Older Age Bands Research Articles

Differences in spine volumetric bone mineral density between grade 1 vertebral fracture and non-fractured participants in the China action on spine and hip status study

This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric bone mineral density (vBMD) derived from quantitative CT (QCT) between those with a grade 1 vertebral fracture and non-fractured individuals. 3,457 participants were enrolled in the China Action on Spine and Hip Status (CASH) study and had upper abdominal CT examinations. Vertebral fractures were identified by Genant's semi-quantitative method from lateral CT scout views or CT sagittal views. L1-3 vBMD was measured by Mindways QCT Pro v5.0 software. The characteristics of different fracture severity groups were compared using one-way ANOVA, independent-samples t-tests, and Kruskal-Wallis H-tests. 1267 males (aged 62.77 ± 9.20 years) and 2170 females (aged 61.41 ± 9.01 years) were included in the analysis. In men, the prevalence of VF increased from 14.7% at age<50 years to 23.2% at age ≥70 years, and in women from 5.1% at age<50 years to 33.0% at age ≥70 years. Differences in mean age and vBMD were found between the different fracture grade groups. After age stratification, vBMD differences in men aged < 50 years old disappeared (p = 0.162) but remained in the older age bands. There was no significant difference in mean vBMD between those with multiple mild fractures and those with a single mild fracture. In women, the prevalence of VF increased rapidly after age 50, while it grew more slowly in men. In general, with the exception of men <50 years old, participants with a grade 1 VF had lower vBMD than non-fractured individuals. The majority of women younger than 50 with a grade 1 VF had normal bone mass. We recommend that a vertebral height reduction ratio of <25% be diagnosed as a deformity rather than a fracture in people under the age of 50. The presence of multiple mild fractured vertebrae does not imply lower BMD.

T cell phenotype in paediatric heart transplant recipients.

Paediatric heart transplantation recipients suffer an increased incidence of infectious, autoimmune and allergic problems. The relative roles of thymus excision and immunosuppressive treatments in contributing to these sequelae are not clear. We compared the immunological phenotypes of 25 heart transplant recipients (Tx), 10 children who underwent thymus excision during non-transplantation cardiac surgery (TE) and 25 age range-matched controls, in two age bands: 1-9 and 10-16years. Significant differences from controls were seen mainly in the younger age band with Tx showing lower CD3 and CD4 cell counts whilst TE showed lower CD8 cell counts. Naïve T cell and recent thymic emigrant proportions and counts were significantly lower than controls in both groups in the lower age band. T cell recombination excision circle (TREC) levels were lower than controls in both groups in both age bands. There were no differences in regulatory T cells, but in those undergoing thymus excision in infancy, their proportions were higher in TE than Tx, a possible direct effect of immunosuppression. T cell receptor V beta spectratyping showed fewer peaks in both groups than in controls (predominantly in the older age band). Thymus excision in infancy was associated with lower CD8 cell counts and higher proportions of Tregs in TE compared to Tx. These data are consistent with thymus excision, particularly in infancy, being the most important influence on immunological phenotype after heart transplantation.

Benzodiazepine prescription in Ontario residents aged 65 and over: a population-based study from 1998 to 2013

Background:Although commonly used in anxiety and insomnia, recent guidelines recommend caution when prescribing benzodiazepines in the elderly. Here we examined rates of benzodiazepine prescribing to older adults in Ontario, Canada from 1998 to 2013 and impact of legislation that made prescribing regulations more strict.Method:Annual benzodiazepine prescription rates for Ontario residents aged 65 and over were examined using the Ontario Drug Benefit database which captures all publicly funded prescriptions. Since most drugs, including benzodiazepines, are funded for residents aged ⩾65, data are essentially population-based. Weighted least squares regression methods were used to examine trends in prescribing rates (all benzodiazepines, anxiolytics, hypnotics, short- and long-acting drugs and individual drugs) from 1998 to 2013 for all Ontario residents aged ⩾65 and by sex and 5-year age bands. Impact on monthly prescribing rates of legislative changes (November 2011) which aimed to promote appropriate prescribing and dispensing practices for controlled substances, including requiring prescribers to record specified information, was assessed by constructing an interrupted time-series model.Results:Benzodiazepines were prescribed to 23.2% of the 1,412,638 Ontario residents aged ⩾65 in 1998, declining to 14.9% of 2,057,899 residents aged ⩾65 in 2013 (p < 0.001 for trend). Rates were significantly greater throughout in older age bands (p < 0.001) and 1.54–1.62 times greater in females than males (p < 0.001). Lorazepam was the most prescribed benzodiazepine throughout, but rates declined from 11.4% in 1998 to 8.5% in 2013. Diazepam rates fell from 2.3% to 0.7%. However, clonazepam prescription rates increased until 2011, 1.7-fold overall. After the November 2011 legal changes, downward shifts were observed in total benzodiazepine prescription rates and for each drug individually. The step function, conditional on covariates, suggested benzodiazepine rates after November 2011 were 2.89 per 1000 (p < 0.001) below rates observed previously, representing a relative reduction of 4.8% compared to the year before the intervention.Conclusion:Benzodiazepine prescribing rates declined markedly in this population from 1998 to 2013. Targeted legislation may have reduced rates, but the effect, although statistically significant, was small.

Richmond Wellbeing Service Access Strategy for Older Adults

IAPT (Improving Access to Psychological Therapies) is a national programme aimed at increasing availability of evidence based psychological therapies in the NHS. IAPT is primarily for people who have mild...

Area-level mortality and morbidity predict ‘abortion proportion’ in England and Wales

Life history theory predicts that where mortality/morbidity is high, earlier reproduction will be favoured. A key component of reproductive decision-making in high income contexts is induced abortion. Accordingly, relationships between mortality/morbidity and ‘abortion proportion’ (proportion of conceptions ending in abortion) are explored at small-area (‘ward’) level in England and Wales. It is predicted that where mortality/morbidity is high, there will be a lower ‘abortion proportion’ in younger women (<25years), adjusting for education, unemployment, income, housing tenure and population density. Results show that this prediction is supported: wards with both shorter life expectancy and a higher proportion of people with a limiting long-standing illness have lower abortion proportions in under 25s. In older age bands, in contrast, elevated mortality and morbidity are mostly associated with a higher ‘abortion proportion’. Further, morbidity appears to have a larger effect than mortality on ‘abortion proportion’ in the under-25 age band, perhaps because a) morbidity is be more salient than mortality in high-income contexts, and/or b) young women are influenced by health of potential female alloparents when scheduling fertility.

Have contractual changes in primary care affected unplanned short stay childhood admissions in England? National time trends study 2001–11

BackgroundShort-stay unplanned hospital admissions in children have much increased over the past decade everywhere. Timely primary care prevents unplanned admissions into hospital and short stays admissions can be regarded as a proxy indicator of conditions that could be dealt with in primary care. In April, 2004, major changes in primary care occurred across England, with the introduction of the new general practitioner (GP) contract. Out-of-hours health provision ceased to be the responsibility of GPs, and alternative services introduced to compensate were unpopular with patients. In-hours health-care provision also altered; the introduction of financial incentives for chronic disease management, having been aimed at adults, altered the availability of GP appointments for children. Reduced access to primary care in and out of hours could have delayed health seeking and potentially driven parents to use emergency care. We investigated the effect of these changes on children. MethodsWe applied a segmented population-based time trends study design, using Hospital Episode Statistics data, in children aged 0–14 years who were admitted in England between April 1, 2001, and March 31, 2004, and between April 1, 2004, and March 31, 2011. The outcome measures were age-specific unplanned admission rates for total and very short stays (same day discharge). The unit of analysis was middle super output area and we applied a generalised estimating equations model, adjusting for deprivation and autocorrelation. Indicator variables modelled a step change at and a trend change after service changes in April, 2004. Interaction coefficients estimated the effect modification of age on the baseline trend and point of intervention. FindingsAge-standardised rates increased by 15% between 2001–02 and 2010–11, from 64·7 (95% CI 64·6–64·9) to 74·3 (74·2–74·5) unplanned admissions per 1000 children. Segmented trends analysis showed a 1% step change (rate ratio [RR] 1·01, 95% CI 1·01–1·02) in the adjusted rate of all-cause unplanned admissions after the introduction of GP service changes in April, 2004, above the baseline trend of a 1% yearly increase in previous years (1·01, 1·01–1·01). The steepest age-specific baseline trends were in children aged less than 1 year, decreasing across older age bands (2% yearly increase in children under 1 year vs 1% in those aged 1–4 years). The largest step change in unplanned admission rates in 2004 was 5% in children aged 10–14 years (RR 1·05, 95% CI 1·04–1·07). Increases have been driven by very short stay rates, a yearly increase of 5% (1·05, 1·05–1·06) and a 4% step change (1·04, 1·03–1·05) in children aged under 15 years. The effect in 2004 ranged from no effect in children under 1 year (1·00, 0·99–1·01) to a 7% step change in children aged 5–9 years (1·07, 1·05–1·09). InterpretationWe noted a 5% increase in the rate of children admitted and discharged on the same day, coinciding with major reorganisation in primary care in 2004. The increase has not been uniform across age groups in children. Alternative explanations for the large increases in 2004 include the introduction of a 4-h waiting target in English emergency departments; changes in population demographics with European Union expansion; and the introduction of payment by results in English hospitals. There are limitations to routine hospital activity data and the observational study design allows only description of associations between exposure and outcome. However, Hospital Episode Statistics has been shown to be a useful method for exploring the effect of national policy change. FundingThis study is part of a National Institute for Health Research research project.

P03-311 - From clues to profiles: an epidemiological survey on cases of completed and attempted suicides in Italy (2001-2008)

ObjectivesSuicide is a complex phenomenon accounting for 1 million deaths per year. This study aims to assess the profiles of those individuals at a higher risk for suicide, which may be of help to clinicians while evaluating patients.MethodsA sample of 30.000 suicides belonging to two age-bands, i.e. 18 to 24 and over-45s, was analysed and compared with respect to the gender, fatality of the act, season, the reason for it, the time and methods employed. Data were provided by ISTAT records and concern completed and attempted suicides in Italy from 2001-2008.ResultsMales are at a higher risk with a higher lethality of the acts in both age bands. The younger age band is at higher risk from March to June and in January especially in the evening, whereas the older age-band from March to June especially in the morning with a higher fatality rate. Unknown reasons are the most common cause for suicide followed by mental illnesses in both age-bands. Hanging is the most common method, followed by jumping from high places in both age-bands. Charcoal - intoxication is more common in the young age-band, whereas fire-arms and drowning in the over-45 age-band.ConclusionsAlthough the two identified profiles are quite general, they can be an adequate basis for public health officials and mental health professionals to early identify those individuals at a higher risk for suicide. Further studies are needed for a better definition of the profiles.

The Effect of Age on Sexual and Violent Reconviction

Although a number of research studies indicate an inverse relationship between age and sexual offence recidivism, the effect of age on sexual and violent reconviction remains unclear, with some studies producing contradictory results. In the present study, reconviction data were obtained for 131 offenders (85 sex offenders and 46 violent offenders) followed up over a 2- and 5-year period. The sample was grouped into four age bands (i.e., ≤24, 25-34, 35-44, and ≥45 years) and rates of sexual, violent, sexual and violent (combined), and any offence reconviction were compared. There was an almost linear relationship between age and rate of reconviction, with the youngest age band (≤24 years) presenting the greatest risk of reconviction and the older age bands (≥45 years) presenting the lowest reconviction rate. At the 5-year follow-up, the youngest age band was significantly more likely to be reconvicted of sexual and violent offences (combined) than any other age band. This age band was significantly more likely to be actuarially assessed (i.e., Static-99) as high risk (controlling for age) and was more likely to target strangers, be single, and display non-sexual violence during the index offence. In relation to sexual reconviction, there was a plateau effect in the middle-age band, with the oldest age band (≥45 years) obtaining the highest sexual reconviction rate compared with all other age bands at the 5-year follow-up. Although these findings support the view that lower-aged sexual and violent offenders pose greater risk than their older-aged counterparts, this was not true for sexual reconviction at the 5-year follow-up. Implications of these findings are discussed.

Examining age effects on prototypic melancholic symptoms as a strategy for refining definition of melancholia

Background Melancholic depression appears to have a later age of onset than the non-melancholic disorders, and its phenotypic picture also appears to change with age. The latter phenomenon allows clarification of key symptoms of melancholia by examining for age effects on putative melancholic symptoms, thus enabling identification and refinement of the melancholic sub-type. Methods We studied 158 patients receiving a diagnosis of unipolar depression (65 melancholic: 93 non-melancholic), dichotomised by age and with a higher representation of those with melancholia in the older age band. The severity of individual DSM-IV-TR melancholic candidate symptom constructs were quantified across age groups and diagnostic sub-type. Results Symptom constructs identified as most clearly associated with age effects in those with melancholia were anhedonia, non-reactivity, diurnal mood variation and, to a lesser degree, psychomotor slowing. When melancholic and non-melancholic patients were compared, non-reactivity, psychomotor slowing and diurnal mood variation were the most differentiating in the older age group. Conclusions The capacity of certain symptoms to mark the changing phenotypic expression of melancholia with age may not only assist refined definition of melancholia but inform about underlying causes and, of key importance, explain the suggested differential impact of narrow-action and broad-action antidepressant on those with melancholia across differing age groups.

Risk Factors for Criminal Recidivism in Older Sexual Offenders

Sexual offenders constitute a substantial proportion of the older male prison population. Recent research findings, with potential consequences for risk management, indicate that recidivism risk might be lower in older sexual offenders. We followed up all adult male sexual offenders released from prison in Sweden during 1993-1997 (N=1,303) for criminal reconviction for an average of 8.9 years. We studied rates of repeat offending (sexual and any violent) by four age bands (<25, 25-39, 40-54, and 55+years), and examined whether risk factors for recidivism remained stable across age groups. Results showed that recidivism rates decreased significantly in older age bands. In addition, the effect of certain risk factors varied by age band. These findings on recidivism rates in older sexual offenders concur with studies from the United Kingdom, United States, and Canada and may suggest some generalizability in Western settings. Further research is needed to address underlying mechanisms.

Risk Factors for Criminal Recidivism in Older Sexual Offenders

Sexual offenders constitute a substantial proportion of the older male prison population. Recent research findings, with potential consequences for risk management, indicate that recidivism risk might be lower in older sexual offenders. We followed up all adult male sexual offenders released from prison in Sweden during 1993-1997 (N=1,303) for criminal reconviction for an average of 8.9 years. We studied rates of repeat offending (sexual and any violent) by four age bands (<25, 25-39, 40-54, and 55+years), and examined whether risk factors for recidivism remained stable across age groups. Results showed that recidivism rates decreased significantly in older age bands. In addition, the effect of certain risk factors varied by age band. These findings on recidivism rates in older sexual offenders concur with studies from the United Kingdom, United States, and Canada and may suggest some generalizability in Western settings. Further research is needed to address underlying mechanisms.

The CORE-OM in an older adult population: Psychometric status, acceptability, and feasibility

There is a need to extend and test the feasibility and acceptability of mental health outcome measures in the older population (i.e., aged 65–100). We present data on the CORE-OM (Clinical Outcomes in Routine Evaluation-Outcome Measure) on a sample of 118 people aged 65–97 presenting for mental health treatment and 214 people aged 65–94 drawn from a non-clinical population. Results show the CORE-OM to be a reliable measure in both samples when the overall mean item is used but the reliability is not as high for the specific domains as psychometrically stable structures. The CORE-OM showed large overall differences between the non-clinical and clinical samples indicating that it is equally as sensitive to these differing populations across this older age band as with working-age adults. However, the norms for the clinical sample were consistently lower than the equivalent clinical norms for a working-age sample. These findings suggest that the collection and compilation of age-specific norms is crucial in ensuring that appropriately referenced norms are used rather than assuming that norms are generalizable across the whole adult life-span.

Population predictors of community health and social service use in Northern Ireland.

STUDY OBJECTIVE: To investigate the characteristics of elderly populations associated with variations in their use of community health and personal social services and to test the hypotheses that the variations...

Cardiovascular Risk and Responsivity to Mental Stress: The Influence of Age, Gender and Risk Factors

Exaggerated cardiovascular and neuroendocrine responses to mental stress may enhance cardiovascular disease risk. Coronary heart disease and hypertension increase in prevalence with advancing age, whereas the excess male/female ratio declines in later middle age. Psychosocial factors may contribute to these changing risk profiles. The hypothesis that cardiovascular and neuroendocrine stress responses are associated with age and gender differences in cardiovascular disease risk was tested. 132 healthy men and women from younger (30-40 years) and older (55-66 years) age bands were selected at random from general practice lists. They performed a series of mental stress tests during which blood pressure, heart rate, cardiovascular baroreflex sensitivity, cortisol, respiration patterns and electrodermal activity were monitored. A submaximal exercise test was performed and psychological characteristics were assessed by questionnaire. At rest, systolic and diastolic blood pressure was higher in men than in women, while cardiac baroreflex sensitivity was greater in younger than in older participants. Blood pressure responses to tasks were substantial, with changes from the baseline averaging 18.6/8.11, 26.0/13.5 and 40.7/19.0 mmHg for computerized problem solving, mirror drawing and speech tasks, respectively. Men and women in the older age band did not differ from each other in blood pressure, heart rate or baroreflex sensitivity responses. Systolic blood pressure responses (mean +/- SEM) were larger in older than in younger women (mean peak difference 6.87 +/- 2.67 mmHg), and in the younger male compared with the younger female groups (mean peak difference 7.20 +/- 2.97 mmHg). Diastolic blood pressure and heart rate responses to mental stress were larger in younger than in older age participants of both sexes. Baroreflex sensitivity was inhibited during behavioural tasks, with significantly greater suppression in younger than in older groups (5.28 +/- 0.52 and 2.62 +/- 0.35 ms/mmHg, respectively). Cortisol responses were greater in men than in women, but did not vary with age. Across the entire sample, systolic blood pressure responsivity was negatively related to the expression of anger. Among older men, heightened blood pressure responses were associated with elevated fasting low-density lipoprotein cholesterol levels, and with lower concentrations of high-density lipoprotein cholesterol. Systolic blood pressure stress responsivity increases with age in women but not in men. Other data do not support the notion that stress responsivity mediates age and gender differences in cardiovascular disease risk. However, in middle-aged men, ex-aggerated cardiovascular stress responsivity is associated with an unfavourable risk profile.

Age-independent anthropometry: an examination of data from rural Khartoum, Sudan.

The data collected in a mixed cross-sectional longitudinal survey of children in a village in rural Khartoum, Sudan, were analysed in order to identify age-independent anthropometric indices. The mean values of weight/height, weight/height, mid arm circumference, mid arm fat area and triceps skinfold thickness all change little with age over certain parts of the age range. 15% of the boys and 22% of the girls had weights less than 75% of standard weight for age. The ability of age-independent indices to identify these low-weight individuals was investigated in terms of their sensitivity and specificity. Weight/height discriminated best, correctly classifying 85% of the low weight boys and 78% of the normal weight boys in the under-five age group. Weight/height and mid arm circumference were also useful, but triceps skinfold thickness and mid arm fat area did not discriminate usefully. All tests performed better in the under-five age group than in the older age bands.