Non-institutionalized Elderly People Research Articles

The role of ghrelin in the energy homeostasis of elderly people: A population-based study

Ghrelin is a hormone secreted mainly in the stomach which stimulates appetite and food intake. Endocrine factors are among the causes of anorexia in elderly people. The main objective of the present study was to examine the effect of age on ghrelin levels in non-institutionalized elderly people. Observational, cross-sectional, population-based study. A random sample of men aged 70 yr or older was taken from the municipal census. All participants underwent a physical examination which measured weight and height, grip strength, functional capacity (according to the Barthel Index) and nutritional status (according to the short form of the Mini Nutritional Assessment). Blood was taken for basic biochemical analysis, determination of somatotropic, corticotropic, and gonadotropic hormones, and for measurement of ghrelin and cholecystokinin. 152 men with a mean (SD) age of 76.7 (5.4) yr were recruited. Mean ghrelin levels were 1143 (401) pg/ml. A weak negative correlation was found between ghrelin levels and age (r=-0.16, p=0.057). Multiple linear regression analysis showed a significant and independent effect of age (beta=-12.1, p=0.049), body mass index (BMI) (beta=-22.0, p=0.021), and creatinine levels (beta=407.7, p=0.002) on ghrelin. No correlations with age and BMI were found for cholecystokinin. There is a slight decrease in ghrelin levels with age in older men aged 70 yr or more, although the clinical relevance of this finding remains unclear.

The effect of mass influenza immunization in children on the morbidity of the unvaccinated elderly.

The objectives of these studies were to analyse the effect of mass influenza immunization in children on the morbidity of unvaccinated non-institutionalized elderly during an influenza epidemic. A mass vaccination campaign with vaccine was conducted in children aged 3-6 years attending kindergartens (57.4% of 6374) and aged 7-17 years attending schools (72% of 34237) in two communities of the Moscow region. The clinical effectiveness of vaccination was 60.9% for kindergartens and 68.8% for schools. There were 3.4 times fewer episodes of influenza-like illnesses and 1.7-2.6 fewer episodes in all seven diseases which are possible complications of influenza out of the 10 evaluated diseases in 158451 unvaccinated non-institutionalized elderly people during the influenza epidemic compared with the control communities. The differences were found to be statistically significant. Mass vaccination of children attending child institutions brought about a significant reduction of both influenza-like illnesses in children and influenza-associated illnesses in unvaccinated non-institutionalized elderly persons living in the home setting.

Serum 25-hydroxyvitamin D levels and activities of daily living in noninstitutionalized elderly Japanese requiring care

To date, no study has investigated the nutritional status of vitamin D in frail elderly people living at home. The purposes of this study were to assess serum 25-hydroxyvitamin D (25[OH]D) levels and associated factors in noninstitutionalized elderly people who had various levels of physical disability, and to propose an adequate vitamin D nutritional status for the elderly by interpreting the serum 25(OH)D levels in relation to serum parathyroid hormone (PTH) levels in this population. Health examinations were conducted in the winter and summer of 2003. The subjects were 143 elderly people in the winter, and 120 elderly people in the summer, who all used the long-term care insurance system at home. Serum 25(OH)D concentrations were determined with a chemiluminescence protein-binding assay, and serum intact PTH concentrations were determined with an immunoradiometric assay. The subjects' disease histories and lifestyle information were obtained through an interview. Activities of daily living (ADL) levels were evaluated using the Barthel index, and grip strength was measured with a digital hand dynamometer. Average serum 25(OH)D levels in the winter and summer were 54.2 nmol/l (SD 29.0) and 53.3 nmol/l (SD 32.3), respectively, and intact PTH concentrations in the winter and summer were 4.2 pmol/l (SD 1.8) and 4.3 pmol/l (SD 1.8), respectively. The proportion of people who had a low 25(OH)D (<30 nmol/l) and high intact PTH levels (>6.9 pmol/l) were 15%-20% and 8%, respectively. Significant predictors of low serum 25(OH)D concentrations were low ADL levels, female sex, and low fish consumption in both seasons. Serum 25(OH)D concentrations of less than 50 nmol/l were associated with elevated serum intact PTH concentrations. In conclusion, elderly people requiring care at home are at high risk of hypovitaminosis D, and their low serum 25(OH)D levels are mainly associated with low ADL levels. In addition, maintenance of serum 25(OH)D concentrations above 50 nmol/l may prevent hypovitaminosis D-induced hyperparathyroidism.

Nutritional status, functional ability and food habits of institutionalised and non-institutionalised elderly people in Morogoro region, Tanzania

To determine nutritional status, food habits and functional abilities of the institutionalised and non-institutionalised elderly. A cross-sectional population survey. Free living and institutionalised elderly of Morogoro municipality, Tanzania. A total of 100 elderly people, fifty institutionalised and fifty non-institutionalised were included. Gender distribution was of equal numbers. Anthropometric measurements of weights and heights were taken to enable calculation of Body Mass Index (BMI) of each subject. Questionnaires were used to collect information on types of foods, amount and frequency of consumption and functional abilities of the elderly. Amount of food consumed was expressed in grams per person per day. There were significant differences (p=0.001) in nutritional status between the institutionalised and the non- institutionalised males, but this relationship did not exist among the females. Similarly, 30% and 26% of the institutionalised males and females, respectively, and none of the non- institutionalised males was observed to be overweight. On the other hand, 39% and 23% of the non-institutionalised males and females, respectively, were underweight or malnourished. Consumption of sardines was higher (p=0.05) among the institutionalised subjects, but the situation was opposite for the case of fruits. Alcohol consumption was higher (p<0.05) among non- institutionalised subjects in both sexes. No difference was noted in consumption of beans, vegetables, cereals and meat. The most common functional disability was urinary incontinence (36%) while feeding (5%) was the least common. The most affected by urinary incontinence were institutionalised male subjects. There was a great variation between elderly people who are cared for in institutional centres and those who are cared for by their relatives in terms of nutritional status, reflected by their BMI levels. The institutionalised ones appear to be better off than their counterparts. However, this condition is not equally reflected in their eating habits. Generally, most of the elderly have poor or no source of income, which make them to have poor living conditions. They are also faced with problems of functional disabilities of which urinary incontinence was more common among males.

Health-wealth association among older Americans: Racial and ethnic differences

Using five-year longitudinal data from the AHEAD survey, this study investigated the direction of association between health and wealth among elderly people. In particular, it focused on how this association varied across racial and ethnic groups. The study found that there was a significant nonmonotonic association between health and wealth and the direction of the association was from health to wealth, but not from wealth to health, and that race and ethnicity moderated the effect of health on wealth. Implications for social policy are discussed. Key words: elderly people; ethnicity; health; race; social policy; wealth ********** The impressive improvements in economic status and health among older Americans were two major public policy achievements of the past century. The 1935 Social Security Act and its 1939 amendments provided monthly cash benefits to retired workers and their spouses ages 65 and over. The increase in cash benefits in early 1970s and the automatic cost of living adjustment since then have remarkably improved the economic status of older Americans. Between 1959 and 1999, the poverty rate for the elderly population dropped from 35% to less than 10% (U.S. Census Bureau, 2000). Advancements in medical technology and increased access to medical care through the Medicare and Medicaid programs have significantly improved the health status and life expectancy of older Americans. Life expectancy at age 65 increased from 12 years at the beginning of the 20th century to 18 years in 1998 (National Center for Health Statistics, 2000). In 1992, 75% of noninstitutionalized elderly people ages 65 to 74 years and 67% of those ages 75 years and over considered their health as good, very good, or excellent (U.S. Census Bureau, 1996). Despite of these impressive improvements, many elderly people still reported that poor health and financial worries were their biggest concerns (American Option, 1999). A long life expectancy means that elderly people need to spread their economic resources over a longer period of time than their parents' generation. It also means that many of them may live the additional years with chronic health problems and functional dependency associated with the aging process. The Medicare and social security programs were designed in an era when life expectancy was shorter and major health problems among the elderly population were acute rather than chronic. These programs may not be able to meet the changing needs of the elderly population in the new millennium. The situation is further complicated by the fact that economic status and health are positively associated. Elderly people who have better health are more likely to have greater economic resources than those with poor health and vice versa (see Feinstein, 1993, and National Institute on Aging [NIA], 1999, for reviews). Although the association between economic status and health is well documented, the direction of the causation is not clear. It is likely that higher economic status leads to better health as people who have more economic resources can afford better medical care, better foods, and better living environments throughout their life course. It is also possible that better health leads to higher economic status as people with good health are able to fully participate in the labor market, earn more income, and accumulate more wealth throughout their life course (NIA; Smith, 1998; Smith & Kington, 1997). Furthermore, many earlier studies on the association between health and economic status used household income as the only indicator for economic status. Although many researchers acknowledged the importance of income, others argued that wealth, measured by household net worth, may be a better measure of economic status for elderly people because it reflects the socioeconomic standing of older people throughout their life course (Hurd, 1989; Mutchler & Burr, 1991; Smith & Kington, 1997). …

Access to prescription drugs among noninstitutionalized elderly people in west Texas.

The determinants of realized, perceived, and potential access to prescription drugs among an elderly population were studied. Data were derived from telephone interviews of 3498 noninstitutionalized elderly persons living in west Texas. Access indicators examined were whether the respondents were taking prescription drugs, had perceived problems in obtaining prescription drugs, had comprehensive prescription drug insurance, and had a usual pharmacy. On the basis of the behavioral model of health services, multivariate logistic regression analysis was performed to determine whether predisposing, enabling, and need factors were associated with each access indicator. Approximately 14% of the patients were not taking prescription drugs at the time of the interview. Of the patients who were taking prescription drugs, about 16% reported having problems obtaining prescription drugs and 24% primarily used a single pharmacy. Nearly 36% did not have comprehensive prescription drug coverage. Among the four indicators of prescription drug access, lack of prescription drug insurance was the most prevalent barrier. Employer-provided insurance improved access more than any other type of coverage. Elderly consumers taking more medications reported more problems accessing prescriptions than those taking fewer medications. Among the indicators of access to prescription drugs among noninstitutionalized elderly people in west Texas, lack of prescription drug insurance was the most prevalent barrier.

Disablement process and the utilization of home care among non-institutionalized elderly people: contrasting results between cross-sectional and panel data

Purpose : In this article we studied the role of disablement process variables in home care utilization in a cross-sectional and in a panel approach among low-functioning community dwelling elderly people. Methods : We analysed data from a prospective follow-up study in The Netherlands ( n v = v 555) and used three outcome variables: professional home care (yes or no) measured in the same year as the process variables (cross-sectional approach), professional home care (yes or no) also after 2 years (panel-approach: no change) and the new users of professional home care 2 years later (panel-approach: change). Process variables were categorized as pathology, functional limitations, disability, risk factors and psychosocial attributes. Results : Trajectories of home care utilization can be divided into an unchanging part and a changing part. Both parts are not predicted by the same process variables. For instance disability did not predict the new users of professional home care 2 years later, but correlated strongly with the stable users. The changing part was predicted by the beginning of the process of disablement (i.c. pathology). In addition, far most predictors could be considered as additive in stead of interactive. Conclusions : It is important to take into consideration the design of the investigation in studying the disablement process: cross-sectional data and panel data provide different results.

Oral microbial flora and oral malodour of the institutionalised elderly in Japan.

To determine the oral health status, especially the level of oral microbial flora and oral malodour, of institutionalised elderly people compared with non-institutionalised elderly people. Three institutions and numerous private homes. 56 institutionalised and 56 non-institutionalised elderly people. Institutionalised elderly people had higher levels of candida, staphylococci, and oral malodour. Institutionalised elderly people had a higher level of candida in denture wearers, and a higher level of staphylococci and oral malodour compared with the non-institutionalised elderly. The institutionalised elderly have a higher risk of opportunistic infections and oral health care should be improved to protect them from these infections and to reduce oral malodour.

Determinants of locomotor disability in people aged 55 years and over: the Rotterdam Study.

Locomotor disability, as defined by difficulties in activities of daily living related to lower limb function, can be the consequence of diseases and impairments of the cardiovascular, pulmonary, nervous, sensory and musculoskeletal system. We estimated the associations between specific diseases and impairments and locomotor disability, and the proportion of disability attributable to each condition, controlling for age and comorbidity. The Rotterdam Study is a prospective follow-up study among people aged 55 years and over in the general population. Locomotor disability in 1219 men and 1856 women was assessed with the Stanford Health Assessment Questionnaire. Diseases and impairments were radiological osteoarthritis, pain of the hips and knees, morning stiffness, fractures, hypertension, vascular disease, ischemic heart disease, stroke, heart failure, chronic obstructive pulmonary disease (COPD), depression, Parkinson's disease, osteoporosis, diabetes mellitus, overweight, and low vision. Adjusted odds ratios, etiologic and attributable fractions were calculated for locomotor disability. The occurrence of locomotor disability can partly be ascribed to joint pain, COPD, morning stiffness, diabetes and heart failure in both men and women. In addition in women osteoarthritis, osteoporosis, low vision, fractures, stroke and Parkinson's disease are significant etiologic fractions. In men with morning stiffness, joint pain, heart failure, diabetes mellitus, and COPD a significant proportion of their disability is attributable to this impairment. In women this was the case for Parkinson's disease, morning stiffness, low vision, heart failure, joint pain, diabetes, radiological osteoarthritis, stroke, COPD, osteoporosis, and fractures of the lower limbs, in that order. We conclude that locomotor complaints, heart failure, COPD and diabetes mellitus contribute considerably to locomotor disability in non-institutionalized elderly people.

Prevalencia de malnutrición en la población anciana española

Malnutrition in elderly has become an important problem of health, and is associated with an increase of morbidity and mortality in this age group. The aim of this study was to determine the prevalence of malnutrition in the Spanish institutionalized and living home elderly people. A sample of 3,460 representative Spanish subjects older than 65 years old were studied (response rate of 96%). Nutritional status was gathered by Mini Nutritional Assessment questionnaire. The prevalence of malnutrition was 3,3% among elderly living at home and 7,7% among institutionalized people. Malnutrition was more prevalent in women and people with a lower income. Increase of malnutrition with age was observed. The observed prevalence of malnutrition in Spanish non-institutionalized elderly people was similar to observed in another populations. Sex, age and income were associated with a risk of malnutrition

Quality of care from the perspective of elderly people: the QUOTE-elderly instrument.

patient views on the quality of care are usually assessed by means of patient satisfaction questionnaires. to develop an instrument that would: (i) produce data related to the expectations and experiences of noninstitutionalized elderly people, (ii) contain items that had been formulated in collaboration with elderly people, (iii) measure quality from the perspective of the users of health care services and (iv) produce data on generic quality aspects and quality aspects specifically related to the needs of elderly people. we developed the instrument for measuring quality of care from the perspective of non-institutionalized elderly people (QUOTE-Elderly) by using a combination of qualitative and quantitative methods. We obtained empirical data on the opinions and experiences of 338 elderly people. We evaluated the taxonomy of the instrument, internal consistency of (sub)scales and the feasibility of the instrument using explorative and confirmative factor analyses and reliability analysis. using scale optimization, we produced a self-administered questionnaire on quality of health care from the perspective of elderly people. This contains scientific characteristics and provides specific information for practical quality-assurance policies.

Reduction in hospital admissions for pneumonia in non-institutionalised elderly people as a result of influenza vaccination: a case-control study in Spain.

OBJECTIVE: To estimate the effectiveness of influenza vaccine in preventing hospital admission for pneumonia in non-institutionalised elderly people. DESIGN: This was a case-control study. SETTING: All three public hospitals in...

VIDEO GAMES AND THE ELDERLY

This study examined the effects of playing video games (Super Tetris) on the reaction time, cognitive/perceptual adaptability, and emotional well-being of 22 noninstitutionalized elderly people aged 69 to 90. Volunteers in an elderly community in the Netherlands were randomly assigned to a videogameplaying experimental group or a nonplaying control group. The televisions of the 10 videogame players were provided with Nintendo SuperNes systems. Participants played Super Tetris 5 hours a week for 5 weeks, and maintained a log of their play. Before and after this play period, measures of reaction time (Sternberg Test; Steinberg, 1969), cognitive/perceptual adaptability (Stroop Color Word Test; Stroop, 1935), and emotional well-being (self-report questionnaire) were administered. Playing video games was related to a significant improvement in the Sternberg reaction time task, and to a relative increase in selfreported well-being. On the Stroop Color Word Test, both the experimental and control groups improved significantly, but the difference between groups was not statistically significant. The videogame-playing group had faster reaction times and felt a more positive sense of well-being compared to their nonplaying counterparts. Consistent with previous research on video games and the elderly, the present study finds the strongest effects on measures of reaction time, and the weakest effects on cognitive performance measures. Explanations and alternative interpretations of these findings are discussed.

Functional health status and instrumental activities of daily living performance in noninstitutionalized elderly people.

The purpose of this descriptive correlational study was to examine the relationship between functional health status and the performance of instrumental activities of daily living (IADL) in a group of noninstitutionalized elderly people. A convenience sample of 47 subjects who were 70 years of age or older participated by completing three questionnaires: the Health Status Questionnaire, the Multidimensional Functional Assessment IADL Scale and a demographic questionnaire. Lawton's (1985) theoretical model of person-environment interaction provided the conceptual framework for the study. Three functional status variables reached statistical significance (0.001) with IADL performance: social functioning (r = -0.6045); health perception (r = -0.6984); and physical functioning (r = -0.6635) suggesting that these are important indicators of overall health status, and that a decline in each could contribute to increased IADL dependency. The IADLs of housekeeping, shopping, and transportation correlated significantly (0.001) with functional health status, implying that, as health declines in elderly people, they may require more assistance with IADLs, in order to remain more independent in the community. The results have implications for nursing administrators and nursing educators with regard to developing health promotion strategies related to independence of elderly people, community health and social policy.

Oral complaints and utilization of dental services in relation to general health factors in a 88-year-old Swedish population.

The aim of this study was to describe dental state, oral health problems, self-assessed ability to perform oral hygiene and utilization of oral health services in a sample of 88-year-old people (n = 374) and to relate these variables to functional ability, subjective health and drug consumption. The intention was also to identify barriers to utilization of dental care in non-institutionalized elderly people. The results of interviews showed that 46% of the subjects were dentate. Oral complaints were reported by 24% of the home living individuals. Poor health, medication and feelings of loneliness were factors associated with oral discomfort. Difficulties in performing oral hygiene activities were reported by 10% of the subjects and were correlated with functional impairments and feelings of loneliness. Utilization of dental services was correlated with dental state; 72% of the dentate and 8% of the edentulous subjects made regular dental visits. The main reason for not visiting a dentist was "no perceived need". Independent of dental state, some factors were significantly correlated to low demand for dental services; these included feelings of loneliness, functional impairments and low school education.

Body iron stores and mortality due to cancer and ischaemic heart disease: a 17-year follow-up study of elderly men and women.

Increased body iron stores have been suggested as a risk factor for cancer and ischaemic heart disease (IHD). However, all studies carried out to date have focused on relatively young populations although the elderly may also be at increased risk. We investigated the association between body iron stores and mortality due to cancer and IHD in a 17-year follow-up study of 260 non-institutionalized elderly people aged 64-87 years. Iron status was assessed in 1971 by means of the haemoglobin level, transferrin saturation and total iron binding capacity (TIBC). Information about the vital status and causes of death was obtained in 1988. Among women mortality due to cancer was inversely related to TIBC; the relative risk for the highest tertile of TIBC, adjusted for age, smoking and alcohol intake was 0.05 (95% confidence interval (CI): 0.007-0.39). The risk of mortality due to all-causes was also inversely associated with TIBC. Among men, no association between body iron stores and mortality due to cancer was observed. Mortality due to IHD was not clearly associated with body iron status. Among men, the adjusted relative risk decreased slightly per tertile of transferrin saturation, but this trend was only of borderline significance (P = 0.10). These results suggest that body iron stores are a risk factor for mortality due to cancer in postmenopausal women. This may be due to accumulation of stored iron among women after menopause. No clear associations with mortality due to IHD were observed in either elderly men or elderly women.

Zinc metabolism and immune function in healthy elderly people

Changes in immune function have been described in the elderly, and zinc is known to influence immune parameters. Zinc supplementation has, however, produced contradictory results. We evaluated zinc metabolism and immunity in 15 healthy non-institutionalised elderly people on a self-selected diet and compared the results with those obtained from 10 young healthy subjects. The elderly subjects had reduced serum zinc levels and their zinc absorption values were lower than in the young subjects. Circulating immune parameters were within the normal range, while delayed immune response was altered in 8 of the 15 elderly subjects. Zinc supplementation (25 mg/day) did not result in a significant improvement in dermal hypersensitivity responses although some effect was seen in 5 cases. It is concluded that zinc supplementation is unnecessary in elderly healthy subjects even if they present zinc metabolism alterations, but may be indicated in the presence of disease.

Social networks, institutionalization, and mortality among elderly people in the United States.

This study focuses on the effect of social networks on institutionalization and mortality among elderly people in the United States. Data are from the Longitudinal Study of Aging (LSOA), which incorporates a baseline interview in 1984 and a follow-up interview two years later. The study population consists of a sample of 5,151 noninstitutionalized elderly people who were 70 years of age or older in 1984. Multivariate analyses using logistic regression revealed that social networks are negatively related to the likelihood of institutionalization and mortality when controlling for sociodemographic characteristics and baseline health status. Elderly people who participated in some form of social activity decreased their risk of institutionalization by almost one-half, whereas living alone increased the likelihood of institutionalization. Participating in social activities and visiting or talking with friends or relatives was negatively related to the likelihood of mortality.

Going to the Mall: A Leisure Activity of Urban Elderly People

RÉSUMÉLe propos de cet article est d'introduire, de définir et de tester un modèle théorique qui puisse expliquer la fréquentation par les personnes âgées des centres d'achats urbains, conçus comme des endroits d'échanges sociaux. Nous estimons que les personnes âgées vont dans les centres d'achats pour satisfaire leurs besoins de vie sociale et de loisirs. Nous créons le néologisme « mailler » pour aller au mail ou au centre d'achat. Nous émettons ensuite l'hypothèse qu'il existe des variables individuelles, c'est-à-dire de prédisposition et des variables environnementales, c'est-à-dire d'incitation, variables qui différencient les personnes âgées adeptes de ces activités de magasinage. En nous fondant sur l'analyse de données secondaires, tirées d'un échantillonnage de 300 personnes âgées montréalaises vivant à domicile, nous avons découvert que le magasinage, effectué dans trois centres d'achats de Montréal, constitue une activité pour plus de 67 pour cent des sujets de l'échantillon. Certaines variables sont à relier à cette activaté: variables de prédisposition telles que l'âge, le sexe, l'éducation et aussi le sentiment de solitude et variables incitatives comme l'architecture du centre d'achat et son ambiance. En nous fondant sur ces résultats, nous pensons que ce modèle nous aide à mieux comprendre les activités de loisirs des personnes âgées demeurant à domicile.

Medical correlates of urinary incontinence in the elderly

A probability sample of noninstitutionalized elderly people in Washtenaw County, Michigan, was interviewed to determine the relationship between urinary incontinence and various health conditions. The results show that between both male and female respondents physical mobility problems, specific neurologic symptoms, lower urinary tract problems, bowel problems, respiratory problems, and history of genital surgery are more prevalent among those who are incontinent than among those who are continent. Additional factors associated with incontinence in females are: history of parent and sibling incontinence, incontinence either during pregnancy or postpartum, hearing problems, use of female hormones, and vaginal infections. Incontinence among males is associated with vision problems and a history of and symptoms of cardiovascular disease. These findings suggest urinary incontinence is part of a complex and multifactorial problem. Further studies are needed to confirm and explain these findings.