol for a randomized clinical trial of interactive video dance: potential for effects on cognitive function.

BackgroundPhysical exercise has the potential to affect cognitive function, but most evidence to date focuses on cognitive effects of fitness training. Cognitive exercise also may influence cognitive function, but many cognitive training paradigms have failed to provide carry-over to daily cognitive function. Video games provide a broader, more contextual approach to cognitive training that may induce cognitive gains and have carry over to daily function. Most video games do not involve physical exercise, but some novel forms of interactive video games combine physical activity and cognitive challenge.Methods/DesignThis paper describes a randomized clinical trial in 168 postmenopausal sedentary overweight women that compares an interactive video dance game with brisk walking and delayed entry controls. The primary endpoint is adherence to activity at six months. Additional endpoints include aspects of physical and mental health. We focus this report primarily on the rationale and plans for assessment of multiple cognitive functions.DiscussionThis randomized clinical trial may provide new information about the cognitive effects of interactive videodance. It is also the first trial to examine physical and cognitive effects in older women. Interactive video games may offer novel strategies to promote physical activity and health across the life span.The study is IRB approved and the number is: PRO08080012ClinicalTrials.gov Identifier: NCT01443455

PS2-04: Effectiveness and Satisfaction with Webinar Training for Multi-site Medical Chart Abstraction: The BOWII Experience

Background Abstractor training is a key element in creating valid and reliable data collection procedures. The choice between in-person vs. remote or simultaneous vs. sequential abstractor training has significant consequences for time and resource utilization. We conducted a web-based (webinar) abstractor training session to standardize training across six individual Cancer Research Network (CRN) sites for a study of breast cancer treatment effects in older women (BOWII).

Webinar Training: an acceptable, feasible and effective approach for multi-site medical record abstraction: the BOWII experience

Backgroundor training is a key element in creating valid and reliable data collection procedures. The choice between in-person vs. remote or simultaneous vs. sequential abstractor training has considerable consequences for time and resource utilization. We conducted a web-based (webinar) abstractor training session to standardize training across six individual Cancer Research Network (CRN) sites for a study of breast cancer treatment effects in older women (BOWII). The goals of this manuscript are to describe the training session, its participants and participants' evaluation of webinar technology for abstraction training.FindingsA webinar was held for all six sites with the primary purpose of simultaneously training staff and ensuring consistent abstraction across sites. The training session involved sequential review of over 600 data elements outlined in the coding manual in conjunction with the display of data entry fields in the study's electronic data collection system. Post-training evaluation was conducted via Survey Monkey©. Inter-rater reliability measures for abstractors within each site were conducted three months after the commencement of data collection.Ten of the 16 people who participated in the training completed the online survey. Almost all (90%) of the 10 trainees had previous medical record abstraction experience and nearly two-thirds reported over 10 years of experience. Half of the respondents had previously participated in a webinar, among which three had participated in a webinar for training purposes. All rated the knowledge and information delivered through the webinar as useful and reported it adequately prepared them for data collection. Moreover, all participants would recommend this platform for multi-site abstraction training. Consistent with participant-reported training effectiveness, results of data collection inter-rater agreement within sites ranged from 89 to 98%, with a weighted average of 95% agreement across sites.ConclusionsConducting training via web-based technology was an acceptable and effective approach to standardizing medical record review across multiple sites for this group of experienced abstractors. Given the substantial time and cost savings achieved with the webinar, coupled with participants' positive evaluation of the training session, researchers should consider this instructional method as part of training efforts to ensure high quality data collection in multi-site studies.

A Bayesian Approach to Occupational Mortality Surveillance

The relationship between different social-economic indices and physical and mental functional health of older people compared with younger people is unclear.To examine the effect of age and sex on the relationship between various social-economic indices and self-reported functional health.A population-based cross-sectional study was conducted in 19,088 participants of European Prospective Investigation into Cancer (EPIC)-Norfolk, UK, ages 40–79 years at baseline. The independent relationships between three different socioeconomic indices; occupational social class, education and residential area deprivation, and functional health measured by anglicized version of 36-item short form questionnaire (UK SF-36), were compared between older (≥65 years) and younger (<65 years) men and women.Residential area deprivation was significantly associated with poor physical and mental functional health independent of social class and education, and consistent in both age groups in men and women. A low level of education in younger men and being in low social class in younger women were associated with poorer physical functional health compared with their respective older counterparts. Social class had a significantly greater effect in older women compared with younger women.Commonly used socioeconomic indices have differing associations with functional health depending the age and sex of an individual. Residential area deprivation predicts poor functional health in all age and sex groups. This may have implications for health policy.

Effect of Age and Sex on the Relationship Between Different Socioeconomic Indices and Self-Reported Functional Health in the EPIC-Norfolk Population-Based Study

The relationship between different social-economic indices and physical and mental functional health of older people compared with younger people is unclear. To examine the effect of age and sex on the relationship between various social-economic indices and self-reported functional health. A population-based cross-sectional study was conducted in 19,088 participants of European Prospective Investigation into Cancer (EPIC)-Norfolk, UK, ages 40-79 years at baseline. The independent relationships between three different socioeconomic indices; occupational social class, education and residential area deprivation, and functional health measured by anglicized version of 36-item short form questionnaire (UK SF-36), were compared between older (>or=65 years) and younger (<65 years) men and women. Residential area deprivation was significantly associated with poor physical and mental functional health independent of social class and education, and consistent in both age groups in men and women. A low level of education in younger men and being in low social class in younger women were associated with poorer physical functional health compared with their respective older counterparts. Social class had a significantly greater effect in older women compared with younger women. Commonly used socioeconomic indices have differing associations with functional health depending the age and sex of an individual. Residential area deprivation predicts poor functional health in all age and sex groups. This may have implications for health policy.

Muscle Cross-Sectional Area and Structural Bone Strength Share Genetic and Environmental Effects in Older Women

The purpose of this study was to estimate to what extent muscle cross-sectional area of the lower leg (mCSA) and tibial structural strength are influenced by common and trait-specific genetic and environmental factors. pQCT scans were obtained from both members of 102 monozygotic (MZ) and 113 dizygotic (DZ) 63- to 76-yr-old female twin pairs to estimate the mCSA of the lower leg, structural bending strength of the tibial shaft (BSIbend), and compressive strength of the distal tibia (BSIcomp). Quantitative genetic models were used to decompose the phenotypic variances into common and trait-specific additive genetic (A), shared environmental (C), and individual environmental (E) effects. The age-adjusted trivariate independent pathway model showed that the total relative contributions of A, C, and E were, respectively, 75%, 0%, and 25% for mCSA, 55%, 20%, and 25% for BSIbend, and 40%, 37%, and 23% for BSIcomp. In addition, the model showed that all three traits shared genetic and individual environmental factors. BSIbend and BSIcomp had common shared environmental factors and were also influenced by trait-specific genetic factors. In conclusion, the association between muscle cross-sectional area and structural bone strength has its origins in both genetic and environmental effects in older women. These results suggest that in older women the same genetic and environmental factors may predispose to or, conversely, protect from both sarcopenia and bone fragility.

Muscle Cross-Sectional Area and Structural Bone Strength Share Genetic and Environmental Effects in Older Women

Muscle Cross-Sectional Area and Structural Bone Strength Share Genetic and Environmental Effects in Older Women

The Other Side of the Coin: Perceived Positive Effects of Illness in Women Following Acute Myocardial Infarction

Although myocardial infarction (MI) is linked with both physical and psychological impairments, the possibility of patients also experiencing positive outcomes of MI has received far less attention in research and in clinical practice. In particular, this aspect has been under-investigated in older persons and in women. The purpose of this study was to investigate possible positive effects of illness, describe the patient characteristics and explore the nature and frequency of these effects in older women after MI. A cross-sectional postal survey was conducted in 145 women aged 62-80 years, three months to five years after MI. Self-reported socio-demographic and clinical data, in addition to data from medical records, were collected. A single-item question--"All in all, was there anything positive about experiencing an MI?"--was used to assess positive effects of illness, in addition to an open-ended question on the nature of possible positive effects. A majority of the women (65%) reported positive effects from their MI experience. The women perceiving positive effects did not differ from those who did not on socio-demographic and clinical variables, except for being older (p=0.007) and less often readmitted (p=0.029). The groups did not differ significantly as to disease severity and time since MI. Four themes emerged from the open-ended questioning on the nature of perceived positive effects of the illness: Appreciating Life (55%), Getting Health Care (42%), Making Lifestyle Changes (36%), and Taking More Care of Self and Others (29%). The findings contribute to a more complete picture of psychosocial issues in women after MI by providing evidence that positive effects are often experienced despite physical limitations. Nurses may use this knowledge as a tool in patient education and communication, although further research is needed to determine the most optimal interventions for MI patients.

A cohort study of the effect of endogenous estrogen on spine fracture risk and bone structure in elderly women and an assessment of its diagnostic usefulness

The decline in endogenous estrogen concentration after menopause is associated with accelerated bone loss. However, effects in older women remain controversial and the usefulness of estrogen status as a predictor of spine fracture has not been assessed. Therefore, we undertook a prospective cohort study of 1350 women mean age 75 years in order to study the role of endogenous estrogen concentration on the risk of morphometric X-ray absorptiometry (MXA)-defined vertebral deformity and atraumatic clinical spine fracture and the association of endogenous estrogen with bone structure. At 5 years 70 patients (5.2%) had sustained ≥ 1 incident spine fracture. The fracture group had significantly lower concentrations of baseline free estradiol index (FEI) median (IQ range) (0.38 (0.22–0.60) vs. 0.49 (0.29–0.84) pmol/nmol, p = 0.009). The patients in the lowest tertile of FEI (FEI < 0.35) had twice the risk of sustaining a clinical vertebral fracture compared to those subjects in the highest tertile (FEI > 0.68) (HR 2.18: 95% CI 1.11–4.28). A low FEI was associated with an increased risk of a vertebral deformity over the 5-year study (OR 1.77: 95% CI 1.02–3.07) for the lowest compared to highest tertile. A low baseline FEI was associated with lower baseline QUS heel bone structure and DXA hip bone structure at 12 months and with deterioration in QUS heel bone structure 5 years later. The effect size of the FEI in predicting spine fracture was similar to the effect size for DXA BMD and heel QUS, probably because of the beneficial effect of the FEI on bone structure. The data suggest that the estrogen effect on reducing spine fracture is at least in part due to an effect on bone structure and its measurement does not significantly improve fracture prediction.

Androgen Therapy Induces Muscle Protein Anabolism in Older Women

Normal healthy men and women undergo a gradual loss of skeletal muscle mass and strength with advancing age. While androgens are protein anabolic in older men, the metabolic effects in older women are poorly understood. The objective of this study was to determine whether oral administration of a synthetic derivative of testosterone [oxandrolone, Oxandrin (OX)] (7.5 mg orally twice daily for 14 d) to five older women (age, 65 +/- 2 yr) would enhance skeletal muscle anabolic biomarkers including mixed muscle fractional synthetic rate (FSR), net phenylalanine balance, androgen receptor, and IGF-I protein expression at d 0, 5, and 14 of treatment. As a positive control, seven older men were examined after 14 d of OX (10 mg orally twice daily). The study was performed at the General Clinical Research Center. Fourteen days of OX significantly increased skeletal muscle FSR in older women (d 0, 0.073 +/- 0.006 vs. d 5, 0.092 +/- 0.006 vs. d 14, 0.115 +/- 0.007%/h) (P < 0.05, d 0 vs. d 14). Conversely, OX stimulated FSR in older men after only 5 d (d 0, 0.061 +/- 0.003 vs. d 5, 0.101 +/- 0.01 vs. d 14, 0.084 +/- 0.01%/h) (P < 0.05, d 0 vs. d 5). Androgen receptor expression was significantly increased in older men by d 14, but had not increased in older women. No change was noted in IGF-I expression in either group. We conclude that the skeletal muscle of older women and men responds to androgen administration, although the time course of anabolism appears to be gender specific.

Effect of a Soymilk Supplement Containing Isoflavones on UrinaryF2 Isoprostane Levels in Premenopausal Women

: Epidemiological studies have associated soy diets with reduced risk of breast and some other cancers, and oxidative cellular damage may contribute to the development of these and other diseases. We tested the effect of a soymilk supplement rich in isoflavones on a measure of cellular lipid peroxidation in a controlled feeding study. Eight premenopausal women consumed a constant diet that included soymilk containing 113-207 mg/day total isoflavones and 4 mo later a constant soy diet low (<5 mg/day) in isoflavones, both for a complete menstrual cycle. The average daily urinary excretions of daidzein and genistein were 24.6 ± 10.1 and 9.2 ± 6.1 mg/day, respectively, during the high-isoflavone soy diet and were below the detection limit during the low-isoflavone diet. F2 isoprostane 8-iso-PGF-2α excretion varied widely within and between subjects, and the group mean was not significantly different during the high- and low-isoflavone soy diet (7.67 ± 1.13 and 8.65 ± 1.18 nmol/12 h, mean ± SD, respectively). However, individual changes in 8-iso-PGF-2α between the two soymilk drinks were significantly associated with age (r = ―0.87; P = 0.006) and several measures of isoflavone exposure, namely, daidzein dose (r = 0.81; P = 0.015), combined daidzein and genistein dose (r = 0.77; P = 0.03), and total urinary excretion of isoflavones (daidzein, genistein, and equol) (r = 0.71; P = 0.05). The findings suggest that soy isoflavones may reduce lipid peroxidation in an age-dependent manner, with greater effects in older women, and with lower doses of isoflavones.

A Systematic Review of Clinical Trials of Hormone Therapy on Cognitive Function: Effects of Age at Initiation and Progestin Use

The putative protective effects of hormone therapy (HT) have been cast in doubt by recent findings from the Women's Health Initiative Memory Study showing an increase in dementia and an increased likelihood of impaired cognitive status in women initiating HT after age 65. To explore the external generalizability of those findings to younger postmenopausal women, the medical literature was surveyed for randomized, double-blind, placebo-controlled trials of treatment with either estrogen alone or estrogen plus a progestin on neuropsychological test performance. Findings from trials in younger women (<65 years) are presented separately from those in older women (>or=65 years). This review finds little support for beneficial cognitive effects in older women of estrogen alone or in combination with progestin. However, evidence from younger women suggests potential beneficial effects in select cognitive domains, particularly among symptomatic women and recently menopausal women, and scant evidence of harm. There is a dearth of studies of the cognitive effects of estrogen plus progestin in younger women. Future studies systematically exploring the effect of age and progestin use are needed to better characterize the effects of HT on cognition in younger women. Without firm evidence of benefit to younger women, it is prudent to caution early postmenopausal women about the cognitive risks observed in WHI, recognizing the low likelihood of dementia at that age.

Structured home visits to older people. Are they only of benefit for women? A randomised controlled trial

Objective – To investigate whether education of primary care professionals improved functional ability in home-dwelling older people, with special focus on gender differences.Design – A prospective controlled three-year follow-up study (1999–2001) with randomisation and intervention at municipality level and outcomes measured at individual level. Intervention municipality visitors received regular education and GPs were introduced to a short assessment programme. Control municipalities received no education but conducted the preventive programme in their own way.Setting – Primary care, 34 municipalities.Subjects – 5788 home-dwelling 75- and 80-year-olds were invited. 4060 (70.1%) participated: 2104 in 17 intervention- and 1956 in 17 matched control-municipalities. The main outcome measure was obtained from 3383 (95.6%) of 3540 surviving participants.Main outcome measure – Functional ability.Results – Municipality intervention in coordination with GPs was associated with better functional ability in women (OR: 1.26; CI95: 1.08–1.47, p=0.004), but not in men (OR: 1.04; CI95: 1.85–1.27). Accepting and receiving free preventive home visits was associated with better functional ability among women (OR: 1.36; CI95: 1.16–1.60, p=0.0002), but not among men (OR: 0.98; CI95: 0.80–1.21).Conclusion – A brief, feasible educational intervention for primary care professionals and to accept and receive preventive home visits may have effect in older women, but not in older men.