Primary care treatment of knee pain--a survey in older adults

OBJECTIVES: To describe the treatment of knee pain in older adults in primary care and to compare reported practice with published evidence. METHODS: A semi-structured interview of older adults with knee pain about their use of 26 interventions for knee pain. RESULTS: 201 adults were interviewed. A median of six interventions had been advised for each participant, with heat and ice (84%) the most frequently advised, followed by paracetamol (71%), compound opioid analgesics (59%) and non-selective non-steroidal anti-inflammatory drugs (59%). Three core treatments for knee pain (written information, exercise and weight loss) were advised to 16%, 46% and 39% of the participants, respectively. Half of the interventions had been initiated through 'self care'. Most core treatments had not been initiated before second-line interventions had been used, paracetamol being the exception. Referral to surgery was commonly initiated before more conservative options had been tried. CONCLUSIONS: Interventions recommended as core treatment for knee pain in older adults were underused-in particular, exercise, weight loss and the provision of written information. There appeared to be early reliance on pharmacological treatments with underuse of non-pharmacological interventions in early treatment choices. Self care played an important role in the management of this condition. The study provides clear evidence on the need to improve the delivery of core treatments for osteoarthritis and highlights the need to support and encourage self care.     

Characteristics of chronic pain associated with sleep difficulty in older adults: the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston study

OBJECTIVES: To evaluate pain severity and distribution in relation to sleep difficulty in older adults. DESIGN: Population‐based cross‐sectional study. SETTING: Community within a 5‐mile radius of the study center at the Institute for Aging Research, Hebrew SeniorLife (HSL), Boston. PARTICIPANTS: Seven hundred sixty‐five participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study aged 64 and older. MEASUREMENTS: Pain severity was measured using the Brief Pain Inventory (BPI) Pain Severity Subscale. Musculoskeletal pain distribution was grouped according to no pain, single site, two or more sites, and widespread pain (upper and lower extremities and back pain). Three aspects of sleep difficulty were measured using items from the Center for Epidemiologic Studies Depression Scale, Revised (trouble getting to sleep, sleep more than usual, and restless sleep). RESULTS: Prevalence of trouble getting to sleep according to BPI severity was 17.8%, 19.7%, 32.0%, and 37.0% for the lowest to highest pain severity quartiles, respectively. Similar relationships between pain and sleep were observed across sleep measures according to pain severity and distribution. Adjusted for sociodemographic characteristics, chronic conditions, and health behaviors, chronic pain was strongly associated with trouble sleeping (≥1 d/wk) (single‐site pain, odds ratio (OR)=1.77, 95% confidence interval (CI)=1.10–2.87; multisite pain, OR=2.38, 95% CI=1.48–3.83; widespread pain, OR=2.55, 95% CI=1.43–4.54, each compared with no pain). Similar associations were observed for restless sleep and sleeping more than usual. For specific pain sites alone or in combination with other sites of pain, only modest associations were observed with sleep problems. CONCLUSION: Widespread or other multisite pain and moderate to severe pain are strongly associated with sleep difficulty in older adults. Further research is needed to better understand the burden and consequences of pain‐related sleep problems in older adults.     

Influence of zolpidem and sleep inertia on balance and cognition during nighttime awakening: a randomized placebo-controlled trial

OBJECTIVES: To determine whether sleep inertia (grogginess upon awakening from sleep) with or without zolpidem impairs walking stability and cognition during awakenings from sleep. DESIGN: Three within‐subject conditions hypnotic medication (zolpidem), placebo (sleep inertia), and wakefulness control randomized using balanced Latin square design. SETTING: Sleep laboratory. PARTICIPANTS: Twelve older and 13 younger healthy adults. INTERVENTION: Five milligrams of zolpidem or placebo 10 minutes before scheduled sleep (double‐blind: zolpidem or sleep inertia); placebo before sitting in bed awake for 2 hours after their habitual bedtime (single‐blind: wakefulness control). MEASUREMENTS: Tandem walk on a beam and cognition, measured using computerized performance tasks, approximately 120 minutes after treatment. RESULTS: No participants stepped off the beam on 10 practice trials. Seven of 12 older adults stepped off the beam after taking zolpidem, compared with none after sleep inertia and three after wakefulness control. Fewer young adults stepped off the beam: three after taking zolpidem, one after sleep inertia, and none after wakefulness control. Number needed to harm analyses showed one tandem walk failure for every 1.7 (95% confidence interval (CI)=1.4–2.0) older and 5.5 (95% CI=5.2–5.8) younger adults treated with zolpidem. Cognition was significantly more impaired after zolpidem exposure than with wakefulness control in older and younger participants (working memory: older, ?4.3 calculations, 95% CI=?7.0 to ?1.7; younger, ?12.4 calculations, 95% CI=?18.2 to ?6.7; Stroop: older, 76‐ms increase (95% CI=13.5–138.4 ms); younger, 126‐ms increase, 95% CI=34.7–217.5 ms), whereas sleep inertia significantly impaired cognition in younger but not older participants. CONCLUSION: Zolpidem produced clinically significant balance and cognitive impairments upon awakening from sleep. Because impaired tandem walk predicts falls and hip fractures and because impaired cognition has important safety implications, use of nonbenzodiazepine hypnotic medications may have greater consequences for health and safety than previously recognized.     

Self-reported napping and duration and quality of sleep in the lifestyle interventions and independence for elders pilot study

OBJECTIVES: To determine the prevalence of self‐reported napping and its association with subjective nighttime sleep duration and quality, as measured according to sleep‐onset latency and sleep efficiency. DESIGN: Cross‐sectional study. SETTING: Lifestyle Interventions and Independence for Elders Pilot Study. PARTICIPANTS: Community‐dwelling older adults (N=414) aged 70 to 89. MEASUREMENTS: Self‐report questionnaire on napping and sleep derived from the Pittsburgh Sleep Quality Index (PSQI) scale. RESULTS: Fifty‐four percent of participants reported napping, with mean nap duration of 55.0±41.2 minutes. Nappers were more likely to be male (37.3% vs 23.8%, P=.003) and African American (20.4% vs 14.4%, P=.06) and to have diabetes mellitus (28% vs 14.3%, P=.007) than non‐nappers. Nappers and non‐nappers had similar nighttime sleep duration and quality, but nappers spent approximately 10% of their 24‐hour sleep occupied in napping. In a multivariate model, the odds of napping were higher for subjects with diabetes mellitus (odds ratio (OR)=1.9, 95% confidence interval (CI)=1.2–3.0) and men (OR=1.9, 95% CI=1.2–3.0). In nappers, diabetes mellitus (β=12.3 minutes, P=.005), male sex (β=9.0 minutes, P=.04), higher body mass index (β=0.8 minutes, P=.02), and lower Mini‐Mental State Examination score (β=2.2 minutes, P=.03) were independently associated with longer nap duration. CONCLUSION: Napping was a common practice in community‐dwelling older adults and did not detract from nighttime sleep duration or quality. Given its high prevalence and association with diabetes mellitus, napping behavior should be assessed as part of sleep behavior in future research and in clinical practice.     

Daily Variations in Objective Nighttime Sleep and Subjective Morning Pain in Older Adults with Insomnia: Evidence of Covariation over Time

OBJECTIVES: To examine the relationship between objectively measured nocturnal sleep and subjective report of morning pain in older adults with insomnia; to examine not only the difference between persons in the association between sleep and pain (mean level over 14 days), but also the within‐person, day‐to‐day association. DESIGN: Cross‐sectional. SETTING: North‐central Florida. PARTICIPANTS: Fifty community‐dwelling older adults (mean age±standard deviation 69.1±7.0, range 60–90) with insomnia. MEASUREMENTS: Daily home‐based assessment using nightly actigraphic measurement of sleep and daily self‐report of pain over 14 consecutive days. RESULTS: Between persons, average sleep over 14 days was not associated with average levels of rated pain, but after a night in which an older adult with insomnia experienced above‐average total sleep time he or she subsequently reported below‐average pain ratings. The model explained approximately 24% of the within‐person and 8% of the between‐person variance in pain ratings. CONCLUSIONS: Sleep and pain show day‐to‐day associations (i.e., covary over time) in older adults with insomnia. Such associations may suggest that common physiological systems underlie the experience of insomnia and pain. Future research should examine the crossover effects of sleep treatment on pain and of pain treatment on sleep.     

A randomized controlled clinical trial of the Seattle Protocol for Activity in older adults

OBJECTIVES: To compare the efficacy of a physical activity program (Seattle Protocol for Activity (SPA)) for low‐exercising older adults with that of an educational health promotion program (HP), combination treatment (SPA+HP), and routine medical care control conditions (RMC). DESIGN: Single‐blind, randomized controlled trial with two‐by‐two factorial design. SETTING: Community centers in King County, Washington, from November 2001 to September 2004. PARTICIPANTS: Two hundred seventy‐three community‐residing, cognitively intact older adults (mean age 79.2; 62% women). INTERVENTIONS: SPA (in‐class exercises with assistance setting weekly home exercise goals) and HP (information about age‐appropriate topics relevant to enhancing health), with randomization to four conditions: SPA only (n=69), HP only (n=73), SPA+HP (n=67), and RMC control (n=64). Active‐treatment participants attended nine group classes over 3 months followed by five booster sessions over 1 year. MEASUREMENTS: Self‐rated health (Medical Outcomes Study 36‐item Short‐Form Survey) and depression (Geriatric Depression Scale). Secondary ratings of physical performance, treatment adherence, and self‐rated health and affective function were also collected. RESULTS: At 3 months, participants in SPA exercised more and had significantly better self‐reported health, strength, and general well‐being (P<.05) than participants in HP or RMC. Over 18 months, SPA participants maintained health and physical function benefits and had continued to exercise more than non‐SPA participants. SPA+HP was not significantly better than SPA alone. Better adherence was associated with better outcomes. CONCLUSION: Older adults participating in low levels of regular exercise can establish and maintain a home‐based exercise program that yields immediate and long‐term physical and affective benefits.     

Hepatocellular carcinoma in older adults: clinical features, treatments, and survival

OBJECTIVES: To evaluate the clinical features, treatments, stages, and survival in older adults with hepatocellular carcinoma (HCC). DESIGN: A consecutive case study with retrospective medical record review. SETTING: University hospital (tertiary referral center) in Korea. PARTICIPANTS: Two hundred sixty‐two participants with HCC diagnosed between May 1, 2003, and December 31, 2006. MEASUREMENTS: Clinical characteristics, treatments, four staging systems for HCC, and survival in older (≥65, n=113) and younger (<65, n=149) people with HCC. RESULTS: The older HCC group were less likely to have hepatitis B virus infection and diffuse tumors and had more comorbidities, poorer performance status, smaller tumor area, and multinodular disease. There were no significant differences between the two groups with regard to Child‐Pugh‐Turcotte score, Model for End Stage Liver Disease (MELD) score, Child class, alpha‐fetoprotein levels, and tumor stage at diagnosis. Approximately 88% of subjects were treated regardless of age, but resection was performed less frequently in the older participants. Older participants with HCC had overall survival and liver‐related mortality similar to those of the younger participants, although they had poorer performance, greater comorbidity, and less likelihood of receiving surgery than the younger patients. CONCLUSION: This study supports the effectiveness and safety of nonsurgical treatment for older adults with HCC. Further study is needed to elucidate the reasons for similar prognoses in the older adults in spite of the greater burdens of comorbidities and poorer performance status.     

Subjective and Objective Napping and Sleep in Older Adults: Are Evening Naps “Bad” for Nighttime Sleep?

OBJECTIVES: To compare objective and subjective measurements of napping and to examine the relationship between evening napping and nocturnal sleep in older adults. DESIGN: For 12 days, participants wore actigraphs and completed sleep diaries. SETTING: Community. PARTICIPANTS: One hundred individuals who napped, aged 60 to 89 (including good and poor sleepers with typical age‐related medical comorbidities). MEASUREMENTS: Twelve days of sleep diary and actigraphy provided subjective and objective napping and sleep data. RESULTS: Evening naps (within 2 hours of bedtime) were characteristic of the sample, with peak nap time occurring between 20:30 and 21:00 (average nap time occurred between 14:30 and 15:00). Two categories of nappers were identified: those who took daytime and evening naps and daytime‐only. No participants napped during the evening only. Day‐and‐evening nappers significantly underreported evening napping and demonstrated lower objectively measured sleep onset latencies (20.0 vs 26.5 minutes), less wake after sleep onset (51.4 vs 72.8 minutes), and higher sleep efficiencies (76.8 vs 82%) than daytime‐only nappers. CONCLUSION: Day and evening napping was prevalent in this sample of community‐dwelling good and poor sleepers but was not associated with impaired nocturnal sleep. Although the elimination or restriction of napping is a common element of cognitive‐behavioral therapy for insomnia, these results suggest that a uniform recommendation to restrict or eliminate napping (particularly evening napping) may not meet the needs of all older individuals with insomnia.     

The Epidemiology of Dependence in Older People in Nigeria: Prevalence, Determinants, Informal Care, and Health Service Utilization. A 10/66 Dementia Research Group Cross-Sectional Survey

OBJECTIVES: To describe the prevalence and determinants of dependence in older Nigerians and associations with informal care and health service utilization. DESIGN: A single‐phase cross‐sectional catchment area survey. SETTING: Dunukofia, a rural community in southeastern Nigeria. PARTICIPANTS: One thousand two hundred thirty‐eight adults aged 65 and older, for whom full data were available on 914. MEASUREMENTS: The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, cognitive impairment, physical impairments, and self‐reported diagnoses. The interviewer rated dependence as not needing care, needing some care, or needing much care. The prevalence of dependence and the independent contribution of underlying health conditions were estimated. Sources of income, care arrangements, caregiver strain, and health service use are described according to level of dependence. RESULTS: The prevalence of dependence was 24.3% (95% confidence interval=22.1–26.5%), with a concentration in participants aged 80 and older. Only 1% of participants received a pension, and fewer than 7% had paid work. Those who were dependent were less likely than others to receive income from their family. Cognitive impairment, physical impairments, stroke, and depression were each independently associated with dependence. Depression made the largest contribution. Dependence was strongly associated with health service use (particularly private doctor and traditional healer services) and with high levels of out‐of‐pocket expenditure. CONCLUSION: In Nigeria, dependence is an important outcome given rapid demographic aging and increases in chronic disease prevalence in all developing regions. Enhancing the social protection of dependent older adults should be a policy priority. Cognitive and mental disorders are important contributors to disability and dependence; more attention should be given to their prevention, detection, and treatment.     

Sleep, blood pressure and obesity in 22,389 New Zealanders

Aim: To determine the relationship of sleep disorders with blood pressure and obesity in a large, relatively healthy, community‐based cohort. Methods: A cross‐sectional study was undertaken using data from 22 389 volunteer blood donors in New Zealand aged 16–84 years. Height, weight, neck circumference and blood pressure were measured directly, and data on sleep and other factors were ascertained using a validated self‐administered questionnaire. Results: Even in a relatively young, non‐clinical cohort, lack of sleep (34%), snoring (33%), high blood pressure (20%) and obesity (19%) are common. After adjusting for relevant confounders, participants at high risk of sleep apnoea had double the odds of having high blood pressure but only in participants over 40 years. Very low and high quantities of sleep are also associated with high blood pressure. Even after controlling for neck circumference, self‐reported sleep apnoea, sleep dissatisfaction and low amounts of sleep are associated with a higher body mass index. Conclusions: Obesity and hypertension have significant associations with a variety of sleep disorders, even in those less than 40 years of age and after adjusting for a wide range of potential confounders.     

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.     

Biopsychosocial Characteristics of Community‐Dwelling Older Adults with Limited Ability to Walk One‐Quarter of a Mile

OBJECTIVES: To establish nationally representative estimates of the prevalence of self‐reported difficulty and inability of older adults to walk one‐quarter of a mile and to identify the characteristics independently associated with difficulty or inability to walk one‐quarter of a mile. DESIGN: Cross‐sectional analysis of data from the 2003 Cost and Use Medicare Current Beneficiary Survey. SETTING: Community. PARTICIPANTS: Nine thousand five hundred sixty‐three community‐dwelling Medicare beneficiaries aged 65 and older, representing an estimated total population of 34.2 million older adults. MEASUREMENTS: Self‐reported ability to walk one‐quarter of a mile, sociodemographics, chronic conditions, body mass index, smoking, functional status. RESULTS: In 2003, an estimated 9.5 million older Medicare beneficiaries had difficulty walking one‐quarter of a mile, and 5.9 million were unable to do so. Of the 20.2 million older adults with no difficulty in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), an estimated 4.3 million (21%) had limited ability to walk one‐quarter of a mile. Having difficulty or being unable to walk one‐quarter of a mile was independently associated with older age, female sex, non‐Hispanic ethnicity, lower educational level, Medicaid entitlement, most chronic medical conditions, current smoking, and being overweight or obese. CONCLUSION: Almost half of older adults and 20% of those reporting no ADL or IADL limitations report limited ability to walk one‐quarter of a mile. For functionally independent older adults, reported ability to walk one‐quarter of a mile can identify vulnerable older adults with greater medical problems and fewer resources and may be a valuable clinical marker in planning their care. Future work is needed to determine the association between ability to walk one‐quarter of a mile walk and subsequent functional decline and healthcare use.     

Sleep Duration and Mortality According to Health Status in Older Adults

OBJECTIVES: To examine the association between usual sleep duration and mortality according to physical and mental health status in older adults. DESIGN: Prospective study conducted from 2001 to 2008. SETTING: Community‐based study. PARTICIPANTS: Cohort study of 3,820 persons representative of the noninstitutionalized population aged 60 and older in Spain. MEASUREMENTS: Sleep duration was self‐reported at baseline. Analyses were performed using Cox regression and adjusted for the main confounders. The analyses were then stratified according to numerous indicators of health status. RESULTS: During follow‐up, 897 persons died. Mortality was higher in those who slept 8 hours (relative risk (RR)=1.34, 95% confidence interval (CI)=1.02–1.76), 9 hours (RR 1.48, 95% CI=1.12–1.96), 10 hours (RR 1.73, 95% CI=1.30–2.29) and 11 hours or more (RR 1.66, 95% CI=1.23–2.24) than in those who slept 7 hours (P for trend <.001). The association between long sleep duration (≥10 vs 7 hours) and mortality was observed even in persons with good health status: optimal perceived health, good cognitive function (Mini‐Mental State Examination score >27), no depression, quality of life better than the cohort median (Medical Outcomes Study 36‐item Short Form Survey Physical Component Summary score ≥46 and Mental Component Summary score ≥52), and without disability in instrumental activities of daily living. Sleeping 6 hours or less was not associated with higher mortality than sleeping 7 hours in persons with good health status. CONCLUSION: Self‐reported sleep duration was associated with 7‐year mortality in this cohort of older adults, even when adjusted for health status. Further research is needed to determine the mechanisms and clinical implications of these findings.     

Sleep optimizes motor skill in older adults

OBJECTIVES: To determine whether sleep benefits motor memory in healthy elderly adults and, if so, whether the observed sleep‐related benefits are comparable with those observed in healthy young adults. DESIGN: Repeated‐measures cross‐over design. SETTING: Boston, Massachusetts (general community) and Harvard University. PARTICIPANTS: Sixteen healthy older and 15 healthy young participants. MEASUREMENTS: Motor sequence task (MST) performance was assessed at training and at the beginning and end of the retest session; polysomnographic sleep studies were recorded for the elderly participants. RESULTS: After 12 hours of daytime wakefulness, elderly participants showed a dramatic decline in MST performance on the first three retest trials, and only a nonsignificant improvement by the end of retest (the last 3 retest trials). In contrast, when the same participants trained in the morning but were retested 24 hours after training, after a day of wake plus a night of sleep, they maintained their performance at the beginning of retest and demonstrated a highly significant 17.4% improvement by the end of the retest session, essentially identical to the 17.3% improvement seen in young participants. These strikingly similar improvements occurred despite the presence of other age‐related differences, including overall slower motor speed, a lag in the appearance of sleep‐dependent improvement, and an absence of correlations between overnight improvement and sleep architecture or sleep spindle density in the elderly participants. CONCLUSION: These findings provide compelling evidence that sleep optimizes motor skill performance across the adult life span.     

Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer

OBJECTIVES: To evaluate the extent to which preexisting mental disorders influence diagnosis, treatment, and survival in older adults with colon cancer. DESIGN: Retrospective cohort study. SETTING: The Surveillance, Epidemiology and End Results (SEER)–Medicare linked database. PARTICIPANTS: Eighty thousand six hundred seventy participants, aged 67 and older with a diagnosis of colon cancer. MEASUREMENTS: The association between the presence of a preexisting mental disorder and the stage of colon cancer at diagnosis, receipt of cancer treatment, and overall and colon cancer‐specific mortality were assessed using Cox proportional hazards regression and logistic regression. RESULTS: Participants with mental disorders were more likely to have been diagnosed with colon cancer at autopsy (4.4% vs 1.1%; P<.001) and at an unknown stage of cancer (14.6% vs 6.2%; P<.001); to have received no surgery, chemotherapy, or radiation therapy (adjusted risk ratio (ARR)=2.09, 95% confidence interval (CI)=1.86–2.35); and to have received no chemotherapy for Stage 3 cancer (ARR=1.63, 95% CI=1.49–1.79). The rate of overall mortality (hazard ratio (HR)=1.33, 95% CI=1.31–1.36) and colon cancer‐specific mortality (HR=1.23, 95% CI=1.19–1.27) was substantially higher in participants with a preexisting mental disorder than in their counterparts. All of these associations were particularly pronounced in participants with psychotic disorders and those with dementia. CONCLUSION: Public health initiatives are needed to improve colon cancer detection and treatment in older adults with mental disorders.     

Effect of new disability subtype on 3-year mortality in Chinese older adults

OBJECTIVES: To examine a new method of classifying disability subtypes by combining self‐reported and performance‐based tools to predict mortality in older Chinese adults. DESIGN: Prospective cohort study. SETTING: Community‐dwelling older adults. PARTICIPANTS: Sixteen thousand twenty Chinese adults aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). MEASUREMENTS: Self‐reported activities of daily living (ADLs) and physical performance (PP) tests (chair standing, lifting a book from floor, turning 360°) cross‐classified to create mutually exclusive disability subtypes: subtype 0 (no limitations in PP or ADLs), subtype 1 (limitations in PP, no limitations in ADLs), subtype 2 (no limitations in PP, limitations in ADLs), and subtype 3 (limitations in PP and ADLs). Outcome was mortality over 3 years. RESULTS: Cox proportional hazard models, controlling for sociodemographic variables, living situation, healthcare access, social support, health status, and life‐style, showed that older adults without any limitations in ADLs or PP had significantly lower mortality risk than those with other disability subtypes and that there was a graded pattern of greater mortality according to subtype 1 (hazard ratio (HR)=1.31, 95% confidence interval (CI)=1.20–1.42), 2 (HR=1.39, 95% CI=1.23–1.59), and 3 (HR=1.88, 95% CI=1.72–2.05). When compared with the average survival curve in the cohort, subtypes of isolated performance deficits or self‐reported disability did not substantially discriminate risks of death over 3 years. CONCLUSION: Combined use of self‐reported and PP tools is necessary when screening for mutually exclusive disability subtypes that confer significantly higher or lower mortality risks on a population of older adults.     

Individual's perspective of local community environment and health indicators in older adults

Aim: This study evaluated the relationship between individual's perspective of local community environment and health in older people. Methods: A survey about quality of life in older adults in Spain was applied to a representative sample of 1106 community‐dwelling people (mean age ± SD = 72.07 ± 7.83 years, 43.67% males). Local community (Community Wellbeing Index, neighborhood problems, time in the neighborhood), psychosocial and sociodemographic measures were considered. Four health outcomes (self‐perceived health status, functional independence, depression and number of chronic medical conditions) were studied. Multivariate logistic analyses were carried out. Results: At least two local community measures were independently associated with each health outcome. Satisfaction with community services significantly contributed to all models; it was positively related with self‐rated health and functional independence, and negatively associated with depression and chronic medical conditions. Conclusion: The individual's perspective of the local community environment was associated with health outcomes in older adults. This can be useful in the development of policies committed to promoting social integration and active aging in the community. Geriatr Gerontol Int 2013; 13: 130–138 .     

Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons

Sleep-related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, cardiovascular disease, and cerebrovascular disease are examples of diseases that are more likely to develop in individuals with sleep disorders. Conversely, individuals with any of these diseases are at a higher risk of developing sleep disorders. The goals of this article are to help guide clinicians in their general understanding of sleep problems in older persons, examine specific sleep disorders that occur in older persons, and suggest evidence- and expert-based recommendations for the assessment and treatment of sleep disorders in older persons. No such recommendations are available to help clinicians in their daily patient care practices. The four sections in the beginning of the article are titled, Background and Significance, General Review of Sleep, Recommendations Development, and General Approach to Detecting Sleep Disorders in an Ambulatory Setting. These are followed by overviews of specific sleep disorders: Insomnia, Sleep Apnea, Restless Legs Syndrome, Circadian Rhythm Sleep Disorders, Parasomnias, Hypersomnias, and Sleep Disorders in Long-Term Care Settings. Evidence- and expert-based recommendations, developed by a group of sleep and clinical experts, are presented after each sleep disorder.     

Coping and disability: evidence from a developing country

Aim: In view of the increasing burden of musculoskeletal‐related disability, the growing number of older persons and the scarcity of research on musculoskeletal conditions in the Eastern Mediterranean region, coping with musculoskeletal problems deserves special attention. This paper examines how good coping links to musculoskeletal‐related disability among Lebanese citizens aged 15 years and older. Methods: The sample included 200 people living in southern Lebanon and who participated in the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) survey. Disability and coping were assessed using self‐reported questions. Covariates included demographics, musculoskeletal pain variables, and body mass index (BMI). Results: Around one‐third of the sample had lifetime functional disability due to musculoskeletal problems and 62% were coping well with their problems. Adjusted data showed that the odds of musculoskeletal‐related disability among individuals who were not coping well was 2.35 times the odds of disability among individuals who were coping well with 95% CI = 1.10–5.02. Conclusion: This study provides evidence of the importance of complementing pharmacological treatment with a cognitive‐behavioral approach for management of musculoskeletal problems.