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Aleixo GFP, Hess DL, Fowler ME, Giri S, Williams GR. Racial differences in body composition and survival among older adults with gastrointestinal malignancies. J Geriatr Oncol 2024; 15:101747. [PMID: 38513310 DOI: 10.1016/j.jgo.2024.101747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/03/2024] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Muscle and adipose tissue measures can be quantified from routinely obtained computed tomography (CT) images and are predictors of chemotherapy-related toxicities and survival among patients with gastrointestinal (GI) malignancies. Most studies to date have consisted of predominantly White patients, and the role of body composition among minoritized racial groups is unknown. We examined racial differences in body composition and survival among patients with GI malignancies. MATERIALS AND METHODS This was a prospective cohort study of patients with GI malignancies. Single slices of axial CT images from L3 segments were analyzed using Slice-O-Matic software. The skeletal muscle area (cm2) was divided by height to obtain the skeletal muscle index (SMI, cm2/m2). Skeletal muscle radiodensity (SMD) in Hounsfield units (HU) was used for muscle composition. We compared body composition parameters between non-Hispanic (NH)-White and NH-Black participants. Cox models were used to examine the impact of body composition on survival. We proposed new race-specific cutoffs for body composition using optimal stratification. RESULTS Five hundred forty patients were included, of which 24% were NH-Black. In Cox models stratified by race, each 5 cm2/m2 decrease in SMI was associated with increase in risk of all-cause mortality in NH-Black patients (hazard ratio [HR] 1.25; 95% confidence interval [CI] 1.04-1.49 p = 0.02). With the existing cut points, neither sarcopenia nor myosteatosis was associated with worse survival. Using a new cutoff for sarcopenia in NH-Black patients, NH-Black patients with sarcopenia (HR 2.31 95%CI 1.10-4.88 p = 0.03) and myosteatosis (HR 2.63 95% CI 1.25-5.53 p = 0.01) had worse survival. DISCUSSION NH-Black older patients with GI cancers and sarcopenia or myosteatosis have worse overall survival.
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Affiliation(s)
- Gabriel F P Aleixo
- University of Pennsylvania, Department of Hematology and Oncology, Philadelphia, PA, United States of America.
| | - Daniel L Hess
- The University of Alabama at Birmingham, Department of Medicine, Birmingham, AL, United States of America
| | - Mackenzie E Fowler
- The University of Alabama at Birmingham, Department of Epidemiology, Birmingham, AL, United States of America
| | - Smith Giri
- The University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America
| | - Grant R Williams
- The University of Alabama at Birmingham, O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America
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Aggarwal G, Malmstrom TK, Morley JE, Miller DK, Nguyen AD, Butler AA. Low circulating adropin levels in late-middle aged African Americans with poor cognitive performance. NPJ AGING 2023; 9:24. [PMID: 37945652 PMCID: PMC10636045 DOI: 10.1038/s41514-023-00122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/22/2023] [Indexed: 11/12/2023]
Abstract
We recently reported accelerated cognitive decline in Europeans aged > 70 years with low circulating adropin levels. Adropin is a small, secreted peptide that is highly expressed in the human nervous system. Expression profiling indicate relationships between adropin expression in the human brain and pathways that affect dementia risk. Moreover, increased adropin expression or treatment using synthetic adropin improves cognition in mouse models of aging. Here we report that low circulating adropin concentrations associate with poor cognition (worst quintile for a composite score derived from the MMSE and semantic fluency test) in late-middle aged community-dwelling African Americans (OR = 0.775, P < 0.05; age range 45-65 y, n = 352). The binomial logistic regression controlled for sex, age, education, cardiometabolic disease risk indicators, and obesity. Previous studies using cultured cells from the brains of human donors suggest high expression in astrocytes. In snRNA-seq data from the middle temporal gyrus (MTG) of human donors, adropin expression is higher in astrocytes relative to other cell types. Adropin expression in all cell-types declines with advance age, but is not affected by dementia status. In cultured human astrocytes, adropin expression also declines with donor age. Additional analysis indicated positive correlations between adropin and transcriptomic signatures of energy metabolism and protein synthesis that are adversely affected by donor age. Adropin expression is also suppressed by pro-inflammatory factors. Collectively, these data indicate low circulating adropin levels are a potential early risk indicator of cognitive impairment. Declining adropin expression in the brain is a plausible link between aging, neuroinflammation, and risk of cognitive decline.
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Affiliation(s)
- Geetika Aggarwal
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, MO, USA
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Theodore K Malmstrom
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, MO, USA
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - John E Morley
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Andrew D Nguyen
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, MO, USA
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Andrew A Butler
- Institute for Translational Neuroscience, Saint Louis University, St. Louis, MO, USA.
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, MO, USA.
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3
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Richardson J, Beauchamp M, Bean J, Brach J, Chaves PHM, Guralnik JM, Jette AM, Leveille SG, Hoenig H, Manini T, Marottoli R, Porter MM, Sinclair S, Letts L, Kuspinar A, Vrkljan B, Morgan A, Mirbaha S. Defining and Measuring Preclinical Mobility Limitation: An Expert Consensus Exercise Informed by a Scoping Review. J Gerontol A Biol Sci Med Sci 2023; 78:1641-1650. [PMID: 37300461 DOI: 10.1093/gerona/glad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Early change in function in older adults has been termed preclinical disability (PCD). PCD has been understudied compared to other stages of disability because it is unlikely to receive comparative priority in clinical settings. It has major implications for prevention and population health as it may be the optimal time to intervene to prevent further decline. A standardized approach to research in PCD, including a common definition and measurement approaches, is needed to advance this work. METHODS The process to establish how PCD should be defined and measured was undertaken in 2 stages: (1) a scoping review of the literature, which was used to inform (2) a web-enabled consensus meeting with content experts. RESULTS The scoping review and the consensus meeting support the use of the term preclinical mobility limitation (PCML) and that it should be measured using both patient-reported and performance-based measures. It was agreed that the definition of PCML should include modification of frequency and/or method of task completion, without overt disability, and that requisite mobility tasks include walking (distance and speed), stairs, and transfers. CONCLUSIONS Currently, there are few standardized assessments that can identify PCML. PCML is the term that most clearly describes the stage where people experience a change in routine mobility tasks, without a perception of disability. Further evaluation into the reliability, validity, and responsiveness of outcome measures is needed to advance research on PCML.
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Affiliation(s)
- Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan Bean
- Faculty of Health Sciences, Department of PM&R, Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Bedford VAMC, Boston, Massachusetts, USA
| | - Jennifer Brach
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paulo H M Chaves
- Benjamin Leon Center for Geriatric Research and Education, Florida International University, Miami, Florida, USA
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jack M Guralnik
- Epidemiology & Public Health, School of Medicine, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Alan M Jette
- Department of Physical Therapy & Athletic Training, College of Health and Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Suzanne G Leveille
- Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Helen Hoenig
- Duke University School of Medicine, Physical Medicine and Rehabilitation Service, Durham VA Medical Center, Durham, North Carolina, USA
| | - Todd Manini
- Institute on Aging, Department of Aging & Geriatric Research, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Richard Marottoli
- Department of Geriatric Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michelle M Porter
- Centre on Aging, University of Manitoba, Winnipeg, Manitoba, Canada
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susanne Sinclair
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Letts
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ashley Morgan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Shaghayegh Mirbaha
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Nguyen AD, Malmstrom TK, Aggarwal G, Miller DK, Vellas B, Morley JE. Serum neurofilament light levels are predictive of all-cause mortality in late middle-aged individuals. EBioMedicine 2022; 82:104146. [PMID: 35830835 PMCID: PMC9284367 DOI: 10.1016/j.ebiom.2022.104146] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Blood biomarkers can offer valuable and easily accessible indicators of normal biological processes, pathogenic conditions, and responses to therapeutic interventions. Recent studies found that levels of neurofilament light chain (NfL) in the blood are associated with mortality in three European cohorts of older adults (median ages 73, 93, and 100 years). Whether similar associations exist in younger adults and in other ethnic groups is currently not known. Methods We utilized a cohort study that included 294 African Americans (baseline ages 49–65). Serum NfL levels were measured using a Meso Scale Discovery-based assay. Vital status was determined by matching through the National Death Index. Findings Seventy-two participants (24.5%) died during the 14–15 years of follow up (2000–2014). Baseline serum NfL levels were significantly higher in the decedent group (86.1±65.7 pg/ml vs. 50.1±28.0 pg/ml, p < 0·001). In binomial logistic regression models adjusted for age, gender, education, baseline smoking status, BMI, and total comorbidities (0–11), serum NfL levels remained a strong predictor of all-cause mortality, and sensitivity analyses employing multiple additional covariates did not substantively change the relationship. Further, Kaplan-Meier curves based on serum NfL quartiles showed reduced survival in groups with higher serum NfL levels. Interpretation This study found a positive association between serum NfL levels and mortality in late middle-aged and older individuals. While our findings support that serum NfL levels may be a useful biomarker for all-cause mortality, further studies are needed to understand the biological mechanisms underlying this association. Funding National Institute on Aging, Saint Louis University.
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Affiliation(s)
- Andrew D Nguyen
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, MO, USA; Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University, St. Louis, MO, USA.
| | - Theodore K Malmstrom
- Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University, St. Louis, MO, USA; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Geetika Aggarwal
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, MO, USA; Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University, St. Louis, MO, USA
| | | | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France; UMR 1295 INSERM, University of Toulouse III, Toulouse, France
| | - John E Morley
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
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5
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Hickson R, Marin MP, Dunn M. Minority Women. Clin Geriatr Med 2021; 37:523-532. [PMID: 34600719 DOI: 10.1016/j.cger.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Perceptions of illness, pain, and death are not static. They vary among populations according to their cultural and biological characteristics. Older black and Hispanic/Latinx women are unique in their approach to health care with respect to mentation, mobility, medication adherence, and what matters to them. It is the complexity of these components, which affect the ability of these women to age gracefully.
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Affiliation(s)
- Renee Hickson
- Oak Street Healthcare, 4800 Chef Menteur Highway, New Orleans, LA 70126, USA.
| | - Monica Pernia Marin
- Department of Geriatrics and Palliative Medicine, The George Washington University, 2150 Pennsylvania Avenue Northwest, Washington, DC 20037, USA
| | - Marisa Dunn
- Jencare Senior Medical Center, 2124 Candler Road, Decatur, GA 30032, USA
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Brown RT, Diaz-Ramirez LG, Boscardin WJ, Cappola AR, Lee SJ, Steinman MA. Changes in the Hierarchy of Functional Impairment from Middle Age to Older Age. J Gerontol A Biol Sci Med Sci 2021; 77:1577-1584. [PMID: 34498040 DOI: 10.1093/gerona/glab250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Understanding the hierarchy of functional impairment in older adults has helped illuminate mechanisms of impairment and inform interventions, but little is known about whether hierarchies vary by age. We compared the pattern of new-onset impairments in activities of daily living (ADLs) and instrumental ADLs (IADLs) from middle age through older age. METHODS We conducted a cohort study using nationally representative data from 32486 individuals enrolled in the Health and Retirement Study. The outcomes were new-onset impairment in each ADL and IADL, defined as self-reported difficulty performing each task, assessed yearly for 9 years. We used multi-state models and competing risks survival analysis to estimate the cumulative incidence of impairment in each task by age group (ages 50-64, 65-74, 75-84, and 85 or older). RESULTS The pattern of incident ADL impairments differed by age group. Among individuals ages 50-64 and 65-74 who were independent at baseline, over 9 years' follow-up, difficulties dressing and transferring were the most common impairments to develop. In individuals ages 75-84 and 85 or older who were independent at baseline, difficulties bathing, dressing, and walking were most common. For IADLs, the pattern of impairments was similar across age groups; difficulty shopping was most common followed by difficulty managing money and preparing meals. Complementary analyses demonstrated a similar pattern. CONCLUSIONS These findings suggest that the hierarchy of ADL impairment differs by age. These findings have implications for the development of age-specific interventions to prevent or delay functional impairment.
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Affiliation(s)
- Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.,Geriatrics and Extended Care Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - L Grisell Diaz-Ramirez
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - W John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Anne R Cappola
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA.,Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Sei J Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Michael A Steinman
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, CA
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Nguyen AD, Malmstrom TK, Niehoff ML, Aziz A, Miller DK, Morley JE. Serum progranulin levels are associated with frailty in middle-aged individuals. PLoS One 2020; 15:e0238877. [PMID: 32886731 PMCID: PMC7473561 DOI: 10.1371/journal.pone.0238877] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE A recent study identified progranulin as a candidate biomarker for frailty, based on gene expression databases. In the present study, we investigated associations between serum progranulin levels and frailty in a population-based sample of late middle-age and older adults. METHODS We utilized a cohort study that included 358 African Americans (baseline ages 49-65). Frailty was assessed by three established methods: the interview-based FRAIL scale, the Cardiovascular Health Study (CHS) frailty scale that includes performance-based measurements, and the Frailty Index (FI) that is based on cumulative deficits. Serum levels of the following proteins and metabolites were measured: progranulin, cystatin C, fructosamine, soluble cytokine receptors (interleukin-2 and -6, tumor necrosis factor α-1 and -2), and C-reactive protein. Sarcopenia was assessed using the SARC-F index. Vital status was determined by matching through the National Death Index (NDI). RESULTS Serum progranulin levels were associated with frailty for all indices (FRAIL, CHS, and FI) but not with sarcopenia. Inflammatory markers indicated by soluble cytokine receptors (sIL-2R, sIL-6R, sTNFR1, sTNFR2) were positively associated serum progranulin. Increased serum progranulin levels at baseline predicted poorer outcomes including future frailty as measured by the FRAIL scale and 15-year all-cause mortality independent of age, gender, and frailty. CONCLUSIONS Our findings suggest that serum progranulin levels may be a candidate biomarker for physical frailty, independent of sarcopenia. Further studies are needed to validate this association and assess the utility of serum progranulin levels as a potential biomarker for prevalent frailty, for risk for developing incident frailty, and for mortality risk over and above the effect of baseline frailty.
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Affiliation(s)
- Andrew D. Nguyen
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, United States of America
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St. Louis, Missouri, United States of America
- Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University, St. Louis, Missouri, United States of America
| | - Theodore K. Malmstrom
- Henry and Amelia Nasrallah Center for Neuroscience, Saint Louis University, St. Louis, Missouri, United States of America
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, Missouri, United States of America
| | - Michael L. Niehoff
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, United States of America
- Veterans Affairs Medical Center, St. Louis, Missouri, United States of America
| | - Asef Aziz
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, United States of America
| | - Douglas K. Miller
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
| | - John E. Morley
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, United States of America
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Sleep duration and physical function in people with severe obesity: a prospective cross-sectional study. Ir J Med Sci 2019; 189:517-523. [PMID: 31721041 DOI: 10.1007/s11845-019-02110-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Subjects with severe obesity (BMI > 40 kg/m2) have worse physical function and sleep less than lean people (BMI 18.5-25 kg/m2). METHODS In 554 subjects with severe obesity, we compared physical function in those with normal sleep duration (NSD, 6-9 h/night), short sleep duration (SSD, ≤ 6 h/night) and long sleep duration (LSD, ≥ 9 h/night). RESULTS The mean (±SD) age and BMI were 43.1 (± 11.1) years and 50.9 ± 8.6 kg/m2 respectively. One hundred ninety-six (35.4%) were male. More subjects in the NSD group (n = 256) were able to ascend and descend a step 50 times than in the SSD group (n = 247) or the LSD group (n = 51, 75.5% vs 62.8% vs 56.9%, p = 0.002). A similar observation was made for step speed (0.45 ± 0.11 vs 0.43 ± 0.10 vs 0.40 ± 0.11 steps/s respectively, p = 0.001). NSD participants were less likely to have fallen in the preceding year compared to LSD participants (21.1% vs 39.2%, p = 0.007) and also reported less low back pain compared to SSD participants (60.8% vs 75.9%, p = 0.004). CONCLUSIONS In conclusion, abnormal sleep duration is associated with reduced physical function in non-elderly severely obese subjects. The effects of sleep hygiene interventions in this cohort warrant further assessment and may be beneficial to their physical function.
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Brown RT, Diaz-Ramirez LG, Boscardin WJ, Lee SJ, Williams BA, Steinman MA. Association of Functional Impairment in Middle Age With Hospitalization, Nursing Home Admission, and Death. JAMA Intern Med 2019; 179:668-675. [PMID: 30958504 PMCID: PMC6503566 DOI: 10.1001/jamainternmed.2019.0008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Difficulty performing daily activities such as bathing and dressing ("functional impairment") affects nearly 15% of middle-aged adults. Older adults who develop such difficulties, often because of frailty and other age-related conditions, are at increased risk of acute care use, nursing home admission, and death. However, it is unknown if functional impairments that develop among middle-aged people, which may have different antecedents, have similar prognostic significance. OBJECTIVE To determine whether middle-aged individuals who develop functional impairment are at increased risk for hospitalization, nursing home admission, and death. DESIGN, SETTING, AND PARTICIPANTS This matched cohort study analyzed longitudinal data from the Health and Retirement Study, a nationally representative prospective cohort study of US adults. The study population included 5540 adults aged 50 to 56 years who did not have functional impairment at study entry in 1992, 1998, or 2004. Participants were followed biennially through 2014. Individuals who developed functional impairment between 50 and 64 years were matched by age, sex, and survey wave with individuals without impairment as of that age and survey wave. Statistical analysis was conducted from March 15, 2017, to December 11, 2018. EXPOSURES Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, and impairment in instrumental ADLs (IADLs), defined similarly. MAIN OUTCOMES AND MEASURES The 3 primary outcomes were time from the first episode of functional impairment (or matched survey wave, in controls) to hospitalization, nursing home admission, and death. Follow-up assessments occurred every 2 years until 2014. Competing risks survival analysis was used to assess the association of functional impairment with hospitalization and nursing home admission and Cox proportional hazards regression analysis was used to assess the association with death. RESULTS Of the 5540 study participants (2739 women and 2801 men; median age, 53.7 years [interquartile range, 52.3-55.2 years]), 1097 (19.8%) developed ADL impairment between 50 and 64 years, and 857 (15.5%) developed IADL impairment. Individuals with ADL impairment had an increased risk of each adverse outcome compared with those without impairment, including hospitalization (subhazard ratio, 1.97; 95% CI, 1.77-2.19), nursing home admission (subhazard ratio, 2.62; 95% CI, 1.99-3.45), and death (hazard ratio, 2.06; 95% CI, 1.74-2.45). After multivariable adjustment, the risks of hospitalization (subhazard ratio, 1.54; 95% CI, 1.36-1.75) and nursing home admission (subhazard ratio, 1.73; 95% CI, 1.24-2.43) remained significantly higher among individuals with ADL impairment, but the risk of death was not statistically significant (hazard ratio, 1.06; 95% CI, 0.85-1.32). Individuals with IADL impairment had an increased risk of all 3 outcomes in adjusted and unadjusted analyses. CONCLUSIONS AND RELEVANCE Similar to older adults, middle-aged adults who develop functional impairment appear to be at increased risk for adverse outcomes. Even among relatively young people, functional impairment has important clinical implications.
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Affiliation(s)
- Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Geriatrics and Extended Care Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - L Grisell Diaz-Ramirez
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - W John Boscardin
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Statistical Editor
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Brie A Williams
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michael A Steinman
- Division of Geriatrics, University of California, San Francisco.,Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
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10
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Edwards JD, Fausto BA, Tetlow AM, Corona RT, Valdés EG. Systematic review and meta-analyses of useful field of view cognitive training. Neurosci Biobehav Rev 2018; 84:72-91. [DOI: 10.1016/j.neubiorev.2017.11.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 12/30/2022]
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11
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Validity and Responsiveness of the FRAIL Scale in Middle-Aged Women. J Am Med Dir Assoc 2018; 19:65-69. [DOI: 10.1016/j.jamda.2017.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 11/18/2022]
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12
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Brown RT, Diaz-Ramirez LG, Boscardin WJ, Lee SJ, Steinman MA. Functional Impairment and Decline in Middle Age: A Cohort Study. Ann Intern Med 2017; 167:761-768. [PMID: 29132150 PMCID: PMC5716833 DOI: 10.7326/m17-0496] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Difficulties with daily functioning are common in middle-aged adults. However, little is known about the epidemiology or clinical course of these problems, including the extent to which they share common features with functional impairment in older adults. OBJECTIVE To determine the epidemiology and clinical course of functional impairment and decline in middle age. DESIGN Cohort study. SETTING The Health and Retirement Study. PARTICIPANTS 6874 community-dwelling adults aged 50 to 56 years who did not have functional impairment at enrollment. MEASUREMENTS Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, assessed every 2 years for a maximum follow-up of 20 years, and impairment in instrumental ADLs (IADLs), defined similarly. Data were analyzed by using multistate models that estimate probabilities of different outcomes. RESULTS Impairment in ADLs developed in 22% of participants aged 50 to 64 years, in whom further functional transitions were common. Two years after the initial impairment, 4% (95% CI, 3% to 5%) of participants had died, 9% (CI, 8% to 11%) had further ADL decline, 50% (CI, 48% to 52%) had persistent impairment, and 37% (CI, 35% to 39%) had recovered independence. In the 10 years after the initial impairment, 16% (CI, 14% to 18%) had 1 or more episodes of functional decline and 28% (CI, 26% to 30%) recovered from their initial impairment and remained independent throughout this period. The pattern of findings was similar for IADLs. LIMITATION Functional status was self-reported. CONCLUSION Functional impairment and decline are common in middle age, as are transitions from impairment to independence and back again. Because functional decline in older adults has similar features, current interventions used for prevention in older adults may hold promise for those in middle age. PRIMARY FUNDING SOURCE National Institute on Aging and National Center for Advancing Translational Sciences through the University of California, San Francisco, Clinical and Translational Sciences Institute.
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Affiliation(s)
- Rebecca T. Brown
- Division of Geriatrics, University of California, San Francisco
- San Francisco Veterans Affairs (VA) Medical Center
| | - L. Grisell Diaz-Ramirez
- Division of Geriatrics, University of California, San Francisco
- San Francisco Veterans Affairs (VA) Medical Center
| | - W. John Boscardin
- Division of Geriatrics, University of California, San Francisco
- San Francisco Veterans Affairs (VA) Medical Center
| | - Sei J. Lee
- Division of Geriatrics, University of California, San Francisco
- San Francisco Veterans Affairs (VA) Medical Center
| | - Michael A. Steinman
- Division of Geriatrics, University of California, San Francisco
- San Francisco Veterans Affairs (VA) Medical Center
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Associations of Clinically Relevant Levels of Depressive Symptoms and Antidepressant Use With Mortality in African American Health. J Am Med Dir Assoc 2017; 18:1058-1062. [PMID: 29169735 DOI: 10.1016/j.jamda.2017.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Institute of Medicine has highlighted unequal treatment for African American individuals in health care. We examined the association of underuse of antidepressants in African American individuals with increased mortality. METHODS We conducted a longitudinal cohort study in Metropolitan St Louis, Missouri, in a population-based study of community-dwelling African American individuals, aged 52 to 68 years. Medication evaluations and clinically relevant levels of depressive symptoms (CRLDS) assessments occurred in 2000 and 2004. The analytic sample included 830 (of 853 total, 97%) participants with complete data. CRLDS was defined as ≥9 on the 11-item Center for Epidemiologic Studies Depression scale. Antidepressant use was determined by in-home medication recording and in-center coding. Participants were placed into 4 exposure categories: persistent CRLDS-no antidepressant (n = 69); intermittent CRLDS-no antidepressant (n = 123); antidepressant treatment (n = 110); and no CRLDS-no antidepressant (n = 528). Logistic regression with backwards elimination of the 9 identified potential confounders was used to examine associations of exposures with all-cause mortality over 6 years (2004-2010). Five sensitivity analyses investigated robustness of the primary findings. RESULTS The antidepressant group was independently associated with reduced mortality compared with the persistent-no antidepressant group (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.08-0.44). Sensitivity analyses showed no substantive differences from the primary model; one indicated that the persistent CRLDS-no antidepressant group experienced significantly increased mortality compared with the no CRLDS-no antidepressant group (OR 2.12, 95% CI 1.10-4.09), whereas the intermittent-no antidepressant group did not (OR 0.83, 95% CI 0.44-1.58). CONCLUSIONS These results highlight that underuse of antidepressants in African American individuals is associated with increased mortality.
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Ribeiro SML, Malmstrom TK, Morley JE, Miller DK. Fruit and vegetable intake, physical activity, and depressive symptoms in the African American Health (AAH) study. J Affect Disord 2017; 220:31-37. [PMID: 28577427 DOI: 10.1016/j.jad.2017.05.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/22/2017] [Accepted: 05/23/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Healthy diet and physical activity (PA) have been associated with reduced depressive symptoms, but few studies have examined them simultaneously in African Americans. AIMS To investigate fruit and vegetable intake (FVI) and PA as predictors of clinically-relevant levels of depressive symptoms (CRLDS) in African Americans. METHODS African American Health (AAH) is a population-based longitudinal study of African Americans in St. Louis, MO, who were born in 1936-1950 (inclusive) and empaneled in 2000-01 (wave 1). At wave 8, participants self-reported fruit and vegetable intake (FVI) and completed the Yale Physical Activity Scale. At both waves 8 and 10, the CES-D 11-item scale was used to identify those who met criteria for CRLDS. Sequential logistic regression modeling was used to examine the associations of components of FVI/PA with CRLDS, both cross-sectionally (n = 680, including imputed values) and longitudinally (n = 582, including imputed values). Modeling employed gender, age, perceived income adequacy, and education as potential confounders. RESULTS Cross-sectionally, vigorous PA, and leisurely walking PA, were independently associated with lower odds of CRLDS in all but the fifth model and green vegetables in all models. Longitudinally, green vegetables and interactions between the FVI summary score, the PA summary score, and other factors at wave 8 were most consistently associated with CRLDS at wave 10. In both cross-sectional and longitudinal models, the socioeconomic variables showed the strongest association as risk factors for CRLDS. LIMITATIONS Both FVI and PA were self-reported rather than observed, our cohort had limited geographic- and age-ranges, and confidence intervals for some results were broad. CONCLUSIONS Green vegetables, total FVI, and various aspects of PA showed protective effects regarding CRLDS. Therefore, the promotion of such lifestyles is likely to help prevent CRLDS in this population.
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Affiliation(s)
- Sandra M L Ribeiro
- University of Sao Paulo, School of Arts, Science and Humanities and School of Public Health, São Paulo, SP, Brazil.
| | - Theodore K Malmstrom
- St Louis University, School of Medicine, Geriatrics Division, St. Louis, MO, USA; St Louis University, School of Medicine, Department of Psychiatry & Behavioral Neuroscience, St. Louis, MO, USA
| | - John E Morley
- St Louis University, School of Medicine, Geriatrics Division, St. Louis, MO, USA
| | - Douglas K Miller
- Regenstrief Institute, Inc., IU Center for Aging, Indianapolis, IN, USA
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Abstract
The world is aging as a result of unprecedented successes worldwide adding 30 years of life expectancy and presenting great opportunities for all of society, but only if we invest effectively. This article, written as a requested background article for the World Health Organization 2015 World Report on Aging, proposes that creating health into the oldest ages could lay the basis for a third demographic dividend resulting from the societal benefits from the generative social capital of older adults, on top of the second demographic dividend's savings associated with longer lives. The combination would contribute to stronger and wealthier societies, greater success of the young, and increased societal ability to provide the humane supports needed at the end of life, plus a dividend that would endure. We now know that prevention works at every age and into the oldest ages. A life-course approach to prevention and health promotion is the key investment. The creation of geriatrically knowledgeable and integrated public health, medical and social care systems has the potential to amplify capabilities and well-being to the end of life. Healthy older populations bring both desire for engagement and unique talents. Institutions designed to create impactful roles for older adults to contribute to the success of the young can activate the societal benefits and further enhance health at older ages. Creating a new vision for the opportunities of an older age is the first critical step toward experiencing the benefits of our longer lives and creating a sustained third demographic dividend.
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Affiliation(s)
- Linda P Fried
- Mailman School of Public Health, Columbia University, New York.
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Owusu C, Margevicius S, Schluchter M, Koroukian SM, Schmitz KH, Berger NA. Vulnerable elders survey and socioeconomic status predict functional decline and death among older women with newly diagnosed nonmetastatic breast cancer. Cancer 2016; 122:2579-86. [PMID: 27348765 DOI: 10.1002/cncr.30046] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/07/2016] [Accepted: 03/17/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of this study was to determine the ability of the Vulnerable Elders Survey (VES-13) to predict the composite outcome of functional decline and death within 12 months of breast cancer treatment among women 65 years old or older with newly diagnosed stage I to III breast cancer. METHODS Two hundred and six participants were recruited from ambulatory oncology clinics at an academic center between April 2008 and April 2013. Participants competed the VES-13 at baseline just before neoadjuvant/adjuvant treatment. The primary outcome, functional decline/death, was defined as either a decrease of at least 1 point on the Activities of Daily Living scale and/or the Instrumental Activities of Daily Living scale or death between baseline and 12 months (yes or no). RESULTS One hundred and eighty four participants (89%) completed 12 months of follow-up. Twenty-two percent functionally declined (n = 34) or died (n = 7). Univariately, with increasing VES-13 scores, the estimated risk of functional decline/death rose from 23% for participants with a VES-13 score of 3 to 76% for participants with a VES-13 score of 10. In multivariate logistic regression analysis, VES-13 scores (adjusted odds ratio, 1.37; 95% confidence interval, 1.18-1.57) and having a high school education or less (adjusted odds ratio, 2.47; 95% confidence interval, 1.08-5.65) were independent predictors of functional decline/death (area under the receiver operator curve, 0.79). CONCLUSIONS Among older women with newly diagnosed nonmetastatic breast cancer, approximately 1 in 5 functionally declined and/or died within 12 months of breast cancer treatment initiation. Women with high school education or less were disproportionately affected. The VES-13 is a useful instrument for the early identification of those at risk for functional decline and/or death. Cancer 2016;122:2579-86. © 2016 American Cancer Society.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Seunghee Margevicius
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Mark Schluchter
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Siran M Koroukian
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Epidemiology and Biostatistics, Case Western Reserve School of Medicine, Cleveland, Ohio
| | - Kathryn H Schmitz
- Department of Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Nathan A Berger
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
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Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle 2016; 7:28-36. [PMID: 27066316 PMCID: PMC4799853 DOI: 10.1002/jcsm.12048] [Citation(s) in RCA: 589] [Impact Index Per Article: 73.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 04/07/2015] [Accepted: 04/23/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A brief, inexpensive screening test for sarcopenia would be helpful for clinicians and their patients. To screen for persons with sarcopenia, we developed a simple five-item questionnaire (SARC-F) based on cardinal features or consequences of sarcopenia. METHODS We investigated the utility of SARC-F in the African American Health (AAH) study, Baltimore Longitudinal Study of Aging (BLSA), and National Health and Nutrition Examination Survey (NHANES). Internal consistency reliability for SARC-F was determined using Cronbach's alpha. We evaluated SARC-F factorial validity using principal components analysis and criterion validity by examining its association with exam-based indicators of sarcopenia. Construct validity was examined using cross-sectional and longitudinal differences among those with high (≥4) vs. low (<4) SARC-F scores for mortality and health outcomes. RESULTS SARC-F exhibited good internal consistency reliability and factorial, criterion, and construct validity. AAH participants with SARC-F scores ≥ 4 had more Instrumental Activity of Daily Living (IADL) deficits, slower chair stand times, lower grip strength, lower short physical performance battery scores, and a higher likelihood of recent hospitalization and of having a gait speed of <0.8 m/s. SARC-F scores ≥ 4 in AAH also were associated with 6 year IADL deficits, slower chair stand times, lower short physical performance battery scores, having a gait speed of <0.8 m/s, being hospitalized recently, and mortality. SARC-F scores ≥ 4 in the BLSA cohort were associated with having more IADL deficits and lower grip strength (both hands) in cross-sectional comparisons and with IADL deficits, lower grip strength (both hands), and mortality at follow-up. NHANES participants with SARC-F scores ≥ 4 had slower 20 ft walk times, had lower peak force knee extensor strength, and were more likely to have been hospitalized recently in cross-sectional analyses. CONCLUSIONS The SARC-F proved internally consistent and valid for detecting persons at risk for adverse outcomes from sarcopenia in AAH, BLSA, and NHANES.
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Affiliation(s)
- Theodore K Malmstrom
- Department of Neurology & Psychiatry Saint Louis University School of Medicine St. Louis MO 63104 USA; Division of Geriatric Medicine, Department of Internal Medicine Saint Louis University School of Medicine St. Louis MO 63104 USA
| | - Douglas K Miller
- Regenstrief Institute, Inc. and Center for Aging Research Indiana University School of Medicine Indianapolis IN 46202 USA
| | - Eleanor M Simonsick
- National Institute on Aging, Translational Gerontology Branch Biomedical Research Center Baltimore MD 21224 USA
| | - Luigi Ferrucci
- National Institute on Aging, Translational Gerontology Branch Biomedical Research Center Baltimore MD 21224 USA
| | - John E Morley
- Division of Geriatric Medicine, Department of Internal Medicine Saint Louis University School of Medicine St. Louis MO 63104 USA
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Chode S, Malmstrom TK, Miller DK, Morley JE. Frailty, Diabetes, and Mortality in Middle-Aged African Americans. J Nutr Health Aging 2016; 20:854-859. [PMID: 27709235 DOI: 10.1007/s12603-016-0801-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Older adult frail diabetics have high mortality risk, but data are limited regarding frail late middle-aged diabetics, especially for African-Americans. The aim of this study is to examine the association of diabetes with health outcomes and frailty in the African American Health (AAH) study. METHODS AAH is a population-based longitudinal cohort study. Participants were African Americans (N=998) ages 49 to 65 years at baseline. Cross-sectional comparisons for diabetes included disability, function, physical performance, cytokines, and frailty. Frailty measures included the International Academy of Nutrition and Aging [FRAIL] frailty scale, Study of Osteoporotic Fractures [SOF] frailty scale, Cardiovascular Health Study [CHS] frailty scale, and Frailty Index [FI]). Longitudinal associations for diabetes included new ADLs ≥ 1 and mortality at 9-year follow-up. RESULTS Diabetics were more likely to be frail using any of the 4 frailty scales than were non-diabetics. Frail diabetics, compared to nonfrail diabetics, reported significantly increased falls in last 1 year, higher IADLs and higher LBFLs. They demonstrated worse performance on the SPPB, one-leg stand, and grip strength; and higher Tumor Necrosis Factor receptors (sTNFR1 and sTNFR2). Mortality and 1 or more new ADLs also were increased among frail compared to nonfrail diabetics when followed for 9 years. CONCLUSIONS Frailty in middle-aged African American persons with diabetes is associated with having more disability and functional limitations, worse physical performance, and higher cytokines (sTNFR1 and sTNFR2 only). Middle-aged African Americans with diabetes have an increased risk of mortality and frail diabetics have an even higher risk of death, compared to nonfrail diabetics.
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Affiliation(s)
- S Chode
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Boulevard, M238, St Louis, MO 63104, E-mail address: ; Phone: 314-977-8462; Fax: 314-771-8571
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Ribeiro SML, Morley JE, Malmstrom TK, Miller DK. Fruit and Vegetable Intake and Physical Activity as Predictors of Disability Risk Factors in African-American Middle-Aged Individuals. J Nutr Health Aging 2016; 20:891-896. [PMID: 27791218 DOI: 10.1007/s12603-016-0780-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate fruit and vegetable intake (FVI) and different dimensions of physical activity (PA) as predictors of change in disabilities and other known precursors of progressive disability in a population-based sample of African Americans. DESIGN Longitudinal investigation of the independent associations of reported FVI and PA with six-year changes in disabilities and other known precursors of progressive disability. SETTING Longitudinal study of a population-representative cohort of late middle-aged African Americans. PARTICIPANTS 432 cohort participants with complete information on all measures. Measurements and Analytic Approach: During wave 8 (2008), FVI was measured using 2005 Behavioral Risk Factor Surveillance System questions and PA dimensions using the Yale Physical Activity Survey (YPAS). Disability measures included basic activities of daily living (ADLs) and instrumental ADLs (IADLs); other precursors included measured gait speed, grip strength, and short physical performance battery (SPPB) and reported lower body functional limitations (LBFLs) and FRAIL scale; these were measured at wave 4 (2004) and wave 10 (2010). Residual-change score linear regression was used to identify FVI and PA factors that were independently associated with six-year changes in disability and other precursors. RESULTS The study cohort was less active than the YPAS-development group. Longitudinally, leisurely walking was independently associated with better ADL, IADL, grip strength, SPPB, LBFL, and frailty outcomes; standing with better IADL and SPPB; intake of vegetables other than carrots, salads, or potatoes with better grip strength and frailty; and fruit juice intake with worse grip strength and frailty. CONCLUSIONS In this relatively inactive cohort, leisurely walking was associated with multiple beneficial outcomes. Benefits were also seen with vegetables other than potato intake, and fruit juice intake was associated with detrimental effects. This study highlights the importance of finding strategies to help this population increase PA (especially leisurely walking) and intake of whole fruits and vegetables.
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Affiliation(s)
- S M L Ribeiro
- Sandra Maria Lima Ribeiro, School of Public Health- University of São Paulo, Av Dr Arnaldo, 715- CEP 01246-904, São Paulo, SP, Brazil, e-mail:
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Mingo CA, Smith ML, Ahn S, Jiang L, Cho J, Towne SD, Ory MG. Chronic Disease Self-Management Education (CDSME) Program Delivery and Attendance among Urban-Dwelling African Americans. Front Public Health 2015; 2:174. [PMID: 25964907 PMCID: PMC4410424 DOI: 10.3389/fpubh.2014.00174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/18/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Older African Americans carry a disproportionate share of chronic diseases. The purpose of this study was to identify the characteristics of urban-dwelling African Americans with chronic disease participating in Chronic Disease Self-Management Education (CDSME) programs and to examine factors related to successful program completion (i.e., attending at least four of the six sessions). METHODS Data were analyzed from 11,895 African Americans who attended a CDSME program at one of the five leading delivery sites (i.e., senior center, health care organization, residential facility, community location, faith-based organization). Logistic regression analyses were used to assess the associations of demographic, delivery site, and neighborhood characteristics with CDSME program successful completion. RESULTS Approximately, half of the African American participants were aged 65-79 years, 83% were female, and 92% lived alone. Approximately, 44% of participants had three or more chronic conditions and 35% resided in an impoverished area (i.e., 200% below federal poverty level). Successful completion of the CDSME program was associated with being between the ages of 50-64 and 65-79 years, being female, living alone, living in an impoverished community, and attending a CDSME program at a residential facility or community center. CONCLUSION Findings highlight the unique patterns of attendance and delivery within the context of self-management interventions among this unique and traditionally underserved target population. Understanding such patterns can inform policy and practice efforts to engage more organizations in urban areas to increase CDSME program adoption. Particularly, employing strategies to implement CDSME programs across all delivery site types may increase reach to African American participants.
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Affiliation(s)
- Chivon A Mingo
- Gerontology Institute, College of Arts and Sciences, Georgia State University , Atlanta, GA , USA
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia , Athens, GA , USA
| | - SangNam Ahn
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis , Memphis, TN , USA ; Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA
| | - Jinmyoung Cho
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA ; Baylor Scott & White Health, Center for Applied Health Research , Temple, TX , USA
| | - Samuel D Towne
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA
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Hawkins MAW, Miller DK, Stewart JC. A 9-year, bidirectional prospective analysis of depressive symptoms and adiposity: the African American Health Study. Obesity (Silver Spring) 2015; 23:192-9. [PMID: 25393086 PMCID: PMC4276428 DOI: 10.1002/oby.20893] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/18/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Depression may be a predictor and consequence of obesity. However, available evidence for racial minorities has been inconsistent, and more prospective studies are needed. Thus, this study's objective was to examine whether depressive symptom severity is a predictor and/or consequence of total adiposity over a 9-year period in a representative sample of late middle-aged African-Americans. METHODS A total of 410 participants (aged 49-65 years; baseline) in the prospective cohort African American Health study were examined. Depressive symptom severity was assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D). Total body fat percent (BF%) and body mass index (BMI; kg/m(2) ) were assessed. Structural equation models were tested. RESULTS All model fit statistics, other than χ(2) , indicated good fit (RMSEA ≤ 0.058, SRMR ≤ 0.052, CFI ≥ 0.95). Baseline CES-D did not predict 9-year changes in BF% (β = -0.01, P = 0.78) or BMI (β = -0.01, P = 0.77). Baseline BF% (β = 0.05, P = 0.39) and BMI (β = 0.08, P = 0.095) did not predict 9-year change in CES-D. CONCLUSIONS Depressive symptom severity was not a predictor or consequence of excess total adiposity in late middle-aged African-American adults. Including a depression module in obesity prevention and treatment programs specifically designed for late middle-aged African-Americans may not have a beneficial effect on obesity outcomes.
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Affiliation(s)
| | - Douglas K. Miller
- Department of Internal Medicine, Indiana University, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Jesse C. Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN
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Lorenz RA, Budhathoki CB, Kalra GK, Richards KC. The relationship between sleep and physical function in community-dwelling adults: a pilot study. FAMILY & COMMUNITY HEALTH 2014; 37:298-306. [PMID: 25167070 PMCID: PMC4286147 DOI: 10.1097/fch.0000000000000046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
More than 50% of community-dwelling adults have sleep complaints. Because aging is associated with decline in physical function, coexistent sleep difficulties may exacerbate functional decline. This pilot study explored the relationships between sleep, age, chronic disease burden, and physical function among 50 community-dwelling older adults. Findings revealed significant relationships between total sleep time and preclinical disability (r = -0.33, P ≤ .05) and mobility difficulty (r = -0.36, P ≤ .05). A regression analysis showed that total sleep time was significantly associated with mobility difficulty and preclinical disability, even after controlling for chronic disease burden. These findings suggest that total sleep time may be a catalyst for functional decline.
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Wolinsky FD, Vander Weg MW, Howren MB, Jones MP, Dotson MM. The effect of cognitive speed of processing training on the development of additional IADL difficulties and the reduction of depressive symptoms: results from the IHAMS randomized controlled trial. J Aging Health 2014; 27:334-54. [PMID: 25239928 DOI: 10.1177/0898264314550715] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We evaluated the effects of cognitive speed of processing training (SOPT) on the development of additional Instrumental Activities of Daily Living (IADL) difficulties and the reduction of depressive symptoms in the Iowa Healthy and Active Minds Study (IHAMS). METHOD Six hundred eighty-one patients were randomized to 4 groups: 10 hr of on-site SOPT, 10 hr of on-site SOPT plus 4 hr of boosters, 10 hr of at-home SOPT, or 10 hr of on-site attention-control (crossword puzzles). Developing additional difficulties with IADLs and reductions in depressive symptoms 1 year later were evaluated using multiple logistic regression. RESULTS The on-site SOPT with boosters group had reduced odds of developing additional difficulties with IADLs (adjusted odds ratio [AOR] = 0.45, p = .044) compared with attention-controls. The on-site SOPT with boosters group also had increased odds of reduced depressive symptom levels (AOR = 2.93, p = .003) compared with attention-controls. DISCUSSION These findings provide evidence that SOPT transfers beyond the cognitive skills trained to meaningful downstream improvements in the lives of middle-aged and older adults.
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Harris-Love MO, Adams B, Hernandez HJ, DiPietro L, Blackman MR. Disparities in the consequences of sarcopenia: implications for African American Veterans. Front Physiol 2014; 5:250. [PMID: 25071595 PMCID: PMC4083180 DOI: 10.3389/fphys.2014.00250] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/16/2014] [Indexed: 12/25/2022] Open
Affiliation(s)
- Michael O Harris-Love
- The Muscle Morphology, Mechanics, and Performance Laboratory, Geriatrics and Extended Care Service, Veterans Affairs Medical Center Washington, DC, USA ; Research Service, Veterans Affairs Medical Center Washington, DC, USA ; Department of Exercise Science, School of Public Health and Health Services, The George Washington University Washington, DC, USA
| | - Bernadette Adams
- Research Service, Veterans Affairs Medical Center Washington, DC, USA
| | - Haniel J Hernandez
- Physical Therapy, Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center Washington, DC, USA
| | - Loretta DiPietro
- Department of Exercise Science, School of Public Health and Health Services, The George Washington University Washington, DC, USA
| | - Marc R Blackman
- The Muscle Morphology, Mechanics, and Performance Laboratory, Geriatrics and Extended Care Service, Veterans Affairs Medical Center Washington, DC, USA ; Department of Medicine, School of Medicine and Health Sciences, The George Washington University Washington, DC, USA
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Abstract
OBJECTIVES To determine how well the interview-based, clinic-friendly International Academy of Nutrition and Aging (FRAIL) frailty scale predicts future disability and mortality in the African American Health (AAH) cohort compared with the clinic-friendly Study of Osteoporotic Fractures (SOF) frailty scale, the phenotype-based Cardiovascular Health Study (CHS) frailty scale, and the comprehensive Frailty Index (FI). DESIGN Longitudinal cohort study. SETTING Metropolitan St. Louis, Missouri. PARTICIPANTS African American Health is a population-based panel study of African Americans (baseline age 49-65) from St. Louis, Missouri. Participants completed in-home assessments at baseline (N = 998) and 3- (n = 853) and 9- (n = 582) year follow-up. MEASUREMENTS Outcomes included activity of daily living (ADL) and instrumental ADL difficulties at 3 and 9 years and 9-year mortality. Frailty measures included the FRAIL, SOF, and CHS scales and the FI. RESULTS The FRAIL, SOF, CHS, and FI measures predicted new 3- and 9-year disability, and the FRAIL and FI scales predicted 9-year mortality. Receiver operating characteristic (ROC) contrasts showed that the FRAIL scale performed as well as (9-year disability and mortality) or better than (3-year disability) the CHS and SOF scales and the FI better than the FRAIL, CHS, and SOF scales for all outcomes except the FRAIL and CHS scales for 9-year ADL difficulties. The CHS and SOF scales were equivalent for all outcomes in ROC contrasts. CONCLUSION Overall the FI and the FRAIL scale exhibited the strongest predictive validity for disability and mortality in AAH. The best prediction tool to identify frail individuals at risk of disability and mortality may be one that includes a comorbidity measure. The FRAIL scale includes a comorbidity item and is a brief interview-based measure that is easy to administer, score, and interpret. The FRAIL scale has demonstrated validity and may prove to be a valuable scale for use by clinicians.
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Affiliation(s)
- Theodore K Malmstrom
- Department of Neurology and Psychiatry, School of Medicine, Saint Louis University, Saint Louis, Missouri; Division of Geriatric Medicine, Department of Internal Medicine, School of Medicine, Saint Louis University, Saint Louis, Missouri
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Higgins TJ, Janelle CM, Manini TM. Diving below the surface of progressive disability: considering compensatory strategies as evidence of sub-clinical disability. J Gerontol B Psychol Sci Soc Sci 2014; 69:263-74. [PMID: 24170713 PMCID: PMC3968860 DOI: 10.1093/geronb/gbt110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/19/2013] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To provide a comprehensive review regarding the role of activity and participation compensations within the disablement process, identify directions for future research, and discuss the implications of compensation pertaining to public health initiatives aimed at preventing and reversing disability. METHOD This article evaluated how using compensatory strategies to cope with functional deficits reveals important transitions within the disablement process and signifies a unique opportunity to identify early declines in function. RESULTS Previous research suggests that (a) adopting compensatory strategies to maintain activity/participation is strongly associated with functional decline and disease severity and significantly predicts the onset of limitations/restrictions; (b) compensation can be reliably quantified; and (c) contextual knowledge about how individuals adapt to functional decline can be used to describe transitions in the disablement process. DISCUSSION Characterizing subtle adaptations prior to the onset of activity limitations and participation restrictions will not only aid in understanding the complex disablement process but also help inform social services and future prevention strategies. Overall, this article integrates the concept of compensation into the current model of disability and proposes a framework for identifying and interpreting compensatory behavior.
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Affiliation(s)
- Torrance J Higgins
- Correspondence should be addressed to Todd M. Manini, Department of Aging and Geriatrics, University of Florida, 210 Mowry Road, Gainesville, Gainesville, FL 32611. E-mail:
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Wolinsky FD, Ayyagari P, Malmstrom TK, Miller JP, Andresen EM, Schootman M, Miller DK. Lower extremity function trajectories in the African American Health Cohort. J Gerontol A Biol Sci Med Sci 2013; 69:1004-10. [PMID: 24336800 DOI: 10.1093/gerona/glt197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We addressed two understudied issues in estimating lower extremity functional trajectories in older adults-incorporating the effect of mortality and evaluating heterogeneity among African Americans. METHODS Data were taken from the 998 participants in the African American Health cohort. A highly reliable and valid 8-item lower extremity function scale was used at baseline and at the 1-, 2-, 3-, 4-, 7-, and 9-year follow-up interviews. Semiparametric (ie, discrete) group-based mixture modeling identified the trajectories, and multinomial logistic regression identified risk factors for differential trajectory groups. RESULTS When treating mortality as informative censoring, six discrete trajectories were observed with 45% of the participants belonging to three stable trajectories (good, fair, or poor function), and the remainder belonging to three declining trajectories (very high function with minimal improvement then minimal decline, very good function with a slow and modest decline, and very good function with a large and quick decline). CONCLUSION Substantial heterogeneity in lower extremity function trajectories exists in the African American Health cohort, after appropriately treating mortality as informative censoring.
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Affiliation(s)
- Fredric D Wolinsky
- Department of Health Management and Policy, College of Public Health, The University of Iowa.
| | - Padmaja Ayyagari
- Department of Health Management and Policy, College of Public Health, The University of Iowa
| | - Theodore K Malmstrom
- Department of Neurology & Psychiatry, School of Medicine, Saint Louis University, Missouri
| | - J Phillip Miller
- Department of Biostatistics, Washington University in St. Louis, Missouri
| | - Elena M Andresen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Mario Schootman
- Department of Epidemiology, School of Public Health, Saint Louis University, Missouri
| | - Douglas K Miller
- Center for Aging Research, Indiana University & the Regenstrief Institute, Indianapolis
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Andresen EM, Malmstrom TK, Schootman M, Wolinsky FD, Miller JP, Miller DK. Observer ratings of neighborhoods: comparison of two methods. BMC Public Health 2013; 13:1024. [PMID: 24168373 PMCID: PMC3840667 DOI: 10.1186/1471-2458-13-1024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/16/2013] [Indexed: 11/19/2022] Open
Abstract
Background Although neighborhood characteristics have important relationships with health outcomes, direct observation involves imperfect measurement. The African American Health (AAH) study included two observer neighborhood rating systems (5-item Krause and 18-item AAH Neighborhood Assessment Scale [NAS]), initially fielded at two different waves. Good measurement characteristics were previously shown for both, but there was more rater variability than desired. In 2010 both measures were re-fielded together, with enhanced training and field methods implemented to decrease rater variability while maintaining psychometric properties. Methods AAH included a poor inner city and more heterogeneous suburban areas. Four interviewers rated 483 blocks, with 120 randomly-selected blocks rated by two interviewers. We conducted confirmatory factor analysis of scales and tested the Krause (5-20 points), AAH 18-item NAS (0-28 points), and a previous 7-item and new 5-item versions of the NAS (0-17 points, 0-11 points). Retest reliability for items (kappa) and scales (Intraclass Correlation Coefficient [ICC]) were calculated overall and among pre-specified subgroups. Linear regression assessed interviewer effects on total scale scores and assessed concurrent validity on lung and lower body functions. Mismeasurement effects on self-rated health were also assessed. Results Scale scores were better in the suburbs than in the inner city. ICC was poor for the Krause scale (ICC=0.19), but improved if the retests occurred within 10 days (ICC=0.49). The 7- and 5-item NAS scales had better ICCs (0.56 and 0.62, respectively), and were higher (0.71 and 0.73) within 10 days. Rater variability for the Kraus and 5- and 7-item NAS scales was 1-3 points (compared to the supervising rater). Concurrent validity was modest, with residents living in worse neighborhood conditions having worse function. Unadjusted estimates were biased towards the null compared with measurement-error corrected estimates. Conclusions Enhanced field protocols and rater training did not improve measurement quality. Specifically, retest reliability and interviewer variability remained problematic. Measurement error partially reduced, but did not eliminate concurrent validity, suggesting there are robust associations between neighborhood characteristics and health outcomes. We conclude that the 5-item AAH NAS has sufficient reliability and validity for further use. Additional research on the measurement properties of environmental rating methods is encouraged.
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Affiliation(s)
- Elena M Andresen
- Institute on Development & Disability, Oregon Health & Science University, Portland, OR, USA.
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Owusu C, Schluchter M, Koroukian SM, Mazhuvanchery S, Berger NA. Racial disparities in functional disability among older women with newly diagnosed nonmetastatic breast cancer. Cancer 2013; 119:3839-46. [PMID: 24114615 DOI: 10.1002/cncr.28232] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 05/07/2013] [Accepted: 05/28/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study sought to assess racial differences in functional disability among older women with nonmetastatic breast cancer. METHODS In this cross-sectional study, between April 2008 and December 2012, women aged ≥ 65 years with newly diagnosed stage I through III breast cancer were recruited from ambulatory oncology clinics at an academic center. Prior to receiving any adjuvant treatment, participants completed a comprehensive geriatric assessment. The primary outcome was functional disability, defined as dependency in any basic or instrumental activity of daily living, categorized as "yes" or "no." Logistic regression analyses were undertaken. RESULTS The study enrolled 190 women whose mean age was 75.0 years at diagnosis (standard deviation = 7.0, range = 65-93 years). Thirty-two percent were African American (AA), and 39% had functional disability. Controlling for age, participants with functional disability were more likely to be AA (versus non-Hispanic white), odds ratio = 4.19, 95% confidence interval = 2.12-8.27. Fifty-nine percent of the racial difference in functional disability was explained by a higher prevalence of lower income and education among AAs. In addition, the higher prevalence of chronic medical conditions and obesity among AAs, after accounting for socioeconomic factors, further explained 40% of the black-white difference in functional disability. CONCLUSIONS Among older women with newly diagnosed nonmetastatic breast cancer, functional disability is highly prevalent, and AAs are disproportionately affected. Interventions to optimize the functional status of at-risk individuals, particularly AAs, during and after cancer treatment may improve treatment tolerance and overall survival outcomes.
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Affiliation(s)
- Cynthia Owusu
- Division of Hematology/Oncology, Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio; Case Comprehensive Cancer Center, Cleveland, Ohio
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Wolinsky FD, Malmstrom TK, Miller JP, Andresen EM, Schootman M, Miller DK. Association between childhood school segregation and changes in adult sense of control in the African American health cohort. J Gerontol B Psychol Sci Soc Sci 2013; 68:956-62. [PMID: 24056692 DOI: 10.1093/geronb/gbt089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Cross-sectional associations between childhood school segregation and adult sense of control and physical performance have been established in the African American Health (AAH) cohort. Here we extend that work by estimating the association between childhood school segregation and 2-year changes in adult sense of control. Method. Complete data on 541 older AAH men and women were used to estimate the association between childhood school segregation and changes in the sense of control. Exposure to segregation was self-reported in 2004, and the sense of control was measured in 2008 and 2010 using Blom rank transformations of Mirowsky and Ross' 8-item scale. Declining subjective income and experiencing major life stressors between 2008 and 2010, as well as traditional covariates (demographic factors, socioeconomic status, self-rated health, racial attitudes and beliefs, and religiosity) were included for statistical adjustment. Multiple linear regression analysis with propensity score reweighting was used. RESULTS Receiving the majority of one's primary and secondary education in segregated schools had a significant net positive association (d = 0.179; p = .029) with 2-year changes in adult sense of control. CONCLUSION AAH participants receiving the majority of their primary and secondary educations in segregated schools appeared to have been protected, in part, from age-related declines in the sense of control.
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Affiliation(s)
- Fredric D Wolinsky
- Correspondence should be addressed to Fredric D. Wolinsky, College of Public Health, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52241. E-mail:
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Bruchas RR, de Las Fuentes L, Carney RM, Reagan JL, Bernal-Mizrachi C, Riek AE, Gu CC, Bierhals A, Schootman M, Malmstrom TK, Burroughs TE, Stein PK, Miller DK, Dávila-Román VG. The St. Louis African American health-heart study: methodology for the study of cardiovascular disease and depression in young-old African Americans. BMC Cardiovasc Disord 2013; 13:66. [PMID: 24011389 PMCID: PMC3847628 DOI: 10.1186/1471-2261-13-66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/13/2013] [Indexed: 01/20/2023] Open
Abstract
Background Coronary artery disease (CAD) is a major cause of death and disability worldwide. Depression has complex bidirectional adverse associations with CAD, although the mechanisms mediating these relationships remain unclear. Compared to European Americans, African Americans (AAs) have higher rates of morbidity and mortality from CAD. Although depression is common in AAs, its role in the development and features of CAD in this group has not been well examined. This project hypothesizes that the relationships between depression and CAD can be explained by common physiological pathways and gene-environment interactions. Thus, the primary aims of this ongoing project are to: a) determine the prevalence of CAD and depression phenotypes in a population-based sample of community-dwelling older AAs; b) examine the relationships between CAD and depression phenotypes in this population; and c) evaluate genetic variants from serotoninP and inflammatory pathways to discover potential gene-depression interactions that contribute significantly to the presence of CAD in AAs. Methods/design The St. Louis African American Health (AAH) cohort is a population-based panel study of community-dwelling AAs born in 1936–1950 (inclusive) who have been followed from 2000/2001 through 2010. The AAH-Heart study group is a subset of AAH participants recruited in 2009–11 to examine the inter-relationships between depression and CAD in this population. State-of-the-art CAD phenotyping is based on cardiovascular characterizations (coronary artery calcium, carotid intima-media thickness, cardiac structure and function, and autonomic function). Depression phenotyping is based on standardized questionnaires and detailed interviews. Single nucleotide polymorphisms of selected genes in inflammatory and serotonin-signaling pathways are being examined to provide information for investigating potential gene-depression interactions as modifiers of CAD traits. Information from the parent AAH study is being used to provide population-based prevalence estimates. Inflammatory and other biomarkers provide information about potential pathways. Discussion This population-based investigation will provide valuable information on the prevalence of both depression and CAD phenotypes in this population. The study will examine interactions between depression and genetic variants as modulators of CAD, with the intent of detecting mechanistic pathways linking these diseases to identify potential therapeutic targets. Analytic results will be reported as they become available.
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Affiliation(s)
- Robin R Bruchas
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St, Louis, MO 63110, USA.
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Low appendicular skeletal muscle mass (ASM) with limited mobility and poor health outcomes in middle-aged African Americans. J Cachexia Sarcopenia Muscle 2013; 4:179-86. [PMID: 23532635 PMCID: PMC3774914 DOI: 10.1007/s13539-013-0106-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 02/28/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent efforts to provide a consensus definition propose that sarcopenia be considered a clinical syndrome associated with the loss of both skeletal muscle mass and muscle function that occurs with aging. Validation of sarcopenia definitions that include both low muscle mass and poor muscle function is needed. METHODS In the population-based African American Health (AAH) study (N = 998 at baseline/wave 1), muscle mass and mobility were evaluated in a clinical testing center in a subsample of N = 319 persons (ages 52-68) at wave 4 (2004). Muscle mass was measured using dual energy x-ray absorptiometry and mobility by a 6-min walk test and 4-m gait walk test. Height corrected appendicular skeletal mass (ASM; 9.0 ± 1.5 in n = 124 males, 8.3 ± 2.2 in n = 195 females) was computed as total lean muscle mass in arms and legs (kilograms) divided by the square of height (meters). Cross-sectional and longitudinal (6-year) associations of low ASM (bottom 25 % AAH sample; <7.96 males and <7.06 females) and low ASM with limited mobility (4-m gait walk ≤1 m/s or 6-min walk <400 m) were examined for basic activities of daily living (ADL) difficulties, instrumental activities of daily living (IADL) difficulties, frailty, falls, and mortality (longitudinal only). RESULTS Low ASM with limited mobility was associated with IADL difficulties (p = .008) and frailty (p = .040) but not with ADL difficulties or falls in cross-sectional analyses; and with ADL difficulties (p = .022), IADL difficulties (p = .006), frailty (p = .039), and mortality (p = .003) but not with falls in longitudinal analyses adjusted for age and gender. Low ASM alone was marginally associated with mortality (p = .085) but not with other outcomes in cross-sectional or longitudinal analyses. CONCLUSION Low ASM with limited mobility is associated with poor health outcomes among late middle-aged African Americans.
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Thorpe RJ, Koster A, Bosma H, Harris TB, Simonsick EM, van Eijk JTM, Kempen GIJM, Newman AB, Satterfield S, Rubin SM, Kritchevsky SB. Racial differences in mortality in older adults: factors beyond socioeconomic status. Ann Behav Med 2013; 43:29-38. [PMID: 22180315 DOI: 10.1007/s12160-011-9335-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about the simultaneous effect of socioeconomic status (SES), psychosocial, and health-related factors on race differences in mortality in older adults. PURPOSE This study examined the association between race and mortality and the role of SES, health insurance, psychosocial factors, behavioral factors, and health-related factors in explaining these differences. METHODS Data consisted of 2,938 adults participating in the Health, Aging and Body Composition study. Mortality was assessed over 8 years. RESULTS SES differences accounted for 60% of the racial differences in all-cause mortality; behavioral factors and self-rated health further reduced the disparity. The racial differences in coronary heart disease mortality were completely explained by SES. Health insurance and behavioral factors accounted for some, but not all, of the race differences in cancer mortality. CONCLUSIONS Race-related risk factors for mortality may differ by the underlying cause of mortality.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, USA.
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Ayyagari P, Ullrich F, Malmstrom TK, Andresen EM, Schootman M, Miller JP, Miller DK, Wolinsky FD. Self-rated health trajectories in the African American health cohort. PLoS One 2012; 7:e53278. [PMID: 23300906 PMCID: PMC3534051 DOI: 10.1371/journal.pone.0053278] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 11/27/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Self-rated health taps health holistically and dynamically blends prior health histories with current illness burdens and expectations for future health. While consistently found as an independent predictor of functional decline, sentinel health events, physician visits, hospital episodes, and mortality, much less is known about intra-individual changes in self-rated health across the life course, especially for African Americans. MATERIALS/METHODS Data on 998 African American men and women aged 50-64 years old were taken from a probability-based community sample that was first assessed in 2000-2001 and re-assessed 1, 2, 3, 4, 7, and 9 years later. Using an innovative approach for including decedents in the analysis, semi-parametric group-based mixture models were used to identify person-centered group trajectories of self-rated health over time. Multivariable multinomial logistic regression analysis was then used to differentiate the characteristics of AAH participants classified into the different group trajectories. RESULTS Four self-rated health group trajectories were identified: persistently good health, good but declining health, persistently fair health, and fair but declining health. The main characteristics that differentiated the self-rated health trajectory groups from each other were age, education, smoking, morbidity (angina, congestive heart failure, diabetes, and kidney disease), having been hospitalized in the year prior to baseline, depressive symptoms, mobility limitations, and initial self-rated health. CONCLUSIONS This is the first study to examine self-rated health trajectories separately among African Americans. Four qualitatively distinct self-rated health group trajectories were identified that call into question the accuracy of prior reports that a single, average self-rated health trajectory for African Americans adequately captures their within-group heterogeneity.
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Affiliation(s)
- Padmaja Ayyagari
- Department of Health Management and Policy, the University of Iowa, Iowa City, Iowa United States of America
| | - Fred Ullrich
- Department of Health Management and Policy, the University of Iowa, Iowa City, Iowa United States of America
| | - Theodore K. Malmstrom
- Department of Neurology and Psychiatry, Saint Louis University, St. Louis, Missouri, United States of America
| | - Elena M. Andresen
- Institute on Development and Disability, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Mario Schootman
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - J. Philip Miller
- Department of Biostatistics, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Douglas K. Miller
- Department of Internal Medicine, Indiana University, Bloomington, Indiana, United States of America
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
| | - Fredric D. Wolinsky
- Department of Health Management and Policy, the University of Iowa, Iowa City, Iowa United States of America
- Department of Internal Medicine, the University of Iowa, Iowa City, Iowa, United States of America
- Department of Adult Nursing, the University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
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Wolinsky FD, Andresen EM, Malmstrom TK, Miller JP, Schootman M, Miller DK. Childhood school segregation and later life sense of control and physical performance in the African American Health cohort. BMC Public Health 2012; 12:827. [PMID: 23017218 PMCID: PMC3526414 DOI: 10.1186/1471-2458-12-827] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 09/25/2012] [Indexed: 02/14/2023] Open
Abstract
Background The association between childhood school desegregation and later life sense of control and physical performance among African Americans is not clear. We hypothesized that childhood school desegregation adversely affected the sense of control of in later life, and that this reduced sense of control accounts in part for reduced physical performance. Methods In-home follow-up assessments were completed in 2010 with 582 of the 58–74 year old men and women participating in the on-going African American Health cohort. We used these data to examine the relationship between (a) retrospective self-reports of attending segregated schools during one’s 1st-to-12th grade education and one’s current sense of control, as well as (b) the association between current sense of control and physical performance. Multiple linear regression analysis with propensity score re-weighting was used. Results Attending segregated schools for at least half of one’s 1st-to-12th grade education was significantly associated with higher scores on the sense of control. Adjusting for all covariates and potential confounders, those receiving half or more of their 1st-to-12th grade education in segregated schools had sense of control scores that were .886 points higher (p ≤ .01; standardized effect size = .22). Sense of control scores were independently (all p < .01) associated with better systolic blood pressure, grip strength, peak expiratory flow, chair stands, balance tests, and the Short Portable Physical Battery even after adjusting for all covariates and potential confounders. Moreover, sense of control scores either partially or fully mediated the statistically significant beneficial associations between childhood school segregation and physical performance. Conclusions Childhood school desegregation was adversely associated with the sense of control of African Americans in later life, and this reduced sense of control appears, in part, to account for their poorer physical performance. The etiologic mechanism through which childhood school segregation at the time that this cohort experienced it improved the sense of control in later life, which subsequently led to better physical performance, has not been identified. We suspect, however, that the pathway involves greater exposure to racial solidarity, same-race students as peer role models and same-race teachers and principals as authority role models, the reduced likelihood of exposure to race-based discrimination or antagonism during their formative early lives, and greater exposure to encouragement and support for academic and life success.
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Affiliation(s)
- Fredric D Wolinsky
- Department of Health Management and Policy, College of Public Health, the University of Iowa, Iowa City, IA, USA.
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Blanco I, Verghese J, Lipton RB, Putterman C, Derby CA. Racial differences in gait velocity in an urban elderly cohort. J Am Geriatr Soc 2012; 60:922-6. [PMID: 22587854 DOI: 10.1111/j.1532-5415.2012.03927.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To investigate whether there are racial differences in gait velocity in elderly adults. DESIGN Cross-sectional analysis. SETTING Bronx, New York. PARTICIPANTS Two hundred thirteen participants of the Einstein Aging Study (157 Caucasian, 56 African American), a longitudinal study of community-residing elderly adults recruited using Medicare and voter registration records. MEASUREMENTS Demographic characteristics, medical history, Geriatric Depression Scale, Blessed Information-Memory-Concentration Test, Total Pain Index, gait velocity. RESULTS Caucasians were older (median 79.9 vs 75.5, P = .002) and more educated (median 14 vs 12 years, P = .007) and had lower body mass index (mean 26.9 ± 4.3 vs 28.9 ± 6.4, P = .03). African Americans were more likely to be female (80.4% vs 59.9%, P = .006) and to have diabetes mellitus (28.6% vs 13.4%, P = .01). Pain levels were not significantly different between Caucasians and African Americans. African Americans had a significantly slower gait velocity (mean 90.2 ± 17.9 vs 99.1 ± 20.1 cm/s, P = .004). This difference persisted after adjusting for multiple covariates. Differences in common factors known to influence gait did not explain a 7.79-cm/s slower gait speed in African Americans than Caucasians. CONCLUSION Differences in gait velocity persist between African Americans and Caucasians despite adjusting for many confounders. Increases of just 10 cm/s are associated with lower mortality. Further studies are needed to evaluate whether there are modifiable risk factors that may explain this difference and whether an intervention could reduce the discrepancy between the groups.
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Affiliation(s)
- Irene Blanco
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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Higgins TJ, Janelle CM, Naugle KM, Knaggs J, Hoover BM, Marsiske M, Manini TM. Role of self-efficacy (SE) and anxiety among pre-clinically disabled older adults when using compensatory strategies to complete daily tasks. Arch Gerontol Geriatr 2012; 55:611-24. [PMID: 22770713 DOI: 10.1016/j.archger.2012.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 06/11/2012] [Accepted: 06/11/2012] [Indexed: 11/26/2022]
Abstract
Classic developmental theory suggests that aging is associated with using compensatory strategies to prolong independence. While compensatory strategies are typically considered positive adaptations, they also signify an early phase in the disablement process - commonly known as pre-clinical disability. To build a better understanding of psychological constructs related to these early signs of disability, we examined the contribution of SE and state anxiety on using compensatory strategies among pre-clinically disabled older adults. Compensatory strategies were observed during performance of daily activities in 257 pre-clinically disabled older adults (67.6 ± 7.04), and SE and state anxiety were evaluated prior to performing each task. In univariate models, lower SE and higher anxiety were associated with more compensation (Spearman correlations: 0.15-0.48, p<0.05). Multivariate logistic regression indicated that low SE [Odds Ratio (OR): 1.70; 95% Confidence Interval (CI): 1.40-2.08) and high anxiety (OR: 1.34; 95% CI: 1.10-1.63) were positively associated with using ≥6 compensatory strategies - a level signifying substantial compensation. When considered jointly with SE, the association with anxiety was reversed - higher anxiety demonstrated a lower likelihood of using compensation (OR: 0.70-0.73; 95% CI: 0.50-0.99). The addition of SE might remove the self-defeating cognitions characterizing anxiety allowing the remaining arousal component to appear beneficial. In conclusion, lower SE and higher anxiety are associated with using compensation to complete daily tasks among pre-clinically disabled older adults. Such psychological constructs may contribute to the use of compensatory strategies and represent future intervention targets to help reduce early signs of disability.
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Affiliation(s)
- Torrance J Higgins
- University of Florida, Department of Applied Physiology and Kinesiology, PO Box 118206, Gainesville, FL 32611-6110, United States
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Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012; 16:601-8. [PMID: 22836700 PMCID: PMC4515112 DOI: 10.1007/s12603-012-0084-2] [Citation(s) in RCA: 1088] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To validate the FRAIL scale. DESIGN Longitudinal study. SETTING Community. PARTICIPANTS Representative sample of African Americans age 49 to 65 years at onset of study. MEASUREMENTS The 5-item FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight), at baseline and activities of daily living (ADLs), instrumental activities of daily living (IADLs), mortality, short physical performance battery (SPPB), gait speed, one-leg stand, grip strength and injurious falls at baseline and 9 years. Blood tests for CRP, SIL6R, STNFR1, STNFR2 and 25 (OH) vitamin D at baseline. RESULTS Cross-sectionally the FRAIL scale correlated significantly with IADL difficulties, SPPB, grip strength and one-leg stand among participants with no baseline ADL difficulties (N=703) and those outcomes plus gait speed in those with no baseline ADL dependencies (N=883). TNFR1 was increased in pre-frail and frail subjects and CRP in some subgroups. Longitudinally (N=423 with no baseline ADL difficulties or N=528 with no baseline ADL dependencies), and adjusted for the baseline value for each outcome, being pre-frail at baseline significantly predicted future ADL difficulties, worse one-leg stand scores, and mortality in both groups, plus IADL difficulties in the dependence-excluded group. Being frail at baseline significantly predicted future ADL difficulties, IADL difficulties, and mortality in both groups, plus worse SPPB in the dependence-excluded group. CONCLUSION This study has validated the FRAIL scale in a late middle-aged African American population. This simple 5-question scale is an excellent screening test for clinicians to identify frail persons at risk of developing disability as well as decline in health functioning and mortality.
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Affiliation(s)
- J E Morley
- Division of Geriatrics, Department of Internal Medicine, 1402 South Grand Boulevard, St. Louis, MO 63104, USA.
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Schootman M, Andresen EM, Wolinsky FD, Malmstrom TK, Miller JP, Miller DK. Effect of street connectivity on incidence of lower-body functional limitations among middle-aged African Americans. Ann Epidemiol 2012; 22:568-74. [PMID: 22658823 DOI: 10.1016/j.annepidem.2012.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 04/14/2012] [Accepted: 04/14/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE We hypothesize that lower street connectivity increases the risk of incident lower-body functional limitations (LBFLs) among urban African Americans aged 49-65 years. METHODS This population-based cohort was interviewed in home visits. Five items measuring LBFL were obtained at baseline and after 3 years. Participants were considered to have LBFL if they reported difficulty on at least two of the five tasks. Census-tract street connectivity was measured as the ratio of the number of street intersections to the maximum possible number of intersections. RESULTS Of 563 subjects with zero or one LBFL at baseline, 109 (19.4%) experienced two or more LBFLs at the 3-year follow-up. Adjusted logistic regression showed that persons who lived in census tracts with the lowest quartile of street connectivity were 3.45 times (95% confidence interval, 1.21-9.78) more likely to develop two or more LBFLs than those who lived in census tracts with the highest quartile of street connectivity independent of other important environmental factors. CONCLUSIONS Areas with low street connectivity appear to be an independent contributor to the risk of incident LBFL in middle-aged African Americans.
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Affiliation(s)
- Mario Schootman
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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Cummings-Vaughn LA, Malmstrom TK, Morley JE, Miller DK. Testosterone is not associated with mortality in older African-American males. Aging Male 2011; 14:132-40. [PMID: 20681930 PMCID: PMC4519078 DOI: 10.3109/13685538.2010.502269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION. Although testosterone and its association with disease progression and mortality is a widely studied topic, no studies have evaluated mortality risks related to testosterone levels in an older African-American population. The mechanisms for known racial differences in mortality risk for certain cancers and cardiovascular risk factors are largely unknown. Elucidating a mortality risk associated with testosterone levels may give insight into the elevated risk for certain diseases in African-Americans. METHODS AND RESULTS. Study data were derived from a cohort 622 African-Americans (age 80.05 ± 6.4, range 68-102) from Saint Louis, Missouri that includes 190 males (age 79.38 ± 6.2, range 70-102). The eligible sample for this report includes 56 of the 190 males (age 78.89 ± 6.9, range 70-102) who donated blood at baseline in 1992-1994 and subsequently tested for total testosterone and bioavailable testosterone. Covariates for adjusted analyses were lower body functional limitations, physician visits and comorbidities, also collected at baseline. Males' mean bioavailable testosterone levels (ng/dl) were 33.33 ± 24.4 (n above 70 ng/dl = 5) and mean total testosterone levels (ng/dl) were 246.63 ± 118.7 (n above 300 ng/dl = 20). Vital status was determined through 2002; 41 males (73%) were deceased and 15 were alive. Mortality did not differ among males with testosterone levels <300 versus 300+ (p = 0.42) or with bioavailable testosterone levels <70 versus > 70 (p = 0.34). Total testosterone levels did not predict mortality when adjusted for age (Adjusted Hazard Ratio [AHR] = 0.998; 95% confidence interval [CI] 0.995-1.001; p = 0.28) or adjusted for age and other covariates (AHR = 0.099; 95% CI 0.996, 1.002; p = 0.35). Bioavailable testosterone levels did not predict mortality when adjusted for age (AHR = 0.992; 95% CI .977-1.007; p = 0.30) or when adjusted for age and other covariates (AHR 0.991; 95% CI .976-1.006; p = 0.261). CONCLUSION. In older African-American males, total and bioavailable testosterone levels, with and without adjustment for covariates, are not independently associated with mortality risk.
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Malmstrom TK, Andresen EM, Wolinsky FD, Schootman M, Miller JP, Miller DK. Urinary and fecal incontinence and quality of life in African Americans. J Am Geriatr Soc 2010; 58:1941-5. [PMID: 20831721 DOI: 10.1111/j.1532-5415.2010.03057.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate associations between quality of life (QoL) and incontinence in a population-based African-American sample. DESIGN Cross-sectional survey. SETTING Metropolitan St. Louis, Missouri. PARTICIPANTS Eight hundred fifty-three non-institutionalized African Americans aged 52 to 68 in the African American Health study. MEASUREMENTS Respondents who reported having involuntarily lost urine over the previous month were classified as having urinary incontinence (UI), and respondents who reported having lost control of their bowels or stool over the past year were classified as having fecal incontinence (FI). QoL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the 11-item Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS Prevalences of UI and FI were 12.1% (weighted n=102/841) and 5.0% (weighted n=42/841). Participants with UI and those with FI had worse SF-36 scores than their referent groups (physical function -15.5 and -38.1 points, respectively; role physical -13.2 and -26.5 points; bodily pain -15.7 and -24.5 points; general health perceptions -15.5 and -27.6 points; vitality -15.0 and -16.5 points; social functioning -18.4 and -25.6 points; role emotional -13.2 and -22.1 points; mental health -12.2 and -17.5 points; all Ps<.001), adjusting for age, sex, body mass index, and chronic conditions. Proportions with clinically relevant levels of depressive symptoms were also higher in both groups (UI+17.9%; P<.001) and FI (+37.2%; P<.001) than in their referent groups. CONCLUSION UI and FI were strongly associated with worse health-related QoL as well as symptoms of depression in this population-based sample of African Americans.
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Affiliation(s)
- Theodore K Malmstrom
- Department of Neurology & Psychiatry, School of Medicine, Saint Louis University, St. Louis, Missouri 63104, USA.
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Schootman M, Andresen EM, Wolinsky FD, Miller JP, Yan Y, Miller DK. Neighborhood conditions, diabetes, and risk of lower-body functional limitations among middle-aged African Americans: a cohort study. BMC Public Health 2010; 10:283. [PMID: 20507573 PMCID: PMC2885338 DOI: 10.1186/1471-2458-10-283] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 05/27/2010] [Indexed: 11/11/2022] Open
Abstract
Background The relationship between presence of diabetes and adverse neighborhood and housing conditions and their effect on functional decline is unclear. We examined the association of adverse neighborhood (block face) and housing conditions with incidence of lower-body functional limitations among persons with and those without diabetes using a prospective population-based cohort study of 563 African Americans 49-65 years of age at their 2000-2001 baseline interviews. Methods Participants were randomly sampled African Americans living in the St. Louis area (response rate: 76%). Physician-diagnosed diabetes was self reported at baseline interview. Lower-body functional limitations were self reported based on the Nagi physical performance scale at baseline and the three-year follow-up interviews. The external appearance of the block the respondent lived on and five housing conditions were rated by study interviewers. All analyses were done using propensity score methods to control for confounders. Results 109 (19.4%) of subjects experienced incident lower-body functional limitations at three-year follow-up. In adjusted analysis, persons with diabetes who lived on block faces rated as fair-poor on each of the five conditions had higher odds (7.79 [95% confidence interval: 1.36-37.55] to 144.6 [95% confidence interval: 4.45-775.53]) of developing lower-body functional limitations than the referent group of persons without diabetes who lived on block faces rated as good-excellent. At least 80 percent of incident lower-body functional limitations was attributable to the interaction between block face conditions and diabetes status. Conclusions Adverse neighborhood conditions appear to exacerbate the detrimental effects on lower-body functioning associated with diabetes.
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Affiliation(s)
- Mario Schootman
- Department of Medicine and Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
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Schootman M, Deshpande AD, Pruitt SL, Aft R, Jeffe DB. National estimates of racial disparities in health status and behavioral risk factors among long-term cancer survivors and non-cancer controls. Cancer Causes Control 2010; 21:1387-95. [PMID: 20401529 DOI: 10.1007/s10552-010-9566-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 04/03/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We examined racial disparities (White, African American, and other race) in health status (self-rated health, lower-body functional limitations, psychological distress, and body mass index [BMI]) and behaviors (smoking, alcohol use, and physical activity) of long-term cancer survivors (>or=5 years) when compared to non-cancer controls. METHODS Using 2005-2007 National Health Interview Survey data, we computed adjusted prevalence estimates of health status and behaviors for all six groups, controlling for sociodemographic factors, medical-care access, or presence of other chronic conditions. RESULTS The sample included 2,762 (3.6%) survivors and 73,059 controls. Adjusted prevalence estimates for each race were higher for long-term survivors than controls in terms of having fair-poor self-rated health, >or=1 limitation, psychological distress, and higher BMI but were similar between survivors and controls in terms of physical activity, smoking, and alcohol use. Adjusted prevalence estimates for having fair-poor self-rated health were higher for African American survivors than white survivors, lower for psychological distress, physical activity and alcohol use, and similar for smoking and BMI. CONCLUSION With the exception of smoking and limitations, racial differences existed among survivors for all health-status and behavioral measures. Clinicians may play a key role in helping to reduce disparities.
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Affiliation(s)
- Mario Schootman
- Department of Medicine, Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, MO 63108, USA.
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Miller DK, Malmstrom TK, Miller JP, Andresen EM, Schootman M, Wolinsky FD. Predictors of change in grip strength over 3 years in the African American health project. J Aging Health 2010; 22:183-96. [PMID: 20051605 DOI: 10.1177/0898264309355816] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine factors associated with change in grip strength. METHOD Grip strength was measured at baseline and 3 years later. Change was divided into "decreased >/=5 kg," "increased >/=5 kg," and "no change" and analyzed using multinomial multivariable logistic regression. RESULTS Decline in grip strength was more likely for men, those reporting having cardiovascular disease, and those with instrumental activities of daily living, lower body functional limitations, high diastolic blood pressure, higher physical activity, and greater body mass. Decline was less likely among those ever having Medicaid, those with basic activities of daily living disabilities, and those unable to see a doctor in past year due to cost. Gain in grip strength was more likely for men and those with instrumental activities of daily living disabilities, lower body functional limitations, high diastolic blood pressure, and higher physical activity; it was less likely for older participants. DISCUSSION Results can be used to design interventions to improve strength outcomes.
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Affiliation(s)
- Douglas K Miller
- Indiana University Center for Aging Research and Regenstrief Institute, Inc, Indianapolis 46202, USA.
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Schootman M, Aft R, Jeffe DB. An evaluation of lower-body functional limitations among long-term survivors of 11 different types of cancers. Cancer 2009; 115:5329-38. [PMID: 19676109 DOI: 10.1002/cncr.24606] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The authors examined potential reasons (sociodemographics, psychologic distress, health behavior, chronic health conditions, access to medical care) for increased prevalence of lower-body functional limitations among long-term (> or =5 years) cancer survivors. METHODS The authors used National Health Interview Survey data from 2005 through 2007, and defined lower-body functional limitation as reporting difficulty/inability to perform at least 1 of 5 activities (walking approximately one-quarter of a mile; walking up and down 10 steps without rest; standing for 2 hours; stooping, crouching, or kneeling; and lifting 10 lbs). Increased prevalence of lower-body functional limitations was compared between long-term survivors of each of 11 cancer types reported by > or =50 respondents (n = 2143) and persons without cancer history (controls; n = 72,618). RESULTS Among cancer survivors, 57.0% had a lower-body functional limitation versus 26.6% of controls. The unadjusted prevalence of lower-body functional limitations varied by cancer type, ranging from 44.9% (lymphoma survivors) to 88.8% (lung cancer survivors). Long-term lung (odds ratio [OR], 7.91), uterine (OR, 2.41), thyroid (OR, 2.27), cervical (OR, 1.76), ovarian (OR, 1.75), and breast (OR, 1.35) cancer survivors had increased odds of reporting a lower-body functional limitation than controls after adjusting for sociodemographic factors (all P < .05). Differences in the prevalence of arthritis and lower-back pain and in access to medical care explained differences in lower-body functional limitation prevalence between controls and long-term breast, cervical, ovarian, and uterine cancer survivors. Long-term bladder, colorectal, lymphoma, melanoma, and prostate cancer survivors were equally likely to report a lower-body functional limitation as controls. CONCLUSIONS Treatment of arthritis and lower-back pain and increasing access to medical care might help reduce the risk of lower-body functional limitations and improve quality of life among specific long-term cancer survivors.
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Affiliation(s)
- Mario Schootman
- Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, St Louis, MO 63108, USA.
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Haren MT, Malmstrom TK, Miller DK, Patrick P, Perry HM, Herning MM, Banks WA, Morley JE. Higher C-reactive protein and soluble tumor necrosis factor receptor levels are associated with poor physical function and disability: a cross-sectional analysis of a cohort of late middle-aged African Americans. J Gerontol A Biol Sci Med Sci 2009; 65:274-81. [PMID: 19812256 DOI: 10.1093/gerona/glp148] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This cohort of "late middle-aged" African Americans has an excess of disability. We aimed to determine associations of circulating cytokine receptors (sTNFR1, sTNFR2, and sIL-6R) and C-reactive protein (CRP) with disability, physical function, and body composition. METHODS Stratified sampling of two socioeconomically diverse strata of St Louis, Missouri, occurred in 2000-2001. Inclusion criteria were self-reported black or African American race, born 1936-1950 inclusive, and Mini-Mental State Examination score of 16 or greater. In-home evaluations of handgrip strength, lean body mass percentage (LBM%), physical performance, upper and lower body functional limitations (UBFLs and LBFLs), and basic and instrumental activities of daily living (BADLs and IADLs) were collected. Of the 998 participants, 368 had blood sampled at baseline. Serum was stored and assayed in 2006. RESULTS Absolute risks were LBFLs of 2 or more, 46%; UBFLs of 1 or more, 23.5%; BADLs of 2 or more, 20.6%; and IADLs of 2 or more, 22.5%. Independent of age, sex, and underlying comorbid conditions, higher CRP and sTNFR were associated with poorer physical performance (beta = -1.462, p < .001 and beta = -0.618, p = .003), UBFLs (odds ratio [OR] 2.26, 95% confidence interval [CI] 1.1-4.64 and OR 1.39, 95% CI 0.96-2.02), LBFLs (OR 2.30, 95% CI 1.19-4.45 and OR 1.91, 95% CI 1.26-2.91), BADLs (OR 2.79, 95% CI 1.03-5.96 and OR 1.66, 95% CI 1.11-2.46), and IADLs (OR 2.13, 95% CI 1.03-4.41 and OR 1.43, 95% CI 0.99-2.08). Higher CRP (beta = -3.251, p <.001), sIL-6R (beta = -6.152, p = .013), and lower adiponectin (beta = 2.947, p = .052) were associated with lower LBM%. CONCLUSIONS Higher CRP and sTNFR are independently associated with disability and physical dysfunction. Higher sIL-6R, CRP, and lower adiponectin associate with lower LBM%.
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Affiliation(s)
- Matthew T Haren
- Division of Geriatrics, Department of Internal Medicine, Saint Louis University School of Medicine, Missouri, USA.
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Informant-based dementia screening in a population-based sample of African Americans. Alzheimer Dis Assoc Disord 2009; 23:117-23. [PMID: 19484913 DOI: 10.1097/wad.0b013e318190a709] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An informant-based screening tool for dementia may be useful in population-based studies of minority populations. OBJECTIVE Investigate the feasibility of screening for very mild dementia in a community sample of African Americans using an informant-based screening tool (AD8). DESIGN Cohort study. PARTICIPANTS One hundred forty-seven persons from the African American Health (AAH) project were screened for dementia; 61 of 93 who were invited had follow-up clinical assessments for dementia diagnosis. MEASUREMENTS The AD8, Mini-Mental State Examination, Short Blessed Test, Brief Instrument for Dementia Detection, and a neuropsychologic battery were administered at visit 1. The Clinical Dementia Rating (CDR) was administered at visit 2 by clinicians blinded to visit 1 results; the presence of dementia was determined by a CDR greater than 0. RESULTS Four hundred sixty-five individuals from the AAH cohort were sent a letter describing the study and, among this group, 252 individuals were contacted by phone to request participation in this study. Six percent (14/252) of the participants contacted by phone were unable to identify an informant (required for the AD8). One hundred fifty individuals agreed by phone to participate of which 2% (n=3) did not have an informant available at the time of participation. The AD8 alone was effective at discriminating between CDR 0 and CDR 0.5 (area under the curve=0.847; P<0.001; 95% confidence interval, 0.73-0.96). CONCLUSIONS A brief informant-based instrument, the AD8, has high sensitivity and specificity for distinguishing CDR 0 from CDR 0.5 in the community. Informant availability may not be a barrier for using the AD8 in an African American community sample; however, further study in larger samples with a higher response rate, different community settings (eg, community clinics), and among older age groups (eg, age 75+) is warranted to confirm this.
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Carlson MC, Saczynski JS, Rebok GW, Seeman T, Glass TA, McGill S, Tielsch J, Frick KD, Hill J, Fried LP. Exploring the effects of an "everyday" activity program on executive function and memory in older adults: Experience Corps. THE GERONTOLOGIST 2009; 48:793-801. [PMID: 19139252 DOI: 10.1093/geront/48.6.793] [Citation(s) in RCA: 177] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE There is little empirical translation of multimodal cognitive activity programs in "real-world" community-based settings. This study sought to demonstrate in a short-term pilot randomized trial that such an activity program improves components of cognition critical to independent function among sedentary older adults at greatest risk. DESIGN AND METHODS We randomized 149 older adults to Experience Corps (EC) or a wait-list control arm. Participants randomized to EC trained in teams to help elementary school children with reading achievement, library support, and classroom behavior for 15 hr/week during an academic year. We compared baseline and follow-up assessments of memory, executive function (EF), and psychomotor speed at 4 to 8 months by intervention arm, adjusting for exposure duration. We observed a range of EF abilities at baseline and stratified analyses according to the presence of baseline impairment using established norms. RESULTS Overall, EC participants tended to show improvements in EF and memory relative to matched controls (ps < .10). EC participants with impaired baseline EF showed the greatest improvements, between 44% and 51% in EF and memory at follow-up, compared to declines among impaired-EF controls (ps < .05). IMPLICATIONS Short-term participation in this community-based program designed to increase cognitive and physical activity in a social, real-world setting may train memory and, particularly, executive functions important to functional independence. This community-based program represents one potentially effective model to bring high doses of sustainable cognitive exercise to the greatest proportion of older adults, particularly those sedentary individuals at elevated risk for health disparities.
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Affiliation(s)
- Michelle C Carlson
- Department of Mental Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA.
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Wolinsky FD, Andresen EM, Malmstrom TK, Schootman M, Miller JP, Miller DK. Three-year measured weight change in the African American health study. J Aging Health 2009; 21:231-43. [PMID: 19204381 DOI: 10.1177/0898264308328949] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examines 3-year weight change in African Americans. METHOD Nine hundred and ninety-eight participants 49 to 65 years old were assessed at baseline and 3 years later. Weight was measured, and weight change was defined as clinically meaningful increases or decreases (+/- 5 kg). Potential risk factors were investigated using multinomial logistic regression. RESULTS In-home measured weights were available for 752 participants (75%): 504 (67%) had stable weights, 131 (17%) gained more than 5 kg, and 117 (16%) lost more than 5 kg. Among all participants, the risks for weight gains were cancer, chronic obstructive pulmonary disease, lower income, and Medicaid status; the risks for weight losses were angina, cancer, high measured systolic blood pressure, asthma, and physical inactivity. Sex-stratified analyses reveal differences involving age, socioeconomic status, cancer, blood pressure, and lower body function. DISCUSSION Three-year weight changes in middle-aged African Americans were frequent and significantly associated with several risk factors.
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Affiliation(s)
- Fredric D Wolinsky
- Iowa City Veterans Affairs Medical Center and College of Public Health, University of Iowa, 200 Hawkins Drive, E-205 General Hospital, Iowa City, IA 52242, USA.
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Thorpe RJ, Weiss C, Xue QL, Fried L. Transitions among disability levels or death in African American and white older women. J Gerontol A Biol Sci Med Sci 2009; 64:670-4. [PMID: 19228790 DOI: 10.1093/gerona/glp010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study examined the racial differences in probabilities of transitioning across three disability levels of walking (1/2) mile in a community-dwelling population of older women. METHODS The sample comprised 436 community-dwelling older women who were among the two-third least disabled women in Baltimore, Maryland. The levels of disability status of walking (1/2) mile included high functioning defined as reporting no difficulty, preclinical disability defined as reports of task modification but no reported difficulty, and disability defined as reported difficulty. First-order Markov transition models were specified to determine whether race influences the types of individual-level transitions between difficulty levels of walking (1/2) mile. RESULTS Among high-functioning women, African Americans were more likely to be disabled at the next round than their White counterparts. African American women who began with preclinical disability were more likely to die before the next round. After adjusting for age, education, and perceived income inadequacy, African American women tended to have an increased risk of becoming disabled if preclinically disabled than White women. CONCLUSIONS Prevention through identification of individuals at an early phase of decline appears to be key to addressing racial disparities in physical disability even in later life.
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Affiliation(s)
- Roland J Thorpe
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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