Elderly Whites Research Articles

Aging: A Feminist Issue

Aging:A Feminist Issue Leni Marshall (bio) When Barbara Macdonald spoke on a plenary at the 1985 NWSA convention, she was angry! A pioneer in feminist aging studies, Macdonald described a four-year fight to get the topic of aging included in a plenary session. She took feminists to task when she asked, "Has it never occurred to those of you in Women's Studies, as you ignore the meaning and the politics of the lives of women beyond our reproductive years, that this is male thinking? Has it never occurred to you as you build feminist theory that ageism is a central feminist issue?" (21). Twenty years later, aging studies remains an emergent topic for scholars outside Women's Studies. Within NWSA, the topic's progress can be measured by two recent events. First, the NWSA governing council unanimously decided to focus an entire plenary on aging studies. Marilyn Hughes Gaston, Margaret Gullette, and Kathleen Woodward were selected to speak at the 2005 convention. Then, the NWSA Journal agreed to devote a special issue to aging studies. With these actions, the organizations' leadership has acknowledged the importance of aging studies, and its centrality to Women's Studies. As Women's Studies develops, it occurs to more and more of us that aging and ageism are important feminist issues. This is good news not only for those of us working in the field of aging studies, but also for those of us who are aging—that is, all of us. Each of us has confronted, or will eventually have to confront, the physical, psychological, social, and other changes that happen with time; all of us who live will eventually belong to the "Othered" category that is old age. Each day, more and more of us realize the eventuality of belonging to the "Othered" category that is old age. In the United States, 10,000 people turn 50 each day (Akers 2001). The U.S. Administration on Aging (AoA) data show that, in the year 2000, 12.4 percent of the U.S. population was over the age of 65. By 2030, the raw numbers will double, bringing the percentage to a projected 20 percent. People of color, who made up 17.2 percent of the over-65 population in 2002, are projected to be 26.4 percent of that population by 2030 (Administration on Aging 2003). The statistics can be overwhelming, but they are worth knowing. The AoA uses the term "elderly" to denote people over age 65; I could argue the term, but I co-opt it for the sake of brevity. Almost 17 percent of the elderly were near (6.4 percent) or below (10.4 percent) the poverty line: 8.3 percent of elderly whites, 23.8 percent of elderly blacks, and 21.4 percent of elderly Hispanics live below the poverty line (Administration on Aging 2003). That 10.4 percent is more than three and a half million people. Elderly people living alone are more likely to be poor than those living with families. Forty-one [End Page vii] percent of elderly women live alone (versus 18 percent for men). Elderly Hispanic women living alone had the highest poverty rate: 47.1 percent. More than half of the non-institutionalized elderly have some form of disability (Administration on Aging 2003). These data make it abundantly clear: aging is a feminist issue, one that women's studies scholars need to incorporate into their analyses. In a country in which the demographic bulge of aging continues to expand, the limited size and influence of aging studies' academic repertoire frustrates scholars of aging as much as those texts' contents illuminate and inspire. Since the 1973 publication of Simone de Beauvoir's The Coming of Age, reviewers have greeted feminist books on aging with words that emphasize the importance of the topic—and that reflect the larger social amnesia. A few examples: The Coming of Age was hailed as a text that "confronts a subject of universal public anguish and universal public silence" ("Five Significant Books" 1972). The back cover of Barbara Macdonald and Cynthia Rich's own text, Look Me in the Eye: Women, Aging, and Ageism (1983), shows...

Promoter and 3′-Untranslated-Region Haplotypes in the Vitamin D Receptor Gene Predispose to Osteoporotic Fracture: The Rotterdam Study

Polymorphisms of the vitamin D receptor gene (VDR) have been shown to be associated with several complex diseases, including osteoporosis, but the mechanisms are unknown and study results have been inconsistent. We therefore determined sequence variation across the major relevant parts of VDR, including construction of linkage disequilibrium blocks and identification of haplotype alleles. We analyzed 15 haplotype-tagging SNPs in relation to 937 clinical fractures recorded in 6,148 elderly whites over a follow-up period of 7.4 years. Haplotype alleles of the 5' 1a/1e, 1b promoter region and of the 3' untranslated region (UTR) were strongly associated with increased fracture risk. For the 16% of subjects who had risk genotypes at both regions, their risk increased 48% for clinical fractures (P = .0002), independent of age, sex, height, weight, and bone mineral density. The population-attributable risk varied between 1% and 12% for each block and was 4% for the combined VDR risk genotypes. Functional analysis of the variants demonstrated 53% lower expression of a reporter construct with the 1e/1a promoter risk haplotype (P = 5 x 10(-7)) in two cell lines and 15% lower mRNA level of VDR expression constructs carrying 3'-UTR risk haplotype 1 in five cell lines (P = 2 x 10(-6)). In a further analysis, we showed 30% increased mRNA decay in an osteoblast cell line for the construct carrying the 3'-UTR risk haplotype (P = .02). This comprehensive candidate-gene analysis demonstrates that the risk allele of multiple VDR polymorphisms results in lower VDR mRNA levels. This could impact the vitamin D signaling efficiency and might contribute to the increased fracture risk we observed for these risk haplotype alleles.

Polymorphisms in the Sclerosteosis/van Buchem Disease Gene ( SOST) Region Are Associated with Bone-Mineral Density in Elderly Whites

Osteoporosis has a strong genetic component, but the genes involved are poorly defined. We studied whether the sclerosteosis/van Buchem disease gene (SOST) is an osteoporosis-risk gene by examining its association with bone-mineral density (BMD). Mutations in SOST result in sclerosteosis, and alterations in the SOST gene expression may be causal in the closely related van Buchem disease. We used a set of eight polymorphisms from the SOST gene region to genotype 1,939 elderly men and women from a large population-based prospective-cohort study of Dutch whites. A 3-bp insertion (f=0.38) in the presumed SOST promoter region (SRP3) was associated with decreased BMD in women at the femoral neck (FN) (P=.05) and lumbar spine (LS) (P=.01), with evidence of an allele-dose effect in the oldest age group (P=.006). Similarly, a G variant (f=0.40) in the van Buchem deletion region (SRP9) was associated with increased BMD in men at the FN (P=.007) and LS (P=.02). In both cases, differences between extreme genotypes reached 0.2 SD. We observed no genotype effects on fracture risk, for the 234 osteoporotic fractures validated during 8.2 years of follow-up and for the 146 vertebral prevalent fractures analyzed. We did not find association between any of several frequent haplotypes across the SOST gene region and BMD. We did find evidence of additive effects of SRP3 with the COLIA1 Sp1 polymorphism but not with haplotypes of 3' polymorphisms in the vitamin-D receptor gene. The SOST-COLIA1 additive effect increased with age and reached 0.5 SD difference in BMD at LS in the oldest age group (P=.02). The molecular mechanism whereby these moderate SOST genotype effects are mediated remains to be elucidated, but it is likely to involve differences in regulation of SOST gene expression.

Racial differences in screening for prostate cancer in the elderly.

Black men are more likely than white men to be diagnosed as having advanced prostate cancer, and their prostate cancer mortality rates are more than twice as high. Low screening rates among black men may contribute to these disparities, but there are few data on racial differences in prostate cancer screening. To present a case-control study of racial differences in the use of prostate-specific antigen (PSA) as a screening test among Medicare beneficiaries in New Jersey and to assess the degree to which race is associated with prostate cancer screening. The study used a statewide database of claims data from Medicare Parts A and B, Medicaid, and the state's Pharmaceutical Assistance for the Aged and Disabled program. Prevalent cases of prostate cancer were excluded using the state's cancer registry. Of 139 672 men who underwent PSA screening, 34 984 were randomly selected along with an identical number of controls matched by month and year of birth. After men with International Classification of Diseases, Ninth Revision, Clinical Modification,or Current Procedural Terminology codes indicative of prostate cancer were excluded, 33 463 case patients and 33 782 control subjects remained. The use of PSA screening was strongly and inversely associated with black race (odds ratio [OR] = 0.50; P<.001), poverty (OR = 0.33; P<.001), and near poverty (OR = 0.69; P<.001). Multivariate logistic regression analysis after age, socioeconomic status, comorbidity, and use of health care services were controlled for revealed that black race remained a strong predictor of not undergoing PSA screening (OR = 0.65; 95% confidence interval, 0.60-0.70). Elderly blacks are substantially less likely to undergo PSA screening than elderly whites. Differences in socioeconomic status and comorbid conditions explain only a small part of the racial differences in screening rates.

Heart failure

Heart failure

Chapter 8: Rural African American Older Adults and the Black Helping Tradition

SUMMARY By the year 2050, 21 percent of all Americans over 65 will be members of a minority group with African Americans being the largest subgroup. What is critical is that there are great disparities in the physical and mental health status, service availability, service access, and socioeconomic factors between elderly African Americans and elderly whites. These disparities are even more evident with older African Americans in rural communities. Along with these disparities, coupled with the “helping tradition” in the African American community, there has been a great reliance on community-based informal care systems for elderly African Americans. This chapter will examine the informal care systems in rural African American communities within the context of the helping tradition found within the African American cultural history. In this examination there will be a discussion of how the gaps in the social services delivery system in rural communities reinforce this helping tradition.

Mortality among elderly Hispanics in the United States: past evidence and new results.

We used vital records and census data and Medicare and NUMIDENT records to estimate age- and sex-specific death rates for elderly non-Hispanic whites and Hispanics, including five Hispanic subgroups: persons born in Cuba, Mexico, Puerto Rico, other foreign countries, and the United States. We found that corrections for data errors in vital and census records lead to substantial changes in death rates for Hispanics and that conventionally constructed Hispanic death rates are lower than rates based on Medicare-NUMIDENT records. Both sources revealed a Hispanic mortality advantage relative to non-Hispanic whites that holds for most Hispanic subgroups. We also present a new methodology for inferring Hispanic origin from a combination of surname, given name, and county of residence.

Frequency of Ophthalmic Assessments among Elderly Whites and African Americans with Eye Disease and Impact on Visual Function

To study the difference in patterns of utilization of eye-care services among white and African American senior citizens with eye disease and its impact on visual function. This study involved cross-sectional assessments of visual function using the Activities of Daily Vision Scale (ADVS), as well as retrospective self-recall of history of eye disease and frequency of ophthalmic assessments. Participants included 99 consecutive elderly patients with history of eye disease who were attending the outpatient medical clinics at Nassau University Medical Center, a community teaching hospital in Long Island, New York. White Americans constituted 52% of the study sample and African Americans constituted the remaining 48%. African American subjects were less likely than whites to report visiting an eye specialist over the previous 5 years (69% versus 88%, P < 0.05). African American subjects who reported undergoing ophthalmic assessments over the past 5 years showed a trend of having higher ADVS scores (indicating better visual function) compared with those who did not report such history (86 +/- 12 versus 79 +/- 15, P = 0.098). On the other hand, reporting such history had no apparent relation to the ADVS scores in whites. African American elderly ambulatory medical patients with eye disease were less likely than their white counterparts to report use of eye-care services. The use of eye-care services in African American but not white subjects was linked to better visual function as assessed by the ADVS.

Strategic Adjustments of Elderly Asian Americans: Living Arrangements and Headship

While many elderly whites in the US live in nuclear families, elderly minorities are more likely to live in extended families. The prevalence of extended families among elderly minorities is often explained in terms of cultural characteristics of ethnic minorities. Using the 1990 US census, we examine family living arrangements and headship among elderly Asian Americans and non-Hispanic whites. Headship is included to distinguish the intergenerational relationship within families. Results show that elderly Asian Americans are more likely than elderly whites to live in extended families, either as a head or in the household of another family member. In addition, the effects of some economic and cultural factors are different for each racial group. We suggest that extended family living among elderly Asian Americans is a result of more than cultural preferences but also reflects their strategic adjustments in American society.

Incidence rates of Alzheimer's disease among elderly blacks, caribbean-hispanics and whites in Northern Manhattan

Incidence rates of Alzheimer's disease among elderly blacks, caribbean-hispanics and whites in Northern Manhattan

New approaches to the uses of beta blocking drugs in hypertension.

After a slow start, beta-blockers have become widely used as first-line agents in the treatment of hypertension, and recommended as such in recently published guidelines. There is evidence that the beta1-selective agents are more efficacious than non-selective blockers that inhibit both beta1 and beta2 receptors. Notwithstanding some earlier evidence to the contrary, it appears that beta1-selective drugs are equi-effective in young and elderly whites, younger, ie, under mid 60s, blacks. It is with the combination of age and being black that beta-blockers are usually less useful than some other groups of antihypertensive drugs, most notably calcium antagonists and diuretics. Primary prevention studies indicate beta-blockers reduce the incidence of cerebro-vascular disease and coronary heart disease in younger patients but they appear less effective than diuretics in the elderly. Beta-blockers are particularly indicated in patients who have experienced a myocardial infarction where they are often under used. There is some evidence that even in post-infarction patients with co-existent chronic obstructive airways disease, usually regarded as a contra-indication, experience an improved 2-year survival with the use of beta-blockers. Recently they have also been demonstrated to improve prognosis in heart failure patients, previously regarded as a contra-indication. Likewise, recent studies have shown that atenolol was at least as effective as captopril in improving the outlook in hypertensive patients with non-insulin dependent diabetes. While earlier comparisons with the non-selective lipid soluble propranolol indicated otherwise, comparisons with beta1-selective agents have indicated a similar effect on quality of life assessments with angiotensin-converting enzyme inhibitors.

The Influence of Ethnicity on Use of Herbal Remedies in Elderly Hispanics and Non-Hispanic Whites

ObjectiveTo compare the use of herbal remedies between elderly, self-identified Hispanics and non-Hispanic whites (NHW). DesignCross-sectional, interviewer-administered survey. Patients/Setting186 patients, 65 years and older, at a university-based, ambulatory, senior health center. InterventionsNot applicable. Main Outcome MeasuresDifferences in herbal use patterns between Hispanic and NHW participants. Main outcome measures were participants' use of herbal remedies, types of remedies used, medical reason for use, age, sex, Hispanic or NHW ethnicity, income, and education. ResultsOverall, 61% of patients had used an herbal remedy at some time in their lives. A larger proportion of Hispanic subjects used herbal remedies than did NHW subjects (77% versus 47%, respectively). Hispanic subjects preferred to use the raw herb in a tea, whereas NHW subjects preferred processed herbs in a capsule or tablet form. Significantly more Hispanic subjects grew or gathered their own herbs and received their information about herbs from a family member than did NHW subjects. Few subjects in either ethnic group received their information about herbal remedies from an allopathic provider. For both groups, the herbs most often used were yerba buena, manzanilla, pol eo, osha, and alhucema. The top perceived medical problems that herbs were used for were health care maintenance, dyspepsia, upper respiratory infection, skin problems, and anxiety/nerves/insomnia. ConclusionEthnicity was related to the frequency of herbal use, the choice and preferred form of herb, and the source of knowledge of herbal remedies. Hispanic culture may account for the observed differences.

Serum cobalamin, homocysteine, and methylmalonic acid concentrations in a multiethnic elderly population: ethnic and sex differences in cobalamin and metabolite abnormalities

Low cobalamin concentrations and mild hyperhomocysteinemia are common in the elderly but ethnic differences have not been defined. Our objective was to determine the demographic characteristics of cobalamin deficiency in the elderly and its role in their hyperhomocysteinemia. We measured serum cobalamin, total homocysteine (Hcys), and methylmalonic acid (MMA) concentrations in 725 subjects >60 y old, and folate concentrations in 520 subjects. After exclusion of subjects taking cobalamin supplements or with renal insufficiency, high prevalences of low cobalamin (11.8%), high MMA (16.6%), and high Hcys (26.1%) concentrations were seen. Most cobalamin concentrations <140 pmol/L appeared to reflect deficiency because 78. 3% of them were accompanied by abnormal metabolites. Subjects with cobalamin concentrations of 140-258 pmol/L had significantly fewer metabolic abnormalities. A low cobalamin concentration and renal insufficiency were the strongest predictors of abnormal Hcys concentrations. Elderly men had higher Hcys concentrations than did women (P = 0.0001). Whites and Latin Americans had lower cobalamin concentrations than did blacks and Asian Americans (P < 0.005). Whites also had higher Hcys concentrations than all the other groups (P < 0.05). When included in the analysis, renal insufficiency in subjects was associated with 23.8% of all high Hcys and 25.5% of all high MMA concentrations; most with renal insufficiency were Asian American and black men. Mild cobalamin deficiency is most common in elderly white men and least common in black and Asian American women. Hyperhomocysteinemia, which is most strongly associated with low cobalamin concentrations, is also most common in elderly whites, whereas that associated with renal insufficiency is more common in blacks and Asian Americans. Ethnic differences in cobalamin deficiency and the Hcys patterns associated with it or with renal insufficiency warrant consideration in supplementation strategies. Extending suspicion of deficiency to persons with cobalamin concentrations of 140-258 pmol/L appears to provide more disadvantages than advantages.

Predictors of sputum culture conversion among patients with tuberculosis in the era of tuberculosis resurgence.

Sputum culture conversion among patients with tuberculosis (TB) is the most important indicator for the effectiveness of treatment and the infectivity of the disease. We sought to investigate predictors for documented sputum culture conversion among TB cases reported in the surveillance system. This study included 780 patients with pulmonary TB who were initially sputum culture positive in New Jersey in 1994-1995. These patients were followed up for at least 1 week and up to 1 year. Kaplan-Meier curves and Cox proportional hazards models were performed to analyze the data. Overall, 469 (60.1%) of the 780 patients had documented sputum culture conversion. The elderly (36%) and non-Hispanic whites (41.3%) were the least likely to have documented sputum conversion. Patients who were initially given 4 or more drugs were 36% more likely to have documented sputum conversion than those who were initially given fewer than 4 drugs, after adjusting for other factors. Patients who were under the care of chest clinics and the model TB center were about 3 times more likely to have documented sputum conversion than those under care of private physicians. Sex, recurrent TB, foreign-born status, homelessness, injecting drug use, human immunodeficiency virus infection and drug-resistant TB were not significantly associated with the documentation of sputum culture conversion. A substantial proportion of sputum culture-positive TB patients have no documented sputum culture conversion. The type of care provider was the predominant determinant for the documentation of sputum culture conversion.

Social determinants of psychiatric morbidity and well‐being in immigrant elders and whites in east London

Objectives. The social conditions under which migrants to the UK live may be more significant than the experience of migration itself in leading to increased risk of mental illness. We aimed to compare the prevalence of mental, physical and social health problems in elderly Somalis, Bengalis and whites living in a deprived inner London area and examine associations between environmental circumstances, social support, physical health status, mood and life satisfaction in these groups. In addition, we wanted to test the hypothesis that differences in mental health between immigrants and whites are explained by social disadvantages rather than ethnicity. Design. Cross-sectional survey with participants drawn from age–sex registers of general practices, augmented by other sources. Setting. East London—‘first-generation’ Somali and Bengali immigrants and white British. Subjects. A total of 274 people aged 60+ years: 72 Somalis, 75 Bengalis and 127 whites. Main outcome measures. Symptoms of Anxiety and Depression Scale (SAD), Life Satisfaction Index (LSI). High SAD scores indicate more anxiety and depression symptoms; high LSI scores indicate greater life satisfaction. Main results. Highest SAD scores were found among Bengalis; lowest LSI scores were found among Bengalis and Somalis. The prevalences of depression (SAD score 6+) were 25% in Somalis, 77% in Bengalis and 25% in east London whites. Physical health status and SAD scores were associated in Somalis (r=+0·31, p≤0·01), Bengalis (r=+0·47, p≤0·001) and east London whites (r=+0·27, p≤0·01). Physical health problems also related to lower LSI scores in Somalis (r=−0·24, p≤0·05) and east London whites (r=−0·24, p≤0·01). Social factors (ie poor housing conditions, low family support and reported need of community services) were strongly associated with SAD scores among Somalis (r=+0·5, p≤0·001) and, to a lesser extent, among Bengalis (r=+0·33, p≤0·01). Ethnicity (ie being an immigrant as opposed to a non-immigrant) became a statistically non-significant risk factor for high SAD scores after adjusting for the effects of age, weekly income, physical health and social problems (OR=0·71, 95% CI=0·5–1·1, p=0·09). A residual, but much attenuated effect for ethnicity on LSI scores persisted in the estimated model after controlling for the same set of independent risk factors (OR=0·7, 95% CI=0·4–1, p=0·05). Conclusion. The marked variation in mental health between ethnic groups in east London might be a reflection of socioeconomic and health differentials acting concomitantly and adversely. Inequalities in housing, social support, income and physical health status accounted for variation in mood observed between immigrants and whites, and may partly explain differences in life satisfaction. These results seem to support a ‘multiple jeopardy’ theory of ageing in ethnic minorities in east London. Greater efforts are needed to recognize anxiety and depression in immigrant elders. Better social support and housing among ‘minority ethnic’ elders who live alone might be expected to alleviate social stress and improve mental health and psychological well-being. Copyright © 1998 John Wiley & Sons, Ltd.

Social determinants of psychiatric morbidity and well-being in immigrant elders and whites in east London.

The social conditions under which migrants to the UK live may be more significant than the experience of migration itself in leading to increased risk of mental illness. We aimed to compare the prevalence of mental, physical and social health problems in elderly Somalis, Bengalis and whites living in a deprived inner London area and examine associations between environmental circumstances, social support, physical health status, mood and life satisfaction in these groups. In addition, we wanted to test the hypothesis that differences in mental health between immigrants and whites are explained by social disadvantages rather than ethnicity. Cross-sectional survey with participants drawn from age-sex registers of general practices, augmented by other sources. East London--'first-generation' Somali and Bengali immigrants and white British. A total of 274 people aged 60+ years: 72 Somalis, 75 Bengalis and 127 whites. Symptoms of Anxiety and Depression Scale (SAD), Life Satisfaction Index (LSI). High SAD scores indicate more anxiety and depression symptoms; high LSI scores indicate greater life satisfaction. Highest SAD scores were found among Bengalis; lowest LSI scores were found among Bengalis and Somalis. The prevalences of depression (SAD score 6+) were 25% in Somalis, 77% in Bengalis and 25% in east London whites. Physical health status and SAD scores were associated in Somalis (r = +0.31, p < or = 0.01). Bengalis (r = +0.47, p < or = 0.001) and east London whites (r = +0.27, p < or = 0.01). Physical health problems also related to lower LSI scores in Somalis (r = -0.24, p < or = 0.05) and east London whites (r = -0.24, p < or = 0.01). Social factors (i.e. poor housing conditions, low family support and reported need of community services) were strongly associated with SAD scores among Somalis (r = +0.5, p < or = 0.001) and, to a lesser extent, among Bengalis (r = +0.33, p < or = 0.01). Ethnicity (i.e. being an immigrant as opposed to a non-immigrant) became a statistically non-significant risk factor for high SAD scores after adjusting for the effects of age, weekly income, physical health and social problems (OR = 0.71, 95% CI = 0.5-1.1, p = 0.09). A residual, but much attenuated effect for ethnicity on LSI scores persisted in the estimated model after controlling for the same set of independent risk factors (OR = 0.7, 95% CI = 0.4-1, p = 0.05). The marked variation in mental health between ethnic groups in east London might be a reflection of socioeconomic and health differentials acting concomitantly and adversely. Inequalities in housing, social support, income and physical health status accounted for variation in mood observed between immigrants and whites, and may partly explain differences in life satisfaction. These results seem to support a 'multiple jeopardy' theory of ageing in ethnic minorities in east London. Greater efforts are needed to recognize anxiety and depression in immigrant elders. Better social support and housing among 'minority ethnic' elders who live alone might be expected to alleviate social stress and improve mental health and psychological well-being.

Adaptation of a food frequency questionnaire to assess diets of Puerto Rican and non-Hispanic adults.

To study issues of diet and health among Hispanic adults living in the northeastern United States, the authors adapted a version of the National Cancer Institute (NCI)/Block food frequency questionnaire. Foods that contributed to nutrient intake of Puerto Rican adults in the Hispanic Health and Nutrition Examination Survey (HHANES) were ranked to identify items to be added to the food list. Portion sizes were compared across HHANES and the Second National Health and Nutrition Examination Survey (NHANES II) to assess the adequacy of the assumed values. Within line items, frequencies of consumption of individual foods were ranked and these data were used to adjust the weighting factors within the database. To test the revised form, 24-hour recalls were collected from 90 elderly Hispanics and 35 elderly non-Hispanic whites. These data were coded into the original and revised food frequency forms and nutrient intake results were compared with recall results by paired t-test, and by Pearson and intraclass correlations. Added foods include plantains, avocado, mango, cassava, empanadas, and custard. Portion sizes differed significantly between HHANES and NHANES II, and were left open-ended. Estimated mean nutrient intakes and correlations with recall data were lower with the original versus the revised form. The authors conclude that the use in minority populations of food frequency questionnaires developed for the general population is likely to result in biased estimates of intake unless modifications are made in the questionnaires.

A 5-year study of attachment loss and tooth loss in community-dwelling older adults.

Tooth loss is a widely recognized endpoint measure for the effects of periodontal diseases and the impact of periodontal therapy. In fact, traditional clinical measures of periodontal status often are considered to be surrogate endpoints in that they are assumed to be related to tooth loss. However, the strength of the relationship between attachment loss and tooth loss in a representative population of untreated subjects has not been studied extensively. The purpose of this paper is to present the trends in attachment loss over a 5-yr period in a population of community-dwelling elderly blacks and whites. Specifically, this paper presents attachment loss trends both at the person and tooth level to address the following issues; 1) whether teeth that experience attachment loss during 1 time period are more likely to be lost at the next time period; and 2) given similar levels of attachment loss, why are some people more likely to lose teeth? In 1988, the University of North Carolina School of Dentistry initiated the Piedmont 65+ Dental Study, which was designed to elicit 800 dentate respondents in the 5-country area who were examined again at 18, 36 and 60 months. Our findings indicated that teeth with poorer attachment level at baseline had a higher probability of being lost during the next 5 yr and teeth that experienced attachment loss during a time period were more likely to be lost during the next time period than teeth without additional attachment loss. In addition, it appears that there are person-level characteristics associated with increasing tendency towards tooth loss in people with similar periodontal status, a finding that may clarify the relationship between attachment loss and tooth loss.

A 5-year study of attachment loss in community-dwelling older adults: incidence density.

This is the second of three papers that present trends in attachment loss and tooth loss over a 5-yr period in a population of community-dwelling elderly black and whites. The first paper in this series showed that in addition to subject attrition during the 5 yr of the study, teeth also were lost. This loss of subjects and teeth resulted in trends that were not always consistent over time, because people were lost from the study and teeth with more active and advanced periodontal disease were more likely to be lost. In these instances, the incidence density (time-to-event) analytic strategy is useful. Incidence density is the average rate of occurrence for a fixed follow-up period. In 1988, the University of North Carolina School of Dentistry initiated the Piedmont 65+ Dental Study, which was designed to elicit 800 dentate respondents in the 5-county area who were examined again at 18, 36 and 60 months. Our findings indicated that for every 1000 sites followed for 1 yr in this population, 20.6 sites will experience attachment loss of 3+mm. Incidence densities varied greatly by subgroup, indicating that certain characteristics predispose sites for attachment loss. A multivariate logistic regression model indicated that people who are smokers, Porphyromonas gingivalis positive, have 5 or more missing teeth, are not high school graduates, and have not had a dental visit in the last 5 yr are at higher risk of attachment loss. Posterior teeth and mesiobuccal sites are at higher risk. We conclude that incidence density analyses are useful for longitudinal periodontal data and we illustrate the use of incidence density rates to plan clinical trials.

Spirometry Reference Values for Healthy Elderly Blacks

Pulmonary function was assessed by spirometry in 497 black and 2,980 white ambulatory elderly male and female participants of the Cardiovascular Health Study. The quality assurance program prompted technicians to exceed American Thoracic Society recommendations for spirometry. A "healthy" subgroup of 235 black and 1,227 white participants age 65 years and older was identified by excluding current and former smoker, and those with self-reported asthma or emphysema, congestive heart failure, and poor-quality results of spirometry tests, since those factors were associated with a lower FEV1. Reference equations and normal ranges for elderly blacks for measurements of FEV1, FVC, and the FEV1/FVC ratio were then determined from the healthy group. These elderly blacks had an FVC about 6% lower than elderly whites, even after correcting for standing height, sitting height (trunk length), and age. The popular use of spirometry reference values from studies of middle-aged white subjects by applying a 12% race correction factor for black patients appears to overestimate predicted values.