Outcomes In Older Women Research Articles

The relationship of perceived control to outcomes in older women undergoing surgery for fractured neck of femur.

This paper examines the relationship between internal locus of control and recovery from surgery for fractured neck of femur in women over the age of 65 years, in order to inform strategies for nursing care. Structured interviews were carried out at 5 and 30 days postsurgery with 112 women (mean age 78.6 years) in five general hospitals in the North of England. Locus of control was assessed as a factor associated with the outcomes of physical disability (measured as dependence in activities of daily living) and psychological distress (measured using the Hospital Anxiety and Depression Scale). Internal locus of control was significantly related to less physical disability, but no association was found between locus of control and depression and anxiety at 30 days postsurgery when age, 5-day measures and other 30-day outcome measures were controlled. The findings suggest that nursing interventions that enhance perceived internal control by patients during rehabilitation may result in better physical outcomes. Further work is required to explore the relationship of control to psychological outcomes.

Androgen supplementation in older women: too much hype, not enough data.

Androgen supplementation in women has received enormous attention in the scientific and lay communities. That it enhances some aspects of cognitive function, sexual function, muscle mass, strength, and sense of well-being is not in question. What is not known is whether physiological testosterone replacement can improve health-related outcome in older women without its virilizing side effects. Although it is assumed that the testosterone dose-response relationship is different in women than in men and that clinically relevant outcomes on the above-mentioned effects can be achieved at lower testosterone doses, these assumptions have not been tested rigorously. Androgen deficiency has no clear-cut definition. Clinical features may include impaired sexual function, low energy, depression, and a total testosterone level of less than 15 ng/dL, the lower end of the normal range. Measurement of free testosterone is ideal, because it provides a better estimate of the biologically relevant fraction. It is not widely used in clinical practice, because some methods of measuring free testosterone assay are hampered by methodological difficulties. In marked contrast to the abrupt decline in estrogen and progesterone production at menopause, serum testosterone is lower in older women than in menstruating women, with the decline becoming apparent a decade before menopause. This article reviews testosterone's effects on sexual function, cognitive function, muscle mass, body composition, and immune function in postmenopausal women.

Posthospital setting, resource utilization, and self-care outcome in older women with hip fracture

Objective: To compare posthospital rehabilitation resource utilization and self-care outcome of women with hip fracture discharged to three types of setting (home, inpatient rehabilitation, skilled nursing). Design: Prospective cohort study. Patient interviews in the hospital, 2 and 6 months after fracture; hospital record reviews. Setting: Two general community and two teaching hospitals. Patients: Consecutive sample of community-living women with hip fracture, aged 65 and over. Of 179 eligible, 130 patients enrolled and 123 completed study. Interventions: Prospective observational study. Main Outcome Measures: Posthospital institutional days, cumulative sessions of physical and occupational therapy within 6 months after fracture, and 2- and 6-month Barthel Index. Results: For patients discharged to home, inpatient rehabilitation, and skilled nursing, respectively, mean posthospital institutional days were 1, 16, and 50; mean sessions of physical therapy were 15, 35, and 50; mean sessions of occupational therapy were 0, 11, and 16; mean 2-month Barthel Index was 93, 89, and 80; mean 6-month Barthel Index was 89, 88, and 86. Differences in posthospital institutional days and physical and occupational therapy sessions, but not 2- and 6-month Barthel Index, were statistically significant after controlling for patient characteristics. Conclusions: Type of posthospital setting is associated with resource utilization, but not self-care outcome after hip fracture.

An IVF fallacy: multiple pregnancy risk is lower for older women.

Multiple pregnancy is one of the most important and preventable complications of in vitro fertilization (IVF) and embryo transfer. The general clinical practice in many IVF clinics is to transfer four or five embryos to older women if available, since pregnancy rates are lower in women older than 35 years of age. However, it is not clear whether the risk for multiple pregnancy is also lower. Our objective was to investigate whether transferring a higher number of embryos actually improves pregnancy outcome in older women, without increasing the risk for multiple pregnancy and to investigate other factors that may affect the occurrence of multiple pregnancy. The setting was university-based IVF program at The Toronto Hospital. The design was a retrospective case series. The outcome of 1116 IVF cycles between January 1992 and December 1993 was investigated according to different age groups. The main outcome measure was multiple pregnancies. Seventy multiple pregnancies resulted from a total of 242 pregnancies. Overall pregnancy and multiple pregnancy rates were inversely correlated with age. However, when the data were adjusted for the number of embryos transferred, this trend disappeared. The result of multiple regression analysis showed that the multiple pregnancy rate was higher without improving the pregnancy rate when the number of embryos transferred exceeded three, regardless of the age of the patients, especially when more embryos were available than the number of transferred ones. The number of embryos transferred should be limited to a maximum of three regardless of the age of patients, to reduce the high frequency of multiple gestations in an IVF program.

Are follicle stimulating hormone measurements predictive of ovarian response to hyperstimulation with human menopausal gonadotrophin?

Previous studies have suggested that elevated serum follicle stimulating hormone (FSH) concentrations are associated with a poor ovarian response to hyperstimulation with human menopausal gonadotrophin (HMG) in in vitro fertilisation (IVF) programmes. We have used the day 2 serum FSH concentration to determine the dose of HMG administered in women under 40 years. If the FSH concentration was below 9 IU/l, a constant dose of 150 IU HMG were administered; if above 9 IU/l a constant dose of 300 IU HMG was used. Women over the age of 40 years were given 300 IU HMG regardless of their serum FSH concentration. This retrospective study was undertaken to assess whether this approach was beneficial for the younger women and also whether the FSH concentration was predictive of outcome in older women. The study included all = = women 40 years (n 143) and 40 years (n 32) having their first IVF treatment cycle during 1994. In the younger women, there was no difference in the number of cancelled treatment cycles (9.7% vs. 7.5%); the number of follicles present (9.6 vs. 8.2); serum oestradiol concentration (6971 pmol/l vs. 6686 pmol/l); number of eggs collected (7.9 vs. 5.7); number of embryos created (3.7 vs. 3.6); and pregnancy rate (13.5% vs. 15%) between women = = with normal (n 103) or elevated (n 40) FSH concentrations. By using the serum FSH concentration to select women in whom a poor response was expected, and administering a higher dose of HMG, a similar ovarian response was produced and the pregnancy rate was similar to those in women with normal FSH concentrations. Women over 40 years with elevated serum FSH concentrations (n 17) had a significantly (P 0.05) higher cancellation rate (17.6% vs. 0%) and fewer number of eggs collected (6.9 vs. 2.5) than the group with normal FSH concentrations = (n 15). One woman conceived in each group. These findings confirmed previous studies showing that the serum FSH is predictive of ovarian response. This study confirmed the value of measuring the day 2 serum FSH concentration as a predictor of response; and it provides a scientific approach to determine the dose of HMG administered for IVF stimulation. A satisfactory response to induction of ovulation will be achieved using 150 IU HMG in women with FSH 9 IU/l but if the FSH is raised i.e. above 9 IU/l, 300 IU is required to achieve a similar response. =

The influence of older age on breast cancer treatment decisions and outcome

Purpose : Information concerning the differences between older and younger women with breast cancer, treated with standard therapy, is lacking from many prospective series. The purpose of this study is to identify factors that influence treatment decisions and determine of women age 65 and older are treated differently than younger women. The outcomes of older women would then be compared to younger women to determine if treatement differences influence of women. Methods and Materials : The records of 558 women with early invasive breast cancer who were treated with breast conserving surgery and radiation therapy were retrospectively reviewed. Four hundred thirty-two women under the age of 65 (range: 24–64) and 126 women age 65 and older (range: 65–85) were assessed for treatment differences including breast reexcision, extent of axillary dissection, extent of breast and nodal irradiation, and the use of chemotherapy or hormonal therapy. Differences in the treatment of the two groups were determined and the end points of local control, disease-free survival, and overall survival were compared. Median follow-up was 5.5 years. Results : The two treatment groups had identical pathologic TNM staging with the exception that 21% of the older age group and 5% of the younger age group did not undergo axillary dissection. Women age 65 and older were less likely to have a reexcision, extensive axillary dissection, chemotherapy, or nodal irradiation. They were more likely to receive hormonal therapy. Reexcision in older women was positively influenced by a family history of breast cancer and negatively influence by a history of previous malignancy. None of the patients who were treated without an axillary dissection suffered a regional recurrence. Although local control was better in older patients, there were no differences in disease-free or overall survival for the two groups. Discussion : The findings of this study reveal that older patients have significant treatment differences as compared to younger patients; however, despite these differences, similar local control and survival were achieved at 5 and 10 years. With the expected survival of older women increasing, the prospective evaluation of treatment options for older women should be considered.

The influence of ovarian response on gamete intra-Fallopian transfer outcome in older women.

Fecundity declines with increasing age in women. The pregnancy rate is lower in in-vitro fertilization/embryo transfer (IVF/ET) in women aged greater than or equal to 40 years. We analysed 349 consecutive gamete intra-Fallopian transfer (GIFT) cycles in women aged greater than or equal to 40 years to identify factors which affected the outcome. A maximum of four oocytes were transferred in GIFT as recommended by the Interim Licensing Authority; 61 women (17.5%) had a positive serum beta-human chorionic gonadotrophin, 35 (10%) had a miscarriage and 26 (7.5%) delivered live infants. The pregnancy rate was lower than with younger women while the conception loss was higher. Pregnancy and delivery rates increased as the number of oocytes retrieved increased but declined again if greater than 10 oocytes were retrieved. If 1-3 oocytes were retrieved, the pregnancy rate was 9.7% and the delivery rate was 3.9%; if 4-10 oocytes were retrieved, the pregnancy rate was 22.1% and the delivery rate was 10.1%, and when greater than 10 oocytes were retrieved, the rates were 17.6 and 5.9% respectively. The highest pregnancy rate was when four oocytes were transformed in GIFT (22.4%) and the delivery rate was 10.0%. An adequate response to long down-regulation with gonadotrophin-releasing hormone agonist was also a factor associated with high delivery rates (13.5%). We conclude that the delivery rate after GIFT in women aged greater than or equal to 40 years is low, but there is a subgroup who have an acceptable delivery rate because of a good ovarian response. In this group, pituitary down-regulation improves the outcome of treatment.

The association of maternal and socioeconomic characteristics in metropolitan Adelaide with medical, obstetric and labour complications and pregnancy outcomes.

Multiple regression analysis was used to measure associations of maternal age, race, gravidity, marital status and socioeconomic status with medical problems and pregnancy outcomes. The study population comprised all singleton births to residents of metropolitan Adelaide (in South Australia) during 1988 that were included in the State's perinatal statistics collection. The results indicate that in metropolitan Adelaide, low socioeconomic status is related to a higher risk profile of mothers and babies. It also highlights that there is a strong association of divorce and separation with medical problems and an adverse pregnancy outcome. Poorer outcomes are also seen in never married women, teenage women, older women, non-Caucasian women and primigravid women. These poorer outcomes in older women and primigravidas include higher risks of low birth-weight and prematurity of their babies. The study also demonstrates that groups that are less likely to have choice of obstetric care, eg. teenage women, non-Caucasian women, and women of low socioeconomic status, have a lower odds of obstetric intervention as characterized by nonspontaneous labour and elective Caesarean section.

Factors Associated With 1-Year Outcome of Major Depression in the Community

Evidence from outcome studies of major depression indicates a high rate of relapse and chronicity, and that prior chronicity, recurrent episodes, and the presence of psychosocial stressors are associated with a poor outcome. However, the generalizability of these findings is limited because most studies have focused on treated samples; thus, these studies may have been biased toward more chronic or severe illnesses. In prospectively surveying a large probability sample of the general population, the Epidemiologic Catchment Area program offers the opportunity to investigate prognosis without selection bias. In this study, the Epidemiologic Catchment Area subjects with a diagnosis of Major Depressive Disorder at first interview (n = 423) were categorized according to their diagnostic status 1 year later. The results confirmed a high rate of nonrecovery, with clinical features associated with a poor outcome that resembled those identified in previous clinical studies. Overall, clinical factors were more important prognostically than were sociodemographic characteristics. However, there was some evidence that a poorer outcome in older women may partially explain the greater female prevalence of depression in the community.