Health Of Older Persons Research Articles

Relative survival: a useful tool to assess generalisability in longitudinal studies of health in older persons

BackgroundGeneralisability of longitudinal studies is threatened by issues such as choice of sampling frame, representativeness of the initial sample, and attrition. To determine representativeness, cohorts are often compared with the population of interest at baseline on demographic and health characteristics. This study illustrates the use of relative survival as a tool for assessing generalisability of results from a cohort of older people among whom death is a potential threat to generalisability.MethodsThe authors used data from the 1921-26 cohort (n = 12,416, aged 70-75 in 1996) of the Australian Longitudinal Study on Women's Health (ALSWH). Vital status was determined by linkage to the National Death Index, and expected deaths were derived using Australian life tables. Relative survival was estimated using observed survival in the cohort divided by expected survival among women of the same age and State or Territory.ResultsOverall, the ALSWH women showed relative survival 9.5% above the general population. Within States and Territories, the relative survival advantage varied from 6% to 23%. The interval-specific relative survival remained relatively constant over the 12 years (1996-2008) under review, indicating that the survival advantage of the cohort has not diminished over time.ConclusionThis study demonstrates that relative survival can be a useful measure of generalisability in a longitudinal study of the health of the general population, particularly when participants are older.

Quality Indicators for the Care of Undernutrition in Vulnerable Elders

As a population, older adults are more likely than younger individuals to be afflicted with a variety of age-related diseases and functional impairments that may interfere with the maintenance of good nutritional status. This is particularly true of vulnerable elders (VEs). This population is also at greater risk of drug-induced nutritional deficiencies because of the number of prescription drugs they take. The term ‘‘malnutrition’’ can encompass a wide range of deficiencies (e.g., protein–energy, vitamins, fiber, water) and excesses (e.g., obesity, hypervitaminosis) that may or may not be clearly associated with adverse health outcomes. However, undernutrition has emerged as a priority area in caring for older persons. For example, an expert panel ranked undernutrition as the third leading condition in hospital and home care sites and the fourth leading condition in office practice and nursing home sites for which quality improvement efforts would enhance the functional health of older persons. Undernutrition in older persons is a particularly complex issue, because three populations must be considered: community dwelling, hospitalized, and institutionalized (nursing home). Although the overlap among these three populations is considerable, the burden of acute and chronic disease differs in the three groups. As a result, their nutritional requirements vary. This article will address quality indicators (QIs) for undernutrition only for communitydwelling and hospitalized VEs. The prevalence of energy undernutrition in VEs varies depending upon the definition used. In community-dwelling individuals in the United States, if energy undernutrition is defined as having a body weight of less than 45.4 kg (100 lbs), slightly more than 3% of those aged 60 and older may be affected. Similarly, low body mass index (BMI) is uncommon in community-dwelling older persons. Based on data from the 1999 to 2002 National Health and Nutrition Examination Survey, the prevalence of BMI levels less than 18.5 in persons aged 70 and older was 2.4%. If undernutrition is defined according to caloric or nutrient intake, 37% to 40% of older community-dwelling men and women ( 65) report energy intakes less than two-thirds of the recommended dietary allowance (RDA). Although other surveys have suggested that 30% of community-dwelling older persons have energy intakes below the RDA, the same surveys indicate that protein intake has generally been above the RDA. The prevalence of undernutrition is considerably higher in hospitalized patients, ranging from 55% to 61% in different populations using different definitions. Developing QIs for undernutrition in older persons is problematic, because there is no universally accepted clinical definition of undernutrition and because the research conducted on malnutrition in older persons, although voluminous, has not systemically focused on concerns of quality of care. As a result, there are substantial knowledge gaps in the literature, and many of the proposed QIs in this article are not supported by randomized clinical trials. When clinical trials have been available, many have studied patients who met narrow entry criteria. Moreover, most of the trials do not meet the highest quality of methodological rigor (e.g., concealed randomization and complete follow-up). Thus, even the clinical trial evidence cannot be regarded as conclusive when evaluating the proposed QIs in this monograph.

The Development of a Multidimensional Attitude Toward Mental Health Scale

In light of older adults' need for mental health services, the present study presents preliminary data gathered from two cohorts of younger and older adults for the purpose of exploring the utility of a multidimensional measure of attitudes toward mental health for older persons. Intercorrelations among the attitude scales suggest that they measure distinct aspects of mental health attitudes, and in varying degrees, these scales intercorrelate with the Fischer and Turner (1970) Attitudes Towards Seeking Professional and Psychological Help scale. Dimensionalized scores also differentially relate to mental health service use across samples. In light of this measure's exploratory nature, future research exploring its factor structure, construct validity, and predictive validity is warranted.

Reports of financial disability predict functional decline and death in older patients discharged from the hospital.

The financial ability to pay for food and medical care is needed to maintain health in older persons following a serious illness. Therefore, we hypothesize that the inability to pay for basic needs, which we call financial disability, predicts adverse health outcomes in older patients discharged from the hospital. To determine the frequency of reported financial disability in older adults being discharged from a hospital, to determine patient characteristics associated with financial disability, and to examine the relationship between financial disability and functional decline and mortality. Prospective cohort study. Two thousand two hundred patients 70 years and older admitted to the general medicine services at two teaching hospitals in Ohio. Respondents were interviewed at the time of discharge to determine patients' financial ability to pay for 6 needs: groceries, general bills, medications, medical bills, a small emergency, and a major emergency. We determined functional decline in ability to perform activities of daily living from discharge to 90 days post-hospital discharge, and death 1 year after hospital discharge. Financial disability was reported to be severe (unable to pay for 3-6 needs) for 21% of patients and moderate (unable to pay for 1-2 needs) for 36%. Financial disability was more common and more severe (P<.001) in persons with an annual household income less than $10,000, in persons with fewer than 12 years of formal education, in African Americans, and in women. In patients with no financial disability, moderate financial disability, and severe financial disability, functional decline 3 months after hospital discharge occurred in 15%, 20%, and 25%, respectively (P=.001), and 1-year mortality rates were 24%, 27%, and 32%, respectively (P=.002). After adjustment for potential confounders, the association of financial disability with functional decline (P=.003) and mortality (P=.02) remained significant. Reports of financial disability at hospital discharge identified vulnerable older adults with increased risk for functional decline and death. Interventions that alleviate financial disability may improve health outcomes in older adults discharged from hospital.

The development of a virtual reality system to study tendency of falling among older people

Injuries related to falls are a major threat to the health of older persons. A fall may result not only in an injury but also in a decreased sense of autonomy in the daily life. To be able to preve ...

Health Status and Health Care Services Among Older Persons in India

Summary India is characterized by significant rural-based living, population heterogeneity, financial constraints, and reverse sex ratio. Traditions of joint families, life-long physical activity, vegetarianism, and social and spiritual enrichment, all known to promote healthy aging, are widely prevalent. With the increasing pace of population aging, the health of older persons in India has been the focus of recent attention. Existing data indicate a significant morbidity among the aged, much of which may remain subclinical. Considerable variations in morbidity exist with respect to gender, place of residence (rural vs. urban), and socioeconomic status. Rapid demographic transition without a concomitant epidemiological transition is responsible for the dual load of infections and degenerative diseases in older persons, these being common causes of death. Most age-related morbidity is preventable. Health promotion and cost-effective interventions based on the primary health care approach over a lifelong course, especially at the village level, will greatly help towards achieving the goal of healthy aging. The rapidly changing socioeconomic scenario in India also calls for appropriate policy actions to achieve this goal.

Promoting Health Through Tai Chi

This study examined the effects of a 6-month Tai Chi exercise program on health-related quality of life (HRQL) in older individuals. Using a randomized controlled trial, ninety-four local community-residing volunteers aged 65-96 (M age = 72.8 years, SD = 5.1) were randomly assigned to a 6-month, twice a week, Tai Chi condition or a wait-list control condition. The Short-Form General Health Survey (SF-20) was used to assess change in multiple dimensions of health status involving physical-, social-, and rolefunctioning, bodily pain, mental health, and health perceptions. Results showed that, compared to the control group, participants in the Tai Chi group reported significant improvements in all functional domains of HRQL over the course of the 6-month intervention. It was concluded that a 6-month Tai Chi exercise program is effective for improving HRQL among older adults. Tai Chi, a self-paced and low intensity activity appears to be an effective, low-cost approach for promoting health in older persons.

Exercise motivation and processes of change in community-dwelling older persons.

Although exercise is important for the health of older persons, many older persons fail to participate in exercise. Knowledge and skills about changing exercise behavior is needed for health professionals to develop appropriate interventions to engage older persons in exercise. The purpose of this study was to determine how exercise processes of change were used by community-dwelling older persons to engage in exercise. A cross- sectional correlational design was employed. Cluster sampling was used to obtain potential subjects. A sample of 167 older persons participated in the study. The age of the participants ranged from 65 to 89 years (M = 73.7, SD = 6.14). Each participant was interviewed face-to-face with the investigator reading the questions and marking the answers on the Exercise Stages of Change Questionnaire and the Exercise Processes of Change Questionnaire. The results revealed that half of the older persons were underactive or inactive. One- way ANOVAs and Scheffe post-hoc analyses revealed that 10 processes of change were significantly different among the stages of change (all p values <.05). The study findings provide guidance in designing exercise interventions to increase compliance of older persons with exercise.

A comparison of correlates of self-rated health and functional disability of older persons in the Far East: Japan and Korea

Self-rated health and physical functioning are recognized as important indicators of health in older persons. Rarely, however, there have been studies done which examine cross-cultural differences in the health of older people using these measures, especially among non-Western countries. The objective of this study was to examine patterns of association of self-rated health and functional disability of Japanese and Korean elderly people living in the community, using nationwide surveys of persons aged 60 years or over. There were striking similarities in the general pattern of associations with covariates. In the multivariate analysis, age, work status, comorbidity, depressive symptoms, life satisfaction, hospitalization, and functional disability were strongly associated with self-rated health in both populations. For functional disability, older age, female, low social contact, depressive symptoms, poor life satisfaction, and poor self-rated health were found to be significantly associated. Some differences in the structure of associations with self-rated health, however, were noted. Women tended to assess their health more favorably than men in Korea, but in the Japanese elderly gender differences disappeared when other variables were taken into account. Health-related variables tended to be more closely associated with functional disability in the Japanese sample. An overall similarity, however, in the pattern of associations of these measures supports their utility in assessing and comparing the health of older populations in this region.

Physical Therapist-Based Group Exercise/Education Program to Improve Functional Health in Older Health Maintenance Organization Members with Arthritis

Purpose: The purpose of this research was to investigate the effects of a group education/low to moderate intensity exercise intervention on the health status of older health maintenance organization (HMO) members with arthritis. Methods: 36 individuals (11 males, mean age = 76.8 ± 5.1 yrs; 25 females, mean age = 71.8 ± 6.4 yrs) with moderate to severe osteoarthritis or rheumatoid arthritis participated in the study. Participants had multiple comorbidities (mean =1.8 ± 1.0) and were taking multiple medications (mean = 4.2 ± 2.1). Participants were pretested and post-tested using the Physical Performance Test (PPT) and the Short Form (SF)-36 health status questionnaire. The intervention consisted of 90-minute classes held twice weekly for 9 weeks. The classes encompassed arthritis education and an exercise program (stretching, strengthening, endurance, and balance). Standing and sitting dynamic balance exercises were emphasized, including use of large therapy balls in sitting. Results: The PPT mean total scores improved significantly from pretest to post-test (p < .001). Scores on 7 of 9 PPT items improved significantly (p < .05). Scores improved on all 8 SF-36 scales, but the changes did not reach significance (p > .05) on the physical component scales. Significant improvement occurred on 3 of 4 of the mental health component scales of the SF-36 (p < 05). Conclusion: A group program of education and exercise led by physical therapists and an arthritis educator had a positive impact on physical performance and mental health in older persons with arthritis. The class may be a worthwhile adjunct to medical management of patients with arthritis.

The Impact of the AIDS Epidemic on the Health of Older Persons in Northwestern Tanzania

We use longitudinal data from a region of Tanzania hard-hit by the AIDS epidemic to measure the impact of prime-aged adult mortality on the body mass index (BMI) of people over 50. BMI of older people declines in better-off households prior to an adult death and in households not receiving private assistance shortly after an adult death. BMI eventually recovers, however. This suggests that interventions prior to an adult death may avert some of the decline. In the longer run, raising household incomes, improving the road infrastructure, and preventing infectious disease epidemics will improve the physical well-being of older persons.

Televisits: Sustaining long distance family relationships among institutionalized elders through technology

The role of social support in the health of older persons is well documented. This support is particularly important for isolated nursing home residents. The purpose of this study was to test the feasibility of using low-cost videophones to enhance communication between nursing home residents and their families. Ten pairs of residents and family members received videophones and engaged in regular televisits for six months. All participants completed brief survey instruments prior to and after the study period to determine the effects of the televisits on the frequency and quality of contacts. A post-study survey assessed ease and satisfaction with using videophones. Findings include identification of technical and design problems, possible solutions, factors affecting actual use of equipment, and conditions under which benefits of use may be optimal. Categories for estimating potential actual users are suggested. Importantly, the study demonstrates that videophones can be used successfully by a wide range of frail nursing home residents and can enhance social interactions, regardless of distance. Affordable videophone technology offers the potential for reduced isolation among institutionalized elders and others with distance and mobility barriers.

Gender and health: a study of older unlike-sex twins.

The primary goal of this study was to assess gender differences in various measures of health conditions, symptoms, and self-rated health among older persons by comparing brothers and sisters in a sample of unlike-sex twins. All living pairs of unlike-sex twins born between 1906 and 1925 were identified through the Swedish Twin Registry and sent surveys assessing health and other factors. This population-based sample consisted of 605 twin pairs. Paired sample t tests were used to analyze gender differences in health-related measures, including a three-level measure of health problems based on physicians' ratings. Women had more total health conditions, not life-threatening health conditions, somewhat life-threatening cardiovascular conditions, and physical and psychological symptoms. Men had more very life-threatening health conditions and cardiovascular conditions. No gender differences were found in somewhat life-threatening health conditions, total cardiovascular conditions, or self-rated health. Important gender differences and similarities in health were found using an unlike-sex twin design that reduced variability due to background characteristics. This design also minimized problems caused by gender differences in survival. Research on gender and health in older persons requires more detailed approaches to address the complexity of this topic.

On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events.

Little research has been done on the uniqueness of risk profiles for depression and anxiety in late life. Delineating risk factors for the decline of mental health in older persons, comparing risk profiles for developing symptoms of pure depression, pure anxiety and both anxiety and depression in a prospective design. Self-report data on depression and anxiety were collected from community-dwelling older respondents (> or = 55 years) on two occasions, 3 years apart. Data from emotionally healthy respondents (n=1810) were used to investigate the effects of long-standing vulnerability factors and stressful life events. After 3 years 9% of the subjects had scored beyond the thresholds for symptoms. Vulnerability for depression and anxiety was quite similar, but life events differed: onset of depression was predicted by death of a partner or other relatives; onset of anxiety was best predicted by having a partner who developed a major illness. No support for moderator effects between vulnerability factors and stress was found; the effects were purely additive. Depression and anxiety have many risk factors in common, but specific risk factors also were found, especially in subjects developing both depression and anxiety.

Nutrition and Health for Older Persons in Rural America: A Managed Care Model

Health care services and resources for older persons living in rural areas may be highly variable, and integrated service-delivery models are often lacking. This article presents a managed-care model of nutrition risk screening and intervention for older persons in rural areas. Nutrition risk screening was implemented by the Geisinger Health Care System, Danville, Pa, to target all eligible enrollees in a regional Medicare risk program. A single remote clinic site participating in the managed health care system was chosen for further study of a linked screening and case-management effort for undernourished persons. Screening and intervention at the clinic site selected for this study were guided by centralized expertise and resources. Individualized evaluation and intervention plans were developed with the aid of a dietitian and implemented by the clinic case manager. Of the 417 subjects who completed screening at the remote site, 68 met the risk criteria for undernutrition and were selected for case management. Many of the targeted persons received interventions that included evaluations by a physician or physician extender (eg, physician assistant, nurse practitioner) at the clinic and consultations with nutrition, mental health, or social services professionals. Twenty-six of the subjects who took part in the intervention completed a follow-up screening 6 months later. Ten of those persons no longer exhibited risk criteria. This demonstrates the feasibility of a linked screening and case management program for nutrition risk in the managed-care setting. J Am Diet Assoc. 1997; 97: 885-888.

The meaning and value of oral health for older persons: research findings and implications for dental education and practice. A symposium at the 1996 IADR

The meaning and value of oral health for older persons: research findings and implications for dental education and practice. A symposium at the 1996 IADR

Meaning and value of oral health for older persons: research findings and clinical care implications. A reactor's notes.

Meaning and value of oral health for older persons: research findings and clinical care implications. A reactor's notes.

Gender Differences in Mental Health Before and After Retirement:

A longitudinal research design was used to examine the relationship between retirement and mental health among 222 retirees (114 men and 108 women) at three different time periods: (I) at preretirement; (2) six months; and (3) one year later. Gender differences in the expression of symptoms, especially psychological anxiety, drinking problems, and health, were found across all three time periods. Retirement resulted in increases in drinking problems and psychological anxiety for both men and women. Intervention strategies are discussed and recommended based on how retirees experience symptoms. Gerontologists must recognize how significantly gender and retirement impact on the mental health of older persons and consider these factors in their practice.

Dental findings in geriatric populations with diverse medical backgrounds

Objective To determine whether there is a difference in the oral/dental health in older persons with different life styles and medical status. Study design Survey (cross-sectional study) included four groups: (1) subjects (n=123) living in a residential retirement home or community dwelling; (2) subjects (n=218) seeking dental treatment at a Veterans Affairs Dental Outpatient Clinic; (3) subjects (n=132) resident in a VA long-term care facility; and (4) subjects (n=81) recently admitted to a VA acute care ward with a diagnosis of cerebral vascular accident or other neurologic problem. Each subject answered questions on medical and dental health and dietary preferences in a comprehensive interview. They were given a comprehensive dental examination that included measurements of stimulated salivary flow and minor salivary gland output. Results The data from groups 2 and 3 confirmed previous reports that independent living subjects have better oral/dental health than dependent living subjects. The data from groups 1 and 4, obtained from geriatric populations on the opposite ends of the medical health/disease continuum provide new information that suggests that good medical health and good oral/dental health are linked. The subjects in group 1 were very healthy as judged by their longevity; 54% were ≥80 years and they had low reported prevalence of medical disease. Only 6% were edentulous and the dentate persons were missing 4.5 teeth. In contrast, over 50% of the patients in group 4 were <70 years; they had an edentulous rate of 49% and among the dentate persons had an average 12 missing and 5 decayed teeth. Conclusions The medically healthy persons had excellent dental health whereas the sickest persons were either edentulous or had many missing teeth.

Oral Disease and Physical Disability in Community‐Dwelling Older Persons

The aim of this epidemiologic investigation was to determine whether poor oral health in older persons was associated with physical disability. The study was a cross-sectional survey involving in-home interviews and dental examinations of older persons. A random sample of 68 cities and towns was selected from the six New England states, with stratification according to population size. The study sample consisted of 1,156 community-dwelling (non-institutionalized) individuals aged 70 and over, randomly selected from the Medicare beneficiary lists for each city and town. Oral health was assessed by three dichotomous indices: edentulism (no teeth); current caries, including either coronal or root decay; and periodontal disease, as measured by gingival pocket depth. Physical disability was indicated by the subject's self-report of difficulty in the areas of personal care (eating, bathing, dressing, and using the toilet) and mobility (walking, bed transfer, getting outside). Additional independent variables included age, sex, number of teeth, education, living alone, oral hygiene practices, and time since last dental visit. We found a direct association between specific areas of physical disability and current caries and edentulism. The risk of poor oral health did not increase with advancing age once the related risk factors were controlled for. Those subjects with mobility disabilities were at increased risk of tooth loss; those with personal care limitations were at increased risk of current caries. Physical disability should be added to the list of known risk factors for oral disease among the older population. Our findings call attention to the need for health care providers to screen for oral health problems among disabled older persons. Further gerontologic research is needed to identify the mechanisms linking physical disability with oral disease in older persons.