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Casillas-Clot J, Pereyra-Zamora P, Nolasco A. Health conditions contribution to disability burden in Spain and the role of ethnicity and migrant status: A nation-wide study. PLoS One 2024; 19:e0306526. [PMID: 38995973 PMCID: PMC11244828 DOI: 10.1371/journal.pone.0306526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Disability is frequently associated with contextual or lifestyle factors. Some health conditions may affect the prevalence of disability differently, especially for some minority groups. This study aims to assess the impact and contribution of different health conditions to disability burden in Spain in Roma and immigrant populations, compared to the general population. METHODS This is a cross-sectional study. We have used data from the Spanish National Survey of 2017 and the National Health Survey of the Roma Population 2014. We have calculated frequencies of demographic variables and prevalence of health conditions grouped by body function. We also have fitted binomial additive hazard models, using the attribution method, to assess disabling impact and contribution of health conditions to disability burden. The software R was used for the computations. RESULTS Roma and immigrant populations had worse socioeconomic status than the general population, although the gap was more heavily marked among Roma. Roma population showed a higher prevalence in all health conditions, with a disability prevalence of 57.90%, contrary to the immigrant population, that showed a lower prevalence in all health conditions, including disability (30.79%), than the general population (40.00%). However, all health conditions were more disabling in the immigrant population. Neurological and cardiovascular diseases, and accidents among Roma, were the most disabling conditions. Nevertheless, musculoskeletal, chronic pain, and sensory diseases among Roma, had a greater contribution to disability burden, mainly due to a combination of a great prevalence and a great impact in functions of those health conditions. CONCLUSION Both ethnicity and migrant status have shown differences in the burden of disability. While in the general population, musculoskeletal problems have the greatest contribution to the disability burden, in immigrants it was chronic pain and in the Roma population it was sensory problems. Disparities by sex were also found, with the contribution of musculoskeletal diseases being more important in females.
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Affiliation(s)
- Javier Casillas-Clot
- Department of Community Nursing, Preventive Medicine, Public Health, and History of Science, Research Unit for the Analysis of Mortality and Health Statistics, University of Alicante, San Vicente del Raspeig, Spain
| | - Pamela Pereyra-Zamora
- Department of Community Nursing, Preventive Medicine, Public Health, and History of Science, Research Unit for the Analysis of Mortality and Health Statistics, University of Alicante, San Vicente del Raspeig, Spain
| | - Andreu Nolasco
- Department of Community Nursing, Preventive Medicine, Public Health, and History of Science, Research Unit for the Analysis of Mortality and Health Statistics, University of Alicante, San Vicente del Raspeig, Spain
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Phyo AZZ, Fransquet PD, Wrigglesworth J, Woods RL, Espinoza SE, Ryan J. Sex differences in biological aging and the association with clinical measures in older adults. GeroScience 2024; 46:1775-1788. [PMID: 37747619 PMCID: PMC10828143 DOI: 10.1007/s11357-023-00941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
Females live longer than males, and there are sex disparities in physical health and disease incidence. However, sex differences in biological aging have not been consistently reported and may differ depending on the measure used. This study aimed to determine the correlations between epigenetic age acceleration (AA), and other markers of biological aging, separately in males and females. We additionally explored the extent to which these AA measures differed according to socioeconomic characteristics, clinical markers, and diseases. Epigenetic clocks (HorvathAge, HannumAge, PhenoAge, GrimAge, GrimAge2, and DunedinPACE) were estimated in blood from 560 relatively healthy Australians aged ≥ 70 years (females, 50.7%) enrolled in the ASPREE study. A system-wide deficit accumulation frailty index (FI) composed of 67 health-related measures was generated. Brain age and subsequently brain-predicted age difference (brain-PAD) were estimated from neuroimaging. Females had significantly reduced AA than males, but higher FI, and there was no difference in brain-PAD. FI had the strongest correlation with DunedinPACE (range r: 0.21 to 0.24 in both sexes). Brain-PAD was not correlated with any biological aging measures. Significant correlations between AA and sociodemographic characteristics and health markers were more commonly found in females (e.g., for DunedinPACE and systolic blood pressure r = 0.2, p < 0.001) than in males. GrimAA and Grim2AA were significantly associated with obesity and depression in females, while in males, hypertension, diabetes, and chronic kidney disease were associated with these clocks, as well as DunedinPACE. Our findings highlight the importance of considering sex differences when investigating the link between biological age and clinical measures.
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Affiliation(s)
- Aung Zaw Zaw Phyo
- Biological Neuropsychiatry & Dementia Unit, School of Public Health and Preventive Medicine, Monash University, 553, St. Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Peter D Fransquet
- Biological Neuropsychiatry & Dementia Unit, School of Public Health and Preventive Medicine, Monash University, 553, St. Kilda Road, Melbourne, VIC, 3004, Australia
- School of Psychology, Deakin University, Burwood, Melbourne, VIC, 3125, Australia
| | - Jo Wrigglesworth
- Biological Neuropsychiatry & Dementia Unit, School of Public Health and Preventive Medicine, Monash University, 553, St. Kilda Road, Melbourne, VIC, 3004, Australia
| | - Robyn L Woods
- ASPREE Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Sara E Espinoza
- Center for Translational Geroscience, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joanne Ryan
- Biological Neuropsychiatry & Dementia Unit, School of Public Health and Preventive Medicine, Monash University, 553, St. Kilda Road, Melbourne, VIC, 3004, Australia
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Wang Y, Ma L, Pei J, Li W, Zhou Y, Dou X, Wang X. The level of life space mobility among community-dwelling elderly: A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 117:105278. [PMID: 37988853 DOI: 10.1016/j.archger.2023.105278] [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: 09/23/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Multiple countries have conducted surveys on the level of life space mobility for community-dwelling elderly through the Life-Space Assessment, the results vary greatly, from 41.7 to 88.6. However, there is no meta-analysis on the current situation of community-dwelling elderly life space mobility. OBJECTIVE To systematically assess the global level of life space mobility for community-dwelling elderly, to identify potential covariates such as geographical regions, survey years, gender, and age that contribute to the heterogeneity between the studies, and to identify the dynamic trend based on survey years. DESIGN Systematic review and meta-analysis. DATA SOURCES Two reviewers searched the following 8 electronic bibliographic databases from inception until May 28, 2023: PubMed, The Cochrane Library, Web of Science, Embase, Chinese Biomedical Database, China Knowledge Resource Integrated Database, WanFang, and Weipu Database. REVIEW METHODS This review was conducted using the Stata 14.1 and R 4.3.1. The Cochrane's Q statistical and I2 index were used to test for heterogenicity and assess the degree of heterogenicity, respectively. Studies were appraised using the Agency for Healthcare Research and Quality tool, the Newcastle-Ottawa Scale for the quality of cross-sectional studies, cohort studies, respectively. RESULTS A total of 29 studies were selected from databases and reference lists. The pooled score of Life-Space Assessment was 66.84 (95% CI: 63.30-70.39) and the prevalence of restricted life space was 42% (95% CI: 0.27-0.57). The geographical regions, survey years, gender were found to be a significant covariate of the pooled score of life space mobility estimate in the subgroup analysis. The mean score of Life-Space Assessment gradually achieved stability after 2017. CONCLUSIONS The life space mobility of community-dwelling elderly in the global is at a moderate level, with 42% of them experiencing restricted life space. South America, females and earlier survey years have a lower level of life space mobility. In the future, the government should identify vulnerable groups for targeted intervention to promote the level of LSM in the community-dwelling elderly. REGISTRATION PROSPERO [CRD42023443054].
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Affiliation(s)
- Yingqiao Wang
- School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Li Ma
- LanZhou University Second Hospital, Lanzhou City, Gansu Province, China
| | - Juhong Pei
- First College of Clinical Medicine of Lanzhou University, China
| | - Weiping Li
- School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China
| | - Yihan Zhou
- LanZhou University Second Hospital, Lanzhou City, Gansu Province, China
| | - Xinman Dou
- LanZhou University Second Hospital, Lanzhou City, Gansu Province, China
| | - Xinglei Wang
- School of Nursing, Lanzhou University, Lanzhou City, Gansu Province, China; Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
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4
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Peng J, Ming L, Wu J, Li Y, Yang S, Liu Q. Prevalence and related factors of cognitive frailty in diabetic patients in China: a systematic review and meta-analysis. Front Public Health 2023; 11:1249422. [PMID: 37927856 PMCID: PMC10620522 DOI: 10.3389/fpubh.2023.1249422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Objective Cognitive frailty (CF) is characterized by physical frailty and potentially reversible cognitive impairment without Alzheimer's disease and other dementias. Clarifying the prevalence and related factors of cognitive frailty can help researchers understand its epidemiological status and formulate intervention measures. This study aims to conduct a systematic review and meta-analysis of the prevalence and related factors of CF in diabetic patients in Chinas to better understand the current status of CF in diabetic patients in China and develop effective intervention measures for related factors. Methods PubMed, Web of Science, Embase, Cochrane Library, CNKI, Weipu(VIP), WANFANG, China Biology Medicine (CBM) and DUXIU were searched to collect epidemiological data on Chinese diabetic patients. Articles published through May 29, 2023, were searched. The number of diabetes with CF and the total number of diabetes in the included studies were extracted to estimate the prevalence of diabetes with CF. For factors related to diabetes with CF, odds ratios (OR) and 95% confidence intervals (CI) were used for estimation. Results A total of 248 records were screened, of which 18 met the inclusion criteria. The results of meta-analysis showed that the prevalence of Chinese diabetic patients with CF was 25.8% (95% CI = 19.7 to 31.9%). Subgroup analysis showed that hospital prevalence was higher than in the community and in women than in men. Combined estimates showed that depression, malnutrition, advanced age (≥70, ≥80), combined chronic diseases ≥4 and glycated hemoglobin ≥8.5 were risk factors for CF in diabetics patients in China, with regular exercise and high education level (≥ college) as protective factors. Conclusion Cognitive frailty was common in diabetic patients in China. Such populations should be screened early and intervened with relevant factors.Systematic review registration: A systematic review of this study evaluated the registered websites as https://www.crd.york.ac.uk/PROSPERO/, CRD42023431396.
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Affiliation(s)
- Junjie Peng
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Limei Ming
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Jiaming Wu
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Yunchuan Li
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Shuhua Yang
- The First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Qin Liu
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, Yunnan, China
- Postdoctoral Research Station of Public Administration, Yunnan University, Kunming, Yunnan, China
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Isernia S, Cazzoli M, Baglio G, Cabinio M, Rossetto F, Giunco F, Baglio F, Blasi V. Differential Roles of Neural Integrity, Physical Activity and Depression in Frailty: Sex-Related Differences. Brain Sci 2023; 13:950. [PMID: 37371428 DOI: 10.3390/brainsci13060950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/15/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
The frailty sex paradox has recently gained attention. At all ages, females are more likely to be frail and show a more severe phenotype but have a higher survival rate compared to males. The main aim was to test sex-specific differences in frailty syndrome using a multimodal evaluation from clinical and imaging data to deepen the understanding of different underlying mechanisms involved in the two sexes, and thus understand the association with different risk factors. Ninety-six community-dwelling older adults were characterized by clinical underpinnings (Fried's frailty indicators: comorbidity, depression, global cognitive level, physical activity, autonomy), and neural integrity (T1-weighted brain 3T MRI). The frailty × sex interaction in clinical and neural profiles was tested. Additionally, frailty risk factors were identified in the two sexes separately. Results showed that fragility was associated with an increment of depressive symptomatology in females, while a decrement in physical activity was observed already in the pre-frail stage in males. Finally, different risk factors were observed in the two groups: significant frailty predictors were neural integrity and physical activity in males, and age and depression in females. These data support the starting hypothesis of at least partially different mechanisms involved in the frailty phenotype between men and women.
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Affiliation(s)
- Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Marta Cazzoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Gisella Baglio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | | | - Fabrizio Giunco
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | | | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
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Liu J, Xu S, Wang J, Yan Z, Wang Z, Liang Q, Luan X. Prevalence of cognitive frailty among older adults in China: a systematic review and meta-analysis. BMJ Open 2023; 13:e066630. [PMID: 37076151 PMCID: PMC10124291 DOI: 10.1136/bmjopen-2022-066630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the prevalence of cognitive frailty among older adults in China. DESIGN Systematic review and meta-analysis. METHODS We searched the Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure(CNKI), Wanfang, Chinese Biomedical Literature and Weipu (VIP) databases to collect information on the epidemiology of cognitive frailty among older adults in China. The study period was from the establishment of the database to March 2022. Two researchers independently screened the literature, extracted the data and assessed the risk of bias in the included studies. All statistical analyses were performed using Stata V.15.0. RESULTS We screened 522 records, of which 28 met the inclusion criteria. The results of the meta-analysis showed that the prevalence of cognitive frailty among older adults in China was 15%(95%CI (0.13%,0.17%)). The prevalence of cognitive frailty was higher in hospitals and nursing homes than in communities. Moreover, the prevalence of cognitive frailty was higher in women than in men. Furthermore, the prevalence rates of cognitive frailty in North China Hospital, older adults aged≥80 years, and illiterate individuals were 25%, 29%, and 55%, respectively. CONCLUSIONS In conclusion, in China, the prevalence of cognitive frailty is higher among older adults, is higher in women than in men, is higher in hospitals and nursing homes than in communities, and is higher in North China than other regions. Moreover, the higher the educational level, the lower the prevalence of cognitive frailty. Multimodal interventions for cognitive frailty, including increased exercise, nutritional support, increased socialisation opportunities and multifactorial strategies, may be effective in preventing cognitive frailty. These findings have important implications for adjusting healthcare and social care systems. PROSPERO REGISTRATION NUMBER CRD42023390486.
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Affiliation(s)
- Jian Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Shengjia Xu
- The First Clinical College, Shandong University, Jinan, Shandong, China
| | - Jiurui Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zeping Yan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhiwei Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qian Liang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaorong Luan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Muhammad T, Maurya P. Gender differences in the association between perceived income sufficiency and self-rated health among older adults: A population-based study in India. J Women Aging 2023; 35:168-182. [PMID: 34821544 DOI: 10.1080/08952841.2021.2002663] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study explores whether gender differences in self-rated health can be attributed to socioeconomic status and self-perceived income sufficiency in particular. We used data from the Building a Knowledge Base on Population Ageing in India (BKPAI-2011) and carried out the descriptive and bivariate analysis along with a chi-square test to explore the significance of possible associations between explanatory and outcome variables in the study. Also, sex-stratified multiple logistic regression models were employed to fulfill the study objectives. The results show that a higher percentage of older women (58.4%) reported their health as fair/poor than older men (52%). Older women reported poor self-rated health than older men with similar self-perceived income sufficiency (OR: 2.04; p < .001 vs. OR: 1.56; p < .010). All the health indicators such as suffering from higher number of chronic conditions (AOR: 3.70; p < .001 vs. AOR: 2.73; p < .001) and disability (AOR: 3.79; p < .001 vs. AOR: 3.33; p < .001) increased odds of rating of poor health among older women than men, except having two plus difficulty in activities of daily living (ADL), which was positively associated with reporting poor health among men than women (OR: 4.03; p < .001 vs. OR: 2.36; p < .001). The study highlights the gender differences in self-rating of health associated with subjective income status and other socioeconomic and health-related variables that are important while framing social policies for the Indian graying population.
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Affiliation(s)
- T Muhammad
- International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Priya Maurya
- International Institute for Population Sciences, Mumbai, Maharashtra, India
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Srivastava S, Muhammad T, Paul R, Khan KA. Multivariate decomposition of gender differentials in successful aging among older adults in India. BMC Geriatr 2023; 23:59. [PMID: 36721109 PMCID: PMC9890860 DOI: 10.1186/s12877-023-03753-0] [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: 06/27/2022] [Accepted: 01/12/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Rowe and Kahn define successful aging as a high physical, psychological, and social functioning in old age without major diseases. It is considered a viable solution to the burdens placed on healthcare systems and financial and social security in societies with aging population. The present study aimed to determine the prevalence of successful aging and explore the factors contributing to gender differentials in successful aging among older adults in India. METHODS This study utilized data from the nationally representative Longitudinal Ageing Study in India, conducted in 2017-18. The study is based on a sample of 15,098 older men and 16,366 older women aged 60 years and above. The outcome variable was a dichotomous measure of successful aging with six components including absence of chronic diseases, free from disability, high cognitive ability, free from depressive symptoms, active social engagement in life and free from obesity. Older adults satisfying all these conditions were considered aging successfully. Descriptive and bivariate analyses were carried out. Proportion test was used to evaluate the gender differentials and reflect the statistical significance in the associated factors. Multivariate decomposition analysis was conducted to identify covariates' contribution in explaining the gender differences in successful aging. RESULTS There was a significant gender difference in successful aging among older adults in India (Difference: 8.7%; p-value < 0.001] with 34.3% older men and 25.6% older women experiencing successful aging. A proportion of 88% of gender difference in successful aging was explained by the differences in the distribution of characteristics (Coef: 0.082; p-value < 0.05). Considerable gender gap in successful aging would be reduced if women had similar levels of work status (28% reduction) to their male counterparts. Bringing the level of frequent physical activity in women to the same levels observed in men would reduce the gender gap by 9%. CONCLUSIONS The findings suggest that women had a lower score in successful aging, which is attributed to several socioeconomic and behavioural factors including not working status and physical inactivity. More studies must be done to explore the reasons for such differences and what particular factors in low-income countries create differences among older men and women in achieving successful aging.
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Affiliation(s)
- Shobhit Srivastava
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra India 400088
| | - T. Muhammad
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra India 400088
| | - Ronak Paul
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra India 400088
| | - Kacho Amir Khan
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra India 400088
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9
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Morbidity status and changes in difficulty in activities of daily living among older adults in India: A panel data analysis. PLoS One 2022; 17:e0269388. [PMID: 35653416 PMCID: PMC9162320 DOI: 10.1371/journal.pone.0269388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The study explored the socioeconomic and demographic factors that determine the onset of difficulty, recovery from difficulty and difficulty remaining in functional activity in later years of life. Additionally, the study examined the effects of several combinations of chronic diseases on the changes in later-life functional difficulty. Methods We used data from two rounds of India Human Development Survey (IHDS) conducted during 2004–2005 and 2011–2012. A sample of 13,849 respondents aged 55 years and above with a seven year follow-up was considered for this study. The Katz Index of Independence in activities of daily living (ADL) was used to measure the functional disability as an outcome variable. Multinomial logistic regression has been conducted to fulfil the study objectives. Results The overall functional difficulty among older adults was 27.3% and onset of functional difficulty (23.5%) was higher than the recovery from difficulty (2.1%) and remaining with difficulty (1.7%). Onset of functional difficulty in second round was higher among women (27.3%) than men (19.3%). Bivariate and multivariate analyses showed that single and multi-morbidity had a positive significant association with all categories of functional difficulty. Female sex, increasing age and rural place of residence had positive association with onset of difficulty and difficulty remaining in second round. The combinations of morbidities were also found to have positive significant association with functional difficulty i.e., the relative risk (RR) of onset of difficulty in second round is higher among those who had diabetes with high blood pressure (RR-1.7; CI: 1.4–2.0), cataracts with high blood pressure (RR-2.0; CI: 1.5–2.6) and cataracts with asthma (RR-3.1; CI: 2.1–4.6) compared to those with no diabetes and cataract but with high blood pressure or asthma, respectively. Conclusion The findings suggest that the risk of onset of functional difficulty is higher among older individuals with single and multiple morbidities compared to their healthy counterparts. It is also found that functional difficulty increased with age and was more prevalent in older women and rural residents, suggesting the need for appropriate policy interventions with special focus on the vulnerable senior adults.
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10
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Chang TE, Goldstein LB, Leifheit EC, Howard VJ, Lichtman JH. Cardiovascular Risk Factor Profiles, Emergency Department Visits, and Hospitalizations for Women and Men with a History of Stroke or Transient Ischemic Attack: A Cross-Sectional Study. J Womens Health (Larchmt) 2022; 31:834-841. [PMID: 35148481 DOI: 10.1089/jwh.2021.0471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The relationship between cardiovascular disease risk factors (CVD-RFs) and health care utilization may differ by sex. We determined whether having more CVD-RFs was associated with all-cause emergency department (ED) visits and all-cause hospitalizations for women and men with prior stroke/transient ischemic attack (TIA). Materials and Methods: In this cross-sectional study, we used nationally representative Medical Expenditure Panel Survey (2012-2015) data for persons aged ≥18 years with a prior stroke/TIA. CVD-RF summary scores include six self-reported factors (hypertension, diabetes, high cholesterol, physical inactivity, smoking, and obesity). Sex-specific covariate-adjusted logistic regression models assessed associations between CVD-RF scores and having one or more all-cause ED visits and one or more all-cause hospitalizations. Results: The weighted sample represents 9.1 million individuals (mean age 66.6 years; 54.3% women). Prevalence of low (0-1 risk factors), intermediate (2-3), and high (4-6) CVD-RF scores was 19.4%, 60.5%, and 20.1% for women and 14.6%, 60.2%, and 25.2% for men, respectively. Women having intermediate and high scores had a 1.58-fold (95% confidence interval [CI], 1.14-2.18) and 2.21-fold (95% CI, 1.50-3.25) increased odds of ED visits compared with women with low scores. Women with high CVD-RF scores had a 2.18-fold (95% CI, 1.42-3.34) increased odds of hospitalizations, but there was no association for women with intermediate CVD-RF profiles. There was no association between CVD-RF scores and either outcome for men. Conclusions: Women, but not men, with high and intermediate CVD-RF profiles had increased odds of all-cause ED visits; women with high CVD-RF profiles had increased odds of all-cause hospitalizations. The burden of CVD-RFs may be a sex-specific predictor of higher health care utilization in women with a history of stroke/TIA.
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Affiliation(s)
- Tiffany E Chang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Larry B Goldstein
- Department of Neurology, KY Neuroscience Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Erica C Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
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11
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Prevalence of cognitive frailty among community-dwelling older adults: A systematic review and meta-analysis. Int J Nurs Stud 2021; 125:104112. [PMID: 34758429 DOI: 10.1016/j.ijnurstu.2021.104112] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to investigate the pooled prevalence of cognitive frailty among community-dwelling older adults and provide evidence-based support for policy-makers planning health and social care policies. DESIGN A systematic review and meta-analysis. METHODS PubMed, Web of Science, Embase and the Cochrane Library were systematically searched from their inception to December 10, 2020. Descriptive studies (cross-sectional studies or population-based longitudinal studies) and cohort studies were available. Participants were community-dwelling older adults aged 60 years and above. Two researchers independently screened the literature, extracted the data and evaluated the quality of the included studies. All statistical analyses were conducted using Stata 15.0. RESULTS We screened 2815 records, among which 24 studies met the inclusion criteria and were included in the review. The pooled prevalence of cognitive frailty was 9% (95% CI: 8%-11%, I2 = 99.3%). The results of the subgroup analysis showed that the pooled prevalence of cognitive frailty was 11% (95% CI: 9%-14%) in men and 15% (95% CI: 11%-19%) in women. The pooled prevalence of cognitive frailty based on the descriptive studies and cohort studies was 7% (95% CI: 5%-9%) and 17% (95% CI: 11%-22%), respectively. The pooled estimates of cognitive frailty prevalence were 6% (95% CI: 4%-8%) from 2012 to 2017 and 11% (95% CI: 9%-14%) from 2018 to 2020. CONCLUSIONS This systematic review analyzed the available literature and revealed that the pooled prevalence of cognitive frailty among community-dwelling older adults was 9%. The stratified analysis showed that the prevalence of cognitive frailty was higher in older women. In addition, the prevalence has increased in recent years, which has important implications for adapting health and social care systems.
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12
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Ryan J, Espinoza S, Ernst ME, Ekram ARMS, Wolfe R, Murray AM, Shah RC, Orchard SG, Fitzgerald S, Beilin LJ, Ward SA, Williamson JD, Newman AB, McNeil JJ, Woods RL. Validation of a Deficit-Accumulation Frailty Index in the ASPirin in Reducing Events in the Elderly Study and Its Predictive Capacity for Disability-Free Survival. J Gerontol A Biol Sci Med Sci 2021; 77:19-26. [PMID: 34338761 PMCID: PMC8751791 DOI: 10.1093/gerona/glab225] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Frailty is a state of heightened vulnerability and susceptibility to physiologic stressors that increases with age. It has shown increasing utility in predicting a range of adverse health outcomes. Here, we characterize a 67-item deficit-accumulation frailty index (FI) in 19 110 community-dwelling individuals in the ASPirin in Reducing Events in the Elderly clinical trial. Participants aged 65-98 years were recruited from the United States and Australia and were without diagnosed dementia and cardiovascular disease, and major physical disability. The median FI score was .10 (interquartile range: .07-.14) at baseline, and the prevalence of frailty (FI > .21) increased from 8.1% to 17.4% after 6 years. FI was positively associated with age, and women had significantly higher scores than men at all ages. The FI was negatively correlated with gait speed (r = -.31) and grip strength (r = -.46), and strongly associated with a modified Fried's frailty phenotype (p < .0001, for all comparisons). Frailty was associated with the primary composite outcome capturing independent life lived free of major disability and dementia, and increased the rate of persistent physical disability (hazard ratio: 21.3, 95% confidence interval: 15.6-28.9). It added significantly to the predictive capacity of these outcomes above age, sex, and ethnicity alone. The FI is thus a useful biomarker of aging even among relatively healthy older individuals and provides important information about an individual's vulnerability to and risk of disease.
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Affiliation(s)
- Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,Address correspondence to: Joanne Ryan, PhD, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, 3004 Victoria, Australia. E-mail:
| | - Sara Espinoza
- Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, Texas, USA,Geriatrics Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, USA,Department of Family Medicine, Carver College of Medicine, University of Iowa, USA
| | - A R M Saifuddin Ekram
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Clinical Outcomes and Research, Hennepin Health Research Institute and Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, USA
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sharyn Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeff D Williamson
- Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anne B Newman
- Center for Aging and Population Health, University of Pittsburgh, Pennsylvania, USA
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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13
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Lange-Maia BS, Karvonen-Gutierrez CA, Kazlauskaite R, Strotmeyer ES, Karavolos K, Appelhans BM, Janssen I, Avery EF, Dugan SA, Kravitz HM. Impact of Chronic Medical Condition Development on Longitudinal Physical Function from Mid- to Early Late-Life: The Study of Women's Health Across the Nation. J Gerontol A Biol Sci Med Sci 2021; 75:1411-1417. [PMID: 31732730 DOI: 10.1093/gerona/glz243] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic medical conditions (CMCs) often emerge and accumulate during the transition from mid- to late-life, and the resulting multimorbidity can greatly impact physical function. We assessed the association of CMC presence and incidence on trajectories of physical function from mid- to early late-life in the Study of Women's Health Across the Nation. METHODS Physical function was assessed at eight clinic visits (average 14 years follow-up) using the physical function subscale of the Short Form-36. CMCs included osteoarthritis, diabetes, stroke, hypertension, heart disease, cancer, osteoporosis, and depressive symptomatology, and were considered cumulatively. Repeated-measures Poisson models estimated longitudinal change (expressed as percent difference) in physical function by chronic CMCs. Change-points assessed physical function change coincident with the development of a new condition. RESULTS Women (N = 2,283) followed from age 50.0 ± 2.7 to 64.0 ± 3.7 years; 7.3% had zero CMCs through follow-up, 22.5% (N = 513) had no baseline CMCs but developed ≥1, 22.7% women had ≥1 baseline CMC but never developed another, and 47.6% had ≥1 baseline CMC and developed ≥1 more. Each additional baseline CMC was associated with 4.0% worse baseline physical function and annual decline of 0.20%/year. Women with more baseline CMCs had greater decline in physical function with a new CMC (-1.90% per condition); and annual decline when developing a new condition accelerated by -0.33%/year per condition. CONCLUSIONS Self-reported physical function changes are evident from mid- to early late-life with the development of CMCs. Preventing or delaying CMCs may delay declines in physical function, and these potential pathways to disability warrant further research.
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Affiliation(s)
- Brittney S Lange-Maia
- Department of Preventive Medicine, Chicago, Illinois.,Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | | | - Rasa Kazlauskaite
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
| | | | | | - Imke Janssen
- Department of Preventive Medicine, Chicago, Illinois
| | - Elizabeth F Avery
- Department of Preventive Medicine, Chicago, Illinois.,Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | - Sheila A Dugan
- Department of Physical Medicine and Rehabilitation, Chicago, Illinois
| | - Howard M Kravitz
- Department of Preventive Medicine, Chicago, Illinois.,Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
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14
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Salinas-Rodríguez A, Rivera-Almaraz A, Scott A, Manrique-Espinoza B. Severity Levels of Disability Among Older Adults in Low- and Middle-Income Countries: Results From the Study on Global Ageing and Adult Health (SAGE). Front Med (Lausanne) 2020; 7:562963. [PMID: 33178712 PMCID: PMC7594509 DOI: 10.3389/fmed.2020.562963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/26/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Recent studies suggest the importance of distinguishing the severity levels of disability in the older adult population. However, there is still no consensus regarding an optimal classification. Few studies have estimated the prevalence of severe disability, and the results have been confined to high-income countries. There is no evidence for low- and middle-income countries (LMICs). Therefore, the aim of this study was to provide estimates of the levels of severity associated with disability in older adult populations in LMICs and to examine their relationship with health and socioeconomic factors. Methods: We used data from the Study on global AGEing and adult health (SAGE), wave 1 (2007-2010). Nationally representative samples of adults over 50 years from China, Ghana, India, Mexico, Russian Federation, and South Africa were analyzed (n = 33,641). We measured disability using the World Health Organization Disability Assessment Instrument version 2.0 (WHODAS 2.0). Disability levels according to severity were identified through the use of latent class analysis. Socioeconomic and health factors associated with severe disability were estimated using ordinal logistic regression models. Results: We identified four groups of older adult: (1) without disability, 43.4%; (2) mild disability, 33.3%; (3) moderate disability, 15.3%; and (4) severe disability, 8.0%. These results were heterogeneous for the six countries analyzed. Education and socioeconomic status were significantly associated with severe disability along with the following chronic conditions: angina, arthritis, asthma, cataracts, chronic obstructive pulmonary disease, depression, diabetes, and stroke. Severe disability was also associated with the frailty status, sarcopenia, and mild cognitive impairment. Conclusions: In this study, we estimated severity levels of disability for the older adult population in LMICs. Our results show that severe disability affects 8% of older adult, and that there are important socioeconomic and health factors associated with this condition. Measuring the severity of disability is a critical element to study the causes and consequences of aging. Moreover, the identification of older adult with severe disability is vital to design prevention programs, modify interventions, or develop enabling environments.
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Affiliation(s)
- Aarón Salinas-Rodríguez
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana Rivera-Almaraz
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Mexico
| | - Ashley Scott
- Division of Chronic Disease Prevention and Control, Boston Public Health Commission, Boston, MA, United States
| | - Betty Manrique-Espinoza
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Mexico
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15
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Sealy-Jefferson S, Roseland M, Cote ML, Lehman A, Whitsel EA, Booza J, Simon MS. Rural-Urban Residence and Stroke Risk and Severity in Postmenopausal Women: The Women's Health Initiative. WOMEN'S HEALTH REPORTS 2020; 1:326-333. [PMID: 33786496 PMCID: PMC7784801 DOI: 10.1089/whr.2020.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 11/13/2022]
Abstract
Background: The impact of rural–urban residence on stroke risk and poor stroke outcomes among postmenopausal women is unknown. Methods: We used data from the Women's Health Initiative (WHI) (1993–2014; n = 155,186) to test the hypothesis that women who live in rural compared with urban areas have higher stroke risk and worse stroke outcomes than urban women. We used rural–urban commuting area codes to categorize geocoded participant addresses into urban, large rural, or small rural areas. Incident strokes during follow-up were adjudicated by neurologists who used standardized criteria for reviewing brain imaging reports and other medical records and determining stroke subtype. Stroke functional recovery was measured with the Glasgow Stroke Outcomes Scale ascertained from the hospital record. We used univariable and multivariable-adjusted Cox proportional hazards models as well as logistic regression models to test whether rural–urban residence predicted stroke risk and odds of poor stroke outcome. Results: Among the 155,186 women in our cohort, 2.3% (n = 3514) had an incident stroke. We observed a modest reduction in risk of incident stroke among women who lived in urban (adjusted hazard ratio [aHR]: 0.86, confidence interval [95% CI]: 0.71–1.05) and large rural areas (aHR: 0.79, 95% CI: 0.60–1.04) compared with women who lived in small rural areas. In contrast, women who lived in urban compared with large rural areas had a similarly modest increased risk of stroke (aHR: 1.09, 95% CI: 0.89–1.32). Women who lived in urban compared with large rural areas were more likely to have poor stroke outcome (odds ratio [OR]: 1.41, 95% CI: 1.06–1.88), but the association was attenuated after adjustment for covariates (adjusted OR [aOR]: 1.27, 0.93–1.74). Conclusions: Future studies should confirm and examine the potential pathways of the reported associations among postmenopausal women.
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Affiliation(s)
- Shawnita Sealy-Jefferson
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Molly Roseland
- Beaumont Hospital, Oakwood Campus, Dearborn, Michigan, USA
| | - Michele L Cote
- Department of Oncology, Karmanos Cancer Institute Population Studies and Disparities Research Program, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Amy Lehman
- Center for Biostatistics, Ohio State University, Columbus, Ohio, USA
| | - Eric A Whitsel
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason Booza
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Michael S Simon
- Department of Oncology, Karmanos Cancer Institute Population Studies and Disparities Research Program, Wayne State University School of Medicine, Detroit, Michigan, USA
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16
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Brown RT, Covinsky KE. Moving prevention of functional impairment upstream: is middle age an ideal time for intervention? Womens Midlife Health 2020; 6:4. [PMID: 32695430 PMCID: PMC7366897 DOI: 10.1186/s40695-020-00054-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
To live independently, individuals must be able to perform basic activities of daily living (ADLs), including bathing, dressing, and transferring out of a bed or chair. When older adults develop difficulty or the need for help performing ADLs, they experience decreased quality of life and an increased risk of acute care utilization, nursing home admission, and death. For these reasons, slowing or preventing the progression to functional problems is a key focus of the care of older adults. While preventive efforts currently focus mainly on older people, difficulty performing basic ADLs (“functional impairment”) affects nearly 15% of middle-aged adults, and this prevalence is increasing. People who develop functional impairment in middle age are at increased risk for adverse outcomes similar to those experienced by older adults. Developing ADL impairment in middle age also impacts work force participation and health expenditures, not just in middle age but also older age. Middle-aged adults have a high capacity for recovery from functional impairment, and many risk factors for developing functional impairment in middle and older age have their roots in mid-life. Taken together, these findings suggest that middle age may be an ideal period to intervene to prevent or delay functional impairment. To address the rising prevalence of functional impairment in middle age, we will need to work on several fronts. These include developing improved prognostic tools to identify middle-aged people at highest risk for functional impairment and developing interventions to prevent or delay impairment among middle-aged people. More broadly, we need to recognize functional impairment in middle age as a problem that is as prevalent and central to health outcomes as many chronic medical conditions.
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Affiliation(s)
- Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104 USA.,Geriatrics and Extended Care, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA.,Center for Health Equity and Research Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, CA USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA USA
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17
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Park YM, Jankowski CM, Ozemek C, Hildreth KL, Kohrt WM, Moreau KL. Appendicular lean mass is lower in late compared with early perimenopausal women: potential role of FSH. J Appl Physiol (1985) 2020; 128:1373-1380. [PMID: 32298212 DOI: 10.1152/japplphysiol.00315.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Age-related declines in skeletal muscle mass (i.e., sarcopenia) contribute to physical disability in older women. Although a menopause-related increase in fat mass is well documented, whether menopause influences muscle mass and sarcopenia is unclear. We determined the extent to which skeletal muscle mass differs across the stages of the menopause transition in women and whether these differences are associated with estradiol or other sex hormones. This was a cross-sectional study of 144 healthy women (aged 30-70 yr) classified as premenopausal [n = 30, 38 ± 6 yr (means ± SD)], early (n = 31, 50 ± 3 yr) and late (n = 30, 50 ± 4 yr) perimenopausal, and early (n = 26, 55 ± 3 yr) and late (n = 27, 62 ± 4 yr) postmenopausal. Appendicular lean mass (ALM) adjusted by the square of height in meters (ALM index; ALMi) was assessed by dual-energy X-ray absorptiometry. ALMi was lower (P < 0.05) in late perimenopausal and postmenopausal compared with early perimenopausal, with no significant differences between other groups (premenopausal 6.6 ± 0.6, early perimenopausal 6.8 ± 0.8, late perimenopausal 6.1 ± 0.8, early postmenopausal 6.5 ± 1.1, and late postmenopausal 6.2 ± 0.9 kg/m2). The prevalence of sarcopenia (ALMi ≤ 5.67 kg/m2) was 7%, 3%, 30%, 27%, and 32% in premenopausal, early and late perimenopausal, and early and late postmenopausal groups, respectively. ALMi measured across menopause stages was inversely correlated to follicle-stimulating hormone (FSH; r = -0.28, P = 0.003) but not to estradiol (r = 0.088, P = 0.34). The menopause transition appears to be a vulnerable period for the loss of skeletal muscle mass that may begin during the late perimenopausal transition. Future studies are necessary to investigate the potential effect of FSH on skeletal muscle.NEW & NOTEWORTHY Our data suggest that the late perimenopausal stage may be a vulnerable period for the loss of skeletal muscle, potentially related to elevations in FSH.
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Affiliation(s)
- Young-Min Park
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Exercise and Health Science, Incheon National University, Incheon, South Korea
| | - Catherine M Jankowski
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Cemal Ozemek
- Department of Physical Therapy, University of Illinois, Chicago, Illinois
| | - Kerry L Hildreth
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wendy M Kohrt
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Kerrie L Moreau
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
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18
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4793] [Impact Index Per Article: 1198.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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19
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Abstract
Frailty describes an individual's vulnerability to adverse health outcomes and is a useful construct that assists health professionals to understand the heterogeneity of the ageing population. While the pathophysiological pathways that lead to frailty are not well defined, an individual's sex appears to be a key factor influencing the ageing trajectory. Compared with age-matched men, women tend to have poorer health status (ie, they are more frail) but longer life expectancy (ie, they are more resilient). It seems likely that a combination of biological, behavioural and social factors underpin this male-female health-survival paradox. Randomised controlled trial data for frailty interventions in older adults are emerging, with multicomponent programs incorporating exercise and nutrition-based strategies showing promise. Pharmaceutical and other innovative therapeutic strategies for frailty are highly anticipated. Sex differences in the effectiveness of frailty interventions have not been addressed in the research literature to date. In the future, successful interventions may target many (if not all) biopsychosocial domains, with careful consideration of issues relevant to each sex.
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Affiliation(s)
- Emily H Gordon
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Ruth E Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
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20
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5274] [Impact Index Per Article: 1054.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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21
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Carmel S. Health and Well-Being in Late Life: Gender Differences Worldwide. Front Med (Lausanne) 2019; 6:218. [PMID: 31649931 PMCID: PMC6795677 DOI: 10.3389/fmed.2019.00218] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/23/2019] [Indexed: 11/13/2022] Open
Abstract
Maintaining health and quality of life and decreasing the number of years lived with disabilities in old age are among the main challenges of aging societies worldwide. This paper aims to present current worldwide health-related gender inequalities throughout life, and especially in late life, as well as gender gaps in social and personal resources which affect health, functioning and well-being. This paper also addresses the question of whether gender gaps at younger ages tend to narrow in late life, due to the many biological and social changes that occur in old age. Based on international data regarding these gender gaps and the trends of change in personal resources and health-related lifestyles in the more and less developed nations, conclusions regarding future changes in gender gaps are presented, along with practical implications for future improvements in women's health and well-being.
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Affiliation(s)
- Sara Carmel
- Department of Public Health, Faculty of Health Sciences, Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer Sheva, Israel
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22
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Xu Y, Richardson J, MacDermid J, Dal Bello-Haas V. Mobility in community-dwelling adults with chronic conditions: the contribution of age and sex. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1503717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ying Xu
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Joy MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- School of Physical Therapy and Surgery, Western University, London, Canada
- Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph’s Health Centre, London, Canada
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23
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A decline in activities of daily living due to acute heart failure is an independent risk factor of hospitalization for heart failure and mortality. J Cardiol 2019; 73:522-529. [DOI: 10.1016/j.jjcc.2018.12.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/24/2018] [Accepted: 12/05/2018] [Indexed: 11/19/2022]
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24
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Mir363-3p attenuates post-stroke depressive-like behaviors in middle-aged female rats. Brain Behav Immun 2019; 78:31-40. [PMID: 30639697 PMCID: PMC6488367 DOI: 10.1016/j.bbi.2019.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/26/2018] [Accepted: 01/09/2019] [Indexed: 01/09/2023] Open
Abstract
Women are more likely to develop Post Stroke Depression (PSD) than men and generally do not respond well to anti-depressants with age. This study investigated the effect of microRNA mir363-3p treatment on PSD using a physiologically-relevant animal model. Our previous work showed that mir363-3p treatment, delivered post-stroke, effectively reduces infarct volume in the acute phase of stroke in middle-aged females but not males. Middle-aged female Sprague Dawley rats were tested for baseline sensory motor function and depressive-like behaviors, and then subjected to ischemic stroke via middle cerebral artery occlusion (MCAo) or sham surgery. Animals received either control oligos (MCAo+scrambled, Sham+scrambled) or mir363-3p (MCAo+mir363-3p, Sham+mir363-3p) treatment 4 h later. Sensory motor function and depressive-like behaviors were reassessed up to 100 d after stroke, and circulating levels of IL-6, TNF-alpha and Brain-Derived Neurotrophic Factor (BDNF) were quantified at regular intervals. Prior to termination, Fluorogold was injected into the striatum to assess meso-striatal projections. MCAo+scrambled animals had impaired sensorimotor performance in the acute phase (5 days) of stroke and developed anhedonia, decreased sociability and increased helplessness in the chronic phase. MCAo+mir363-3p animals showed significantly less sensory motor impairment and fewer depressive-like behaviors. IL-6 and TNF-alpha were elevated transiently at 4 weeks after MCAo in both groups. BDNF levels decreased progressively after stroke in the MCAo+scrambled group, and this was attenuated in the mir363-3p group. The number of retrogradely-labeled SNc and VTA cells was reduced in the ischemic hemisphere of the MCAo+scrambled group. In contrast, there was no interhemispheric difference in the number of retrogradely-labeled SNc and VTA cells of MCAo+mir363-3p treated animals. Our results support a therapeutic role for mir363-3p for long-term stroke disability.
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Maltais M, Rolland Y, Vellas B, Haÿ PE, Armaingaud D, Cestac P, Rouch L, Cesari M, de Souto Barreto P. Effect of Exercise on Behavioral Symptoms and Pain in Patients With Dementia Living in Nursing Homes. Am J Alzheimers Dis Other Demen 2019; 34:89-94. [PMID: 30278777 PMCID: PMC10852510 DOI: 10.1177/1533317518803773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVES Examine the effects of a 6-month exercise intervention on neuropsychiatric symptoms, pain, and medication consumption in older people with dementia (PWD) living in nursing homes (NH). METHODS Ninety-one older PWD living in NH performed a 6-month structured exercise intervention (n = 44) or a social activity intervention (n = 47). Neuropsychiatric symptoms were measured by the neuropsychiatric inventory (NPI), pain was assessed using the Algoplus scale, and dementia-related drug prescriptions were obtained for all participants. RESULTS Between-group analysis found a nonsignificant difference that could be of clinical relevance: a 4-point difference in the NPI and 1.3-point difference in the reduction of the number of medications favoring exercisers. No significant differences were found for pain, and a trend was found for an increase in medication consumption in the social group. CONCLUSION Exercise effects did not differ from social intervention effects on neuropsychiatric symptoms, pain, and medication consumption in older PWD living in NH.
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Affiliation(s)
- Mathieu Maltais
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR INSERM, 1027 University of Toulouse III, Toulouse, France
| | | | | | - Philippe Cestac
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Laure Rouch
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Matteo Cesari
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
- UMR INSERM, 1027 University of Toulouse III, Toulouse, France
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Gordon EH, Hubbard RE. Do sex differences in chronic disease underpin the sex-frailty paradox? Mech Ageing Dev 2019; 179:44-50. [PMID: 30825457 DOI: 10.1016/j.mad.2019.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 12/21/2022]
Abstract
The 'male-female health-survival paradox' is a well-described clinical phenomenon. More recently, it has been conceptualized as a 'sex-frailty paradox': females may be considered to be more frail (because they have poorer health status) but also less frail (because they are less vulnerable to death) than males of the same age. Here, we review potential biological, behavioral and social mechanisms underpinning sex differences in morbidity, mortality and frailty before considering the question at the center of the sex paradox - why is it that females are able to tolerate poor health better than males? We explore, in detail, a frequently cited explanation for the sex paradox that centers on sex differences in chronic disease and conclude by presenting a new approach to this old hypothesis.
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Affiliation(s)
- E H Gordon
- Centre for Health Services Research, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - R E Hubbard
- Centre for Health Services Research, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
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Nusselder WJ, Wapperom D, Looman CWN, Yokota RTC, van Oyen H, Jagger C, Robine JM, Cambois EM. Contribution of chronic conditions to disability in men and women in France. Eur J Public Health 2019; 29:99-104. [PMID: 30107556 DOI: 10.1093/eurpub/cky138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Women report more disability than men perhaps due to gender differences in the prevalence of diseases and/or in their disabling impact. We compare the contribution of chronic diseases to disability in men and women in France, using a disability survey conducted in both private households and institutions, and we also examine the effect of excluding the institutionalized population. Methods Data comprised 17 549 individuals age 50+, who participated in the 2008-09 French Disability Health Survey including people living in institutions. Disability was defined by limitations in activities people usually do due to health problems (global activity limitation indicator). Additive regression models were fitted separately by gender to estimate the contribution of conditions to disability taking into account multi-morbidity. Results Musculoskeletal diseases caused most disability for both men (10.1%, CI: 8.1-12.0) and women (16.0%, CI 13.6-18.2). The second contributor for men was heart diseases (5.7%, CI: 4.5-6.9%), and for women anxiety-depression (4.0, CI 3.1-5.0%) closely followed by heart diseases (3.8%, CI 2.9-4.7%). Women's higher contribution of musculoskeletal diseases reflected their higher prevalence and disabling impact; women's higher contribution of anxiety-depression and lower contributions of heart diseases reflected gender differences in prevalence. Excluding the institutionalized population did not change the overall conclusions. Conclusions The largest contributors to the higher disability of women than men are moderately disabling conditions with a high prevalence. Whereas traditional disabling conditions such as musculoskeletal diseases are more prevalent and disabling in women, fatal diseases such as cardiovascular disease are also important contributors in women and men.
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Affiliation(s)
- Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dagmar Wapperom
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Caspar W N Looman
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Renata T C Yokota
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium.,Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium
| | - Carol Jagger
- Institute of Health and Society, Newcastle University, Newcastle, UK.,Institute for Ageing, Newcastle University, Newcastle, UK
| | - Jean Marie Robine
- INSERM (National Institute of Health and Medical Research), Montpellier, France.,EPHE (École Pratique des Hautes Études), Paris, France
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Miller EC, Boehme AK, Chung NT, Wang SS, Lacey JV, Lakshminarayan K, Zhong C, Woo D, Bello NA, Wapner R, Elkind MSV, Willey JZ. Aspirin reduces long-term stroke risk in women with prior hypertensive disorders of pregnancy. Neurology 2019; 92:e305-e316. [PMID: 30587515 PMCID: PMC6345119 DOI: 10.1212/wnl.0000000000006815] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether hypertensive disorders of pregnancy (HDP) increased long-term stroke risk in women in the California Teachers Study (CTS), a prospective cohort study, and whether aspirin or statin use modified this risk. METHODS CTS participants ≤60 years of age at the time of enrollment in 1995 were followed up prospectively for validated stroke outcomes obtained via linkage with California hospital records through December 31, 2015. We calculated unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the primary outcomes of all stroke and stroke before 60 years of age among those with and without a history of HDP. We tested for interactions (p < 0.2) and performed stratified analyses to assess the risk of the primary outcomes in women with and without self-reported use of aspirin or statins. RESULTS Of 83,749 women included in the analysis, 4,070 (4.9%) had HDP. Women with prior HDP had increased risk of all stroke (adjusted HR 1.3, 95% CI 1.2-1.4) but no increased risk of stroke before age 60 (adjusted HR 1.2, 95% CI 0.9-1.7). There was an interaction (p = 0.18) between aspirin use and HDP history on risk of stroke before age 60: nonusers of aspirin had higher risk (adjusted HR 1.5, 95% CI 1.0-2.1) while aspirin users did not (adjusted HR 0.8, 95% CI 0.4-1.7). This effect was not seen with statins. CONCLUSIONS After controlling for comorbid conditions, women with prior HDP had increased long-term stroke risk, which was reduced by aspirin use. Randomized trials may be needed to assess whether long-term aspirin use could benefit selected women with a history of HDP.
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Affiliation(s)
- Eliza C Miller
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH.
| | - Amelia K Boehme
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - Nadia T Chung
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - Sophia S Wang
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - James V Lacey
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - Kamakshi Lakshminarayan
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - Charlie Zhong
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - Daniel Woo
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - Natalie A Bello
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - Ronald Wapner
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - Mitchell S V Elkind
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
| | - Joshua Z Willey
- From the Departments of Neurology (E.C.M., A.K.B., M.S.V.E., J.Z.W.), Medicine (N.A.B.), and Obstetrics and Gynecology (R.W.), Columbia University; Department of Epidemiology (A.K.B., M.S.V.E.), Columbia University Mailman School of Public Health, New York, NY; Department of Population Sciences (N.T.C., S.S.W., J.V.L., C.Z.), Beckman Research Institute and City of Hope National Medical Center, Duarte, CA; Department of Neurology (K.L.), University of Minnesota Medical Center, Minneapolis; and Department of Neurology (D.W.), University of Cincinnati Medical Center, OH
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Chatzopoulos G, Tziomalos K. The challenge of gender-specific pharmacotherapy for stroke prevention and treatment. Expert Opin Pharmacother 2018; 19:1849-1851. [DOI: 10.1080/14656566.2018.1528227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Georgios Chatzopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4483] [Impact Index Per Article: 747.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Zhang Y, Chen G, Zhang Q, Lu J, Yu H. Gender disparities in the association between socio-demographics and non-communicable disease risk factors among adults with disabilities in Shanghai, China. PeerJ 2018; 6:e4505. [PMID: 29576973 PMCID: PMC5855884 DOI: 10.7717/peerj.4505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background Non-communicable disease (NCD) risk factors can co-exist with disability and cause a greater burden on the health status of adults with disabilities. A lack of egalitarian social policies in China may result in gender disparities in the NCD risk factors of adults with disabilities. However, little is known about the gender disparities in the association between socio-demographics and NCD risk factors among adults with disabilities in China; consequently, we examined this association among adults with disabilities in Shanghai, China. Methods We used the health examination data of 44,896 adults with disabilities in Shanghai in 2014. Descriptive analyses and logistic regression models were conducted to estimate gender disparities in the association between socio-demographics, disability characteristics, and four selected NCD risk factors among adults with disabilities—including high blood pressure, high blood glucose, high blood lipids, and being overweight. We estimated marginal effects (MEs) on NCD risk factors between gender and other confounders. Results Women with disabilities were about 11.6 percentage points more likely to suffer from high blood lipids and less likely to develop the other three risk factors than men were. The association of age group, residence permit, education level, marital status, and disability type with health outcomes varied by gender among adults with disabilities. The difference in age effects between men and women was more pronounced in older age groups. Urban residence was associated with less risk of high blood pressure risk among women (ΔME = − 0.035, p < 0.01), but no significant difference in other NCD risk factors. Education remained a major protective factor against high blood pressure, high blood glucose and being overweight among women with disabilities (MEs < 0, p < 0.05); however, this did not hold for men. The difference in marriage effects between men and women was observed in high blood lipids (ΔME = − 0.048 for the married group and −0.054 for the divorced or widowed group) and overweight individuals (ΔME = − 0.091 for the married group and −0.114 for the divorced or widowed group). Women with intellectual disabilities or mental disabilities reported worse health conditions than men did. Discussion Preventive strategies and interventions on NCD risk factors for adults with disabilities should take into account gender disparities in these socio-demographic effects. Rural women or poorly educated women with disabilities can be a vulnerable population that requires more health education and promotion strategies. Health education for caregivers of women with intellectual or mental disabilities may also play a vital role in preventing their NCD risk factors.
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Affiliation(s)
- Youran Zhang
- Department of Health Law and Health Inspection, School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Shanghai, China
| | - Gang Chen
- Department of Health Law and Health Inspection, School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Shanghai, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, United States of America
| | - Jun Lu
- China Research Center on Disability Issues at Fudan University, Shanghai, China
| | - Huijiong Yu
- Department of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
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Raeisi-Giglou P, Volgman AS, Patel H, Campbell S, Villablanca A, Hsich E. Advances in Cardiovascular Health in Women over the Past Decade: Guideline Recommendations for Practice. J Womens Health (Larchmt) 2018; 27:128-139. [PMID: 28714810 PMCID: PMC5815443 DOI: 10.1089/jwh.2016.6316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) remains the number one cause of death in women. It is estimated that 44 million women in the United States are either living with or at risk for heart disease. This article highlights the recent significant progress made in improving care, clinical decision-making, and policy implications for women with CVD. We provide our perspective supported by evidence-based advances in cardiovascular research and clinical care guidelines in seven areas: (1) primary CVD prevention and community heart care, (2) secondary prevention of CVD, (3) stroke, (4) heart failure and cardiomyopathies, (5) ischemia with nonobstructive coronary artery disease, (6) spontaneous coronary artery dissection, and (7) arrhythmias and device therapies. Advances in these fields have improved the lives of women living with and at risk for heart disease. With increase awareness, partnership with national organizations, sex-specific research, and changes in policy, the morbidity and mortality of CVD in women can be further reduced.
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Affiliation(s)
| | - Annabelle Santos Volgman
- Rush Heart Center for Women Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Hena Patel
- Rush Heart Center for Women Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | - Amparo Villablanca
- Women's Cardiovascular Medicine Program, Division of Cardiovascular Medicine, University of California, Davis, Davis, California
| | - Eileen Hsich
- Heart and Vascular Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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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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Barry LC, Wakefield DB, Trestman RL, Conwell Y. Disability in prison activities of daily living and likelihood of depression and suicidal ideation in older prisoners. Int J Geriatr Psychiatry 2017; 32:1141-1149. [PMID: 27650475 PMCID: PMC7864224 DOI: 10.1002/gps.4578] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The study objective was to determine if disability in activities of daily living specific to prison, prison activities of daily living (PADLs), is associated with depression and severity of suicidal ideation (SI) in older prisoners, a rapidly growing population at high risk of suicide. METHODS Cross-sectional design using data from a study of prisoners age ≥50 years (N = 167). Depression was operationalized as a score of ≥15 on the 9-item Physician Health Questionnaire (PHQ-9). SI severity was assessed using the Geriatric Suicide Ideation Scale (GSIS). Participants were considered to have PADL disability if they reported any of the following as "very difficult" or "cannot do:" dropping to the floor for alarms, climbing on/off the top bunk, hearing orders, walking while wearing handcuffs, standing in line for medications, and walking to chow. Associations were examined with bivariate tests and with multivariable logistic and linear regression models, and the interaction term gender × PADL disability was tested. RESULTS PADL disability was associated with depression and SI severity. There was no main effect of gender on either depression or SI, yet the association between PADL disability and depression was considerably stronger in male than in female older prisoners. CONCLUSIONS Identifying older prisoners who have difficulty performing PADLs may help distinguish prisoners who may also be likely to be depressed or experience more severe SI. Furthermore, the association between PADL disability and depression may be particularly salient in older male prisoners. Longitudinal studies are needed as causal inferences are limited by the cross-sectional design. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lisa C. Barry
- University of Connecticut Health Center, UConn Center on Aging, Farmington, CT, USA
| | - Dorothy B. Wakefield
- University of Connecticut Health Center, Center for Public Health and Health Policy, Farmington, CT, USA
| | - Robert L. Trestman
- Correctional Managed Health Care, University of Connecticut Health Center, Farmington, CT, USA
| | - Yeates Conwell
- University of Rochester School of Medicine, Rochester, NY, USA
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Brown RT, Komaiko KD, Shi Y, Fung KZ, Boscardin WJ, Au-Yeung A, Tarasovsky G, Jacob R, Steinman MA. Bringing functional status into a big data world: Validation of national Veterans Affairs functional status data. PLoS One 2017; 12:e0178726. [PMID: 28570678 PMCID: PMC5453575 DOI: 10.1371/journal.pone.0178726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/17/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The ability to perform basic daily activities ("functional status") is key to older adults' quality of life and strongly predicts health outcomes. However, data on functional status are seldom collected during routine clinical care in a way that makes them available for clinical use and research. OBJECTIVES To validate functional status data that Veterans Affairs (VA) medical centers recently started collecting during routine clinical care, compared to the same data collected in a structured research setting. DESIGN Prospective validation study. SETTING Seven VA medical centers that collected complete data on 5 activities of daily living (ADLs) and 8 instrumental activities of daily living (IADLs) from older patients attending primary care appointments. PARTICIPANTS Randomly selected patients aged 75 and older who had new ADL and IADL data collected during a primary care appointment (N = 252). We oversampled patients with ADL dependence and applied these sampling weights to our analyses. MEASUREMENTS Telephone-based interviews using a validated measure to assess the same 5 ADLs and 8 IADLs. RESULTS Mean age was 83 years, 96% were male, and 75% were white. Of 85 participants whom VA data identified as dependent in 1 or more ADLs, 74 (87%) reported being dependent by interview; of 167 whom VA data identified as independent in ADLs, 149 (89%) reported being independent. The sample-weighted sensitivity of the VA data for identifying ADL dependence was 45% (95% CI, 29%, 62%) compared to the reference standard, the specificity was 99% (95% CI, 99%, >99%), and the positive predictive value was 87% (95% CI, 79%, 93%). The weighted kappa statistic was 0.55 (95% CI, 0.41, 0.68) for the agreement between VA data and research-collected data in identifying ADL dependence. CONCLUSION Overall agreement of VA functional status data with a reference standard was moderate, with fair sensitivity but high specificity and positive predictive value.
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Affiliation(s)
- Rebecca T. Brown
- Geriatrics, Palliative and Extended Care, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Kiya D. Komaiko
- Geriatrics, Palliative and Extended Care, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Ying Shi
- Geriatrics, Palliative and Extended Care, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States of America
| | - Kathy Z. Fung
- Geriatrics, Palliative and Extended Care, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States of America
| | - W. John Boscardin
- Geriatrics, Palliative and Extended Care, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Alvin Au-Yeung
- Geriatrics, Palliative and Extended Care, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Gary Tarasovsky
- Geriatrics, Palliative and Extended Care, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States of America
| | - Riya Jacob
- Geriatrics, Palliative and Extended Care, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Michael A. Steinman
- Geriatrics, Palliative and Extended Care, San Francisco Veterans Affairs (VA) Medical Center, San Francisco, CA, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6051] [Impact Index Per Article: 864.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Santos VRD, Christofaro DGD, Gomes IC, Freitas Júnior IF, Gobbo LA. Factors associated with mobility of the oldest old. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.001.ao07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Several factors can be associated to the reduction of mobility among the elderly. Early identification of these factors is crucial, since it may lead to prevention of functional dependencies. Objective: To analyze the association between mobility, sociodemographic factors and the prevalence of noncommunicable chronic diseases (NCDs) in oldest old. Methods: The sample consisted of 120 elderly persons aged (80 and 95 years), with 76 of them being women (83 ± 3 years) and 44 of them men (83 ± 3 years). Sociodemographic factors and NCDs which we studied were: age, gender, marital status, education, nutritional status, ethnicity, hypertension, diabetes and osteoarticular diseases. Mobility was analyzed using a battery of Physical Performance Tests. For statistical analysis we used the chi-square test and binary logistic regression to examine the relationship between sociodemographic factors, NCDs and mobility. SPSS (17.0) software was used for this and the significance level was set at 5%. Results: Level of education (p ≤ 0.001) and age (p = 0.034) are the two factors related to low mobility. However, the model built by multiple logistic regression analysis revealed that age is independently related to limited mobility in oldest old people (OR 3.29; 95% CI 1.09 to 9.87). Conclusion: Thus, oldest old >85 years are at a greater risk of decreased mobility independent of their education, marital and nutritional statuses and gender. We encourage further studies in this area. Studies which will not only address those facts considered in this study but that also examine family-related aspects, especially using longitudinal studies.
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Abstract
Pharmacologic management of chronic pain in older adults is one component of the multimodal, interdisciplinary management of this complex condition. In this article, we summarize several of the key barriers to effective pharmacologic management in older adults and review the existing (albeit limited) evidence for its effectiveness and safety, especially in a medically complex population with multimorbidity. This review covers topical formulations, acetaminophen, oral nonsteroidal antiinflammatory drugs, and adjuvant therapies. The article concludes with a suggested approach to managing chronic pain in the older patient, incorporating goals and expectations for treatment as well as careful monitoring of medication adjustments.
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Affiliation(s)
- Zachary A Marcum
- Department of Pharmacy, University of Washington School of Pharmacy, 1959 Northeast Pacific Avenue, Box 357630, Seattle, WA 98195, USA
| | - Nakia A Duncan
- Texas Tech University Health Sciences Center School of Pharmacy, 4500 South Lancaster Street, Building 7, Room 215, Dallas, TX, USA
| | - Una E Makris
- Division of Rheumatic Diseases, Department of Internal Medicine, VA North Texas Health Care System, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9169, USA.
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Caro CC, Mendes PVB, Costa JD, Nock LJ, Cruz DMCD. Independence and cognition post-stroke and its relationship to burden and quality of life of family caregivers. Top Stroke Rehabil 2016; 24:194-199. [DOI: 10.1080/10749357.2016.1234224] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Camila Caminha Caro
- Postgraduate Program in Occupational Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Lauren Jane Nock
- School of Health and Life Sciences, Coventry University, Coventry, UK
| | - Daniel Marinho Cezar da Cruz
- Department of Occupational Therapy, Postgraduate Program in Occupational Therapy, Federal University of São Carlos, São Carlos, Brazil
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Cao B. Future healthy life expectancy among older adults in the US: a forecast based on cohort smoking and obesity history. Popul Health Metr 2016; 14:23. [PMID: 27408607 PMCID: PMC4941025 DOI: 10.1186/s12963-016-0092-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 06/23/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In the past three decades, the elderly population in the United States experienced increase in life expectancy (LE) and disability-free life expectancy (LE(ND)), but decrease in life expectancy with disability (LE(D)). Smoking and obesity are two major risk factors that had negative impacts on these trends. While smoking prevalence continues to decline in recent decades, obesity prevalence has been growing and is currently at a high level. This study aims to forecast the healthy life expectancy for older adults aged 55 to 85 in the US from 2011 to 2040, in relation to their smoking and obesity history. METHODS First, population-level mortality data from the Human Mortality Database (HMD) and individual-level disability data from the US National Health Interview Survey (NHIS) were used to estimate the transition rates between different health states from 1982 to 2010, using a multi-state life table (MSLT) model. Second, the estimated transition rates were fitted and projected up to 2040, using a modified Lee-Carter model that incorporates cohort smoking and obesity history from NHIS. RESULTS Mortality and morbidity for both sexes will continue to decline in the next decades. Relative to 2010, men are expected to have 3.2 years gain in LE(ND) and 0.8 years loss in LE(D). For women, there will be 1.8 years gain in LE(ND) and 0.8 years loss in LE(D). By 2040, men and women are expected to spend respectively 80 % and 75 % of their remaining life expectancy between 55 and 85 disability-free. CONCLUSIONS Smoking and obesity have independent negative impacts on both the survival and disability of the US older population in the coming decades, and are responsible for the present and future gender disparity in mortality and morbidity. Overall, the US older population is expected to enjoy sustained health improvements and compression of disability, largely due to decline in smoking.
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Affiliation(s)
- Bochen Cao
- Population Studies Center, University of Pennsylvania, McNeil Building, 3718 Locust Walk, Philadelphia, PA 19104 USA
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Kirchberger I, Heier M, Amann U, Kuch B, Thilo C, Meisinger C. Variables associated with disability in male and female long-term survivors from acute myocardial infarction. Results from the MONICA/KORA Myocardial Infarction Registry. Prev Med 2016; 88:13-9. [PMID: 27002251 DOI: 10.1016/j.ypmed.2016.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/09/2016] [Accepted: 03/16/2016] [Indexed: 11/19/2022]
Abstract
Increasing attention is paid on functional limitations and disability among people with chronic diseases. However, only few studies have explored disability in persons with acute myocardial infarction (AMI). The objective of this study was to provide a description of disability and to identify determinants of disability in a population-based sample of long-term AMI survivors. The sample consisted of 1943 persons (35-85years) with AMI from the German population-based MONICA/KORA Myocardial Infarction Registry, who responded to a postal follow-up survey in 2011. Disability was assessed with the 12-item version of the World Health Organization Disability Schedule (WHODAS). Multivariate linear regression models were established in order to identify socioeconomic and clinical factors, risk factors and comorbidities which are associated with disability. The mean WHODAS score for the total sample was 7.86±9.38. The regression model includes 26 variables that explained 37.2% of the WHODAS variance. Most of the explained variance could be attributed to the presence of depression, female sex, joint disorders, digestive disorders, and stroke. Depression was the most important determinant of disability in both sexes. Replacement of single comorbidities by the total number of comorbidities resulted in a model with 15 variables explaining 31.9% of the WHODAS variance. Most of the variance was explained by the number of comorbidities. Further significant determinants of disability were female sex, low education level, angina pectoris, and no revascularization therapy. In AMI patients, the number of comorbidities and particularly the presence of depression are important determinants of disability and should be considered in post-AMI health care.
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Affiliation(s)
- Inge Kirchberger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156 Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany.
| | - Margit Heier
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156 Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Ute Amann
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156 Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Bernhard Kuch
- Hospital of Nördlingen, Department of Internal Medicine/Cardiology, Stoffelsberg 4, 86720 Nördlingen, Germany; Central Hospital of Augsburg, Department of Internal Medicine I - Cardiology, Stenglinstr. 2, D-86156 Augsburg, Germany
| | - Christian Thilo
- Central Hospital of Augsburg, Department of Internal Medicine I - Cardiology, Stenglinstr. 2, D-86156 Augsburg, Germany
| | - Christa Meisinger
- Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Stenglinstr. 2, D-86156 Augsburg, Germany; Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
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Balogun SA, Guntupalli AM. Gender difference in the prevalence and socio-demographic correlates of mobility disability among older adults in Nigeria. Eur J Ageing 2016; 13:231-239. [PMID: 28804380 DOI: 10.1007/s10433-016-0386-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of the current study is to examine gender differences in mobility disability among older people in Nigeria, and to explore factors associated with gender differences in mobility disability in later life. Data were used from the first (2010-2011) wave of the Nigeria General Household Survey-Panel, which included 3586 respondents aged 50 years and above. Mobility disability was assessed as self-reported difficulty in walking 100 m, walking 1 km, walking uphill, running, bending or stooping, and climbing stairs. Regression analyses were used to estimate the extent to which socio-demographic conditions contribute to gender differences in mobility disability. We observed a higher prevalence of mobility disability among women compared to men (20.1 vs. 12.5 %, P < 0.001). The prevalence ratios (PR) of mobility disability for women versus men was 1.61 (95 % CI 1.38-1.88, P < 0.001); after adjusting for age, marital status, place of residence, self-reported health status and cognitive difficulties, the PR was 1.55 (95 % CI 1.30-1.85, P < 0.001). In the fully adjusted model, mobility disability still remained significantly higher among women (PR 1.60, 95 % CI 1.32-1.93, P < 0.001). The marginal effects of socio-demographic and health factors were stronger for women than for men. Socio-demographic and health variables considered in this study explained between 19.3 % (men) and 22.3 % (women) of variance in mobility disability suggesting that additional factors beyond those considered in this study warrant further investigation, so that differences in mobility disability between older men and women in Nigeria can be fully understood.
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Brismée JM, Yang S, Lambert ME, Chyu MC, Tsai P, Zhang Y, Han J, Hudson C, Chung E, Shen CL. Differences in musculoskeletal health due to gender in a rural multiethnic cohort: a Project FRONTIER study. BMC Musculoskelet Disord 2016; 17:181. [PMID: 27113571 PMCID: PMC4845308 DOI: 10.1186/s12891-016-1042-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/20/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Very few studies have investigated differences in musculoskeletal health due to gender in a large rural population. The aim of this study is to investigate factors affecting musculoskeletal health in terms of hand grip strength, musculoskeletal discomfort, and gait disturbance in a rural-dwelling, multi-ethnic cohort. METHODS Data for 1117 participants (40 years and older, 70% female) of an ongoing rural healthcare study, Project FRONTIER, were analyzed. Subjects with a history of neurological disease, stroke and movement disorder were excluded. Dominant hand grip strength was assessed by dynamometry. Gait disturbance including stiff, spastic, narrow-based, wide-based, unstable or shuffling gait was rated. Musculoskeletal discomfort was assessed by self-reported survey. Data were analyzed by linear, logistic regression and negative binomial regressions as appropriate. Demographic and socioeconomic factors were adjusted in the multiple variable analyses. RESULTS In both genders, advanced age was a risk factor for weaker hand grip strength; arthritis was positively associated with musculoskeletal discomfort, and fair or poor health was significantly associated with increased risk of gait disturbance. Greater waist circumference was associated with greater musculoskeletal discomfort in males only. In females, advanced age is the risk factor for musculoskeletal discomfort as well as gait disturbance. Females with fair or poor health had weaker hand grip strength. Higher C-reactive protein and HbA1c levels were also positively associated with gait disturbance in females, but not in males. CONCLUSION This cross-sectional study demonstrates how gender affects hand grip strength, musculoskeletal discomfort, and gait in a rural-dwelling multi-ethnic cohort. Our results suggest that musculoskeletal health may need to be assessed differently between males and females.
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Affiliation(s)
- J M Brismée
- Center for Rehabilitation Research, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - S Yang
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - M E Lambert
- F. Marie Hall Institute for Rural and Community Health Research, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - M C Chyu
- Graduate Healthcare Engineering, Whitacre College of Engineering, Texas Tech University, Lubbock, TX, 79409, USA
| | - P Tsai
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Y Zhang
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - J Han
- Department of Nutrition and Food Hygiene, Xinjiang Medical University, Xinjiang, China
| | - C Hudson
- F. Marie Hall Institute for Rural and Community Health Research, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Eunhee Chung
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, USA
| | - C L Shen
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA.
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Santos VRD, Gobbo LA, Christofaro DGD, Gomes IC, Mota J, Gobbi S, Freitas Júnior IF. Osteoarticular diseases and physical performance of Brazilians over 80 years old. CIENCIA & SAUDE COLETIVA 2016; 21:423-30. [DOI: 10.1590/1413-81232015212.16032015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/30/2015] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective To investigate the physical performance of Brazilian individuals older than 80 years with and without OD. Methods The sample consisted of 135 individuals (aged > 80 years) of both gender. Identification of osteopenia/osteoporosis was verified by Dual Energy X-ray Absorptiometry, and the presence of others osteoarticular diseases (OD) was obtained using a questionnaire of morbidities. Physical performance was analyzed by motor tests. Results Men presented higher proportion of osteopenia/osteoporosis compared to women (p = 0.013). The proportion of older people with arthritis/osteoarthritis for women and men was 33% and 26%, respectively, and with OD in the spine was 19% and 12%, respectively. No significant difference for physical performance, measured by each test and overall score, was observed between groups of OD. According to gender, male with OD presented lower performance in gait speed, balance and overall score (p < 0.05), while older people with osteopenia/osteoporosis are at higher risk for low physical performance (OR 2.73; CI 95% 1.31-5.66). Conclusion In conclusion it was verified in older people with age of 80 years or more, a high prevalence of OD, especially in men, and the presence of these diseases interfered negatively their physical performance.
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3729] [Impact Index Per Article: 414.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Saito T, Izawa KP, Omori Y, Watanabe S. Functional Independence and Difficulty Scale: Instrument development and validity evaluation. Geriatr Gerontol Int 2015; 16:1127-1137. [DOI: 10.1111/ggi.12605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Takashi Saito
- Department of Rehabilitation; Visiting Nursing and Rehabilitation Network; Kawasaki-shi Kanagawa Japan
- Doctoral Course of Gerontology; Kobe University; Kobe Japan
| | | | - Yutaka Omori
- Department of Rehabilitation; Visiting Nursing and Rehabilitation Network; Kawasaki-shi Kanagawa Japan
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48
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Mochari-Greenberger H, Xian Y, Hellkamp AS, Schulte PJ, Bhatt DL, Fonarow GC, Saver JL, Reeves MJ, Schwamm LH, Smith EE. Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry. J Am Heart Assoc 2015; 4:e002099. [PMID: 26268882 PMCID: PMC4599467 DOI: 10.1161/jaha.115.002099] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Differences in activation of emergency medical services (EMS) may contribute to racial/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity and sex among a current, diverse national sample of hospitalized acute stroke patients. METHODS AND RESULTS We analyzed data from 398,798 stroke patients admitted to 1613 Get With The Guidelines-Stroke participating hospitals between October 2011 and March 2014. Multivariable logistic regression was used to evaluate the associations between combinations of racial/ethnic and sex groups with EMS use, adjusting for potential confounders including demographics, medical history, and stroke symptoms. Patients were 50% female, 69% white, 19% black, 8% Hispanic, 3% Asian, and 1% other, and 86% had ischemic stroke. Overall, 59% of stroke patients were transported to the hospital by EMS. White women were most likely to use EMS (62%); Hispanic men were least likely to use EMS (52%). After adjustment for patient characteristics, Hispanic and Asian men and women had 20% to 29% lower adjusted odds of using EMS versus their white counterparts; black women were less likely than white women to use EMS (odds ratio 0.75, 95% CI 0.72 to 0.77). Patients with weakness or paresis, altered level of consciousness, and/or aphasia were significantly more likely to use EMS than patients without each symptom; the observed racial/ethnic and sex differences in EMS use remained significant after adjustment for stroke symptoms. CONCLUSIONS EMS use differed by race/ethnicity and sex. These contemporary data document suboptimal use of EMS transport among US stroke patients, especially by racial/ethnic minorities and those with less recognized stroke symptoms.
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Affiliation(s)
| | - Ying Xian
- Duke Clinical Research Institute, Durham, NC (Y.X., A.S.H., P.J.S.)
| | - Anne S Hellkamp
- Duke Clinical Research Institute, Durham, NC (Y.X., A.S.H., P.J.S.)
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- David Geffen School of Medicine, University of California at Los Angeles, CA (G.C.F., J.L.S.)
| | - Jeffrey L Saver
- David Geffen School of Medicine, University of California at Los Angeles, CA (G.C.F., J.L.S.)
| | | | | | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.)
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49
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Egüez-Guevara P, Andrade FCD. Gender differences in life expectancy with and without disability among older adults in Ecuador. Arch Gerontol Geriatr 2015; 61:472-9. [PMID: 26316253 DOI: 10.1016/j.archger.2015.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Knowledge on disability's impact among older women and men in Ecuador is limited. This paper provides gender-specific estimates of disability prevalence, life expectancy with and without disability, and the factors associated with gender differences in disability at older age in Ecuador (2009-2010). METHODS Data from the Health, Well-Being, and Aging Survey (SABE) Ecuador 2009 was used. Participants were 4480 men and women aged 60 and over. Life expectancy with and without disability was calculated using the Sullivan method. Logistic regression analyses were used to explore gender differences in disability prevalence. Two disability measures, indicating limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), were used. RESULTS 60-year-old women in Ecuador can expect to live 16.3 years without ADL limitations compared to 16.9 years for men. Life expectancy without IADL limitations was 12.5 years for women and 15.5 years for men. At age 60, women's length of life with ADL and IADL disability was higher (7.9 years for women vs. 4.9 years for men with ADL, and 11.7 years for women vs. 6.3 years for men with IADL). After controlling for socioeconomic characteristics, chronic conditions and lifestyle factors, gender differences in ADL disability were not statistically significant. However, older women were 58% more likely (OR=1.58, 95% CI 1.27, 1.95) to report having IADL limitations than men, even after including control variables. CONCLUSION Interventions should tackle chronic disease, physical inactivity, and socioeconomic differences to reduce women's vulnerability to disability in older age.
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Affiliation(s)
- Pilar Egüez-Guevara
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois, 1206 South 4th Street, Champaign, IL 61820, USA.
| | - Flávia Cristina Drumond Andrade
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois, 1206 South 4th Street, Champaign, IL 61820, USA
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50
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Zunzunegui MV, Alvarado BE, Guerra R, Gómez JF, Ylli A, Guralnik JM. The mobility gap between older men and women: the embodiment of gender. Arch Gerontol Geriatr 2015; 61:140-8. [PMID: 26113021 DOI: 10.1016/j.archger.2015.06.005] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/31/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies. METHODS Data are from surveys on random samples of people aged 65-74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios. RESULTS Age-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men. DISCUSSION Results provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age.
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Affiliation(s)
- M V Zunzunegui
- Research Institute of Public Health of the Université de Montréal (IRSPUM), Canada.
| | - B E Alvarado
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - R Guerra
- School of Physiotherapy, Universidade Federale do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - J F Gómez
- School of Medicine, Universidad de Caldas, Manizales, Caldas, Colombia
| | - A Ylli
- Albanian National Institute of Health, Tirana, Albania
| | - J M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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- Research Institute of Public Health of the Université de Montréal (IRSPUM), Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; School of Physiotherapy, Universidade Federale do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; School of Medicine, Universidad de Caldas, Manizales, Caldas, Colombia; Albanian National Institute of Health, Tirana, Albania; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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