Infectious disease hospitalizations among older adults in the United States from 1990 through 2002

BACKGROUND: To understand conditions associated with substantial morbidity among older adults (aged > or = 65 years), we describe hospitalization rates and trends for overall infectious disease (ID) and for specific ID groups among older adults in the United States from January 1, 1990, through December 31, 2002. METHODS: The National Hospital Discharge Survey was used to generate hospitalization estimates from 1990 through 2002 for the US population of older adults. By using a comprehensive list of International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with IDs, we identified and analyzed hospitalizations associated with specific ID and ID-related categories. RESULTS: There were approximately 21.4 million (SE, 636 000) ID hospitalizations among older adults from 1990 through 2002, and between 1990 through 1992 and 2000 through 2002, the ID hospitalization rate increased 13% from 449.4 to 507.9 hospitalizations per 10 000 older adults (P = .01). This increase was caused in part by the increasing relative contributions of patients aged 75 through 84 years and 85 years or older to the older adult ID hospitalization rate. Almost half of ID hospitalizations (46% [SE, 0.7%]) and ID-related hospital deaths (48% [SE, 1.6%]) among older adults were associated with lower respiratory tract infections from 2000 through 2002. CONCLUSIONS: The hospitalization rate for IDs increased slightly among the older adult US population during the 13-year study and was associated with the aging of the older adult population. The reduction of ID hospitalization rates among older adults could help attenuate the anticipated increase in the number of hospitalizations among older adults and should be a high priority given the projected population growth among older adults in the United States.     

Recurrent hospitalizations with moderate to severe hyponatremia in older adults and its associated mortality

BackgroundRecurrent hospitalizations with hyponatremia are commonly encountered in older adults admitted to Internal Medicine wards. However, the incidence and the prognostic implication of this phenomenon have never been studied.MethodsMedical charts of all older adults (≥ 75 years) admitted to Internal Medicine wards at a tertiary medical center during 2009–2010 with symptomatic moderate to severe hyponatremia (blood sodium ≤ 130 meq/l) upon admission were reviewed. The study group included patients with one or more hospitalizations with hyponatremia in the year following the first hospitalization with hyponatremia. The control group included patients with a single hospitalization with hyponatremia. Mortality rates were studied one year following the second hospitalization with hyponatremia in the study group and one year following the single hospitalization with hyponatremia in the control group. Regression analysis was used to study the association between recurrent hospitalizations with hyponatremia and 1-year mortality while controlling for demographics, chronic co-morbidities, albumin serum levels, and the number of hospitalizations.ResultsThe cohort included 431 older adults: 301 (69.8%) women; mean age of 84.6 ± 5.6 years. Overall, 120 (27.8%) patients had recurrent hospitalizations with hyponatremia and 125 (29.0%) patients died within a year. 1-Year mortality rates were higher in patients with recurrent hospitalizations with hyponatremia than in patients with a single hospitalization with hyponatremia (42.5% vs. 23.8%; p < 0.0001). Regression analysis showed that recurrent hospitalizations with hyponatremia were independently associated with 1-year mortality (odds ratio 1.9; 95% confidence interval 1.1–3.2; p = 0.018).ConclusionsRecurrent hospitalizations with hyponatremia in older adults are common and associated with 1-year mortality.     

Accidental falls among community-dwelling older adults

Elderly persons living in the community are a heterogeneous population. Among them, the screening of persons at risk of falling is still a matter of debate. The aim of this analysis was to improve the identification process of elderly persons living in the community at risk for falling by nursing staff of community- based services. A secondary analysis was performed with the data from a prospective non-randomized interventional trial. The study included 268 community-dwelling older adults (mean age of 82 years, 81.3% female) from Ulm and Neu-Ulm with a followup period of 12 months. Fall risk indicators were extracted from the nursing assessment and analysis with crude odds ratios revealed the following risk indicators for falls: assistance when transferring, bathing and climbing a flight of stairs as well as fall history. Afterwards, fall risk indicators were selected by backward elimination in a multiple logistic regression. Variable selection identified a positive fall history and the need for assistance when bathing as important risk indicators. These two risk indicators could be used as a screening tool, which would be easy to perform by nursing staff in their daily work. This screening test defined as more than one fall in the last 12 months or bathing assistance, the first ADL to be affected in the disablement process, has a sensitivity of 85.3% and a specificity of 42.1%.     

Altruistic moral judgment among older adults

This study investigated altruistic moral judgment among the elderly, and examined its relationships to demographic and personality variables, self-reported helping, and subjective social integration (the perception that one is integrated into one's social milieu). The moral judgment interview included three stories, each of which contained a moral dilemma. Participants solved each dilemma and gave reasons for their solutions. The moral dilemmas and scoring system emphasized the positive, prosocial aspects of morality, rather than a prohibition-oriented approach. The categories used most often were, in descending order of frequency 1) pragmatic needs-of-others oriented reasons, 2) empathy-based reasons, 3) reasons based on internalized and/or abstract moral principles, and 4) hedonistic reasons. Of the higher levels of moral judgment, only reasoning based on abstract internalized principles had significant positive relationships with self-reported helping, the personality correlates of helping, and with subjective social integration into one's social milieu.     

Measuring social support among older adults

The purpose of this study is to introduce a measure of natural supportive behaviors for use in studies that examine the relationship between stress, social support, and health among older adults. The index improves on existing measures in three ways: it avoids problems arising from confounding potentially supportive relationships with support that is actually received; the scale also assesses variations in individual support needs; and it measures four distinct dimensions of social support (informational support, tangible help, emotional support, and integration). Based on data from a random community survey of 351 older adults, the basic psychometric properties and the factor structure of the scale are explored. The predictive validity of the scale is demonstrated by showing that the dimensions of support buffer the stressful effects of bereavement on depressive symptoms.     

Self-rated health trajectories and mortality among older adults

OBJECTIVES: For this article, we evaluated whether measures of prior self-rated health (SRH) trajectories had associations with subsequent mortality that were independent of current SRH assessment and other covariates. METHODS: We used multivariable logistic regression that incorporated four waves of interview data (1993, 1995, 1998, and 2000) from the Asset and Health Dynamics Among the Oldest Old Survey in order to predict mortality during 2000-2002. We defined prior SRH trajectories for each individual based on the slope estimated from a simple linear regression of their own SRH between 1993 and 1998 and the variance around that slope. In addition to SRH reported in 2000, other covariates included in the mortality models reflected health status, health-related behaviors, and individual resources. RESULTS: Among the 3,129 respondents in the analytic sample, SRH in 2000 was significantly (p <.0001) associated with mortality, but the measures of prior SRH trajectories were not. Prior SRH trajectory was, however, a significant determinant of current SRH. We observed significant independent associations with mortality for age, sex, education, lung disease, and having ever smoked. DISCUSSION: Although measures of prior SRH trajectories did not have significant direct associations with mortality, they did have important indirect effects via their influence on current SRH.     

Productive activities and psychological well-being among older adults

OBJECTIVES: The purpose of this study was to test whether paid work and formal volunteering reduce the rate of mental health decline in later life. METHODS: Using four waves of Health and Retirement Study data collected from a sample of 7,830 individuals aged 55 to 66, I estimated growth curve models to assess the effects of productive activities on mental health trajectories. The analytical strategy took into account selection processes when examining the beneficial effects of activities. The analyses also formally attended to the sample attrition problem inherent in longitudinal studies. RESULTS: The results indicated that activity participants generally had better mental health at the beginning of the study. Full-time employment and low-level volunteering had independent protective effects against decline in psychological well-being. Joint participants of both productive activities enjoyed a slower rate of mental health decline than single-activity participants. DISCUSSION: The results are consistent with activity theory and further confirm the role accumulation perspective. The finding that full-time work combined with low-level volunteering is protective of mental health reveals the complementary effect of volunteering to formal employment. Methodological and theoretical implications are discussed.     

Bereavement among African American and White older adults

PURPOSE: The authors examined epidemiology and sociodemographic predictors of spousal, non-spousal family, and friendship bereavement among African American and White community-dwelling older adults using longitudinal data from 839 participants of the University of Alabama at Birmingham Study of Aging, a prospective cohort study of a random sample of Alabama Medicare beneficiaries. METHOD: Authors calculated cumulative incidences of each type of loss and used logistic regression to identify factors significantly and independently associated with loss. RESULTS: Of participants, 71% reported at least one loss; 50% reported non-spousal family loss, and 37% reported friendship loss. For married participants, the cumulative incidence of spousal loss was 8.1%. Female sex and income < $12,000 were predictors of spousal loss. Female sex and education >/= 12 years were predictors of friendship loss. Higher educated African American women were at greater risk of non-spousal family loss. DISCUSSION: Future research should examine bereavement burden and identify health outcomes of multiple losses.     

Urban neighborhoods and depressive symptoms among older adults

OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older. METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models. RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population. DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.     

Interventions to prevent pneumonia among older adults

Pneumonia is a common cause of death in older people. Antimicrobial drugs do not prevent pneumonia and, because of increasingly resistant organisms, their value in curing infection will become more limited. Establishing new strategies to prevent pneumonia through consideration of the mechanisms of this devastating illness is essential. The purpose of this review is to discuss how pneumonia develops in older people and to suggest preventive strategies that may reduce the incidence of pneumonia among older adults. Aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract is one of the most important risk factors for pneumonia; impairments in swallowing and cough reflexes among older adults, e.g., related to cerebrovascular disease, increase the risk for the development of pneumonia. Thus, strategies to reduce the volumes and pathogenicity of aspirated material should be pursued. For example, since both swallowing and cough reflexes are mediated by endogenous substance P, pharmacologic therapy using angiotensin-converting enzyme inhibitors, which decrease substance P catabolism, may improve both reflexes and result in the lowering of the risk of pneumonia. Similarly, since the production of substance P is regulated by dopaminergic neurons in the cerebral basal ganglia, treatment with dopamine analogs or potentiating drugs such as amantadine (and, of course, prevention of cerebral vascular disease, which can result in basal ganglia strokes) should affect the incidence of pneumonia. The purpose of this review is to consider promising pharmacologic treatments as methods of preventing pneumonia in older adults and to review other proven strategies, e.g., infection control and cerebrovascular disease prevention that will lessen the incidence of pneumonia.