Decline in cognitive function and risk of elder self-neglect: finding from the Chicago Health Aging Project

OBJECTIVES: To examine the longitudinal association between decline in cognitive function and risk of elder self‐neglect in a community‐dwelling population. DESIGN: Prospective population‐based study. SETTING: Geographically defined community in Chicago. PARTICIPANTS: Community‐dwelling subjects reported to the social services agency from 1993 to 2005 for self‐neglect who also participated in the Chicago Health Aging Project (CHAP). Of the 5,519 participants in CHAP, 1,017 were reported to social services agency for suspected elder self‐neglect from 1993 to 2005. MEASUREMENTS: Social services agency identified reported elder self‐neglect. The primary predictor was decline in cognitive function assessed using the Mini‐Mental State Examination (MMSE), the Symbol Digit Modalities Test (Executive Function), and immediate and delayed recall of the East Boston Memory Test (Episodic Memory). An index of global cognitive function scores was derived by averaging z‐scores of all tests. Outcome of interest was elder self‐neglect. Logistic and linear regression models were used to assess these longitudinal associations. RESULTS: After adjusting for potential confounding factors, decline in global cognitive function, MMSE score, and episodic memory were not independently associated with greater risk of reported and confirmed elder self‐neglect. Decline in executive function was associated with greater risk of reported and confirmed elder self‐neglect. Decline in global cognitive function was associated with greater risk of greater self‐neglect severity (parameter estimate=0.76, standard error=0.31, P=.01). CONCLUSION: Decline in executive function was associated with risk of reported and confirmed elder self‐neglect. Decline in global cognitive function was associated with risk of greater self‐neglect severity.     

Sociodemographic and sexual behavior characteristics of an online MSM sample in Guangdong,China

Public health research and interventions often assume that men who have sex with men (MSM) who use the Internet in China have similar characteristics to those in Western countries, though with little empirical evidence. This study aimed to describe and examine the sociodemographic and basic sexual behavioral characteristics of an online sample of MSM in Guangdong, China. In 2010, a total of 1100 MSM were recruited from an lesbian, gay, bisexual, and transgender (LGBT)-oriented website and were asked about their sociodemographic and sexual behavior characteristics. The majority of the participants (77.9%) self-identified as homosexual, and the mean age was 30.0 years (SD = 6.7). About 80% of the participants had attained a college degree and only 4.8% were unemployed. About 60% had a monthly salary of more than CNY 3000 (476 USD), and more than 10% were married. The majority (71.7%) had used condoms in the last anal sex. Nearly half of the participants have never been tested for HIV or other sexually transmitted infections (STIs) (47.3% and 47.7%, respectively). More than 80% were willing to be contacted by researchers after the survey. Findings indicate that the sociodemographic characteristics of Chinese MSM who use the Internet are relatively similar to those in the Western countries. However, Chinese MSM are less likely to self-identify as homosexual and be tested for HIV and other STIs than Western MSM. On a positive note, Chinese MSM would be likely to engage in e-technology research showing potential feasibility of an online HIV/STI intervention.     

Migration and regional population aging in the Philippines

There is a growing realization that developing countries will be affected in the future by the problems associated with population aging. Although internal migration could exacerbate the problems of aging at subnational levels, there remains a paucity of research on the role of migration in elderly population change for the developing countries of the world. This study uses 1980 census data for the Philippines to explore the spatial and temporal dynamics of the country's elderly population. Through examination of internal migration patterns among the thirteen regions of the country and population projections, this paper demonstrates the potentially large role that migration plays in determining local patterns of aging.The National Capital Region, which is a primary destination of labor force migrants, exhibits the greatest projected increase in the share of the nation's elderly population, while the centrally located Visayas regions show rapid reductions in the future. The Visayas regions, however, may be expected to have the highest concentrations of elderly in their populations. Such findings suggest that labor force migration patterns, with subsequent aging-in-place, will most strongly influence near future distributions and concentrations of the elderly, and that national planning for the future's elderly population should incorporate regional examinations as a means of appropriately distributing financial and service related support.     

Self‐Neglect in an Elderly Community‐Dwelling U.S. Chinese Population: Findings from the Population Study of Chinese Elderly in Chicago Study

This study aimed to examine the prevalence of self‐neglect and its specific behaviors in an elderly community‐dwelling U.S. Chinese population through a population‐based cohort study (PINE Study) in the greater Chicago area. Community‐dwelling population of older Chinese adults were interviewed from 2011 to 2013 (n = 3,159). The personal and home environment of participants was rated based on prevalence of hoarding behavior, personal hygiene, repairs needed on the home, sanitary condition of the home, and adequacy of utilities. Prevalence estimates were presented according to self‐reported quality of life (QOL). It was found that the prevalence of self‐neglect was 18.2% for mild self‐neglect and 10.9% for moderate to severe self‐neglect. Unsanitary conditions (17.0%) was the most prevalent, followed by need for home repair (16.3%), hoarding behavior (14.9%), poor personal hygiene (11.3%), and inadequate utilities (4.2%). The prevalence of elder self‐neglect of all severities and of all types was higher in older adults with fair or poor QOL than in those with good or very good QOL. Poorer QOL was significantly associated with greater risk of self‐neglect of all severities (mild self‐neglect: odds ratio (OR) = 1.93, 95% confidence interval (CI) = 1.26–2.96, P < .001; moderate to severe self‐neglect: OR = 3.58, 95% CI = 1.79–7.13, P < .001) and specific personal and environmental hazards. The study's authors conclude that elder self‐neglect is prevalent, especially in elderly adults with poorer QOL. Future research is needed to examine risk and protective factors associated with elder self‐neglect.     

中老年人群糖代谢异常的临床特点分析

目的:探讨中老年人群糖代谢异常的分布情况及其临床特点。方法:测定951例年龄≥45岁人群的身高、体重、腰围、臀围,计算体重指数(BMI)、腰臀比(WHR);口服75g葡萄糖耐量试验确定其糖代谢状态,测定血脂、空腹及餐后2h血浆血糖和血清胰岛素水平,用稳态模型评估法(HOMA)计算胰岛素抵抗(IR)指数(HOMA-IR)、胰岛细胞功能指数(HOMA-β),进行组间比较。结果:①糖耐量正常者(NGT)占53.00%,单纯糖耐量异常(IGT)占25.34%;空腹血糖受损(IFG)占5.15%;IFG合并IGT占3.79%;糖尿病(DM)占12.72%;②IGT、IFG+IGT、DM患者的年龄、血压、脉压、BMI显著高于NGT和IFG者;WHR值按NGT、IFG→IGT→IFG+IGT、DM的顺序依次增高(P<0.05);IGT、IFG+IGT、DM者的三酰甘油(TG)水平高于NGT者(P<0.05),其中隐性糖尿病(LDM)和显性糖尿病(ODM)患者的TG水平又显著高于IFG者(P<0.05);③IR的程度按NGT、IGT→IFG→LDM→IFG+IGT→ODM的顺序依次升高;除IGT外,其他糖代谢异常的IR程度均显著高于NGT(P<0.05);HOMA-β按IGT、NGT→LDM→IFG+IGT→IFG→ODM的顺序依次降低;各组中以ODM的IR最高,基础胰岛素分泌功能最差。结论:中老年人群的糖代谢异常的患病率高,应重视对餐后血糖的检测,合并有中心性肥胖、高血压等危险因素者建议做口服葡萄糖耐量试验以明确诊断。中老年人群中糖代谢异常者普遍存在IR及胰岛β细胞分泌功能不足。     

Can an active aging index (AAI) provide insight into reducing elder abuse? A case study in Rajshahi District,Bangladesh

We use data from respondents aged 60 years and above, collected during April 2009 in the Rajshahi district of Bangladesh, to examine whether high activeness, as captured by an AAI or in sub-domains, can help reduce the risk of elder abuse. The findings suggest that more than half of rural elderly and 14 percent of urban elderly were at some point abused. High activeness in health and security dimensions lowers the risk of being abused while those who are low active in community participation have the lowest risk of being abused in both rural and urban areas. Being literate (elderly with primary/secondary education) is revealed to be a significant factor that lowers the risk of abuse in both rural and urban areas. These results imply a need for educational programs that bolster positive and proper community interaction, in turn promoting a secure later life for elders, and reducing burden for families and society. High activeness in health and security dimensions should also be promoted to keep the elderly healthy and protect from abusive behavior.     

Serum total and bioavailable testosterone levels, central obesity, and muscle strength changes with aging in healthy Chinese men

OBJECTIVES: To investigate the effects of the changes in serum bioavailable and total testosterone (TT) levels with aging on visceral body fat distribution and muscle strength in Chinese men.
DESIGN: Cross-sectional study.
SETTING: Ambulatory care.
PARTICIPANTS: Four hundred seventy-five healthy ambulatory Chinese men (aged 18–89, body mass index (BMI) 16.4–40.0 kg/m²).
MEASUREMENTS: Morning serum total and bioavailable testosterone levels, waist circumference (WC), waist-hip ratio (WHR), and right handgrip strength.
RESULTS: Mean serum TT levels fell mildly but significantly with aging ( P =.02, linear trend; one-way analysis of variance (ANOVA)), whereas mean serum bioavailable testosterone (BT) levels fell greatly with aging ( P <.001, linear trend, one-way ANOVA). The rates of decline in serum TT and BT levels were 0.2% and 1.14% per year, respectively. [Correction added after online publication 14-May-2008: BT levels have been corrected from 1.44% to 1.14%.] After adjustment for adiposity according to BMI, multiple linear regression analyses showed that age remained significantly related to serum TT and BT levels. Handgrip strength decreased with age (correlation coefficient ( r )=−0.394, P <.001) and was greater with higher serum BT levels ( r =0.239, P <.001) but not with higher TT levels. WHR, before and after adjustment for BMI, was inversely related to serum TT ( r =−0.34 and −0.197 respectively, P <.001) and BT levels ( r =−0.104, P <.05 and −0.161, P <.001, respectively).
CONCLUSION: In Chinese men, serum BT levels decreased with aging and may contribute to central obesity and poorer muscle strength in aging men.     

Sociodemographic,behavioral, and geriatric characteristics in older adults with and without HIV: A case-control study

Older adults with human immunodeficiency virus (HIV) have higher risks for early manifestations of age-related disabilities. The objective of this study was to compare HIV-positive and HIV-negative adults aged ≥50 years in relation to sociodemographic, behavioral, and geriatric characteristics. A case-control study was conducted with a >90% estimated statistical power. A total of 52 individuals living with HIV were matched by age, sex, and neighborhood of residence with 104 community controls. Age-related disabilities were assessed throughout a comprehensive geriatric assessment. Review of medical records and interviews were used to obtain behavioral and clinical covariates. No statistical differences on clinically significant age-related disabilities were found. However, multivariate regression analyses, controlling for education and income, revealed that behavioral (use of condom [odds ratio {OR}: 7.03; 95% confidence intervals {CI}: 2.80–7.65] and number of medical visits [OR: 1.25; 95%CI: 1.09–1.43]), along with faster gait speed (OR: 17.68; 95%CI: 2.55–122.85) and lower body and muscle mass indexes were independently associated with HIV (OR: .88; 95%CI: .79–.98 and OR: .72; 95%CI: .54–.97, respectively). In summary, results on age-related disabilities between groups could mean that public policies on HIV might be contributing to patients’ positive outcomes regardless of the effects of aging, albeit gait speed, body and muscle mass indexes were independently associated with HIV. Screenings for age-related disabilities in specialized HIV services are recommended.     

Sociodemographic and health characteristics of older Chinese on admission to a nursing home: a cross-racial/ethnic study

OBJECTIVES: To investigate sociodemographic characteristics (SDCs) and health status of older Chinese newly admitted to a nursing home (NH) and to compare them with the characteristics of residents from other racial/ethnic groups. DESIGN: Secondary analysis of the admission Minimum Data Set Plus (MDS+). SETTING: A New York City municipal NH near Chinatown. PARTICIPANTS: Two hundred fifty-eight (125 Chinese, 57 white, 53 Hispanic, and 23 black) of 292 residents consecutively admitted from November 1992 to May 1997 were selected after excluding those younger than 60 or transferred from another NH. MEASUREMENTS: SDCs, health status parameters (cognitive performance, physical functioning, mood/behavior patterns, and psychosocial well-being), and morbidity information (most-frequent diagnoses/conditions and medication use) documented in or generated from the MDS+. RESULTS: The majority of these Chinese were first-generation immigrants and spoke primarily Cantonese or Mandarin Chinese. Compared with whites, they were more likely to be married, less likely to have lived alone, more likely to be using Medicaid, less likely to make medical decision alone, and more likely to depend on family members for decision-making. Nearly three-quarters of Chinese had cognitive impairment. There was an underdiagnosis of dementia in the Chinese subjects on admission. Severe dependence in activity of daily living was identified in more than one-third of Chinese. Fewer Chinese were using psychotropic medications on admission than the whites. Similar to other groups, many of the Chinese subjects were incontinent of bowel and bladder and had chewing or swallowing problems, hypertension, anemia, and stroke. CONCLUSION: This is the first systematic report of the SDCs and health status of a group of newly admitted older Chinese to an urban NH in the United States using the Minimum Data Set database. These findings suggest that Chinese residents are as frail as other racial/ethnic residents on admission. NHs caring for older Chinese need to be sensitive to the presence of dementia, and require a staff that can speak Cantonese and Mandarin Chinese and is comfortable negotiating with families who are more likely to be the designated decision makers.     

Measuring population aging as a function of fertility,mortality, and migration

Researchers often describe population aging with measures such as proportion of population under 15 years of age, proportion of population 65 years and over, the aged-child ratio (a ratio of the first two measures), median age, and mean age. Investigators of cross-cultural gerontology, too, use such measures to compare population aging between populations. While insights from comparing only the values of an aging measure between two populations may be helpful, results from such comparison can be misleading due to the influences of fertility, mortality, and migration. To show the effects of these demographic processes on measures of population aging, rates of change in five measures of population aging as a function of fertility, mortality, and migration are developed. These rates of change are estimated for various stable populations, for stable populations disequilibrated by fertility and mortality declines and by net migration, and for the population in Japan, 1988–1989. The findings demonstrate that the five aging measures, in general, do not give consistent rate-of-change estimates; they also suggest that directly comparing values of aging measures without considering the levels and patterns of fertility, mortality and migration will lead to misleading conclusions.     

Epidemiology and clinical characteristics of ulcerative colitis in Chinese population: experience from a single center in Hong Kong

Background and Aim: Rising incidence and prevalence of ulcerative colitis (UC) had been observed in Asian countries. We conducted a study in an Asian center, aiming to describe the epidemiology and clinical characteristics of UC in local Chinese population. Methods: This is a retrospective analysis of patients with diagnosis of UC in our hospital from June 1990 to December 2006. The diagnosis of UC has to satisfy the internationally accepted criteria. All patients were Chinese residents in a well‐defined catchment area. Clinical and epidemiological data were obtained from medical records and patient interviews. Results: Seventy‐three Chinese UC patients had been managed in our hospital. The hospital‐based prevalence had risen by three times over a 10‐year period, but no definite rising incidence can be demonstrated. The mean age at diagnosis was 40.6 years and the median duration of disease is 72 months. In our patient cohort, 38.4% had ulcerative proctitis and 26% had left‐sided UC, whereas 35.6% had extensive UC at presentation. The majority presented with mild (39.7%) or moderate (30.2%) disease activity, but 27.4% presented with severe disease. Two patients (2.7%) present with fulminant disease with one of them developed toxic megacolon. Extra‐gastrointestinal manifestations occurred in 13.7%. During the follow‐up period, most patients (86.3%) were in disease remission. Four patients (5.5%) underwent colectomy, four patients (5.5%) died, and two patients (2.7%) were lost to follow up. Conclusion: The prevalence but not the incidence of UC is rising in Chinese population. It usually affects young patients and a substantial proportion of patients presented with severe and fulminant disease. The disease activity of most Chinese patients can be controlled with medical treatment, though a small proportion of patients need surgery or have fatal outcome.     

21世纪我国老年医学发展方向

老年人具有基础疾病多、器官功能储备差、起病隐匿、多重用药等特点,老年医学除具有其综合性、全面性和个体化的特点外,还需注重维持老年人的能力和生活质量,对老年人提供全方位的健康服务。在中国,目前老年医学的发展还需要现代观念、政策及资金上的支持,建立独立的老年医学学科有其必要性及合理性。     

Impact of population aging on trends in diabetes prevalence: A meta‐regression analysis of 160,000 Japanese adults

Aims/Introduction

To provide age- and sex-specific trends, age-standardized trends, and projections of diabetes prevalence through the year 2030 in the Japanese adult population.

Materials and Methods

In the present meta-regression analysis, we included 161,087 adults from six studies and nine national health surveys carried out between 1988 and 2011 in Japan. We assessed the prevalence of diabetes using a recorded history of diabetes or, for the population of individuals without known diabetes, either a glycated hemoglobin level of ≥6.5% (48 mmol/mol) or the 1999 World Health Organization criteria (i.e., a fasting plasma glucose level of ≥126 mg/dL and/or 2-h glucose level of ≥200 mg/dL in the 75-g oral glucose tolerance test).

Results

For both sexes, prevalence appeared to remain unchanged over the years in all age categories except for men aged 70 years or older, in whom a significant increase in prevalence with time was observed. Age-standardized diabetes prevalence estimates based on the Japanese population of the corresponding year showed marked increasing trends: diabetes prevalence was 6.1% among women (95% confidence interval [CI] 5.5–6.7), 9.9% (95% CI 9.2–10.6) among men, and 7.9% (95% CI 7.5–8.4) among the total population in 2010, and was expected to rise by 2030 to 6.7% (95% CI 5.2–9.2), 13.1% (95% CI 10.9–16.7) and 9.8% (95% CI 8.5–12.0), respectively. In contrast, the age-standardized diabetes prevalence using a fixed population appeared to remain unchanged.

Conclusions

This large-scale meta-regression analysis shows that a substantial increase in diabetes prevalence is expected in Japan during the next few decades, mainly as a result of the aging of the adult population.