Urinary incontinence and psychological distress in community-dwelling older adults

OBJECTIVES: To examine the relationship between urinary incontinence (UI) and psychological distress in older adults. We hypothesized that persons with UI associated with condition-specific functional loss would be most likely to report psychological distress. DESIGN: A population-based longitudinal survey. SETTING: Continuing participants in a study of community-dwelling adults who were initially living in East Baltimore in 1981. PARTICIPANTS: Persons aged 50 and older (n=781) at follow-up interviews conducted between 1993 and 1996 for whom complete data were available. MEASUREMENTS: Participants were classified as incontinent if they reported any uncontrolled urine loss within the 12 months preceding the 13-year follow-up interview. Condition-specific functional loss secondary to UI was further assessed based on a series of questions relating directly to participants' inability to engage in certain activities due to their UI. Psychological distress was assessed using the General Health Questionnaire (GHQ) at interviews in 1981 and at the 13-year follow-up. RESULTS: Persons with UI were more likely to experience psychological distress as measured by the GHQ than were persons without UI (unadjusted odds ratio (OR)=1.74, 95% confidence interval (CI)=1.13-2.68). Persons with condition-specific functional loss secondary to UI were substantially more likely to have psychological distress as measured by the GHQ than were persons without UI (unadjusted OR=4.02, 95% CI=1.86-8.70). In multivariate models that controlled for potentially influential characteristics such as age, gender, ethnicity, and chronic medical conditions the association between condition-specific functional loss secondary to UI and psychological distress remained statistically significant. Among people with UI, persons with persistently elevated GHQ scores were much more likely to report condition-specific functional impairment from UI (adjusted OR=6.55, 95% CI=1.94-22.12). CONCLUSION: Individuals with UI, especially when incontinence was associated with condition-specific functional loss, were more likely to have psychological distress than were other older adults. Our findings support a general conceptual model that condition-specific functional impairment mediates the relationship between a chronic medical condition and psychological distress.     

Participation of metropolitan, urban and rural community-dwelling older adults

Environmental factors are important in maintaining a high level of participation. This cross-sectional study aimed at comparing the level of participation of older adults living in rural, urban and metropolitan environments and exploring sociodemographic factors associated with participation according to each type of environment. A total of 350 community-dwelling participants showing a normal aging process were randomly recruited. Participation in daily activities and social roles was measured with the Assessment of Life Habits. Sociodemographic and environmental data were gathered using a questionnaire. Participants from the rural region reported less schooling, a lower income, no access to public transportation and less access to stores than others. Participants from the metropolitan region differed in terms of less use of a car, less satisfaction with their social support and feeling less secure in their neighborhood. However, no significant difference was found between the metropolitan, urban and rural groups for participation in daily activities and social roles. Furthermore, the variables most associated with participation were similar for all three regions. This suggests that although the environment of older adults living in metropolitan, urban and rural region differs, their level of engagement in daily activities and social roles is similar.     

Measuring life-space mobility in community-dwelling older adults

OBJECTIVES: To evaluate the validity and reliability of a standardized approach for assessing life-space mobility (the University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA)) and its ability to detect changes in life-space over time in community-dwelling older adults. DESIGN: Prospective, observational cohort study. SETTING: Five counties (three rural and two urban) in central Alabama. PARTICIPANTS: Community-dwelling Medicare beneficiaries (N=306; 46% male, 43% African American) who completed in-home baseline interviews and 2-week and 6-month telephone follow-up interviews. MEASUREMENTS: The LSA assessed the range, independence, and frequency of movement over the 4 weeks preceding assessments. Correlations between the baseline LSA and measures of physical and mental health (physical performance, activities of daily living, instrumental activities of daily living, a global measure of health (the short form-12 question survey), the Geriatric Depression Scale, and comorbidities) established validity. Follow-up LSA scores established short-term test-retest reliability and the ability of the LSA to detect change. RESULTS: For all LSA scoring methods, baseline and 2-week follow-up LSA correlations were greater than 0.86 (95% confidence interval=0.82-0.97). Highest correlations with measures of physical performance and function were noted for the LSA scoring method considering all attributes of mobility. The LSA showed both increases and decreases at 6 months. DISCUSSION: Life-space correlated with observed physical performance and self-reported function. It was stable over a 2-week period yet showed changes at 6 months.     

Anxiety, depression, and 1-year incident cognitive impairment in community-dwelling older adults

OBJECTIVES: To examine in men and women the independent associations between anxiety and depression and 1‐year incident cognitive impairment and to examine the association of cognitive impairment, no dementia (CIND) and incident cognitive impairment with 1‐year incident anxiety or depression. DESIGN: Prospective cohort study. SETTING: General community. PARTICIPANTS: Population‐based sample of 1,942 individuals aged 65 to 96. MEASUREMENTS: Two structured interviews 12 months apart evaluated anxiety and mood symptoms and disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Incident cognitive impairment was defined as no CIND at baseline and a follow‐up Mini‐Mental State Examination score at least 2 points below baseline and below the 15th percentile according to normative data. The associations between cognitive impairment and anxiety or depression were assessed using logistic regression adjusted for potential confounders. RESULTS: Incident cognitive impairment was, independently of depression, associated with baseline anxiety disorders in men (odds ratio (OR)=6.27, 95% confidence interval (CI)=1.39–28.29) and anxiety symptoms in women (OR=2.14, 95%=1.06–4.34). Moreover, the results indicated that depression disorders in men (OR=8.87, 95%=2.13–36.96) and anxiety symptoms in women (OR=4.31, 95%=1.74–10.67) were particularly linked to incident amnestic cognitive impairment, whereas anxiety disorders in men (OR=12.01, 95%=1.73–83.26) were especially associated with incident nonamnestic cognitive impairment. CIND at baseline and incident cognitive impairment were not associated with incident anxiety or depression. CONCLUSION: Anxiety and depression appear to have different relationships with incident cognitive impairment according to sex and the nature of cognitive impairment. Clinicians should pay particular attention to anxiety in older adults because it may shortly be followed by incident cognitive treatment.     

Prevalence and correlates of functional disability in Chinese older adults

Aim:   This article examines the prevalence of functional disability as well as sociodemographic correlations among Chinese older adults based on the most recent China National Sample Survey on Disability in 2006.
Methods:   Functional disability was defined as lost motor function or limited movements and activities according to the International Classification of Function, Disability and Health, and physicians made the diagnosis of disability. Utilizing stratified, multiphase and cluster probability sampling design, a nationally representative sample of the non-institutionalized elderly Chinese population was studied. Factors associated with functional disability were determined using a logistic regression model.
Results:   The prevalence of functional disability was 8.1%. Major causes were vascular disease, osteoarthritis and accidents. In the non-institutionalized elders, increased age, rural residence, less education, lower income, unemployment, being unmarried, living in simple housing, and living with others or non-homeowners emerged as factors associated with functional disability in men and women.
Conclusion:   To face the challenge of the rising prevalence of functional disability, prevention strategies should focus on reducing the incidences of chronic disease and improving socioeconomic status of older adults.     

The relationship between atrial fibrillation and frailty in community-dwelling older adults

Objectives(1) To compare the frailty status between community-dwelling older adults with and without atrial fibrillation (AF) in Taiwan and (2) to test the hypothesis that AF is associated with frailty in community-dwelling older adults.MethodsWe conducted a cross-sectional study in several communities in Taipei. AF was confirmed by electrocardiogram recordings or medical diagnosis. Frailty status was assessed using both the Cardiovascular Health Study (CHS) frailty phenotype and Edmonton Frail Scale (EFS).ResultsA total of 207 community-dwelling older adults voluntarily participated in this study, and 38 had AF. There was a significantly higher percentage of frailer (prefrail and frailty) older adults in the AF group (69 % vs. 36 %, p < 0.001) according to CHS phenotype, but no significant difference was detected by EFS criteria (92 % vs. 92 %, p = 0.966). The AF group showed significantly lower grip strength in men (26.8 ± 8.3 vs. 33.0 ± 6.9 kg, p = 0.006), walking speed (1.1 ± 0.3 vs. 1.2 ± 0.3 m/s, p = 0.003), and Timed Up and Go performance (8.8 ± 2.4 vs. 7.0 ± 1.9 s, p < 0.001) than the control group. The multiple logistic regression model showed that AF was an independent factor associated with frailer community-dwelling older adults after adjusted for covariates (odds ratio, 3.02; 95 % confidence interval, 1.32–6.89, p = 0.009).ConclusionCommunity-dwelling older adults with AF showed a significantly higher percentage of frailer individuals and lower physical function than those without AF. Furthermore, AF was an independent predictor of frailer community-dwelling older adults.     

Depressive symptoms and self-rated health in community-dwelling older adults: a longitudinal study

OBJECTIVES: To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self-rated health and decrease the likelihood of subsequent improvement in self-rated health. DESIGN: A 2-year prospective cohort study. SETTING: Six thousand seven hundred fourteen community-dwelling older persons who completed the first and second wave of the Asset and Health Dynamics among the Oldest-Old Survey in the United States. PARTICIPANTS: Community-dwelling older people in the United States. MEASUREMENTS: Baseline depressive symptoms were measured using a short-form of the Center for Epidemiological Studies Depression Scale. Self-rated health was measured using a single item of global health rating. RESULTS: After adjustment for covariates, a high burden of depressive symptoms at baseline was predictive of greater decline in self-rated health (odds ratio (OR) for decline in those with high burden of depressive symptoms vs those without = 1.47, 95% confidence interval (CI) = 1.26-1.70). Likewise, high burden of depressive symptoms at baseline predicted less improvement in self-rated health (OR for improvement in those with high burden of depressive symptoms vs those without = 0.57, 95% CI = 0.50-0.65). CONCLUSIONS: Depressive symptomatology is an independent risk factor for subsequent changes in self-rated health in older adults. Thus, early prevention and intervention of depressive symptoms in community-dwelling older adults might be critical to promote and maintain their self-rated health.     

Transient versus persistent fear of falling in community-dwelling older adults: incidence and risk factors

OBJECTIVES: To investigate the incidence of fear of falling (FOF) and the risk factors associated with transient versus persistent FOF in community‐dwelling older adults. DESIGN: Prospective cohort study. SETTING: Bronx County, New York. PARTICIPANTS: Three hundred eighty participants without FOF at baseline in the Einstein Aging Study aged 70 and older. MEASUREMENTS: FOF was assessed at baseline and during follow‐up interviews at 2‐ to 3‐month intervals for a minimum 2 years. Incident FOF was classified as transient or persistent FOF. Transient FOF was defined as new‐onset FOF reported at only one interview, and persistent FOF was FOF reported at two or more interviews over a 2‐year period. RESULTS: Twenty‐four‐month cumulative incidence of incident FOF was 45.4%, with 60.0% of FOF being persistent. Predictors of incident FOF included female sex (adjusted hazard ratio (aHR)=1.55, 95% confidence interval (CI)=1.08–2.23), depressive symptoms (aHR=1.16, 95% CI=1.07–1.26), falls (aHR=1.50, 95% CI=1.01–2.21), and clinical gait abnormality (aHR=2.07, 95% CI=1.42–3.01). The proportion of participants with incident FOF increased linearly with increasing number of risk factors. Predictors for transient and persistent FOF were depressive symptoms and clinical gait abnormality. Female sex and previous falls were predictors of persistent but not transient FOF. CONCLUSION: FOF status in older adults may change over time, with shared and distinct risk factors for persistent and transient FOF. Understanding the dynamic nature of FOF and these risk factors will help identify high‐risk groups and design future intervention studies.     

The prevalence and risk factors for sarcopenia in older adults and long-living older adults

PurposeSarcopenia is a muscular syndrome that is related to several adverse risks. The present study aimed to evaluate the prevalence of risk of sarcopenia and associated factors in older adults and long-living older adults.MethodsA crosssectional epidemiological study of older adults patients at a geriatric outpatient clinic. The older adults were evaluated for sarcopenia risk using the SARC-F questionnaire supplemented with the measurement of the calf circumference. In addition, nutritional status was characterized using the Mini Nutritional Assessment, and the relationship of sarcopenia with associated factors (comorbidities, polypharmacy, smoking).ResultsA total of 100 eligible older adults with a mean age of 77.2 ± 1.8 years in the older adults and 86.3 ± 4.2 years in the long-living older adults (p < 0.001) were evaluated. The long-living older adults (OR = 6.1; 95 % CI: 1.44–16.09; p = 0.01) and older adults at risk of malnutrition (OR = 13.6; 95 % CI: 1.55–11.38; p < 0.05) had a higher risk of sarcopenia, whereas BMI ≥ 27 kg/m 2 (OR = 0; 95 % CI: 0–0.06; p < 0.001) was a protective factor. The risk of sarcopenia was six times higher in the over-80 s (95 % CI = 1.44, 16.09), while the older adults with malnutrition or at nutritional risk ran a 13 times higher risk of sarcopenia (95 % CI = 1.55, 11.38).ConclusionThe prevalence of risk of sarcopenia was higher in the long-living older adults and the older adults at nutritional risk, making its early evaluation in clinical practice important.     

Effect of exercise on cognitive performance in community-dwelling older adults: review of intervention trials and recommendations for public health practice and research

There is evidence from observational studies that increasing physical activity may reduce the risk of cognitive decline in older adults. Exercise intervention trials have found conflicting results. A systematic review of physical activity and exercise intervention trials on cognition in older adults was conducted. Six scientific databases and reference lists of previous reviews were searched. Thirty studies were eligible for inclusion. Articles were grouped into intervention-outcome pairings. Interventions were grouped as cardiorespiratory, strength, and multicomponent exercises. Cognitive outcomes were general cognition, executive function, memory, reaction time, attention, cognitive processing, visuospatial, and language. An eight-member multidisciplinary panel rated the quality and effectiveness of each pairing. Although there were some positive studies, the panel did not find sufficient evidence that physical activity or exercise improved cognition in older adults. Future research should report exercise adherence, use longer study durations, and determine the clinical relevance of measures used.     

Socio-demographics,spirituality, and quality of life among community-dwelling and institutionalized older adults: A structural equation model

PurposeThe increasing life expectancy of the population prompts an array of health conditions that impair an older adults’ quality of life (QoL). Although demographics and spirituality have been associated with QoL, limited literature elucidated the exact mechanisms of their interactions, especially in a culturally-diverse country like Philippines. Hence, this study determined the relationship among socio-demographics, spirituality, and QoL of Filipino older adults in a community and institutional setting.Materials and methodsA predictive-correlational study among 200 randomly-selected community-dwelling and institutionalized older adults was conducted, with a 99% power and a medium effect size. Data were collected using a three-part questionnaire from September to November 2015. The questionnaire was composed of the robotfoto, Spirituality Assessment Scale, and modified Older People’s Quality of Life which assessed socio-demographics, spirituality, and QoL.ResultsAnalysis showed that institutionalization in a nursing home positively and negatively affected spirituality and QoL, generating an acceptable model (χ²/df = 2.12, RMSEA = 0.08, and CFI = 0.95). The negative direct effect of institutionalization on social relationship, leisure, & social activities QoL (β=–0.42, p < 0.01) also initiates a cascade of indirect negative effects on both spirituality and QoL dimensions.ConclusionsThe development of a structural model illustrating the interrelationship of socio-demographics, spirituality, and QoL helps healthcare professionals in predicting facets of spirituality and QoL that can be compromised by living in a nursing home. This understanding provides impetus in evaluating and refining geriatric healthcare programs, policies, and protocols to render individualized, holistic care in a socially-cohesive environment among older adults.     

Transitions in the functional status of disabled community-living older adults over a 3-year follow-up period

The purpose of this study was to investigate transitions over time in the functional status of disabled community-living elderly. The study explored clinical and socio-demographic predictors of functional status decline. Data from the SIPA 3-year longitudinal study were analyzed (n = 1164). Three categories of functional status were defined: no important disability, significant IADL disability and significant ADL disability. At baseline, results show that the prevalence rates were 26.9%, 58.6% and 14.5% for the three categories of functional status. After 12 months, about 50-60% of participants had remained in the same status, while some 10-15% of those with baseline significant disability had improved. The patterns of transitions between 12 and 36 months of follow-up were slightly different. The results indicated more deterioration (13-38%) and less improvement (6-9%). After controlling for baseline functional status, the best predictors for functional decline at 36 months were prior disability, functional limitations, cognitive impairment and comorbidity burden. We found that older adults’ functional status may decline or improve even if the participants are disabled. Disabled conditions play a crucial role in the development of future disability and preventive actions need to be implemented.