Archives of Gerontology and Geriatrics

Editorial Board

2009-11-01

Investigation on status and influential factors of cognitive function of the community-dwelling elderly in Changsha City

Shuqiao Yao, Hui Zeng, Shuiying Sun — 2009-01-05

Abstract: The present study describes the results of investigations on the cognitive status and the influential factors of cognitive function in the community-dwelling elderly of Changsha City, China. Analyzing data of 1000 subjects over 60 years of age was collected by the self-designed demographic information sheet, the Mini-Mental State Examination (MMSE) and Activity of Daily Living (ADL) scales. The result showed that MMSE mean score was 24.35±4.91, ranging from 4 to 30; there were 275 subjects with cognitive impairments of various extents. These results reveal that the elderly in this study differed quite strongly in their cognitive function; over one-fourth of them showed slight to severe cognitive impairment. Moreover, the influential factors such as gender, age, marriage status, education level, occupation, income, hobby, caregivers, medical history, self-appraised health, and ADL were detected. Of these parameters, age, education level, gender, self-appraised health, ADL, medical history, and caregivers were the striking influential factors.

Home environmental problems and physical function in Taiwanese older adults

Tzuo-Yun Lan, Shwu-Chong Wu, Wen-Chiung Chang, Ching-Yu Chen — 2009-01-06

Abstract: Environmental hazards play an important role in the disablement process. The purpose of this study was to investigate the relationship between home environmental problems and personal physical function. Data were based on a two-stage nationwide survey and evaluation on the needs of long-term care in Taiwan. A total of 10,596 individuals aged 65 and over were included in this study. These participants were identified with physical or cognitive problems at the screening interview and further evaluated at the second interview on health condition, functional status, needs of long-term care, and home environmental problems. Six items of environmental hazards were assessed at the participants’ homes with direct observation. The prevalence rates of home environmental problems were similar among older adults with different levels of physical function. No grab bars (79.6–85.1%) and no protections against slip (81.9–92.8%) in the bathroom were two commonly present hazards in older adults’ homes. Older adults with a higher income (Odds ratio=OR=0.75), without income information (OR=0.78) or living with other persons (OR=0.74) were less likely to experience environmental problems at home. Results from this study revealed that home environment condition was associated with factors other than personal disabling conditions for the elderly. Modifying home environment, especially the bathroom, should be attached with great importance for physically disabled older adults.

The effect of trust and change in trust on self-rated health: A longitudinal study among aging people

Olli Nummela, Tommi Sulander, Ossi Rahkonen, Antti Uutela — 2009-01-12

Abstract: This study examined whether trust predicted subsequent self-rated health over time at 3 years follow-up among aging people, and whether changes in trust were associated with self-rated health. Longitudinal, questionnaire-based data were collected from three age cohorts (born in 1926–1930, 1936–1940, and 1946–1950) living in the Province of Päijät-Häme, southern Finland. The response rate at the baseline in 2002 was 66% (n=2815). The follow-up was carried out in 2005, with 79% of eligible individuals participating (n=2216). Logistic regression analyses were used to derive the results. High trust was a strong predictor for good self-rated health at the follow-up. Adjusting for background variables, however, attenuated the association. In addition, good self-rated health was most common among men with sustained high trust, among women the association was somewhat weaker. Among men improvement in trust was associated with good self-rated health, but this correlation weakened after multiple adjustments. Thus, longitudinally trust is an important contributor to self-rated health among aging people. Moreover, improvement of trust but also the stability of high trust especially among men indicate better self-rated health. Trust has a positive effect on health and should therefore be seen as a significant element in health promotion.

Effects of muscle strength and aerobic training on basal serum levels of IGF-1 and cortisol in elderly women

2009-01-09

Abstract: The aim of this study was to compare the effects of muscle strength and aerobic training on the basal serum levels of IGF-1 and cortisol in elderly women. The subjects were divided in three groups as follows. 1. Strength training group (SG) submitted to the weight training called 1-repetition maximum test (1-RM, 75–85%). This group contained 12 subjects of mean age=66.08±3.37 years; and body mass index (BMI)=26.0±3.72kg/m2. (2) Aerobic training group (AG) submitted to aquatic exercise; they were 13 subjects of the mean age=68.69±4.70 years; and BMI=29.19±2.96kg/m2. (3) A control group (CG) of 10 subjects, of mean age=68.80±5.41 years; BMI=29.70±2.82kg/m2. The training periods were 12 weeks, Fasting blood was analyzed to measure IGF-1 and basal cortisol levels (by chemiluminescence method), both at the beginning and the end of the intervention. Student's t-test revealed increased IGF-1 in the SG (p<0.05) compared to the other two groups. Repeated-measure ANOVA showed also elevated IGF-1 (p<0.05) in the SG compared to the other groups (AG and CG). There were no differences in cortisol levels. In conclusion, high-intensity training caused changes in IGF-1. This suggests that strength training may provoke anabolic effects in elderly individuals.

Calculated serum calcium is an insufficient surrogate for measured ionized calcium

Mikko P. Björkman, Antti J. Sorva, Reijo S. Tilvis — 2009-01-12

Abstract: Direct measurement of serum-ionized calcium (Ca2+) is the best available method to assess ‘true’ calcemia because serum total calcium is confounded by serum proteins, mainly albumin. However, calculated surrogates for Ca2+, albumin-adjustment particularly, have been widely used in the literature despite their insufficiency to evaluate calcemic status accurately. Recently, a new formula, in which serum total protein instead of albumin is used for adjustment of total calcium, has been suggested for very old hospitalized patients. We compared these two surrogates for Ca2+ with the direct measurement in both frail bedridden inpatients and in a general aged population. Both surrogates were equally insufficient in detecting hypocalcemia in both patient groups. However, the sensitivity and specifity for detecting hypercalcemia by both surrogates were relatively high in the bedridden inpatients. Precise assessment of calcemic status is particularly needed in research and in detecting mild hypo- or hypercalcemia. However, the calculated surrogates for Ca2+ have consistently failed in accurate assessment of ‘true’ calcemia. Thus, the direct measurement of Ca2+ should be favored instead of readily available automated surrogates. Adjustments of calcium for albumin or total protein may be useful in clinical practice in excluding hypercalcemia in very old bedridden patients, only.

Relationship between clinical phenotypes and cognitive impairment in Parkinson's disease (PD)

Joo Young Oh, Ye-Sung Kim, Byung Hee Choi, Eun Hee Sohn, Ae Young Lee — 2009-01-12

Abstract: Most patients with idiopathic PD (IPD) show variable degrees of cognitive decline. The purpose of this study was to evaluate the relationship between the predominant motor symptom at the time of disease onset and the level of cognitive function in patients with IPD. A total of 159 patients with IPD were enrolled in this study. The patients’ initial motor symptoms were classified into three types: tremor-dominant (TD), bradykinesia and rigidity-dominant (BRD), gait and postural instability-dominant (GPD). Disease severity was rated according to the Hoehn–Yahr classification (H&Y stage). Overall cognitive status was evaluated using the Korean versions of the Mini-Mental State Examination (K-MMSE) and the Modified Mini-Mental State (3MS) tests. The GPD group showed the lowest scores of the K-MMSE/3MS, and the patients with TD showed the best performance in the cognitive analysis (p<0.05). The patients who were older at disease onset showed worse cognitive performance than those the patients who were younger at disease onset (p<0.05). There was no difference in cognitive status according to H&Y stages. The accurate classification of initial motor symptoms and the detailed history, including the exact onset age of IPD, may allow us to predict cognitive decline in IPD.

Biopsychosocial differences between drivers and non-drivers over the age of 74

2009-01-09

Abstract: The growing aging population will lead to an increased number of elderly drivers. There are few epidemiological studies that have approached this issue. Our aim was to compare the biopsychosocial characteristics of elderly drivers vs. elderly non-drivers. The method was a door-to-door population-based cross-sectional study of a sample consisting of inhabitants over 75 years of age in the Anglés (Girona) Basic Healthcare Area. The study protocol included an extensive biopsychosocial assessment using standardized instruments. Descriptive and logistic regression analyses were performed to identify the variables associated with driving. A total of 875 inhabitants participated in the study (82%). The prevalence of drivers in this age group was 24.8% (95% confidence interval—CI=21.9–27.7). The variables associated with driving were age, sex, visual acuity, physical self-concept and cognitive and functional capacity. Of the drivers, 45.8% (CI=38.9–52.7) were undergoing treatment with central nervous system drugs. The findings of this study suggest that age, gender, visual acuity, functional independence, preserved cognitive functioning and positive physical self-concept are correlated to the driving ability in elderly aged 75 years and over. Implications for driving practices related with these variables are discussed.

Two years adherence to anti-osteoporotic medications in postmenopausal Israeli women

Elena Segal, Sophia Ish-Shalom — 2009-01-15

Abstract: Treatment of postmenopausal osteoporosis comprises a major public health challenge requiring adherence to long-term therapy in order to prevent fractures and disability. The aim of this work was to assess long-term adherence to anti-osteoporosis treatments in Israeli postmenopausal women. We assessed 178 consecutive Metabolic Bone Diseases Unit patients, aged 67.4±8.5, treated with alendronate or raloxifene. Adherence was assessed at a clinic visit after 6 months and by telephone survey 2 years after starting the therapy. After 6 months 137 (77%) patients were adhered to the treatment; 41(23%) discontinued it. Two years after initiating the therapy 78 (43.8%) continued the treatment, 39 (21.9%) discontinued it, 17 (9.6%) changed the initial drug to another anti-osteoporosis therapy, 21 (11.8%) lost to follow-up. Of 41 patients reported treatment discontinuation at 6 months 17 (41.5%) restarted the treatment with one of the anti-resorbing medications. Age, family history of osteoporosis and previous fracture history have not influenced patients’ adherence. Conclusion: Two years after the initiation of fracture prevention treatment, it was discontinued by one fifth of the patients. Neither age nor disease-related factors such as family history of osteoporosis, previous fracture history or the degree of bone loss influenced patients’ decision to adhere to treatment.

Low patient compliance—A major negative factor in achieving vitamin D adequacy in elderly hip fracture patients supplemented with 800IU of vitamin D3 daily

Elena Segal, Chaim Zinman, Batia Raz, Sophia Ish-Shalom — 2009-01-15

Abstract: Achievement of adequate vitamin D3 level is crucial for the treatment of hip fracture patients. Currently used vitamin D3 supplementation in Israel ranges between 200 and 800IU/day. The study objectives were to evaluate the effects of 800IU/day vitamin D3 and 1.200mg of calcium carbonate supplementation to achieve adequate vitamin D3 level of 30ng/ml in elderly hip fracture patients. One hundred and twenty-two elderly patients after surgical hip fracture correction aged 73.0±9.5, who were enrolled in a post-surgical treatment program (PSTP). The patients received 800IU of vitamin D3 and 1.200mg of calcium carbonate daily. Serum 25(OH)D and plasma PTH levels were assessed during initial hospital stay and at quarterly follow-up visits for 2 years. At baseline, 120 patients (98.4%) had 25(OH)D serum level <30ng/ml. Forty-two patients (34.4%) had 25(OH)D serum level <10ng/ml and these were considered as vitamin D3 deficient. After 3 months, 29 patients (23.8%) were fully adherent to the supplement, 32 were (26.2%) partially adherent. The dropout rate at 1 year was 55.7%. The major reason for the discontinuation of participation was non-compliance. We conclude that the majority of elderly hip fracture patients had inadequate 25(OH)D serum levels. Compliance with calcium and vitamin D3 supplements was extremely low. An adequate vitamin D status was not achieved with daily vitamin D3 supplementation of 800IU. Supplementation strategies using a periodic single high dose of vitamin D3 might be more appropriate and should be considered in these patients.

Quality of life (QOL) axiological profile of the elderly population served by the Family Health Program (FHP) in Brazil

2009-01-21

Abstract: With the purpose of optimizing the satisfaction of the elderly subjects, either existential or not, presenting their unique preference, this research aimed to evaluate the effects of aging on QOL of the aged persons, served by the FHP. The basic intention was to establish parameters of QOL-impact on aging. Our sample was a non-selected population of aged volunteers from Perequê-Mirim-I Family Health Unity, in Caraguatatuba, São Paulo, Brazil. In this correlational descriptive research, the elderly subjects answered a questionnaire on QOL, specific to the aged persons (WHOQOL-OLD). These answers revealed the degree to which of the six facets of WHOQOL-OLD was given priority. The dimensional techniques of descriptive statistics (mean±S.D., median, coefficient of variation) normality evaluation (Kolmogorov–Smirnov), and inferential statistical techniques (Z-score test, χ2) were adopted, considering the level-II error=10% and accepting level-I error=5%. The main results revealed a correlation between the income and QOL. Death and dying appeared to be a substantial preoccupation, opposed to intimacy that raised the QOL level. It is suggested that any works directed to the elderly population should take in consideration the self-evaluation of aging effects on QOL.

An explanatory mechanism for the different decline in limb strength in older women

Leandro Ferrreira, Sebastião Gobbi, Lilian Teresa Bucken Gobbi — 2009-01-22

Abstract: The aim of the study was to compare the physical activity level and intensity of the upper and lower limbs in Brazilian women who are usually active, functionally independent, and living in a medium size city. Seventy-two women were assigned into a younger group (YG; n=38; mean age 23.08±2.80 years) and older group (OG; 60.68±7.16 years; n=34) groups. To discriminate the physical activity level of the upper and lower limbs, a daily activity record questionnaire (DARQ) was developed based on Bouchard's three-day physical activity record (3-day PAR). When compared to the YG, the OG presented: (a) higher levels of daily physical activity for upper limbs compared to the lower limbs and (b) higher levels of perceived exertion for both sets of limbs. In conclusion, these results suggest that women change their inter-limb pattern of daily physical activity with age; that is, they increase upper limb activity and decrease lower limbs activity. Furthermore, they decrease the exertion intensity for both sets of limbs. These findings may help to explain the more accentuated decline in lower limbs muscle strength during the aging process.

Efficacy of oxycodone/acetaminophen and codeine/acetaminophen vs. conventional therapy in elderly women with persistent, moderate to severe osteoarthritis-related pain

2009-01-19

Abstract: We aimed to evaluate the efficacy and safety of oxycodone/acetaminophen (O/A) and codeine/acetaminophen (C/A) vs. conventional therapy (CT) without opioids in older women suffering from osteoarthritis (OA)-related pain, sub-optimally responsive to prior conventional treatments. We performed a 6 week, randomized, single blind, controlled study in three nursing homes. We enrolled 154 women with painful OA. They were assigned to treatment with O/A (n=52) and C/A (n=52) vs. CT (n=50). We evaluated at baseline and at week 6: average pain in the last week (mean pain, MeP), pain at rest (RP), pain in movement (MP) (numeric rating scale, NRS); depressive symptoms (Beck Depression Inventory-II, BDI-II); functional status (activities of daily living, ADL) and cognitive status (mini mental state evaluation, MMSE). We considered the adverse events (AEs) in the study period. At week 6, MeP, RP and MP were significantly reduced in all three groups (p<0.001); compared to CT, O/A and C/A were associated with greater reductions in MeP (p<0.001 and p=0.004, respectively), in RP (p=0.028 and p=0.032, respectively) in MP (p<0.001 and p=0.002, respectively) and with significant improvement in BDI-II score (p=0.05 and p=0.04, respectively) and ADL value (p=0.04 and p=0.05, respectively). AE rates did not differ between groups.

Comparison of three statistical methods for analysis of fall predictors in people with dementia: Negative binomial regression (NBR), regression tree (RT), and partial least squares regression (PLSR)

Staffan Eriksson, Anders Lundquist, Yngve Gustafson, Lillemor Lundin-Olsson — 2009-01-27

Abstract: Searching for background factors associated with falls in people with dementia is difficult because the population is heterogeneous. The aim of this study was to compare the efficacies of three statistical methods for analysis of fall predictors in people with dementia. NBR, RT and PLSR analyses were compared. Data used for the comparison were from a prospective cohort study of 192 patients at a psychogeriatric ward, specializing in patients with cognitive impairment and related behavioral and psychological symptoms. Seventy-eight of these patients fell a total of 238 times. PLSR and RT analyses are directed at finding patterns among predictor variables related to outcome, whereas an NBR model is directed at finding predictor variables that, independent of other variables, are related to the outcome. The NBR analysis explained an additional 10–15% variation compared with the PLSR and RT analyses. The results of PLSR and RT show a similar plausible pattern of predictor variables. However, none of these techniques appears to be sufficient in itself. In order to gain patterns of explanatory variables, RT would be a good complement to NBR for analysis of fall predictors.

Falls in very old people: The population-based Umeå 85+ Study in Sweden

2009-01-14

Abstract: The aim of this study was to describe incidences of falls and fall-related injuries, and to identify predisposing factors for falls in very old people in a prospective population-based follow-up study for falls. The study is part of the Umeå 85+ Study which includes half of the population aged 85, and the total population aged 90 and ≥95 (−103), in Umeå, Sweden. Of the 253 people interviewed, 220 (87%) were followed up for falls for 6 months, of whom 109 lived in ordinary and 111 in institutional housing. A comprehensive geriatric baseline assessment was made through interviews and testing during home visits. Forty percent of the participants did fall a total 304 times, corresponding to 2.17 falls per Person Year (PY). It occurred 0.83 injuries per PY, including 0.14 fractures per PY. In a Cox regression analysis, the independent explanatory risk factors for time to first fall were dependency in activities of daily living (ADL), thyroid disorders, treatment with selective serotonin reuptake inhibitors (SSRIs) and occurrence of falls in the preceding year. It could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture within 1 year. ADL, thyroid disorders and treatment with SSRIs should be considered in fall prevention programmes.

Comparison and correlates of participation in older adults without disabilities

2009-01-12

Abstract: This study was conducted to compare, by age group and gender, the level of participation of older adults who had no disabilities, and to determine which characteristics are most associated with participation. This study involved 350 randomly recruited community-dwelling older adults. Participation in daily activities and social roles were measured with the Assessment of Life Habits (LIFE-H). Demographic, health-related and environmental data were also collected. A decline with age was observed in four of the six daily activities domains and two of the four social roles domains of participation. However, these lower scores are mainly explained by the 85+ group, which consistently scored lower than the 65–69-year-old group. No differences were found between the 65–69, 70–74 and 75–79 years old groups. Some participation domains differed according to gender. Satisfaction with participation was high and did not differ between age groups. Characteristics most associated with participation vary according to the domains; generally, age and marital status are the best determinants of participation. This study found that most of older adults have an unrestricted level of participation which decreases only late in the aging process. This reduction in participation in very old adults was not accompanied by a decrease in satisfaction, supporting the hypothesis that they can participate satisfactorily in valued activities.

Functional assessment and health-related quality of life (HRQOL) of elderly patients on the basis of the functional assessment of chronic illness therapy (FACIT)-F questionnaire

Marta Muszalik, Kornelia Kędziora-Kornatowska, Tomasz Kornatowski — 2009-01-29

Abstract: Elderly patients represent a significant part of all the patients in various hospital wards. They also suffer from many diseases. Maintenance of their everyday independence, treatment, rehabilitation and improvement of their HRQOL is the main goal of geriatric care in the world, and also in Poland. Performing a comprehensive geriatric assessment for each elderly patient to identify their needs and problems is a standard procedure. The goal of this research was a functional assessment of the influence of social and clinical factors on HRQOL in elderly people. The aim of the study was to assess the influence of social and clinical factors on the functional state and HRQOL in elderly people. The study group was recruited among hospitalized patients in the Department and Clinic of Geriatrics, 64 women and 60 men, for a total of 124 people. The mean age of the study group was 72.1 years. The research was carried out using a diagnostic poll method with the application of FACIT-F questionnaire. The results of FACIT-F for the study group were running at an average level and were dependent on age, marital status, education level and duration of the illness. Correlations were found between the FACIT-F results and the following expectations of the patients: treatment, rehabilitation and information given about treatment, alleviating pain, referral to social care, organizing home care. Results of FACIT-F were dependent on activities of daily living (ADL) scores in the study group.

Functional decline after prolonged bed rest following acute illness in elderly patients: Is trunk control test (TCT) a predictor of recovering ambulation?

2009-02-09

Abstract: Authors wanted to assess the predictive value of the trunk control test (TCT) on recovering ambulation in elderly patients who have developed walking disability. The study design was a prospective study performed in a hospital-based intermediate-care unit. Twenty-one patients (mean age 78.5±6.7 years) were investigated, who had developed walking disability after prolonged bed rest for an acute condition. A comprehensive geriatric assessment with functional status evaluation, based on the activities of daily living (ADL) (expressed as Barthel index=BI), and instrumental activities of daily living (IADL) (expressed as Lawton index=LI), cognitive function (Mini-Mental State Examination-Folstein=MMSE), depression (Geriatric Depression Scale=GDS) and comorbidity (Charlson comorbidity index=CCI) was performed within 72h after admission. A specialist in physical medicine and rehabilitation designed a rehabilitation program. TCT was performed in all patients before they started the program. The mean TCT score of the 21 patients was 52.7±22.9 (range: 0–100), while this score was 47.3±16.9 in the 15 patients who recovered ambulation, and 66.2±31.4 in the rest who did not (p=0.08). No statistically significant differences were observed either in subtotal scores of the TCT between groups. Furthermore, none of the TCT cutoff point was significantly associated with recovery. Cognitive function assessed by the MMSE was significantly better in patients who recovered, than in those who did not (23.4±3.9 vs. 17.8±5.2; p<0.02). Our conclusion is that TCT has not proved to be a predictor of recovering ambulation in elderly patients. In the present study, cognitive function was significantly associated with recovery after prolonged bed rest.

Analysis of multimorbidity in individual elderly nursing home residents. Development of a multimorbidity matrix

Gunnar Akner — 2009-01-30

Abstract: The chronic multimorbidity in individual elderly people is rarely documented in its entirety in present medical records, neither as cross-sectional overview nor as longitudinal time-course of various health problems. This obviously hampers an integrated clinical analysis. This work was aimed at evaluating the chronic multimorbidity in individual elderly patients and developing a method to map, quantify and grade the prevalence of the multimorbidity. An explorative study in 70 nursing home residents (55 women), mean age 85 was performed. Information on health problems was obtained through history, clinical examination and medical records. A 19-item multimorbidity matrix that maps, quantifies and grades the chronic morbidity in individual patients is presented. The 70 residents exhibited 275 different health problems; the top 3 items being neuropsychiatric, cardiovascular and gastrointestinal ones. The residents had a mean of 17 different chronic health problems and were prescribed a mean of 6.6 continuous medications per day. There was a significant correlation between the number of continuous drug prescriptions and both quantitative and graded multimorbidity-scores. The presented multimorbidity matrix provides a useful taxonomic overview over the health situation in individual multimorbid elderly and constitutes the basis for ongoing work to develop and renew the electronic health record into an “interactive health analysis system”.

Volume Contents

2009-11-01

Author Index

2009-11-01