Are All Commonly Prescribed Antipsychotics Associated with Greater Mortality in Elderly Male Veterans with Dementia?

OBJECTIVES: To estimate mortality risk associated with individual commonly prescribed antipsychotics. DESIGN: Five‐year retrospective study. SETTING: Veterans national healthcare data. PARTICIPANTS: Predominantly male, aged 65 and older, with a diagnosis of dementia and no other indication for an antipsychotic. Subjects who received an antipsychotic were compared with randomly selected controls who did not. Exposed and control cohorts were matched according to their date of dementia diagnosis and time elapsed from diagnosis to the start of antipsychotic therapy. MEASUREMENTS: Mortality during incident antipsychotic use. RESULTS: Cohorts who were exposed to haloperidol (n=2,217), olanzapine (n=3,384), quetiapine (n=4,277), or risperidone (n=8,249) had more comorbidities than their control cohorts. During the first 30 days, there was a significant increase in mortality in subgroups prescribed a daily dose of haloperidol greater than 1 mg (hazard ratio (HR)=3.2, 95% confidence interval (CI)=2.2–4.5, P<.001), olanzapine greater than 2.5 mg (HR=1.5, 95% CI=1.1–2.0, P=.01), or risperidone greater than 1 mg (HR=1.6, 95% CI=1.1–2.2, P=.01) adjusted for demographic characteristics, comorbidities, and medication history using Cox regression analyses. Greater mortality was not seen when a daily dose of quetiapine greater than 50 mg (HR=1.2, 95% CI=0.7–1.8, P=.50) was prescribed, and there was no greater mortality associated with a dose less than 50 mg (HR=0.7, 95% CI=0.5–1.0, P=.03). No antipsychotic was associated with greater mortality after the first 30 days. CONCLUSION: Commonly prescribed doses of haloperidol, olanzapine, and risperidone, but not quetiapine, were associated with a short‐term increase in mortality. Further investigations are warranted to identify patient characteristics and antipsychotic dosage regimens that are not associated with a greater risk of mortality in elderly patients with dementia.     

Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study

OBJECTIVES: To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. DESIGN: A 2‐year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. SETTING: Community‐dwelling and institutionalized participants. PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini‐Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible anticholinergic properties, and 4% used a drug with definite anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonanticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite anticholinergic effects was associated with a 0.33‐point greater decline in MMSE score (95% confidence interval (CI)=0.03–0.64, P=.03) than not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI=?0.14–0.11, P=.79). Two‐year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30–2.16; P<.001) and possible (OR=1.56; 95% CI=1.36–1.79; P<.001) anticholinergics. CONCLUSION: The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.     

Comparing antidepressant treatment patterns in older and younger adults: a claims database analysis

OBJECTIVES: To compare depressed older (≥65) and younger (25–64) adults with regard to antidepressant treatment patterns and to assess factors associated with 180‐day nonpersistence. DESIGN: Retrospective matched cohort study. SETTING: U.S. managed care population. PARTICIPANTS: Older and matched younger adults diagnosed with depression and treated with antidepressants. MEASUREMENTS: Sociodemographic characteristics, comorbidities, polypharmacy, and characteristics of antidepressant treatment at 180 days were compared between older and younger adults. Analyses were conducted before and after the implementation of Medicare Part D on January 1, 2006, to consider the effect of this policy. RESULTS: Few participants received psychotherapy, especially older ones; rates were constant before and after 2006. Before 2006, older adults more frequently received antidepressants at lower (odds ratio (OR)=5.38, 95% confidence interval (CI)=3.57–8.13) or intermediate dose (OR=2.42, 95% CI=1.93–3.02) and had poorer adherence to treatment (P<.001) than younger adults. After 2006, older adults received similar proportions of intermediate or high antidepressant doses as younger adults, but a lower dosage was still more likely to be prescribed (OR=1.87, 95% CI=1.09–3.20) and had higher treatment adherence (P<.001). Medication profile did not significantly affect the risk of nonpersistence, but increased with lower antidepressant dose (P<.001). Whereas nonpersistence was higher in older adults before 2006 (hazard ratio (HR)=1.25, 95% CI=1.22–1.46), the trend reversed after 2006 (HR=0.76, 95% CI=0.66–0.88). CONCLUSION: More than half of participants with depression discontinued antidepressant treatment, and psychotherapy was rarely used. Implementation of Medicare Part D was associated with substantial changes in treatment of older adults with depression. The presence of comorbidities or polypharmacy was not associated with nonpersistence in depressed older adults.     

Infecciones por bacterias multirresistentes en pacientes cirróticos en un hospital terciario

Introduction

Infections in cirrhotic patients caused by multidrug-resistant bacteria are currently increasing and are associated with greater morbidity and mortality.

Age-based testing for driver's license renewal: potential implications for older Australians

OBJECTIVES: To investigate the effect of age‐based testing (ABT) for driver's license renewal policies on older Australians. DESIGN: Secondary data analysis of a pooled dataset. SETTING: Community‐based samples drawn from three Australian states. PARTICIPANTS: Five thousand two hundred six adults aged 65 to 103 from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. MEASUREMENTS: Self‐reported driving status, age‐based testing (ABT) for driver's license renewal status, demographics, medical conditions, Mini‐Mental State Examination (MMSE), and visual acuity. RESULTS: After accounting for significant demographic and health covariates, logistic regression analyses revealed that older adults required to undergo ABT were between 2.2 (95% confidence interval (CI)=1.35–3.57, P=.001) and 1.5 (95% CI=1.18–1.92, P=.001) times as likely to report not driving. Similar proportions of drivers with cognitive or visual impairments were found regardless of ABT status. CONCLUSION: Required ABT for license renewal was associated with lower rates of driving. The proportion of drivers with probable cognitive or visual impairments was similar in those who had ABT and those who did not. Future investigation of the effect of current ABT policies on crash rates and the potential to use other scientifically designed ABT strategies is therefore needed.     

Volunteering, driving status, and mortality in U.S. retirees

OBJECTIVES: To evaluate how accounting for driving status altered the relationship between volunteering and mortality in U.S. retirees. DESIGN: Observational prospective cohort. SETTING: Nationally representative sample from the Health and Retirement Study in 2000 and 2002 followed to 2006. PARTICIPANTS: Retirees aged 65 and older (N=6,408). MEASUREMENTS: Participants self‐reported their volunteering, driving status, age, sex, race or ethnicity, presence of chronic conditions, geriatric syndromes, socioeconomic factors, functional limitations, and psychosocial factors. Death by December 31, 2006, was the outcome. RESULTS: For drivers, mortality in volunteers (9%) and nonvolunteers (12%) was similar; for limited or non‐drivers, mortality for volunteers (15%) was markedly lower than for nonvolunteers (32%). Adjusted results showed that, for drivers, the volunteering‐mortality odds ratio (OR) was 0.90 (95% confidence interval (CI)=0.66–1.22), whereas for limited or nondrivers, the OR was 0.62 (95% CI=0.49–0.78) (interaction P=.05). The effect of driving status was greater for rural participants, with greater differences between rural drivers and rural limited or nondrivers (interaction P=.02) and between urban drivers and urban limited or nondrivers (interaction P=.81). CONCLUSION: The influence of volunteering in decreasing mortality seems to be stronger in rural retirees who are limited or nondrivers. This may be because rural or nondriving retirees are more likely to be socially isolated and thus receive more benefit from the greater social integration from volunteering.     

Understanding the reasons for the underuse of pneumococcal vaccination by community-dwelling older African Americans

OBJECTIVES: To understand the potential roles of various patient and provider factors in the underuse of pneumococcal vaccination in Medicare‐eligible older African Americans. DESIGN: The Cardiovascular Health Study. SETTING: Four U.S. states. PARTICIPANTS: Seven hundred ninety‐five pairs of community‐dwelling Medicare‐eligible African‐American and white adults aged 65 and older, balanced according to age and sex. MEASUREMENTS: Data on self‐reported race, receipt of pneumococcal vaccination, and other important sociodemographic and clinical variables were collected at baseline. RESULTS: Participants had a mean age ± standard deviation of 73 ± 6; 63% were female. Pneumococcal vaccination rates were 22% for African Americans and 28% for whites (unadjusted odds ratios (OR) for African Americans=0.75; 95% confidence interval (CI)=0.60–0.94; P=.01). This association remained significant despite adjustment for sociodemographic and clinical confounders, including education, income, chronic obstructive pulmonary disease, and prior pneumonia (OR=0.74, 95% CI=0.56–0.97; P=.03), but the association was no longer significant after additional adjustment for the receipt of influenza vaccination (OR=0.79, 95% CI=0.59–1.06; P=.12). Receipt of influenza vaccination was associated with higher odds of receiving pneumococcal vaccination (unadjusted OR=6.43, 95% CI=5.00–8.28; P<.001), and the association between race and pneumococcal vaccination lost significance when adjusted for influenza vaccination alone (OR=0.81, 95% CI=0.63–1.03; P=.09). CONCLUSION: The strong association between receipt of influenza and pneumococcal vaccinations suggests that patient and provider attitudes toward vaccination, rather than traditional confounders such as education and income, may help explain the underuse of pneumococcal vaccination in older African Americans.     

Motor vehicle crash characteristics and medical outcomes among older drivers in Utah, 1992-1995

STUDY OBJECTIVE: We sought to compare the characteristics and medical outcomes of motor vehicle crashes for drivers 70 years and older with those of drivers between the ages of 30 and 39 years. METHODS: We probabilistically linked statewide motor vehicle crash and hospital discharge data between the years of 1992 and 1995 for the state of Utah. We calculated the odds of older drivers exhibiting certain motor vehicle crash characteristics compared with younger drivers. Adjusting for nighttime crash, high-speed crash, and seatbelt use, we calculated the odds of an older driver being killed or hospitalized compared with those of a younger driver. RESULTS: During the study years, there were 14,466 drivers older than 69 years and 68,706 drivers between the ages of 30 and 39 years involved in motor vehicle crashes in Utah. Older drivers were less likely to have crashes involving drug or alcohol use (odds ratio [OR] 0.1; 95% confidence interval [CI] 0.1 to 0.2) and less likely to have crashes at high speed (OR 0.6; 95% CI 0.6 to 0.7). Although older drivers were no more likely to have a crash involving a right-hand turn (OR 1.0; 95% CI 0.9 to 1.1) than younger drivers, they were over twice as likely to have a crash involving a left-hand turn (OR 2.3; 95% CI 2.2 to 2.5). Also, older drivers were more likely to be killed or hospitalized than younger drivers (OR, 3.5; P <.001). Among belted drivers, an older driver was nearly 7 times more likely to be killed or hospitalized than a younger driver (OR 6. 9; 95% CI 5.4 to 8.9). CONCLUSION: Older drivers do have distinctive motor vehicle crash patterns. Interventions must be taken to reduce the number of left-hand turn crashes involving older drivers. In addition, further research is needed to design, implement, and evaluate countermeasures that may enable older drivers to continue driving while keeping public safety in the forefront.     

Life‐Space Assessment in Urogynecology and Gynecological Oncology Surgery Patients: A Measure of Perioperative Mobility and Function

OBJECTIVE: To assess the effect of gynecological surgery on mobility and functional status in women aged 60 and older using Life‐Space Assessment (LSA). DESIGN: Observational prospective cohort study. SETTING: Academic outpatient urogynecology and gynecological oncology clinics. PARTICIPANTS: Women presenting for urogynecology (n=51) and gynecological oncology (n=51) surgery. MEASUREMENTS: LSA scores 6 weeks, 6 months, and 1 year after surgery. Information on participant demographics, preoperative diagnoses, surgical approach, and medical comorbidities was collected. Analyses used repeated measures. RESULTS: Mean age was 71 ± 7. Urogynecology participants started and maintained a higher LSA (P=.03) than oncology participants at all study intervals. Six weeks after surgery, urogynecology and oncology participants' mean decline was 13 points (95% confidence interval (CI)=4–21; P=.004) and 23 points (95% CI=13–33; P<.001), respectively. At 6 months, the urogynecology and oncology participants' scores increased by a mean of 9 points (95% CI=1–17; P=.03) and 13 points (95% CI=5–20; P=.001), respectively. No significant difference was found 1 year from baseline within each group or between groups in LSA scores. Income, depression, body mass index, and having an operative complication predicted a larger decline in life‐space over time in both groups. CONCLUSION: Gynecological surgical interventions in older women limit physical and functional ability at 6 weeks after surgery. The urogynecology and gynecological oncology cohorts returned to baseline levels by 6 months, which was sustained to 1 year.     

Greater Risk of Dementia When Spouse Has Dementia? The Cache County Study

OBJECTIVES: To examine the effects of caring for a spouse with dementia on the caregiver's risk for incident dementia. DESIGN: Population‐based study of incident dementia in spouses of persons with dementia. SETTING: Rural county in northern Utah. PARTICIPANTS: Two thousand four hundred forty‐two subjects (1,221 married couples) aged 65 and older. MEASUREMENTS: Incident dementia was diagnosed in 255 subjects, with onset defined as age when subject met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria for dementia. Cox proportional hazards regression tested the effect of time‐dependent exposure to dementia in one's spouse, adjusted for potential confounders. RESULTS: A subject whose spouse experienced incident dementia onset had a six times greater risk for incident dementia as subjects whose spouses were dementia free (hazard rate ratio (HRR)=6.0, 95% confidence interval (CI)=2.2–16.2, P<.001). In sex‐specific analyses, husbands had higher risks (HRR=11.9, 95% CI=1.7–85.5, P=.01) than wives (HRR=3.7, 95% CI=1.2–11.6, P=.03). CONCLUSION: The chronic and often severe stress associated with dementia caregiving may exert substantial risk for the development of dementia in spouse caregivers. Additional (not mutually exclusive) explanations for findings are discussed.     

Waist Circumference but Not Body Mass Index Predicts Long‐Term Mortality in Elderly Subjects with Chronic Heart Failure

OBJECTIVES: To examine whether waist circumference (WC) and body‐mass index (BMI) can predict long‐term mortality in elderly subjects with and without chronic heart failure (CHF). DESIGN: Longitudinal evaluation with a 12‐year follow‐up. SETTING: Campania, a region of southern Italy. PARTICIPANTS: One thousand three hundred thirty‐two subjects aged 65 and older selected from the electoral rolls of Campania. MEASUREMENTS: The relationship between WC or BMI and mortality during a 12‐year follow‐up in 125 subjects with and 1,143 subjects without CHF. RESULTS: Mortality increased as WC increased in elderly subjects without CHF (from 47.8% to 56.7%, P=.01), and the increase was even greater in patients with CHF (from 58.1% to 82.0%, P=.01). In contrast, mortality decreased as BMI increased in elderly subjects without CHF (from 53.8% to 46.1%, P0 =.046) but not in those with CHF. According to Cox regression analysis, BMI protected against long‐term mortality in the absence but not in the presence of CHF. In the absence of CHF, WC was associated with a 2% increased risk of long‐term mortality for each 1‐cm greater WC (Hazard Ratio (HR)=1.02, 95% confidence interval (CI)=1.01–1.03; P<.001), versus 5% increased in the presence of CHF (HR=1.06, 95% CI=1.02–1.10; P<.001). CONCLUSION: WC, but not BMI, is predictive of long‐term mortality in elderly individuals with CHF and to a lesser extent in those without CHF.     

Driving Patterns of Older Adults: Results from the Second Injury Control and Risk Survey

OBJECTIVES: To describe older adults' driving patterns, including self‐imposed driving restrictions and motor vehicle crashes (MVCs). DESIGN: The Second Injury Control and Risk Survey (ICARIS‐2) was a national, random‐digit‐dial telephone survey conducted by the Centers for Disease Control and Prevention in 2001 to 2003. ICARIS‐2 sampled 113,476 English‐ and Spanish‐speaking households, using weighting variables to generate national estimates. RESULTS: The response rate was 48% (N=9,684). Six percent (n=728) of respondents were aged 75 and older. Of these, 85.6% (n=613) were aged 75 to 84, and 14.4% (n=115) were aged 85 and older; 59.2% were female. Three‐fourths (74.9%, 95% confidence interval (CI)=70.4–79.4%) of adults aged 75 to 84 and 69.9% (95% CI=48.2–71.6%) aged 85 and older were current drivers. Most (81.9%; 95% CI=77.6–86.2%) older drivers limited their driving, usually in bad weather (59.0%), at night (57.0%), on long trips (49.6%), in traffic (49.0%), or at high speeds (33.6%); only 15.4% limited driving for medical reasons. Women were more likely to self‐limit driving (odds ratio (OR)=1.83, 95% CI=0.99–3.39). Few (4.2%, 95% CI=2.4–6.1%) older adults reported MVC involvement in the past year as a driver or passenger. In multivariate analysis, drivers living alone (OR=3.93, 95% CI=1.55–9.95) and men (OR=2.59, 95% CI=1.18–5.67) were more likely to report a recent crash; drivers who self‐limited were less likely (OR=0.55, 95% CI=0.18–1.60). CONCLUSION: Large majorities of older adults, including those aged 85 and older, are current drivers. Although many limit driving in hazardous conditions, fewer do for medical reasons. Men and older adults who live alone are more likely to report a recent MVC; those who self‐limit their driving are less likely to report crash involvement.     

Hypertension Control and Its Correlates Among Adults Attending a Hypertension Clinic in Tanzania

Hypertension control rates are low in sub‐Saharan Africa. Population‐specific determinants of blood pressure (BP) control have not been adequately described. The authors measured BP and conducted interviews to determine factors associated with BP control among adults attending a hypertension clinic in Tanzania. Three hundred adults were enrolled. BP was controlled in 47.7% of patients at the study visit but only 28.3% over three consecutive visits. Demographic and socioeconomic factors were not associated with control. Obesity and higher medication cost were associated with decreased control. Their effect was mediated through adherence. Good knowledge of (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.0–6.1; P=.047), attitudes towards (OR, 2.7; 95% CI, 1.0–7.1; P=.04), and practices concerning (OR, 5.4; 95% CI, 2.3–13.0; P<.001) hypertension were independently associated with increased control, even after adjusting for mediation through adherence. Good adherence had the strongest association with control (OR, 14.6; 95% CI, 5.8–37.0; P<.001). Strategies to reduce hypertension‐related morbidity and mortality in sub‐Saharan Africa should target these factors. Interventional studies of such strategies are needed.     

Nonfatal Overdose Among Heroin Users in Southwestern China

Objective: To evaluate the prevalence of and risk factors for nonfatal overdose among heroin users in southwestern China. Methods: In 2005, 731 heroin users in Sichuan Province, China were interviewed for overdose experiences in the past 12 months. Factors hypothesized to be associated with overdose were evaluated with logistic regression models. Results: Eighty-eight (12%) drug users experienced at least one overdose, with a range from 1 to 20; 45 (51%) experienced 2 or more overdoses. Over half of participants with experience of overdose were recently released from prison (52%), and 56% used benzodiazepines before overdose. Longer methadone treatment in the past year (≥180 vs. 0 days; OR,. 3; 95% CI,. 1–.8; P = .02), longer duration of using drugs (≥7 vs. <7 years; OR, 2.2; 95% CI, 1.3–3.6; P = .002), and more frequency of injecting drugs in the past 3 months (≥7 vs. <7 times/week; OR, 5.4; 95% CI, 3.2–9.0; P < .001) were independently associated with increased risk of nonfatal heroin overdose. Conclusions: Nonfatal heroin overdoses are common among Chinese heroin users. Drug users should be encouraged to participate and remain in methadone treatment to prevent overdose and be educated about proper response to overdose to reduce risk of overdose death.     

Trail Making Test Predicts Physical Impairment and Mortality in Older Persons

OBJECTIVES: To examine whether performance in the Trail Making Test (TMT) predicts mobility impairment and mortality in older persons. DESIGN: Prospective cohort study. SETTING: Community‐dwelling older persons enrolled in the Invecchiare in Chianti (InCHIANTI) Study. PARTICIPANTS: Five hundred eighty‐three participants aged 65 and older and free of major cognitive impairment (Mini‐Mental State Examination score >21) with baseline data on TMT performance. Of these, 427 performed the Short Physical Performance Battery (SPPB) for the assessment of lower extremity function at baseline and after 6 years. Of the initial 583 participants, 106 died during a 9‐year follow‐up. MEASUREMENTS: The TMT Parts A and B (TMT‐A and TMT‐B) and SPPB were administered at baseline and 6‐year follow‐up. Impaired mobility was defined as an SPPB score less than 10. Vital status was ascertained over a 9‐year follow‐up. RESULTS: InCHIANTI participants in the fourth quartile of the time to complete TMT‐B minus time to complete TMT‐A (TMT (B‐A)) were significantly more likely to develop an SPPB score less than 10 during the 6‐year follow‐up than those in the first quartile (relative risk (RR)=2.4, 95% confidence interval (CI)=1.4–3.9, P=.001). After adjusting for potential confounders, these findings were substantially unchanged (RR=2.2, 95% CI=1.4–3.6, P=.001). Worse performance on the TMT was associated with significantly greater decline in SPPB score over the 6‐year follow‐up, after adjusting for age, sex, and baseline SPPB scores (β=?0.01, standard error=0.003, P=.004). During the 9‐year follow‐up, 18.2% of the participants died. After adjustment for age and sex, the proportion of participants who died was higher in participants in the worst than the best performance quartile of TMT (B‐A) scores (hazard ratio (HR)=1.7, 95% CI=1.0–2.9, P=.048). Results were similar in a parsimonious adjusted model (HR=1.8, 95% CI=1.0–3.2, P=.04). CONCLUSION: Performance on the TMT is a strong, independent predictor of mobility impairment, accelerated decline in lower extremity function, and death in older adults living in the community. The TMT could be a useful addition to geriatric assessment.     

Total insulinlike growth factor 1 and insulinlike growth factor binding protein levels, functional status, and mortality in older adults

OBJECTIVES: To assess the association between total insulinlike growth factor (IGF)‐1, IGF binding protein‐1 (IGFBP‐1), and IGFBP‐3 levels and functioning and mortality in older adults. DESIGN: Cohort study. SETTING/PARTICIPANTS: One thousand one hundred twenty‐two individuals aged 65 and older without prior cardiovascular disease events participating in the Cardiovascular Health Study. MEASUREMENTS: Baseline fasting plasma levels of IGF‐1, IGFBP‐1, and IGFBP‐3 (defined as tertiles, T1‐T3) were examined in relationship to handgrip strength, time to walk 15 feet, development of new difficulties with activities of daily living (ADLs), and mortality. RESULTS: Higher IGFBP‐1 predicted worse handgrip strength (P‐trend_T1‐T3<.01) and slower walking speed (P‐trend_T1‐T3=.03), lower IGF‐1 had a borderline significant association with worse handgrip strength (P‐trend_T1‐T3=.06), and better grip strength was observed in the middle IGFBP‐3 tertile than in the low or high tertiles (P=.03). Adjusted for age, sex, and race, high IGFBP‐1 predicted greater mortality (P‐trend_T1‐T3<.001, hazard ratio (HR)_T3vsT1=1.48, 95% confidence interval (CI)=1.15–1.90); this association was borderline significant after additional confounder adjustment (P‐trend_T1‐T3=.05, HR_T3vsT1=1.35, 95% CI=0.98–1.87). High IGFBP‐1 was associated with greater risk of incident ADL difficulties after adjustment for age, sex, race, and other confounders (P‐trend_T1‐T3=.04, HR_T3vsT1=1.40, CI=1.01–1.94). Neither IGF‐1 nor IGFBP‐3 level predicted mortality or incident ADL difficulties. CONCLUSION: In adults aged 65 and older, high IGFBP‐1 levels were associated with greater risk of mortality and poorer functional ability, whereas IGF‐1 and IGFBP‐3 had little association with these outcomes.     

Prevalence and Correlates of Nocturia in Community‐Dwelling Older Adults

OBJECTIVES: To determine the prevalence and correlates of nocturia in community‐dwelling older adults. DESIGN: Planned secondary analysis of cross‐sectional data from the University of Alabama at Birmingham Study of Aging population‐based survey. SETTING: Participants' homes. PARTICIPANTS: One thousand older adults (aged 65–106) recruited from Medicare beneficiary lists between 1999 and 2001. The sample was selected to include 25% each African‐American women, African‐American men, white women, and white men. MEASUREMENTS: In‐person interviews included sociodemographic information, medical history, Mini‐Mental State Examination (MMSE) score, and measurement of body mass index (BMI). Nocturia was defined in the main analyses as rising two or more times per night to void. RESULTS: Nocturia was more common in men than women (63.2% vs 53.8%, odds ratio (OR)=1.48, 95% confidence interval (CI)=1.15–1.91, P=.003) and more common in African Americans than whites (66.3% vs 50.9%, OR=1.89, 95% CI=1.46–2.45, P<.001). In multiple backward elimination regression analysis in men, nocturia was significantly associated with African‐American race (OR=1.54) and BMI (OR=1.22 per 5 kg/m²). Higher MMSE score was protective (OR=0.96). In women, nocturia was associated with older age (OR=1.21 per 5 years), African‐American race (OR=1.64), history of any urine leakage (OR=2.17), swelling in feet and legs (OR=1.67), and hypertension (OR=1.62). Higher education was protective (OR=0.92). CONCLUSION: Nocturia in community‐dwelling older adults is a common symptom associated with male sex, African‐American race, and some medical conditions. Given the significant morbidity associated with nocturia, any evaluation of lower urinary tract symptoms should include assessment for the presence of nocturia.     

Body Mass Index and Risk of Adverse Cardiac Events in Elderly Patients with Hip Fracture: A Population-Based Study

OBJECTIVES: To determine whether obesity affects cardiac complications after hip fracture repair. DESIGN: A population‐based historical study using data from the Rochester Epidemiology Project. SETTING: Olmsted County, Minnesota. PARTICIPANTS: All urgent hip fracture repairs between 1988 and 2002. MEASUREMENTS: Body mass index (BMI) was categorized as underweight (<18.5 kg/m²), normal‐weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), and obese (≥30 kg/m²). Postoperative cardiac complications were defined as myocardial infarction, angina pectoris, congestive heart failure, or new‐onset arrhythmias within 1‐year of surgery. Incidence rates were estimated for each outcome, and overall cardiac complications were assessed using Cox proportional hazards models adjusted for age, sex, year of surgery, use of beta‐blockers, and the Revised Cardiac Risk Index. RESULTS: Hip fracture repairs were performed in 184 (15.6%) underweight, 640 (54.2%) normal‐weight, 251 (21.3%) overweight, and 105 (8.9%) obese subjects (mean age 84.2 ± 7.5; 80% female). Baseline American Society of Anesthesiologists (ASA) status was similar in all groups (ASA I/II vs III–V, P=.14). Underweight patients had a significantly higher risk of developing myocardial infarction (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.0–2.1; P=.05) and arrhythmias (OR=1.59, 95% CI=1.0–2.4; P=.04) than normal‐weight patients. Multivariate analysis demonstrated that underweight patients had a higher risk of developing an adverse cardiac event of any type (OR=1.56, 95% CI=1.22–1.98; P<.001). Overweight and obese patients with hip fracture had no excess risk of any cardiac complication. CONCLUSION: The obesity paradox and low functional reserve in underweight patients may influence the development of postoperative cardiac events in elderly people with hip fracture.     

Comparison of fatigue levels in patients with stroke and patients with end-stage heart failure: application of the fatigue assessment scale

OBJECTIVES: To examine the assessment of fatigue using the Fatigue Assessment Scale (FAS) in patients with stroke and to compare the levels of fatigue reported by patients with stroke, patients with chronic heart failure (CHF), and healthy controls. DESIGN: Cross‐sectional analysis. SETTING: Stroke rehabilitation unit, heart failure outpatient clinic, general Dutch population. PARTICIPANTS: Three different samples were included: 80 patients with stroke, 137 patients with CHF, and 160 healthy controls. MEASUREMENTS: Fatigue was measured according to the FAS at baseline and at 2‐month follow‐up. Depressive symptoms were assessed at baseline using the Beck Depression Inventory (BDI). RESULTS: The internal consistency (α) of the FAS was 0.77 at baseline and at 2‐month follow‐up. Test–retest reliability was 0.81 for a 2‐month interval. Factor analysis of the combined pool of FAS and BDI items revealed two distinct factors that measure fatigue and depression as two separate constructs. Patients with stroke (15.3±7.6) and patients with CHF (16.5±7.9) reported similar levels of fatigue (P=.44). The level of fatigue in patients with stroke and patients with CHF was considerably higher than in healthy controls (9.2±5.6; P<.001). Using the healthy controls as a reference group, multivariable logistic regression revealed that patients with stroke were at six times greater risk (odds ratio (OR)=6.18, 95% confidence interval (CI)=3.31–11.55; P<.001) and patients with CHF were at eight times greater risk (OR=8.03; 95% CI=4.63–13.94; P<.001) for having fatigue symptoms. CONCLUSION: The FAS is an adequate measure of fatigue in patients with stroke. Levels of fatigue in patients with stroke are similar to levels in patients with CHF, emphasizing its clinical significance in stroke.     

Alcohol Consumption and the Risk of Hypertension in Men and Women: A Systematic Review and Meta‐Analysis

J Clin Hypertens (Greenwich). 2012;14:792–798. ©2012 Wiley Periodicals, Inc. Heavy alcohol intake increases the risk of hypertension, but the relationship between light to moderate alcohol consumption and incident hypertension remains controversial. The authors sought to analyze the dose‐response relationship between average daily alcohol consumption and the risk of hypertension via systematic review and meta‐analysis. Electronic databases were searched for prospective control studies examining quantitative measurement of alcohol consumption and biological measurement of outcome. The primary endpoint was the risk of developing hypertension based on alcohol consumption. The level of alcohol consumption from each study was assigned to categorical groups based on the midpoint of their alcohol consumption classes to make possible the comparison of heterogeneous classification of alcohol intake. A total of 16 prospective studies (33,904 men and 193,752 women) were included in the analysis. Compared with nondrinkers, men with alcohol consumption with <10 g/d and 11 to 20 g/d had a trend toward increased risk of hypertension (relative risk [RR], 1.03; 95% confidence interval [CI], 0.94–1.13; P=.51) and (RR, 1.15; 95% CI, 0.99–1.33; P=.06), respectively, whereas a significantly increased risk of hypertension was found with heavy alcohol consumption of 31 to 40 g/d (RR, 1.77; 95% CI, 1.39–2.26; P<.001) and >50 g/d (RR, 1.61; 95% CI, 1.38–1.87; P<.001). Among women, the meta‐analysis indicated protective effects at <10 g/d (RR, 0.87; 95% CI, 0.82–0.92; P<.001) and a trend toward decreased risk of hypertension with alcohol consumption 11 to 20 g/d (RR, 0.9; 95% CI, 0.87–1.04; P=.17), whereas a significantly increased risk of hypertension was indicated with heavy alcohol consumption of 21 to 30 g/d (RR, 1.16; 95% CI, 0.91–1.46; P=.23) and 31 to 40 g/d (RR, 1.19; 95% CI, 1.07–1.32; P=.002). In men, heavy alcohol consumption is associated with increased risk of hypertension, whereas there is a trend toward increased risk of hypertension with low and moderate alcohol consumption. The relationship between alcohol consumption and hypertension is J‐shaped in women. Limiting alcohol intake should be advised for both men and women.