Responsiveness and Clinical Utility of the Geriatric Self-Efficacy Index for Urinary Incontinence

OBJECTIVES: To report on the responsiveness testing and clinical utility of the 12-item Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI).
DESIGN: Prospective cohort study.
SETTING: Six urinary incontinence (UI) outpatient clinics in Quebec, Canada.
PARTICIPANTS: Community-dwelling incontinent adults aged 65 and older.
MEASUREMENTS: The abridged 12-item GSE-UI, measuring older adults' level of confidence for preventing urine loss, was administered to all new consecutive incontinent patients 1 week before their initial clinic visit, at baseline, and 3 months posttreatment. At follow-up, a positive rating of improvement in UI was ascertained from patients and their physicians using the Patient's and Clinician's Global Impression of Improvement scales, respectively. Responsiveness of the GSE-UI was calculated using Guyatt's change index. Its clinical utility was determined using receiver operating curves.
RESULTS: Eighty-nine of 228 eligible patients (39.0%) participated (mean age 72.6+5.8, range 65–90). At 3-month follow-up, 22.5% of patients were very much better, and 41.6% were a little or much better. Guyatt's change index was 2.6 for patients who changed by a clinically meaningful amount and 1.5 for patients having experienced any level of improvement. An improvement of 14 points on the 12-item GSE-UI had a sensitivity of 75.1% and a specificity of 78.2% for detecting clinically meaningful changes in UI status. Mean GSE-UI scores varied according to improvement status ( P <.001) and correlated with changes in quality-of-life scores ( r =0.7, P <.001) and reductions in UI episodes ( r =0.4, P =.004).
CONCLUSION: The GSE-UI is responsive and clinically useful.     

Reliability and Validity of Prehospital Case Finding for Depression and Cognitive Impairment

OBJECTIVES: To evaluate the test–retest reliability, the concurrent criterion validity, and the construct validity of prehospital, emergency medical service (EMS) case finding for depression and cognitive impairment in older adults.
DESIGN: Cross-sectional study.
SETTING: Prehospital EMS system and hospital emergency department.
PARTICIPANTS: EMS providers and community-dwelling older adult (aged ≥60) patients.
INTERVENTIONS: Case finding instruments for depression (Patient Health Questionnaire-2; PHQ-2) and cognitive impairment (Six-Item Screener).
MEASUREMENTS: The reliability and validity of these instruments.
RESULTS: Moderate test–retest reliability was found for prehospital application of the PHQ-2 (kappa=0.50) and Six-Item Screener (kappa=0.52), fair concurrent criterion validity for depression (kappa=0.36), and slight to fair concurrent criterion validity for cognitive impairment (kappa=0.11–0.23). Construct validity was demonstrated using the Multitrait-Multimethod Matrix.
CONCLUSION: Moderate test–retest reliability and construct validity were demonstrated for prehospital case finding by EMS providers for cognitive impairment and depression using these instruments. Slight to fair concurrent criterion validity was found, a result that methodological limitations could explain. These findings provide additional support for the concept of using EMS providers to detect older adults at risk for these conditions. Further work is needed to confirm the validity and effectiveness of prehospital screening before such programs are implemented.     

Reliability of the hierarchical assessment of balance and mobility in frail older adults

OBJECTIVES: To study the test–retest and interrater reliability of the Hierarchical Assessment of Balance and Mobility (HABAM) in frail older adults.
DESIGN: Convenience sample of 167 frail older adults seen as part of routine care by an academic geriatrician at a tertiary care teaching hospital.
SETTING: Inpatient medical and geriatric wards, geriatric ambulatory care clinic, emergency department, home visits.
PARTICIPANTS: The interrater reliability sample consisted of 98 inpatients and 69 outpatients. The test–retest reliability sample tracked 63 of the inpatients over the first 2 days of their hospital stay.
MEASUREMENTS: Mobility and balance were assessed using the HABAM. Frailty was assessed using a frailty index based on a standardized Comprehensive Geriatric Assessment. Reliability was assessed using Pearson correlations and the intraclass correlation coefficients.
RESULTS: The interrater reliability of the HABAM was 0.92 and ranged from 0.88 to 0.96 across settings for the various components (balance, transfers, mobility). Test–retest reliability was 0.91 (range 0.85–0.92).
CONCLUSION: The HABAM appears to be a reliable means of assessing mobility and balance in frail older adults.     

Measuring stigma associated with tuberculosis and HIV/AIDS in southern Thailand: exploratory and confirmatory factor analyses of two new scales

Objective  To develop scales to measure tuberculosis and HIV/AIDS stigma in a developing world context.
Methods  Cross-sectional study of tuberculosis patients in southern Thailand, who were asked to rate their agreement with items measuring TB and HIV/AIDS stigma. Developing the scales involved exploratory and confirmatory factor analyses, internal consistency, construct validity, test–retest reliability and standardized summary scores.
Results  Factor analyses identified two sub-scales associated with both tuberculosis and HIV/AIDS stigma: community and patient perspectives. Goodness-of-fit was good (TLI = 94, LFI = 0.88 and RMSEA = 0.11), internal consistency was excellent (Cronbach's alphas 0.82–0.91), test–retest reliability was moderate, and construct validity showed an inverse correlation with social support.
Conclusion  Our scales have good psychometric properties that measure stigma associated with tuberculosis and HIV/AIDS and allow assessment of stigma from community and patient perspectives. Their use will help document the burden of stigma, guide the development of interventions and evaluate stigma reduction programmes in areas with a high HIV/AIDS and tuberculosis burden.     

Development of elderly diabetes burden scale for elderly patients with diabetes mellitus

Background:   The purpose of the present paper was to validate an elderly diabetes burden scale (EDBS) and to assess its correlates in elderly patients with diabetes mellitus.
Methods:   Comprehensive questionnaires about both diabetes-specific and non-specific quality of life (QOL) were given by an interviewer to 455 elderly diabetic patients aged > 65 years. To assess diabetes-specific QOL, the EDBS was developed. The internal consistency and test–retest reliability of the EDBS were assessed. The validity of the EDBS was assessed with the correlation with the Philadelphia Geriatric Center morale scale, the mini-mental state examination (MMSE) and diabetic complications, treatment of diabetes, hemoglobin (Hb) A1c, frequency of hypoglycemia, and socioeconomic factors.
Results:   Factor analysis of the 23 items on EDBS produced six reliable components (Cronbach's α): symptom burden (0.55), dietary restrictions (0.89), social burden (0.89), worry about diabetes (0.85), treatment dissatisfaction (0.85), and burden by tablets or insulin (0.77). It was found that the EDBS and its six subscales had good test–retest reliability ( r  = 0.94–0.99). However, the EDBS correlated significantly with the morale scale but not with MMSE, suggesting convergent and discriminant validity. The high scores of some subscales and total EDBS were significantly associated with high HbA1c level, frequency of hypoglycemia, and insulin therapy, showing construct validity. Multivariate analyses revealed that hyperglycemia, frequency of hypoglycemia, insulin treatment, the presence of microangiopathy, and low positive social support were independently associated with increased elderly diabetes burden scores.
Conclusion:   The EDBS is a simple but reliable and valid measure of diabetic-specific QOL in elderly people with diabetes mellitus.     

The epidemiology of urinary incontinence in older women: incidence, progression, and remission

OBJECTIVES: To examine the epidemiology of urinary incontinence (UI) in older women.
DESIGN: Prospective study.
SETTING: Nurses' Health Study.
PARTICIPANTS: Incidence of UI was determined in 23,792 women aged 54 to 79 without UI at baseline. Progression or remission of UI was determined in 28,813 women with UI at least monthly at baseline.
MEASUREMENTS: UI was ascertained according to questionnaires in 2000 and 2002. Rates of incident UI and progression or remission of prevalent UI were calculated. Logistic regression was used to estimate relative risks of UI associated with risk factors.
RESULTS: In women with no urine leakage at baseline, 9.2% reported leakage at least monthly after 2 years. For women with leakage at least weekly, the incidence was 3.6%; of these cases, stress UI had the highest incidence, followed by mixed and urge UI. Relationships between UI and age differed for stress UI, which decreased with age (relative risk (RR)=0.63, 95% confidence interval (CI)=0.43–0.92 for aged 70–79 vs 54–59), and urge and mixed UI, which increased with age (RR=2.28, 95% CI=1.09–4.75 and RR=2.11, 95% CI=1.24–3.61, respectively). For prevalent UI in 2000, 32.1% of subjects with leakage once a month progressed to leakage at least once a week over follow-up. Only 8.9% with frequent leakage in 2000 reported improvement to monthly leakage or less, with 2.0% having complete remission.
CONCLUSION: The incidence of UI is high in older women, and progression from occasional to frequent leaking is common. Urge UI, for which there are limited effective treatments, increases with age, thus research on UI prevention in older women is particularly important.     

Renal Function in Older Hospital Patients Is More Accurately Estimated Using the Cockcroft-Gault Formula Than the Modification Diet in Renal Disease Formula

OBJECTIVES: To compare the accuracy of the two most popular creatinine clearance (CrCl) estimation formulae (Cockcroft-Gault (CG) and Modification Diet in Renal Disease (MDRD)) in older hospitalized patients.
DESIGN: Prospective, cross-sectional, observational study.
SETTING: Two hospital geriatric wards.
PARTICIPANTS: Consecutive patients aged 70 and older with an indwelling urinary catheter for the purpose of care.
MEASUREMENTS: CrCl was determined according to three methods: measured CrCl from plasma and urine creatinine and 24-hour urine volume, CG (CG-CrCl), and MDRD (MDRD-CrCl). Results were expressed as median and interquartile range (IQR). Moderate and severe renal impairment were defined as a CrCl between 30.0 and 59.9 mL/min and less than 30.0 mL/min, respectively.
RESULTS: One hundred twenty-one patients were included (46% male). Mean age was 86.1±6.7 (range 72–100). Median measured CrCl was 43.8 mL/min (IQR 33.6–61.1 mL/min), CG-CrCl was 40.9 mL/min (IQR 31.0–52.6 mL/min), and MDRD-CrCl was 61.3 mL/min (IQR 49.4–77.0 mL/min). The biases of CG-CrCl and MDRD were −3.5±22.5 and 20.1±28.2, respectively ( P <.001). Misclassification of renal impairment (absent/moderate/severe) occurred in 33% of patients according to CG-CrCl, and concordance was mild to moderate (kappa=0.50). Misclassification occurred in 50% of patients according to MDRD-CrCl, and concordance was poor (kappa=0.33). Bias was significantly related to bed confinement for both formulae and to plasma creatinine for MDRD.
CONCLUSION: In elderly hospitalized patients, CG slightly underestimates CrCl, and MDRD strongly overestimates it. CG gave a better prediction of measured CrCl than MDRD.     

Fecal incontinence quality of life scale

PURPOSE: This goal of this research was to develop and evaluate the psychometrics of a health-related quality of life scale developed to address issues related specifically to fecal incontinence, the Fecal Incontinence Quality of Life Scale. METHODS: The Fecal Incontinence Quality of Life Scale is composed of a total of 29 items; these items form four scales: Lifestyle (10 items), Coping/Behavior (9 items), Depression/Self-Perception (7 items), and Embarrassment (3 items). RESULTS: Psychometric evaluation of these scales demonstrates that they are both reliable and valid. Each of the scales demonstrate stability over time (test/retest reliability) and have acceptable internal reliability (Cronbach alpha >0.70). Validity was assessed using discriminate and convergent techniques. Each of the four scales of the Fecal Incontinence Quality of Life Scale was capable of discriminating between patients with fecal incontinence and patients with other gastrointestinal problems. To evaluate convergent validity, the correlation of the scales in the Fecal Incontinence Quality of Life Scale with selected subscales in the SF-36 was analyzed. The scales in the Fecal Incontinence Quality of Life Scale demonstrated significant correlations with the subscales in the SF-36. CONCLUSIONS: The psychometric evaluation of the Fecal Incontinence Quality of Life Scale showed that this fecal incontinence-specific quality of life measure produces both reliable and valid measurement.     

Standardizing assessment of elderly people in acute care: the interRAI Acute Care instrument

OBJECTIVES: To examine the frequency distributions and interrater reliability of individual items of the interRAI Acute Care instrument.
DESIGN: Observational study of a representative sample of older inpatients; duplicate assessments conducted on a subsample by independent assessors to examine interrater reliability.
SETTING: Acute medical, acute geriatric and orthopedic units in 13 hospitals in nine countries.
PARTICIPANTS: Five hundred thirty-three patients aged 70 and older (mean age 82.4, range 70–102) with an anticipated stay of 48 hours or longer of whom 161 received duplicate assessments.
MEASUREMENTS: Sixty-two clinical items across 11 domains. Premorbid (3-day observation period before onset of the acute illness) and admission (the first 24 hours of hospital stay) assessments were conducted.
RESULTS: The frequency of deficits exceeded 30% for most items, ranging from 1% for physically abusive behavior to 86% for the need for support in activities of daily living after discharge. Common deficits were in cognitive skills for daily decision-making (38% premorbid, 54% at admission), personal hygiene (37%, 65%), and walking (39%, 71%). Interrater reliability was substantial in the premorbid period (average κ=0.61) and admission period (average κ=0.66). Of the 69 items tested, less than moderate agreement (κ<0.4) was recorded for six (9%), moderate agreement (κ=0.41–0.6) for 14 (20%), substantial agreement (κ=0.61–0.8) for 40 (58%), and almost perfect agreement (κ>0.8) for nine (13%).
CONCLUSION: Initial assessment of the psychometric properties of the interRAI Acute Care instrument provided evidence that item selection and interrater reliability are appropriate for clinical application. Further studies are required to examine the validity of embedded scales, diagnostic algorithms, and clinical protocols.     

Development and testing of an instrument to assess the Quality of Life of Children with Haemophilia in Europe (Haemo-QoL)

Summary.  In spite of an increased interest in the assessment of quality of life (QoL) in children, so far no instrument for children with haemophilia is available. Because of the low prevalence of the condition, such an instrument should also be cross-culturally applicable. In the study presented, a (QoL) assessment instrument for children with haemophilia (the Haemo-QoL questionnaire) was developed and tested in six countries (France, Germany, Italy, the Netherlands, Spain and the United Kingdom) for psychometric properties in 339 children with haemophilia and their parents. The Haemo-QoL is a self-reported questionnaire for children in the age ranges 4–7 (I: 21 items), 8–12 (II: 64 items), 13–16 years (III: 77 items) as well as for parent rating containing 9–11 subscales (depending on age-group versions). Psychometric testing involved the examination of reliability and validity. The three age-group versions of the Haemo-QoL had acceptable internal consistency and retest reliability values, as well as possessing sufficient discriminant and convergent validity. However, in young children when compared to older children, these indicators were less satisfactory. The Haemo-QoL full version is now available for children of three age groups and their parents and is ready for use in clinical research ( http://www.haemoqol.org ).     

Geriatric Pain Measure short form: development and initial evaluation

OBJECTIVES: To develop and evaluate a short form of the 24-item Geriatric Pain Measure (GPM) for use in community-dwelling older adults.
DESIGN: Derivation and validation of a 12-item version of the GPM in a European and an independent U.S. sample of community-dwelling older adults.
SETTING: Three community-dwelling sites in London, United Kingdom; Hamburg, Germany; Solothurn, Switzerland; and two ambulatory geriatrics clinics in Los Angeles, California.
PARTICIPANTS: European sample: 1,059 community-dwelling older persons from three sites (London, UK; Hamburg, Germany; Solothurn, Switzerland); validation sample: 50 persons from Los Angeles, California, ambulatory geriatric clinics.
MEASUREMENTS: Multidimensional questionnaire including self-reported demographic and clinical information.
RESULTS: Based on item-to–total scale correlations in the European sample, 11 of 24 GPM items were selected for inclusion in the short form. One additional item (pain-related sleep problems) was included based on clinical relevance. In the validation sample, the Cronbach alpha of GPM-12 was 0.92 (individual subscale range 0.77–0.92), and the Pearson correlation coefficient ( r ) between GPM-12 and the original GPM was 0.98. The correlation between the GPM-12 and the McGill Pain Questionnaire was 0.63 ( P <.001), similar to the correlation between the original GPM and the McGill Pain Questionnaire (Pearson r =0.63; P <.001). Exploratory factor analysis indicated that the GPM-12 covers three subfactors (pain intensity, pain with ambulation, disengagement because of pain).
CONCLUSION: The GPM-12 demonstrated good validity and reliability in these European and U.S. populations of older adults. Despite its brevity, the GPM-12 captures the multidimensional nature of pain in three subscales. The self-administered GPM-12 may be useful in the clinical assessment process and management of pain and in pain-related research in older persons.     

Measuring disability in older adults: The International Classification System of Functioning, Disability and Health (ICF) framework

Background:   Despite the importance of disability to geriatric medicine, no large scale study has validated the activity and participation domains of the International Classification System of Functioning, Disability, and Health (ICF) in older adults. The current project was designed to conduct such as analysis, and then to examine the psychometric properties of a measure that is based on this conceptual structure.
Methods:   This was an archival analysis of older adults ( n  = 1388) who had participated in studies within our Claude D Pepper Older Americans Independence Center. Assessments included demographics and chronic disease status, a 23-item Pepper Assessment Tool for Disability (PAT-D) and 6-min walk performance.
Results:   Analysis of the PAT-D produced a three-factor structure that was consistent across several datasets: activities of daily living disability, mobility disability and instrumental activities of daily living disability. The first two factors are activities in the ICF framework, whereas the final factor falls into the participation domain. All factors had acceptable internal consistency reliability (>0.70) and test–retest (>0.70) reliability coefficients. Fast walkers self-reported better function on the PAT-D scales than slow walkers: effect sizes ranged from moderate to large (0.41–0.95); individuals with cardiovascular disease had poorer scores on all scales than those free of cardiovascular disease. In an 18-month randomized clinical trial, individuals who received a lifestyle intervention for weight loss had greater improvements in their mobility disability scores than those in a control condition.
Conclusion:   The ICF is a useful model for conceptualizing disability in aging research, and the PAT-D has acceptable psychometric properties as a measure for use in clinical research.     

Effect of biofeedback on psychological burden and symptoms in older women with urge urinary incontinence

OBJECTIVES: To determine the effect of biofeedback (BFB) therapy on psychological burden of urge urinary incontinence (UI) and whether prior depression or current depressive symptoms affect older women's response to BFB.
DESIGN: Secondary analysis of an ongoing trial.
SETTING: Academic medical center.
PARTICIPANTS: Forty-two community-dwelling women aged 60 and older with urge UI.
INTERVENTION: BFB and behavioral training in urge suppression provided over 8 weeks.
MEASUREMENTS: UI frequency on 3-day bladder diary, psychological burden assessed using Urge Impact Scale (URIS-24) total and subscale scores, history of depression, and depressive symptoms on the Mental Component Subscale (MCS) of the Medical Outcomes Study 36-item Short Form Survey (SF-36). Age and chronic conditions were included as covariates.
RESULTS: BFB improved UI (by 45%, P =.001) and psychological burden ( P =.001 for total URIS-24 score and for all three of its subscales; P =.01 for SF36-MCS). However, although the magnitude of UI improvement was equivalent for those with and without a history of depression, improvement in psychological outcomes was twice as great in those with a history of depression, especially on the perception of control subscale, and improvement was not related to baseline depressive symptoms.
CONCLUSION: In older women with urge UI, BFB significantly improves psychological burden, especially in those with a history of depression, in whom psychological burden is linked to change in perception of control. Psychological factors are relevant outcome measures for UI, and these data suggest that focusing on UI frequency alone may have underestimated BFB's efficacy and additional therapeutic benefits.     

Association of impaired respiratory function with urinary incontinence

Background and objective:   This study investigated the relationship between urinary incontinence and respiratory function in middle-aged and older Japanese men.
Methods:   Seven hundred community-dwelling men aged 40 years or above were recruited from community centres and hospital outpatient clinics. The International Consultation on Incontinence Questionnaire-Short Form was administered to ascertain their urinary incontinence status. Standardized spirometric measurements of respiratory function were performed.
Results:   The prevalence of urinary incontinence was 7.6% among the 668 eligible participants (mean age 62.7 years). The 51 men who leaked urine had significantly lower FEV₁ and FVC than those who were continent ( P  < 0.01). The adjusted risks of urinary incontinence were 0.67 (95% CI: 0.43–1.04) and 0.63 (95% CI: 0.40–0.98) for the two continuous respiratory function variables (L), respectively.
Conclusion:   The findings indicate an inverse association between urinary incontinence and respiratory function and an additional health burden in lung diseases.     

Montreal Cognitive Assessment Arabic version: Reliability and validity prevalence of mild cognitive impairment among elderly attending geriatric clubs in Cairo

Aim:   Mild cognitive impairment (MCI) is a clinical label which includes elderly subjects with memory impairment and with no significant daily functional disability. MCI is an important target for Alzheimer's dementia prevention studies. Data on the prevalence and incidence of MCI varies greatly according to cultural difference. The first aim of this study was to assess the reliability and validity of Montreal Cognitive Assessment (MoCA) Arabic version in MCI detection. The second was to determine the prevalence of MCI among apparently healthy elderly people attending geriatric clubs in Cairo.
Methods:   In stage I reliability & validity of MoCA Arabic version were assessed in reference to Cambridge Cognitive Examination (CAMCOG). In stage II prevalence of MCI was estimated using Arabic MoCA among apparently healthy elderly attending geriatric clubs. These geriatric clubs were randomly selected from different regions in Cairo governorate.
Results:   Test–retest reliability data of the Arabic MoCA were collected approximately 35.0 ± 17.6 days apart. The mean change in Arabic MoCA scores from the first to second evaluation was 0.9 ± 2.5 points, and correlation between the two evaluations was high (correlation coefficient = 0.92, P  < 0.001). The internal consistency of the Arabic MoCA was good, yielding a Cronbach's α on the standardized items of 0.83. In diagnosing mild cognitive impairment, the Arabic MoCA showed 92.3% sensitivity and 85.7% specificity. The prevalence of MCI among elderly subjects attending geriatric clubs in Cairo is 34.2% and 44.3% of healthy men and women, respectively.
Conclusion:   Older age, female sex and less education are the independent risk factors for MCI among apparently healthy elderly subjects attending geriatric clubs in Cairo.     

Vitality Index as a useful tool to assess elderly with dementia

Background: The aim of the present paper was to establish a new objective scale to measure vitality related to activities of daily living in elderly patients with dementia.

Methods:

Methods: Cross-sectional and longitudinal observational studies were carried out on patients and residents in long-term care facilities. Reliability of the scale was examined by determining test–retest reliability, interrater reliability and internal consistency. Validity of the scale was evaluated with respect to criterion validity and predictive validity. Clinical usefulness of the scale was tested by measuring the time taken to perform scoring and evaluating the changes in the score before and after behavioral therapy for functional urinary incontinence.

Results:

Results: The test–retest correlation coefficient was 0.98. Mean kappa coefficient of Vitality Index was 0.63. Interrater coefficient of variation was 0.14. Cronbach α of the Index was 0.88. Vitality Index was negatively correlated with Geriatric Depression Scale (GDS) ( P < 0.01). A low score was an independent risk factor for survival. Behavioral therapy for functional urinary incontinence increased Activities of Daily Living (ADL) ( P < 0.05) and Vitality Index ( P < 0.05).

Conclusion:

Conclusion: Vitality Index could be a new tool to assess patients with dementia.     

Development and validation of the Attitudes Towards Smoking Scale (ATS-18)

Aim. To develop and test the validity of a scale measuring attitudes towards smoking in current and former cigarette smokers. Design and participants. In a first mail survey, we collected qualitative data from 616 smokers. In a second mail survey, we collected quantitative data from 529 smokers and ex-smokers. We conducted a 16-month follow-up survey among 93 participants in the second survey. Setting. Geneva, Switzerland, 1995–98. Findings. The study resulted in a three-dimensional, 18-item scale: the "Attitudes Towards Smoking Scale" (ATS-18). The scale was validated with reference to criteria of content-, construct and predictive validity. The three subscales measure perceptions of adverse effects of smoking (10 items), psychoactive benefits (four items) and pleasure of smoking (four items). Internal consistency coefficients (0.85, 0.88 and 0.81) and test–retest correlations were high (0.90, 0.75, 0.89, respectively). Differences in attitude scores between smokers in the pre-contemplation and preparation stages of change were - 0.83, 0.71 and 1.23 standard deviation units, respectively. A differential score (advantages minus disadvantages of smoking) predicted smoking cessation in baseline smokers and relapse in baseline ex-smokers. Conclusion. ATS-18 is a valid and reliable instrument which can be used in both research and clinical settings.     

Medical student attitudes toward older people and willingness to consider a career in geriatric medicine

OBJECTIVES: To evaluate the attitudes of first- and fourth-year medical students toward older people and the relationship between these attitudes and possible career choice. To examine the effects of an intensive geriatric medicine (GM) teaching program on these attitudes and career aspirations.
DESIGN: Observational study.
SETTING: University of Aberdeen.
PARTICIPANTS: Medical students.
MEASUREMENTS: In September 2005, first-year students (n=163) at the start of their undergraduate training completed a questionnaire based on the University of California at Los Angeles Geriatrics Attitudes Scale. Students were asked how likely they were to consider a career in GM in the future on a 5-point Likert scale. From the beginning of the academic year 2005/06, fourth-year students completed the same questionnaire before and after an intensive 8-day GM teaching program.
RESULTS: First-year medical students had a mean attitude score±standard deviation of 3.69±0.39. A more-positive attitude increased the likelihood of considering a career in GM ( P <.001). Fourth-year students had better attitude scores than first-year students (3.86±0.36, P =.002). The GM teaching program did not significantly affect attitude scores but significantly increased the willingness to consider a career in GM by a mean 0.52 points (95% confidence interval=0.35–0.70, P <.001).
CONCLUSION: Attitudes toward older people were better in fourth-year than first-year medical students. A more-positive attitude toward older people increased the likelihood of considering a career in GM. An intensive 8-day course in GM had no significant effect on attitudes but increased the likelihood of fourth-year students considering a career in GM.     

Estimated functional capacity predicts mortality in older adults

OBJECTIVES: To examine associations between functional capacity estimated from cardiorespiratory fitness (CRF) and mortality risks in adults aged 60 and older.
DESIGN: Prospective study, averaging 13.6 years follow-up.
SETTING: Preventive medical clinic.
PARTICIPANTS: Four thousand sixty adults who completed preventive medical examinations between 1971 and 2001; 24.7% women, mean age±standard deviation 64.6±4.9, body mass index (BMI) 25.9±3.8 kg/m².
MEASUREMENTS: CRF was quantified as metabolic equivalents (METs) achieved during maximal treadmill exercise. The lowest 20% of the age- and sex-specific MET distribution was defined as having low CRF, the middle 40% moderate CRF, and the upper 40% high CRF. Cox regression was used to estimate death rates (per 1,000 person-years), hazard ratios (HRs), and their 95% confidence intervals (CIs).
RESULTS: Nine hundred eighty-nine deaths occurred during follow-up. Death rates adjusted for age, sex, and examination year were 30.9, 18.3, and 13.4 for all causes ( P <.001); 15.9, 8.6, and 5.4 for cardiovascular disease (CVD) ( P <.001); and 6.1, 4.9, and 4.2 for cancer ( P =.04) for subjects with low, moderate, and high CRF, respectively. After adjusting for smoking, abnormal electrocardiograms at rest or while exercising, percentage of age-predicted maximal heart rate achieved during exercise testing, baseline medical conditions, BMI, hypercholesterolemia, and family CVD and cancer history, subjects with high CRF had notably lower mortality risk than those with low CRF from all causes (HR=0.59, 95% CI=0.47–0.74) and from CVD (HR=0.57, 95% CI=0.41–0.80).
CONCLUSION: CRF is an important independent predictor of death in older adults. The results add to the existing evidence that promoting physical activity in older adults provides substantial health benefits, even in the oldest old.     

Development and testing of a measure of health-related quality of life for men with urinary incontinence

OBJECTIVES: To describe the development and psychometric testing of male versions of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). DESIGN: Instrument development. SETTING: Urology clinic at a large urban Veterans Affairs Medical Center. PARTICIPANTS: Convenience sample of English-speaking community-dwelling male urology clinic patients who acknowledged concerns about urine leakage. MEASUREMENTS: Content experts and male clinic patients evaluated items for clarity and fit. Revised instruments were administered to 153 participants. Data were analyzed to examine issues of feasibility of administration, internal consistency reliability, and validity. RESULTS: Modal completion time for the Male Urogenital Distress Inventory (MUDI) (27 items) and Male Urinary Symptom Impact Questionnaire (MUSIQ) (32 items) was 20 minutes. Cronbach's coefficients were.89 for the MUDI and.95 for the MUSIQ. Total MUDI and MUSIQ scores were moderately correlated (r =.59, P <.001). Mean MUDI and MUSIQ scores varied significantly with self-reported desire for socialization, urine leakage, and depression. Principal components analyses suggested the presence of seven factors accounting for 65.4% of the variance in the MUDI and six factors accounting for 72.9% of the variance in the MUSIQ. CONCLUSIONS: It is feasible to use the MUDI and MUSIQ to measure health-related quality of life in men with continence problems. The scores appeared to be reliable and valid in this racially and educationally diverse sample. Use of the MUDI and MUSIQ may provide more sensitive measurement of the specific effect of urinary incontinence and related symptoms on health-related quality of life in men. Future research should determine reproducibility and responsivity and reexamine the construct validity of these instruments.