Effect of widowhood on disability onset in elderly men from three European countries

OBJECTIVES: To investigate in different countries the effects of becoming widowed, duration of widowhood, and household composition of widowed men on disability onset in different disability domains. DESIGN: Longitudinal data from a cohort study collected around 1990, 1995, and 2000. SETTING: Three cohorts from Finland, The Netherlands, and Italy. PARTICIPANTS: Seven hundred thirty-six men, aged 70 and older at baseline. MEASUREMENTS: Disability was measured using standardized questionnaire on activities of daily living (ADLs). Three domains were assessed: instrumental ADLs (IADLs), mobility, and basic ADLs (BADLs). Duration of widowhood was divided into less than 5 years and 5 or more years and household composition into living alone and living with family or in an institution. RESULTS: Men who became widowed developed more IADL disabilities (odds ratio (OR)=2.15; 95% confidence interval (CI)=1.22-3.81) and mobility (OR=1.84; 95% CI=1.15-2.96) than men who were still married. Men who had been widowed for less than 5 years developed more IADL disabilities than those who had been widowed for 5 years or more (OR=2.27; 95% CI=1.14-4.54). Widowed men living alone showed fewer disabilities in mobility (OR=0.25; 95% CI=0.09-0.73) and BADLs (OR=0.02; 95% CI=0.001-0.33) than those living with others. The effects on disability onset did not differ between countries. CONCLUSION: Widowhood in elderly men is a risk factor for dependency in IADLs and mobility. The growth in the number of widowers may lead to higher demands on family care and professional care.     

Interaction of apolipoprotein E genotype with smoking and physical inactivity on coronary heart disease risk in men and women

ObjectiveApolipoprotein E genotype (APOE) polymorphism affects lipid levels and coronary heart disease (CHD) risk. However, these associations may be modified by lifestyle factors. Therefore, we studied whether smoking, physical inactivity or overweight interact with APOE on cholesterol levels and CHD risk.MethodsCombining two Swedish case-control studies yielded 1735 CHD cases and 4654 population controls (3747 men, 2642 women). Self-reported questionnaire lifestyle data included smoking (ever [current or former regular] or never) and physical inactivity (mainly sitting leisure time). We obtained LDL cholesterol levels and APOE genotypes. CHD risk was modelled using logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for relevant covariates.ResultsSmoking interacted with APOE on CHD risk; adjusted ORs for ever versus never smoking were 1.45 (95% CI 1.00–2.10) in ?2 carriers, 2.25 (95% CI 1.90–2.68) in ?3 homozygotes and 2.37 (95% CI 1.85–3.04) in ?4 carriers. Female ?4 carriers had OR 3.62 (95% CI 2.32–5.63). The adjusted ORs for physical inactivity were 1.09 (95% CI 0.73–1.61), 1.34 (95% CI 1.12–1.61), and 1.79 (95% CI 1.38–2.30) in ?2, ?3?3 and ?4 groups, respectively. No interaction was seen between overweight and APOE for CHD risk, or between any lifestyle factor and APOE for LDL cholesterol levels.ConclusionThe APOE ?2 allele counteracted CHD risk from smoking in both genders, while the ?4 allele was seen to potentiate this risk mainly in women. Similar ?2 protection and ?4 potentiation was suggested for CHD risk from physical inactivity.     

Pulmonary Function and Cognitive Decline in an Older Chinese Population in Singapore

Abstract

Introduction: Various cognitive deficits associated with reduced pulmonary function are reported in different studies, but the pattern of cognitive deficits across multiple domains and its associated everyday functional disability remain unclear. Methods: We analyzed neuropsychological functioning, cognitive impairment and accompanying disability in instrumental activities of daily living (IADL) associated with reduced pulmonary function in community-living middle-aged and older adults in Singapore. Performance on a comprehensive battery of neuropsychological tests, spirometry and cognitively demanding IADLs were assessed in the population-based Singapore Longitudinal Ageing Studies. Results: Consecutive 10% increase in forced expiratory volume in 1 s (FEV1) as percent of predicted was positively associated with 0.18 points increase in Mini-mental state examination (MMSE) and 0.04 points increase in executive function, independent of age, education and other variables. Subjects with moderate-to-severe airway obstruction showed significantly poorer MMSE score (p for linear trend = 0.001), and information processing speed (p for linear trend < 0.001). FEV1 (per 10% of predicted) was significantly associated with lower risk of cognitive impairment (OR = 0.92, 95% CI: 0.87-0.98, P = 0.005) and cognitive IADL disability (OR = 0.86,95% CI:0.79–0.93, P < 0.001). Pulmonary restriction was associated with greater risk of cognitive impairment (OR = 1.98, 95% CI: 1.26-3.11, P = 0.003) and cognitive IADL disability (OR = 2.43, 95% CI: 1.31-4.53, P = 0.005). Moderate-to-severe airway obstruction (OR = 2.04, 95% CI: 1.11–3.74, P = 0.022) was positively associated with cognitive IADL disability. Conclusion: The findings suggest a measurable but modest cognitive effect of low pulmonary function that was accompanied by corresponding disability in living activities. The effect on executive functioning should be further investigated in longitudinal studies.     

The combined effect of visual impairment and cognitive impairment on disability in older people

OBJECTIVES: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity. DESIGN: Prospective cohort. SETTING: North Carolina. PARTICIPANTS: Three thousand eight hundred seventy-eight participants in the North Carolina Established Populations for the Epidemiologic Studies of the Elderly with nonmissing visual status, cognitive status, and disability status data at baseline MEASUREMENTS: Short Portable Mental Status Questionnaire (cognitive impairment defined as > or =4 errors), self reported visual acuity (visual impairment defined as inability to see well enough to recognize a friend across the street or to read newspaper print), demographic and health-related variables, disability status (activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility), death, and time to nursing home placement. RESULTS: Participants with coexisting visual and cognitive impairment were at greater risk of IADL disability (odds ratio (OR)=6.50, 95% confidence interval (CI)=4.34-9.75), mobility disability (OR=4.04, 95% CI=2.49-6.54), ADL disability (OR=2.84, 95% CI=1.87-4.32), and incident ADL disability (OR=3.66, 95%, CI=2.36-5.65). In each case, the estimated OR associated with the multimorbidity was greater than the estimated OR associated with visual or cognitive impairment alone, a pattern that was not observed for other adverse outcomes assessed. No significant interactions were observed between cognitive impairment and visual impairment as predictors of disability status. CONCLUSION: Individuals with coexisting visual impairment and cognitive impairment are at high risk of disability, with each condition contributing additively to disability risk. Further study is needed to improve functional trajectories in patients with this prevalent multimorbidity. When visual or cognitive impairment is present, efforts to maximize the other function may be beneficial.     

Loss of muscle strength, mass (sarcopenia), and quality (specific force) and its relationship with functional limitation and physical disability: the Concord Health and Ageing in Men Project

OBJECTIVES: To determine the association between loss of muscle strength, mass, and quality and functional limitation and physical disability in older men. DESIGN: Cross‐sectional study of older men participating in the Concord Health and Ageing in Men Project (CHAMP). SETTING: Elderly men living in a defined geographical region in Sydney, Australia. PARTICIPANTS: One thousand seven hundred five community‐dwelling men aged 70 and older who participated in the baseline assessments of CHAMP. MEASUREMENTS: Upper and lower extremity strength were measured using dynamometers for grip and quadriceps strength. Appendicular skeletal lean mass was assessed using dual X‐ray absorptiometry. Muscle quality was defined as the ratio of strength to mass in upper and lower extremities. For each parameter, subjects in the lowest 20% of the distribution were defined as below normal. Functional limitation was assessed according to self‐report and objective lower extremity performance measures. Physical disability was measured according to self‐report questionnaire. RESULTS: After adjusting for important confounders, the prevalence ratio (PR) for poor quadriceps strength and self‐reported functional limitation was 1.91 (95% confidence interval (CI)=1.10–2.40); for performance‐based functional limitation the PR was 1.81 (95% CI=1.45–2.24). The adjusted PR for poor grip strength and physical disability in instrumental activities of daily living (IADLs) was 1.37 (95% CI=1.20–1.56). The adjusted PR for low skeletal lean mass (adjusted for fat mass) and physical disability in basic activities of daily living was 2.08 (95% CI=1.37–3.15). For muscle quality, the PR for lower extremity specific force and functional limitation and physical disability was stronger than upper extremity specific force. CONCLUSION: Muscle strength is the single best measure of age‐related muscle change and is associated with physical disability in IADLs and functional limitation.     

Predictive validity of the Brazilian version of the Tilburg Frailty Indicator for adverse health outcomes in older adults

PurposeThis study aimed to determine the predictive value of the Brazilian Tilburg Frailty Indicator (TFI) for adverse health outcomes (falls, hospitalization, disability and death), in a follow-up period of twelve months.MethodsThis longitudinal study was carried out with a sample of people using primary health care services in Rio de Janeiro, Brazil. At baseline the sample consisted of 963 people aged 60 years and older. A subset of all respondents participated again one year later (n = 640, 66.6% response rate). We used the TFI, the Katz’s scale for assessing ADL disability and the Lawton Scale for assessing IADL disability. Falls, hospitalization and death were also assessed using a questionnaire.ResultsThe prevalence of frailty was 44.2% and the mean score of the TFI was 4.4 (SD = 3.0). There was a higher risk of loss in functional capacity in ADL (OR = 3.03, CI95% 1.45–6.29) and in IADL (OR = 1.51, CI95% 1.05–2.17), falls (OR = 2.08, CI95% 1.21–3.58), hospitalization (OR = 1.83, CI95% 1.10–3.06), and death (HR = 2.73, CI95% 1.04–7.19) for frail when compared to non-frail elderly, in the bivariate analyses. Controlling for the sociodemographic variables, the frailty domains together improved the prediction of hospitalization, falls and loss in functional capacity in ADL, but not loss in functional capacity in IADL.ConclusionThe TFI is a good predictor of adverse health outcomes among elderly users of primary care services in Brazil and appears an adequate and easy to administer tool for monitoring their health conditions.     

Depression after stroke: a prospective epidemiological study

OBJECTIVES: To elucidate the relationship between stroke and depressive symptoms and to determine whether disability or cerebrovascular risk factors mediate that relationship. DESIGN: A prospective longitudinal epidemiological survey. SETTING: The mid-Monongahela Valley, a rural, nonfarm, low-socioeconomic-status community. PARTICIPANTS: Random sample of 1,134 subjects aged 65 and older. MEASUREMENTS: The dependent variable was clinically significant depressive symptoms, as defined by five or more symptoms on the modified Center for Epidemiological Studies Depression scale. The independent variables were demographics (age, sex, education), stroke, number of impaired instrumental activities of daily living (IADLs), diabetes mellitus, hypertension, atherosclerotic heart disease, and smoking. Logistic regression analyses were conducted for cross-sectional and longitudinal models examining whether stroke was associated with or predicted depressive symptoms, with other associated factors included as covariates. RESULTS: Clinically significant depressive symptoms were cross-sectionally associated with stroke (odds ratio (OR)=3.5, 95% confidence interval (CI)=1.4-8.3), diabetes mellitus (OR=2.8, 95% CI=1.7-4.6; P相似文献   

Urinary incontinence and its association with death, nursing home admission, and functional decline

OBJECTIVES: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs). DESIGN: A population-based prospective cohort study from 1993 to 1995. SETTING: Community-dwelling within the United States. PARTICIPANTS: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline. MEASUREMENTS: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status. RESULTS: The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18-2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36-2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67-1.21), nursing home admission (AOR=1.33, 95% CI=0.86-2.04), or ADL decline (AOR=1.24, 95% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05-1.63), although adjustment markedly reduced the strength of this association. CONCLUSION: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.     

Prevalence and correlates of fecal incontinence in community-dwelling older adults

Objectives: To determine prevalence and correlates of fecal incontinence in older community‐dwelling adults. Design: A cross‐sectional, population‐based survey. Setting: Participants interviewed at home in three rural and two urban counties in Alabama from 1999 to 2001. Participants: The University of Alabama at Birmingham Study of Aging enlisted 1,000 participants from the state Medicare beneficiary lists. The sample was selected to include 25% black men, 25% white men, 25% black women, and 25% white women. Measurements: The survey included sociodemographic information, medical conditions, health behaviors, life‐space assessment (mobility), and self‐reported health status. Fecal incontinence was defined as an affirmative response to the question “In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?” Severity was classified as mild if reported less than once a month and moderate to severe if reported once a month or greater. Results: The prevalence of fecal incontinence in the sample was 12.0% (12.4% in men, 11.6% in women; P=.33). Mean age±standard deviation was 75.3±6.7 and ranged from 65 to 106. In a forward stepwise logistic regression analysis, the following factors were significantly associated with the presence of fecal incontinence in women: chronic diarrhea (odds ratio (OR)=4.55, 95% confidence interval (CI)=2.03–10.20), urinary incontinence (OR=2.65, 95% CI=1.34–5.25), hysterectomy with ovary removal (OR=1.93, 95% CI=1.06–3.54), poor self‐perceived health status (OR=1.88, 95% CI=1.01–3.50), and higher Charlson comorbidity score (OR=1.29, 95% CI=1.07–1.55). The following factors were significantly associated with fecal incontinence in men: chronic diarrhea (OR=6.08, 95% CI=2.29–16.16), swelling in the feet and legs (OR=3.49, 95% CI=1.80–6.76), transient ischemic attack/ministroke (OR=3.11, 95% CI=1.30–7.41), Geriatric Depression Scale score greater than 5 (OR=2.83, 95% CI=1.27–6.28), living alone (OR=2.38, 95% CI=1.23–4.62), prostate disease (OR=2.29, 95% CI=1.04–5.02), and poor self‐perceived health (OR=2.18, 95% CI=1.13–4.20). The following were found to be associated with increased frequency of fecal incontinence in women: chronic diarrhea (OR=6.39, 95% CI=2.25–18.14), poor self‐perceived health (OR=5.37, 95% CI=1.75–16.55), and urinary incontinence (OR=4.96, 95% CI=1.41–17.43). In men, chronic diarrhea (OR=5.38, 95% CI=1.77–16.30), poor self‐perceived health (OR=3.91, 95% CI=1.39–11.02), lower extremity swelling (OR=2.86, 95% CI=1.20–6.81), and decreased assisted life‐space mobility (OR=0.73, 95% CI=0.49–0.80) were associated with more frequent fecal incontinence. Conclusion: In community‐dwelling older adults, fecal incontinence is a common condition associated with chronic diarrhea, multiple health problems, and poor self‐perceived health. Fecal incontinence should be included in the review of systems for older patients.     

Determinants of cognitive impairment over time among the elderly in Taiwan: results of the national longitudinal study

This study aimed to identify the risk factors for cognitive impairment among the elderly population in Taiwan. Data were drawn from three waves of the “Survey of Health and Living Status of the Elderly in Taiwan”, a national longitudinal study started in 1989. We included respondents without dementia or cognitive impairment at baseline in 1993 and followed them over a 10-year period. Cognitive function was measured by the nine-item Short Portable Mental Status Questionnaire in 1993, 1999, and 2003. Independent variables, including age, sex, marital status, education, ethnicity, ADLs, IADLs, physical function, social participation, chronic diseases, smoking, and alcohol drinking, were collected at baseline in 1993. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regression was used to evaluate the predictive factors for cognitive impairment. Of the eligible 1,626 respondents, 72 (4.43%) and 484 (29.77%) individuals did not complete follow-up in 1999 and 2003, respectively, mostly due to death. Our results showed that older age (OR = 2.60, 95% CI = 1.79–3.78), being female, lower educational level, IADL disability (OR = 2.06, 95% CI = 1.38–3.09), and having a history of diabetes (OR = 1.70, 95% CI = 1.06–2.74) or stroke (OR = 2.36, 95% CI = 1.06–5.26) were independent predictors for cognitive impairment in Taiwan.     

Interleukin‐1β and ‐10 polymorphisms influence erosive reflux esophagitis and gastritis in Taiwanese patients

Background and Aims: Helicobacter pylori (H. pylori) infection induces cytokine production and is associated with gastrointestinal diseases. This study examined the relationship of gene polymorphisms, including interleukin (IL)‐1β, ‐10, ‐8, and tumor necrosis factor‐α (TNF‐α), H. pylori infection, and susceptibility to gastrointestinal disorders in Taiwanese patients. Methods: IL‐1β?511/?31/+3953, ‐10?1082/?819/?592, ‐8?251, and TNF‐α?308 polymorphisms were assessed in 628 gastrointestinal disease patients, and 176 healthy controls were analyzed using the polymerase chain reaction?restriction fragment length polymorphism method. Results: IL‐1β?511 T/T and ?31 C/C genotypes, and IL‐1β?511 T and ?31 C alleles were associated with an increased risk of reflux esophagitis (P = 0.034, odds ratio [OR] = 1.384, 95% confidence interval [CI]: 1.023–1.871; P = 0.031, OR = 1.388, 95% CI: 1.028–1.873; P = 0.044, OR = 1.342, 95% CI: 1.008–1.786; and P = 0.040, OR = 1.349, 95% CI: 1.014–1.796, respectively). No relationship was found between H. pylori infection and the risk of reflux esophagitis. IL‐10?819 C/T and ‐10?592 A/C genotypes and IL‐10?1082/?819/?592 ATA/ACC and ATA/GCC haplotypes were associated with an increased risk of gastritis (P = 0.021, OR = 1.721, 95% CI: 1.084–2.733; P = 0.016, OR = 1.766, 95% CI: 1.112–2.805; P = 0.039, OR = 1.662, 95% CI: 1.024–2.697; and P = 0.035, OR = 1.600, 95% CI: 1.024–2.499, respectively). Conclusion: Among Taiwanese patients, IL‐1β and ‐10 polymorphisms were associated with an increased risk of erosive reflux esophagitis and gastritis, respectively.     

Geriatric Impairments and Disability: The Cardiovascular Health Study

OBJECTIVES: To determine the relative importance of geriatric impairments (in muscle strength, physical capacity, cognition, vision, hearing, and psychological status) and chronic diseases in predicting subsequent functional disability in longitudinal analyses. DESIGN: Longitudinal data from the Cardiovascular Health Study were analyzed. Multivariable Cox hazards regression modeling was used to analyze associations between time‐dependent predictors and onset of disability in activities of daily living (ADLs) and mobility. SETTING: Four communities across the United States (Sacramento County, CA; Washington County, MD; Forsyth County, NC; and Allegheny County, PA). PARTICIPANTS: Five thousand eight hundred eighty‐eight elderly persons. MEASUREMENTS: Data were collected annually through in‐person examinations. RESULTS: ADL disability developed in 15% of participants and mobility disability in 30%. A single multivariable model was developed that included demographics, marital status, body mass index, and number of impairments and diseases. The hazard ratios (HRs) of having one, two, and three or more geriatric impairments (vs none) for the outcome of ADL disability were 2.12 (95% confidence interval (CI)=1.63–2.75), 4.25 (95% CI=3.30–5.48), and 7.87 (95% CI=6.10–10.17), respectively, and for having one, two, and three or more chronic diseases were 1.75 (95% CI=1.41–2.19), 2.45 (95% CI=1.95–3.07), and 3.26 (95% CI=2.53–4.19), respectively. Similarly, the HRs of having one, two, and three or more impairments for the outcome of mobility disability were 1.48 (95% CI=1.27–1.73), 2.08 (95% CI=1.77–2.45), and 3.70 (95% CI=3.09–4.42), respectively, and for having one, two, and three or more diseases were 2.06 (95% CI=1.76–2.40), 2.80 (95% CI=2.36–3.31), and 4.20 (95% CI=3.44–5.14), respectively. CONCLUSION: Number of geriatric impairments was more strongly associated than number of chronic diseases with subsequent ADL disability and nearly as strongly associated with the subsequent mobility disability.     

Effect of exercise on ease in performing activities of daily living and instrumental activities of daily living from age 70 to 77: the Jerusalem longitudinal study

OBJECTIVES: To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well-characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later. DESIGN: Two stages of a longitudinal study of an age-homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation. SETTING: Home-based interviews and examinations in Jerusalem. PARTICIPANTS: Two hundred eighty-seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase. MEASUREMENTS: Two-stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990-91 and 1997-98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise. RESULTS: Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self-reliance in IADLs for women. A more-sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self-assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95% confidence interval (CI) = 2.0-36.2) and for men (OR = 4.3, 95% CI = 1.1-17.1). Ease of independent function in at least four of five IADL tasks also correlated to exercise for men in this regression (OR = 3.7, 95% CI = 1.1-12.2) but not for women (OR = 2.0, 95% CI = 0.6-6.3). Ease in shopping, alternatively, correlated with physical activity for men (OR = 4.3, 95% CI = 1.5-12.0) and women (OR = 2.6, 95% CI = 1.1-6.1). CONCLUSIONS: Subjects remained active and independent at age 77. Reported ease of performance declined and revealed changes in function. Exercise at least four times a week at age 70 preserved ease of performance at age 77 independent of the influence of specific disease or general self-assessed health.     

Sensory impairments and incident disability in older men living in a British community: a 2 year follow-up study

BackgroundSensory impairments are common in older adults, who are a rapidly growing proportion of the UK population, making age-related sensory impairments an increasingly important public health concern. We explored the association between impairments in hearing and vision and the risk of incident mobility disability, activities of daily living (ADL), and instrumental ADL (IADL).Methods3981 men aged 63–85 years from the population-based British Regional Heart Study were followed from Jan 1, 2003, to April 30, 2005. Self-reported data on hearing aid use and ability to follow television at a volume acceptable to others allowed for four categories of hearing: could hear (reference group), could hear with hearing aid, could not hear and no aid, and could not hear despite aid. Vision impairment was defined as not being able to recognise a friend across a road. Measures of disability included mobility disability (defined as unable to take stairs up or down, or unable to walk 400 yards, or a combination of these movements), ADL difficulties, and IADL difficulties. Logistic regression was used to assess associations. All participants provided written, informed consent. Ethics approval was obtained from local research ethics committees.FindingsAt baseline, 3108 men were free from mobility disability, 3346 were free from ADL difficulties, and 3410 were free from IADL difficulties. New cases of disability at follow-up included mobility disability (n=238), ADL (n=260), and IADL (n=207). Men who could not hear and did not use a hearing aid had greater risks of mobility disability (age-adjusted relative risk 2·24, 95% CI 1·29–3·89). Being unable to hear, irrespective of hearing aid, was associated with increased risks of ADL (without aid 1·74, 1·19–2·55; with aid 2·01, 1·16–3·46). Men who could hear and used a hearing aid and men who could not hear despite an aid had increased risks of IADL (1·86, 1·29–2·70 and 2·74, 1·53–4·93, respectively). Vision impairment was not associated with incident mobility disability.InterpretationOlder men with hearing impairment have an increased risk of subsequent disability. Prevention and correction of hearing impairment could enhance independent living in later life. Further research is warranted on the possible pathways underlying the associations, to prevent adverse health outcomes associated with age-related hearing impairment.FundingThe British Regional Heart Study is funded by the British Heart Foundation. AEML is funded by the National Institute for Health Research School for Public Health Research (509546). SER is funded by a UK Medical Research Council Fellowship (G1002391).     

Excess alcohol consumption and health outcomes: a 6-year follow-up of men over age 50 from the health and retirement study

Aims This study examined the association of problem drinking history and alcohol consumption with the onset of several health conditions and death over a 6‐year follow‐up period. Setting We analyzed two waves of longitudinal data on men over 50 who participated in the Health and Retirement Study, a nationally representative sample of people aged 51–61 and their spouses living in the United States in 1992. Measurements Five types of health outcomes—mortality, general health, functional status, cognitive status, and mental health—were examined. Drinking categories were based on average drinks per day (0, <1, 1–2, 3–4, 5+), with 5 + defined as ‘very heavy drinking’. Problem drinking history was identified as 2+ affirmative responses to the CAGE questionnaire. We controlled for smoking and other factors at baseline. Findings Over the 6‐year follow‐up period, very heavy drinking at baseline quadrupled the risk of developing functional impairments (OR: 4.21 95% CI: 1.67, 10.61). A problem drinking history increased the onset of depression (OR: 1.67 95% CI: 1.02, 2.74), psychiatric problems (OR: 2.15 95% CI: 1.47, 3.13) and memory problems (OR: 1.71 95% CI: 1.14, 2.56). Heavy drinking among mature adults was not associated with increased incidence of other adverse health events (i.e. angina, cancer, congestive heart failure, diabetes, myocardial infraction, lung disease or stroke). Conclusion Very heavy drinking and a problem drinking history greatly increased rates of onset of functional impairments, psychiatric problems and memory loss in late middle age for men who had not experienced these impairments at their initial interview.     

Prediction of functional disability by depressive state among community‐dwelling elderly in Japan: A prospective cohort study

Aim: We carried out a prospective cohort study to evaluate the risk factors of functional disability by depressive state. Methods: A total of 783 men and women, aged 70 years and over, participated in this study. We followed the participants in terms of the onset of functional disability by using a public long‐term care insurance database. The Geriatric Depression Scale (GDS) was used to measure depressive state. Age, sex, history of chronic disease, living alone, fall experience, cognitive impairment, instrumental activities of daily living (IADL), the Motor Fitness Scale (MFS), frequency of going out and social support at baseline were used as the main covariates. The Cox regression analysis was used to examine the difference in functional disability stratified according to depressive state. Results: The incidence of functional disability was 38 persons in the non‐depression group and 42 persons in the depression group (RR 2.34; 95% CI 1.46–3.79). The results of the depression group showed a significant difference in cognitive impairment (HR 3.51; 95% CI 1.39–8.85), MFS (HR 5.60; 95% CI 1.32–23.81) and IADL (HR 3.37; 95% CI 1.65–6.85). The results of the non‐depression group showed a significant difference in MFS (HR 2.97; 95% CI 1.47–6.96), and frequency of going out (HR 3.21; 95% CI 1.47–6.96). Conclusions: In conclusion, risk factors for functional disability were found to differ on the basis of whether or not community‐dwelling elderly individuals experience depressive state. The type of support offered must be based on whether or not depressive state is present. Geriatr Gerontol Int 2012; ??: ??–?? .     

What Level of Alcohol Consumption Is Hazardous for Older People? Functioning and Mortality in U.S. and English National Cohorts

OBJECTIVES: To estimate disability plus mortality risks in older people according to level of alcohol intake. DESIGN: Two population-based cohort studies. SETTING: The Health and Retirement Study (United States) and the English Longitudinal Study of Aging (England). PARTICIPANTS: Thirteen thousand three hundred thirty-three individuals aged 65 and older followed for 4 to 5 years. MEASUREMENTS: Difficulties with activities of daily living (ADLs), instrumental activities of daily living (IADLs), poor cognitive function, and mortality. RESULTS: One-tenth (10.8%) of U.S. men, 28.6% of English men, 2.9% of U.S. women, and 10.3% of English women drank more than the U.S. National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older. Odds ratios (ORs) of disability, or disability plus mortality, in subjects drinking an average of more than one to two drinks per day were similar to ORs in subjects drinking an average of more than none to one drink per day. For example, those drinking more than one to two drinks per day at baseline had an OR of 1.0 (95% confidence interval (CI)=0.8-1.2) for ADL problems, 0.7 (95% CI=0.6-1.0) for IADL problems, and 0.8 (95% CI=0.6-1.1) for poor cognitive function. Findings were robust across alternative models. The shape of the relationship between alcohol consumption and risk of disability was similar in men and women. CONCLUSION: Functioning and mortality outcomes in older people with alcohol intakes above U.S. recommended levels for the old but within recommendations for younger adults are not poor. More empirical evidence of net benefit is needed to support screening and intervention efforts in community-living older people with no specific contraindications who drink more than one to two drinks per day.     

Disability and Incident Coronary Heart Disease in Older Community‐Dwelling Adults: The Three‐City Study

OBJECTIVES: To prospectively assess the association between disability and incident fatal and nonfatal coronary heart disease (CHD) in older adults free of cardiovascular disease (CVD). DESIGN: A French multicenter prospective population‐based cohort of 9,294 subjects, aged 65 and older at baseline, recruited between 1999 and 2001 and followed for 6 years. SETTING: Three cities in France: Bordeaux in the southwest, Dijon in the northeast, and Montpellier in the southeast. PARTICIPANTS: Seven thousand three hundred fifty‐four participants with no history of CVD and with available information on disability status. Subjects were categorized at baseline as having no disability, mild disability (mobility only), and moderate or severe disability (mobility plus activities of daily living or instrumental activities of daily living). MEASUREMENTS: Incident fatal and nonfatal coronary events (angina pectoris, myocardial infarction, revascularization procedures, and CHD death). RESULTS: At baseline, the mean level of the risk factors increased gradually with the severity of disability. After a median follow‐up of 5.2 years, 264 first coronary events, including 55 fatal events, occurred. After adjustment for cardiovascular risk factors, participants with moderate or severe disability had a 1.7 times (95% confidence interval (CI)=1.0–2.7) greater risk of overall CHD than nondisabled subjects, whereas those with mild disability were not at greater CHD risk. An association was also found with fatal CHD, for which the risk increased gradually with the severity of disability (hazard ratio (HR)_{mild disability}=1.7, 95% CI=0.8–3.6; HR_{moderate/severe disability}=3.5, 95% CI=1.3–9.3; P for trend=.01). CONCLUSION: In older community‐dwelling adults, the association between disability and incident CHD is mostly due to an association with fatal CHD.     

Disparities between black and white patients in functional improvement after hospitalization for an acute illness

The aim of this study was to determine whether older black and white patients experience different rates of improvement in functioning after being acutely hospitalized. Of the 2,364 community-living patients in this prospective cohort study, 25% self-reported their race/ethnicity to be black. The outcomes were improvement in basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) from admission to discharge and 90 days postdischarge. Multivariable models that included statistical adjustment for age, illness severity, in-hospital social service referral, dementia, admission level of functioning, and change in functioning from 2 weeks before admission were computed to determine whether black and white patients experienced significantly different rates of recovery at discharge and 90 days after discharge in ADL and IADL functioning. Black patients were as likely as white patients to improve in ADL functioning by discharge (odds ratio (OR)=0.97, 95% confidence interval (CI)=0.76-1.24) or by 90 days after discharge (OR=0.95, 95% CI=0.73-1.24) but significantly less likely to improve IADL functioning by discharge (OR=0.72, 95% CI=0.56-0.93) or by 90 days after discharge (OR=0.68, 95% CI=0.51-0.90). The findings suggest that differential rates of recovery in functioning after an acute hospitalization may contribute to racial/ethnic disparities in IADL functioning, which has implications for the setting of future interventions oriented toward reducing these disparities.