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.     

Higher Level of Systemic C-Reactive Protein Is Independently Predictive of Coronary Heart Disease in Older Community-Dwelling Adults: The Three-City Study

OBJECTIVES: To assess the association between systemic C-reactive protein (CRP) and incident coronary heart disease (CHD) in community-dwelling elderly people.
DESIGN: A French population-based multicenter prospective cohort study.
SETTING: Three cities in France: Bordeaux in the southwest, Dijon in the northeast, and Montpellier in the southeast.
PARTICIPANTS: After 4 years of follow-up, a case–cohort study was designed including 1,004 subjects randomly selected from the initial cohort of 9,294 subjects free of CHD at baseline and 174 subjects who developed first CHD events during follow-up.
MEASUREMENTS: Hazard ratios (HRs) were estimated using a Cox proportional hazard model adapted for the case–cohort design using a CRP level less than 1 mg/L as the reference category.
RESULTS: Of the random sample, 24.3% had a CRP level less than 1.0 mg/L, 45.8% had a CRP level of 1.0 to 2.9 mg/L, and 29.9% had a CRP level of 3.0 to 10.0 mg/L. The HRs for CHD, adjusted for age, sex, and study center, were 1.69 (95% confidence interval (CI)=1.04–2.75) for CRP from 1.0 to 2.9 mg/L and 2.32 (95% CI=1.41–3.82) for CRP from 3.0 to 10.0 mg/L ( P for trend <.001). After additional adjustment for smoking, body mass index, diabetes mellitus, systolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, statin use, and antihypertensive treatment, a baseline CRP of 3.0 to 10.0 mg/L remained associated with risk of CHD (HR=1.87, 95% CI=1.09–3.25), although CRP did not improve the discriminative ability of a predicting model based on traditional risk factors (receiver operating characteristic curves from 0.740 to 0.749).
CONCLUSION: CRP is an independent CHD risk marker but does not improve CHD risk prediction in community-dwelling elderly people.     

Traditional Chinese Medicine Use and Health in Community‐Dwelling Chinese‐American Older Adults in Chicago

Chinese people have practiced traditional Chinese medicine (TCM) for thousands of years, but there is a paucity of research regarding TCM use in Chinese older adult immigrants in the United States. This study aims to provide an overall estimate of TCM use for Chinese older adults in the United States and to examine associations between sociodemographic characteristics, health measures, and TCM use. Data were collected through the Population Study of Chinese Elderly in Chicago, a community‐based participant research study that surveyed 3,158 Chinese older adults aged 60 and older. TCM use was measured using an eight‐item scale that examined eight kinds of TCM. Seventy‐six percent of participants reported any use of TCM within the past year. After adjusting for potential confounding factors, health status was associated with greater use of acupuncture (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.06–1.68) and massage therapy (OR = 1.53, 95% CI = 1.21–1.93), and quality of life was associated with less use of prescribed herbal products (OR 0.69, 95% CI = 0.55–0.87), tai chi (OR = 0.62, 95% CI = 0.50–0.78), and other traditional medicine (OR = 0.47, 95% CI = 0.40–0.56). These findings call for further investigation of TCM use by Chinese older adults, especially those with poor health and those with better quality of life. In the clinical setting, physicians should have awareness of TCM when treating Chinese older adults and look toward possible integration with Western medicine for more culturally appropriate, patient‐centered care.     

Successful Dissemination of a Community‐Based Strength Training Program for Older Adults by Peer and Professional Leaders: The People Exercising Program

The objective of this longitudinal study was to determine the feasibility of a model for disseminating community‐based strength training programs for older adults through leadership training of laypersons or “peers” and health and fitness professionals. The intervention consisted of a progressive strength training, balance, and flexibility exercise program and a leader training and certification workshop. Feasibility was defined as 75% or more of individuals who completed leader training establishing or teaching at least two 12‐week strength training classes within 1 year. Program dissemination was quantified as the number of classes established between January 2005 and December 2006. Demographic characteristics and health status of leaders and program participants were evaluated. Two hundred forty‐four leaders (peers, n=149; professionals, n=95) were trained and certified. Seventy‐nine percent of all leaders (n=193) met the feasibility criteria of establishing or teaching strength training classes. There was no difference in the percentage of peer leaders (80%, n=119) and professional leaders (78%, n=74) who established or taught classes (P=.71) despite significant differences in their demographic and health profiles. Ninety‐seven self‐sustaining strength training classes were established in senior and community centers, and 2,217 older adults (women, n=1,942; men, n=275) aged 50 to 97 with multiple chronic medical conditions enrolled. In conclusion, training peer and professional leaders is a feasible and successful model for disseminating a community strength training program for older adults. Widespread dissemination of this program has significant public health implications for increasing physical activity participation by older adults.     

Depressive Symptoms and Cognitive Decline in Community‐Dwelling Older Adults

OBJECTIVES: To examine the temporal association between depressive symptoms and cognitive functioning and estimate the effect measure modification of the apolipoprotein E (APOE) ?4 allele on this relationship. DESIGN: Prospective cohort study. SETTING: General community. PARTICIPANTS: Population‐based sample of 598 cognitively intact older adults aged 60 and older, with re‐assessments after 3 (N=479) and 6 years (N=412). MEASUREMENTS: Depressive symptoms (Symptom Checklist) and neurocognitive functioning (memory, Visual Verbal Learning Test; attention, Stroop Color–Word Test; processing speed, Letter Digit Substitution Test; general cognition, Mini‐Mental State Examination). Longitudinal associations were assessed using linear mixed models. The risk for cognitive impairment, no dementia (CIND) was examined using logistic regression. RESULTS: Adjusting for age, sex, education, and baseline cognition, the rate of change in memory z‐scores was 0.00, ?0.11, ?0.20, and ?0.37 for those in the lowest (reference group), second, third, and highest depressive symptom quartiles at baseline, respectively (P<.001 for highest vs lowest quartile). The odds ratios for developing CIND with amnestic features were 1.00, 0.87, 0.69, and 2.98 for the four severity groups (P=.05 for highest vs lowest quartile). Associations were strongest for those with persistent depressive symptoms, defined as high depressive symptoms at baseline and at least one follow‐up visit. Results were similar for processing speed and global cognitive function but were not as strong for attention. No APOE interaction was observed. CONCLUSION: Depression and APOE act independently to increase the risk for cognitive decline and may provide targets for prevention and early treatment.