Heart Disease Risk Factors in Midlife Predict Subclinical Coronary Atherosclerosis More than 25 Years Later in Survivors without Clinical Heart Disease: The Rancho Bernardo Study

OBJECTIVES: To determine which of the classic modifiable coronary heart disease (CHD) risk factors, measured in midlife, are associated with subclinical coronary atherosclerosis in older age.
DESIGN: Prospective study.
SETTING: Community based.
PARTICIPANTS: Participants were 400 community-dwelling middle-aged adults who had no history of CHD at baseline (1972–1974), when CHD risk factors were measured, and who were still free of known CHD in 2000 to 2002.
MEASUREMENTS: Coronary artery plaque burden was assessed according to coronary artery calcium (CAC) score using computed tomography in 2000 to 2002.
RESULTS: Ordinal logistic regression analysis was used to compare baseline risk factors with severity of CAC. Mean age was 42 at baseline and 69 at the time of CAC assessment; 46.5% were male. In analyses adjusted for age, sex, and all other risk factors, one standard deviation increase in body mass index (odds ratio (OR)=1.24, 95% confidence interval (CI)=1.02–1.51; P =.03), cholesterol (OR=1.28, 95% CI=1.03–1.58; P =.020, pulse pressure (OR=1.24, 95% CI=1.03–1.50; P =.03), and log triglycerides (OR=1.22, 95% CI=0.99–1.50; P =.06) each independently predicted the presence and severity of coronary artery atherosclerosis.
CONCLUSION: Modifiable risk factors measured more than 25 years earlier influence plaque burden in elderly survivors without clinical heart disease.     

Loop Diuretic Use and Rates of Hip Bone Loss and Risk of Falls and Fractures in Older Women

OBJECTIVES: To determine whether loop diuretic use is associated with hip bone loss and greater risk of falls and fractures in older women.
DESIGN: Prospective cohort study from August 1992 to April 2004.
SETTING: Four regions in the United States from the Study of Osteoporotic Fractures (SOF).
PARTICIPANTS: Women aged 65 and older (N=8,127) with medication use data who participated in the fourth SOF examination, from which three study cohorts were derived.
MEASUREMENTS: Bone mineral density (BMD) of the total hip assessed using dual-energy X-ray absorptiometry at the fourth and sixth examinations (n=2,980); recurrent (≥2) falls in the year after the fourth examination (n=6,244); and incident fracture, including nonspine (n=6,778) and hip fracture (n=7,272).
RESULTS: After multivariable adjustment, loop diuretic users had greater loss of total hip BMD than nonusers (mean annualized % BMD −0.87 vs −0.71, P =.03) after a mean of 4.4±0.6 years. The risks of recurrent falls (odds ratio=0.99, 95% confidence interval (CI)=0.71–1.39), nonspine (relative risk (RR)=1.04, 95% CI=0.90–1.21), and hip fracture (RR=1.03, 95% CI=0.81–1.31) were not greater in loop diuretic users than in nonusers.
CONCLUSION: In this cohort of older women, loop diuretic use was associated with a small but significantly higher rate of hip bone loss than nonuse after a mean duration of 4.4 years, although the risk of falls or fracture did not differ between the two groups.     

Single-point assessment of warfarin use and risk of osteoporosis in elderly men

OBJECTIVES: To determine whether warfarin use, assessed at a single point in time, is associated with bone mineral density (BMD), rates of bone loss, and fracture risk in older men.
DESIGN: Secondary analysis of data from a prospective cohort study.
SETTING: Six U.S. clinical centers.
PARTICIPANTS: Five thousand five hundred thirty-three community-dwelling, ambulatory men aged 65 and older with baseline warfarin use data.
MEASUREMENTS: Warfarin use was assessed as current use of warfarin at baseline using an electronic medication coding dictionary. BMD was measured at the hip and spine at baseline, and hip BMD was repeated at a follow-up visit 3.4 years later. Self-reported nonspine fractures were centrally adjudicated.
RESULTS: At baseline, the average age of the participants was 73.6 ± 5.9, and 321 (5.8%) were taking warfarin. Warfarin users had similar baseline BMD as nonusers (n=5,212) at the hip and spine (total hip 0.966 ± 0.008 vs 0.959 ± 0.002 g/cm², P =.37; total spine 1.079 ± 0.010 vs 1.074 ± 0.003 g/cm², P =.64). Of subjects with BMD at both visits, warfarin users (n=150) also had similar annualized bone loss at the total hip as nonusers (n=2,683) (−0.509 ± 0.082 vs −0.421 ± 0.019%/year, P =.29). During a mean follow-up of 5.1 years, the risk of nonspine fracture was similar in warfarin users and nonusers (adjusted hazard ratio=1.06, 95% confidence interval=0.68–1.65).
CONCLUSION: In this cohort of elderly men, current warfarin use was not associated with lower BMD, accelerated bone loss, or higher nonspine fracture risk.     

Lower levels of serum albumin and total cholesterol associated with decline in activities of daily living and excess mortality in a 12-year cohort study of elderly Japanese

OBJECTIVES: To examine the association between levels of serum albumin and total cholesterol (TC) and risk of subsequent mortality and future decline in activities of daily living (ADLs) in elderly people.
DESIGN: Population-based cohort study.
SETTING: National Integrated Project for Prospective Observation of Non-Communicable Disease and Its Trends in the Aged, 1980.
PARTICIPANTS: One thousand eight hundred forty-four Japanese individuals aged 60 to 74 randomly selected throughout Japan and followed for 12.4 years.
MEASUREMENTS: Decline in ADLs and mortality.
RESULTS: After adjusting for other covariates, the multivariable odds ratios (ORs) of impaired ADLs were highest in the lowest albumin quartile (≤40 g/L) for women. The multivariable OR of having a composite outcome of death or impaired ADL for the lowest albumin quartile compared with the highest was 1.56 (95% confidence interval (CI)=1.94–2.57) for men and 3.06 (95% CI=1.89–4.95) for women. Serum albumin was significantly and inversely associated with a composite outcome of death or impaired ADLs in the group below the median of TC in both sexes (multivariable OR for 1-g/L increase in serum albumin=0.88 for men (95% CI=0.79–0.97) and 0.79 for women (95% CI=0.72–0.87)), which was not significantly associated in the group with TC at or above the median.
CONCLUSION: In the Japanese general population, low-normal serum albumin and TC levels are associated with loss of activity during old age, especially for women.     

Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium

OBJECTIVES: To measure the prevalence of depressive symptoms, cognitive impairment, and delirium in patients with hip fracture and to estimate their effect on functional recovery, institutionalization, and death after surgical repair.
DESIGN: Prospective cohort.
SETTING: Hospital, follow-up to community and nursing home.
PARTICIPANTS: One hundred twenty-six patients aged 65 and older admitted for hip fracture repair.
MEASUREMENTS: Baseline measurements: Mini-Mental State Examination, Blessed Dementia Rating Scale, Geriatric Depression Scale, prefracture activities of daily living (ADLs), ambulatory status. The Confusion Assessment Method was used to diagnose in-hospital delirium. One- and 6-month outcomes were ADL decline, loss of ambulation, and new nursing home placement or death.
RESULTS: Twenty-two percent of patients had one cognitive or mood disorder, 30% had two, and 7% had three. At 1 month, each cognitive or mood disorder was independently associated with one or more adverse outcome. Considered together, each additional cognitive or mood disorder was associated with greater odds of 1 month outcomes (ADL decline: odds ratio (OR)=1.8, 95% confidence interval (CI)=1.1–2.9; decline in ambulation: OR=1.8, 95% CI=1.1–3.0; nursing home placement or death: OR=3.9, 95% CI=1.9–8.1).
CONCLUSION: Cognitive and mood disorders were common in elderly hip fracture patients and were associated with greater risk of poor outcomes, both independently and in combination. Recognition and treatment of these conditions may reduce adverse outcomes in this vulnerable population.     

Albumin, Apolipoprotein E-ɛ4 and Cognitive Decline in Community-Dwelling Chinese Older Adults

OBJECTIVES: To examine the association between serum albumin and cognitive impairment and decline in community-living older adults.
DESIGNS: Population-based cohort study, followed up to 2 years; serum albumin, apolipoprotein E (APOE)-ɛ4, and cognitive impairment measured at baseline and cognitive decline (≥2-point drop in Mini-Mental State Examination (MMSE) score). Odds ratios were controlled for age, sex, education, medical comorbidity, hypertension, diabetes mellitus, cardiac disease, stroke, smoking, alcohol drinking, depression, APOE-ɛ4, nutritional status, body mass index, anemia, glomerular filtration rate, and baseline MMSE.
SETTINGS: Local area whole population.
PARTICIPANTS: One thousand six hundred sixty-four Chinese older adults aged 55 and older.
RESULTS: The mean age of the cohort was 66.0±7.3, 65% were women, mean serum albumin was 42.3±3.1 g/L, and mean MMSE score was 27.2±3.2. Lower albumin tertile was associated with greater risk of cognitive impairment in cross-sectional analysis (low, odds ratio (OR)=2.30, 95% confidence interval (CI)=1.31–4.03); medium, OR=1.59, 95% CI=0.88–2.88) versus high ( P for trend=.002); and with cognitive decline in longitudinal analyses: low, OR=1.73, 95% CI=1.18–2.55; medium, OR=1.32, 95% CI=0.89–1.95, vs high ( P for trend=.004). In cognitively unimpaired respondents at baseline (MMSE≥24), similar associations with cognitive decline were observed ( P for trends <.002). APOE-ɛ4 appeared to modify the association, due mainly to low rates of cognitive decline in subjects with the APOE-ɛ4 allele and high albumin.
CONCLUSION: Low albumin was an independent risk marker for cognitive decline in community-living older adults.     

Fecal Incontinence in Elderly Koreans

OBJECTIVES: To estimate the prevalence and correlates of fecal incontinence (FI) and its effect on quality of life in ambulatory elderly people in Korea.
DESIGN: Cross-sectional, convenience sample–based survey.
SETTING: Twenty-seven senior citizen centers and two health clinics in two cities of Korea.
PARTICIPANTS: Nine hundred eighty-one relatively healthy and ambulatory community-dwelling people aged 60 and older.
MEASUREMENTS: Data were collected through in-person interviews with a structured questionnaire. Multivariate logistic regression analysis was used to determine independent risk factors for FI.
RESULTS: The prevalence of FI was 15.5%. FI was significantly associated with lower quality of life (Medical Outcomes Study 36-item Short-Form Survey) for physical and mental health. In men, FI was significantly associated with urinary incontinence (odds ratio (OR)=4.89, 95% confidence interval (CI)=2.45–9.77), hemorrhoids (OR=4.66, 95% CI=1.67–12.97), and poor self-perceived health status ( P for trend=.02). In women, FI was associated with urinary incontinence (OR=2.91, 95% CI=1.76–4.81), diabetes mellitus (OR=2.04, 95% CI=1.24–3.37), hemorrhoids (OR=2.99, 95% CI=1.31–6.83), and infrequent dietary fiber intake ( P for trend=.02).
CONCLUSION: FI is prevalent in elderly Koreans and has a profound effect on quality of life. Physicians should closely screen for FI in elderly patients with certain risk factors and evaluate to control these potentially preventable or modifiable factors.     

Depressive Symptoms and Incident Cognitive Impairment in Cognitively Well-Functioning Older Men and Women

OBJECTIVES: To investigate whether the effect of depressive symptoms on the risk of cognitive decline and incident cognitive impairment (CI) in cognitively well-functioning older persons differed between men and women and whether sex differences in cerebrovascular factors might explain this.
DESIGN: Prospective cohort study.
SETTING: General community.
PARTICIPANTS: One thousand four hundred eighty-seven well-functioning Chinese older adults (Mini-Mental State Examination (MMSE) score ≥24) assessed at baseline for the presence of depressive symptoms (Geriatric Depression Scale score ≥5), and covariates (age, apolipoprotein E ɛ4, education, smoking, alcohol drinking, and vascular risk factors and diseases).
MAIN OUTCOME MEASURES: Incident CI and change in MMSE were assessed at 2-year follow-up.
RESULTS: In the whole sample, participants with depression showed significantly more incident CI than those without (5.7% vs 2.6%, P =.04; adjusted odds ratio (OR)=2.29, 95% confidence interval (CI)=1.05–5.00. Significantly higher OR was observed only in men (OR=4.75, 95% CI=1.22–18.5) and not for women (OR=1.29). There was a correspondingly greater rate of cognitive decline in participants with depressive symptoms that was observed to be marked only in men and not in women. The association was accentuated in subgroups with hypertension or vascular factors, but the sex differences in association were consistently observed.
CONCLUSION: The association between depressive symptoms and risk of cognitive decline was observed only in men and was not explained by sex differences in vascular factors. The comorbid presence of underlying cerebral vascular pathology or multi-infarct disease was possibly not a mediating factor but might amplify the process of cognitive decline.     

Effect of arthritis in middle age on older-age functioning

OBJECTIVES: To examine whether symptomatic arthritis in middle age predicts the earlier onset of functional difficulties (difficulty with activities of daily living (ADLs) and walking) that are associated with loss of independence in older persons.
DESIGN: Prospective longitudinal study.
SETTING: The Health and Retirement Study, a nationally representative sample of persons aged 50 to 62 at baseline who were followed for 10 years.
PARTICIPANTS: Seven thousand five hundred forty-three subjects with no difficulty in mobility or ADL function at baseline.
MEASUREMENTS: Arthritis was measured at baseline according to self-report. The primary outcome was time to persistent difficulty in one of five ADLs or mobility (walking several blocks or up a flight of stairs). Difficulty with ADLs or mobility was assessed according to subject interview every 2 years. Analyses were adjusted for other comorbid conditions, body mass index, exercise, and demographic characteristics.
RESULTS: Twenty-nine percent of subjects reported arthritis at baseline. Subjects with arthritis were more likely to develop persistent difficulty in mobility or ADL function over 10 years of follow-up (34% vs 18%, adjusted hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.43–1.86). When each component of the primary outcome was assessed separately, arthritis was also associated with persistent difficulty in mobility (30% vs 16%, adjusted HR=1.55, 95% CI=1.41–1.71) and persistent difficulty in ADL function (13% vs 5%, adjusted HR=1.85, 95% CI=1.58–2.16).
CONCLUSION: Middle-aged persons who report a history of arthritis are more likely to develop mobility and ADL difficulties as they enter old age. This finding highlights the need to develop interventions and treatments that take a life-course approach to preventing the disabling effect of arthritis.     

A Comparison of Frailty Indexes for the Prediction of Falls, Disability, Fractures, and Mortality in Older Men

OBJECTIVES: To compare the validity of a parsimonious frailty index (components: weight loss, inability to rise from a chair, and poor energy (Study of Osteoporotic Fractures (SOF) index)) with that of the more complex Cardiovascular Health Study (CHS) index (components: unintentional weight loss, low grip strength, poor energy, slowness, and low physical activity) for prediction of adverse outcomes in older men.
DESIGN: Prospective cohort study.
SETTING: Six U.S. centers.
PARTICIPANTS: Three thousand one hundred thirty-two men aged 67 and older.
MEASUREMENTS: Frailty status categorized as robust, intermediate stage, or frail using the SOF index and criteria similar to those used in CHS index. Falls were reported three times for 1 year. Disability (≥1 new impairments in performing instrumental activities of daily living) ascertained at 1 year. Fractures and deaths ascertained during 3 years of follow-up. Analysis of area under the receiver operating characteristic curve (AUC) statistics compared for models containing the SOF index versus those containing the CHS index.
RESULTS: Greater evidence of frailty as defined by either index was associated with greater risk of adverse outcomes. Frail men had a higher age-adjusted risk of recurrent falls (odds ratio (OR)=3.0–3.6), disability (OR=5.3–7.5), nonspine fracture (hazard ratio (HR)=2.2–2.3), and death (HR=2.5–3.5) ( P <.001 for all models). AUC comparisons revealed no differences between models with the SOF index and models with the CHS index in discriminating falls (AUC=0.63, P =.97), disability (AUC=0.68, P =.86), nonspine fracture (AUC=0.63, P =.90), or death (AUC=0.71 for model with SOF index and 0.72 for model with CHS index, P =.19).
CONCLUSION: The simple SOF index predicts risk of falls, disability, fracture, and mortality in men as well as the more-complex CHS index.     

Chronic Pain and Obesity in Elderly People: Results from the Einstein Aging Study

OBJECTIVES: To determine the prevalence of chronic pain in elderly people and its relationship with obesity and associated comorbidities and risk factors.
DESIGN: Cross-sectional.
SETTING: Community.
PARTICIPANTS: A representative community sample of 840 subjects aged 70 and older.
MEASUREMENTS: The prevalence of chronic pain and its relationship with obesity (categories defined according to body mass index (BMI)), other medical risk factors, and psychiatric comorbidities were examined. Chronic pain was defined as pain of at least moderate severity (≥4 on a 10-point scale) some, most, or all of the time for the previous 3 months.
RESULTS: The sample was mostly female (62.8%), and the average age was 80 (range 70–101). The prevalence of chronic pain was 52% (39.7% in men; 58.9% in women). Subjects with chronic pain were more likely to report a diagnosis of depression (odds ratio (OR)=2.5, 95% confidence interval (CI)=1.40–4.55) and anxiety (OR=2.3, 95% CI=1.22–4.64). Obese subjects (BMI 30–34.9) were twice as likely (OR=2.1, 95%CI=1.33–3.28) and severely obese subjects (BMI≥35) were more than four times as likely (OR=4.5, 95% CI=1.85–12.63) as those of normal weight (BMI 18.5–24.9) to have chronic pain. Obese subjects were significantly more likely to have chronic pain in the head, neck or shoulder, back, legs or feet, and abdomen or pelvis than subjects who were not obese. In multivariate models, obesity (OR=2.0, 95% CI=1.27–3.26) and severe obesity (OR=4.1, 95% CI=1.57–10.82) were associated with chronic pain after adjusting for age, sex, diabetes mellitus, hypertension, depression, anxiety, and education.
CONCLUSION: Chronic pain is common in this elderly population, affects women more than men, and is highly associated with obesity.     

Recurrent Falls and Dual Task–Related Decrease in Walking Speed: Is There a Relationship?

OBJECTIVES: To determine whether dual task–related changes in walking speed were associated with recurrent falls in frail older adults.
DESIGN: Twelve-month prospective cohort study.
SETTING: Thirteen senior housing facilities.
PARTICIPANTS: Two hundred thirteen subjects (mean age 84.4±5.5).
MEASUREMENTS: Usual and dual-tasking walking speeds (m/s) were calculated on a 10-m straight walkway at baseline. Information on incident falls during the follow-up year was collected monthly, and participants were divided into three groups based on the occurrence of falls (0, 1, and ≥2). Recurrent falls were defined as two or more falls during the 12-month follow-up period.
RESULTS: Twenty subjects (9.4%) were classified as recurrent fallers. The occurrence of recurrent falls was associated with age (crude odds ratio (OR)=1.11, P =.02), number of drugs (crude OR=1.28, P =.002), and walking speed under both walking conditions (crude OR=0.96, P =.002 for usual walking and crude OR=0.60, P =.005 for walking while counting backward). Multiple Poisson regression showed that only walking speed while dual tasking and number of drugs were associated with incident falls (incident rate ratio (IRR)=0.84, P =.045 and IRR=1.10, P =.004).
CONCLUSION: Slower walking speed while counting backward was associated with recurrent falls, suggesting that changes in gait performance while dual tasking might be an inexpensive way of identifying frail older adults prone to falling.     

Risk factors for deep vein thrombosis in older patients: a multicenter study with systematic compression ultrasonography in postacute care facilities in France

OBJECTIVES: To identify risk factors for deep vein thrombosis (DVT) in older patients with restricted mobility or functional disability.
DESIGN: Cross-sectional.
SETTING: Forty-two postacute care departments in France.
PARTICIPANTS: Eight hundred twelve patients aged 65 and older.
MEASUREMENTS: Twenty-two predefined characteristics were investigated, including medical and surgical risk factors, dependence in six basic activities of daily living (ADLs) rated using the Katz index, mobility, the reported value of the Timed Up and Go Test, and pressure ulcers. All patients underwent lower limb ultrasonography on the day of the cross-sectional study.
RESULTS: DVT was found in 113 patients (14%, 33 proximal DVTs (4%) and 80 isolated distal DVTs (10%)). A positive trend was found in the odds of DVT for higher values on the Timed Up and Go Test for patients who were not bedridden or confined to a chair ( P =.007). In two-level multivariable analysis adjusting for prophylaxis against venous thromboembolism, independent risk factors for DVT were aged 80 and older (adjusted odds ratio (aOR)=1.71, 95% confidence interval (CI)=1.05–2.79), previous history of venous thromboembolism (aOR=2.03, 95% CI=1.06–3.87), regional or metastatic-stage cancer (aOR=2.71, 95% CI=1.27–5.78), dependence in more than three ADLs (aOR=2.18, 95% CI=1.38–3.45), and pressure ulcers (aOR=1.85, 95% CI=1.05–3.24).
CONCLUSION: Severe dependence in basic ADLs and higher Timed Up and Go Test score are associated with greater odds of DVT in older patients in postacute care facilities in France.     

Elderly Patients' Knowledge of Drug Benefit Caps and Communication with Providers About Exceeding Caps

OBJECTIVES: Many elderly persons have drug benefits with coverage gaps, such as in Medicare Part D. Because beneficiaries who have such gaps must pay all drug costs, an accurate knowledge of gap thresholds and communication with providers about exceeding caps is important for elderly persons to manage out-of-pocket drug costs.
DESIGN: Cross-sectional survey.
SETTING: Health plan.
PARTICIPANTS: One thousand three hundred eight health plan members aged 65 and older. The study was a 2002 cross-sectional survey of elderly persons with capped drug benefits in a managed care plan in one state. Participants were sampled so that half reached coverage caps and half did not.
METHODS: Participants reported cap levels, communication with providers about exceeding caps, and decreased medication use due to cost.
RESULTS: Of the 1,308 participants (65.4% response rate), 68.6% did not know their correct cap level. Rates were similar in those who exceeded caps (66.2%), reported difficulty paying for medications (63.9%), or decreased medication use (66%). For participants who exceeded caps, 59.1% did not know beforehand that they were close to exceeding caps and 50.2% did not tell providers afterward. In multivariate analyses accounting for demographics and health, the oldest participants (≥85 vs 65–74) were at greater risk for not knowing cap levels (odds ratio (OR)=2.0, 95% confidence interval (CI)=1.2–3.4) and not telling providers about exceeding caps (OR=2.2, 95% CI=1.1–4.5).
CONCLUSIONS: Elderly patients often did not know correct cap levels and did not tell providers about exceeding caps. Providers, plans, and policymakers should actively assess and improve Medicare beneficiaries' knowledge of Part D coverage gaps.     

Personal Mastery and Lower Body Mobility in Community-Dwelling Older Persons: The Invecchiare in Chianti Study

OBJECTIVES: To test the hypothesis that, in older persons, sense of personal mastery, defined as the extent to which one regards one's life chance as being under one's own control, predicts change in lower extremity performance during a 6-year follow-up.
DESIGN: Prospective cohort study.
SETTING: Community based.
PARTICIPANTS: Six hundred twenty-six participants aged 65 and older.
MEASUREMENTS: Personal mastery was assessed at baseline using Pearlin's mastery scale. Lower extremity performance was measured at baseline and at 6-year follow-up using the Short Physical Performance Battery (SPPB) of lower extremity function.
RESULTS: Higher sense of mastery was associated with a significantly less-steep decline in lower extremity performance. Participants in the two lowest quartiles of personal mastery had, respectively, a 2.6 (95% confidence interval (CI)=1.4–5.1, P =.01) and 3.2 (95% CI=1.6–6.6, P =.002) higher risk of experiencing a substantial decline (≥3 points) in SPPB scores after 6 years as those in the highest quartile.
CONCLUSIONS: Older individuals with poor sense of personal mastery are at high risk of accelerated lower extremity physical function decline. Whether interventions aimed at improving personal mastery may prevent disability remains unknown.     

An Outpatient Multifactorial Falls Prevention Intervention Does Not Reduce Falls in High-Risk Elderly Danes

OBJECTIVES: To evaluate the effect of multifactorial fall prevention in community-dwelling people aged 65 and older in Denmark.
DESIGN: Randomized, controlled clinical trial.
SETTING: Geriatric outpatient clinic at Glostrup University Hospital.
PARTICIPANTS: Three hundred ninety-two elderly people, mean age 74, 73.7% women, who had visited the emergency department or had been hospitalized due to a fall.
INTERVENTION: Identification of general medical, cardiovascular, and physical risk factors for falls and individual intervention in the intervention group. Participants in the control group received usual care.
MEASUREMENTS: Falls were registered prospectively in falls diaries, with monthly telephone calls for collection of data. Outcomes were fall rates and proportion of participants with falls, frequent falls, and injurious falls in 12 months.
RESULTS: Groups were comparable at baseline. Follow-up exceeded 90.0%. A total of 422 falls were registered in the intervention group, 398 in the control group. Intention-to-treat analysis revealed no effect of the intervention on fall rates (relative risk=1.06, 95% confidence interval (CI)=0.75–1.51), proportion with falls (odds ratio (OR)=1.20, 95% CI 0.81–1.79), frequent falls (OR=0.97, 95% CI=0.60–1.56), or injurious falls (OR=0.97, 95% CI=0.57–1.62).
CONCLUSION: A program of multifactorial fall prevention aimed at elderly Danish people experiencing at least one injurious fall was not effective in preventing further falls.     

Kidney transplantation in elderly people: the influence of recipient comorbidity and living kidney donors

OBJECTIVES: To examine the extent to which donor and recipient characteristics were associated with transplant outcomes in elderly kidney transplant recipients.
DESIGN: Retrospective review.
SETTING: Single university center.
PARTICIPANTS: One thousand one hundred two patients, including 266 patients aged 60 and older.
MEASUREMENTS: Recipient and donor characteristics and patient and graft outcomes.
RESULTS: Of the 1,102 patients included in this study, 266 (25%) were aged 60 and older, and 117 (11%) were aged 67 and older. According to Cox proportional hazards analysis, patient survival was worse in elderly recipients, although the survival outcome in the oldest group (ages 68–86) was comparable with that in their slightly younger peers (ages 61–67). Graft function did not differ according to age. Comorbidity was a significant predictor of patient survival in elderly recipients (hazard ratio (HR)=1.17, 95% confidence interval (CI)=1.03–1.34, P =.02) but not in the subset of elderly recipients of living donor kidneys (HR=1.01, 95% CI=0.8–1.3, P =.9).
CONCLUSION: Older adults can achieve good outcomes with kidney transplantation, although in recipients with significant comorbid illness, careful donor selection and selective use of living donors may be vital to achieving good outcomes.