Association Between Vitamin B12 Levels and Mortality in Hospitalized Older Adults

OBJECTIVES: To investigate the effect of various medications on vitamin B12 status and the association between vitamin B12 levels and mortality. DESIGN: Retrospective cross‐sectional study. SETTING: Four internal medicine departments and the geriatrics department at Kaplan Medical Center (KMC), Rehovot and Harzfeld Geriatrics Hospital, Gedera, Israel. PARTICIPANTS: One thousand five hundred seventy patients aged 65 and older hospitalized at the KMC and Hartzfeld Hospital in 2007. MEASUREMENTS: Blood vitamin B12 levels and demographic, clinical, and laboratory data obtained from electronic medical records. RESULTS: Vitamin B12 deficiency (≤200 pmol/L) was found in 15% of older hospitalized patients. Fifty percent of the patients had high vitamin B12 levels (≥350 pmol/L), 68.2% of whom were aged 80 and older. Metformin use was clearly associated with lower vitamin B12 levels. In patients aged 65 and older, an inverse correlation was found between vitamin B12 levels and albumin, metformin, and angiotensin‐converting enzyme (ACE) inhibitor use. Age, number of medications, and mortality were linearly correlated with vitamin B12 levels. CONCLUSION: Higher vitamin B12 levels were associated with greater mortality, but it is unclear whether vitamin B12 is a marker or a surrogate marker or even a substance that directly causes death. Further investigation is needed to clarify.     

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.     

The Relationship of Psychosocial Factors to Total Mortality Among Older Japanese-American Men: The Honolulu Heart Program

OBJECTIVE: To examine the predictive value of psychosocial factors as risk factors for all-cause mortality. DESIGN: A community-based longitudinal cohort study: The Honolulu Heart Program. SETTING: Population-based study conducted in Oahu, Hawaii. PARTICIPANTS: Three thousand four hundred and ninety-seven men age 71 to 93 were examined and followed prospectively for all-cause mortality for an average of 6 years. MEASUREMENTS: Psychosocial data were obtained using the Lubben Social Networks Scale (LSNS). The LSNS consists of 10 items-family relationships (three items), relationships with friends (three items), and interdependent social supports and living arrangements (four items). We divided the LSNS score into quartiles for comparison, with the first quartile representing the lowest social support and the fourth quartile representing the highest social support. RESULTS: A significant dose-response relationship was noted with LSNS score and total mortality: 33.8% in the first quartile died over the follow-up period, 23.4% in the second, 18% in the third, and 15.7% in the fourth (P < .001). Six-year age-adjusted mortality rates were 66.2, 45.7, 37.8, and 33.7 per 1,000 person years in the first, second, third, and fourth, respectively (P < .001). Using age-adjusted Cox proportional hazards models, with the first quartile of LSNS as the reference group, relative risk for mortality was 0.69 (95% confidence interval (CI) = 0.58-0.82), 0.57 (95% CI = 0.47-0.70), and 0.52 (95% CI = 0.43-0.64) in the second, third, and fourth quartiles, respectively. Cox models were repeated, controlling for age and smoking status, and low LSNS scores remained significantly associated with higher mortality (P = .0001). CONCLUSIONS: Our findings suggest that social networks were significantly independently associated with 6-year all-cause mortality in this cohort of older Japanese-American men. Social interventions in old age may reduce early mortality.     

急性心肌梗塞患者住院死亡率女性高于男性原因探讨

本文对181例女性和214例男性急性心肌梗塞(AMI)住院患者的资料进行分析.结果发现,住院期间女性AMI的死亡率明显高于男性(26%与14%;P<0.01).女性AMI患者具有发病年龄大、胸痛少、糖尿病较多、广泛前壁及复合部位梗塞较多、血清肌酸磷酸肌酶水平较低,心源性并发症多等特点.多因素回归分析表明,年龄、心绞痛、糖尿病、心力衰竭及休克为预示女性AMI死亡的重要因素.     

The Relationship Between Well-Being and Self-Rated Health Among Middle-Aged and Older Women in Israel

Self-rated health (SRH) is widely used to assess global health. This study evaluated the SRH of two groups of women aged 40 to 59 and 60+ years. In a sample (n = 306), from a random telephone survey, variables reflecting sociodemographic status, subjective well-being, and health were examined to explain SRH. The results showed that the two groups differed significantly on measures of subjective well-being, as well as in number of comorbidities and level of disability. Two hierarchical regression analyses showed that whereas the sociodemographic characteristics—in particular education, immigrant status, and economic difficulties—explained 24% in the variance in SRH in the middle-aged group, in the older group only economic difficulties was significantly connected with SRH and explained only 8%. Comorbidity was much more salient in the middle-aged group than in the older group, whereas disability was more dominant in the older than in the middle-aged group. This suggests that SRH reflects psychosocial as well as medical and functional aspects of health.     

Sleep Duration and Mortality According to Health Status in Older Adults

OBJECTIVES: To examine the association between usual sleep duration and mortality according to physical and mental health status in older adults. DESIGN: Prospective study conducted from 2001 to 2008. SETTING: Community‐based study. PARTICIPANTS: Cohort study of 3,820 persons representative of the noninstitutionalized population aged 60 and older in Spain. MEASUREMENTS: Sleep duration was self‐reported at baseline. Analyses were performed using Cox regression and adjusted for the main confounders. The analyses were then stratified according to numerous indicators of health status. RESULTS: During follow‐up, 897 persons died. Mortality was higher in those who slept 8 hours (relative risk (RR)=1.34, 95% confidence interval (CI)=1.02–1.76), 9 hours (RR 1.48, 95% CI=1.12–1.96), 10 hours (RR 1.73, 95% CI=1.30–2.29) and 11 hours or more (RR 1.66, 95% CI=1.23–2.24) than in those who slept 7 hours (P for trend <.001). The association between long sleep duration (≥10 vs 7 hours) and mortality was observed even in persons with good health status: optimal perceived health, good cognitive function (Mini‐Mental State Examination score >27), no depression, quality of life better than the cohort median (Medical Outcomes Study 36‐item Short Form Survey Physical Component Summary score ≥46 and Mental Component Summary score ≥52), and without disability in instrumental activities of daily living. Sleeping 6 hours or less was not associated with higher mortality than sleeping 7 hours in persons with good health status. CONCLUSION: Self‐reported sleep duration was associated with 7‐year mortality in this cohort of older adults, even when adjusted for health status. Further research is needed to determine the mechanisms and clinical implications of these findings.     

雄激素与绝经后女性冠状动脉粥样硬化性心脏病相关研究进展

冠状动脉粥样硬化性心脏病发病率存在着明显的年龄差异,女性在绝经前发病率较低,绝经后迅速增加,几乎达到绝经前的4倍.这种现象提示绝经后女性冠状动脉粥样硬化性心脏病的发生可能与性激素水平的改变有关.近期关于绝经后雄激素水平改变与冠状动脉粥样硬化性心脏病的关系已成为研究的热点,但由于雄激素的确切作用机制较为复杂,所以其对冠状动脉粥样硬化性心脏病的作用仍未完全明确.现就目前雄激素与绝经后女性冠状动脉粥样硬化性心脏病关系的研究进展做一综述,并对雄激素能否用于绝经后女性冠状动脉粥样硬化性心脏病的治疗进行展望.