Gender differences in cognitive impairment and mobility disability in old age: A cross-sectional study in Ouagadougou,Burkina Faso

This study aims to examine differences in cognitive impairment and mobility disability between older men and women in Ouagadougou, Burkina Faso, and to assess the extent to which these differences could be attributable to gender inequalities in life course social and health conditions. Data were collected on 981 men and women aged 50 and older in a 2010 cross-sectional health survey conducted in the Ouagadougou Health and Demographic Surveillance System. Cognitive impairment was assessed using the Leganés cognitive test. Mobility disability was self-reported as having any difficulty walking 400 m without assistance. We used logistic regression to assess gender differences in cognitive impairment and mobility disability. Prevalence of cognitive impairment was 27.6% in women and 7.7% in men, and mobility disability was present in 51.7% of women and 26.5% of men. The women to men odds ratio (95% confidence interval) for cognitive impairment and mobility disability was 3.52 (1.98–6.28) and 3.79 (2.47–5.85), respectively, after adjusting for the observed life course social and health conditions. The female excess was only partially explained by gender inequalities in nutritional status, marital status and, to a lesser extent, education. Among men and women, age, childhood hunger, lack of education, absence of a partner and being underweight were independent risk factors for cognitive impairment, while age, childhood poor health, food insecurity and being overweight were risk factors for mobility disability. Enhancing nutritional status and education opportunities throughout life span could prevent cognitive impairment and mobility disability and partly reduce the female excess in these disabilities.     

Gender differences in cognitive impairment and mobility disability in old age: A cross-sectional study in Ouagadougou,Burkina Faso

This study aims to examine differences in cognitive impairment and mobility disability between older men and women in Ouagadougou, Burkina Faso, and to assess the extent to which these differences could be attributable to gender inequalities in life course social and health conditions. Data were collected on 981 men and women aged 50 and older in a 2010 cross-sectional health survey conducted in the Ouagadougou Health and Demographic Surveillance System. Cognitive impairment was assessed using the Leganés cognitive test. Mobility disability was self-reported as having any difficulty walking 400 m without assistance. We used logistic regression to assess gender differences in cognitive impairment and mobility disability. Prevalence of cognitive impairment was 27.6% in women and 7.7% in men, and mobility disability was present in 51.7% of women and 26.5% of men. The women to men odds ratio (95% confidence interval) for cognitive impairment and mobility disability was 3.52 (1.98–6.28) and 3.79 (2.47–5.85), respectively, after adjusting for the observed life course social and health conditions. The female excess was only partially explained by gender inequalities in nutritional status, marital status and, to a lesser extent, education. Among men and women, age, childhood hunger, lack of education, absence of a partner and being underweight were independent risk factors for cognitive impairment, while age, childhood poor health, food insecurity and being overweight were risk factors for mobility disability. Enhancing nutritional status and education opportunities throughout life span could prevent cognitive impairment and mobility disability and partly reduce the female excess in these disabilities.     

Association of urgency symptoms with self-rated health, mood and functioning in an older population

BACKGROUND AND AIMS: Lower urinary tract symptoms (LUTS) with comorbidities are common in old age. The aim here was to investigate the associations of urgency symptoms with self-rated health, mood and functioning in a random older population adjusted for comorbid conditions. METHODS: A population-based cross-sectional survey was made involving 343 people (159 men and 184 women) aged 70 years and over. LUTS were categorized as symptoms with or without urgency. Perceived inconvenience from LUTS, self-rated health, mood, social activity and activities of daily living (ADL), instrumental activities of daily living (IADL) and mobility disability were the outcome measures. Ageand gender-adjusted and multivariate logistic regression models were constructed in order to examine the associations of urgency and non-urgency symptoms with the outcomes. The covariates were age, gender, and self-reported cardiovascular, musculoskeletal, neurological and other chronic diseases. RESULTS: Perceived inconvenience from urgency symptoms was more frequent than that from non-urgency symptoms (64% vs 20%, p<0.001). In the age- and gender-adjusted logistic regression models, LUTS with urgency were associated with poor self-rated health (OR [odds ratio] 2.35; 95% CI [confidence interval] 1.06-5.20), depressive mood (OR 7.29; 95% CI 2.91-18.30), ADL (OR 2.33; 95% CI 1.10-4.92), IADL (OR 2.16; 95% CI 1.19-3.92) and mobility disability (OR 2.44; 95% CI 1.37-4.36). LUTS without urgency were associated with depressive mood (OR 5.02; 95% CI 1.97-12.82) and mobility disability (OR 1.97; 95% CI 1.10-3.53). In the multivariate analyses in which comorbid conditions were added to the model, the associations of non-urgency and urgency symptoms persisted only with depressive mood (OR 4.00; 95% CI 1.52-10.53 and OR 6.16; 95% CI 2.39-15.84, respectively). CONCLUSION: Urgency symptoms are associated with poor self-rated health, depressive mood and disability in older people. There is an independent association between both urgency and non-urgency LUTS and depressive mood. A careful assessment of the mental state of older individuals with LUTS is warranted.     

Prevalence rate of urinary incontinence in community-dwelling elderly individuals: the Veneto study

BACKGROUND: Urinary incontinence (UI) is a common problem in elderly people, due mainly to functional impairments and concurrent medical diseases. Few studies, however, have assessed the prevalence of UI in noninstitutionalized individuals. The objectives of the present work were to estimate the prevalence of UI in a community-based population of elderly Italians and to determine the associated physical, social, and psychological factors. METHODS: A random sample of noninstitutionalized men (n = 867) and women (n = 1531), aged 65 years and older, from the Veneto region of northeastern Italy, were interviewed at home, using an extensive multidisciplinary questionnaire, to assess their quality of life and social, biological, and psychological correlates. RESULTS: The prevalence rate of UI was of 11.2% among men and of 21.6% among women. Among those reporting the condition, approximately 53% of women and 59% of men reported experiencing incontinence daily or weekly. Association of UI was found for participants older than 70 years in both men (odds ratio [OR] 2.49, 95% confidence interval [CI] 1.45-4.28) and women (OR 1.49, 95% CI 1.11-2.02). Three of the medical conditions investigated were associated with increases in the odds in women, namely chronic obstructive pulmonary disease (OR 1.53, 95% CI 1.11-2.12), Parkinsonism (OR 2.27, 95% CI 1.14-4.54), and hip fracture (OR 1.38,95% CI 1.02-1.88), whereas chronic diarrhea was the only condition associated with UI in men (OR 6.92, 95% CI 2.22-21.5). Participants with a physical disability were two times more likely to report incontinence, and the odds were increased by 50% in women who had sleep disturbances. CONCLUSIONS: Incontinence is highly prevalent in the Italian elderly population, and several common chronic conditions are significantly associated with it. Moreover, very few people with incontinence seek health care or are aware of potential treatments.     

Health status indicators among community-dwelling elders with arthritis: the Bambuí health and aging study

OBJECTIVE: To investigate the association of arthritis with health status indicators among elders living in Bambuí, Brazil. METHODS: A cross-sectional study was conducted among 1606 elders using baseline data from the Bambuí Health and Aging Study, a population based cohort study of older adults. Arthritis was self-reported and defined as a physician diagnosis of arthritis or rheumatism, and/or chronic hand and knee symptoms. Health status indicators, defined a priori as the main independent variables, were self-rated health, psychological distress (based on the General Health Questionnaire), report of sleep complaints, disability in activities of daily living (ADL), "2-week" disability, mobility disability, and 2 composite indexes of mental health problems and physical disability problems. Logistic regression compared health status indicators among elders reporting arthritis (N = 833) and non-arthritis subjects. RESULTS: After controlling for sociodemographics and chronic conditions, all measures were found to be associated with arthritis: sleep complaints (OR 1.81, 95% CI 1.43-1.92), fair (OR 2.17, 95% CI 1.62-2.90) and poor self-rated health (OR 3.48, 95% CI 2.46-4.94), ADL disability (OR 1.73, 95% CI 1.02-2.87), mobility disability (OR 2.65, 95% CI 2.06-3.41), 2-week disability (OR 1.86, 95% CI 1.35-2.57), 2 mental health problems (OR 2.25, 95% CI 1.67-3.04), and one (OR 2.46, 95% CI 1.91-3.16) and 2 physical disability problems (OR 4.19, 95% CI 2.02-8.59). CONCLUSION: Considering the paucity of similar studies addressing the impact of arthritis in developing nations, these findings may be applied to similar communities and support better planning of resource allocations to minimize the effects of arthritis among the elderly.     

Gender differences in incidence and determinants of disability in activities of daily living among elderly individuals: SABE study

Determining the groups that are most susceptible to developing disability is essential to establishing effective prevention and rehabilitation strategies. The aim of the present study was to determine gender differences in the incidence of disability regarding activities of daily living (ADL) and determinants among elderly residents of Sao Paulo, Brazil. In 2000, 1634 elderly with no difficulties regarding ADL (modified Katz Index) were selected. These activities were reassessed in 2006 and disability was the outcome for the analysis of determinants. The following characteristics were analyzed at baseline: socio-demographic, behavioral, health status, medications, falls, hospitalizations, depressive symptoms, cognition, handgrip, mobility and balance. The incidence density was 42.4/1000 women/year and 17.5/1000 men/year. After adjusting for socioeconomic status and health conditions, women with chronic diseases and social vulnerability continued to have a greater incidence of disability. The following were determinants of the incidence of disability: age and depressive symptoms in both genders; stroke and slowness on the sit-and-stand test among men; and osteoarthritis and sedentary lifestyle among women. Better cognitive performance and handgrip strength were protective factors among men and women, respectively. Adverse clinical and social conditions determine differences between genders regarding the incidence of disability. Decreased mobility and balance and health conditions that affect the central nervous system or lead to impaired cognition disable men more, whereas a sedentary lifestyle, reduction in muscle strength and conditions that affect the osteoarticular system disable women more.     

Gender differences in four-year incidence of self-reported and performance-based functional disability: The International Mobility in Aging Study

ObjectivesTo examine differences in incidence of functional disability between older women and men.Methods2002 participants (65–74 years) were recruited in 2012 from Canada, Brazil, Colombia, and Albania, and re-assessed in 2016. Three measures of functional disability were used (1) Difficulty in any of five mobility-related Activities of Daily Living (ADL disability); (2) Self-reported difficulty climbing a flight of stairs or walking 400 m (mobility disability); and (3) Poor physical performance. We estimated the adjusted gender-specific incidence risk ratios (IRR) for each outcome in 2016.ResultsIn 2016, 1506 participants (52% women) were re-examined, 80% of the surviving cohort. Among those not disabled in 2012, seventy-four (12.9%) men developed ADL disability, while 105 (19.2%) developed mobility disability, and 97 (16.1%) developed poor physical performance. For women, numbers were higher 120 (21.4%) developed ADL disability, 117 (26.5%) developed mobility disability, and 140 (23.0%) developed poor physical performance. Compared to men, women had a higher adjusted incidence of self-reported ADL disability (IRR 1.4; 95% CI 1.04–1.88) and mobility disability (IRR 1.4; 95% CI 1.06–1.77), but not of poor physical performance (IRR 1.03; 95% CI 0.88–1.32).ConclusionsAlthough women have a higher self-reported incidence of ADL and mobility disability than men, there was no significant difference in poor physical performance. Reasons for this discrepancy between self-reported and performance-based measures require further investigation. Understanding gender differences in functional disabilities can provide the basis for interventions to prevent mobility loss and minimize any gender gap.     

Gender difference in the prevalence and socio-demographic correlates of mobility disability among older adults in Nigeria

The aim of the current study is to examine gender differences in mobility disability among older people in Nigeria, and to explore factors associated with gender differences in mobility disability in later life. Data were used from the first (2010–2011) wave of the Nigeria General Household Survey-Panel, which included 3586 respondents aged 50 years and above. Mobility disability was assessed as self-reported difficulty in walking 100 m, walking 1 km, walking uphill, running, bending or stooping, and climbing stairs. Regression analyses were used to estimate the extent to which socio-demographic conditions contribute to gender differences in mobility disability. We observed a higher prevalence of mobility disability among women compared to men (20.1 vs. 12.5 %, P < 0.001). The prevalence ratios (PR) of mobility disability for women versus men was 1.61 (95 % CI 1.38–1.88, P < 0.001); after adjusting for age, marital status, place of residence, self-reported health status and cognitive difficulties, the PR was 1.55 (95 % CI 1.30–1.85, P < 0.001). In the fully adjusted model, mobility disability still remained significantly higher among women (PR 1.60, 95 % CI 1.32–1.93, P < 0.001). The marginal effects of socio-demographic and health factors were stronger for women than for men. Socio-demographic and health variables considered in this study explained between 19.3 % (men) and 22.3 % (women) of variance in mobility disability suggesting that additional factors beyond those considered in this study warrant further investigation, so that differences in mobility disability between older men and women in Nigeria can be fully understood.     

Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period

BACKGROUND AND AIMS: Little is known about muscle strength as a predictor of disability among older Mexican Americans. The aim of this study was to examine the association between hand grip strength and 7-year incidence of ADL disability in older Mexican American men and women. METHODS: A 7-year prospective cohort study of 2493 non-institutionalized Mexican American men and women aged 65 or older residing in five south-western states. Maximal hand grip strength test, body mass index, cognitive function, activities of daily living, self-reports of medical conditions (arthritis, diabetes, heart attack, stroke, cancer, hip fracture), and depressive symptoms were obtained. RESULTS: In a Cox proportional regression analysis, there was a linear relationship between hand grip strength at baseline and risk of incident ADL disability over a 7-year follow-up. Among non-disabled men at baseline, the hazard ratio of any new ADL limitation was 1.90 (95% CI 1.14-3.17) for those in the lowest quartile, when compared with men in the highest hand grip strength quartile, after controlling for age, marital status, medical conditions, high depressive symptoms, MMSE score, and BMI at baseline. Among non-disabled women at baseline, the hazard ratio of any new ADL limitation was 2.28 (95% CI 1.59-3.27) for those in the lowest quartile, when compared with women in the highest hand grip strength quartile. CONCLUSIONS: Hand grip strength is an independent predictor of ADL disability among older Mexican American men and women. The hand grip strength test is an easy, reliable, valid, inexpensive method of screening to identify older adults at risk of disability.     

Ten-year change in disability prevalence and related factors in two generations of French elderly community dwellers: data from the PAQUID study

BACKGROUND AND AIMS: Some studies have reported a decline in disability prevalence in older people, but few data were available for Europe, especially for France. Our aim was to study the 10-year evolution of disability prevalence in elderly community dwellers and related factors. METHODS: Two generations of subjects aged 75 to 84, participants in the PAQUID (Personnes Agées QUID) cohort were compared. The first generation included 1496 subjects (born between 1903 and 1912) and the second 910 subjects (born between 1913 and 1922). Three domains of disability were assessed: mobility, Activities of Daily Living (ADL) and Instrumental ADL (IADL). Logistic regressions were used to explain the effect of generation on disability, controlling for sociodemographic characteristics, impairment, life-style, medical care, and social support. RESULTS: The percentage of subjects fully independent increased from 13.5 to 23.3% (p < 0.001). A large decline in disability prevalence independent of the controlled factors was observed for mobility in both genders [Odds Ratio for the second generation (OR(G2)) = 0.48, 95% CI 0.38-0.60]. When adjusting for age and education, the risk of IADL disability was significantly lower in women in the second generation (ORG2 0.61, 95% CI 0.49-0.77), and the generation effect was strengthened when adjusting for the other covariates, but unchanged in men (ORG2 1.09, 95% CI 0.81-1.48). There was no significant change for ADL. CONCLUSIONS: A significant decline in disability prevalence was observed over 10 years, which was not explained by the selected covariates. These aggregate changes differed by gender, education, and the domain of disability considered.     

A life-course approach in explaining social inequity in obesity among young adult men and women

OBJECTIVE: To examine the cumulative influence of adverse behavioural, social, and psychosocial circumstances from adolescence to young adulthood in explaining social differences in overweight and obesity at age 30 years and if explanations differ by gender. DESIGN: A 14-year longitudinal study with 96.4% response rate. SUBJECT: Data from 547 men and 497 women from a town in north Sweden who were baseline examined at age 16 years and prospectively followed up to age 30 years. MEASUREMENTS: Overweight and obesity were ascertained at ages 16 and 30 years. Occupation and education were used to measure socioeconomic status. The explanatory measurements were: age at menarche, smoking, physical activity, alcohol consumption, TV viewing, home and school environment, social support, social network, and work environment. RESULTS: No gender or social difference in overweight was observed at age 16 years. At age 30 years, significantly more men than women (odds ratio (OR) = 2.81, 95% confidence interval (CI) 2.14-3.68) were overweight or obese. Educational level was associated with overweight at age 30 years, but not occupational class. Both men (OR = 1.55, 95% CI 1.10-2.19) and women (OR = 1.78, 95% CI 1.16-2.73) with low education (< or =11 years) were at risk of overweight. The factors that explained the educational gradient in overweight among men were low parental support in education during adolescence, and physical inactivity, alcohol consumption, and nonparticipation in any association during young adulthood. The educational gradient in overweight in women was explained mostly by adolescence factors, which include early age at menarche, physical inactivity, parental divorce, not being popular in school, and low school control. Restricted financial resource during young adulthood was an additional explanatory factor for women. All these factors were significantly more common among men and women with low education than with high education. CONCLUSION: Social inequities in overweight reflect the cumulative influence of multiple adverse circumstances experienced from adolescence to young adulthood. Underlying pathways to social inequity in overweight differ between men and women. Policy implications to reduce social inequity in overweight include reduction of social differences in health behaviours and social circumstances that take place at different life stages, particularly psychosocial circumstances during adolescence.     

Health correlates of overweight and obesity in adults aged 50 years and over: results from the Survey of Health, Ageing and Retirement in Europe (SHARE). Obesity and health in Europeans aged > or = 50 years

QUESTIONS UNDER STUDY: To examine the association between overweight/obesity and several self-reported chronic diseases, symptoms and disability measures. METHODS: Data from eleven European countries participating in the Survey of Health, Ageing and Retirement in Europe were used. 18,584 non-institutionalised individuals aged 50 years and over with BMI > or = 18.5 (kg/m2) were included. BMI was categorized into normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9) and obesity (BMI > or = 30). Dependent variables were 13 diagnosed chronic conditions, 11 health complaints, subjective health and physical disability measures. For both genders, multiple logistic regressions were performed adjusting for age, socioeconomic status and behaviour risks. RESULTS: The odds ratios for high blood pressure, high cholesterol, diabetes, arthritis, joint pain and swollen legs were significantly increased for overweight and obese adults. Compared to normal-weight individuals, the odds ratio (OR) for reporting > or = 2 chronic diseases was 2.4 (95% CI 1.9-2.9) for obese men and 2.7 (95% CI 2.2-3.1) for obese women. Overweight and obese women were more likely to report health symptoms. Obesity in men (OR 0.5, 95% CI 0.4-0.6), and overweight (OR 0.5, 95% CI 0.4-0.6) and obesity (OR 0.4, 95% CI 0.3-0.5) in women, were associated with poorer subjective health (i.e. a decreased risk of reporting excellent, very good or good subjective health). Disability outcomes were those showing the greatest differences in strength of association across BMI categories, and between genders. For example, the OR for any difficulty in walking 100 metres was non-significant at 0.8 for overweight men, at 1.9 (95% CI 1.3-2.7) for obese men, at 1.4 (95% CI 1.1-1.8) for overweight women, and at 3.5 (95% CI 2.6-4.7) for obese women. CONCLUSIONS: These results highlight the impact of increased BMI on morbidity and disability. Healthcare stakeholders of the participating countries should be aware of the substantial burden that obesity places on the general health and autonomy of adults aged over 50.     

Disability-free life expectancy of elderly people in a population undergoing demographic and epidemiologic transition

BACKGROUND: the major purpose of health and social policy in old age is to increase quality of life of elderly people. In many demographically developing countries, life expectancy is increasing very rapidly, but little information is available on survival free of disability. OBJECTIVES: to determine prevalence and severity of disability among the elderly population and to compare disability-free life expectancy and self-care life expectancy among different age groups and between men and women. DESIGN: a cross-sectional multi-stage random sample survey and routine life tables for Thailand. SETTING: national population of Thailand. SUBJECTS: 4,048 elderly subjects aged 60+ years. RESULTS: prevalence rates (95% CI) of long-term disability and dependency in self-care activities of daily living were 19% (95% CI 17.8, 20.2) and 6.9% (6.1, 7.7) respectively. Rates of disabilities increased with age and women were more disabled than men. The life expectancy and disability-free life expectancy at age 60 for men were 20.3 years and 16.4 years, and for women were 23.9 years and 18.2 years respectively. Self-care life expectancies at age 60, calculated from the prevalence of needing help with basic self-care activities, were 18.6 years and 21.3 years for men and women respectively. Women spent proportionately more of their longer life expectancy in a disabled state than men. Men and women can, respectively, expect that 19% and 24% of their life expectancy at age 60 will be spent in a disabled state, but may expect only about 10% of their life expectancy to be spent unable to manage basic self-care activities of daily living. CONCLUSION: long-term disability is common in old age, affecting a quarter of people over 60 years. However, self-care problems are much less common and suggest that the social and health care consequences of demographic transitions are over-estimated by use of simple questions about limiting long-standing disability. Self-care life expectancy provides a useful monitoring tool for censuses and national disability surveys.     

Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study

OBJECTIVES: To define frailty using simple indicators; to identify risk factors for frailty as targets for prevention; and to investigate the predictive validity of this frailty classification for death, hospitalization, hip fracture, and activity of daily living (ADL) disability. DESIGN: Prospective study, the Women's Health Initiative Observational Study. SETTING: Forty U.S. clinical centers. PARTICIPANTS: Forty thousand six hundred fifty-seven women aged 65 to 79 at baseline. MEASUREMENTS: Components of frailty included self-reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow-up. Death, hip fractures, ADL disability, and hospitalizations were ascertained during an average of 5.9 years of follow-up. RESULTS: Baseline frailty was classified in 16.3% of participants, and incident frailty at 3-years was 14.8%. Older age, chronic conditions, smoking, and depressive symptom score were positively associated with incident frailty, whereas income, moderate alcohol use, living alone, and self-reported health were inversely associated. Being underweight, overweight, or obese all carried significantly higher risk of frailty than normal weight. Baseline frailty independently predicted risk of death (hazard ratio (HR)=1.71, 95% confidence interval (CI)=1.48-1.97), hip fracture (HR=1.57, 95% CI=1.11-2.20), ADL disability (odds ratio (OR)=3.15, 95% CI=2.47-4.02), and hospitalizations (OR=1.95, 95% CI=1.72-2.22) after adjustment for demographic characteristics, health behaviors, disability, and comorbid conditions. CONCLUSION: These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women. Underweight, obesity, smoking, and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention.     

Angiotensin-converting enzyme (ACE) genotypes and disability in hospitalized older patients

The association between angiotensin-converting enzyme (ACE) genotypes and functional decline in older adults remains controversial. To assess if ACE gene variations influences functional abilities at older age, the present study explored the association between the common ACE insertion/deletion (I/D) polymorphism and disability measured with activities of daily living (ADL) in hospitalized older patients. We analyzed the frequency of the ACE genotypes (I/I, I/D, and D/D) in a population of 2,128 hospitalized older patients divided according to presence or absence of ADL disability. Logistic regression analysis adjusted for possible confounding factors, identified an association between the I/I genotype with ADL disability (OR=1.54, 95% CI 1.04-2.29). This association was significant in men (OR=2.01, 95% CI 1.07-3.78), but not in women (OR=1.36, 95% CI 0.82-2.25). These results suggested a possible role of the ACE polymorphism as a genetic marker for ADL disability in hospitalized older patients.     

The role of waist circumference in predicting disability in periretirement age adults

OBJECTIVE: To measure the risk of periretirement age disability associated with five different anthropometric measures of body mass and shape, and to compare the measures in this group, the peak age group of obesity prevalence. DESIGN: Longitudinal study of Health Survey for England 1998 respondents followed-up in the English Longitudinal Study of Ageing in 2002. SUBJECTS: National population sample of 1030 women and 888 men aged 55-74 years. MEASUREMENTS: Five baseline exposure measures (weight (WT), body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-hip ratio (WHR)) at baseline, and disability outcomes (measured gait speed, self-reported mobility problems, instrumental and ordinary activities of daily living (I/ADLs)) after 5 years. RESULTS: Individually, the heaviest quartile of WC and WHR predicted disability using all outcomes in men. In women, the heaviest category of each of the five exposure measures predicted disability, for each of the outcomes. In competing measures models, WC was included in the best fit model of tested mobility disability in men (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.4-4.1; P<0.05) and women (OR 3.0; 95% CI 1.9-4.8; P<0.001), adjusted for age, height, smoking, social class, and education. WC was also included in the best fit model of all self-reported disabilities in men, and for self-reported I/ADL disabilities in women. CONCLUSIONS: Across the periretirement age period, body mass and shape are major determinants of disability, with increases in WC, a marker for abdominal obesity, best predicting risk for most disability outcomes. This result adds to the case for WC to be used in estimates of obesity-related health risks for epidemiological monitoring and clinical care.     

Gender and rural-urban differences in reported health status by older people in Bangladesh

The study aims to (i) describe regional variation and gender differences in health status of older people (60 years and older) in Bangladesh, indicated by self-reported health problems and functional ability; (ii) explore influence of socio-economic factors on health status of older people. In a cross-sectional study in rural and urban Bangladesh, 696 older persons were asked about their health problems and ability to manage activities of daily living (ADL). More than 95% of older people reported health problems. Approximately 80% of elderly women in both the regions reported having four or more health problems compared with 42% and 63% elderly men in the urban and rural regions, respectively. More women (urban: 55%; rural: 36%) than men (urban: 32%; rural: 22%) also reported difficulties with ADL. Irrespective of age, sex and area of residence, those reporting greater number of health problems were more likely to report difficulty with at least one ADL task. Reporting pattern of specific health problems varied between urban and rural regions. Socio-economic indicators were found to have little influence on reporting of health problems, particularly in the rural region. Observed regional difference may be related to the influence of social and environmental factors, and level of awareness concerning certain health conditions.     

Gender and socio-economic variations in employment among patients with a diagnosed musculoskeletal disorder: a longitudinal record linkage study in Sweden

OBJECTIVE: To establish whether the employment consequences of musculoskeletal disorder vary by gender and socio-economic group in Sweden. METHODS: Two linked registers, containing diagnostic and socio-economic data for the 1.8 million residents of Stockholm County, were used to investigate the subsequent employment consequences over 5 yr of having a musculoskeletal disorder requiring hospital admission in 1996. Age-standardized employment rates of all patients with musculoskeletal disorder (n = 2185) were compared with patients employed prior to hospital admission (n = 1286) and with the general population of Stockholm. Odds of leaving employment between 1996-2001 were calculated for men, women and patients from different socio-economic groups. RESULTS: Employment rates increased and social differentials narrowed in the general population, while employment declined and social differentials widened among patients with musculoskeletal disorders. These trends were masked when analyses were restricted to individuals employed at baseline. Following hospital admission, the odds of leaving employment increased annually for patients; by 2001, their adjusted odds were over three times greater [odds ratio (OR) = 3.36, 95% confidence interval (CI) 2.89-3.91] than for the general population. Women with musculoskeletal disorders were significantly more likely to leave employment during follow-up than men (OR = 1.95, 95% CI 1.49-2.56). Semi- and unskilled manual workers with musculoskeletal disorders were over three times as likely to leave employment than their professional counterparts (OR = 3.40, 95% CI 2.41-4.81). CONCLUSIONS: People with musculoskeletal disorders, particularly women and semi- and unskilled manual workers, are vulnerable to leaving employment. Health and social policies must do more to protect the employment of people with musculoskeletal disorders.     

Morbidity and comorbidity in relation to functional status: a community-based study of the oldest old (90+ years)

OBJECTIVES: To describe health and functional status in the oldest old; to explore the relationships of morbidity and functional status; and to verify whether this relationship was modified by gender. DESIGN AND SETTING: A community-based survey including all inhabitants aged > or = 90 living in central Stockholm, Sweden. All participants were clinically examined by physicians, cognitively assessed by psychologists, and interviewed by nurses. Diagnoses were made according to the International Classification of Diseases-Ninth Revision (ICD-9), the DSM-III-R criteria for dementia, and Katz index of activities of daily living. PARTICIPANTS: Of the 698 subjects in the study population, 99 (14%) had died and 29 (4%) moved before examination. Of the remaining subjects, 502 (88.1%) were examined, and the refusal rate was 11.9%. MEASUREMENTS: Age- and gender-specific prevalence figures, and age-, gender- and education-adjusted odds ratios (OR) were used. RESULTS: Of 502 examined subjects, 19% had no disease and 73% were functionally independent. Dementia was the most prevalent disease among women (42.2%), and cardio- and cerebrovascular diseases were the most frequent among men (42.4%). Women had higher prevalences of dementia (adjusted OR = 2.1, 95% confidence interval (CI) 1.2-3.7) and fractures and musculoskeletal diseases (adjusted OR = 2.8, 95% CI 1.1-7.3), whereas men had a higher prevalence of malignancy (OR = 0.2, 95% CI 0.1-0.7). Women were more disabled than men independent of age, education, and number of diseases (adjusted OR = 2.2, 95% CI 1.1-4.3). CONCLUSIONS: A great proportion of nonagenarians were functionally independent despite their advanced age. Further studies are needed to clarify the excess of disability among very old women.     

The prevalence of dizziness and its association with functional disability in a biracial community population

BACKGROUND: Information regarding the prevalence of dizziness and its association with functional disability among African American and white residents from defined community populations is limited. METHODS: A total of 6,158 persons 65 years and older (78.8% of age-eligible persons) completed in-home interviews that included three common measures of self-reported disability: the Katz Activities of Daily Living (ADL) Scale, the Rosow-Breslau Functional Health Scale, and the Nagi Physical Disability Scale. A stratified random sample of 729 persons underwent a detailed evaluation that included questions on the frequency and severity of dizziness, which was defined as having an episode of dizziness or lightheadedness at least once a month. RESULTS: The overall prevalence of dizziness in this population was 9.6% (95% confidence interval [CI] 7.2-12.0). It increased with age, from 6.6% in those 65-74 years old, to 11.6% in those 75-84 years old, and to 18.4% in those persons > or =85 years old. It was more common in women (odds ratio [OR] 2.03, 95% CI 0.99-4.19) but was not associated with race. After adjusting for age, sex, and race, dizziness was associated with greater disability on the Rosow-Breslau (OR 2.29, 95% CI 1.18-4.46) and Nagi (OR 2.54, 95% CI 1.48-4.36) measures but not on the Katz ADL Scale (OR 1.18, 95% CI 0.64-2.20). CONCLUSIONS: Dizziness is common among older persons and is associated with functional disability.