Sample Of Community-dwelling Elders Research Articles

Cognitive function and vitamin B12 and D among community-dwelling elders: A cross-sectional study.

Little is know on the association between mild or sub-clinical vitamin B12 or D deficiencies and cognitive decline. The objective of the present work was to evaluate the association between vitamin B12 and D levels, and cognitive function in community-dwelling elders. Cross-sectional study that included data from elders who participated in the SABE study, a population-based study that was carried out in Ecuador. Participants of SABE were selected by probabilistic sampling from the whole country. Vitamin B12 and D were measured in blood and cognitive status was assessed using an abbreviated version of the minimental state examination (MMSE). The sample included 1733 elders from whom 936 (54.01%) were female. Independently from sex, age, years of education, ethnicity, socioeconomic status and geographical zone of residence, we found that vitamin B12 levels were associated to MMSE scores and that this relationship changed depending on age. In this way, we observed that from 75 years of age, drop of cognitive function was particularly steep in individuals with low levels of vitamin B12. We did not find evidence to support an association between vitamin D levels and cognitive function. Low levels of vitamin B12 but not of vitamin D are associated with low cognitive functioning in a sample of community-dwelling elders.

Anhedonia as a Potential Risk Factor of Alzheimer's Disease in a Community-Dwelling Elderly Sample: Results from the ZARADEMP Project.

(1) Introduction: Dementia is a major public health problem, and Alzheimer’s disease (AD) is the most frequent subtype. Clarifying the potential risk factors is necessary in order to improve dementia-prevention strategies and quality of life. Here, our purpose was to investigate the role of the absence of hedonic tone; anhedonia, understood as the reduction on previous enjoyable daily activities, which occasionally is underdetected and underdiagnosed; and the risk of developing AD in a cognitively unimpaired and non-depressed population sample. (2) Method: We used data from the Zaragoza Dementia and Depression (ZARADEMP) project, a longitudinal epidemiological study on dementia and depression. After excluding subjects with dementia, a sample of 2830 dwellers aged ≥65 years was followed for 4.5 years. The geriatric mental state examination was used to identify cases of anhedonia. AD was diagnosed by a panel of research psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. A multivariate survival analysis and Cox proportional hazards regression model were performed, and the analysis was controlled by an analysis for the presence of clinically significant depression. (3) Results: We found a significant association between anhedonia cases and AD risk in the univariate analysis (hazard ratio (HR): 2.37; 95% CI: 1.04–5.40). This association persisted more strongly in the fully adjusted model. (4) Conclusions: Identifying cognitively intact individuals with anhedonia is a priority to implement preventive strategies that could delay the progression of cognitive and functional impairment in subjects at risk of AD.

Prevalence of substance abuse and socio-economic differences in substance abuse in an Australian community-dwelling elderly sample.

A sample of 324 55–90-year-old Australian adults participated in a survey on elderly substance abuse using the Clinical Assessment Scales for the Elderly. Overall, males had a higher prevalence rate of substance abuse than females. Significant differences in substance abuse mean scores were found for gender, age, income, community involvement, and retirement. The findings also reveal that being a female, involved in community groups, being a retiree, and being a non-baby boomer are protective factors of substance abuse. Being an upper medium income earner appears to be a risk factor of substance abuse.

Are migraine and non-migrainous headache risk factors for stroke in the elderly? Findings from a 12-year cohort follow-up.

There is evidence that migraine is a risk factor for stroke but little is known about this association in elderly people. Furthermore, non-migrainous headache (NMH) has received little attention despite being the most frequently reported type of headache. Late-life migraine and NMH were examined as candidate risk factors for stroke in a community-dwelling elderly sample over a 12-year follow-up. One thousand nine hundred and nineteen non-institutionalized subjects aged 65+, without dementia (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, DSM-IV criteria) and with no stroke history at baseline, were drawn from the Three-City Montpellier cohort (recruitment 1999-2001) for longitudinal analysis. Ischaemic and haemorrhagic stroke was reported at baseline and at each of the five follow-ups, with cases validated by a panel of experts, according to ICD-10 criteria (International Classification of Diseases, 10th revision). Migraine and NMH were determined at baseline during a neurological interview and examination using 1988 International Headache Society criteria. A total of 110 (5.4%) cases of migraine and 179 (8.9%) cases of NMH were identified at baseline. During the median 8.8-year follow-up, incident stroke was observed in 1.9% of baseline migrainers, 6.2% of NMH and 3.6% of those with no lifetime history of headache. Cox proportional hazard models indicated that migraine was not a risk factor for stroke; however, NMH sufferers were twice as likely to have a stroke (hazard ratio 2.00, 95% confidence interval 1.00-3.93, P = 0.049). This study is one of the first to suggest that late-life NMH rather than migraine could be an independent risk factor for stroke and a warning sign. The incidence of stroke in elderly migrainers, seldom reported, is particularly low.

Patterns of selective serotonin reuptake inhibitor use and risk of falls and fractures in community-dwelling elderly people: the Three-City cohort.

Increased risk of falls and fractures has been reported in elderly users of SSRIs. However, biases were insufficiently addressed notably temporality between exposure and outcome and confounding by residual depression. Our objective was to examine the associations between SSRIs and fall or fracture incidence focusing on their chronic use and different types of SSRIs. The population-based cohort included participants aged 65years and above, who had not fallen before inclusion (n = 6599) or were free of recent fracture (n = 6823) and were followed up twice over 4years. New fall and fracture events were self-reported and defined as at least two falls and one fracture, respectively, during the previous 2years. SSRI users were compared with those taking no antidepressants. Hazard ratios (HRs) were estimated using Cox models with delayed entry and adjusted for many confounders including residual depressive symptoms. Incidence of falls was 19.3% over 4years and that of fractures 9.5%. After multi-adjustment, SSRI intake was significantly associated with a higher risk of falls (HR, 95% CI = 1.58, 1.23-2.03) and fractures (HR, 95% CI = 1.61, 1.16-2.24). The risks were significantly increased by 80% in those continuing the treatment over 4years. Citalopram intake only was at significant risk for falls and fluoxetine for fractures. In this large community-dwelling elderly sample, SSRI users were at higher risk of falls and fractures. This association was not due to reverse causality or residual depressive symptoms. Different SSRI drugs may have specific adverse effects on falls and fractures.

Health Related Quality Of Life In A Community Dwelling Elderly Sample In Brazil

Health Related Quality Of Life In A Community Dwelling Elderly Sample In Brazil

Prevalence and Patterns of Alcohol Misuse in a Community-Dwelling Elderly Sample in Brazil

The aim of this study was to estimate prevalence and patterns of lifetime alcohol misuse. This was a cross-sectional study of a representative sample of 1,078 individuals aged 60 or more. Structured interview included sociodemographic, lifestyle, health data, and the five alcohol misuse screening questions of the Self-Reporting Questionnaire. Prevalence of misuse was 6.5%. Men, aged 60 to 69, low educational level, separated/divorced, and tobacco smoking were independently associated with lifetime alcohol misuse. Odds ratios show increasing association with levels of alcohol misuse groups in males, low-educated, and tobacco users. Persons aged 60 to 69, 4 to 7 education years, and non-White ethnicity were significantly associated with the major alcohol misuse score. Younger elderly were more exposed to alcohol than previous cohorts. Thus, problems with alcohol in old age will possibly increase as they grow older. The results of this study call attention to a field of lacking evidence in alcohol-related problems of older persons.

The Role of Children’s Support in Elders’ Decisions to Live in a Yanglaoyuan (Residential Long-Term Care)

The purpose of this study is to investigate the role of children's support in elders' decisions to live in a yanglaoyuan (residential long-term care) in Shanghai based on their intentions and actual experiences, drawing on both quantitative and qualitative data. The 2005 Shanghai Elderly Citizen Longitudinal Tracking Study (SECLTS) examines a stratified sample of community-dwelling elders and their intention to live in a yanglaoyuan (N = 1,512). Eleven semi-structured, retrospective interviews described how children participated in residents' decision-making to live in a yanglaoyuan. Logistic regression analyses reveal that satisfaction with children's support-financial, instrumental, and emotional-is negatively associated with respondents' intention to live in a yanglaoyuan. Higher levels of respondents' satisfaction with their children's support are associated with lower levels of intention to live in a yanglaoyuan. Such support, however, does not necessarily determine elders' decision to live in a yanglaoyuan. Qualitative analyses suggest that children participated throughout residents' actual process of deciding to live in a yanglaoyuan. Children helped residents to make the decision to live in a yanglaoyuan. Residents reported how their children contributed to instrumental support to face family caregiving challenges and how they experienced and shared the emotional process in the decision-making. Quantitative and qualitative findings complement each other to provide a holistic understanding of the role of children's support in elders' intention to live in a yanglaoyuan, as well as in their actual decision-making experiences. These findings also suggest the evolving nature of children's support in family caregiving in contemporary Chinese society.

Perceptions of Successful Aging Among Diverse Elders With Late-Life Disability

Researchers often use the term "successful aging" to mean freedom from disability, yet the perspectives of elders living with late-life disability have not been well described. The purpose of this study was to explore the meaning of successful aging among a diverse sample of community-dwelling elders with late-life disability. Using qualitative grounded theory methodology, we interviewed 56 African American, White, Cantonese-speaking Chinese, and Spanish-speaking Latino disabled elders who participate in On Lok Lifeways, a Program of All-inclusive Care for the Elderly. Through semi-structured interviews with open-ended questions, we explored the elders' perceptions of what successful aging and being old meant to them. Despite experiencing late-life disability, most participants felt they had aged successfully. An overarching theme was that aging results in Living in a New Reality, with two subthemes: Acknowledging the New Reality and Rejecting the New Reality. Participants achieved successful aging by using adaptation and coping strategies to align their perception of successful aging with their experiences. Themes were common across race/ethnic groups but certain strategies were more prominent among different groups. Across race and ethnic groups, most of these participants with late-life disability felt they had aged successfully. Thus, successful aging involves subjective criteria and has a cultural context that is not captured in objective measurements. Understanding elders' perception will help establish common ground for communication between clinicians and elders and identify the most appropriate interventions to help elders achieve and maintain the experience of successful aging.

Influence of blood pressure profile on frailty phenotype in community-dwelling elders in Brazil – FIBRA study

Frailty is a clinical condition associated with pathological aging and biological vulnerability. In the spectrum of events related to frailty, aging of the cardiocirculatory system and abnormalities in arterial blood pressure (BP) partly explain the changes in tissue perfusion and, potentially, the decrease in physiological reserves. This study investigated the relationship between BP levels, systemic arterial hypertension (SAH) and the frailty phenotype by analyzing frailty criteria in a cross-sectional model into the FIBRA network, a populational sample of community-dwelling elders in Southeastern Brazil. Study participants with ≥65 years were selected by probabilistic sampling of residents in the urban area of the municipality of Campinas (n=900). Considering frailty as a whole and the difference between genders, there was a greater proportion of frail or pre-frail individuals among women than men. Analysis of individual frailty criteria showed that weight loss and fatigue were more common among women (18.3% vs. 12.5%, p=0.034 and 22.5% vs. 11.9%, p<0.001, respectively). Comparison of individuals with or without SAH failed to reveal any differences related to frailty criteria. Nevertheless, averages of diastolic blood pressure (DBP) and mean arterial blood pressure values were lower among elderly individuals with reduced grip strength, physical activity and the frailty classification as a whole (OR 0.986, IC 0.975–0.997) (for every 1mmHg reduction in MBP values, the likelihood of being frail increased 1.4%). Our findings corroborate the relationship between BP values and frailty in the elderly and contribute to an understanding of the pathophysiological mechanisms of the syndrome.

Analysis of the normative conditions of oral health, depression and serotonin‐transporter‐linked promoter region polymorphisms in an elderly population

To investigate the association between depression, the normative conditions of oral health and serotonin-transporter-linked promoter region (5-HTTLPR) polymorphisms in a community-dwelling elderly sample. Elderly adults living in a community (n=200) were submitted to an oral clinical examination. Depression was assessed using the 15-item Geriatric Depression Scale. The 5-HTTLPR was analyzed by polymerase chain reaction-restriction fragment length polymorphism. Associations between the biomarkers and clinical covariates were assessed by bivariate and multivariate statistical tests. Statistical significance was set at P<0.05. The prevalence of dental caries, periodontal disease, edentulism and oral mucosal lesions was 51.2%, 20.8%, 58.0% and 21.5%, respectively. The prevalence of depression was 21.5%. A higher frequency of the S allele was recorded in older individuals with depression (P=0.017). The present findings showed no significant association between depression and the normative conditions of oral health. The observed allelic polymorphisms were 44% S and 56% L, respectively. Genotypic variants were 33.5% LL, 45.0% SL and 21.5% SS. Individuals carrying the SS genotype showed a significantly high prevalence of periodontal disease (prevalence ratio=3.077, CI 95%=1.008-9.393, P=0.048). The present findings suggest that depressive community-dwelling older individuals did not show any association with alterations of oral health normative conditions. However, the SS genotypic polymorphic variant of 5-HTTLPR seems to contribute to the occurrence of periodontal disease in the elderly.

Physical activity participation and functional limitations in geriatric cancer survivors.

9009 Background: Functional limitations (FL) increase with age, as does cancer incidence. Treatments for cancer may exacerbate age-related FL. Physical activity (PA) reduces the risk of recurrence of some cancers and may improve survival. FL may reduce PA participation in geriatric cancer survivors (&gt;65 yrs.) which could increase the risk of recurrence and reduce survival. This investigation describes and compares patterns of PA and FL in geriatric cancer survivors versus those without a cancer history. Methods: Using a national sample of community-dwelling elders (&gt; 65 yrs.) from the 2003 Medicare Current Beneficiary Survey (N=14,887), we characterized the differences between cancer survivors and those without a cancer history in FL, current amount of PA, and current amount of PA compared to PA one year prior. Respondents rated FL on a 1-5 scale (1=no difficulty, 5=can’t do): stooping, crouching, or kneeling (stoop), carrying objects up to 10 lbs (lift), extending arms above shoulder level (reach), grasping small objects (grasp), and walking ¼ of a mile (walk). Frequency of walking for a least 10 minutes (1-5 rating scale; 1=daily, 5=never), weekly participation in PA, exercise, or sports (yes/no), and time spent doing moderate or vigorous PA (hrs/wk) were reported. Multivariate logistic regression was used to determine associations. Results: Of the 14,887 participants, 2,603 (6%) reported a history of cancer. Compared to those without a cancer history, a greater proportion of cancer survivors reported having difficulty or being unable to stoop, lift, reach, grasp or walk (all p&lt;0.01). Cancer survivors who had more FL were less likely to engage in PA (all p&lt;0.01). Cancer survivors reported a lower frequency of walking at least 10 minutes at a time (p&lt;0.01). Cancer survivors were more likely to decrease PA from the previous year (p&lt;0.01) and spent less time doing moderate (p=0.01) or vigorous activity (p&lt;0.01) than those without a cancer history. Conclusions: Older cancer survivors engage in less PA and are at greater risk of FL than those without a history of cancer. This may lead to reduced independence, a greater risk of cancer recurrence, and reduced survival. Therefore, PA interventions are important in this population.

Analgesic Use for Knee and Hip Osteoarthritis in Community-Dwelling Elders

To examine the prevalence and correlates of non-opioid and opioid analgesic use and descriptively evaluate potential undertreatment in a sample of community-dwelling elders with symptomatic knee and/or hip osteoarthritis (OA). Cross-sectional. Health, Aging, and Body Composition Study. Six hundred and fifty-two participants attending the year 6 visit (2002-03) with symptomatic knee and/or hip OA. Analgesic use was defined as taking ≥1 non-opioid and/or ≥1 opioid receptor agonist. Non-opioid and opioid doses were standardized across all agents by dividing the daily dose used by the minimum effective analgesic daily dose. Inadequate pain control was defined as severe/extreme OA pain in the past 30 days from a modified Western Ontario and McMaster Universities Osteoarthritis Index. Just over half (51.4%) reported taking at least one non-opioid analgesic and approximately 10% was taking an opioid, most (88.5%) of whom also took a non-opioid. One in five participants (19.3%) had inadequate pain control, 39% of whom were using <1 standardized daily dose of either a non-opioid or opioid analgesic. In adjusted analyses, severe/extreme OA pain was significantly associated with both non-opioid (adjusted odds ratio [AOR] = 2.44; 95% confidence interval [95% CI] = 1.49-3.99) and opioid (AOR = 2.64; 95% CI = 1.26-5.53) use. Although older adults with severe/extreme knee and/or hip OA pain are more likely to take analgesics than those with less severe pain, a sizable proportion takes less than therapeutic doses and thus may be undertreated. Further research is needed to examine barriers to optimal analgesic use.

Cinical research Reliability and validity of the Repeatable Battery for the Assessment of Neuropsychological Status in community-dwelling elderly

IntroductionThe Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used screening instrument in neuropsychological assessment and is a brief, individually administered measure. The present study aims to assess the reliability and validity of the Chinese version of the RBANS in community-dwelling elderly.Material and methodsAll subjects come from the community-dwelling elderly in Shanghai, China. They completed a questionnaire concerning demographic information, the mini-mental state examination (MMSE) and the Chinese version of the RBANS. To test for internal consistency, Cronbach's α was calculated for all six RBANS indices. Correlations between each of the RBANS and MMSE subtests were conducted to measure the concurrent validity. A confirmatory factor analysis (CFA) was conducted to test the construct validity.ResultsThe final sample of participants included 236 community-dwelling elderly. The mean total score on the RBANS was 86.02 (±14.19). The RBANS total score showed strong internal consistency (r = 0.806), and the coefficient α value for each of the RBANS scales ranged from 0.142 to 0.727. The total RBANS score was highly correlated with that of the MMSE (r = 0.594, p<0.001), and the RBANS subtests also demonstrated strong correlations with most of the MMSE subtests. The results of the CFA indicated an acceptable fit between the Chinese version of the RBANS and the original.ConclusionsThe Chinese version of the RBANS had relatively good reliability and validity in a community-dwelling elderly sample. It may be a useful screening instrument for conducting cognitive assessments in community-dwelling elderly.

P4-050: Race, depression, APOE, and dementia in a biracial sample of community dwelling elders

P4-050: Race, depression, APOE, and dementia in a biracial sample of community dwelling elders

Racial differences in the frequency of depressive symptoms among community dwelling elders: The role of socioeconomic factors

In a biracial sample of community dwelling elders (n = 4162, the Duke EPESE), African-Americans endorsed more items than Whites on a standardized depression scale, the CES-D, in unadjusted, cross-sectional analyses. However, indices of socioeconomic status (e.g., education and problems meeting needs) were found to mediate the relationship between race and depression. When these socioeconomic variables were included in cross-sectional analyses, the association between depressive symptoms and race reversed such that Whites were significantly more likely to endorse depressive symptoms than African-Americans. Further, whereas in unadjusted, longitudinal analyses, race was unrelated to changes in depressive symptoms over time, with the inclusion of the socioeconomic variables Whites were found to endorse more depressive symptoms than African-Americans. We conclude that socioeconomic variables influence the size and direction of racial differences in the endorsement of depressive symptoms in community dwelling elders.

Prevalence and risk factors for depressive symptoms among community-dwelling elders in Taiwan

Depression in the elderly has become a serious health care issue worldwide. However, no studies have determined the prevalence and risk factors for depressive symptoms among a representative sample of community-dwelling elders in Taiwan. To determine the prevalence and risk factors for depressive symptoms among community-dwelling elders in Taiwan. Stratified random sampling was used to recruit a representative sample of 1200 elderly participants from northern, middle, southern, and eastern regions of Taiwan. The prevalence of depressive symptoms was 27.5%. Logistic regression analysis demonstrated that having a respiratory disease, poor cognitive function, poor social support network, dissatisfaction with living situation, perception of poor health status, and perceived income inadequacy were significant predictors of depressive symptoms in this sample. The risk factors for depression identified in this study need to be considered when assessing the health of elderly persons. In addition, interventions to reduce depressive symptoms in elders should include strategies to change some of these modifiable risk factors.

The Bath! Reassessing a Familiar Elixir in Old Age

The Bath! Reassessing a Familiar Elixir in Old Age

Caregiving Network Compositions and Use of Supportive Services by Community-Dwelling Dependent Elders

This study examines the effect of characteristics of the caregiving network on the likelihood of using supportive services by dependent older persons. Logistic regression analysis was conducted with a probability sample of community-dwelling elders cared for by their wives or daughters (n = 209). Results indicate that the specific composition of the caregiving networks, including the identity of the primary caregiver (wives vs. daughters), the availability and identity (kin or friends) of secondary helpers determines the likelihood of service use. The findings suggest that elders cared for by their wives alone may be quite isolated and should be the priority for community outreach services.

Measuring disability with parsimony: evidence for the utility of a single item

Purpose: To provide evidence for the utility of a single item measure designed to quantify disability in the past 30 days.Method: Australian data from studies comprising a community-dwelling elderly sample (N = 328) and a sample of chronic osteoarthritis (OA) patients (N = 119) are reported. Degree of disability was classified as 0 – 30 days, 0 vs. 1 or more days, and 0 – 9 vs. 10 or more days. Associations between disability and a range of demographic, health-related, and psychological variables were assessed.Results: Participants with OA reported a significantly higher level of disability than participants from the community sample regardless of how disability was classified. Modest levels of association were noted between the number of disability days (0 – 30) and both health and psychological indices in both samples. The three alternative classifications of disability made little difference to the significance of associations. On balance, the comparison of 0 – 9 vs. 10 or more days appeared the more predictive classification of disability.Conclusions: The performance of the single item measure of disability was generally very satisfactory. Future investigations into the clinical application of the item across a range of patient groups are encouraged.