Influence of the Amazonian context on the frailty of older adults: A population-based study

The study aimed to identify the prevalence of frailty syndrome and its associated factors in older adults residents in an urban area in the interior of Amazonas, Brazil. This is a population-based cross-sectional study with a sample of 265 older adults (60 years or older), representative of the urban area of Coari-AM. Using the adapted Fried phenotype, those with 3 criteria or more were considered frail. Socio-demographic, health, and functionality information was collected. Multivariate analysis was used through Poisson regression with robust variance, using a hierarchical method for the dichotomous outcome of frailty. The prevalence of frailty was 9.4 % and in the final multivariate analysis model the factors associated with frailty were: advanced age (PR: 4.1; 95 % CI: 1.8–9.3), income less than one minimum wage (PR: 3.4; 1.7–6.9), masonry housing (PR: 3.3; 1.3–8.2), never having lived in a riverside community (PR: 2.7; 1.4–5.4), use of 3 medications or more (PR: 3.1; 1,4–6.9), history of falling (PR: 2.3; 1.1–4.9), and fear of falling (PR: 4.1; 1.3–13.0). The study concluded that the prevalence of frailty in Coari-AM was lower than other Brazilian cities with a similar HDI. In addition to factors associated with frailty already well described in the literature, the influence of the Amazonian culture and environment during the course of life was shown to have a possible protective effect on health outcomes in later life.     

Health-related quality of life of institutionalized older adults: Influence of physical,nutritional and self-perceived health status

IntroductionInstitutionalized older adults have higher risks of diseases and worse health-related quality of life (HRQoL) than noninstitutionalized.ObjectiveTo evaluate the influence of physical state, nutritional status and self-perceived general health and oral health on the quality of life of institutionalized older adults in two Brazilian cities.MethodsA multicenter cross-sectional study was conducted in 17 homes for the aged of two Brazilian cities. Six trained researchers interviewed 344 older adults. The performance of activities of daily living (Katz scale) and frailty status (Fried scale) were applied to evaluate the physical state. The Mini Nutritional Assessment Short-Form (MNA-SF®) and the body composition were used to screening the nutritional status. A hand dynamometer was used to measure the dominant hand grip strength. The 12-Item Short Form Survey for self-perceived health (SF-12) was used to determine the HRQoL. A Likert scale was used to assess the general and oral health self-perception. Multiple Poisson regression model was applied to analyze the data (α = 0.05).ResultsThe mean (SD) score of the SF-12 was 60.89 (14.50) points. The factors associated with the highest SF-12 score were being able to walk, being nonfrail, being normal nourished, taking fewer medications, having greater dominant hand grip strength and higher self- perceived general health (p < 0.05).ConclusionBetter HRQoL in institutionalized older adults was associated with better physical state, nutritional status and self-perceived general health.     

Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults

BACKGROUND: Physical activity has been associated with a reduced risk of coronary heart disease, but the mechanism underlying this association is unclear. Because coronary heart disease is increasingly seen as an inflammatory process, it might be reasonable to hypothesize that physical activity reduces risk of coronary heart disease by reducing or preventing inflammation. METHODS: The study examined the relationship between physical activity and elevated inflammation as indicated by a high C-reactive protein level, white blood cell count, or fibrinogen level. Study subjects were 3638 apparently healthy US men and women 40 years and older who participated in the Third National Health and Nutrition Examination Survey. RESULTS: More frequent physical activity was independently associated with a lower odds of having an elevated C-reactive protein level. Compared with those engaging in physical activity 0 to 3 times per month, the odds of having an elevated C-reactive protein level was reduced among those engaging in physical activity 4 to 21 times per month (odds ratio, 0.77; 95% confidence interval, 0.58-1.02) and 22 or more times per month (odds ratio, 0.63; 95% confidence interval, 0.43-0.93) (P for trend,.02). Similar associations were seen for white blood cell count and fibrinogen levels. CONCLUSIONS: More frequent physical activity is independently associated with a lower odds of having elevated inflammation levels among apparently healthy US adults 40 years and older, independent of several confounding factors. The results suggest that the association between physical activity and reduced coronary heart disease risk may be mediated by anti-inflammatory effects of regular physical activity.     

Factors associated with happiness in the elderly persons living in the community

ObjectiveThe aim of the present study was to evaluate factors associated with happiness in a sample of Brazilian older adults.MethodsA study was conducted with 263 elderly people in the area of coverage of a family health unit located in the state of São Paulo, Brazil. The Subjective Happiness Scale was used to measure happiness, the final score of which determined one of three outcomes: not happy, intermediate, and happy. Disability, sociodemographic characteristics, and psychological, cognitive, and physical factors were considered for the multinomial logistic regression analysis.ResultsStatistically significant differences were found among the three groups regarding satisfaction with life, disability, social phobia, anxiety, depression, and frailty (p ≤ 0.05). In the multinomial regression analysis, being “not happy” was significantly associated with satisfaction with life (RRR: 0.53), depression (RRR: 1.46), social phobia (RRR: 1.24), and age (RRR: 1.06).ConclusionThe present findings indicate that psychological factors and age influence the levels of happiness in older adults living in the community. Furthermore, better screening, diagnosis, and treatment of mental health disorders could increase the feeling of happiness among older adults.     

Prevalence of falls among older adults in the Gulf Cooperation Council countries: A systematic review and meta-analysis

AimThe aim of this study was to conduct a systematic review and meta-analysis for studies that have examined the prevalence and risk factors of falls in older adults living in the Gulf Cooperation Council countries (GCC).MethodsA literature search was performed using PubMed, Web of Science, Physiotherapy Evidence Database; and SCOPUS up to October 2018 to identify studies that have examined prevalence, risk factors, or consequences of falls in older adults living in the GCC.ResultsA total of 6 studies met the inclusion criteria. The pooled prevalence of falls among older adults residing in GCC countries was 46.9%. Falls among included studies were associated with older age, female gender, low educational level, and number of medications.ConclusionsThe study shows a high prevalence of falls in older adults living in the GCC countries. The risk factors in the current study must be interpreted with caution, since some of the included studies did not report any risk factors. Due to the limited number of evidence evaluating risk factors and consequences of falls in the GCC countries population, a further longitudinal research is needed.     

Factors associated with falls in active older adults in Japan and Brazil

Background/PurposeAging populations are a global public health concern. The risk of falls increases with age, so fall prevention is becoming an important health issue. However, few studies have focused on cross-cultural analyses of falls. Therefore, we aimed to compare the incidence of falls and compare anthropometric measures and physical function between active Japanese and Brazilian older adults.Materials and methodsWe measured the incidence of falls (investigated by self-reported questionnaire), body mass index (BMI), waist circumference (WC), grip strength (GS), one-legged stance (BALANCE), frequency of physical activity (PA), medication use (MU), and hospitalization history in 114 physically active community-dwelling adults 65 years of age and older in Japan (73.9 ± 4.0 years, n = 40) and Brazil (70.7 ± 4.5 years, n = 74).ResultsThe Japanese elderly were older (p < 0.01), but had a better BALANCE score (p < 0.05) than the Brazilian elderly. Nevertheless, Brazilian elderly showed higher engagement in PA and had higher BMI and WC (p < 0.01). Despite the lack of a difference in the incidence of falls between the two cohorts, Japanese elderly who fell had decreased GS compared to Japanese elderly who did not fall [odds ratio (OR): 0.83, 95% confidence interval (CI) 0.72–0.97, p < 0.05]. In Brazil, those who fell had larger WC than those who did not fall (OR: 1.07, 95% CI 1.01 – 1.13, p < 0.01).ConclusionOur results indicate that physical function (i.e., grip strength) is a more important predictor of falls in Japanese elderly. However, increasing waist size is a predictor of falls in Brazilian elderly. These findings suggest that risk factors for falls are multifactorial and vary according to setting.     

A comparison of the prevalence of the metabolic syndrome and its components among native Japanese and Japanese Brazilians residing in Japan and Brazil.

BACKGROUND: This study investigated the prevalence of risk factors associated with the metabolic syndrome (MetSyn) among individuals of Japanese descent exposed to different cultural environments. DESIGN: A cross-sectional study to assess component risk factors for the diagnosis of MetSyn was undertaken in urban areas in Japan and Brazil. A total of 773 men and women aged 35 years or over were included in three groups: 249 native Japanese, 269 Brazilian individuals of Japanese ancestry residing in Japan, and 255 Brazilian individuals of Japanese ancestry residing in Brazil. RESULTS: Higher rates of metabolic abnormalities with respect to central obesity and serum lipid profiles were observed among Brazilian individuals of Japanese ancestry residing in Brazil compared with those residing in Japan and native Japanese. Likewise, an increased risk of hypertension was observed among Japanese Brazilian individuals residing in Japan. The prevalence of MetSyn in men was significantly higher among Brazilians of Japanese ancestry residing in Brazil (37.5%) compared with those residing in Japan (25.3%) or native Japanese (21.4%), whereas no significant difference was observed among women. In the logistic model, Brazilian individuals of Japanese ancestry residing in Brazil were twice as likely to develop MetSyn compared with native Japanese, whereas no significant differences were found among those residing in Japan. CONCLUSIONS: These findings underscore the significant heterogeneity in risk factors among communities of Japanese ancestry residing in Brazil and Japan, and suggest that immigrants exposed to the Brazilian cultural environment are more susceptible to the development of risk factors associated with MetSyn than native Japanese.     

Trajectories of Frailty and Related Factors of the Older People in Taiwan

Background/Study Context: This study aimed to identify the different trajectories of frailty and factors related to frailty among older adults over time.

Methods: Data were obtained from a five-wave panel composed of older Taiwanese adults from 1993 to 2007 (N = 2306). Frailty was defined as the presence of three or more of the following criteria: shrinking, weakness, exhaustion, slowness, and low physical activity. A group-based model of trajectory analysis was applied with time-dependent and time-independent variables.

Results: Three trajectory groups were identified: maintaining nonfrailty, developing frailty, and high risk of frailty. Being female, older, and having a lower level of education were risk factors for being in the developing frailty group or high risk of frailty group. Physical risk factors and psychological factors were associated with frailty within each group. Higher financial satisfaction and social participation were protective factors from frailty for the developing frailty group and high risk of frailty group, respectively.

Conclusion: Older adults should promote their health physically, psychologically, and socially.     

Determining prevalence and correlates of elder abuse using promotores: low-income immigrant Latinos report high rates of abuse and neglect

Low-income Latino immigrants are understudied in elder abuse research. Limited English proficiency, economic insecurity, neighborhood seclusion, a tradition of resolving conflicts within the family, and mistrust of authorities may impede survey research and suppress abuse reporting. To overcome these barriers, promotores, local Spanish-speaking Latinos, were recruited and trained to interview a sample of Latino adults aged 66 and older residing in low-income communities. The promotores conducted door-to-door interviews in randomly selected census tracts in Los Angeles to assess the frequency of psychological, physical, and sexual abuse; financial exploitation; and caregiver neglect. Overall, 40.4% of elderly Latino adults had experienced some form of abuse or neglect within the previous year. Nearly 25% reported psychological abuse, 10.7% physical assault, 9% sexual abuse, and 16.7% financial exploitation, and 11.7% were neglected by their caregivers. Younger age, higher education, and experiencing sexual or physical abuse before age 65 were significant risk factors for psychological, physical, and sexual abuse. Years lived in the United States, younger age, and prior abuse were associated with greater risk of financial exploitation. Years spent living in the United States was a significant risk factor for caregiver neglect. Abuse prevalence was much higher in all mistreatment domains than findings from previous research on community-dwelling elderly adults, suggesting that low-income Latino immigrants are highly vulnerable to elder mistreatment or that respondents are more willing to disclose abuse to promotores who represent their culture and community.     

Physical activity level and body composition among adults with Type 1 diabetes

Aims Physical activity is part of a healthy lifestyle and contributes to prevent weight gain and cardiometabolic disorders. Adults with Type 1 diabetes are at risk of weight gain attributable to various factors, including a high prevalence of sedentary lifestyle related to fear of exercise‐induced hypoglycaemia. This project aims to observe the association between physical activity level and body composition in adults with Type 1 diabetes. Methods Cross‐sectional study; 75 adults with and 75 adults without diabetes (52% men; 41.8 ± 11.8 years old) wore a motion sensor for 1 week and performed a cardiorespiratory fitness test on an ergocycle (VO_{2 peak}). Body composition was assessed by dual energy X‐ray absorptiometry and circumferences measures. Results Mean body composition was not different between the two groups. VO_{2 peak} was lower among the group with diabetes than the control subjects (29.3 ± 9.2 vs. 33.5 ± 9.0 ml kg^?1 min^?1; P = 0.005), but their physical activity level (ratio total/resting energy expenditure) was similar (1.68 ± 0.37 vs. 1.65 ± 0.26; P = 0.572). In both groups, having an active lifestyle (physical activity level ≥ 1.7) compared with a more sedentary lifestyle (physical activity level < 1.7) was associated with lower BMI and percentage of total and truncal fat mass (P ≤ 0.030 to P ≤ 0.001). Among adults with diabetes, physical activity level was not associated with diabetes treatment (insulin doses) and control (HbA_1c and hypoglycaemia) or cardiovascular risk factors (blood pressure and lipid profile). Conclusion As in the population without diabetes, an active lifestyle is associated with a better body composition profile in adults with Type 1 diabetes.     

Prevalence and correlates of physical inactivity among older adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015

Malaysia has an increasingly aging population. Despite the substantial benefits of physical activity for healthy aging, older adults are considered the most physically inactive segment of the Malaysian population. The purpose of this study was to determine the prevalence of physical inactivity among older adults in Malaysia and its correlates. We analysed data on adults aged ≥60 years (n = 3790) from the National Health and Morbidity Survey (NHMS) 2015, a cross-sectional, nationwide population-based survey covering information on socio-demographic characteristics, physical activity and other lifestyle-related variables, health conditions, and functional limitations. Individuals included in this study were classified as physically active or physically inactive. Logistic regression was used to determine factors associated with physical inactivity. The overall prevalence of physical inactivity among older adults aged ≥60 years old was 48.8%. Physical inactivity was significantly more prevalent among females, older age groups, Indians, those being single/widowed/divorced, those with no formal education, those who reported high sedentary time (≥7 h/day), those with diabetes, anaemia, and functional limitations (p < 0.001). In fully adjusted analyses, females, older age, high household income (≥MYR4000), inadequate fruits and vegetables consumption (<5 servings/day), high sedentary time, having diabetes, and having mobility impairment were all associated with physical inactivity. Approximately half of the Malaysian older population are physically inactive. Identifying the correlates of physical inactivity among Malaysian older adults will help to develop public health policies and interventions that encourage active living among older people and promote healthy aging in Malaysia.     

北京市门诊老年人跌倒风险与躯体功能的相关性

目的 调查老年人跌倒风险现状并分析其影响因素,为老年人跌倒预防措施的制定提供参考。方法 便利抽样法抽取2021年5月至2022年4月北京市某三甲医院多学科联合跌倒门诊进行跌倒测评的老年人572例为研究对象,采用现场面对面调查的方式采集研究对象的一般资料、疾病情况、跌倒风险评分,并进行躯体功能测试。根据跌倒风险评估得分,将患者分为2组。对比2组各指标差异,确定跌倒风险的独立影响因素。采用SPSS 26.0软件进行数据分析。采用多因素logistic回归分析跌倒风险的独立影响因素。结果 572例老年人中278例(48.60%)有跌倒风险。Logistic回归分析结果显示,大专及以上文化程度(OR=2.059,95%CI 1.285～3.298)、共病(OR=1.978,95%CI 1.321～2.962)、多重用药(OR=2.211,95%CI 1.348～3.625)、睡醒后头晕/萎靡/疲劳(OR=2.948,95%CI 1.906～4.560)是老年人跌倒风险的独立危险因素,男性(OR=0.520,95%CI 0.343～0.788)、四阶段平衡测试达标(OR=0.487,95%CI ...     

Quality of life and associations with health-related behaviours among older adults with increased cardiovascular risk

Background and aimsA better understanding of the relationship between cardiovascular disease risk factors and quality of life (QoL) in older age is needed to inform development of risk reduction strategies. This cross-sectional study investigated the association of QoL with health-related behaviours in older adults at risk of heart failure.Methods and resultsOlder adults (N = 328) at risk of heart failure residing in Melbourne, Australia, provided data on QoL and health-related behaviours including physical activity, diet, smoking and alcohol consumption. Multiple linear regression modelling was used to examine associations between health-related behaviours, QoL and its constituent domains. After adjustment for age, gender, body mass index and comorbidities, current smoking was found to have a negative association with the mental component score (MCS) of QoL (β = ?0.174, p ≤ 0.01), with a positive association seen between MCS and physical activity (β = 0.130, p = 0.01). Current alcohol use had a positive association with the physical component score (PCS) (β = 0.120, p = 0.02) and saturated fat intake consumption had a negative association with the physical functioning domain of QoL (β = ?0.105, p = 0.03) but was not associated with either PCS or MCS.ConclusionEngagement of older adults at increased cardiovascular risk with behavioural risk factor modification using QoL as a driver of change may offer new opportunities to promote healthy ageing. Development of such strategies should consider that for some behaviours which are cardiovascular risk factors (alcohol intake, in particular), the positive association to QoL is complicated and needs further deliberation.     

Hypertension and frailty in older adults

The association between hypertension and frailty syndrome in older adults remains unclear. There is scarce information about the prevalence of hypertension among frail elderly patients or on its relationship with frailty. Up to one quarter of frail elderly patients present without comorbidity or disability, yet frailty is a leading cause of death. The knowledge and better control of frailty risk factors could influence prognosis. The present study evaluated: (1) the prevalence of hypertension in robust, prefrail, and frail elderly; and (2) factors that might be associated with frailty including hypertension. A cross‐sectional study was conducted in 619 older adults at a university‐based outpatient center. Study protocol included sociodemographic data, measures of blood pressure and body mass index, frailty screening according to the internationally validated FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, number of comorbidities, drug use assessment, physical activity, cognitive status, and activities of daily living. Ordinal logistic regression was used to evaluate factors associated with frailty. Prevalence of hypertension and frailty was 67.3% and 14.8%, respectively, in the total sample. Hypertension was more prevalent in the prefrail (72.5%) and frail (83%) groups than among controls (51.7%). Hypertension, physical activity, number of prescribed drugs, and cognitive performance were significantly associated with frailty status. Hypertension presented an odds ratio of 1.77 towards frailty (95% confidence interval, 1.21–2.60; P = .002). Hypertension was more prevalent in frail elderly patients and was significantly associated with frailty. Intensive control of hypertension could influence the trajectory of frailty, and this hypothesis should be explored in future prospective clinical trials.     

Differential determinants of physical daily activities in frail and nonfrail community-dwelling older adults

Background/Purpose

The purpose of this study was to determine whether or not daily activities determined by average daily steps are associated with age, gender, body mass index, fear of falling, and physical functions (locomotive function, balance function, and muscle power) in community-dwelling nonfrail and frail older adults.

Methods

This is a cross-sectional study conducted in community-dwelling older adults in Japan. Based on the Timed Up and Go (TUG) test, 629 elderly adults were divided into two groups: 515 were grouped to nonfrail elderly (TUG time less than 13.5 seconds, mean age 77.0 ± 7.2 years) and 114 to frail elderly (TUG time of 13.5 seconds or more, mean age 76.1 ± 7.5 years). Daily physical activities were determined by average daily steps measured by pedometer and four other physical function tests (10-m walk test, single-leg standing, functional reach, and five-chair stand test) were performed along with the assessment of fear of falling.

Results

Stepwise regression analysis revealed that age, gender, 10-m walk test, and single-leg standing were significant and independent determinants of the average step counts in the nonfrail elderly (R² = 0.282, p < 0.001), whereas fear of falling was the only significant and independent determinant of the average step counts in the frail elderly (R² = 0.119, p < 0.001).

Conclusion

These results indicate that differential factors may be related to daily activities depending on the level of frailty in community-dwelling older adults.     

Does leisure‐time physical activity attenuate or eliminate the positive association between obesity and high blood pressure?

We examine the joint association of weight status and leisure‐time physical activity on high blood pressure in a nationally representative sample of adults and older adults in Brazil. This was a national cross‐sectional survey conducted in Brazil in 2013 (Brazilian Health Survey). The sample consisted of 59 402 participants (56% women, aged 18 to 100 years). Outcome was objectively assessed blood pressure. Body mass index (BMI) was objectively measured, while self‐reported information on leisure‐time physical activity, TV viewing, chronological age, race, educational status, tobacco smoking, sodium consumption, and hypertension medication was obtained using questionnaires. Logistic regression analysis with adjusted odds ratio was conducted to test the joint association of BMI and leisure‐time physical activity categories on high blood pressure. Overall, compared to normal weight (NW) and physically active group, the NW/inactive (OR = 1.28; 1.04 to 1.58), overweight/active (OR = 1.38; 1.08 to 1.78), overweight/inactive (OR = 1.89; 1.53 to 2.33), obese/active (OR = 2.19; 1.59 to 3.01) and obese/inactive (OR = 2.54; 2.05 to 3.15) groups were 28% to 254% more likely to have high blood pressure. The attenuation and high blood pressure was greater for women and adults than for men and older adults. Thus, leisure‐time physical inactivity and being overweight and obesity were associated with high blood pressure in Brazilian population. Engaging in sufficient level of physical activity during leisure could attenuate, but not eliminate, the negative influence of obesity on high blood pressure in Brazilian adults and older adults.     

The relationship between expectations for aging and physical activity among older adults

BACKGROUND: New strategies to increase physical activity among sedentary older adults are urgently needed. OBJECTIVE: To examine whether low expectations regarding aging (age-expectations) are associated with low physical activity levels among older adults. DESIGN: Cross-sectional survey. PARTICIPANTS: Six hundred and thirty-six English- and Spanish-speaking adults aged 65 years and above attending 14 community-based senior centers in the Los Angeles region. Over 44% were non-Latino whites, 15% were African American, and 36% were Latino. The mean age was 77 years (range 65 to 100). MEASUREMENTS: Self-administered written surveys including previously tested measures of age-expectations and physical activity level in the previous week. RESULTS: Over 38% of participants reported <30 minutes of moderate-vigorous physical activity in the previous week. Older adults with lower age-expectations were more likely to report this very low level of physical activity than those with high age-expectations, even after controlling for the independent effect of age, sex, ethnicity, level of education, physical and mental health-related quality of life, comorbidity, activities of daily living impairment, depressive symptoms, self-efficacy, survey language, and clustering at the senior center. Compared with the quintile of participants having the highest age-expectations, participants with the lowest quintile of age-expectations had an adjusted odds ratio of 2.6 (95% confidence intervals: 1.5, 4.5) of reporting <30 minutes of moderate-vigorous physical activity in the previous week. CONCLUSIONS: In this diverse sample of older adults recruited from senior centers, low age-expectations are independently associated with very low levels of physical activity. Harboring low age-expectations may act as a barrier to physical activity among sedentary older adults.     

Effectiveness of Diabetes Interventions in the Patient-Centered Medical Home

With the aging of the population and longer life expectancies, the prevalence of population with multiple chronic medical conditions has increased. Difficulty managing these conditions as people age (because of changes in physical, functional, or cognitive abilities and the complexity of many treatment regimens), has led to more individuals with multiple medical conditions admitted to the long-term care facilities. Older adults with diabetes residing in the long-term facilities represent the most vulnerable of this cohort. Studies that specifically target diabetes management in older population are lacking and those that target diabetes management in the long-term care facilities are even fewer. The lack of knowledge regarding the care of the elderly residing in long-term care with diabetes may lead to treatment failure and higher risk of hyperglycemia, as well as hypoglycemia. In aging populations, hypoglycemia has the potential for catastrophic consequences. To avoid this, the management of older population with diabetes and other medical comorbidities residing in long-term care facilities requires a more holistic approach compared with focusing on individual chronic disease goal achievement.     

Glycemic control and management of cardiovascular risk factors among adults with diabetes in the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study

AimsTo determine the level of glycemic control and cardiovascular (CVD) risk among adults with diabetes in the Eastern Caribbean.MethodsBaseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study (ECS) were used for the analysis. ECS participants were 40 years of age and older, residing in the US Virgin Islands, Puerto Rico, Trinidad, or Barbados. Participants completed a survey, physical exam, and laboratory studies. CVD risk was calculated using the Atherosclerotic CVD risk equation. Bivariate analysis followed by multinomial logistic regression was used to assess social and biological factors (education, lifestyle, access to care, medical history) associated with level of glycemic control.ResultsTwenty-three percent of participants with diabetes had an HbA1c ≥ 9% (>75 mmol/mol). Participants with diabetes had poorly controlled CVD risk factors: 70.2% had SBP ≥ 130 mmHg, 52.2% had LDL ≥ 100 mg/dl (2.59 mmol/L), and 73.2% had a 10-year CVD risk of more than 10%. Age and education level were significant, independent predictors of glycemic control.ConclusionThere is a high prevalence of uncontrolled diabetes among adults in ECS. The high burden of elevated CVD risk explains the premature mortality we see in the region. Strategies are needed to improve glycemic control and CVD risk factor management among individuals with diabetes in the Caribbean.     

Prevalence and correlates of overweight and obesity among older adults: findings from the Canadian National Population Health Survey

BACKGROUND: The prevalence of obesity among elderly persons in industrialized countries ranges from 15% to 20%. Little is known about variations of overweight within subgroups of the elderly population. This study examined the factors associated with overweight and obesity among older men and women. METHODS: Data for 12,823 community-dwelling persons aged 65 and older from the 1996-1997 Canadian National Population Health Survey were examined. Predictors of overweight (body mass index [BMI] = 25.0-29.9 kg/m2) and obesity (BMI = >30 kg/m2) relative to normal weight (BMI = 20.0-24.9 kg/m2) were examined using logistic regression analyses. Analyses were stratified by gender. The predictor variables included age, education, marital status, place of birth, region, smoking status, alcohol use, chronic conditions, physical activity, functional limitations, self-rated health, social support, and psychological distress. RESULTS: Overall, 39% and 13% of Canadian older adults were classified as overweight and obese, respectively. Some of the risk factors for overweight were male gender, low education, being married, Canadian born, residence in the Atlantic provinces, no use of alcohol, comorbidity, physical inactivity, and limited functional status. Risk factors for obesity were similar to those for overweight except for being unmarried; American, European, and Australian born; lower and higher levels of alcohol use; poor self-rated health; and psychological distress. CONCLUSIONS: The results could lead to more effective weight-control interventions that are designed to promote increased physical activity and healthy eating habits among obese older individuals.