Population-based Sample Of Older Adults Research Articles

Association of visual field loss and mobility performance in older adults: Salisbury Eye Evaluation Study.

To determine the association between visual field loss and orientation and mobility (O&M) performance in a population-based sample of older adults and to identify the specific regions of the visual field that are most strongly associated with O&M performance. A population-based sample of 1504 persons between the ages of 72 to 92 was enrolled in the third round of Salisbury Eye Evaluation. Monocular visual fields (60 degrees radius) were tested with the 81-point, single intensity (24 dB) screening test strategy on the Humphrey Field Analyzer. Binocular visual fields were estimated from a combination of the monocular fields. The number of points missed was calculated for the overall visual field and for 3 non-overlapping regions: central (< or = 20 degrees radius), upper- and lower-peripheral visual fields. Orientation and mobility performance was evaluated by walking speed, number of bumps, and number of orientation errors on a circuitous, 32.8-m course seeded with obstacles. Log-linear regressions and linear regressions, adjusting for age, gender, body mass, height, cognitive and general health status, were performed. Loss in the overall visual field was associated with an increase in the number of bumps and decrease in walking speed. Visual field loss was not associated with the number of orientation errors. Out of the three visual field sub-regions that we tested, in terms of percentage of loss, the central and lower peripheral regions showed comparable decrements in walking speed and the central region was most strongly associated with number of bumps. The loss in visual field, which occurs with aging, is associated with a decline in mobility performance. Walking speed decreases, and the number of bumps into obstacles increases, with decreases in the visual field. The number of orientation errors is not associated with the loss in visual field that occurs with aging.

Predictors of falling cholesterol levels in older adults: the Cardiovascular Health Study.

To estimate 4-year change in serum total cholesterol levels in a population-based sample of older adults and identify independent predictors of cholesterol decline. Prospective study of 2837 adults aged 65 years and older with serum cholesterol measured in 1992-1993 and 1996-1997. Mean serum cholesterol levels declined 6.3 mg/dl between the two examinations. Declines were greater in white (-7.3 mg/dl) than black (-1.4 mg/dl) participants and in those in good/excellent health (-0.9 mg/dl) vs. fair/poor health (-3.1 mg/dl; both p < 0.01). Factors associated with greater decline on multivariate analysis included age, male gender, and higher white cell count, albumin, and baseline cholesterol. Cholesterol levels declined 2.0 mg/dl per 6 year increment in baseline age and 6.8 mg/dl more in men than women after adjustment for other factors. C-reactive protein levels were unrelated to cholesterol change. Declining cholesterol levels were associated with male gender, advanced age, weight loss, and white blood cell count but not with C-reactive protein levels. The role of declining cholesterol synthesis, due to as yet undefined age-related changes or to cytokine-mediated reductions related to illness, should be examined to help clarify the mechanisms of the sometimes marked declines in cholesterol levels observed at advanced ages.

The Association Between Health and Cognitive Performance in a Population-Based Study of Older Adults: The Charlotte County Healthy Aging Study (CCHAS)

In the present study, the relationship between self-reports and objective measures of health status and measures of cognitive performance was examined. Participants consisted of 437 persons (M =72.91 years) from the Charlotte County Healthy Aging Study, a population-based sample of older adults. Cognitive performance was assessed by tests of episodic memory, perceptual speed, and attention. Health status was indexed by subjective ratings, self-reports, and objective measures. The health measures accounted for significant variance on both the Trailmaking A and B tests, accounting for a modest amount of variance (4.4% and 1.1%, respectively). The health measures were not significantly associated with performance on the measures of attention or episodic memory. The results suggest that health status is associated with processing speed to a greater degree than higher order cognitive processes.

Alcohol consumption and inflammatory markers in older adults: the Cardiovascular Health Study

Objective: We sought to determine the relation of alcohol intake and systemic inflammation in a population-based sample of older adults. Methods and results: As part of the Cardiovascular Health Study (CHS), 5865 adults aged 65 years and older reported their intake of beer, wine, and liquor. We determined white blood cell count (WBC), factor VIII coagulant activity (factor VIIIc), and levels of C-reactive protein (CRP), fibrinogen, and albumin as markers of systemic inflammation. Among participants without confirmed cardiovascular disease, alcohol consumption was inversely associated with WBC, factor VIIIc, and fibrinogen level, and positively associated with albumin concentration in multivariate analyses. We found no consistent modification of these results by sex, obesity, or beverage type. The relation of alcohol use and CRP levels was significantly modified by apoE genotype (P interaction 0.03), with a positive association among participants with an apoE4 allele ( P=0.05), but a trend toward an inverse association among those without an apoE4 allele ( P=0.15). Conclusions: Alcohol intake is associated with lower levels of inflammatory markers in older adults free of cardiovascular disease.

Telephone screening to identify potential dementia cases in a population-based sample of older adults.

This study examined the utility of the TELE, a telephone assessment for dementia, in a sample of 269 individuals that was not selected on the basis of previous dementia diagnosis. Thus, the conditions of the study reflect the actual situation in which a screening instrument might be employed. Scores on TELE were compared to dementia diagnoses. Using the best cutoff score, sensitivity was .86 and specificity was .90. Longitudinal follow-up established that false positives primarily included those who subsequently developed dementia. Telephone screening for dementia has both clinical and research applications. One recommendation based on our experience is that longitudinal studies should include a telephone interview component for anyone who drops out of the study, to enable characterizing the cognitive status of dropouts.

Stability and change in older adults' social contact and social support: the Cardiovascular Health Study.

The aim of this study was to examine the degree of individual change in structural indicators of social support (family network contact and close friend network contact) and functional indicators of social support (belonging, appraisal, and tangible support) during late life. Using a large population-based sample of older adults, hierarchical linear modeling was applied to examine the extent of change in social contact and support as well as sociodemographic characteristics (age, race, gender, and education) that might explain individual variability in contact and support at baseline and over time. Consistent with predictions, small yet significant increases were observed in belonging support and tangible support. Contrary to predictions, no evidence was found for significant individual change in family network contact, close friend network contact, or appraisal support. Sociodemographic characteristics were more consistent predictors of variability in contact and support at baseline than variability over time. The findings of this study add to a growing literature suggesting that late life is not typically characterized by a decline in important social resources.

Ethnic Differences in the Expression of Caregiver Burden

African American caregivers regularly report less burden than their White counterparts. Less is known about levels of burden among Puerto Rican caregivers. Yet both of these ethnic minority groups tend to provide more hours of care to their elders, mostly due to higher levels of functional disability among ethnic minority elders. A qualitative study was undertaken to detect differences in the way care-givers in three ethnic groups (African American, Puerto Rican and White) describe their experiences with and reactions to caregiving. Caregivers were selected from the larger sample of the Springfield Elder Project, a study of a population-based sample of older adults and their caregivers. Ethnic and gender differences were detected both in how caregivers in the three groups describe the caregiving experience and how they cope with it. White females, and African American and Puerto Rican males expressed feelings of frustration and anger during difficult times in their caregiving situations. Women, particularly African Americans and Puerto Ricans, used somatic complaints as outlets for those feelings. In addition, African American caregivers described their caregiving as an extremely time-consuming activity. Puerto Rican female caregivers described their caregiving situation as one which fostered social isolation. Resignation, denial, respect and faith in religion were ways these caregivers dealt with the burden of their caregiving responsibilities. These findings suggest that African American and Puerto Rican carcgivers are experiencing burden, but expressing it in different ways than White caregivers and that available measures of caregiver burden do not adequately measure the impact of caregiving on minority caregivers.

Relation of smoking with carotid artery wall thickness and stenosis in older adults. The Cardiovascular Health Study. The Cardiovascular Health Study (CHS) Collaborative Research Group.

Cigarette smoking has been associated with increased risk of atherosclerotic diseases in hospital-based studies and in studies of middle-aged populations but not in population-based studies of older adults with and without clinical cardiovascular disease. We investigated the relation of smoking to carotid artery atherosclerotic disease, expressed as intimal-medial wall thickness and arterial lumen narrowing (stenosis) measured by ultrasound. Subjects were 5116 older adults participating in the baseline examination of the Cardiovascular Health Study, a community-based study of cardiovascular diseases in older age. With increased smoking there was significantly greater internal and common carotid wall thickening and internal carotid stenosis: current smokers > former smokers > never-smokers; for instance, the unadjusted percent stenosis was 24%, 20%, and 16%, respectively (P < .0001). A significant dose-response relation was seen with pack-years of smoking. These findings persisted after adjusting for other cardiovascular risk factors and were also confirmed when analyses were restricted to those without prevalent cardiovascular disease. The difference in internal carotid wall thickness between current smokers and nonsmokers was greater than the difference associated with 10 years of age among never-smoking participants (0.39 mm versus 0.31 mm). Among all participants, the prevalence of clinically significant (> or = 50%) internal carotid stenosis increased from 4.4% in never-smokers to 7.3% in former smokers to 9.5% in current smokers (P < .0001). These findings extend previous reports of a positive relation between smoking and carotid artery disease to a population-based sample of older adults using several different indicators of atherosclerotic disease.