Disability,more than multimorbidity,was predictive of mortality among older persons aged 80 years and older

ObjectiveIn this study, we evaluate the impact of disability and multimorbidity on the risk of all-cause death in a population of frail older persons living in community.Study Design and SettingWe analyzed data from the Aging and Longevity Study in the Sirente geographic area, a prospective cohort study that collected data on all subjects aged 80 years and older (n = 364). The main outcome measure was all-cause mortality over 4-year follow-up.ResultsA total of 150 deaths occurred. Sixty-seven subjects (44.6%) died in the nondisabled group compared with 83 subjects (55.3%) in the disabled group (P < 0.01). Thirty-nine subjects (31.7%) died among subjects without multimorbidity compared with 111 subjects (46.0%) with two or more diseases (P < 0.01). When examining the combined effect of multimorbidity and disability, the effect of disability on the risk of death was higher than that of multimorbidity. After adjusting for potential confounders, relative to those without disability and multimorbidity, disabled subjects showed an increased risk of death when multimorbidity was associated (hazard ratio [HR] = 3.91; 95% confidence interval [CI] = 1.53–10.00) and in absence of multimorbidity (HR = 2.36; 95% CI = 0.63–8.83).ConclusionOur results show that disability exerts an important influence on mortality, independently of age and other clinical and functional variables.     

Aspects of preventive health care for older persons.

Preventive health care for older persons is considered in terms of primary, secondary and tertiary prevention and examples of relevant services are provided both from Canada and from other countries. Three areas of concern are identified, namely communication, quality assurance and funding. It is suggested that various approaches used in other countries, such as Home Visitor Programs, be examined and more generally that comparisons with health care services in other countries be carried out, particularly with respect to evaluations and possible economic steering effects.     

腹泻病患儿合并惊厥的临床特征及高危因素分析

目的探讨腹泻合并惊厥患儿的临床特征及危险因素,以提高对该种疾病的认识。方法采用病例对照研究方法,选取2008年3月至2018年2月因急性腹泻病于西安交通大学第一附属医院儿科住院的582例患儿为研究对象,以腹泻合并惊厥患儿为研究组(n=277),腹泻无惊厥患儿为对照组(n=305)。通过自行设计的调查问卷收集符合纳入标准患儿的临床资料,包括一般人口学资料、出生史、临床症状、辅助检查等,采用单因素方差分析及Logistic回归模型分析腹泻合并惊厥的危险因素。结果两组患儿性别和年龄的分布差异均有统计学意义(χ²值分别为23.70、110.68,P<0.01);两组患儿喂养方式和异常出生史的分布差异均有统计学意义(χ²值分别为7.23、8.12,P<0.05)。Logistic回归分析显示:女性患儿发生腹泻合并惊厥明显高于男性(P=0.01);1～<3岁患儿发生腹泻合并惊厥是0～<1岁的6.20倍(P<0.01),≥6岁患儿是0～<1岁的0.23倍(P=0.02);呕吐持续时间1天的患儿发生腹泻合并惊厥是<1...     

Seroprevalence of brucella antibodies among persons in high-risk occupation in Lebanon.

Prevalence of brucella-specific antibodies was measured in 597 persons in high-risk occupations living in 10 regions of Lebanon using the standard agglutination test (SAT), anti-human globulin (Coombs'') test (AHGT) and enzyme-linked immunosorbent assay (ELISA) for measuring immunoglobulin G (IgG), IgM and IgA. The study population consisted of butchers (54%), farmers (35%), laboratory technicians (8%), abbatoir workers (2%) and veterinarians (1%), with 82% males and 18% females. The overall seroprevalence based on SAT and AHGT titres of > or = 80 was 1.7% and 15%, respectively, but seroprevalence varied by region from 0-5% in SAT and from 3.4-34% for AHGT. The overall seroprevalence based on ELISA IgG (OD > or = 0.6), IgM (OD > or = 0.6) and IgA (OD > or = 0.3) was 57, 61 and 26%, respectively. The highest seroprevalence was noted in Biqaa (34%), Kisrwan (24%), Shouf (21%), Sidon (16%) and Aley (12%) regions. Nineteen percent of those surveyed reported symptoms that could be associated with brucellosis. We conclude that exposure to brucellosis is high among persons in high-risk occupations from all surveyed regions in Lebanon. Such findings should be used to design control measures especially now that the 17 years of civil strife is over.     

HIV risk behaviour of older persons

BACKGROUND: This study investigated social and psychological determinants of preventive behaviour in HIV-relevant situations. METHODS: Using computer-assisted telephone survey methodology, 2275 male and female were interviewed about their sexual habits. RESULTS: For the first time in Switzerland, data concerning HIV-relevant protection as well as their determinants were systematically collected also from persons older than 45. This age group (n=834) showed an increased risk with regard to HIV-relevant sexual contacts. CONCLUSIONS: The present findings call for more adequate monitoring of sexual behaviour of people older than 40 and suggest the development and implementation of respective age-specific prevention measures.     

Blood lipid distributions in older persons. Prevalence and correlates of hyperlipidemia.

Distributions of blood total cholesterol, triglyceride, low-density-lipoprotein (LDL) cholesterol, and high-density-lipoprotein (HDL) cholesterol levels are presented for a geographically defined cohort of rural elderly Iowans, 71 to 102 years old. Cross-sectionally, women had higher levels of total and LDL cholesterol than men did, levels that declined with increasing age. Mean HDL cholesterol levels were also higher in women than in men, but remained relatively constant across the age range. Age- and sex-specific total, LDL, and HDL cholesterol levels were lower among participants residing in long-term-care facilities. HDL but not total cholesterol levels were lower in cigarette smokers and those with chronic illnesses, physical dependence, and poorer performance on physical function tests, and higher among those consuming alcohol. If subjected to the screening guidelines of the National Cholesterol Education Program, a majority of this population, having total cholesterol levels of 5.2 mmol/L (200 mg/dL) or higher, would require further evaluation for possible hyperlipidemia.     

Prevalence of alcohol consumption among older persons

Percent prevalences of alcohol consumption were determined in a cross-sectional study of randomly chosen residents of San Diego County, California aged 45 years and over. The study sample (N=2,105) showed statistically significant drinking differences between Whites (n=819), Blacks (n=629), and Mexican-Americans (n=657). Overall, the highest prevalence of drinking occurred among the White elderly. The common belief that socioeconomic conditions are inversely associated with a high prevalence of drinking was not supported in this sample. Statistically significant differences in age-specific and sex-specific percent prevalences of alcohol intake were also found. There was a generally decreasing prevalence of alcohol consumption with advancing age, which existed regardless of ethnicity. Initial empirical measures and a better understanding of drinking correlates will identify those elderly persons at risk and provide the basis for future interventions in the areas of applied epidemiology and health promotion.Craig A. Molgaard, Ph.D., M.P.H. is Associate Professor, Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University; Chester M. Nakamura is M.P.H., Medical Student, Tulane University School of Medicine; E. Percil Stanford, Ph.D. is Director, University Center on Aging, San Diego State University; K. Michael Peddecord, Dr.P.H. is Associate Professor, Division of Health Service Administration Graduate School of Public Health, San Diego State University; Deborah J. Morton, M.A. is Research Associate, University Center on Aging, San Diego State University.This study was supported in part by the National Institute of Mental Health, Grant No. 1R01MH37067-01A2     

Equity in GP and specialist contacts by older persons in Belgium

Objectives

To explore the existence of socioeconomic differences in probability and intensity of general practitioner (GP) and specialist contacts among the Belgian elderly population, compared with the younger population.

Methods

A nationally representative cross-sectional study based on 4,825 older (≥65) and 14,738 younger participants (<65) in the Belgian Health Interview Surveys 2001 and 2004. Socioeconomic differences in contacts with a GP and specialist were examined using two-part hurdle models; use versus nonuse by logistic regression, and intensity of use by zero-truncated negative binomial regression.

Results

The intermediate income group was more likely to contact a GP and tenants reported more GP contacts. Lower educated older persons were less likely to contact a specialist and household income seemed to play a role in the intensity of specialist contacts.

Conclusions

The probability and intensity of general practitioner and specialist contacts among the Belgian older population are mainly determined by sociodemographic and health status variables, but a certain degree of inequity remains. The socioeconomic gradient differs in probability and intensity of contacts, indicating the advantage of using a two-part model in investigating socioeconomic differences in healthcare utilisation.     

Change in the number of informal helpers of frail older persons.

Little is known of the extent to which helper networks of frail older persons change over time and what factors are associated with change. Few national estimates of the scope of change exist to aid policy planners. This study provides national estimates of changes in the size of the informal helping network of frail elderly by sociodemographic and functional status subgroups of this segment of the population. The data are drawn from the 1982-84 National Long Term Care Survey, which included longitudinal followup of 4,530 respondents living in the community at both times. Bivariate patterns of change over 2 years in the number of informal helpers were analyzed. Sociodemographic factors (sex, age group, and race) of the frail elderly may be more important influences on change in the number of helpers than functional status expressed in terms of their limitations in activities of daily living.     

Perceptions of influenza and pneumococcal vaccine uptake by older persons in Australia

BackgroundInfluenza and pneumococcal vaccinations reduce adverse health outcomes in older adults. The Australian National Immunisation Program (NIP) provides free seasonal influenza and pneumococcal vaccinations for adults ≥65 y. Guidelines recommend all adults ≥65 y receive one dose of 23-valent pneumococcal polysaccharide vaccine (23vPPV) regardless of their risk of invasive pneumococcal disease. However, the reported rate of vaccination against pneumococcal disease is much lower than seasonal influenza. Identifying and understanding the perspective of older people on vaccination is important to informing effective promotional strategies for this age group.MethodsUsing a purposive and snowball recruitment strategy, 36 participants aged between 65 and 84 years of age were recruited in south-east Queensland and northern New South Wales. Face-to-face qualitative interviews conducted between July 2017 and January 2018 were recorded, transcribed and thematically analysed.ResultsIn this sample, the uptake of the influenza vaccine (n = 28, 78%) was greater than for the pneumococcal vaccine (n = 14, 39%). Five key themes identified were health practitioner influence; anti-vaccination influence; social responsibility; work-based vaccination; and perceptions of age. The influences on uptake were complex and multi-faceted.ConclusionsFindings provide new insights, in particular, the role of social responsibility, the long-term impact of workplace vaccinations, and how older people do not necessarily consider themselves old.     

Predictors of vaccination behavior among persons ages 65 years and older.

We estimated influenza vaccination coverage of 32 percent among persons 65 years of age and older from the 1987 Behavioral Risk Factor Surveillance System survey. Race other than White, obesity, lack of seatbelt use, and current smoking were associated with decreased likelihood of having been vaccinated. Controlling for these factors, the best predictor of having received influenza vaccination was having had a medical checkup within the last year (Odds Ratio = 2.40, 95% confidence interval = 1.84, 3.14).     

HMO vs fee-for-service care of older persons with acute myocardial infarction.

OBJECTIVES. Health maintenance organizations (HMOs) continue to grow in number and in their enrollment of Medicare recipients. They are also increasingly viewed as organizational structures that might contribute to control of health care costs. Yet little is known about the quality of care that elderly HMO enrollees receive. METHODS. We compared patients from three HMOs to a fee-for-service (FFS) sample that was national in scope. Sickness at admission, the quality of process of care, and mortality were assessed for patients aged 65 years and older who had been hospitalized with a diagnosis of acute myocardial infarction. RESULTS. After adjustment for sickness at admission, there were no significant mortality differences between the HMO and FFS groups at either 30 (23.2% vs 23.5%) or 180 days (34.4% vs 34.5%) after admission. Compliance with process criteria was higher for the HMO group as a whole (P < .05). The HMOs had greater compliance with three of five scales measuring different aspects of care for patients with acute myocardial infarction. CONCLUSIONS. We conclude that older patients from our participating HMOs who were hospitalized for acute myocardial infarction received hospital care that was generally better in terms of process than that received by patients in a national FFS sample.     

Clinical causes of death of 2372 older persons in a nursing home during 15-year follow-up

OBJECTIVE: To investigate the causes of death in older persons in a nursing home. DESIGN: The major clinical cause of death of all persons aged 60 years older residing in a nursing home during a 15-year period was investigated in a prospective study. The author carefully reviewed the major cause of death with the physicians who took care of all persons who died either in the nursing home or after transfer to a general hospital. SETTING: A large nursing home in which 2372 of 3164 older persons (75%) died during a 15-year period. PATIENTS: The 2372 persons who died included 766 men and 1606 women, mean age 81 +/- 8 years. MEASUREMENTS AND MAIN RESULTS: A total of 2372 of 3164 persons (75%) died during the 15-year period,. Seven hundred sixty-six of 1023 men (75%) and 1606 of 2141 women (75%) died (P not significant). The major cause of death in these 2372 persons was sudden cardiac death in 25%, myocardial infarction in 18%, refractory congestive heart failure in 11%, thromboembolic stroke in 6%, cerebral hemorrhage in 1%, pulmonary embolism in 2%, mesenteric vascular infarction diagnosed at surgery in 1%, peripheral vascular disease, including dissecting aneurysm of aorta and ruptured abdominal aneurysm, in <1%, pneumonia in 15%, urosepsis in 4%, bacterial endocarditis in 1%, sepsis from abdominal abscess or gastrointestinal or biliary tract in 1%, sepsis from decubiti, gangrene of lower extremity, and osteomyelitis in <1%, cancer in 9%, renal failure in 3%, gastrointestinal or liver disease in 2%, hematologic disorders in 1%, and chronic obstructive pulmonary disease in 1% of persons. CONCLUSIONS: The major cause of death of persons in the nursing home was cardiovascular disease, which accounted for 63% of deaths. The second major cause of death was infectious disease, accounting for 21% of deaths. Cancer accounted for 9% of deaths, renal failure for 3% of deaths, gastrointestinal or liver disease for 2% of deaths, hematologic disorders for 1% of deaths, and chronic obstructive pulmonary disease for 1% of deaths.     

Cholesterol and carotid atherosclerosis in older persons: the Framingham Study.

We studied the relationship between extracranial carotid atherosclerosis as measured by high-resolution carotid sonography and serum total cholesterol and high-density-lipoprotein cholesterol (HDL-C) levels which were determined at the time of carotid sonography and 8 years previously in 1189 members of the Framingham cohort, aged 66 to 93 years. Among participants, no carotid disease was found in 30%; 1 to 49% stenosis, in 62%; 50 to 74% stenosis, in 5%; 75 to 99% stenosis, in 2%; and 100% stenosis, in 1%. Total cholesterol measured 8 years prior to the carotid examination showed a strong positive association with the occurrence of stenosis in both men and women. There was no association between concurrently measured cholesterol levels and stenosis for either men or women. For women there was a strong association between both the 8-year HDL-C level and the concurrently measured HDL-C level and the degree of carotid stenosis. For men, neither concurrent nor 8-year HDL-C measurements were significantly related to carotid stenosis. These results suggest that there is a time lag between the observation of an elevated cholesterol level and its expression as an increased degree of carotid atherosclerosis.