Population-based Sample Of Older Women Research Articles

Patient views and correlates of radiotherapy omission in a population-based sample of older women with favorable-prognosis breast cancer.

The omission of radiotherapy (RT) after lumpectomy is a reasonable option for many older women with favorable-prognosis breast cancer. In the current study, we sought to evaluate patient perspectives regarding decision making about RT. Women aged 65 to 79 years with AJCC 7th edition stage I and II breast cancer who were reported to the Georgia and Los Angeles County Surveillance, Epidemiology, and End Results registries were surveyed (response rate, 70%) regarding RT decisions, the rationale for omitting RT, decision-making values, and understanding of disease recurrence risk. We also surveyed their corresponding surgeons (response rate, 77%). Patient characteristics associated with the omission of RT were evaluated using multilevel, multivariable logistic regression, accounting for patient clustering within surgeons. Of 999 patients, 135 omitted RT (14%). Older age, lower tumor grade, and having estrogen receptor-positive disease each were found to be strongly associated with omission of RT in multivariable analyses, whereas the number of comorbidities was not. Non-English speakers were more likely to omit RT (adjusted odds ratio, 5.9; 95% confidence interval, 1.4-24.5). The most commonly reported reasons for RT omission were that a physician advised the patient that it was not needed (54% of patients who omitted RT) and patient choice (41%). Risk of local disease recurrence was overestimated by all patients: by approximately 2-fold among those who omitted RT and by approximately 8-fold among those who received RT. The risk of distant disease recurrence was overestimated by approximately 3-fold on average. To some extent, decisions regarding RT omission are appropriately influenced by patient age, tumor grade, and estrogen receptor status, but do not appear to be optimally tailored according to competing comorbidities. Many women who are candidates for RT omission overestimate their risk of disease recurrence. Cancer 2018;124:2714-2723. © 2018 American Cancer Society.

Pre-diagnosis health-related quality of life, surgery, and survival in women with advanced epithelial ovarian cancer: A SEER-MHOS study

ObjectiveHealth-related quality of life (HRQOL) has been found to be associated with overall survival in women with ovarian cancer. However, previous studies assessed HRQOL after surgery within clinical trial populations only. The study goal was to determine the association of pre-cancer diagnosis HRQOL with the likelihood of receiving surgery and with overall survival in a national, population-based cohort of older women with advanced ovarian cancer. MethodsThe Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database was queried to identify 374 women aged 65years and older with advanced stage epithelial ovarian cancer from 1998 to 2011. Responses to the Short Form 36 (SF-36) and Veterans-RAND-12 (VR-12), two single-item global health questions, and Activities of Daily Living (ADLs) were abstracted. Multivariable models were used to quantify associations of HRQOL and ADL assessments with surgery and overall survival, adjusted for demographic and clinical characteristics. ResultsOf 374 women with a HRQOL assessment prior to diagnosis, 199 (53%) underwent surgery. Increases in physical and mental HRQOL domains were significantly associated with receipt of surgery. The relationship between HRQOL domains and overall survival were not statistically significant. For ADLs, only difficulty in toilet use was significantly associated with survival. ConclusionIn this population-based sample of older women with advanced epithelial ovarian cancer, pre-diagnosis HRQOL was predictive of receiving surgery, but not of overall survival.

Assessing the Risk of Institutional Entry: A Semi-nonparametric Framework Using a Population-based Sample of Older Women

ObjectiveInstitutional entry or long-term care (LTC) is an important area to investigate owing to global aging. This study examines which types of disabilities lead to institutionalization for older White and Black women in the United States. MethodsUsing the 3-year (2009–2011) American Community Survey cross-sectional data, this study applies semi-nonparametric maximum likelihood estimation methods to examine the association between disability and institutional entry on a sample of 222,562 older White women and 19,229 older Black women. This approach provides consistent estimators because no assumptions are made about the distribution of the error terms. ResultsFor older White women, the risk of entering LTC is high in the presence of self-care and independent living difficulties (1.10 [p < .01] and 0.54 [p < .01], respectively). For older Black women, the risk of entering LTC is elevated in the presence of self-care difficulty and cognitive impairment (1.56 [p < .01] and 0.48 [p < .01], respectively) but widowed/divorced/separated marital states do not show this association. ConclusionsDisability, marital status, and race are important considerations for assessing the risk of institutional entry. Impairments that limit personal hygiene and self-care are associated with increased risk for older women. Additionally, limitations that affect reasoning and memory are associated with increased risk for older Black women.

Influence of parity-related factors adjusted for abortion on knee osteoarthritis in Korean women aged 50 or older: A cross-sectional study

ObjectivesKnee osteoarthritis (OA) is pervasive in aged populations, and induces considerable socioeconomic expense. The objective of this study was to investigate the association between OA prevalence and pregnancy and parity in Koreans, considering for the potential effect of abortion. Study designA total 5449 women aged ≥50 years with radiological knee examination results of 24,173 participants of the 5th Korean National Health and Nutrition Examination Survey (2010–2012) were analyzed in a cross-sectional study. Main outcome measuresAssociation between OA prevalence (Kellgren/Lawrence grade) and pregnancy and parity as odds ratios (ORs) by logistic regression. ResultsKnee OA results were normal in 1996 participants (36.1%), suspected in 1012 (18.6%), mild in 781 (14.3%), moderate in 1073 (19.7%), and severe in 617 (11.3%). Increase in number of pregnancies adjusted for abortion was significantly associated with increased OA prevalence (OR 1.081; 95% CI 1.015, 1.152). OA prevalence increased with parity (continuous variable) in ever-abortion (OR 1.092; 95% CI 1.009, 1.181) and with parity (categorical variable) with reference value set at 1–2 (P for trend; p=0.0195). In analyses adjusted for abortion, ever-abortion negatively influenced OA prevalence. Parity was not associated with OA in number of pregnancies unadjusted for abortion or in never-abortion women. ConclusionsThis study shows that maternity-related factors such as pregnancy and parity were related with knee OA prevalence in this population-based sample of older women, and that relationships with abortion were stronger.

Higher CSF interleukin-6 and CSF interleukin-8 in current depression in older women. Results from a population-based sample.

The literature regarding cerebrospinal fluid (CSF) cytokines in geriatric depression is sparse. The aim of this study was to examine associations between CSF interleukin-6 (IL-6), interleukin-8 (IL-8) and depression in a population-based sample of older women who were followed for 17 years. 86 dementia-free women aged 70-84 years who participated in the Prospective Population Study of Women in Gothenburg, Sweden took part in a lumbar puncture in 1992-3. CSF IL-6 and CSF IL-8 were measured. Psychiatric symptoms were rated with the Comprehensive Psychopathological Rating Scale at baseline and at three subsequent face-to-face examinations. Depression (major or minor) was diagnosed in accordance with DSM-IV/DSM-IV research criteria. At baseline, women with ongoing major (n=10) or minor depression (n=9) had higher levels of CSF IL-6 (p=0.008) and CSF IL-8 (p=0.007) compared with those without depression (n=67). Higher CSF IL-8 was related to higher MADRS score (p=0.003). New cases of depression were observed in 9 women during follow-ups. No associations between CSF cytokine levels and future depression could be shown in women without depression at baseline. Higher levels of CSF IL-6 and IL-8 were associated with current depression in this population-based sample. CSF IL-6 and CSF IL-8 may play a role in depression in late life.

Retraction notice to “Lower CSF interleukin-6 predicts future depression in a population-based sample of older women followed for 17 years” [Brain Behav. Immun. 32 (2013) 153–158

0889-1591/$ see front matter 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.bbi.2013.11.011 DOI of original article: http://dx.doi.org/10.1016/j.bbi.2013.03.011 ⇑ Corresponding author. Address: Neuropsychiatric Epidemiology Unit, Neuropsykiatri SU/Molndal, Wallinsgatan 6, SE 431 41 Molndal, Sweden. Tel.: +46 031 342 2164; fax: +46 031 828163. E-mail address: silke.kern@vgregion.se (S. Kern).

Lower CSF interleukin-6 predicts future depression in a population-based sample of older women followed for 17 years

The literature regarding cerebrospinal fluid (CSF) cytokines in geriatric depression is sparse. The aim of this study was to examine associations between CSF interleukin-6 (IL-6) and related proinflammatory cytokines and current and future depression in a population-based sample of older women who were followed for 17 years. 83 non-demented women aged 70-84 years who participated in the Prospective Population Study of Women in Gothenburg, Sweden took part in a lumbar puncture in 1992-3. CSF- IL-6, interleukin-1β (IL-1β), interleukin- 8 (IL-8) and tumor necrosis factor-α (TNF-α) were measured. Psychiatric symptoms were rated with the Comprehensive Psychopathological Rating Scale at baseline and at three subsequent face-to-face examinations. Depression (major or minor) was diagnosed in accordance with DSM-IV/DSM-IV research criteria. At baseline, women with ongoing depression had lower levels of IL-6 (p<0.04), IL-8 (p<0.05) and TNF-α (p<0.05) compared with those without depression. In women without depression at baseline, lower CSF IL-6 levels predicted depression at one or more follow-up examination (p<0.03). Results from the generalized linear mixed logistic model using all baseline and follow-up data on depression status and Mini Mental State Examination score showed a significant relationship between IL-6 and depression (p=0.005 OR 0.370 CI [0.184-0.744]). Lower levels of CSF IL-6 were associated with current depression and with future depression during a follow-up of almost two decades. Our findings suggest that lower levels of CSF IL-6 may be related to depression vulnerability in later life.

The associations between parity, other reproductive factors and cartilage in women aged 50–80 years

Sex hormones and reproductive factors may be important for osteoarthritis (OA). The aim of this study was to describe the associations of parity, use of hormone replacement therapy (HRT) and oral contraceptives (OCs) with cartilage volume, cartilage defects and radiographic OA in a population-based sample of older women. Cross-sectional study of 489 women aged 50-80 years. Parity, use of HRT and OC was assessed by questionnaire; knee cartilage volume and defects by magnetic resonance imaging and knee joint space narrowing (JSN) and osteophytes by X-ray. Parity was associated with a deficit in total knee cartilage volume [adjusted β=-0.69 ml, 95% confidence interval (CI) -1.34, -0.04]. Increasing parity was associated with decreasing cartilage volume in both the tibial compartment and total knee (both P trend <0.05). Parity was also associated with greater cartilage defects in the patella compartment [adjusted odds ratio (OR)=2.87, 95% CI=1.39, 5.93] but not other sites. There was a consistent but non-significant increase in knee JSN (OR=2.78, 95% CI=0.75, 10.31) and osteophytes (OR=1.69, 95% CI=0.59, 4.82) for parous women. Use of HRT and/or OC was not associated with cartilage volume, cartilage defects or radiographic change. Parity (but not use of HRT or OC) is independently associated with lower cartilage volume primarily in the tibial compartment and higher cartilage defects in the patella compartment in this population-based sample of older women.

Physical activity and calcium consumption are important determinants of lower limb bone mass in older women.

A population-based study of 1363 older women showed that the 24% who achieved high physical activity and dietary calcium intakes had a 5.1% higher hip BMD than those who did not, supporting the concept that lifestyle factors play an important role in the maintenance of lower extremity bone mass in older women. Although there is general agreement that increased dietary calcium consumption and exercise can slow bone loss in older women, the amount required to have this effect in an older population remains uncertain. This study was devised to examine the effects of calcium consumption (CC) and physical activity (PA) (lifestyle management) on bone mass in an older female population. Using a cross-sectional study design, a population-based sample of older women (mean age, 75 +/- 3 years) had hip and heel bone mass measured using DXA (Hologic 4500A; n = 1076) and quantitative ultrasound (QUS, Lunar Achilles; n = 1363), respectively. CC and PA were measured by a validated habitual food frequency and activity questionnaire, respectively. Dose-response effects of PA and CC on bone mass were examined using ANOVA. Division of the PA and CC into tertiles best described the dose-response effects. After adjustment for CC, age, weight, alcohol consumption, and cigarette smoking, high PA compared with medium or low PA was associated with higher hip BMD and heel QUS (total hip BMD, 3.1%; p < 0.001; QUS stiffness, 2.7%; p = 0.002). After adjustment for PA and covariates, high or medium CC compared with low CC was associated with higher total hip BMD (1.8%; p = 0.027), with no effect at the QUS heel site. PA and CC were dichotomized at the cut-points for effects on BMD. The combination of high PA and CC, achieved by 24% of the population, was associated with a total hip BMD that was 5.1% higher (34% of SD) than those individuals in the low PA and CC group. Stiffness was 3.6% (23% of SD) higher in the high PA and CC group than in the low PA and CC group. If the whole population undertook and achieved a high PA and high CC lifestyle, the population risk of hip fractures may be expected to be reduced by about 17% in this age group as a result of beneficial effects on the musculoskeletal system.

Prevalence and clustering of menopausal symptoms in older women by hysterectomy and oophorectomy status.

This study examines the association of hysterectomy and oophorectomy with the prevalence and clustering of menopausal symptoms in a large population-based sample of older women. Subjects were 1121 women aged 50-89 from the Rancho Bernardo Study. Information on menopause, hysterectomy, oophorectomy, estrogen use, and other covariates was obtained in 1984-1987. A 1989 mailed survey obtained information on menopausal symptoms. In this sample, 22.1% reported hysterectomy with bilateral oophorectomy, and 25.3% reported hysterectomy with ovarian conservation. Mean time since hysterectomy was 26 (+/-12) years. Overall, 37% reported current estrogen use, and 40% reported past use. The duration of estrogen use was longer for women who had a hysterectomy (p < 0.001). Age-adjusted comparisons indicated that more women who had a hysterectomy, with or without bilateral oophorectomy, reported greater energy after menopause (p = 0.003 and p = 0.001, respectively), and more women with bilateral oophorectomy reported greater interest in sex (p = 0.007) and that life was getting better (p = 0.012) than women with natural menopause. Principal components factor analysis of the symptom data for all women yielded four factors: psychological, vasomotor, positive feelings, and self-image. Analyses performed within each group of women yielded similar factors and loadings. Adjusted comparisons of factor scores indicated that positive feelings were significantly higher in women who had a hysterectomy, with or without bilateral oophorectomy (p < 0.01) than in women with natural menopause. This difference was limited to current estrogen users. Vasomotor symptoms, psychological symptoms, and negative self-image did not differ by hysterectomy or oophorectomy status before or after stratification for estrogen use (p > 0.10). This study found after a hysterectomy, women are more likely to recall positive feelings about their menopause than women with natural menopause. Relief from symptoms leading to hysterectomy and use of replacement estrogen may be partly responsible. Results do not support the thesis that surgical menopause is associated with a sustained increased prevalence of vasomotor, psychological, or other symptoms.