Inflammation biomarkers and near-term death in older men

Associations of C-reactive protein (CRP) and fibrinogen with death may weaken over time. Combining both markers may improve prediction of death in older adults. In 5,828 Cardiovascular Health Study participants (United States, 1989-2000), 383 deaths (183 cardiovascular disease (CVD)) in years 1-3 (early) and 914 deaths (396 CVD) in years 4-8 (late) occurred. For men, when comparing highest to lowest quartiles, hazard ratios for early death were 4.1 (95% confidence interval (CI): 2.7, 6.3) for CRP and 4.1 (95% CI: 2.7, 6.4) for fibrinogen in models adjusted for CVD risk. For early CVD death, hazard ratios were 4.3 (95% CI: 2.2, 8.4) and 3.4 (95% CI: 1.8, 6.3), respectively. When comparing men in the highest quartiles of both biomarkers with those in the lowest, hazard ratios were 9.6 (95% CI: 4.3, 21.1) for early death and 13.5 (95% CI: 3.2, 56.5) for early CVD death. Associations were weaker for late deaths. For women, CRP (hazard ratio = 2.3, 95% CI: 1.4, 3.9), but not fibrinogen (hazard ratio = 1.3, 95% CI: 0.8, 2.2), was associated with early death. Results were similar for CVD death. Neither was associated with late deaths. CRP and fibrinogen were more strongly associated with death in older men than women and more strongly associated with early than late death. Combining both markers may identify older men at greatest risk of near-term death.     

Longitudinal changes in radial bone density in older men

OBJECTIVE: To examine changes in radial bone density and biochemical status, with particular reference to calcium, over 18 months in a group of older men. SUBJECTS: Thirty-six healthy men (aged 66 76 y) were recruited to the study during July and August, 1993. These men were free-living residents of Edmonton who were recruited through local organizations for the retired and semi-retired. Data for the younger group of men (age 29-60 y) were taken from a previous study conducted in our laboratory. DESIGN: using special-purpose computed tomography (gammaCT), trabecular (TBD), cortical (CBD) and integral (IBD) bone densities (gm/cm3) were measured in the ultra-distal radius at 6-month intervals over 18 months. At baseline, and at each subsequent study visit, serum was obtained from each subject for determinations of calcium, phosphate, 25-hydroxyvitamin D, alkaline phosphatase, and immunoreactive parathyroid hormone. A 24-h urine sample was also obtained at each study visit for determination of urinary calcium, phosphate and creatinine. RESULTS: In repeated measures analysis of variance of the data for the older men serum 25-hydroxyvitamin D was significantly decreased (P<0.001) over time, while TBD was increased (+0.60% per year, P<0.01). Longitudinal rates of change for TBD, CBD and IBD were: -0.94%, 0.92% and 0.74% per year respectively when bone density data at baseline for the older men and the historical data for younger men were combined. However, separate analyses of the data for the younger and the older men indicated no significant age-related changes in bone density for men aged 29-60 y, or for men aged 66-76 y. However, differences in TBD, CBD and IBD between the younger and older groups of men were significant (P < 0.001). CONCLUSIONS: In a group (n = 36) of older men (mean age 71.7 y) studied longitudinally over 18 months, bone density in the distal radius did not decrease over time. Mean bone density in this group of men was, however, significantly (P < 0.001) lower than in a group of younger men (n = 17, mean age 46.7 y). Regression analysis using cross-sectional bone density data at baseline for the older male group, and historical data for the younger male group, indicates that bone loss occurs with increasing age at a rate of about 1% per year averaged over ages 29-76 y. Bone density variables were not correlated with either height or weight, or with any biochemical or hormonal variable measured in this study.     

Suicide in older men: The health in men cohort study (HIMS)

Suicide rates are high in later life, particularly among older men. Mood disorders are known risk factors, but the risk of suicide associated with poor physical health remains unclear. We completed a cohort study of a community representative sample of 38,170 men aged 65–85 in 1996 who were followed for up to 16 years. Data on suicide attempts and completion were obtained from the Western Australia Data Linkage System, as was information about medical and mental health diagnoses. 240 (0.6%) participants had a recorded history of past suicide attempt, most commonly by poisoning (85%). Sixty-nine men died by suicide during follow up (0.3% of all deaths), most often by hanging (50.7%). Age-adjusted competing risk regression showed that past suicide attempt was not a robust predictor of future suicide completion (sub-hazard ratio, SHR = 1.58, 95% CI = 0.39, 6.42), but bipolar (SHR = 7.82, 95% CI = 3.08, 19.90), depressive disorders (SHR = 2.26, 95% CI = 1.14, 4.51) and the number of health systems affected by disease (SHR for 3–4 health systems = 6.02, 95% CI = 2.69, 13.47; SHR for ≥ 5 health systems = 11.18, 95% CI = 4.89, 25.53) were. The population fraction of suicides attributable to having 5 or more health systems affected by disease was 79% (95% CI = 57%, 90%), and for any mood disorder (bipolar or depression) it was 17% (95% CI = 3%, 28%). Older Australian men with multiple health morbidities have the highest risk of death by suicide, even after taking into account the presence of mood disorders. Improving the overall health of the population may be the most effective way of decreasing the rates of suicide in later life.     

骨质疏松症健康信念量表的信度和效度测定

目的了解骨质疏松症住院患者对骨质疏松预防相关的危险因素、运动及摄钙基本知识的掌握,在此基础上采用因人制宜的健康教育方式,探讨健康教育对患者骨质疏松预防知识掌握的影响。方法对60例老年女性骨质疏松住院患者进行骨质疏松知识问卷调查,根据问卷调查结果有针对性对骨质疏松预防相关的危险因素、运动及摄钙知识进行宣教,比较宣教前后患者对骨质疏松预防知识认知变化情况。结果患者对骨质疏松预防危险因素知识由5.06分提高到8.20分、危险因素知识答对率由44.93%提高到74.53%;运动知识由2.68分提高到4.76分、运动知识答对率由38.30%提高到67.98%;摄钙知识由1.70分提高到4.96分、摄钙知识答对率由20.80%提高到62.00%;骨质疏松整体预防知识由9.42分提高到17.88分、骨质疏松整体预防知识答对率由34.26%提高到67.77%。差异均显著(P < 0.01)。结论老年女性骨质疏松患者对于骨质疏松预防知识认识普遍不足,经因人制宜的宣教干预后,患者对骨质疏松症危险因素认识、运动和摄钙知识水平显著提高,健康宣教对于提高骨质疏松症患者预防知识的掌握切实有效。     

Driving habits and patterns in older men with glaucoma

Glaucoma, an eye disorder that gradually decreases peripheral vision, affects millions of older adults. Consequences of glaucoma can mean changes in the ability to perform familiar tasks, including driving an automobile. We surveyed older drivers with glaucoma and a control comparison group in order to learn more about their driving habits and expectations about driving cessation. Findings indicate that compared to the control group, drivers with glaucoma are significantly more likely to change their driving habits with regard to driving at night (p=0.003), on freeways (p=0.05), and in unfamiliar areas (p=0.01). Drivers with glaucoma were also significantly more likely to report family concern about their driving (p=0.01). However, the drivers with glaucoma did not anticipate that their disease would force them to discontinue driving. Social workers play a pivotal role in coordinating the complex care needs of visually impaired elders. When driving skills are affected, social workers must address transportation, housing as well as quality of life concerns.     

The hormonal pathway to cognitive impairment in older men

In older men there is a multiple hormonal dysregulation with a relative prevalence of catabolic hormones such as thyroid hormones and cortisol and a decline in anabolic hormones such as dehydroepiandrosterone sulphate, testosterone and insulin like growth factor 1 levels. Many studies suggest that this catabolic milieu is an important predictor of frailty and mortality in older persons. There is a close relationship between frailty and cognitive impairment with studies suggesting that development of frailty is consequence of cognitive impairment and others pointing out that physical frailty is a determinant of cognitive decline. Decline in cognitive function, typically memory, is a major symptom of dementia. The "preclinical phase" of cognitive impairment occurs many years before the onset of dementia. The identification of relevant modifiable factors, including the hormonal dysregulation, may lead to therapeutic strategies for preventing the cognitive dysfunction. There are several mechanisms by which anabolic hormones play a role in neuroprotection and neuromodulation. These hormones facilitate recovery after brain injury and attenuate the neuronal loss. In contrast, elevated thyroid hormones may increase oxidative stress and apoptosis, leading to neuronal damage or death. In this mini review we will address the relationship between low levels of anabolic hormones, changes in thyroid hormones and cognitive function in older men. Then, giving the contradictory data of the literature and the multi-factorial origin of dementia, we will introduce the hypothesis of multiple hormonal derangement as a better determinant of cognitive decline in older men.     

Reproducibility of a diet history in older men in Hawaii

A diet history method was tested for reproducibility among 106 older men from the five major ethnic groups (Japanese, Caucasian, Hawaiian, Filipino, and Chinese) of Hawaii. The questionnaire, administered by trained interviewers, was designed to estimate the dietary intakes of total and saturated fat, cholesterol, vitamin A, beta-carotene, vitamin C, and zinc. Subjects were asked to recall their usual frequencies and amounts of consumption during a usual month of more than 100 food items, along with the intake of seasonal foods with a high vitamin A content. A second interview was conducted 1-14 months later to obtain a diet history covering the same time period as the first interview. The same questionnaire was utilized in both interviews. The effects of ethnicity, age, and recall interval (period between the diet reference date and initial interview) on the reproducibility of nutrient intakes were examined. The intraclass correlation coefficient (rI) and the weighted kappa statistic (Kw) were used to assess agreement. The overall levels of reproducibility were relatively good. Neither ethnicity, age, nor length of recall period had a major effect on reproducibility. The data suggested that this diet history method is an appropriate instrument for estimating the usual dietary intakes of a healthy heterogeneous group of older men in Hawaii.     

Lead exposure biomarkers and mini-mental status exam scores in older men

BACKGROUND: Lead is neurotoxic; yet, whether cognitive decline in older persons is associated with lead exposure is unknown. We studied whether lead exposure biomarkers are associated with cognitive test scores, as well as the modifying effects of age on the lead-cognition relationship. METHODS: Lead exposure biomarkers and Mini-Mental Status Exam (MMSE) scores were measured among subjects in the Normative Aging Study. Multiple linear and logistic regression analyses were performed to examine the cross-sectional association of these 2 variables. RESULTS: We found an odds ratio (OR) of 2.1 for MMSE <24 with an increase from the lowest to the highest quartile of patella lead levels (95% confidence interval [CI] = 1.1 to 4.1). From the lowest to the highest quartile of blood lead the OR for low MMSE was 3.4 (CI = 1.6 to 6.2). There was an interaction between lead biomarkers and age. Among subjects in the lowest quartile of patella lead levels, MMSE score decreased by 0.03 points per year (CI = -0.07 to 0.005), whereas in the highest quartile, MMSE score decreased by 0.13 points per year (CI = -0.19 to -0.07). Similar interactions were found between blood lead levels and age. CONCLUSIONS: Increased levels of lead in bone and blood are inversely associated with cognitive performance among older men. Lead exposure might accelerate age-associated cognitive decline.     

Echographic screening of the abdominal aorta in older men is useful

Ultrasound detection of abdominal aortic aneurysm (AAA) in men aged 65 years or older meets the WHO criteria for screening. Evidence shows a 50% reduction of AAA-related mortality and the costs per life-year gained are acceptable. AAA-screening is not only recommended in the USA and UK but in the Netherlands as well.     

Atherosclerosis and physical functioning in older men, a longitudinal study

Objective

Functional decline is a major threat to independency, progressing into functional limitations and eventually leading to disability. Chronic diseases, especially cardiovascular diseases, are important determinants of functional limitations and disability. Vascular damage exits long before it is clinically manifest and can have adverse effects on health, physical and cognitive functioning. The objective was to investigate the association between non-invasive atherosclerosis measures and physical functioning in older men.

Design

Prospective cohort study.

Setting

The study was conducted in the general community.

Participants

195 independently living older men.

Measurements

Atherosclerosis was measured by intima media thickness (CIMT) of the common carotid artery using ultrasonography and assessment for presence of atherosclerotic plaques. Physical functioning was measured by isometric handgrip strength and leg extensor strength using a hand held dynamometer, lower extremity function using the physical performance score and ability to perform activities of daily life using the modified Stanford Health Assessment Questionnaire. Linear regression analysis was performed to estimate the associations between CIMT or plaques and physical functioning.

Results

After adjustment for confounders, higher baseline CIMT was associated with lower isometric handgrip strength at follow up (β^CIMT =?7.21, 95% CI[?13.64;?0.77]). No other associations were found between CIMT and physical functioning. In addition, no associations were found for the presence of plaques and physical functioning either at baseline, or at follow-up.

Conclusion

Atherosclerosis, as measured by higher CIMT, is related to a lower isometric handgrip strength at follow-up, but no further associations with physical functioning were found in this longitudinal study among independently living older men.