Association of diuretic use and overactive bladder syndrome in older adults: a propensity score analysis

Diuretic use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n=172) had a mean age of 79+/-7.5 (+/-S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients, respectively, reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio (OR)=3.48; 95% confidence interval (CI)=1.73-7.03) and urgency (74% versus 57% non-diuretic; OR=2.17; 95% CI=1.11-4.24) but not with incontinence (OR=1.74; 95% CI=0.87-3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR=3.09; 95% CI=1.20-7.97) and urgency (adjusted OR=2.50; 95% CI=1.00-6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR=2.54; 95% CI=1.09-5.91), which lost significance after propensity adjustment (adjusted OR=1.88; 95% CI=0.57-6.17). Overall summary mean Urge-IIQ score was 1.83+/-0.85 with 1.75+/-0.86, 1.68+/-0.76, and 2.03+/-0.88, respectively, for no diuretic, non-loop, and loop-diuretic patients (one-way analysis of variance (ANOVA) p=0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use.     

Prevalence and Correlates of Nocturia in Community‐Dwelling Older Adults

OBJECTIVES: To determine the prevalence and correlates of nocturia in community‐dwelling older adults. DESIGN: Planned secondary analysis of cross‐sectional data from the University of Alabama at Birmingham Study of Aging population‐based survey. SETTING: Participants' homes. PARTICIPANTS: One thousand older adults (aged 65–106) recruited from Medicare beneficiary lists between 1999 and 2001. The sample was selected to include 25% each African‐American women, African‐American men, white women, and white men. MEASUREMENTS: In‐person interviews included sociodemographic information, medical history, Mini‐Mental State Examination (MMSE) score, and measurement of body mass index (BMI). Nocturia was defined in the main analyses as rising two or more times per night to void. RESULTS: Nocturia was more common in men than women (63.2% vs 53.8%, odds ratio (OR)=1.48, 95% confidence interval (CI)=1.15–1.91, P=.003) and more common in African Americans than whites (66.3% vs 50.9%, OR=1.89, 95% CI=1.46–2.45, P<.001). In multiple backward elimination regression analysis in men, nocturia was significantly associated with African‐American race (OR=1.54) and BMI (OR=1.22 per 5 kg/m²). Higher MMSE score was protective (OR=0.96). In women, nocturia was associated with older age (OR=1.21 per 5 years), African‐American race (OR=1.64), history of any urine leakage (OR=2.17), swelling in feet and legs (OR=1.67), and hypertension (OR=1.62). Higher education was protective (OR=0.92). CONCLUSION: Nocturia in community‐dwelling older adults is a common symptom associated with male sex, African‐American race, and some medical conditions. Given the significant morbidity associated with nocturia, any evaluation of lower urinary tract symptoms should include assessment for the presence of nocturia.     

Prevalence of peripheral arterial disease and risk factors in persons aged 60 and older: data from the National Health and Nutrition Examination Survey 1999-2004

OBJECTIVES: Peripheral arterial disease (PAD) is associated with significant cardiovascular morbidity and mortality. The study objectives were to examine the prevalence of PAD and associated risk factors. DESIGN: A cross-sectional nationally representative health examination survey. SETTING: The National Health and Nutrition Examination Survey 1999-2004. PARTICIPANTS: Data from 3,947 men and women aged 60 and older who received a lower extremity examination. MEASUREMENTS: The main outcome was PAD, defined as an ankle-brachial blood pressure index of less than 0.9 in either leg. RESULTS: In older U.S. adults, PAD prevalence was 12.2% (95% confidence interval (CI) = 10.9-13.5%). PAD prevalence increased with age. PAD prevalence was 7.0% (95% CI = 5.6-8.4%) for those aged 60 to 69, 12.5% (95% CI = 10.4-14.6%), and 23.2% (95% CI = 19.8-26.7%) for those aged 70 to 79 and 80 and older. Age-adjusted estimates show that non-Hispanic black men and women and Mexican-American women had a higher prevalence of PAD than non-Hispanic white men and women (19.2%, 95% CI = 13.7-24.6%; 19.3%, 95% CI = 13.3-25.2%; and 15.6%, 95% CI = 12.7-18.6%, respectively). The results of the fully adjusted model show that current smoking (OR = 5.48, 95% CI = 3.60-8.35), previous smoking (OR = 1.94, 95% CI = 1.39-2.69), diabetes mellitus (OR = 1.81, 95% CI = 1.12-2.91), low kidney function (OR = 2.69, 95% CI = 1.58-4.56), mildly decreased kidney function (OR = 1.71, 95% CI = 1.22-2.38), high-sensitivity C-reactive protein greater than 3.0 mg/L (OR = 2.69, 95% CI = 1.24-5.85), treated but not controlled hypertension (OR = 1.95, 95% CI = 1.40-2.72), and untreated hypertension (OR = 1.68, 95% CI = 1.13-2.50) were all significantly associated with prevalent PAD. CONCLUSION: PAD prevalence increases with age and is associated with treatable risk factors for cardiovascular disease.     

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   

Clinical manifestations associated with HTLV type I infection: a cross-sectional study

Human T-lymphotropic virus type I (HTLV-I) causes HTLV-I-associated myelopathy/tropical spastic paraparesis and adult T cell leukemia in a small percentage of infected individuals. HTLV-I infection is increasingly associated with clinical manifestations. To determine the prevalence of clinical manifestations in HTLV-I infected individuals, we conducted a cross-sectional study of 115 HTLV-I-infected blood donors without myelopathy and 115 age- and sex-matched seronegative controls. Subjects answered a standardized questionnaire and underwent physical examination. Compared with controls, HTLV-I-infected subjects were more likely to report arm or leg weakness (OR = 3.8, 95% CI: 1.4-10.2; OR = 4.0, 95% CI: 1.6-9.8, respectively), hand or foot numbness (OR = 2.1, 95% CI: 1.1-3.9; OR = 4.8, 95% CI: 2.0-11.7, respectively), arthralgia (OR = 3.3, 95% CI: 1.7-6.4), nocturia (OR = 2.7, 95% CI: 1.04-6.8), erectile dysfunction (OR = 4.0, 95% CI: 1.6-9.8), and to have gingivitis (OR = 3.8, 95% CI: 1.8-7.9), periodontitis (OR = 10.0, 95% CI: 2.3-42.8), and dry oral mucosa (OR = 7.5, 95% CI: 1.7-32.8). HTLV-I infection is associated with a variety of clinical manifestations, which may occur in patients who have not developed myelopathy.     

甘肃陇西县35岁及以上人群高血压流行病学现况调查

目的调查甘肃陇西县≥35岁的居民高血压的患病现况,分析其相关危险因素。方法整群分层随机抽取陇西县5个社区≥35岁的居民共12040例,对所选对象进行问卷调查,测量身高、体质量指数(BMI)、腰围、血压,并测定空腹血糖及血脂。计算不同年龄及性别的调查对象高血压及相关疾病的患病率,分析高血压的相关危险因素。结果标化后高血压患病率为26.8%,男性为28.3%,女性为21.4%。Logistic逐步回归分析结果表明,盐摄入量(OR=2.403,95%CI2.066～2.759)、超重(OR=1.566,95%CI1.417～1.730)、高血糖(OR=1.700,95%CI1.303～2.217)、总胆固醇(OR=2.617,95%CI2.294～2.986)、三酰甘油(OR=2.147,95%CI1.960～2.351)、脑力劳动(OR=0.640,95%CI0.490～0.830)、吸烟(烟龄>10年)(OR=1.567,95%CI1.413～1.738)、饮酒(每周>2次)(OR=1.372,95%CI1.340～1.479)是高血压的独立危险因素。结论陇西县35岁以上居民中高血压患病率较高,年龄、男性、高盐饮食、超重及肥胖、高血糖、腰围超标、血脂异常、高三酰甘油是高血压的危险因素。     

Sleep-disordered breathing and nocturia in older adults

OBJECTIVES: To investigate the relationship between sleep-disordered breathing (SDB) and nocturia episodes in community-dwelling older adults. DESIGN: A cross-sectional study. SETTING: Community. PARTICIPANTS: Community-dwelling older adults (N=72) recruited from independent living facilities and adult learning centers in Atlanta, Georgia. MEASUREMENTS: Three-day voiding diary, ambulatory sleep recording, focused physical examination, Epworth Sleepiness Scale, and Geriatric Depression Scale. RESULTS: Fifty-eight of the 72 subjects completed the study. The mean age+/-standard deviation was 77.7+/-6.7; 44 (76%) were female. Of the 58 subjects, 26 (45%) had an apnea-hypopnea index (AHI) of less than 10 per hour of sleep, 21 (36%) had an AHI between 10 and 24 per hour sleep, and 11 (19%) had an AHI of 25 or higher per hour of sleep. The mean nocturia episodes were 1.7+/-1.1, 1.6+/-0.9, and 2.6+/-1.4 for subjects in these groups, respectively (F=3.82; P=.028). Those with an AHI of 25 or higher had more nocturia episodes, higher mean arterial blood pressure, and higher body mass index than those with a lower AHI. CONCLUSION: These results suggest that older adults with severe SDB have a greater number of nocturia episodes. These findings underscore the importance of considering SDB as a differential diagnosis in the evaluation of older patients with nocturia.     

Preclinical disability as a risk factor for falls in community-dwelling older adults

BACKGROUND: Falls are common and serious problems in older adults. The goal of this study was to examine whether preclinical disability predicts incident falls in a European population of community-dwelling older adults. METHODS: Secondary data analysis was performed on a population-based longitudinal study of 1644 community-dwelling older adults living in London, U.K.; Hamburg, Germany; Solothurn, Switzerland. Data were collected at baseline and 1-year follow-up using a self-administered multidimensional health risk appraisal questionnaire, including validated questions on falls, mobility disability status (high function, preclinical disability, task difficulty), and demographic and health-related characteristics. Associations were evaluated using bivariate and multivariate logistic regression analyses. RESULTS: Overall incidence of falls was 24%, and increased by worsening mobility disability status: high function (17%), preclinical disability (32%), task difficulty (40%), test-of-trend p <.003. In multivariate analysis adjusting for other fall risk factors, preclinical disability (odds ratio [OR] = 1.7, 95% confidence interval [CI], 1.1-2.5), task difficulty (OR = 1.7, 95% CI, 1.1-2.6) and history of falls (OR = 4.7, 95% CI, 3.5-6.3) were the strongest significant predictors of falls. In stratified multivariate analyses, preclinical disability equally predicted falls in participants with (OR = 1.7, 95% CI, 1.0-3.0) and without history of falls (OR = 1.8, 95% CI, 1.1-3.0). CONCLUSIONS: This study provides longitudinal evidence that self-reported preclinical disability predicts incident falls at 1-year follow-up independent of other self-reported fall risk factors. Multidimensional geriatric assessment that includes preclinical disability may provide a unique early warning system as well as potential targets for intervention.     

Albumin, Apolipoprotein E-ɛ4 and Cognitive Decline in Community-Dwelling Chinese Older Adults

OBJECTIVES: To examine the association between serum albumin and cognitive impairment and decline in community-living older adults.
DESIGNS: Population-based cohort study, followed up to 2 years; serum albumin, apolipoprotein E (APOE)-ɛ4, and cognitive impairment measured at baseline and cognitive decline (≥2-point drop in Mini-Mental State Examination (MMSE) score). Odds ratios were controlled for age, sex, education, medical comorbidity, hypertension, diabetes mellitus, cardiac disease, stroke, smoking, alcohol drinking, depression, APOE-ɛ4, nutritional status, body mass index, anemia, glomerular filtration rate, and baseline MMSE.
SETTINGS: Local area whole population.
PARTICIPANTS: One thousand six hundred sixty-four Chinese older adults aged 55 and older.
RESULTS: The mean age of the cohort was 66.0±7.3, 65% were women, mean serum albumin was 42.3±3.1 g/L, and mean MMSE score was 27.2±3.2. Lower albumin tertile was associated with greater risk of cognitive impairment in cross-sectional analysis (low, odds ratio (OR)=2.30, 95% confidence interval (CI)=1.31–4.03); medium, OR=1.59, 95% CI=0.88–2.88) versus high ( P for trend=.002); and with cognitive decline in longitudinal analyses: low, OR=1.73, 95% CI=1.18–2.55; medium, OR=1.32, 95% CI=0.89–1.95, vs high ( P for trend=.004). In cognitively unimpaired respondents at baseline (MMSE≥24), similar associations with cognitive decline were observed ( P for trends <.002). APOE-ɛ4 appeared to modify the association, due mainly to low rates of cognitive decline in subjects with the APOE-ɛ4 allele and high albumin.
CONCLUSION: Low albumin was an independent risk marker for cognitive decline in community-living older adults.     

Factors associated with hypertension awareness, treatment, and control in Ghana, West Africa

Hypertension is rapidly becoming a major public health burden in sub-Saharan/Africa but awareness, treatment, and control is lagging behind. We analysed cross-sectional data from Ghana (West-Africa) to examine factors associated with awareness, treatment, and control of hypertension. The overall prevalence of hypertension was 29.4%. Of these, 34% were aware of their condition, 28% were receiving treatment, and 6.2% were controlled below SBP/DBP <140/90 mmHg. Multivariate analysis showed that old age was independently associated with higher hypertension awareness: 35-49-year-olds (odds ratio (OR) = 2.57, 95% (confidence interval) CI: 1.26-5.22), > or =50-year-olds (OR = 6.14, CI: 2.98-12.64) compared with 16-34-year-olds. Old age: > or =50-year-olds (OR: 6.25, 95% CI: 2.87-13.62), trading (OR = 2.46, 95% CI: 1.17-5.17), and overweight (OR = 1.85, 95% CI: 1.02, 3.34) were independently associated with pharmacological treatment of hypertension. Trading (OR = 2.51, 95% CI: 1.03-7.40) was independently associated with adequate blood pressure (BP) control but old age: > or =50-year-olds (OR = 0.11, 95% CI: 0.01-0.60) was independently associated with inadequate BP control. The identified factors provide important information for improving BP control among this population. Given the high cost of hypertension medication relative to income, increasing awareness and simple preventive measures such as promotion of physical activity, normalising body weight and reduction of salt intake, present the best hope for reducing the impact of hypertension on morbidity and mortality.     

Lifestyle Modification Advice for Lowering or Controlling High Blood Pressure: Who's Getting It?

Lifestyle modifications (LSMs) are important in hypertension management. Using data from a population-based sample of hypertensive adults (N=28,457), the authors examined variations in reports of receipt of LSM advice by patient characteristics. Most adults (90.3%) with known hypertension reported receiving some type of advice. Exercise advice was reported most frequently (74.6%), followed by advice to reduce salt intake (69.3%), change eating habits (61.9%), and reduce alcohol intake (43.5%). Compared with adults aged 60 years or older, persons aged 18 to 39 years were more likely to report receipt of advice (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.11-1.81). Overweight persons (OR, 1.64; 95% CI, 1.40-1.93) and obese persons (OR, 2.75; 95% CI, 2.28-3.31) were more likely to report receipt of advice. Persons receiving antihypertensive medication were also more likely to report receiving advice (OR, 2.35; 95% CI, 1.98-2.81). This study demonstrates that older persons, persons not taking antihypertensive medication, and individuals who are not overweight or obese are less likely to report receiving LSM advice.     

Is a fall just a fall: correlates of falling in healthy older persons. The Health,Aging and Body Composition Study

OBJECTIVES: To identify factors associated with falling in well-functioning older people. DESIGN: Cross-sectional analyses of report of falls over the past 12 months using baseline data from the Health, Aging and Body Composition Study. SETTING: Clinic examinations in Pittsburgh, Pennsylvania, or Memphis, Tennessee. PARTICIPANTS: Three thousand seventy-five high-functioning black and white elderly aged 70 to 79 living in the community. MEASUREMENTS: Physical function assessed using self-report and performance measures. Health status indicators included diseases, medication use, and body composition measures. RESULTS: Almost one-quarter (24.1%) of women and 18.3% of men reported at least one fall within the year before the baseline examination. Fallers were more likely to be female; white; report more chronic diseases and medications; and have lower leg strength, poorer balance, slower 400-meter walk time, and lower muscle mass. In men, multivariate logistic regression models showed white race (adjusted odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.2-1.6), slower 6-meter walk speed (OR = 1.1, 95% CI = 1.0-1.3), poor standing balance (OR = 1.2, 95% CI = 1.0-1.4), inability to do 5 chair stands (OR = 1.7, 95% CI = 1.3-1.9), report of urinary incontinence (UI) (OR = 1.5, 95% CI = 1.1-2.0), and mid-quintile of leg muscle strength (OR = 0.6, 95% CI = 0.4-0.9) to be independently associated with report of falling. In women, benzodiazepine use (OR = 1.6, 95% CI = 1.0-2.6), UI (OR = 1.5, 95% CI = 1.2-1.9), and reported difficulty in rising from a chair (OR = 1.4, 95% CI = 1.2-1.6) were associated with past falls. CONCLUSION: Falls history needs to be screened in healthier older adults. Even for well-functioning older persons, specific correlates of falling can be identified to define those at risk.     

Blood pressure levels and hypertension status among ethnic groups in England

The prevalence of cardiovascular disease and hypertension show wide variability among different ethnic groups in the UK. We combined data collected annually between 1991-1996 in the Health Surveys for England--nationwide surveys that provide information on the health status in a representative sample of the population living in England, to compare blood pressure (BP) levels, hypertension rates (systolic BP > or = 160 mm Hg or diastolic BP > or = 95 mm Hg, or those on antihypertensive medication), hypertension treatment and control rates in people of white, black (combining black-Caribbean, black-African and black-other), and South Asian origin (combining Indians, Pakistanis and Bangladeshis). Analyses were stratified into two age groups, 16-39 (younger) and > or = 40 years (older), but were focused on older adults (30,619 whites, 295 blacks and 529 South Asians). Age-adjusted mean BP levels and hypertension rates of older adults were highest among blacks, while South Asian men showed BP levels and hypertension rates similar to black men and South Asian women had mean BP levels and hypertension rates similar to white women. After controlling for age, BMI, smoking, alcohol consumption, and social class the odds ratio (OR) of being hypertensive among older adults was higher in black men (OR 2.0; 95% CI 1.4, 2.9; P < 0.001); black women (OR 1.7; 95% CI 1.2, 2.5; P < 0.01); and South Asian men (1.9; CI 1.4, 2.4; P < 0.001), than in their white counterparts. Among those studied with hypertension, treatment rates were highest among black men and women. Among those on antihypertensive medication, the odds of having BP controlled (SBP < 160 mm Hg and DBP < 95 mm Hg) did not differ among the three groups of older men but was reduced in older South Asian women, compared with white women.     

Prevalence and correlates of anxiety symptoms in well-functioning older adults: findings from the health aging and body composition study

OBJECTIVES: To determine the prevalence and correlates of anxiety symptoms in the absence of depression, in older black and white people. DESIGN: Cross-sectional study. SETTING: Baseline assessment of a biracial cohort of community-resident well-functioning men and women aged 70 to 79 participating in the Health Aging and Body Composition study. PARTICIPANTS: Three thousand forty-one participants (mean age 74, 52% women, 58% white). MEASUREMENTS: Participants were asked about three major anxiety symptoms (feeling fearful, tense/keyed-up, or shaky/nervous) derived from the Hopkins Symptom Checklist. Participants were considered to have anxiety symptoms if they reported feeling at least two anxiety symptoms "a little" or one symptom "quite a bit" in the past week. Logistic regression models were used to identify demographic, psychosocial, and health-related correlates of anxiety symptoms. RESULTS: Anxiety symptoms occurred in 15% of older people without depression and 43% of those with depression. Of nondepressed older people, women were more likely to have anxiety symptoms than men (P <.01), especially white women (20% prevalence). After multivariate adjustment, the chronic conditions of urinary incontinence (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.1-1.9), hearing impairment (OR = 1.4, 95% CI = 1.0-2.1), hypertension (OR = 1.3, 95% CI = 1.0-1.7) and poor sleep (OR = 1.7, 95% CI = 1.3-2.4) were associated with a higher prevalence of anxiety symptoms. Persons with poorer psychosocial functioning, low personal mastery (OR = 2.0, 95% CI = 1.6-2.5) and the need for more emotional support (OR = 2.2, 95% CI = 1.7-2.8), also had higher rates of anxiety symptoms. CONCLUSION: Anxiety symptoms are common in depressed and nondepressed older people. Given the high prevalence and coexistence with depressive symptoms, it will be important to conduct longitudinal studies that assess depressive and anxiety symptoms to clarify the direction and influence and disentangle the health-related consequences of these two conditions.     

Inverse relationship between alcohol consumption and active Helicobacter pylori infection: the Bristol Helicobacter project

OBJECTIVE: The aim of this study was to examine whether smoking or consumption of alcohol or coffee is associated with active Helicobacter pylori (H. pylori) infection. METHODS: This was a cross-sectional population study conducted as part of a randomized controlled trial of H. pylori infection eradication in southwest England. A total of 10,537 subjects, recruited from seven general practices, underwent 13C-urea breath testing for active infection with H. pylori and provided data on smoking, usual weekly consumption of alcohol, and daily intake of coffee. RESULTS: Smoking or coffee consumption were not related to active H. pylori infection. Total alcohol consumption was associated with a small, but not statistically significant, decrease in the odds of infection. After adjustment for age, sex, ethnic status, childhood and adult social class, smoking, coffee consumption, and intake of alcoholic beverages other than wine, subjects drinking 3-6 units of wine/wk had an 11% lower risk of H. pylori infection compared with those who took no wine: OR = 0.89, 95% CI = 0.80-0.99. Higher wine consumption was associated with a further 6% reduction in the risk of infection: OR = 0.83, 95% CI = 0.64-1.07. Intake of 3-6 units of beer (but no greater intake) was associated with a similar reduction in the risk of infection when compared to no beer intake (OR = 0.83, 95% CI = 0.75-0.91). CONCLUSIONS: This study indicates that modest consumption of wine and beer (approximately 7 units/wk) protects against H. pylori infection, presumably by facilitating eradication of the organism.     

Age- and gender-related use of low-dose drug therapy: the need to manufacture low-dose therapy and evaluate the minimum effective dose.

OBJECTIVES: Low-dose drug therapy is promoted as a way to maximize benefit and minimize adverse drug effects when prescribing for older adults. This population-based study evaluates the age and sex-related use of two common therapies: thiazide diuretics, where evidence supports the use of low-dose therapy, and beta-blockers, where trials have not evaluated the minimum effective dose. DESIGN: Using linked administrative databases we identified all of the 120,613 persons dispensed a thiazide diuretic therapy and 12,908 myocardial infarction survivors dispensed beta-blocker therapy in Canada's largest province. We used logistic regression models to study the association of age and sex with dispensing of low-dose thiazide diuretic and beta-blocker therapy at doses lower than evaluated in trials. RESULTS: Of 120,613 older people dispensed a thiazide diuretic, 32,372 (26.8%) were dispensed a low dose. Patients 85 years of age or older, relative to the youngest group, were 30% more likely to be dispensed low-dose therapy (OR=1.31; 95% CI, 1.27 to 1.36; P < .001). Women were 8% more likely than men to be dispensed a low-dose thiazide diuretic (OR=1.08; 95% CI, 1.05 to 1.11; P < .001). Of 10,991 myocardial infarction survivors dispensed atenolol, metoprolol, propranolol, or timolol, 9458 (86.1%) were dispensed a lower-than-evaluated dose. Patients 85 years of age or older, relative to those in the youngest group, were more than twice as likely to be dispensed a lower-than-evaluated beta-blocker therapy dose (OR=2.28; 95% CI, 1.74 to 3.04; P < .001). No difference was noted in the use of beta-blocker therapy dose by sex (OR=1.0; 95% CI, .89 to 1.15; P = .95). CONCLUSIONS: Low-dose thiazide diuretic therapy prescribed widely to older people, particularly those of advanced age and women. The vast majority of myocardial infarction survivors were dispensed beta-blocker therapy at lower-than-evaluated doses. These findings highlight the need to manufacture low-dose thiazide diuretic therapy and to evaluate the minimum effective dose of beta-blocker therapy.     

Hospitalization and development of dependence in activities of daily living in a cohort of disabled older women: the Women's Health and Aging Study I

BACKGROUND: Changes in self-reported function in older adults are known to occur in the 2 weeks prior to, during, and in the first few months after hospitalization. The long-term outcome of hospitalization on functional status in disabled older adults is not known. The objective of this study was to determine whether hospitalization predicts long-term Activities of Daily Living (ADL) dependence in previously ADL independent, although disabled, older women. METHODS: The Women's Health and Aging Study I is a population-based, prospective cohort study of disabled, community-dwelling women > or =65 years old. We evaluated participants who were independent in ADLs at baseline and excluded women with incident stroke, lower extremity joint surgery, amputation, or hip fracture. We examined the association between self-reported incident hospitalization at three consecutive 6-month intervals and incident dependence in at least one ADL at 18 months (n = 595). RESULTS: Of 595 women evaluated, 32% had at least one hospitalization. Women who were hospitalized were more likely to become dependent in ADLs than were women who were not hospitalized (17% vs 8%, p =.001). In a multivariate model, hospitalization was independently predictive of development of ADL dependence that persisted at 18 months after baseline (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.7-5.8), adjusting for age, race, education, baseline walking speed, difficulty with ADLs, self-reported health status, depressive symptoms, cognitive status, and presence of congestive heart failure, diabetes, or pulmonary disease. Increasing numbers of 6-month intervals with hospitalizations were independently predictive of higher risk in an adjusted model: one (OR, 2.3; 95% CI, 1.1-4.6), two (OR, 5.8; 95% CI, 2.4-14.4), and three (OR, 12.5; 95% CI, 2.7-57.6). CONCLUSIONS: These results suggest that hospitalization has an independent and dose-response effect on loss of ADL independence in disabled older women over an 18-month period.     

The effect of comorbid illness on receipt of cancer screening by older people

OBJECTIVES: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people. DESIGN: Sixth annual follow-up of a community-based survey with 4,162 participants aged 65 and older at baseline in 1986. SETTING: Piedmont area of North Carolina. PARTICIPANTS: Two thousand two hundred twenty-five subjects with a mean age of 79 who responded in 1992. MEASUREMENTS: Self-reported receipt of clinical breast examination, mammography, Papanicolaou (Pap) smear, and fecal occult blood testing (FOBT) within the 2 years before the survey. RESULTS: Hip fracture was associated with lower rates of mammography (odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.32-0.87) and cognitive impairment with lower rates of FOBT (OR = 0.71, 95% CI = 0.54-0.94). Hypertension was associated with higher rates of breast examination (OR = 1.56, 95% CI = 1.18-2.07), Pap smear (OR = 1.41, 95% CI = 1.09-1.83), and FOBT (OR = 1.37, 95% CI = 1.12-1.66) and a trend toward increasing rates of mammography (OR = 1.28, 95% CI = 0.98-1.69). The presence of three or more comorbid conditions was associated with an increased rate of mammography (OR = 1.35, 95% CI = 1.06-1.71), breast examination (OR = 1.46, 95% CI = 1.12-1.89), and Pap smear (OR = 1.31, 95% CI = 1.04-1.65). CONCLUSIONS: With few exceptions, the presence of comorbid conditions is not associated with a decreased rate of receipt of screening. In fact, hypertension and the presence of a higher number of comorbid conditions are associated with a higher rate of receipt of cancer screening. This finding may be due to an increase in the frequency of office visits increasing the opportunity for cancer screening.     

Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004

OBJECTIVES: To describe hypertension trends in U.S. adults aged 60 and older using National Health and Nutrition Examination Survey (NHANES) data. SETTING: NHANES III (1988-1994) and NHANES 1999 to 2004. DESIGN: Cross-sectional nationally representative health examination survey. PARTICIPANTS: Participants in NHANES III (n=5,093) and NHANES 1999 to 2004 (n=4,710). MEASUREMENTS: Blood pressure (BP). RESULTS: In 1999 to 2004, 67% of U.S. adults aged 60 and older years were hypertensive, an increase of 10% from NHANES III. Between 1988 to 1994 and 1999 to 2004, hypertension control increased for men from 39% to 51% (P<.05) but remained unchanged for women (35% to 37%; P>.05). Non-Hispanic black men and women had higher prevalences of hypertension than non-Hispanic whites (odds ratio (OR)=2.54, 95% confidence interval (CI)=1.90-3.40 and OR=2.07, 95% CI=1.31-3.26, respectively), but men were less likely to have controlled BP (OR=0.60, 95% CI=0.41-0.86). Mexican-American men and women were less likely than non-Hispanic whites to have controlled BP (OR=0.55, 95% CI=0.33-0.91 and OR=0.63, 95% CI=0.40-0.98, respectively). Women and men aged 70 and older were significantly less likely to control their hypertension than those aged 60 to 69. In addition, women aged 70 and older were significantly less aware and treated. Having BP measured within 6 months was significantly associated with greater awareness, greater treatment in men and women, and greater control in women. A history of diabetes mellitus or chronic kidney disease (CKD) was significantly associated with less hypertension control. CONCLUSION: There was a significant increase in hypertension prevalence from 1988 to 2004. Hypertension control continues to be problematic for women, persons aged 70 and older, non-Hispanic blacks and Mexican Americans, and individuals with diabetes mellitus and CKD.     

Relationship between social network and hypertension in older people in Spain

INTRODUCTION AND OBJECTIVES: To investigate the association between a patient's social network and hypertension risk in older adults in Spain and to determine whether the nature of the social network is related to a patient's awareness of hypertension, to disease treatment and control, or to adherence to hypertension drug therapy. PATIENTS AND METHOD: Cross-sectional study of 3483 subjects representative of the non-institutionalized Spanish population aged 60 years or more. Logistic regression analysis, adjusted for sex, age, educational level, lifestyle and frequency of medical consultation, was used to derive odds ratios (ORs) for associations between characteristics of the social network (e.g., marital status, cohabitation status, frequency of contact with family members, and frequency of contact with friends and neighbors) and aspects of hypertension. RESULTS: The hypertension risk in married individuals and those living with others was less than in those who were unmarried (OR=0.79; 95% confidence interval [CI] 0.67-0.94) or who lived alone (OR=0,75; 95% CI, 0.61-0.93). Men who saw their friends frequently were more likely to be aware of hypertension (OR=1.57; 95% CI, 1.19-2.07). Women who saw their friends or neighbors frequently were less likely to be aware (OR=0.70; 95% CI, 0.51-0.97). No clear relationship between social network characteristics and other hypertension-related variables was observed. CONCLUSIONS: In older adults, hypertension was associated with aspects of social integration, such as marital and cohabitation status. Among hypertensives, awareness of hypertension was partly related to the frequency of contact with family and friends or neighbors.