Predictors of mortality in the old-old in Israel: the Cross-sectional and Longitudinal Aging Study

OBJECTIVES: To examine whether well-known predictors of mortality change their predictive power over time, being reduced or even reversed in the old-old. DESIGN: A multidimensional survey of the Cross-Sectional and Longitudinal Aging Study conducted from 1989 to 1992 with follow-up of mortality after 6, 8, 10, and 12 years since 1989. SETTING: Israel. PARTICIPANTS: Participants (N=1,369) were drawn from a national sample of the Jewish Israeli population aged 75 to 94. MEASUREMENTS: Data included sociodemographic factors and measures of health, physical condition, cognitive performance, and depression. RESULTS: The results showed that age, sex, disability, self-rated health, and marital status predicted mortality and that their predictive power changed over 9 years. CONCLUSION: In the old-old, predictors of mortality changed over time, and their predictive effect eventually diminished. The predictors found to be most significant (age, sex, disability, and self-rated health) support the common cause theory.     

Physician visits, emergency room utilization, and overnight hospitalization in the old-old in Israel: the cross-sectional and longitudinal aging study (CALAS)

OBJECTIVES: The objective of this paper is to assess the risk factors for physician contact in the month before the interview (PM) and emergency room utilization (ERU) and overnight hospitalization (OH) in the year before the interview, through the use of the behavioral model as a conceptual framework. DESIGN: A random stratified sample of subjects age 75 to 94 was selected from the National Population Register (a complete listing of the Israeli population maintained by the Ministry of the Interior). The study sample consisted of Jews living in Israel on January 1, 1989, stratified by age (four 5-year age groups: 75-79, 80-84, 85-89, and 90-94), sex, and place of birth (Europe/America, Asia/Africa, and Israel). SETTING: Community-dwelling old-old Jewish Israelis. PARTICIPANTS: 1,487 people living in the community at the time of the baseline interview. MEASUREMENTS: The dependent variables were PM in the month before the interview and ERU and OH in the previous year. The independent variables were: predisposing variables (age, sex, place of birth, and education); enabling variables (income and the social network variables of marital status, living arrangements, and number of in-person contacts per week with any child); and need variables (number of self-reported chronic medical conditions, subjective health, depressive symptoms, number of difficulties with activities of daily living and instrumental activities of daily living, measures of physical robustness, and engaging in regular physical sportive activities). RESULTS: The predisposing and enabling factors were only minimally associated with utilization rates in the old old in Israel, with the exception of lower rates of ERU by those who were living alone. Age was not significantly associated with healthcare utilization in the old-old population studied. Healthcare utilization was found to be associated primarily with health and functional status. CONCLUSION: In a system of free and equal access to healthcare services, the demand for health services by a population with high levels of chronic disease and disability is driven primarily by health needs, rather than by extraneous factors such as income and education. The study indicates that equity in the provision of health services is attainable. Policy makers should provide for actual need, remove artificial barriers, and prepare accurate estimates of future needs.     

Social factors and mortality in the old-old in Israel: the CALAS study

OBJECTIVES: Using a theoretical framework that divided social factors measures into structure, function, and social engagement, this study determined those aspects of social networks most significantly associated with 8-year, all-cause mortality among the old-old in Israel. METHODS: Jews (n = 1,340) aged 75-94 living in Israel on January 1, 1989, were randomly selected from the National Population Register; stratified by age, sex, and place of birth; and interviewed in person. Mortality was determined according to the National Death Registry (December 1997). RESULTS: After controlling for sociodemographics and measures of health, cognitive status, depressive symptoms, and physical function, the measures of social engagement that explicitly involved others were associated with a lower risk of mortality. No measure of the function of the social network was associated with risk of mortality. Living in the community without a spouse and with a child and living in an institution were significantly associated with a higher risk of mortality. DISCUSSION: The finding that participating in activities with people outside of the immediate family is associated with a lower risk of death has practical implications for helping the aging population and their families in their decision-making process. Lack of support for the hypothesis that those with more social support would show reduced risk of mortality may indicate that the positive effect of perceiving support and the negative effect of needing support may cancel each other out and result in no perceived effect. In this population, the association between socioeconomic status (SES) and the risk of mortality seems to be expressed through the living arrangements, with the sick and frail, both in institutions (higher SES) and in the community with a child or other (lower SES), having a higher risk of mortality. These findings are consistent with the use of children as a substitute for institutionalization, and imply that at least some cohabitation was the caretaking solution for the noninstitutionalized old-old who were of low SES, frail, and close to death.     

Decreased activities of daily living at discharge predict mortality and readmission in elderly patients after cardiac and aortic surgery: A retrospective cohort study

Recently, activities of daily living (ADL) were identified as a prognostic factor among elderly patients with heart disease; however, a specific association between ADL and prognosis after cardiac and aortic surgery is not well established. We aimed to clarify the impact of ADL capacity at discharge on prognosis in elderly patients after cardiac and aortic surgery.This retrospective cohort study included 171 elderly patients who underwent open operation for cardiovascular disease in a single center (median age: 74 years; men: 70%). We used the Barthel Index (BI) as an indicator for ADL. Patients were classified into 2 groups according to the BI at discharge, indicating a high (BI ≥ 85) or low (BI < 85) ADL status. All-cause mortality and unplanned readmission events were observed after discharge.Thirteen all-cause mortality and 44 all-cause unplanned readmission events occurred during the median follow-up of 365 days. Using Kaplan–Meier analysis, a low ADL status was determined to be significantly associated with all-cause mortality and unplanned readmission. In the multivariable Cox proportional hazard models, a low ADL status was an independent predictor of all-cause mortality and unplanned readmission after adjusting for age, sex, length of hospital stay, and other variables (including preoperative status, surgical parameter, and postoperative course).A low ADL status at discharge predicted all-cause mortality and unplanned readmission in elderly patients after cardiac and aortic surgery. A comprehensive approach from the time of admission to postdischarge to improve ADL capacity in elderly patients undergoing cardiac and aortic surgery may improve patient outcomes.     

Late-life depression in primary care: a nationwide Italian epidemiological survey

OBJECTIVES: To assess 1-week prevalence of International Classification of Disease, Tenth Edition (ICD-10) current depression, physical comorbidity, associated disability, and healthcare utilization in older primary care patients. Comparisons with younger patients are also reported. DESIGN: Cross-sectional, two-phase epidemiological study. SETTING: One hundred ninety-one primary care clinics. PARTICIPANTS: Six hundred six patients aged 60 and older and 1,290 patients aged 14 to 59. MEASUREMENTS: Screening was conducted using the General Health Questionnaire-12. Probable cases were assessed by primary care physicians (PCPs) with the World Health Organization ICD-10 Checklist for depression to diagnose ICD-10 current depression and subsyndromal depression. Other instruments included the Brief Disability Questionnaire and the PCPs' rating of the severity of physical illness. RESULTS: The prevalence of current depression was 8.6%; 3.6% for subsyndromal depression (8.3% and 5.5%, respectively, in younger subjects). Current depression was associated with physical illness, physical disability, days lost from work or days unable to perform activities of daily living, and frequency of PCP consultation. Both physical illness and current depression independently resulted in increased disability, and, when the two conditions coexisted, there was a further increase in disability. Comorbidity with physical illness was the hallmark of late-life depression, distinguishing this condition from depression in younger patients. Moreover, depressed older patients were more disabled and had a higher frequency of PCP consultation than younger depressed patients. CONCLUSION: The prevalence of current depression does not decrease with age in primary care, in contrast to that seen in community studies. Late-life depression is characterized by physical comorbidity and associated with significant disability. The specific features of late-life depression call for intervention programs taking into account the relationship between the mental, physical, and functional aspects of this condition.     

The health status of the Palestinians living in Israel: a cross-sectional study

Background

In mid-2014, 1?350?800 Palestinians were living in Israel (excluding residents of occupied East Jerusalem and the Golan Heights). Palestinians comprise 17% of the total population in Israel. The Palestinian community in Israel is very young, with 36% of Palestinians aged 14 years and younger, whereas in the Naqab, 49% of the Palestinian community is aged 14 years and younger. According to Ministry of Health reports, there is a gap between Arabs and Jews in most health indicators (life expectancy, infant mortality, chronic morbidity, and health behaviours). Most official surveys on the health of Palestinians living in Israel are based on small samples and do not consider specific characteristics of the Arab population (eg, composition, geographic distribution). The aim of this study was to obtain broader data on the health status of Palestinians in Israel as part of a socioeconomic survey.

Depression after stroke: a prospective epidemiological study

OBJECTIVES: To elucidate the relationship between stroke and depressive symptoms and to determine whether disability or cerebrovascular risk factors mediate that relationship. DESIGN: A prospective longitudinal epidemiological survey. SETTING: The mid-Monongahela Valley, a rural, nonfarm, low-socioeconomic-status community. PARTICIPANTS: Random sample of 1,134 subjects aged 65 and older. MEASUREMENTS: The dependent variable was clinically significant depressive symptoms, as defined by five or more symptoms on the modified Center for Epidemiological Studies Depression scale. The independent variables were demographics (age, sex, education), stroke, number of impaired instrumental activities of daily living (IADLs), diabetes mellitus, hypertension, atherosclerotic heart disease, and smoking. Logistic regression analyses were conducted for cross-sectional and longitudinal models examining whether stroke was associated with or predicted depressive symptoms, with other associated factors included as covariates. RESULTS: Clinically significant depressive symptoms were cross-sectionally associated with stroke (odds ratio (OR)=3.5, 95% confidence interval (CI)=1.4-8.3), diabetes mellitus (OR=2.8, 95% CI=1.7-4.6; P相似文献   

A longitudinal study of characteristics and predictors of perceived instrumental and emotional support among the old-old in Israel.

The structure and function of social networks and the perceived instrumental and emotional support associated with these networks were studied longitudinally among a random sample of 687 Jewish Israelis aged seventy-five to ninety-four, stratified by five-year age groups, place of birth (Europe-America, Asia-Africa, or Israel), and gender, interviewed in 1989-92 and 1993-94. Perceived instrumental support at follow-up was predicted by baseline measures of proximity of at least one child and by four or more weekly contacts with intimate friends or family, whereas perceived emotional support was more broadly based and was predicted by more frequent contacts with children, neighborliness, and having more intimate friends. Changes occurring during the follow-up interval, such as entering long-term care or losing a confidant, were associated with a decrease in perceived emotional support but not with a loss of instrumental support. Emotional support was less replaceable over time than was instrumental support.     

Predicting the need of formal care in Taiwan: analysis of a national random sample

The study aimed to examine the determinants of needing formal care and the factors impacting care arrangements in elderly Taiwanese by analyzing the 1999 and 2003 data of “The Survey of Health and Living Status of the Elderly in Taiwan”, a prospective cohort study of older Taiwanese. For the purpose of this study, only participants 70 years or older were analyzed. The association of sociodemographic, lifestyle and health-related variables with care need and care arrangements at baseline and four years later were analyzed. Results showed that the major predictors of needing formal care in elderly Taiwanese were old age, cognitive impairment and functional disability. Self-perceived poor health and prior nursing-home admission were marginally significant. Results also showed that the traditional culture dictated care arrangement. Most elderly Taiwanese preferred to have private home carers (usually from neighboring countries) over institutionalization. The ratio of private care vs. institutionalization increased from 1:3 in 1999 to 1:1 in 2003 as the government allowed introducing more foreign carers. Results suggest that the major determinants of needing formal care in elderly Taiwanese are old age, and cognitive and functional impairments, similar to that observed in Western countries. However, culture and public policy impact care options.     

Health-related services use and the onset of functional disability: 10 year follow-up study

This study aimed to examine the effect of health-related service use on the development of functional disability in an older adult Taiwanese cohort. The sample population consisted of 871 participants without Instrumental Activities of Daily Living (IADL) disabilities, 1061 participants without Activities of Daily Living (ADL) disabilities and 817 participants without IADL and ADL disabilities at baseline. The onset of IADL and ADL disabilities were estimated as the follow-up survey year that these functional disabilities were first noted, or the follow-up survey year that the participant was noted as having died. A Cox proportional hazards model, with time-dependent covariates, was used to analyze the association between the time of onset of the functional disabilities and the health-related service use, after controlling for age, gender, education, marital status and time varying chronic disease status. This study found that an increase in the number of services used by the participants resulted in fewer IADL and ADL disabilities. Furthermore, participants who attended recreational programs, regular health examinations, and who received the information assistance and meal preparation were significantly less likely to develop disabilities. Participants who used one or more services were 55–77% less likely to be IADL disabled, and were 54–81% less likely to be ADL disabled, and were also 59–89% less likely to develop IADL and ADL disabilities as compared to those who used none. In the present study therefore, as the number of health services used increased the likelihood of developing a functional disability decreased.     

Risk factors of syphilis co-infection among HIV-infected men who have sex with men in Tel-Aviv,Israel

Syphilis incidence in Israel and other industrialized countries has increased in the past decade, mainly among men who have sex with men (MSM) who were co-infected with HIV. This study aimed to assess the demographic characteristics and behavioral risk factors for syphilis infection among HIV-infected MSM in the Tel-Aviv region, Israel. This cross-sectional study compared HIV-infected MSM who were co-infected with syphilis since 2005 with HIV-infected MSM without syphilis, using an anonymous self-administered questionnaire distributed at the AIDS treatment clinic in central Israel in 2016. This study included 75 HIV-infected MSM who were diagnosed with syphilis after their HIV diagnosis and 99 HIV-infected MSM without syphilis. Variables associated with syphilis infection included inadequate adherence to antiretroviral therapy (ART) (OR?=?1.8 [1.2–2.4]), frequent unprotected receptive anal intercourse (UAI) with casual sex partners (OR?=?2.2 [1.5–8.2]), especially with HIV-infected partner (OR?=?3.2 [1.1–7.9]).

In conclusion, HIV and syphilis co-infection were associated with frequent UAI with casual sex partners, inadequate adherence to ART and limited partner notification. In order to minimize syphilis transmission among HIV-infected MSM, AIDS clinics should encourage HIV-infected MSM to use condoms, ensure that patients perform periodic syphilis serology testing and improve partner notifications.