Post-1980 regional migration patterns of the U.S. elderly population

We investigated how three aspects of the U.S. elderly population's residential relocation behaviors have changed over the past three decades (1955-60, 1965-70, 1975-80, 1980-85): their rates of overall mobility, interstate, interregional, and intracounty moves; their interregional origin-destination migration streams; and their regional net migration patterns. Data were obtained from published reports of the 1960, 1970, and 1980 U.S. Decennial Censuses and the 1985 U.S. Current Population Survey. Overall mobility rates consistently declined in all regions and periods, while interstate and interregional migration rates increased through 1980. In the period 1980-85 there were decreased numbers and rates of elderly out-migrants from the Midwest and Northeast, resulting in unprecedented declines in the net migration gains of older persons in the South. The likely persistence of these trends in the future and their explanation are discussed.     

Statistical analysis on spatial and temporal patterns of the Chinese elderly population

China contains over one-fifth of the world population. Over the past 20 years, the Chinese population has been ageing rapidly due to the dramatic family planning programs enforced by the Chinese government. These family planning programs have been implemented gradually during the last two decades and the programs implemented were varied from region to region. In this study, we statistically examined the spatial and temporal patterns of the processes of the Chinese elderly populations among the provinces, autonomous regions and municipalities (P/A/M) from 1953 to 1994. The D-statistic was used in assessing the spatial autocorrelation for the proportions of the elderly population of the 30 (29) P/A/M in the Chinese mainland. The simple T-statistic was used in measuring the temporal changes since 1953. The spatial and temporal patterns were statistically significant according to the testing statistics. We also found that the proportions of the elderly population were highly correlated with the population densities of the P/A/M. We linked these statistical results with the changes in the socio-economic situations since the founding of the People's Republic of China in 1949.     

Does pulsed field ablation regress over time? A quantitative temporal analysis of pulmonary vein isolation

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Finances of unmarried elderly people over time

This research assessed the effect of widowhood, divorce, and life-long singleness on income and evaluations of finances at two points, and investigated factors associated with satisfaction with level of living in old age. Data were analyzed from two interviews with 2,047 older, unmarried men and women. Models explaining satisfaction with level of living were relatively similar for the marital status groups. Marital status affected the economic circumstances and perceptions of finances of women more often than men. The strains of divorce and widowhood for women and divorce for older men had an enduring influence on finances, and in the instance of men, were heightened over time.     

Assessment of regional adipose tissue depots: A DXA and CT comparison in cadavers of elderly persons

Objective

Since dual energy X-ray absorptiometry (DXA) cannot distinguish between different adipose tissue (AT) deposits, it remains unclear how DXA-derived body composition variables relate to anatomical tissue (sub)compartments. The aim of the present study was to compare and relate regional DXA variables with absolute tissue masses obtained by computer tomography (CT) scanning of the lower limbs in elderly persons.

Methods

Eleven well-preserved white Caucasian adults (seven male and four female cadavers) with a median age of 79.0 years (ranging from 68 to 96 years) were fully scanned with DXA and CT. Separate densities of skin tissue, AT, muscle tissue and bone were obtained by hydrostatic weighing.

Results

The leg DXA-variables were significantly related (rho-values between 0.60 and 0.98, P < 0.01) to CT-derived tissue counterparts, but showed significant systematic differences except for subcutaneous AT mass (P = 0.773). After controlling for other AT depots, fat as measured by DXA (fat_DXA) related only to intermuscular AT (rho = 0.82, P < 0.01) in males and to subcutaneous AT (rho = 0.84, P < 0.05) in females.

Conclusion

Although significantly interrelated, DXA and CT variables should not be used interchangeably since they have different quantitative and physiological significance. Our results suggest that fat_DXA represents different parts of AT depots in elderly men and women. Since DXA is not appropriate for assessing tissue variability cautious clinical interpretation is warranted.     

Individuality of breathing patterns in adults assessed over time

Sixteen healthy adult subjects underwent two studies separated by 4-5 years to test whether their resting pattern of breathing was reproducible over time. From breath-by-breath analysis of airflow, measured with a pneumotachometer, the pattern of breathing was quantified in terms of individual respiratory variables; inspiratory time (TI), expiratory time (TE), total breath duration (TTOT), tidal volume (VT), VT/TI, TI/TTOT, and by taking TI, TE and VT all together (TRIAD). Also, the shape of the entire airflow profile was quantified by harmonic analysis (ASTER). A statistical analysis was designed to compare differences between the 1st and the 2nd recording within individuals with those differences observed between random pairs of recordings from the two studies in the same 16 individuals. It was found that all variables were significantly more similar within-individuals than between-individuals; this is best demonstrated when considering the ASTER and/or the TRIAD. It was concluded that the individuality of breathing pattern is maintained over a long period despite changes in smoking habit, weight, mild respiratory diseases, and other changes which occurred between the two studies in our subjects.     

Depressive symptoms and physical health of caregivers of persons with cognitive impairment: analysis of reciprocal effects over time

Research indicates that caregivers of persons with cognitive impairment are at elevated risk for clinical depression. The current study examines the association between physical illness and depressive symptoms among caregivers over a 5-year interval. Methods: Participants were recruited as part of a longitudinal study of dementia prevalence in Canada (N = 382). Persons with cognitive loss and their primary caregivers were randomly identified from each Canadian province. Results: Subsequent to control for sociodemographic variables, patient illness characteristics and initial depressive symptomatology, baseline health of caregivers contributed significantly to the prediction of depressive symptoms five years later. In contrast, depressive symptomatology was not a significant predictor of physical health over this same interval (again controlling for sociodemographic variables, patient illness characteristics, and caregivers' health at baseline). Discussion: These analyses provided partial support for reciprocal effects between physical illness and depression. Findings are discussed in terms of the applicability of a model of reciprocal effects to older adults.     

Inconsistency over time in the preferences of older persons with advanced illness for life-sustaining treatment

OBJECTIVES: To determine whether preferences for future attempts at life-sustaining treatment change over time in a consistent and predictable manner. DESIGN: Observational cohort study. SETTING: Community. PARTICIPANTS: One hundred eighty-nine community-dwelling persons ages 60 and older with advanced cancer, heart failure, or chronic obstructive pulmonary disease. MEASUREMENTS: Participants were asked, if faced with an illness exacerbation that would be fatal if untreated, whether they would undergo high-burden therapy for a chance to avoid death and risk an impaired health state to avoid death. Interviews occurred at least every 4 months for up to 2 years. RESULTS: When asked their willingness to undergo high-burden therapy for a chance to avoid death, 35% had an inconsistent preference trajectory (e.g., becoming more and then less willing over time or vice versa). The proportion with inconsistent trajectories increased to 48% and 49% when asked their willingness to risk physical or cognitive disability, respectively, to avoid death. Participants with variable health states over time were more likely to have inconsistent trajectories, although inconsistent trajectories were also common in those with stable health states. CONCLUSION: A large proportion of older persons with advanced illness have inconsistent trajectories of willingness to undergo burdensome therapy or risk an impaired health state for a chance to avoid death. Variability in their health state over time explained this in part, although the frequency of inconsistent trajectories even in those with stable health states suggests that preferences are influenced by transient factors rather than representing stable core values.     

The utility of the revised elderly persons disability scale (REPDS) in an Asian psychogeriatric patient group

Objective: The Revised Elderly Persons Disability Scale (REPDS) was developed in Australia as a measure of disability in psychogeriatric patients. We sought to test its utility in an Asian psychiatric hospital. Method: The study involved 33 patients, 65 years or older, and admitted for the first time to an acute psychogeriatric ward at Woodbridge Hospital, Singapore Results: The total REPDS score was significantly higher in male patients and in patients with dementia, due to there being more male patients with dementia and with dementia generating high disability Itvels. There was no significant difference in the total disability score between those referred from nursing homes and other sources. REPDS scores decreased during hospital stay, with decreases significant on several scales. Conclusions: The REPDS appeared to have utility in an Asian psychogeriatric unit in allowing disability components to be profiled, while scale score differences and changes over time indicated that the measure was sensitive to change. The measure identified the core problem areas in the disability profile of a psychogeriatric population and of sub‐groups with and without dementia, results which can assist clinical service delivery and staff training activities.     

From the Cover: Global meta-analysis reveals no net change in local-scale plant biodiversity over time

Global biodiversity is in decline. This is of concern for aesthetic and ethical reasons, but possibly also for practical reasons, as suggested by experimental studies, mostly with plants, showing that biodiversity reductions in small study plots can lead to compromised ecosystem function. However, inferring that ecosystem functions will decline due to biodiversity loss in the real world rests on the untested assumption that such loss is actually occurring at these small scales in nature. Using a global database of 168 published studies and >16,000 nonexperimental, local-scale vegetation plots, we show that mean temporal change in species diversity over periods of 5–261 y is not different from zero, with increases at least as likely as declines over time. Sites influenced primarily by plant species’ invasions showed a tendency for declines in species richness, whereas sites undergoing postdisturbance succession showed increases in richness over time. Other distinctions among studies had little influence on temporal richness trends. Although maximizing diversity is likely important for maintaining ecosystem function in intensely managed systems such as restored grasslands or tree plantations, the clear lack of any general tendency for plant biodiversity to decline at small scales in nature directly contradicts the key assumption linking experimental results to ecosystem function as a motivation for biodiversity conservation in nature. How often real world changes in the diversity and composition of plant communities at the local scale cause ecosystem function to deteriorate, or actually to improve, remains unknown and is in critical need of further study.A huge number of experiments has investigated the effects of species diversity (typically the number of species) on ecosystem function in small study plots (≤400 m²), with a general consensus emerging that processes such as primary productivity and nutrient uptake increase as a function of the number of species in a community (1–6). These experiments thus appear to provide a powerful motivation for biodiversity conservation, given that ecosystem functions underpin many ecosystem services from which people benefit, such as forage production and carbon sequestration (1). However, the link between diversity-function experiments and the widespread argument that ecosystem function should motivate biodiversity conservation (7–11) hinges on the untested assumption that global biodiversity declines apply to the small scale (2). Experimental studies typically focus on small spatial scales not only for practical reasons, but also because organisms, plants in particular, typically interact over short distances (12), and so it is at the small scale that biodiversity is most likely to have an important impact on the functioning of ecosystems (13–15).Habitat loss, invasive species, and overexploitation, among other factors, have accelerated global species’ extinction well beyond the background rate (16–18), and it is tempting to assume that a global decline in biodiversity is necessarily accompanied by declines at smaller spatial scales. However, this is not a logical inevitability because, unlike other key variables involved in global environmental change, biodiversity at large scales (often termed gamma diversity) is not an additive function of biodiversity at smaller scales (alpha diversity). If global temperature or atmospheric CO₂ concentrations, for example, are increasing at the global scale, the net change over time within local areas must, on average, be positive. However, because local species losses may be accompanied by immigration of species from elsewhere, decreases in biodiversity at the global scale do not necessarily result in any biodiversity change at smaller scales (16, 19, 20). Here we present a global synthesis testing for directional changes in local-scale biodiversity of terrestrial plants, which have been the focus of most well-replicated biodiversity-ecosystem function (BDEF) experiments. We focus on the most commonly studied component of biodiversity—species diversity—estimated by metrics that reflect the number of species (richness) and/or the equitability of their abundances (indices of diversity or evenness).     

Race and the self-reported health of elderly persons

This research examined race differences in the structure and measurement of six self-reports of health that are widely used in studies of elderly persons. Second-order confirmatory factor analyses (LISREL) revealed race differences only in the validity of subjective interpretations of health state and in the measurement error of a chronic conditions indicator. No race differences were found in the form of the four-factor model of self-reported health. Results, interpreted within a cognitive illness-labeling framework, have implications for future race-comparative health research.     

Changes in patterns of the double burden of undernutrition and overnutrition in Nepal over time

Knowledge regarding nutrition transition in Nepal remains limited. This systematic review examined the shifts in undernutrition and overnutrition in Nepal during the past two decades. We searched PubMed for studies and reports published between January 1, 2000, and June 30, 2018. Publications with a sample size greater than or equal to 500 that reported prevalence of nutritional status were included. Six large national reports and 36 studies met study inclusion criteria and were included. Overall, available nationally representative data remained limited. The Nepal Demographic and Health Survey 2001 to 2016 showed that underweight prevalence decreased from 26.7% to 17.2% and prevalence of overweight/obesity increased from 6.5% to 22.1% among women of reproductive age (15‐49 years). In preschool children, prevalence of stunting, wasting, and underweight decreased from 57.2% to 35.8%, 11.2% to 9.7%, and 42.7% to 27.0%, respectively. Prevalence of overweight/obesity was low among children and was higher in higher socio‐economic status (SES) groups. The overweight‐obesity/underweight ratios indicate a shift from undernutrition to overnutrition problem; it was more evident in urban areas and higher SES groups. In conclusion, Nepal is experiencing a nutrition transition. More research is warranted to address this shift, and well‐tailored public health efforts need to combat the double burden of overweight/obesity and undernutrition.     

Spectral analysis of heart rate dynamics in elderly persons with postprandial hypotension.

Prior studies suggest that postprandial hypotension in elderly persons may be due to defective sympathetic nervous system activation. We examined autonomic control of heart rate (HR) after a meal using spectral analysis of HR data in 13 old (89 +/- 6 years) and 7 young (24 +/- 4 years) subjects. Total spectral power, an index of overall HR variability, was calculated for the frequency band between 0.01 and 0.40 Hz. Relatively low-frequency power, associated with sympathetic nervous system and baroreflex activation, was calculated for the 0.01 to 0.15 Hz band. High-frequency power, representing parasympathetic influences on HR, was calculated for the 0.15 to 0.40 Hz band. Mean arterial blood pressure declined 27 +/- 8 mm Hg by 60 minutes after the meal in elderly subjects, compared with 9 +/- 8 mm Hg in young subjects (p less than or equal to 0.0001, young vs old). The mean change in low-frequency HR power from 30 to 50 minutes after the meal was +19.4 +/- 25.3 U in young subjects versus -0.1 +/- 1.5 U in old subjects (p less than or equal to 0.02). Mean change in total power was also greater in young (19.0 +/- 26.6 U) subjects compared with old subjects (0.0 +/- 1.6 U, p greater than or equal to 0.02). Mean ratio of low:high-frequency power increased 3.1 +/- 3.3 U in young subjects vs 0.5 +/- 2.7 U in old subjects (p less than or equal to 0.01). The increase in low-frequency HR power and in the low:high frequency band ratio in young subjects is consistent with sympathetic activation in the postprandial period.(ABSTRACT TRUNCATED AT 250 WORDS)