Excess mortality attributable to hip fracture in white women aged 70 years and older.

OBJECTIVE: The purpose of this study was to estimate the excess mortality attributable to hip fracture. METHODS: The 6-year survival rate of community-dwelling White female hip fracture patients aged 70 years and older entering one of seven hospitals from 1984 to 1986 (n = 578) was compared with that of White female respondents aged 70 years and older interviewed in 1984 for the Longitudinal Study on Aging (n = 3773). RESULTS: After age, education, comorbidity, and functional impairment were controlled, the mortality differential between the two groups accumulated to an excess among hip fracture patients of 9 deaths per 100 women 5 years postfracture. Among those with three or more functional impairments or one or more comorbidities, the excess was 7 deaths per 100: the effect of the fracture had disappeared in these groups by 4 years. In contrast, those with two or fewer impairments and those with no comorbidities had a continuing trend of increased mortality, with an excess of 14 deaths per 100 by 5 years. CONCLUSIONS: There is an immediate increase in mortality following a hip fracture in medically ill and functionally impaired patients, whereas among those with no comorbidities and few impairments, there is a gradual increase in mortality that continues for 5 years postfracture.     

The relationship between hip fracture and water fluoridation: an analysis of national data

Data from the 1973-1977 National Health Interview Surveys were used to determine whether water fluoridation prevents hip fractures related to osteoporosis. No protective effect was found for fluoride levels of 0.7 ppm, the level recommended for the prevention of dental caries. There are some indications that higher concentrations of fluoride might have a protective effect for groups with a high incidence of osteoporosis. However, no determination of the actual levels needed or the possible adverse effects of high water fluoride levels could be made.     

Seasonal variation in the incidence of hip fracture among white persons aged 65 years and older in the United States, 1984-1987

This study uses 44 consecutive months of data from the Health Care Financing Administration to assess seasonal trends in hip fracture incidence among the United States white population aged 65 years and older. The authors studied a total of 621,387 cases of hip fracture which occurred from January 1984 to September 1987. During the study period, hip fracture incidence rates display a distinctive pattern of seasonal periodicity; high rates are found in the winter and low rates in the summer among both males and females. This pattern of seasonal periodicity is consistent at ages 65-74 years, 75-84 years, and greater than or equal to 85 years. When the time series of rates are stratified into five geographic levels, each level covering 5 degrees of latitude, the distinctive pattern of seasonal periodicity is the same for all levels.     

A two-step intervention of increase mammography among women aged 65 and older.

OBJECTIVES: This study evaluated a two-step intervention for mammography screening among older women. METHODS: Four hundred and sixty women, identified from physician practices, were randomized to a control or a two-step intervention (physician letter and peer counseling call) group. Women in the intervention group who obtained a mammogram received a grocery coupon. RESULTS: Over the 12 months of the study, more women in the intervention group than in the control group obtained mammograms (38% vs 16%). The most dramatic difference was in the higher odds that women in the intervention group would obtain a mammogram within 2 months (odds ratio = 10.5). CONCLUSIONS: The intervention significantly increased screening mammography. Future efforts must be multifaceted and incorporate the unique concerns of older women.     

中国65岁及以上老年人睡眠时长对认知障碍影响的队列研究

目的:探讨我国老年人睡眠时长对认知障碍发生风险的影响。方法:将2005年中国老年健康影响因素跟踪调查招募的9 679名认知完好老年人的调查信息作为基线数据,随访该队列人群至2018年,采用Cox比例风险回归模型分析老年人的不同睡眠时长与其认知障碍发生风险的关联。结果:与睡眠时长为6 h的老年人比较,睡眠时长≤5 h的老...     

Treatment of metastatic breast cancer in women aged 65 years and older

Breast cancer is a disease of aging and the incidence of breast cancer increases dramatically with increasing age. In spite of major advances in prevention, screening and treatment approximately 40,000 Americans still die of metastatic breast cancer every year--the majority being women aged 65 years and older. Metastatic breast cancer remains incurable regardless of age and the goals of treatment are to reduce symptoms when present and to provide the patient with the best quality of life for as long as possible. Cornerstones of treatment to control metastases include endocrine therapy, chemotherapy and radiation therapy. Supportive care that includes psychosocial support and treatment of pain is also a key component of management. This review focuses on the issues related to the care of older women with metastatic breast cancer.     

Risk factors for hip fracture in US men aged 40 through 75 years.

Relatively few studies have examined risk factors for hip fracture among men. This study analyzes data from the Health Professionals Follow-up Study, a prospective study of approximately 50,000 men who were between the ages of 40 and 75 years in 1986. Body mass index, smoking status, and alcohol consumption were not associated with hip fracture in this population. However, age and height were related to hip fracture. Men who were 65 and older had a significantly higher risk of sustaining a hip fracture than younger adults. Men 6 feet or taller were more than twice as likely to sustain a hip fracture as those under 5 feet, 9 inches.     

An intervention study on screening for breast cancer among single African-American women aged 65 and older

BACKGROUND: Older African-American women with single marital status are least likely to use screening procedures. This study aimed to evaluate a breast screening intervention program conducted in this population. METHODS: Ten public housing complexes were randomly assigned to either the intervention or the control group. African-American women aged 65 and over were recruited into the study if they were widowed, divorced, separated, or never married and did not have a history of breast cancer (n = 325). The intervention program was delivered by lay health educators at the participant's apartment and was designed to increase knowledge about breast screening, reduce psychological problems, and increase support from significant others. Breast-screening-related cognition and behavior were measured at baseline and at 1 and 2 years postintervention. RESULTS: Comparisons of the preintervention and postintervention measurements showed that while the proportion of women who had a clinical breast examination or mammogram in the preceding year was decreased at 1 year postintervention in the control group, it was increased in the intervention group. However, the differences did not reach a significant level. No consistent patterns could be found in changes of breast self-examination and variables in knowledge, attitudes, and beliefs. When analyses were restricted to women whose significant others had provided information or help on breast screening, results were better, but the differences between the intervention and control groups still did not reach statistical significance. CONCLUSIONS: These results did not suggest significant effects of an intervention program that used lay health educators to promote breast cancer screening in older single African-American women.     

An intervention study on screening for breast cancer among single african-american women aged 65 and older

PURPOSE: Older single African-American women are the population that is least likely to use screening procedures because of cognition-related, income-related, social-support-related and medical care-related barriers. This study aims to evaluate a breast screening intervention program developed according to socioeconomic, cultural, psychological and behavioral characteristics of older single African-American women.METHODS: Ten public housing complexes were randomly assigned to either intervention or control group. African-American women aged 65 and over were recruited into the study if they were widowed, divorced, separated or never-married in the preceding year, and did not have a history of breast cancer (n = 325). Delivered by lay health educators, the intervention program targeted increasing knowledge on breast health and breast screening, reducing emotional or psychological problems, and increasing support from the significant others of study women. Breast screening-related cognition and behavior were measured at pre-intervention and post-intervention.RESULTS: Comparisons of the pre-intervention and post-intervention measurements showed that while the proportion of women who had a clinical breast examination or mammogram in the preceding year was decreased at the post-intervention in the control group, it was increased in the intervention group. However, the differences did not reach a significant level. No consistent patterns could be found in changes of variables in knowledge, attitudes and beliefs. These results remained similar when potential confounding factors were adjusted using mixed model regression analyses.CONCLUSIONS: These results did not suggest significant effects of an intervention program which used lay health educators to promote breast cancer screening in older single African-American women.     

Serum cholesterol and 20-year mortality in black and white men and women aged 65 and older in the Evans County Heart Study.

Serum cholesterol and 20-year mortality rates were studied in 396 Evans County black and white men and women who were 65 years and older and free of prevalent coronary heart disease (CHD) at baseline examination in 1960 to 1962. Previous reports on Evans County men and women younger than 65 found cholesterol levels to be significantly associated with all-cause and CHD mortality in white men, with CHD mortality in black men, and with cardiovascular disease mortality in white women. The independent role of total serum cholesterol as a predictor of CHD and all-cause mortality in the 65-and-older age group was evaluated using Cox proportional hazards models. Among white men, serum cholesterol level was positively associated with CHD mortality (relative risk of 1.54, P < 0.05 for an increment of 40 mg/dL [1.03 mmol/L], or one standard deviation in cholesterol). A significant J-shaped relationship of cholesterol with all-cause mortality was found among white men. Among black women, cholesterol was negatively associated with all-cause mortality. Neither all-cause nor CHD mortality was related to serum cholesterol among black men or white women. Although based on small numbers, the results of this study suggest that in Evans County, total serum cholesterol is an independent predictor of mortality in white men aged 65 and over, while these results should not be generalized to other race-gender groups in this cohort.     

Body mass and risk of hip fracture among a national cohort of postmenopausal white women: a reanalysis

To assess the prospective relationship between body mass and rate of hip fracture, we analyzed data from 2,285 postmenopausal women, aged 50-77 years, who responded to the first National Health and Nutrition Examination Survey (NHANES I) in 1971-1974 and the 1982-84 interview of the National Health Epidemiologic Follow-up Study (NHEFS). We plan to add to the previous analysis of these same data by Farmer et al. by 1) including retrospective information on estrogen replacement therapy; 2) increasing the follow-up time by 5 years and using only hospital-verified cases of hip fracture from the 1987 Health Care Facilities Stay data tape; and 3) limiting the analysis to postmenopausal white women, ages 50-77 years. Results of the multivariable Cox regression modeling showed that women with a baseline body mass index in the highest quartile (> 37 kg/m1.5) experienced a 70% lower rate of hip fracture compared with women in the lowest quartile (< or = 28.7 kg/m1.5)(RR=0.32; 95%CI:0.12, 0.82). Age was positively related to the risk of hip fracture, with the rate over 20% higher per year of age (RR=1.21; 95%CI:1.13, 1.29). Although reported education level, smoking history, physical activity level, and estrogen replacement were significantly (p < 0.0001) associated with body mass index, these covariates were not related to hip fracture in the multivariable analysis. Our findings corroborate earlier results using this same data source, and suggest that interventions aimed at preserving lean mass and consequent bone integrity should be encouraged among women before menopause and maintained through older adulthood.     

A cost-utility analysis of multivitamin and multimineral supplements in men and women aged 65 years and over

BACKGROUND & AIMS: As people age there is a progressive dysregulation of the immune system that may lead to an increased risk of infections, which may precipitate hospital admission in people with chronic heart or respiratory diseases. Mineral and vitamin supplementation in older people could therefore influence infections in older people. However, the evidence from the available randomised controlled trials (RCTs) is mixed. The aim of the study was to assess the relative efficiency of multivitamin and multimineral supplementation compared with no supplementation. METHODS: Cost-utility analysis alongside an RCT. Participants aged 65 years or over from six general practices in Grampian, Scotland, were studied. They were randomised to one tablet daily of either a multivitamin and multimineral supplement or matching placebo. Exclusion criteria were use of mineral, vitamin or fish oil supplements in the previous 3 months (1 month for water soluble vitamins), vitamin B12 injection in the last 3 months. RESULTS: Nine hundred and ten participants were recruited (454 placebo and 456 supplementation). Use of health service resources and costs were similar between the two groups. The supplementation arm was more costly although this was not statistically significant ( pound15 per person, 95% CI-3.75 to 34.95). After adjusting for minimisation and baseline EQ-5D scores supplementation was associated with fewer QALYs per person (-0.018, 95% CI-0.04 to 0.002). It was highly unlikely that supplementation would be considered cost effective. CONCLUSIONS: The evidence from this study suggests that it is highly unlikely that supplementation could be considered cost effective.     

The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian communities.

OBJECTIVES. The purpose of this study was to compare hip fracture hospitalization rates between a fluoridated and a non-fluoridated community in Alberta, Canada: Edmonton, which has had fluoridated drinking water since 1967, and Calgary, which considered fluoridation in 1991 but is currently revising this decision. METHODS. Case subjects were all individuals aged 45 years or older residing in Edmonton or Calgary who were admitted to hospitals in Alberta between January 1, 1981, and December 31, 1987, and who had a discharge diagnosis of hip fracture. Edmonton rates were compared with Calgary rates, with adjustment for age and sex using the Edmonton population as a standard. RESULTS. The hip fracture hospitalization rate for Edmonton from 1981 through 1987 was 2.77 per 1000 person-years. The age-sex standardized rate for Calgary was 2.78 per 1000 person-years. No statistically significant difference was observed in the overall rate, and only minor differences were observed within age and sex subgroups, with the Edmonton rates being higher in males. CONCLUSIONS. These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture.     

Influenza vaccination: the persuasiveness of messages among people aged 65 years and older

About 90% of all influenza-related deaths occur among people aged 65 years and older. Vaccination remains the primary option for preventing influenza infection. This study examined the efficacy of messages designed to increase the uptake of influenza vaccination. Two messages, narrative and didactic, were created based on the Extended Parallel Process Model (EPPM). The study employed a one-factor between-subjects experimental design with participants assigned randomly to three conditions: no message, didactic communication, and narrative communication. Participants were 311 Italian people aged 65 years or older. The results showed that, compared to no message and didactic communication, narrative communication was related to higher risk perception of influenza, to higher perception of the efficacy of the vaccine, and to self-efficacy related to vaccination, controlling for social trust, previous flu shot, and demographic variables. There were no differences among the three conditions with respect to the intention to receive the influenza vaccine. Findings suggest that narrative communication based on EPPM may have a persuasive effect on people aged 65 years or older.     

中国65岁及以上老年人睡眠时长与认知功能受损的关联研究

目的探索我国65岁及以上老年人每日睡眠时长与认知功能受损之间的关联。方法数据来自中国老年健康影响因素跟踪调查在2017-2018年调查的数据集,最终共纳入14966名研究对象,同时收集社会经济状况、社会参与、行为、饮食营养、生活习惯、家庭结构、疾病状况、心理健康、认知功能等数据。用简易精神状态评价量表(MMSE)评价老年人的认知功能。采用广义线性混合效应模型分析睡眠时长与认知功能受损之间的关联,并进一步分析不同年龄组(65~79岁、80~89岁、90~99岁和≥100岁)、性别研究对象睡眠时长和认知功能受损间的关联。结果14966名研究对象中,65~79岁、80~89岁、90~99岁和≥100岁的研究对象分别有5148名(34.40%)、3777名(25.24%)、3322名(22.20%)和2719名(18.16%);女性有8455名(56.49%);每日睡眠时长≤5 h和≥9 h的老年人分别有2704名(18.94%)和3883名(27.19%);认知功能受损者有3748名(25.04%)。广义线性混合效应模型的结果显示,与自报每日睡眠时长为7 h者相比,睡眠时长≤5 h和睡眠时长≥9 h与认知功能受损有关联,OR值(95%CI)分别为1.35(1.09~1.68)和1.70(1.39~2.07)。分层分析的结果显示,睡眠时长与认知功能受损之间的关联在65~79岁老年人和男性老年人中更为显著。结论老年人睡眠时长过短或过长可增加认知功能受损的发生风险。     

The effects of gender and age on associations between blood lipid levels and obesity in Danish men and women aged 35-65 years.

The purpose of the study was to assess the influence of gender and age on the associations between different measures of obesity, and blood lipid levels. Overall obesity (body fat, body fat percentage and body mass index) or abdominal obesity (waist/hip-ratio, waist/thigh-ratio and waist-circumference) and lipid levels [high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), total cholesterol and triglyceride level] were measured in 1987/88 in a random Danish population sample of men and women (N = 2987), aged 35, 45, 55 and 65 yr. All lipid levels were dependent on gender and age. The associations between most measures of obesity and HDL or LDL were independent of gender and age, whereas, with a few exceptions, associations between measures of obesity and total cholesterol, VLDL or triglycerides were dependent on gender and/or age. Compared to levels of HDL, LDL and total cholesterol, abdominal obesity specifically affected levels of VLDL or triglycerides, whereas overall obesity affected HDL, LDL, VLDL, total cholesterol and triglyceride levels more evenly. When men and women were compared, associations between the measures of obesity and blood lipids were stronger in men than in women of the same age, except for the associations between measures of abdominal obesity and VLDL or triglycerides in 45-year-old women. No age trend was found for associations between the measures of obesity and VLDL or triglycerides, whereas young age-groups showed stronger associations between obesity and total cholesterol than older age-groups. Failure to consider age/gender effects induces bias and may lead to misleading conclusions regarding the bivariate association between obesity and lipids, and further may make results from population studies incomparable.     

中国65岁及以上老年人睡眠时长与其认知障碍风险的关联研究

目的 探讨我国老年人睡眠时长与认知障碍患病风险的关联。方法 数据来源于2018年中国老年健康影响因素跟踪调查（CLHLS），按照中文版简易智力状态检查测试量表（CMMSE）将7 111例≥ 65岁老年人分为认知障碍组和认知正常组，使用多因素logistic回归模型分析睡眠时长与认知障碍患病风险之间的关联。结果 研究对象的CMMSE得分随睡眠时长呈倒"U"形分布；调整了人口学、社会经济因素、生活方式和健康状况后，与睡眠时长为7 h的老年人相比，睡眠时长为8 h和≥ 9 h的老年人患认知障碍的OR值分别为1.21（95%CI：0.90~1.64）和1.41（95%CI：1.06~1.86），趋势检验显示，随着睡眠时间延长（>7 h）老年人患认知障碍的风险增加，且存在剂量反应关系（趋势性P=0.017），而睡眠时间<7 h的老年人与认知障碍发生风险无关。结论 我国≥ 65岁老年人的睡眠时间过长与其认知障碍患病风险存在关联。     

Surveillance of COVID-19 vaccine safety among elderly persons aged 65 years and older

BackgroundMonitoring safety outcomes following COVID-19 vaccination is critical for understanding vaccine safety especially when used in key populations such as elderly persons age 65 years and older who can benefit greatly from vaccination. We present new findings from a nationally representative early warning system that may expand the safety knowledge base to further public trust and inform decision making on vaccine safety by government agencies, healthcare providers, interested stakeholders, and the public.MethodsWe evaluated 14 outcomes of interest following COVID-19 vaccination using the US Centers for Medicare & Medicaid Services (CMS) data covering 30,712,101 elderly persons. The CMS data from December 11, 2020 through Jan 15, 2022 included 17,411,342 COVID-19 vaccinees who received a total of 34,639,937 doses. We conducted weekly sequential testing and generated rate ratios (RR) of observed outcome rates compared to historical (or expected) rates prior to COVID-19 vaccination.FindingsFour outcomes met the threshold for a statistical signal following BNT162b2 vaccination including pulmonary embolism (PE; RR = 1.54), acute myocardial infarction (AMI; RR = 1.42), disseminated intravascular coagulation (DIC; RR = 1.91), and immune thrombocytopenia (ITP; RR = 1.44). After further evaluation, only the RR for PE still met the statistical threshold for a signal; however, the RRs for AMI, DIC, and ITP no longer did. No statistical signals were identified following vaccination with either the mRNA-1273 or Ad26 COV2.S vaccines.InterpretationThis early warning system is the first to identify temporal associations for PE, AMI, DIC, and ITP following BNT162b2 vaccination in the elderly. Because an early warning system does not prove that the vaccines cause these outcomes, more robust epidemiologic studies with adjustment for confounding, including age and nursing home residency, are underway to further evaluate these signals. FDA strongly believes the potential benefits of COVID-19 vaccination outweigh the potential risks of COVID-19 infection.