Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study

Osteoarthritis is one of the most common joint disorders in the elderly, yet few studies have targeted symptomatic osteoarthritis, especially symptomatic hand osteoarthritis. The authors conducted a survey in 1992-1993 among an elderly population to estimate the prevalence of symptomatic hand osteoarthritis and to assess its impact on grip strength and functional activities. Framingham Study subjects received hand radiographs and answered queries on joint symptoms. Functional activities were assessed using an interviewer-administered questionnaire. Grip strength and observed functional performance were evaluated using standard procedures. A hand joint was defined as having symptomatic osteoarthritis if both symptoms and radiographic evidence of osteoarthritis were present. Of 1,041 subjects aged 71-100 years (36% men), the prevalence of symptomatic hand osteoarthritis was higher in women (26.2%) than in men (13.4%). Compared with those without symptomatic hand osteoarthritis, subjects with the disease had 10% reduced maximal grip strength, reported more difficulty writing, handling, or fingering small objects (odds ratio = 3.4), and showed more self-reported and observed difficulty carrying a 10-pound (4.5-kg) bundle (odds ratio = 1.7 and 1.6, respectively). In conclusion, in the context of a remarkable paucity of data on the epidemiology of symptomatic hand osteoarthritis, this study suggests that symptomatic hand osteoarthritis is a common disease among elders and frequently impairs hand function.     

The impact of protein supplementation on cognitive performance in frail elderly

Purpose

Maintenance of cognitive abilities is important for elderly to stay independent. With the aging of the population, the call for modifiable factors is emerging. Dietary protein might improve cognitive performance; however, this has hardly been studied. Therefore, we studied the impact of 24-week dietary protein supplementation on cognitive performance in pre-frail and frail elderly people.

Methods

Pre-frail and frail elderly subjects, according to the Fried criteria, randomly received a protein drink containing 15 g protein or a placebo drink twice a day. Cognitive performance was measured at baseline and after 24 weeks by means of a sensitive neuropsychological test battery. In addition, reaction time was assessed after both 12 and 24 weeks of intervention. Domain scores were calculated for the domains episodic memory, attention and working memory, information processing speed, and executive functioning. Analyses of covariance were used to determine differences between groups. Linear mixed models were used to determine differences in reaction time over time and per treatment.

Results

In total, 65 subjects (79 ± 8 years) with a median Mini-Mental State Examination score of 28 (interquartile range 26–30) were included. Reaction time improved more in the protein group (68 ms) than in the placebo group (18 ms, P = 0.03). Dietary protein had no significant effect on any of the cognitive domain scores.

Conclusions

Protein supplementation might improve reaction time performance in pre-frail and frail elderly, but did not improve other cognitive functions.     

The impact of changes in marital status on the mortality of elderly Japanese

PURPOSE: To assess the impact of changes in marital status on the mortality of elderly Japanese men and women.METHODS: In a baseline survey conducted in 1992, 2039 male and 1466 female residents in Takayama City, Gifu, who were married and aged 65 years or over responded to a detailed health and lifestyle questionnaire. Information regarding deaths of subjects and their spouses, the causes of death, and whether the subjects and spouses moved away from the city between 1992 and 1999 was obtained from the National Vital Statistics and the residential registers of the city. A proportional hazard model was used including marital status as time- varying independent variable.RESULTS: During the study period, six men and two women became separated/divorced and 151 men and 448 women became widowed. Widowhood was not significantly associated with mortality in men. Duration of widowhood was significantly inversely associated with mortality in women (p = 0.04). A significant decreased hazard ratio (=0.40, p = 0.04) was observed for women widowed for 3 years or more.CONCLUSIONS: We found no evidence indicating that widowed men and women have an increased mortality rate. Instead, the data suggested a decreased mortality rate among long-term widowed women.     

Determinant factors of functional status among the elderly

OBJECTIVE: To investigate the impact of health-related demographic and socioeconomic factors, as well as the impact of factors associated to social activity and the subjective health evaluation on the functional status of elderly people. METHODS: A cross-sectional multicentric study was conducted in a representative population sample in the city of S?o Paulo, Brazil, in 1989. Functional status was evaluated using a scale of activities of personal and instrumental daily living. It was studied as a dichotomous variable: absence of dependency - disability/difficulty in none of the activities in contrast with moderate/severe dependency - disability/difficulty in 4 or more activities. Multiple regression analysis was applied to hierarchically clustered factors. RESULTS: Those with the following features were more associated to moderate/severe dependency: illiterate, retired, pensioner, house keeper, living in a rented home, age over 65 years, multigenerational family composition, hospitalization in the last 6 months, mental health screening case, no visiting friends, and having a pessimistic perception of his/her own health when compared to their peers. CONCLUSIONS: The identified features associated to moderate/severe dependency suggest a complex net of causes for the declining functional status. However, one can assume that preventive measures directed to specific factors can benefit these population by improving their well-being.     

The relationship between physician cost and functional status in the elderly.

OBJECTIVE: To explore the relationship between functional status and physician cost (general practitioner/specialist) in an elderly population. DESIGN, SETTING AND PARTICIPANTS: A longitudinal study involving 328 patients aged 65 years or over admitted to medical and surgical wards of a Sydney metropolitan hospital over a 10-month period. MAIN OUTCOME MEASURES: Two predictive cost models were developed using multiple linear regression analyses. Nine predictors were modelled including functional status (Short Form 36; SF-36) and major diagnostic categories. These models were then applied to the Australian SF-36 norms to produce a profile of cost by level of functioning. RESULTS: After adjusting for potential confounders, five variables were found to be predictive of general practitioner cost at a 5% significance level. Females and age were positively associated, whereas case note mention of post-discharge services and high SF-36 vitality and role emotional scores were negatively predictive. For specialist cost, five variables were statistically significant. The SF-36 domains of physical functioning and mental health were positively associated. Higher vitality, role emotional scores and case note mention of post-discharge services were negatively associated. CONCLUSIONS: Cost models can be used to highlight the differences between general practitioner and specialist attendances, guide future physician care of the aged, and facilitate informed decision making.     

社区老年人健康功能多维评价及影响因素

目的 评价福州市社区老年人的健康状况，并探讨影响健康的有关因素。方法 对1767名65岁及以上的老年人进行问卷调查，从日常生活功能、躯体健康、精神健康、社会健康和经济状况等5个基本方面对老年人健康功能状况进行多维评价。结果 研究对象中综合健康状况优良、一般和较差分别占总人数的47．1％，44．6％和8．3％。5项单维健康损害发生率介于37．7％和74％之间，其中躯体健康损害发生率最高。影响老年人健康水平的主要慢性病为高血压、心脏病和糖尿病。结论 慢性病防治、婚姻家庭生活、适度体育锻炼、科学膳食营养以及参与社会活动等均有益于社区老年人健康水平的提高。     

中国老年人群认知功能状况的现况调查

目的 调查中国老年人群认知功能的状况及其分布特征.方法 选取2010年中国慢性病及其危险因素监测项目中所有60岁以上的老年人作为研究对象,共18 137名.应用问卷调查研究对象的年龄、性别等基本情况,以及相关疾病患病情况;对主诉存在记忆力下降的老年人使用简易精神状况检查(mini-mental state examination,MMSE)量表测定其认知功能.对数据经过复杂加权后,比较不同性别、年龄、教育程度、城乡和地区60岁及以上居民的认知功能状况和认知异常患病率.结果 最终纳入18 086名研究对象,MMSE得分中位数为23分,男性得分中位数为25分,女性为22分.城市人群得分中位数为25分,农村为22分.60～ 64岁组得分最高,为26分,80岁组最低,为19分,得分随年龄增长而降低;得分随教育程度增加而增加,初中以上人群得分最高,为28分,文盲组最低,为20分.加权后我国60岁以上老年人认知异常患病率为10.12％ (95％ CI:8.22％～12.02％);女性患病率为12.45％(95％ CI:9.95％ ～ 14.94％),高于男性的7.68％ (95％ CI:5.94％～9.43％);60 ～64岁组认知异常患病率最低,为4.69％ (95％CI:3.40％ ～5.98％),80岁组为22.43％(95％CI:17.80％ ～27.05％),认知异常患病率随年龄增加而上升(x2=320.02,P＜0.01).文盲组的认知异常患病率为14.6％(95％ CI:12.01％～17.23％),小学和初中以上组患病率为6.92％(95％ CI:5.21％ ～ 8.64％)和3.99％(95％ CI:2.58％ ～ 5.40％),患病率随教育程度增加而降低(x2=156.49,P＜0.01);已婚或同居老年人的认知异常患病率(8.51％,95％ CI:6.58％～ 10.43％)低于单身(9.32％,95％CI:4.00％～14.64％)和离婚或丧偶或分居人群(14.94％,95％CI:12.37％～17.50％);农村认知异常患病率(12.16％,95％ CI:9.51％～14.82％)高于城市(5.93％,95％ CI:4.78％ ～ 7.07％);中部地区(13.57％,95％ CI:8.55％～18.58％)高于东部(7.96％,95％ CI:6.17％ ～ 9.74％)和西部(9.50％,95％ CI:7.62％ ～ 11.38％),差异均有统计学意义(x2值分别为:54.55,29.76,8.81,P＜0.05).结论 我国60岁以上居民的认知异常患病率随年龄升高而增加,并在不同性别、婚姻状况、教育程度和地区分布上有差异.     

老年人功能性便秘及精神状况影响因素分析

目的老年功能性便秘(functional constipation,FC)的发生与多种因素有关,但各因素对便秘症状与精神状况的具体影响尚不明确。本研究旨在对相关影响因素进行调查与分析。方法选择2017-09-01-2018-02-28就诊于上海市宝山区大场镇第三社区卫生服务中心的338例老年FC患者为研究对象,调查患者基础资料、生活方式、症状量表(patient assessment of constipation-symptoms,PAC-SYM)与焦虑/抑郁精神量表(self-rating anxiety scale/self-rating depression scale,SAS/SDS)评分,采用t检验、单因素方差分析及多元线性回归分析等统计学方法,分析相关因素与量表评分的关系。结果不同性别、体质量指数、高血压和糖尿病者,量表评分差异无统计学意义,均P0.05。70～74岁年龄组患者PAC-SYM评分高于其他年龄组,75～80岁年龄组患者SAS/SDS评分高于其他组,均P0.05。病程≥3年者、小学及以下学历者、低收入者、运动时间50min/周、少素食者、饮水量1.5L/d及需长期口服药物者,量表评分显著高于其他患者,均P0.05。多因素分析结果显示,便秘病程、学历水平、饮水量及长期口服药物对PAC-SYM评分有影响,均P0.05;便秘病程、运动时间及长期口服药物对SAS/SDS评分有影响,均P0.05。患者的SAS/SDS评分与PAC-SYM评分呈正相关,P0.01,但r值很小,关系较弱。结论病程长、低学历、少饮水及长期口服药物等因素均可加重老年FC患者的症状与精神状态,治疗中应针对上述因素进行相应干预。     

Current status of functional imaging in eating disorders

Eating Disorders are complex psychiatric problems that involve biologic and psychological factors. Brain imaging studies provide insights about how functionally connected brain networks may contribute to disturbed eating behavior, resulting in food refusal and altered body weight, but also body preoccupations and heightened anxiety. In this article, we review the current state of brain imaging in eating disorders, and how such techniques may help identify pathways that could be important in the treatment of those often detrimental disorders. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2012; 45:723–736)     

Community-level socio-economic status and cognitive and functional impairment in the older population

BACKGROUND: This study aimed to determine if people living in communities with higher socio-economic deprivation are at an increased risk of cognitive and functional impairment even after controlling for the effects of individual socio-economic status. METHODS: We analysed cross-sectional data from the Medical Research Council Cognitive Function and Ageing Study which consists of a community-based sample of Cambridgeshire, Gwynedd, Newcastle, Nottingham and Oxford. The study included 13 004 men and women aged 65 years and over who were randomly selected from Family Health Services Authority computerized records after being stratified to ensure equal numbers of those aged 75 years and over and those under 75 years. The outcome measures were cognitive impairment (Mini-Mental State Exam 0-21) and functional impairment (Instrumental Activities of Daily Living and/or Activities of Daily Living disability). RESULTS: Individuals living in more deprived areas, as measured by the Townsend deprivation score, were found to have a higher prevalence of cognitive impairment [odds ratio (OR) (most deprived versus least deprived quintile) = 2.3; 95% confidence interval (CI)1.8-3.0; P < 0.001] and functional impairment [OR (most deprived versus least) = 1.6; 95% CI 1.4-1.9; P < 0.001] after controlling for age, sex, centre effects, education and social class. CONCLUSIONS: There is a significantly higher prevalence of cognitive impairment and functional impairment in elderly individuals living in socio-economically deprived areas regardless of their own socio-economic status. This evidence is of relevance for informing public health policy and those allocating resources for the long-term care of the elderly.     

The functional status and utilization of care of elderly people living at home

A postal questionnaire was used to obtain information on the functional status of and the utilization of care by elderly people living at home. The aim of the questionnaire was to enable the investigators to select elderly people for a further interview to identify the factors that lead to a demand for professional care. The questionnaire provided relevant information as to the prevalence of physical limitations in elderly people and their use of professional and informal care. The information obtained was reliable and valid as is shown by comparison with information given in subsequent interviews. It appears that the prevalence of limitations was of the same size as that found in other studies, both national and international.The more limitations, the higher the proportion of professional care utilization. The factors use of informal care and not living alone were inversely related to the utilization of professional care.The amount of informal care provided was very high among elderly people with handicaps. Rather than being a substitute, it seems that informal care is a condition for professional home care to be successful.The postal questionnaire appeared to be an efficient means of investigating the functional status of and utilization of care by elderly people living at home. As such it could be used for planning and allocation of home care.Carla M.A. Frederiks M.Sc. M.P.H. is a senior staff member of the Department of Epidemiology and Health Care Research, University of Limburg, P.O. Box 616, 6200 MD Maastricht, Netherlands. Margreet J.M. te Wierik M.A. is a junior staff member of the same department. Adriaan Ph. Visser M.A. Ph.D. is a senior investigator in the research project Services for the elderly and a senior staff member of the Department of Health Economics at the same university. Ferd Sturmans M.D. Ph.D. is professor at the Department of Epidemiology and Health Care Research at the same university.     

深圳市老年人群睡眠状况与认知功能关联研究

目的 探讨深圳市老年人群睡眠状况与认知功能之间的关系。方法 以在深圳市某医院体检的老年人群为研究对象,分别采用匹兹堡睡眠质量指数量表（PSQI）和简易智力状态量表（Mini-Cog）完成该人群的睡眠状况和认知功能评估。采用Logistic回归分析睡眠状况与认知功能的相关性。结果 共纳入7 510名调查对象,其中男性占43.5%,女性占56.5%;60~69岁占68.4%,70~79岁占28.3%,仅有14.9%的老年人文化程度在小学及以下,87.5%为已婚,79.5%从不吸烟,85.6%从不饮酒,81.4%近半年规律锻炼身体。睡眠质量差的老年人占17.9%,认知功能障碍的老年人占10.5%。多因素Logistic回归分析显示,睡眠障碍（OR=1.250）和日间功能障碍（OR=1.128）是认知功能障碍的危险因素。结论 睡眠质量是影响老年人群认知功能的因素,良好的睡眠质量可能对认知功能起到一定的积极作用。建议在社区进行健康睡眠知识以及认知知识的宣教活动,提高老年人群的生活质量。     

Homocysteine, B vitamin status, and cognitive function in the elderly

BACKGROUND: Old age is associated with reduced cognitive performance. Nutritional factors may contribute to this association. OBJECTIVE: We tested associations between cognitive performance and plasma vitamin B-12, folate, and homocysteine concentrations in the elderly. DESIGN: We studied survivors of the Scottish Mental Surveys of 1932 (Aberdeen 1921 Birth Cohort, or ABC21) and 1947 (Aberdeen 1936 Birth Cohort, or ABC36), which surveyed childhood intelligence quotient. We measured folate, vitamin B-12, and homocysteine concentrations in fasting blood samples and cognitive performance by the Mini Mental State Examination (MMSE), National Adult Reading Test (NART), Raven's Progressive Matrices (RPM), Auditory Verbal Learning Test (AVLT), digit symbol (DS) subtest, and block design (BD) subtest. RESULTS: Homocysteine was higher in the ABC21 than in the ABC36 (P < 0.0001). There were positive correlations between folate and vitamin B-12 and negative correlations between homocysteine and both folate and vitamin B-12. MMSE, RPM, AVLT, DS, and BD scores were higher in the ABC36. In the ABC21, folate, vitamin B-12, and MMSE score were positively correlated and homocysteine was negatively correlated with RPM, DS, and BD scores. Folic acid was positively correlated with AVLT and DS scores. In the ABC36, folate was positively correlated with BD score. After adjustment for childhood intelligence quotient, partial correlations were strengthened between vitamin B-12 and NART score and between homocysteine and RPM score but weakened between red blood cell folate and DS score. CONCLUSIONS: B vitamins and homocysteine are associated with cognitive variation in old age. In the ABC21 but not the ABC36, homocysteine accounted for approximately 7-8% of the variance in cognitive performance. This may prove relevant to the design of neuroprotective studies in late life.     

A review of functional status evaluation instruments in the elderly

The Comprehensive Geriatric Assessment is characterized as a functional and interdisciplinary evaluation. The first step is the assessment of functional status, which lies at the core of the procedure and can be defined by the level at which an individual performs roles and activities of daily living. Such assessment can be carried out by instruments (questionnaires) whose conceptual framework and psychometric properties must be well-defined. The present study systematically reviewed published data on the properties of the functional status measurement instruments and their adaptation and use in Brazil, through a search of the medical literature in reference textbooks and the LILACS and MEDLINE databases. After selection of the instruments, the next step consisted of a systematic scrutiny of validation, replication, and cultural adaptation studies. Thirty instruments were included according to explicit criteria. Only two, the Medical Outcomes Study SF-36 and the Health Assessment Questionnaire, were found to have equivalence studies in Brazil. However, some of these were apparently used in this country without any formal adaptation. The cultural adaptation of functional status measurement instruments is incomplete and inconsistent in Brazil.     

不同麻醉方法对老年胸科手术患者应激反应及认知功能的影响简

目的：研究不同麻醉方法对老年胸科手术患者应激反应及认知功能的影响。方法将48例老年胸科手术患者随机分为两组,A组23例实施全麻,B组25例实施全麻复合硬膜外麻醉,检测诱导前即刻（T0）、切皮时（T1）、切皮后2h（T2）、切皮后4 h（T3）、停药时（T4）、拔管后5 min（T5）的皮质醇（Cor）、肾上腺素（E）、去甲肾上腺素（NE）、白细胞介素6（IL-6）、局部脑氧饱和度（rSO2）、变化,并采用简易精神状态检查表（MMSE）评价患者认知功能。结果两组切皮后Cor、E、NE、IL-6水平均高于基础值,切皮后3～5h达到最高峰,T2-T3时段B组Cor、E、NE、IL-6水平低于A组;B组术中rSO2较基础下降幅度小于A组;B组术后1d、3dMMSE评分高于A组,两组差异比较具有统计学意义（P＜0．05）;结论胸科手术使老年患者应激激素升高,硬膜外麻醉对此有一定的抑制作用,全麻复合硬膜外麻醉可作为老年胸科手术的首选麻醉方式。