Lower cardiac output is associated with greater white matter hyperintensities in older adults with cardiovascular disease

OBJECTIVES: To preliminarily examine the association between cardiac output, a measure of systemic blood flow, and structural brain magnetic resonance imaging indices of white matter hyperintensities (WMHs). DESIGN: Cross-sectional. SETTING: University medical setting. PARTICIPANTS: Thirty-six older adults without dementia with prevalent cardiovascular disease (aged 56-85). MEASUREMENTS: Cardiac output, WMHs. RESULTS: Partial correlations, adjusting for age and history of hypertension, yielded an inverse relationship between WMHs adjacent to subcortical nuclei and cardiac output (correlation coefficient=-0.48, P=.03); as cardiac output decreased, WMHs increased significantly. No significant associations were found between cardiac output and total WMHs or periventricular WMHs. CONCLUSION: These preliminary data suggest that systemic blood flow, measured according to cardiac output, is inversely associated with WMHs adjacent to the subcortical nuclei. Cerebrovascular degeneration and the chronicity of hypoperfusion may exacerbate the susceptibility of white matter integrity to alterations in blood flow in older adults.     

Prediction and classification of cardiovascular disease risk in older adults with diabetes

Aims/hypothesis

We sought to derive and validate a cardiovascular disease (CVD) prediction algorithm for older adults with diabetes, and evaluate the incremental benefit of adding novel circulating biomarkers and measures of subclinical atherosclerosis.

Methods

As part of the Cardiovascular Health Study (CHS), a population-based cohort of adults aged ≥65 years, we examined the 10 year risk of myocardial infarction, stroke and cardiovascular death in 782 older adults with diabetes, in whom 265 events occurred. We validated predictive models in 843 adults with diabetes, who were followed for 7 years in a second cohort, the Multi-Ethnic Study of Atherosclerosis (MESA); here 71 events occurred.

Results

The best fitting standard model included age, smoking, systolic blood pressure, total and HDL-cholesterol, creatinine and the use of glucose-lowering agents; however, this model had a C statistic of 0.64 and poorly classified risk in men. Novel biomarkers did not improve discrimination or classification. The addition of ankle–brachial index, electrocardiographic left ventricular hypertrophy and internal carotid intima–media thickness modestly improved discrimination (C statistic 0.68; p?=?0.002) and classification (net reclassification improvement [NRI] 0.12; p?=?0.01), mainly in those remaining free of CVD. Results were qualitatively similar in the MESA, with a change in C statistic from 0.65 to 0.68 and an NRI of 0.09 upon inclusion of subclinical disease measures.

Conclusions/interpretation

Standard clinical risk factors and novel biomarkers poorly discriminate and classify CVD risk in older adults with diabetes. The inclusion of subclinical atherosclerotic measures modestly improves these features, but to develop more robust risk prediction, a better understanding of the pathophysiology and determinants of CVD in this patient group is needed.     

Blood pressure variability and white matter hyperintensities in older adults with cardiovascular disease

The present study examined the relationship between multiple blood pressure (BP) indices and white matter hyperintensities (WMH) in a sample of 39 older adults with cardiovascular disease (CVD). Resting BP was measured using an automated monitor every 10 min for 2 h. WMH were quantified on FLAIR images and separate indices were generated for neocortical, periventricular and subcortical brain regions. Correlation analyses revealed systolic BP variability was related to neocortical and total WMH. A function of systolic BP variability and average diastolic pressure showed the strongest relationships, including significant correlation to neocortical, subcortical and total WMH. No BP index was related to WMH in periventricular regions. Exploratory analyses showed only the function of systolic BP variability and average diastolic pressure predicted total WMH, whereas as age, CVD conditions and psychosocial factors did not. These findings demonstrate BP variability is an important contributor to WMH in older adults with CVD and suggests it may have differential relationships to WMH in different brain regions. Additional studies are needed to examine the role of autoregulatory systems in the development of WMH, particularly those using beat-to-beat measures of BP.     

Sociodemographic characteristics associated with self-care and quality of life among community-dwelling older adults with type 2 diabetes

AimsTo assess how well community-dwelling older adults in Singapore were coping with their diabetes, and the sociodemographic characteristics that were associated with their level of coping.MethodsThis was a cross-sectional study involving 257 older adults. Multiple regression was used to assess the associations between various sociodemographic characteristics and coping measures of present quality of life and level of self-care.ResultsOlder adults mainly sought care in the primary care setting. They were not coping well given their mean scores for diabetes-dependent quality of life and the self-care index were ?3.57 and 3.55 respectively. Compared to those with post-secondary education, individuals who had no formal (adjusted B ?0.92, p 0.003), primary level (adjusted B ?0.76, p < 0.001) and secondary level (adjusted B ?0.50, p < 0.02) education reported lower present quality of life. Those with prior lowest skill level occupations were less likely to consume a healthy diet per week than those with prior highest skill level occupations (adjusted B ?1.48, p 0.004).ConclusionsThere should be provision of diabetes self-care interventions targeting older adults in Singapore especially for those with lower education and work skill levels. As the first line of contacts, primary care providers should advocate for diabetes self-care and develop community-based interventions for these priority groups.     

Depressive symptoms among African American and white older adults

Guided by a stress and coping model, we explored determinants of depressive symptoms among community samples of older African Americans (n=255) and older Whites (n=452). We gave focus to the effects of demographic variables, physical health constraints (chronic conditions and functional disability), and psychosocial attributes (sense of mastery, religiosity, social support, and satisfaction with support), along with their interactive roles. We identified lower education, greater functional disability, lower sense of mastery, and poorer satisfaction with support as common risk factors for depressive symptoms in both groups; in contrast, the effects of age, gender, and religiosity were race specific. In addition, we obtained significant interactions among predictor variables in each group, identifying risk-reducing and risk-enhancing factors within each group.     

The sex and age of older adults influence the outcome of induced trips

BACKGROUND: Falls are a significant source of morbidity and mortality in older adults, with up to 53% of these falls due to tripping. To aid in fall prevention, there is a need to identify the factors that determine whether a trip is recoverable and those factors that increase an older adult's risk of falling. METHODS: Trips were induced during gait in 79 healthy, community-dwelling, safety-harnessed older adults (50 women) using a concealed, mechanical obstacle. Trip outcomes were graded as recoveries, falls, rope-assists, or misses. Kinematics were recorded during normal gait, without and with the safety harness. Selected gait parameters were compared to determine whether the experimental conditions affected gait at the time of the trip. RESULTS: Thirty-nine trip outcomes were classified as recoveries, 10 as falls, 12 as rope-assists, and 18 as misses. Women fell more than four times as frequently as men. Women younger than 70 years fell more than three times as frequently as those older. Trip outcomes in the men were essentially unaffected by age. The foot obstructed to induce the trip did not affect the trip outcome. The presence of the safety harness had almost no effect on gait. The length of the stride preceding the trip did not differ from normal. CONCLUSIONS: The majority of trips in healthy older adults did not result in falls. Older women were more likely than men to fall following a trip. The likelihood of falling from a trip was greatest in the youngest older women.     

Retirement intentions among black professionals: implications for practice with older black adults.

This study examined the preretirement intentions of black professionals. The sample consisted of 234 blacks and was stratified by gender, age, and professional status. Based on a model developed for predicting the retirement intentions and attitudes of a sample of white professionals, six categories of independent variables (sociocultural, work history, alienation, leisure and social activities, financial planning, and plans for retirement life) were included in the analysis. Professionals who were highly committed to their work, had few financial investments, and socialized primarily with co-workers tended to avoid planning for retirement. These results have important implications for practitioners concerned with more effectively meeting the preretirement and retirement needs of older black adults.     

Prevalence and factors associated with frailty among Peruvian older adults

The objective of this study is to examine the prevalence and factors associated with frailty in Peruvian Navy Veteran's older adults and family members. A total of 311 non-institutionalized men and women aged 60 years and older, from the Geriatrics Service of the Peruvian Navy Medical Center (Centro Médico Naval “Cirujano Mayor Santiago Távara”) were assessed between May and October 2010. Frailty was defined as having two or more of the following components: (1) unintentional weight-loss, (2) weakness (lowest 20% in grip-strength), (3) self-reported exhaustion, and (4) slow walking speed (lowest 20% 8-m walk-time in seconds). Additionally, information on socio-demographic factors, medical conditions, depressive symptoms, disability, and cognitive function were obtained. Of the 311 participants, 78 (25.1%) were not frail, 147 (47.3%) were pre-frail, and 86 (27.8%) were frail. Using logistic regression analysis, we found that older age, being married, falls in the last year and disability were factors significantly associated with being frail. We conclude that prevalence of pre-frail and frail status in Peruvian Navy Veterans and family members is high. Our data reports risk factors for frailty that have been reported in the past in other population groups. A larger sample and longitudinal follow-up are needed to design and implement comprehensive geriatric interventions that can benefit Peruvian Navy Veteran's older adults at risk of becoming frail.     

Comparison of risk factors for cardiovascular mortality in black and white adults

BACKGROUND: Recent attention to racial and ethnic disparities in health outcomes highlights the excess coronary heart disease mortality in black patients compared with white patients. We investigated whether traditional cardiovascular disease (CVD) risk factors were similarly associated with CVD mortality in black and white men and women. METHODS: Participants included 3741 black and 33,246 white men and women (44%) without a history of myocardial infarction, aged 18 to 64 years at baseline (1967-1973) from the Chicago Heart Association Detection Project in Industry study. Blood pressure, total cholesterol level, body mass index, cigarette smoking, and physician-diagnosed diabetes were assessed at baseline using standard methods. RESULTS: Through 2002, there were 107, 1586, 177, and 2866 deaths from CVD in black women, white women, black men, and white men, respectively. In general, the magnitude and direction of associations between traditional risk factors and CVD mortality were similar by race. However, in black women the multivariable-adjusted hazard ratio (HR) per 12 mm Hg of diastolic blood pressure was 1.08 (95% confidence interval [CI], 0.90-1.29), whereas it was 1.31 in white women (95% CI, 1.25-1.38). There was no association between higher cholesterol level (per 40 mg/dL [1.04 mmol/L]) and CVD mortality in black men (HR, 0.94; 95% CI, 0.80-1.10), whereas the risk was elevated in white men (HR, 1.21; 95% CI, 1.16-1.26). CONCLUSIONS: Most traditional risk factors demonstrated similar associations with mortality in black and white adults of the same sex. Small differences were primarily in the strength, not the direction, of association.     

The impact of group-based Tai chi on health-status outcomes among community-dwelling older adults with hypertension

Objectives

To test the effects of group-based Tai chi on health-status outcomes among older adults with hypertension.

Stress and sex differences in depressive symptoms among older adults

The purpose of this study was to determine whether elderly women experience more symptoms associated with depression than elderly men and, if such sex differences exist, to examine several factors that might account for the greater preponderance of psychological distress among women. Unlike previous studies of elderly adults, this study attempted to explain sex differences in depression in terms of differential-exposure and differential-vulnerability to the effects of life stress. The results from a random community survey of 351 older adults indicate that women are more depressed than men. Moreover, a series of demographic-mean decomposition analyses suggest that greater vulnerability among women to the effects of chronic life strains explains a substantial portion of the observed sex differences in distress. Stressful life events were found to be a less important factor in this process.     

Asthma outcomes are poor among older adults with low health literacy

Objective: To examine the association of health literacy (HL) with asthma outcomes among older asthmatics. Methods: The study included adults ages ≥60 with moderate to severe asthma in New York City and Chicago. We assessed asthma control with the Asthma Control Questionnaire (ACQ) and the percent predicted forced expiratory volume at 1?s (FEV₁) by spirometry, hospitalizations and emergency department (ED) visits in the past 6 months, and quality of life. HL was assessed with the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Multivariate logistic regression models controlled for age, sex, race, income, general health and years with asthma. Results: Among 433 individuals, 36% had low HL, 55% were over age 65, 38% were Hispanic and 22% were black. Poor asthma control was reported by 40% and 32% had FEV₁ <70% of predicted; 9% had a hospital stay, 23% had an ED and 38% had poor quality of life. In multivariable analysis, individuals with low HL were more likely to have FEV₁ <70% predicted (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.39–3.94, p?=?0.001), hospitalizations (OR 2.53, 95% CI 1.17–5.49, p?=?0.02) and ED visits for asthma (OR 1.81, 95% CI 1.05–3.10, p?=?0.03). There were no differences in self-reported asthma control and quality of life. Conclusions: Low HL is associated with poor asthma control by objective measure, and greater likelihood of ED visits and hospitalization. HL is a modifiable target for interventions to improve asthma outcomes in the elderly.     

Antecedents and dimensions of religious involvement among older black adults.

This study proposed and tested a measurement model of religiosity among a sample of older (55 years of age and above) Black Americans. This model incorporates three correlated dimensions of religious involvement, termed organizational, nonorganizational, and subjective religiosity. Findings indicate that the proposed model provides a good fit to the data, is preferable to other alternative models, and exhibits convergent validity with respect to exogenous or antecedent variables (age, gender, marital status, income, education, urbanicity, and region) known to predict religious involvement. In addition, these antecedents exhibit stronger effects on subjective religiosity than on the two more behavioral dimensions of religiosity. Interpretation of these status-group differences in religiosity focuses on socialization experiences and social environment factors which may promote a religious world-view.     

Hostility and prevalent diabetes among black adults: The Jackson Heart Study

Background and aimsThe relationship between hostility and the prevalence of diabetes mellitus (DM) among black adults was investigated using the Jackson Heart Study (JHS) cohort. We hypothesized that Cook-Medley Hostility scores will be positively related with the prevalence of DM.Methods and resultsA total of 3232 black adults who completed at least one question for each of the three subscales of the Cook-Medley Hostility Scale and had data available regarding DM status were included. Using multivariate logistic regression, we studied the cross-sectional relationship between the overall Total Cook-Medley Hostility scores and individual subscales, hostile affect (n = 3232), aggression (n = 3119) and cynical distrust (n = 3085), with prevalent DM, adjusting for known DM confounders. Our population was 36% male with a mean age of 53.5 ± 0.9 years. In risk-factor adjusted models, each point higher in the overall Total Cook-Medley Hostility scores was associated with increased odds of having DM [Adjusted OR 1.02, 95%CI 1.00–1.04, P = 0.03]. Higher scores of cynicism were independently associated with prevalent DM [Adjusted OR 1.04, 95%CI 1.01–1.07, p = 0.021].ConclusionsThere was a positive relationship between overall hostility levels and prevalent DM. Future studies should investigate the extent to which additional social determinants may impact the relationship between hostile affect and prevalent DM.