Recurrent elderly fallers.

Factors associated with recurrent falling during a one-year period were analysed among elderly Finns (65 yrs and more) seeking medical treatment due to a fall. Recurrent falling in men was independently related to a lesser amount of depressive symptoms and to less severe injury due to the first fall. In women, recurrent falling was independently related to the non-occurrence of a fear of falling. Furthermore, recurrent falling, amount of daily movement, mental capacity, and falling during the previous year were related variables. Here the risk of recurrent falling was high among persons with poor mental capacity, who moved about a large amount daily, and who had had at least one accident during the previous year. In addition, there was an association between poor health and recurrent falling women. Demented women moving about daily, frail women, and incautious men and women seemed to be the main risk groups for repeated falling. What could general practitioners do to prevent repeated falls in the elderly? First, the overall health status and functional capacities of frail elderly women should be improved. Second, all elderly persons, especially those who have fallen, should be informed about how to minimize the risks of falls. Prevention is not easy among the demented population, however.     

Recurrent Elderly Fallers

Factors associated with recurrent failing during a one-year period were analysed among elderly Finns (65 yrs and more) seeking medical treatment due to a fall. Recurrent falling in men was independently related to a lesser amount of depressive symptoms and to less severe injury due to the first fall.

In women, recurrent falling was independently related to the non-occurrence of a fear of falling. Furthermore, recurrent falling, amount of daily movement, mental capacity, and falling during the previous year were related variables. Here the risk of recurrent falling was high among persons with poor mental capacity, who moved about a large amount daily, and who had had at least one accident during the previous year. In addition, there was an association between poor health and recurrent falling in women.

Demented women moving about daily, frail women, and incautious men and women seemed to be the main risk groups for repeated falling. What could general practitioners do to prevent repeated falls in the elderly? First, the overall health status and functional capacities of frail elderly women should be improved. Second, all elderly persons, especially those who have fallen, should be informed about how to minimize the risks of falls. Prevention is not easy among the demented population, however.     

The risk factors related to falling in elderly females

The purpose of this study was to explore the relationship between muscle strength and functional mobility and falls in women aged 65 and over. Thirty-one female subjects with a mean age of 69.57 +/- 4.89 years (65-78) were enrolled in the study. Demographic properties, body mass index, comorbid medical conditions, smoking, the number of medications taken, and fall characteristics were recorded. Knee flexor and extensor strength of the dominant extremity was measured by Biodex isokinetic system, and physical capacity was assessed with a 6-minute walk test. Cognitive status was evaluated by the Mini-Mental State Examination, and disability in daily activities was determined with the Barthel Index. Twelve subjects (38.7%) reported experiencing a fall in the previous year. Eight (25.8%) had experienced a fall outside the home and 4 (12.9%) inside the home. Nine subjects had fallen once, 2 subjects twice, and 1 subject had fallen 3 times. Six (19.4%) subjects reported a fracture after falling. Muscle strength of the knee extensors and flexors and work capacity was similar between those who had fallen and those who had not. The risk factors related to falling were evaluated, but no related factor was determined. Fear of falling was found to be high in patients who had fallen in the previous year. In conclusion, knee extensor and flexor strength are not significant factors in falls or the risk of falling for elderly women, particularly those who are able to function independently. Balance tests in current use are not effective predictors of falls in older adults who live independently and who do not have any significant health problem. These results suggest that there may be a significant interactive effect of the many causal factors that we need to address. Further study is needed to develop new assessment tools for active elderly people to help prevent falls and fall-related injuries.     

Factors contributing to falls in elderly men living in the community

The purpose of this study was to investigate factors related to falls in elder men and the differences between those who fall and those who do not. A convenience sample (n = 71) of men age 65-87 was interviewed, and their activity levels, mental status, mobility status, and weight were evaluated. Most men (73%) had fair to good mental status, minimal (35%) to moderate (56%) activity levels, and average (30%) or high (49%) weight. Fifty-two percent reported falling in the past 2 years: 43% of these men fell once, 19% fell two or three times, and 38% fell four or more times. Only two variables were significant (P <.05) between men who fell and those who did not: Low weight and slow gait time. Poor balance approached significance at P =.0512. In ambulatory elderly men, those who were underweight with slow gait time and poor balance were most at risk for falling.     

Influence of Gender on Falls

ABSTRACT

This study examined whether gender influenced fall-related risk factors among community-dwelling adults of 50 years of age and older who lived in a rural county in eastern North Carolina. Over a 4-year period, a semistructured fall questionnaire was administered. Significant findings at the 0.05 level included (a) women fell more frequently than men in the 71–80-year-old group; (b) women notified other people about their falls more often than men; (c) women who lived alone fell more often than men living alone; and (d) women were more fearful of falling than men. New findings from this study included the percentage of participants who felt like they were going to fall again; comparison of gender to the location of fall; activities engaged in when the fall occurred; fall-related injuries; bathroom safety equipment; and activity restriction due to a fear of falling.     

Gender differences associated with physical functioning in older persons with angina

OBJECTIVE: The objective of this study was to determine whether older men and women with and without angina experience differences in specific areas of physical functioning. METHOD: A historical population based cohort design was used to examine this question. Data were taken from the Established Populations for the Epidemiologic Studies of the Elderly which consists of four large cohorts of samples over 65 years of age living in four communities East Boston, Iowa, New Haven and North Carolina. The Rose Questionnaire was used to identify persons who had angina. Physical functioning was conceptualized under the Nagi framework and considered as either functional limitation/mobility or activities of daily living. Persons were considered disabled if they required assistance with any activity in these categories. Logistic regression was used to examine variables associated with gender differences in physical function. RESULTS: Six hundred and twenty-four person met the criteria for the classification of angina; 249 (39.9%) were men and 375 (60%) were women. In men and women, disability was greater with items associated with functional mobility than for activities of daily living but women were more affected than men. Self-rated health was important in explaining functioning in both areas. CONCLUSION: Older women who experience angina symptoms also have a greater lower extremity disability compared to men with angina. Angina may force older women to curtail more strenuous activities which could lead to further disablement.     

Men's Views About Hysterectomies and Women Who Have Them

Men's (N=25) views about the effects of hysterectomy on women and on their relationships with women they knew who had experienced hysterectomies were solicited by interviews. Many men were not knowledgeable about hysterectomy. They perceived negative psychological, social and sexual effects of hysterectomy on women; but they did not think hysterectomy affected their relationships with women. However, they also communicate very little with women or health care professionals about hysterectomy.     

A Prevalence Study of Sexual Abuse of Adults with Intellectual Disabilities Referred for Sex Education

This paper reports on a prevalence study of sexual abuse of 65 women and 120 men with intellectual disabilities who were referred for sex education. The prevalence rate of abuse was found to be significantly higher for women (61%) than men (25%). Almost all perpetrators were men, with the majority being men with intellectual disabilities or fathers. Women are shown to experience the sexual contact more negatively than the men, although it was usual for both the women and men to feel quite ambivalent about the perpetrator and what he had done to them. Typically the abuse was revealed by the victims themselves, but they were unaware of its social meaning. Generally responses to the abuse were very weak, however there is evidence that the abuse of men is taken more seriously. The poorest service responses were recorded for women who had been abused by men with intellectual disabilities.     

Association between exercise and fear of falling in community-dwelling elderly Koreans: results of a cross-sectional public opinion survey

Lim J-Y, Jang S-N, Park W-B, Oh MK, Kang EK, Paik N-J. Association between exercise and fear of falling in community-dwelling elderly Koreans: results of a cross-sectional public opinion survey.

Objective

To investigate the association between habitual exercise and fear of falling in an older Korean population.

Design

Cross-sectional study conducted in a population-based sample of an urban city.

Setting

Urban city in South Korea.

Participants

Randomly sampled older Korean people (N=828; aged ≥65y) living in a typical urban city located in South Korea.

Intervention

Standardized telephone interview.

Main Outcome Measures

Data on exercise habits, history of falls during the previous year, and fear of falling were obtained using a random digit dialing telephone survey method. Multiple linear regression and multiple logistic regression analyses were used to examine the association between exercise habits and the fear of falling.

Results

The incidence of falls in the study cohort was 13%, and the prevalence of the fear of falling was 67.4% (47.6% in men and 80.8% in women). About 30% of those that expressed a fear of falling stated that this was the cause of their limited activity. Older men and women who exercised regularly showed a similar level of fear of falling, but they were less likely to experience fear-related activity restriction than nonexercisers.

Conclusions

A regular exercise habit was found to be inversely associated with fear-related activity restriction regardless of fall experience among older Korean men and women.     

Help-seeking behaviour for sexual problems: the global study of sexual attitudes and behaviors

The Global Study of Sexual Attitudes and Behaviors (GSSAB) investigated various aspects of sex and relationships among 27,500 men and women aged 40-80 years. Here, we report help-seeking behaviours for sexual problems in this population. A questionnaire was administered using the accepted survey method in each country. Although almost half of all sexually active respondents had experienced at least one sexual problem, less than 19% of them (18.0% of men and 18.8% of women) had attempted to seek medical help for their problem(s). The most frequent action taken by men and women was to talk to their partner (39%). Only 9% of men and women had been asked about their sexual health by a doctor in a routine visit during the past 3 years. Although sexual problems are highly prevalent, few men and women seek medical help for these problems. Overall, men and women show similar help-seeking behaviours.     

The nature and impact of urinary incontinence experienced by patients receiving community nursing services: a cross-sectional cohort study

BACKGROUND: Nurses have played a pivotal role in the delivery of continence services yet little is known about the nature or impact of urinary symptoms experienced by patients in receipt of such care. AIM: To define the nature and impact of urinary symptoms experienced by patients in receipt of community nursing services. METHOD: The Leicestershire Urinary Symptoms Questionnaire was administered to 1078 patients with incontinence identified from 176 community nurses' caseloads in 157 general practices in England. Information included type and severity of urinary symptoms, impact on quality of life, help with coping, use of continence products and health service resources. RESULTS: Nine hundred and ninety nine (92.7%) patients (median age 79.0 years) returned completed questionnaires. Most patients had incontinence between 1 and 5 years duration, women were more likely than men to have had long standing ( > 5 years) symptoms and more than half the sample reported severe leakage. Women were more likely than men to report symptoms of stress incontinence (71.7% and 46.8%, respectively, p < 0.001) and urge incontinence UI (86.3% vs. 74.8%, respectively, p < 0.01). Half of the men and most women also experienced leakage as a result of difficulty getting to, on or off, a toilet/commode. Men were more likely than women to report getting up three or more times a night to pass urine (53.6% vs. 37.0%, respectively, p < 0.05). Most patients reported that their symptoms had a significant impact on many aspects of quality of life, and 45.7% would be very dissatisfied to continue "the way they are now". Professional help appeared principally one of containment. CONCLUSION: Many people with incontinence receiving community nursing services experience two or more urinary symptoms which, in the majority, have a significant impact on quality of life. Many older patients were not satisfied to "put up" with their urinary symptoms. Current service provision appears to be failing those who are most in need of such care.     

Comparison of Spectinomycin Hydrochloride and Aqueous Procaine Penicillin G in the Treatment of Uncomplicated Gonorrhea

Men and women with uncomplicated gonorrhea were randomly assigned to receive aqueous procaine penicillin G (2,400,000 U for men; 2,400,000 U daily for 2 days for women) or spectinomycin hydrochloride (2.0 g for men; 4.0 g for women). Among men who returned for post-treatment evaluation within 10 days, treatment failures were noted among 16 (20.3%) of 79 men who received penicillin and 8 (9.5%) of 84 men who received spectinomycin (P < 0.1). Similarly, 6 (13.3%) of 45 women who received penicillin and 3 (6.5%) of 46 women who received spectinomycin had positive endocervical cultures for Neisseria gonorrhoeae at the time of the post-treatment examination (P = not significant).     

Three-day antibiotic therapy in bacteriuria of old age

A three day oral antibiotic course was given to 71 elderly bacteriuric subjects with no or only moderate mobility problems. Seven of 17 men (41%) and 34 of 54 women (63%) had strongly positive antibody coated bacteria (ACB) in the urine. Following sensitivity tests and randomization one of the following agents was given: cefadroxil 1 g tid (13 subjects): co-trimoxazole 160/800 mg bd (23 subjects); or norfloxacin 400 mg bd (35 subjects). One week after therapy urines were negative in 13 men (76.5%) and 37 women (68.5%). Patients who were fully mobile and/or were ACB(-) responded better than those with moderate mobility problems or who were ACB(+). At six months, urines were negative in six (40%) of 15 men and 15 (33.3%) of 45 women. Two men and six women of these 21 subjects had a positive urine at one month. Of the three agents tested cefadroxil was less effective in women. The study indicates that a three day course will clear bacteriuria in about 70% of patients at one week, but only about 25% will remain free of infection at six months; these are usually patients with adequate mobility and normal renal function.     

Premature ejaculation: presentation and associations. An audit of patients attending a sexual problems clinic

The diagnostic register and case summaries of all male and female patients who attended the clinic on account of one or more sexual symptoms or relationship problems between 1 January 1992 and 31 December 1997 were reviewed. The index symptom or problem was considered the complaint that caused the patient most concern. When patients or couples were experiencing more than one sexual problem, the concomitant problems were tabulated against the index symptom. During this period, 1,056 (440 men and 616 women) patients with sexual symptoms were seen and 131 couples attended primarily with relationship problems. Overall, 18.2% of men referred to the clinic with sexual problems had premature ejaculation (PE), but this was the index symptom in only 11.6% of men. There was a high occurrence of PE in the partners of women presenting with sexual symptoms. Among couples presenting with relationship dissatisfaction or conflict, 18.3% of the male partners had ongoing PE.     

Study of the burden on patients with chronic obstructive pulmonary disease

Background: Health‐related quality of life measures are widely used in patients with chronic obstructive pulmonary disease (COPD). However, they are extremely limited when used to evaluate patients outside the clinical trials. The aim of this study was to analyse the burden of the disease using a simple, validated, self‐administered questionnaire specifically developed for patients in daily clinical practice. Methods: A total of 3935 patients (74.5% men; mean age, 67 years) participated in a cross‐sectional study. The burden of COPD on patients was measured using the Clinical COPD Questionnaire (CCQ). COPD was rated at four levels by the forced expiratory volume in one second (FEV₁) according to The Global Initiative for Chronic Obstructive Lung Disease (GOLD) scale. Results: The disease mainly affects old men (more than 50% were over 65 years of age) and non‐employed men (23% were employed). Of the patients studied, 22.7% continued smoking, especially men (24.4% of men vs. 18.1% of women). Most patients (54%) were diagnosed with moderate stage II COPD. Severity of COPD was lower in women: 29.6% of men had severe COPD compared with 13.7% of women. During the last year, 65.1% had at least one acute exacerbation and 36.6% were admitted to hospital because of COPD exacerbation. No association was found between the body mass index and COPD stage. The variable that most influenced the disease burden was dyspnoea, as progression from grade 0 to grade 4 increased the disease burden by 1.78 points for symptoms, 2.43 for functional state and 1.53 for mental state. The functional classification of COPD also had a significant influence on the disease burden. Conclusions: The present findings show that dyspnoea and the degree of airflow limitation are the clinical variables that most affect the burden of COPD from the patient’s point of view.     

Age and Racial/Ethnic Differences in the Prevalence of Reported Symptoms in Human Immunodeficiency Virus-Infected Persons on Antiretroviral Therapy

Few studies have evaluated age and racial/ethnic differences in the prevalence of symptoms in human immunodeficiency virus (HIV)-infected persons. Thus, the objective of this study was to compare the prevalence of gastrointestinal, metabolic, general malaise, neurologic, or other self-reported symptoms by age and race/ethnicity among 1574 HIV-infected women enrolled in the Women's Interagency HIV Study and 955 HIV-infected men who have sex with men (MSM) enrolled in the Multicenter AIDS Cohort Study. All patients had known dates of initiation of highly active antiretroviral therapy. It was observed that women aged 50 years or more were less likely to experience gastrointestinal symptoms (24% vs. 27%; multivariable P = 0.024), but more likely to experience general malaise (47% vs. 37%; multivariable P = 0.004), neurologic (44% vs. 38%; multivariable P = 0.048), or other symptoms (40% vs. 28%; multivariable P < 0.001) compared with women less than 40 years of age. Only neurologic symptoms had a higher prevalence among older MSM (52% vs. 37%; multivariable P = 0.002), largely driven by paresthesias (48% vs. 31%; multivariable P = 0.004), the most common individual symptom reported by men. Caucasian women generally had the highest prevalence of symptoms, and African American women had the lowest prevalence. Few racial/ethnic differences were noted for MSM. Depression and a prior diagnosis of acquired immunodeficiency syndrome were the strongest and most consistent predictors of clinical symptoms in both cohorts. In summary, the prevalence of reported symptoms varies with patient race/ethnicity, age, and modifiable factors, such as depression and HIV disease stage. Clinicians should consider these factors when counseling patients regarding potential adverse effects of antiretrovirals or symptoms associated with HIV disease.     

Does a physically active lifestyle improve symptoms in women with irritable bowel syndrome?

It has been proposed that physical activity moderates physiological or psychological responses to chronic conditions. The purpose of this study was to determine if women with a chronic functional gastrointestinal (GI) disorder, irritable bowel syndrome, had less active lifestyles than healthy controls and to test whether active women with irritable bowel syndrome had less severe recalled or daily reports of GI, psychological, and somatic symptoms than inactive women with irritable bowel syndrome. Questionnaires were used to measure GI and psychological distress and somatic symptoms in 89 women who participated in this study. A daily symptom and activity diary was kept for one menstrual cycle. Women with irritable bowel syndrome were significantly less likely to be active (48%) than control women (71%) (X2 = 3.4, p = .05). Within the irritable bowel syndrome group, active women were less likely to report a feeling of incomplete evacuation following a bowel movement than inactive women (p < .04), yet active women did not have less severe recalled psychological or somatic symptoms than inactive women. Active women with irritable bowel syndrome reported less severe daily somatic symptoms, which were accounted for by a lower level of fatigue (p = .003), but not daily GI or psychological symptoms. These results suggest that physical activity may produce select symptom improvement in women with irritable bowel syndrome.     

Osteoarthritis overview.

Osteoarthritis (OA) is a nearly universal, slowly progressive degenerative condition affecting men and women as they age. OA of the hip and knee represent two of the most significant causes of pain and physical disability in adults. In the United States, OA is the second most common form of disability, and although it affects both men and women, women are more likely to be symptomatic. Despite its prevalence, OA is not necessarily an inevitable consequence of aging. Many advances have been made in understanding the pathophysiology and epidemiology of OA, and these advances are helping to dispel such attitudes. Evolving recognition of predisposing risk factors and pathophysiology suggest prudent steps that can be recommended. This article provides information for caretakers that will help them understand the disease process and plan appropriate therapeutic interventions.