Long-term effects of childhood abuse on the quality of life and health of older people: results from the Depression and Early Prevention of Suicide in General Practice Project

OBJECTIVES: To determine whether childhood physical and sexual abuse are associated with poor mental and physical health outcomes in older age.
DESIGN: Cross-sectional, postal questionnaire survey.
SETTING: Medical clinics of 383 general practitioners (GPs) in Australia.
PARTICIPANTS: More than 21,000 older adults (aged ≥60) currently under the care of GPs participating in the Depression and Early Prevention of Suicide in General Practice (DEPS-GP) Study. Participants were divided into two groups according to whether they acknowledged experiencing childhood physical or sexual abuse.
MEASUREMENTS: Main outcome measures targeted participants' current physical health (Medical Outcomes Study 12-item Short Form Survey, Version 2 and Common Medical Morbidities Inventory) and mental health (Patient Health Questionnaire-9 and Hospital Anxiety and Depression Scale).
RESULTS: One thousand four hundred fifty-eight (6.7%) and 1,429 participants (6.5%) reported childhood physical and sexual abuse, respectively. Multivariate models of the associations with childhood abuse indicated that participants who had experienced either childhood sexual or physical abuse had a greater risk of poor physical (odds ratio (OR)=1.35, 95% confidence interval (CI)=1.21–1.50) and mental (OR=1.89, 95% CI=1.63–2.19) health, after adjustments. Older adults who reported both childhood sexual and physical abuse also had a higher risk of poor physical (OR=1.60, 95% CI=1.33–1.92) and mental (OR=2.40, 95% CI=1.97–2.94) health.
CONCLUSION: The effects of childhood abuse appear to last a lifetime. Further research is required to improve understanding of the pathways that lead to such deleterious outcomes and ways to minimize its late-life effects.     

Amount of social contact and hip fracture mortality

OBJECTIVES: To study the association between amount of social contact and mortality after hip fracture in elderly participants.
DESIGN: Prospective cohort.
SETTING: Community residents of Baltimore, Maryland.
PARTICIPANTS: Six hundred seventy-four elderly participants.
MEASUREMENTS: Amount of telephone and direct personal contact between participants and their relatives and friends and mortality up to 2 years after fracture.
RESULTS: No social contact with friends during the 2 weeks before the fracture was associated with a five times greater risk of death over 2 years than daily contact with friends during the 2 weeks before the fracture (hazard ratio (HR)=5.04, 95% confidence interval (CI)=2.75–9.23). Participants with less than daily contact were also at greater risk of dying, although the CI spanned 1 (HR=1.76, 95% CI=0.99–3.13). Participants who had no contact with family members prefracture were more than twice as likely to die as those who communicated daily during the 2 weeks before fracture (HR=2.26, 95% CI=1.36–3.77). Participants who had less than daily contact were also more than twice as likely to die (HR=2.55, 95% CI=1.65–3.94).
CONCLUSION: This study suggests that lower social contact before hip fracture is associated with poorer survival after 2 years.     

Self-Reported Sleep and Nap Habits and Risk of Mortality in a Large Cohort of Older Women

OBJECTIVES: To determine the association between self-reported sleep and nap habits and mortality in a large cohort of older women.
DESIGN: Study of Osteoporotic Fractures prospective cohort study.
SETTING: Four communities within the United States.
PARTICIPANTS: Eight thousand one hundred one Caucasian women aged 69 and older (mean age 77.0).
MEASUREMENTS: Sleep and nap habits were assessed using a questionnaire at the fourth clinic visit (1993/94). Deaths during 7 years of follow-up were confirmed with death certificates. Underlying cause of death was assigned according to the International Classification of Diseases, Ninth Revision, Clinical Modification.
RESULTS: In multivariate models, women who reported napping daily were 44% more likely to die from any cause (95% confidence interval (CI)=1.23–1.67), 58% more likely to die from cardiovascular causes (95% CI=1.25–2.00), and 59% more likely to die from noncardiovascular noncancer causes (95% CI=1.24–2.03) than women who did not nap daily. This relationship remained significant in relatively healthy women (those who reported no comorbidities). Women who slept 9 to 10 hours per 24 hours were at greater risk of death from cardiovascular and other (noncardiovascular, noncancer) causes than those who reported sleeping 8 to 9 hours.
CONCLUSION: Older women who reported napping daily or sleeping at least 9 hours per 24 hours are at greater risk of death from all causes except cancer. Future research could determine whether specific sleep disorders contribute to these relationships.     

Relationship Between Higher Estradiol Levels and 9-Year Mortality in Older Women: The Invecchiare in Chianti Study

OBJECTIVES: To investigate the relationship between total estradiol (E2) levels and 9-year mortality in older postmenopausal women not taking hormone replacement therapy (HRT).
DESIGN: Population-based study of persons living in the Chianti geographic area (Tuscany, Italy).
SETTING: Community.
PARTICIPANTS: A representative sample of 509 women aged 65 and older with measures of total E2.
MEASUREMENTS: Serum total E2 was measured at the University of Parma using ultrasensitive radioimmunoassay (RIA).
RESULTS: Women who died (n=135) during 9 years of follow up were older; had higher total E2 levels; and were more likely to have evidence of stroke, hypertension, diabetes mellitus, and congestive heart failure at baseline than survivors. Higher E2 levels were associated with a greater likelihood of death (hazard ratio (HR)=1.03, 95% confidence interval (CI)=1.01–1.06), and the relationship was independent of age, waist:hip ratio, C-reactive protein, education, cognitive function, physical activity, caloric intake, smoking, and chronic disease (HR=1.08 pg/mL, 95% CI=1.03–1.13, P =.003). The excessive risk of death associated with higher total E2 was not attenuated after adjustment for total testosterone (HR=1.12, 95% CI=1.02–1.18, P <.001) and after further adjustment for insulin resistance evaluated using the homeostasis model assessment (HR=1.07, 95% CI=1.03–1.17, P <.001).
Total E2 was highly predictive of death after more than 5 years (HR=1.42: CI 1.01–1.91, P =.04) and not predictive of death for less than 5 years ( P =.78).
CONCLUSION: Higher total E2 concentration predicts mortality in older women not taking HRT.     

Chewing problems and mortality in older adults in home care: results from the Aged in Home Care study

OBJECTIVES: To assess the association between chewing problems and risk of mortality in an older population receiving home care in Europe.
DESIGN: Retrospective cohort study.
SETTING: Eleven European countries.
PARTICIPANTS: Two thousand seven hundred fifty-five older adults (mean age±standard deviation 82.2±7.2) in home care.
MEASUREMENTS: Data were collected using the Minimum Data Set for Home Care. Study personnel recorded chewing problems (inability to chew food easily and without pain or difficulties, regardless of cause) that presented in the last 3 days before baseline assessment. Data on mortality were collected over a 1-year period.
RESULTS: Three hundred ninety-five participants (14.3%) presented with chewing problems. One-year mortality differed significantly according to presence of chewing problems; 303 of 2,361 (12.8%) without chewing problems (crude incident rate per person-year (p-y)=0.15) and 80 of 394 (20.3%) participants with chewing problems (crude incident rate per p-y=0.24) died during follow-up. After adjusting for potential confounders, the risk of death was significantly higher for participants with chewing problems (adjusted hazard ratio (HR)=1.45, 95% confidence intervals (CI)=1.05–1.99). This association remained after exclusion of participants with cognitive impairment (adjusted HR=1.50, 95% CI=1.03–2.20) and those with unintended weight loss (adjusted HR=1.62, 95% CI=1.12–2.34).
CONCLUSION: In older adults in home care in Europe, chewing problems are associated with greater risk of mortality.     

The Poor Outcome of Ischemic Stroke in Very Old People: A Cohort Study of Its Determinants

OBJECTIVES: To assess how much of the excess risk of poor outcome from stroke in people aged 80 and older aging per se explains, independent of other prognostic determinants.
DESIGN: Cohort, observational.
SETTING: University hospital.
PARTICIPANTS: One thousand five hundred fifty-five patients with first-ever ischemic stroke consecutively referred to an in-hospital Clinical Pathway program were studied.
MEASUREMENTS: The relationship between age and 1-month outcome (death, disability (modified Rankin Scale 3–5), and poor outcome (modified Rankin Scale 3–6)) was assessed, with adjustment for several prognostic factors.
RESULTS: Six hundred twelve patients aged 80 and older showed worse outcome after 1 month than those who were younger, in terms of mortality (19% vs 5%, hazard ratio (HR)=3.85, 95% confidence interval (CI)=2.8–5.4) and disability (51% vs 33%, odds ratio (OR)=3.16, 95% CI=2.5–4.0), although in multivariate models, the adjusted HR for mortality decreased to 1.47 (95% CI=1.0–2.16) and the ORs for disability and poor outcome decreased to 1.76 (95% CI=1.32–2.3.) and 1.83 (95% CI=137–2.43), respectively. Stroke severity, the occurrence of at least one medical complication, and premorbid disability explained most of the risk excess in the oldest-old.
CONCLUSION: Stroke outcome is definitely worse in very old people, and most of the excess risk of death and disability is attributable to the higher occurrences of the most-severe clinical stroke syndromes and of medical complications in the acute phase. These represent potential targets for preventive and therapeutical strategies specifically for elderly people.     

Survival of Community-Dwelling Older People: The Effect of Cognitive Impairment and Social Engagement

OBJECTIVES: To examine the association and interaction between cognitive impairment and social support and mortality.
DESIGN: Prospective cohort study.
SETTING: Fifty-three family practices in the United Kingdom.
PARTICIPANTS: Community-dwelling people (aged ≥75) participating in the Medical Research Council Trial of the Assessment and Management of Older People in the Community (10,720 individual subjects analyzed).
MEASUREMENTS: Cognition was measured using the Mini-Mental State Examination. Social engagement was assessed using categorical data on marital status, living situation, availability of assistance, availability of a confidant, and frequency of social contact. The primary outcome was all-cause mortality.
RESULTS: The prevalence of cognitive impairment was 13.0% (mild) and 2.0% (moderate to severe). In Cox survival models (fully adjusted for physical health, lifestyle, daily function, and depression), there was a consistent association between greater cognitive impairment and mortality risk (mild cognitive impairment, hazard ratio (HR)=1.31, 95% confidence interval (CI)=1.21–1.40; moderate to severe cognitive impairment, HR=1.64, 95% CI=1.41–1.93. Mortality risk was greater in the medium (HR=1.09, 95% CI=1.02–1.16) and low social engagement groups (HR=1.17, 95% CI=1.05–1.29) than in those with the highest level of social engagement. Lower social engagement did not increase mortality risk in those who were more cognitively impaired.
CONCLUSION: Cognitive impairment and social support are independent risk factors for mortality. Interventions that promote early identification and management of cognitive impairment and enhance social support for older people may decrease mortality and produce public health benefits.     

Clinical Relevance of a Raised Plasma N-Terminal Pro-Brain Natriuretic Peptide Level in a Population-Based Cohort of Nonagenarians

OBJECTIVES: To investigate whether plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) remains a specific marker of cardiac illness in very old age and can be used to identify very elderly people at high risk for death independent of the presence of known cardiac diagnoses.
DESIGN: Prospective, observational, population-based follow-up study within the Leiden 85-Plus Study of a 2-year birth cohort (1912–1914).
SETTING: General population, municipality of Leiden, the Netherlands.
PARTICIPANTS: Two hundred seventy-four participants were followed up from age 90 onward (median follow-up 42.3 months, interquartile range 20.2–50.2 months).
MEASUREMENTS: Plasma NT-proBNP level, indicators of general health and functioning, and specific cardiac diagnoses at age 90 and mortality from age 90 onward.
RESULTS: Plasma levels of NT-proBNP were not correlated with indicators of poor health or poor functioning, but the level of NT-proBNP increased significantly with increasing numbers of cardiac diagnoses ( P <.001). High NT-proBNP was associated with overall mortality in participants with (hazard ratio (HR)=2.8, 95% confidence interval (CI)=1.5–5.2) and without (HR=3.5, 95% CI=1.6–7.5) specific cardiac diagnoses. This was also found for cardiovascular mortality risks (with specific cardiac diagnoses HR=4.1, 95% CI=1.5–11 vs without HR=5.6, 95% CI=1.0–30) and noncardiovascular mortality risks (with specific cardiac diagnoses HR=1.9, 95% CI=0.84–4.5 vs without HR=3.4, 95% CI=1.3–8.6).
CONCLUSION: Plasma NT-proBNP is a disease-specific marker of cardiac illness in nonagenarians and can possibly be used as a predictor of mortality in elderly people with and without specific cardiac diagnoses.     

Biomarkers of inflammation and malnutrition associated with early death in healthy elderly people

OBJECTIVES: To determine whether malnutrition and biomarkers of inflammation predict all-cause, cancer, and cardiovascular mortality in healthy elderly subjects.
DESIGN: Population-based study, prospective cohort.
SETTING: Sète, on the French Mediterranean coast.
PARTICIPANTS: Five hundred and fifty-three men and 888 women aged 60 and older from the Pathologies Oculaires Liées à l'Age cohort free of known comorbidities.
MEASUREMENTS: Plasma levels of cholesterol, albumin, transthyretin (TTR), C-reactive protein (CRP), and alpha 1-acid glycoprotein (AAG) were measured at baseline. To investigate the risks of 5-year (early) and 5- to 9-year (late) mortality, hazard ratios (HR) were evaluated using Cox models.
RESULTS: In men, early death was associated with high CRP and AAG and low albumin and TTR. In women, early death was associated with high AAG, low TTR and low cholesterol. For late death, the only significant association was with CRP in men. A synergistic effect was observed between biomarkers of inflammation and malnutrition. In men, the adjusted HR of early death was 4.98 (95% confidence interval (CI)=2.25–11.01) for both CRP in the highest quartile and albumin in the lowest. In men, this risk was greatest for both AAG in the highest quartile and TTR in the lowest (HR=6.86, 95% CI=3.20–14.71). In women, this risk was greatest for both AAG in the highest quartile and TTR in the lowest (HR=4.64, 95% CI=1.79–12.05). Cancer mortality was greater for high CRP and AAG and for low albumin and TTR in men but not in women.
CONCLUSION: Biomarkers of inflammation and malnutrition together predict early mortality. In healthy elderly subjects, TTR and AAG could be helpful in identifying elderly subjects at higher risk of death.     

Visual Field Loss and Risk of Fractures in Older Women

OBJECTIVES: To evaluate the associations between visual field loss and nonspine fractures.
DESIGN: Prospective cohort study.
SETTING: Community.
PARTICIPANTS: Four thousand seven hundred seventy-three community-dwelling white and African-American women aged 65 and older with no previous history of hip fracture at the time of recruitment.
MEASUREMENTS: Radiographically confirmed hip and nonspine, nonhip fractures identified from September 1997 to April 2008. Visual field loss was measured using a Humphrey Field Analyzer suprathreshold screening test of the peripheral and central vision of each eye and was classified into an ordinal rating of no, mild, moderate, or severe binocular visual field (BVF) loss.
RESULTS: For hip and nonspine, nonhip fractures and in unadjusted and covariate-adjusted analyses, the highest incidence of fractures was seen in women with the most-severe BVF loss. In covariate-adjusted analysis, women with mild, moderate, and severe BVF loss had a 49% (hazard ratio (HR)=1.49, 95% confidence interval (CI)=1.18–1.88), 25% (HR=1.25, 95% CI=0.87–1.80), and 66% (HR=1.66, 95% CI=1.19–2.32) greater risk, respectively, for hip fractures than women without BVF loss. Similarly, women with mild visual field loss had a 12% (HR=0.88, 95% CI=0.75–1.04) lower risk for nonspine, nonhip fractures, whereas women with moderate and severe visual field loss had a 18% (HR=1.18, 95% CI=0.92–1.52) and 59% (HR=1.59, 95% CI=1.24–2.03) greater risk of nonspine, nonhip fractures than women without BVF loss.
CONCLUSION: BVF loss is independently associated with hip and nonspine, nonhip fractures in older female volunteers.