Prevalence of Alzheimer's disease in a community population of older persons. Higher than previously reported

Clinically diagnosed Alzheimer's disease and other dementing illnesses were assessed in a geographically defined US community. Of 3623 persons (80.8% of all community residents over 65 years of age) who had brief memory testing in their homes, a stratified sample of 467 persons underwent neurological, neuropsychological, and laboratory examination. Prevalence rates of Alzheimer's disease were calculated for the community population from the sample undergoing clinical evaluation. Of those over the age of 65 years, an estimated 10.3% (95% confidence limits, 8.1% and 12.5%) had probable Alzheimer's disease. This prevalence rate was strongly associated with age. Of those 65 to 74 years old, 3.0% (95% confidence limits, 0.8 and 5.2) had probable Alzheimer's disease, compared with 18.7% (95% confidence limits, 13.2 and 24.2) of those 75 to 84 years old and 47.2% (95% confidence limits, 37.0 and 63.2) of those over 85 years. Other dementing conditions were uncommon. Of community residents with moderate or severe cognitive impairment, 84.1% had clinically diagnosed Alzheimer's disease as the only probable diagnosis. These data suggest that clinically diagnosed Alzheimer's disease is a common condition and that its public health impact will continue to increase with increasing longevity of the population.     

Quality of the last year of life of older adults: 1986 vs 1993

CONTEXT: The population is aging and life expectancy is increasing, but whether morbidity and disability late in life also increase is unknown. OBJECTIVE: To examine whether the use of health care services, disability and cognitive function, and overall quality of life in the year before death among older adults has changed over time. DESIGN AND SETTING: The 1986 and 1993 National Mortality Followback Surveys, which were probability samples of all deaths in the United States with response rates of next of kin of 90% and 88% for those aged 65 years and older. PARTICIPANTS: Next of kin were asked to report the health status of a total of 9179 decedents who were 65 years and older in 1986 and 6735 in 1993, representing 1.5 and 1.6 million decedents aged 65 years and older. MAIN OUTCOME MEASURES: Days of hospital or nursing home stays, number and length of disability in 5 activities of daily living, duration of impairment in 3 measures of cognitive function, and an overall sickness score among individuals aged 65 through 84 years and those aged 85 years and older. RESULTS: Women used significantly fewer hospital and nursing home services in the last year of life in 1993 vs 1986 (mean reduction, 3.3 nights for both age groups for hospital services; mean reduction 18.4 nights for nursing home for women aged 65-84 years and 42.3 nights for women > or =85 years). Men had no changes except those aged 85 years and older had a decline in nursing home nights of 32.6. The proportion of women aged 85 years and older with restriction of at least 2 activities of daily living decreased from 62.5% in 1986 to 52.1% in 1993 (P<.01), and those with normal cognitive function increased from 50.3% to 56.2% (P<.05). Their mean overall sickness score decreased and quality-of-life improved. Among women aged 65 through 84 years, the number with normal cognitive function increased and the mean sickness score decreased, but those with at least 2 activities of daily living impairments increased and the overall quality of life declined. A similar pattern of change was found in the oldest-old men except that cognitive function worsened. Most parameters for men aged 65 through 84 years did not change significantly. CONCLUSIONS: Men and women at least 85 years old in the US experienced a better overall quality of life in the last year of life in 1993 than those in 1986. Most measures for men and women aged 65 through 84 years improved or did not change.     

Down's syndrome in South Australia.

In a survey of Down's syndrome in South Australia, 921 persons, both living and deceased, were identified; 717 individuals with the disorder were living in South Australia. Cytogenetic confirmation of the diagnosis had been made in 774 cases. From 1955 to 1977, the over-all incidence of Down's syndrome at birth was found to be 1.175/1000 live births. The incidence of Down's syndrome was significantly lower over the last five years of this period than for the first 18 years; thus it appears that the incidence of Down's syndrome in South Australia is falling. Analysis of maternal age changes with time has not revealed any changes to the maternal age-specific rates for Down's syndrome, although the rate for mothers aged 25 years or younger appears to be falling. The proportion of Down's syndrome babies born to women aged 35 years or more has decreased from 65.7% for those born before 1950 to 30.4% for those born from 1975 to 1977; similarly, the median maternal age has fallen from 37.12 years to 28.25 years. Regression analyses of maternal age rates for Down's syndrome by single years have produced figures suitable for genetic counselling. A plea is made that Down's syndrome should become a notifiable condition.     

上海市区1997～1999年部分新生儿及体检人群血脂水平调查

目的 分析90年代末期在上海居民生活水平提高情况下的血脂值,并与70-80年代作的调查进行比较,了解不同年龄段居民平均血脂水平的变化。方法 采集1997年至1999年上海市工厂,机关,企、事业单位,学校等职工和学生健康体检血样以及新生儿脐带血共3647名,测定血脂项目包括总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）水平,从新生儿至70岁以上按10岁为一年龄组,男、女性分别进行统计学分析。结果 （1）血脂水平胡年龄增径而增高,TC和LDL-C50岁以后女性高于男性,TG50岁以后女性接近男性,HDL-C则各年龄组女性均高于男性;（2）90年代与70年代相比TC和TG水平明显升高,分别增了6.79%-17.69%和21.95%-45.53%,而HDL-C则明显下降了8.05%-29.19%;（3）40岁以上人群TC和TG水平超过正常上限者90年代（TC男11.57%、女16.02%,TG男4.40%,女5.40%)较70年代（TC男4.40%、女5.40%,TGL国5.20%、女5.70%)明显增多;（4）40岁以上组比40岁以下组TG/HDL-C≥4,同时TG≥1.70mmol/L的有明显升高（男20.74%比10.99%,女13.32%比2.06%)。结论 随着居民生活水平的提高,平均血脂水平有上升趋势,必须十分注意饮食结构的合理安排。     

SOCIAL EPIDEMIOLOGY OF AGING IN THE UNITED STATES

Unprecedented changes in the structure of the population have led to a "graying" of America. Increase in life expectancy and de- clining birth rate have resulted in a larger pro- portion of Americans who are elderly. At the beginning of this century, less than 10% 0f the population were aged 55 0r older-about 7.1 million people; in 1982, more than one-fifth of the population were over the age of 55-an estimated 48.9 million persons. In the year 2050, one in three persons is expected to be over the age of 55. During the past two decades, the 65-plus population grew twice as fast as the rest of the population, and those over 85 years of age comprised the fastest growing segment of the U.S. population. In 1960, those over the age of 85 comprised one-half of i% of the population; just 20 years later, this proportion was doubled and is expected to double again t0 1.9% in the year 2000. Given current projec- tions, the 85-plus age group will comprise more than 5% 0f the population in the year 2050. There are currently more than 2.2 million peo- ple in the U.S. over the age of 85 and this age group is expected to increase t0 16 million in 2050 (Figs l,2).     

海南岛55岁及以上人群轻度认知障碍的患病率调查

目的全面了解海南岛55岁及以上人群轻度认知障碍（MCI）的患病率。方法采用人口学、健康史、简易精神状态检查量表（MMSE）、日常生活自理能力量表（ADL）、临床痴呆评定量表（CDR）等问卷和量表进行筛查。结果海南岛55岁及55岁以上人群MCI的患病率为4.25%,男性患病率为3.88%,女性患病率为4.57%,男女之间差异无统计学意义（P﹥0.05）;各年龄组随着年龄的增加,患病率增高（P﹤0.001）;相同年龄组男女之间比较,55～64岁、65～74岁年龄组女性患病率较男性高（P﹤0.05,P﹤0.01）,75～84岁年龄组男性患病率较女性高（P﹤0.05）,而在≥85岁的年龄组男女之间患病率差异无统计学意义（P﹥0.05）。文化程度越低,患病率越高（P﹤0.001）。结论高龄、低教育水平是海南岛MCI高发人群,应注意防治MCI,减少阿尔茨海默病（AD）的发生。     

贵州省养老现状及对机构养老需求的调查研究

目的：了解贵州省养老现状及对机构养老需求。方法：采用自设问卷在全省九个地区选择43个县,对60岁以上老人进行问卷调查,数据用SPSS19.0软件进行统计分析。结果：受调查的2004名老人中,与家人同住者67%,独居25.5%,社区养老4.8%,机构养老2.6%。老年人中愿意入住养老院者37.27%,不愿意者40.22%。经多元逐步回归分析,影响老年人养老方式的主要因素有健康状况、子女数、对家人赡养满意度及有无医保。影响入住养老院意愿的主要因素有年龄、子女数、收入、职业、有无医保、对家人赡养满意度等。结论：贵州省老年人养老方式以家庭养老为主,社区养老及机构养老程度低,应加强社会养老体系建设。     

上海县家庭卫生服务调查研究

1981年中美合作在上海县率先开展了卫生服务研究,采用家庭健康询问调查方法研究人群健康状状及卫生服务利用状况。为了进行纵向和横向比较研究,1991年在上海县又进行了本次家庭卫生服务调查研究。 本次调查采用整群分层随机抽样方法,对上海县3个乡9个村1546户家庭共5505人进行了调查。调查内容主要有个人基本情况、健康状况、卫生服务利用情况、医疗费用、个人行为生活方式等。结果表明:两周患病率为48‰,三月慢性病患病率为116.1‰,与1981年及1985年调查结果相比较,两周患病率较低,而慢性病患病率则相似。两周患病主要疾病为呼吸、消化循环系统疾病。15岁以上男性吸烟率为73.5％,饮酒率为39.4％,较1981年调查有明显的上升,建议开展广泛而有效的健康教育,以降低人群的吸烟率。     

Prevalence of hypertension among individuals aged 50 years and over and its impact on health related quality of life in a semi-rural area of western Turkey

Background Hypertension is common, especially in individuals aged 40 years and over, and it affects about half of the population aged 60 years and over. This study aimed to determine the frequency and risk factors of hypertension among individuals aged 50 years and over, and to examine its effect on the health related quality of life （HRQOL）. Methods This population-based cross-sectional study was conducted in two settlements in a region of western Turkey between March 1 and April 30, 2007. A questionnaire concerning life habits associated with hypertension, medical histories, and demographic characteristics was filled in by a face to face interview. The SF-36 scale was used to assess HRQOL. Body mass index （BMI） was calculated by measuring the weight and length of the body. Results Of 1599 individuals living in the region, 1193 participated in the survey （48.3% men and 51.7% women）. The overall prevalence rate of hypertension was 59.5% （n=-710）, being 58.0% in men and 60.9% in women （P 〉0.05）. The variables that most positively influenced hypertension （P ≤0.05, for each one） were older age （especially the age group of those aged 60 and over）, single, no health insurance, consumption of animal fat in meals, and family history of hypertension. The HRQOL of the patients with hypertension was lower than that of those without hypertension （P ≤0.05）. The HRQOL was better in hypertensive patients whose blood pressure was under control, whereas it was worse in those with at least one chronic disorder accompanying hypertension （P≤0.05, for each one）. Conclusions Great emphasis should be placed on the need for a public health program for the detection, prevention, and control of hypertension, including other risk factors, as well as for the modification of foods and life habits, specifically in individuals who are most likely to be at risk of hypertension.     

Acute rheumatic fever and rheumatic heart disease in a rural central Australian aboriginal community

A retrospective study of clinical case records was conducted at the health centre of a rural central Australian Aboriginal community to determine the frequency of acute rheumatic fever and of rheumatic heart disease between 1978 and 1987. The case records of 976 residents over 5 years of age were examined for evidence of the clinical indicators of acute rheumatic fever or rheumatic heart disease; together they contributed 8015 person-years of study. During the 10-year study period, 18 patients developed acute rheumatic fever and 12 patients had rheumatic heart disease. The annual incidence of acute rheumatic fever (first and recurrent attacks) for children aged 5-14 years was 815 per 100,000 person-years. For the residents aged 5 years and over, the point prevalence for rheumatic heart disease at the end of 1987 was between 7.9 and 12.3 per 1000 persons, according to health clinic records and the official population census, respectively. These rates are similar to those reported for Third World countries. Preventive measures must include efforts by health professionals to help to alleviate the adverse living conditions in Aboriginal communities.     

Variations de l''incidence des fractures de l''extrémité supérieure du fémur chez les personnes agées de la région de Québec.

To estimate the incidence of fracture of the proximal end of the femur in people aged 50 years or older living in the Quebec area in 1971, 1976 and 1981 we determined the number of admissions for such fractures to the 15 acute care hospitals in the region. From 1971 to 1981 the number of fractures increased by 71%; the increases for those aged 75 to 84 years and 85 years or over were 98% and 118% respectively. The variation is only partly explained by changes in sex and age distribution of the population; the incidence rates also increased. Among men aged 75 to 84 years the incidence rate per 1000 person-years rose from 2.63 in 1971 to 5.22 in 1981, an increase of 98%; the corresponding figures for men aged 85 years or more were 9.76 and 16.91, an increase of 73%. Among women aged 75 to 84 years the rate rose from 7.28 to 8.81, an increase of 21%; the corresponding figures for women aged 85 years or more were 20.40 and 24.27, an increase of 21% and 19% respectively.     

Low prevalence of postural hypotension among community-dwelling elderly

Postural hypotension (PH) has a prevalence of about 20% in most large studies of elderly individuals; however, these studies do not exclude subjects with diseases and medications known to cause PH. We sought to determine the prevalence of PH in healthy, community-living, elderly individuals in contrast to those with known risk factors for the condition. We measured supine and one-minute standing blood pressures in 300 independently living elderly persons who visited a senior citizen health screening program. Subjects were divided into two groups: those with known risk factors (n = 175) and those without (n = 125). The prevalence of PH (systolic decrease, greater than or equal to 20 mm Hg) for for the entire population was 10.7%. In the group with risk factors, the prevalence was 13.7% (24/175), compared with 6.4% in the group without risk factors (8/125). Supine hypertension was associated with PH, but there was no relationship between the presence of PH and age, history of falls, symptoms on standing, or recent meal. These data suggest that PH is a relatively uncommon finding in healthy elderly, its prevalence is significantly related to risk factors, and its association with falls or symptoms may be less than previously reported.     

Influenza vaccination in Australia: a review of the economic evidence for policy recommendations

The National Health and Medical Research Council recommends that persons who are believed to be at a higher risk of the complications and of dying of influenza should receive annual vaccinations against the disease. The Council refers specifically to persons who are over the age of 65 years and to those with chronic medical conditions. Recommendations such as these place demands on scarce health resources and it is important to determine if such policies result in the efficient utilization of resources. Accordingly, this article reviews the evidence on the economic efficiency of different vaccination strategies. Two major conclusions emerge. First, even allowing for variability in vaccine effectiveness due to viral antigenic drift, influenza-vaccination programmes, in general, are more cost-effective than are many other interventions that are undertaken as a routine in Australia. Secondly, vaccinating healthy persons who are 45 years of age to 64 years of age is more cost-effective than is vaccinating persons in some of the high-risk groups. Thus, there is likely to be a case for reconsidering whether healthy persons who are younger than 65 years of age also should be included in the official recommendations.     

中山市脑卒中患者社会支持及其影响因素分析

目的 了解脑卒中患者的社会支持情况,探讨其影响因素,为进一步有效和有针对性地进行脑卒中患者的健康教育服务提供科学的指导和依据。 方法 采用整群抽样的方法,使用社会支持评定量表(SSRS)对中山市某三甲医院神经科2014年1—6月期间住院的脑卒中患者进行现场问卷调查,并使用EpiData 3.1建立数据库并对数据进行双份录入和整理,使用SPSS 16.0进行数据统计分析。 结果 共调查脑卒中患者309人,其中男性178人(57.61%),女性131人(42.39%),患者平均年龄为(66.36±11.57)岁;患者社会支持中的客观支持、主观支持、社会支持的利用度、社会支持总得分分别为(8.63±1.54)分、(27.71±2.99)分、(6.69±2.75)分、(43.21±5.04)分,与国内常模相比较,均偏低;5种生活状况状态中独居的客观支持度最低。4种健康自评状况中状况不好的客观支持度最低,70岁以上、未婚、独居、居住在县城和健康自评状况不好者主观支持度较低,居住在城区、收入水平在1 000～3 000元/月者社会支持利用度较低,未婚、独居、居住在城郊、健康状况自评不好及收入水平在1 000元/月以下者社会支持总分较低;社会支持影响因素的多因素分析结果显示居住状况、收入水平和健康自评状况是影响脑卒中患者社会支持的主要因素。 结论 应以社区卫生服务机构为主体,为患者营造良好的社会支持环境,并建立系统科学的脑卒中健康教育体系,提高患者的生活质量。      

Changes in financial burdens for health care: national estimates for the population younger than 65 years, 1996 to 2003

Context  Policymakers as well as physicians need to understand how rapidly rising health care costs are affecting specific groups of patients. Objective  To estimate the number and characteristics of individuals in the United States faced with very high financial burdens for health care. Design, Setting, and Population  Data from a nationally representative sample of civilian, noninstitutionalized US individuals younger than 65 years from the Medical Expenditure Panel Surveys were used to calculate 2 measures of financial burden as a function of tax-adjusted family income. Total burden included all out-of-pocket expenditures for health care services, including premiums. Health care services burden excluded premiums and, when applied to the insured population, was used to identify the underinsured. We defined the underinsured as insured persons with health care service burdens in excess of 10% of tax-adjusted family income. Main Outcome Measures  Total and health care services burdens exceeding 10% and 20% of family income in 1996 and 2003. Results  In 2003, there were 48.8 million individuals (19.2%) living in families spending more than 10% of family income on health care, an increase of 11.7 million persons since 1996. Of these individuals, about 18.7 million (7.3%) were spending more than 20% of family income. In 2003, individuals with higher-than-average risk of incurring high total burdens included poor and low-income persons and those with nongroup coverage, aged 55 to 64 years, living in a non–metropolitan statistical area, in fair or poor health, having any type of limitation, or having a chronic medical condition. Applying our definition of underinsured to the insured population, an estimated 17.1 million persons younger than 65 years were underinsured in 2003, including 9.3 million persons with private employment-related insurance, 1.3 million persons with private nongroup policies, and 6.6 million persons with public coverage. Conclusions  Our analysis identifies patients at greatest risk of health-related financial burdens that may adversely affect their access and adherence to recommended treatments. Our study also highlights the high costs associated with nongroup health insurance policies.      

Community health service utilisation and needs in an elderly population

This study was carried out to determine community health service utilisation and needs of an elderly population living in a geographically defined area of Dublin. A random sample of 208 persons was taken from the 11,852 elderly persons living in the area. Activities of daily living and cognitive function were assessed in the person’s own home. Whilst the community health services provided were less than comprehensive, they were targeted to those most in need; the very elderly, those living alone, and persons with a mental or physical disability. Objectively assessed need for further services far outweighed the demand for such services. Studies such as this are essential if the elderly are to receive their fair share of services in a demand based health service.     

Sperm and ova as property.

To whom do sperm and ova belong? Few tissues are produced by the human body with more waste than the germ cells. Yet dominion over the germ cells, and over the early embryo that results from their union in vitro, is behind much of the emotion that modern reproductive intervention can engender. The germ cells differ from other human tissues that can be donated or transplanted because they carry readily utilizable genetic information. Eventual expression of the germ cells'' genetic potential is the legitimate concern and responsibility of their donors, although in the right circumstances the responsibility can by agreement be entrusted to institutions administering gamete or embryo donor programmes; these institutions, in turn, may need to assume responsibility for decisions if, in the case of embryo storage, the wishes of the two donors conflict. The fact of sperm and ovum ownership (and the genetic potential that goes with it) before individuals part with these tissues is beyond dispute. Some contentious issues may be clarified if this area of human dominion, namely control over genetic expression among offspring, is acknowledged to be the legitimate persisting concern of those who have produced sperm and ova after storage commences.     

Estimated burden of diabetes mellitus in Manitoba according to health insurance claims: a pilot study.

OBJECTIVE: To estimate the burden of diabetes mellitus in Manitoba from 1980 to 1984. DESIGN: Review of the Manitoba Health Services Commission (MHSC) database. The validity of the MHSC data was established through two substudies: one involved self-reports from a survey of elderly Manitobans, and the other involved people with confirmed diabetes enrolled in the provincial diabetes education program. SUBJECTS: Sample of 100,000 people stratified by age, sex and MHSC health region: 50,000 were aged 25 to 64 years, and 50,000 were aged 65 or more. All MHSC claims containing the ICD-9-CM code for diabetes mellitus or gestational diabetes were identified. MAIN RESULTS: Of the sample 7627 people were found to have a diagnosis of diabetes, the annual prevalence being 0.8% among those 25 to 44 years of age, 3.5% among those 45 to 64 and 7.6% among those 65 or older. The annual incidence rate among those over 25 years of age was 7.8 per 1000. Of the 4556 pregnant women 25 to 44 years old 85 (1.9%) had diabetes; 23 were believed to have gestational diabetes. CONCLUSIONS: The incidence and prevalence rates were similar to those determined on the basis of self-reports in Canadian and US national surveys. The use of an administrative database such as that of the MHSC will provide key information for planning health services for diabetic patients and will permit the monitoring of long-term trends in the incidence and prevalence of the disease.     

老年期痴呆和老年抑郁症的流行病学调查

目的 了解老年期痴呆和老年抑郁症的发病率及其相关因素。方法 以1997年北京西城区老年性痴呆和老年抑郁症患病率调查时的非病例老人作为发病率调查的对象,于1999年进行随访。调查流程和工具及诊断标准均与患病率调查所采用的相同。结果 60岁以上老年期痴呆的年发病率为0．89％,发病率随年龄增长而增高;老年抑郁症的最小年发病率为1．28％,健康状况差组发病率高于健康状况一般组和健康状况较好组。中、重度痴呆发病率与1989年同一地区的调查结果相比较差异无显著意义。结论 老年性痴呆的发病率与10年前相比处于稳定水平。年龄与老年性痴呆的发病率密切相关,健康状况与老年抑郁症的发病率明显相关。老年性痴呆和老年抑郁症可共患。     

Vaccination in the control of influenza

Although killed influenza vaccine given by injection is protective, able to reduce sickness absence in industry and to control influenza in the armed forces, it has not so far been possible to demonstrate more than a small effect on the disease in otherwise healthy adults in industry and offices in the United Kingdom. The reasons are probably the poor rate of acceptance of vaccine, the relatively low incidence of clinical influenza in most years, and the incomplete protection given by the vaccine. Until major epidemics can be accurately forecast it is suggested that influenza vaccination may most usefully be used on a selective basis, namely for protecting those with illness predisposing to a severe effect from influenza; persons in institutions such as schools and homes for the elderly; key workers in the general population; and persons over the age of 65 years among whom considerable mortality occurs in winters when influenza is prevalent.