Receipt of exercise counseling by older women

Diabetes in US women on the rise independent of increasing BMI and other risk factors; a trend investigation of serial cross-sections

BACKGROUND

The epidemic of diabetes continues leaving an enormous and growing burden of chronic disease to public health. This study investigates this growing burden of diabetes independent of increasing BMI in a large population based female sample, 2006-2010.

METHODS

Serial cross-sectional data using the Behavioral Risk Factor Surveillance System (BRFSS) 2006-2010 surveys from 1,168,418 women. Diabetes was assessed by self-report of a physician diagnosis, and body mass index (BMI) was calculated based on self-reported height and weight.

RESULTS

Almost 60% of women responders had a BMI > 25 (defined as overweight or obese). Diabetes was reported in 16% of respondents whose BMI > 25, and in 4% of respondents with reported BMI ≤ 25. Overall, 11% of the women in this sample reported being diagnosed with diabetes, of whom 83% had a BMI > 25. BMI, physical activity, age, and race were each independently associated with diabetes (p-value < 0.05). The odds of reported diabetes increased each year independent of BMI, physical activity, age, and race.

CONCLUSIONS

After adjusting for age, race, physical activity, and year of survey response, results indicate a threefold increase in diabetes among respondents with a BMI > 25 (OR = 3.57; 95% CI = 3.52-3.63). Potentially more alarming was a notable increase in odds of diabetes across the years of study among women, implying a near 30 percent projected increase in odds of diabetes diagnoses by 2020. This is likely due to advances in diagnosis and treatment but also highlights a burden of disease that will have a growing and sustained impact on public health and healthcare systems.

Multiple risk factors and the likelihood of patient-physician communication and health maintenance services in medicare health plans

This study examined both individual and combined effects of race, education, and health-based risk factors on health maintenance services among Medicare plan members. Data were from 110 238 elderly completing the 2006 Medicare Health Outcomes Survey. Receipt of recommended patient-physician communication and interventions for urinary incontinence, physical activity, falls, and osteoporosis was modeled as a function of risk factors. Low education decreased the odds of receiving services; poor health increased odds. Race had little effect. Evidence suggested moderation among competing effects. While clinicians target services to most at-risk elderly individuals, patients with low education experience gaps. Synergies among co-occurring risks warrant further research.

General practitioner advice on physical activity: analyses in a cohort of older primary health care patients (getABI)

Background

Although the benefits of physical activity for health and functioning are recognized to extend throughout life, the physical activity level of most older people is insufficient with respect to current guidelines. The primary health care setting may offer an opportunity to influence and to support older people to become physically active on a regular basis. Currently, there is a lack of data concerning general practitioner (GP) advice on physical activity in Germany. Therefore, the aim of this study was to evaluate the rate and characteristics of older patients receiving advice on physical activity from their GP.

Methods

This is a cross-sectional study using data collected at 7 years of follow-up of a prospective cohort study (German epidemiological trial on ankle brachial index, getABI). 6,880 unselected patients aged 65 years and above in the primary health care setting in Germany were followed up since October 2001. During the 7-year follow-up telephone interview, 1,937 patients were asked whether their GP had advised them to get regular physical activity within the preceding 12 months. The interview also included questions on socio-demographic and lifestyle variables, medical conditions, and physical activity. Logistic regression analysis (unadjusted and adjusted for all covariables) was used to examine factors associated with receiving advice. Analyses comprised only complete cases with regard to the analysed variables. Results are expressed as odds ratios (ORs) with 95% confidence intervals (95% CI).

Results

Of the 1,627 analysed patients (median age 77; range 72-93 years; 52.5% women), 534 (32.8%) stated that they had been advised to get regular physical activity. In the adjusted model, those more likely to receive GP advice on physical activity were men (OR [95% CI] 1.34 [1.06-1.70]), patients suffering from pain (1.43 [1.13-1.81]), coronary heart disease and/or myocardial infarction (1.56 [1.21-2.01]), diabetes mellitus (1.79 [1.39-2.30]) or arthritis (1.37 [1.08-1.73]), and patients taking a high (> 5) number of medications (1.41 [1.11-1.80]).

Conclusions

The study revealed a relatively low rate of older primary health care patients receiving GP advice on physical activity. GPs appeared to focus their advice on patients with chronic medical conditions. However, there are likely to be many more patients who would benefit from advice.

Index to predict 5-year mortality of community-dwelling adults aged 65 and older using data from the National Health Interview Survey

BACKGROUND

Prognostic information is becoming increasingly important for clinical decision-making.

OBJECTIVE

To develop and validate an index to predict 5-year mortality among community-dwelling older adults.

DESIGN AND PARTICIPANTS

A total of 24,115 individuals aged >65 who responded to the 1997-2000 National Health Interview Survey (NHIS) with follow-up through 31 December 2002 from the National Death Index; 16,077 were randomly selected for the development cohort and 8,038 for the validation cohort.

MEASUREMENTS

39 risk factors (functional measures, illnesses, behaviors, demographics) were included in a multivariable Cox proportional hazards model to determine factors independently associated with mortality. Risk scores were calculated for participants using points derived from the final model's beta coefficients. To evaluate external validity, we compared survival by quintile of risk between the development and validation cohorts.

RESULTS

Seventeen percent of participants had died by the end of the study. The final model included 11 variables: age (1 point for 70-74 up to 7 points for >85); male: 3 points; BMI <25: 2 points; perceived health (good: 1 point, fair/poor: 2 points); emphysema: 2 points; cancer: 2 points; diabetes: 2 points; dependent in instrumental activities of daily living: 2 points; difficulty walking: 3 points; smoker-former: 1 point, smoker-current: 3 points; past year hospitalizations-one: 1 point, >2: 3 points. We observed close agreement between 5-year mortality in the two cohorts; which ranged from 5% in the lowest risk quintile to 50% in the highest risk quintile in the validation cohort.

CONCLUSIONS

This validated mortality index can be used to account for participant life expectancy in analyses using NHIS data.

Preventive health care among older women: missed opportunities and poor targeting

BACKGROUND

Experts recommend that clinicians target mammography and colon cancer screening to individuals with at least 5 years life expectancy. Generally, immunizations and exercise counseling are recommended for all women aged > or =65 years, while Pap smears are generally not encouraged for these women.

METHODS

We used the 2005 National Health Interview Survey to examine receipt of several preventive health measures simultaneously among community dwelling US women aged > or =65 years by age and health status. We used functional status, significant diseases, and perceived health to categorize women into those most likely to be in above-average, average, or below-average health status. We used age and health status to estimate life expectancy.

RESULTS

Of 4683 participants, 25.8% were > or =80 years; 81.8% were non-Hispanic white; 21% were in above-average and 20% were in below-average health status. Receipt of mammography and colon cancer screening decreased with age and was not associated with health status for women aged > or =80 years. Nearly half (49%) of women aged > or =80 years in below-average health received mammography screening, while 19% of women aged 65-79 years in above-average health did not report receiving mammography. Nearly half of women aged 65-79 years (49%) in above-average health did not report receiving colon cancer screening. Pap smear screening was common among older women. Few (34%) reported receiving exercise counseling. Many did not report receiving pneumococcal (43%) or flu vaccinations (40%).

CONCLUSIONS

In our comprehensive review of preventive health measures for older women, we found evidence to suggest a need to improve delivery and targeting of preventive health services.

The Exercise Assessment and Screening for You (EASY) Tool: Application in the Oldest Old Population

The screening tool, the Exercise Assessment and Screening for You (EASY), was developed to call attention to the benefits of exercise and to assist older adults in selecting safe and effective exercise. The purpose of this study is to describe the use of the EASY in an oldest old population, consider the factors associated with EASY scores, and examine the relationship between exercise and adverse events in this population. The sample comprised 163 oldest old adults with an average age of 86.5 (SD = 5.8), the majority of whom were women (73%) and unmarried (64%). The participants responded affirmatively to approximately 2 of the 6 items on the EASY (mean = 1.9, SD = 1.3). Fear of falling, negative outcome expectations, number of comorbidities, age, and pain were all significantly associated with the total score on the EASY and accounted for 24% of the variance. Those who responded affirmatively to at least 1 item on the EASY were more likely to engage in exercise than those who did not (chi-square = 8.0, P = .01). The findings from this study help establish some baseline evidence of the applicability of the EASY when used as a screening tool to help guide oldest old adults prior to starting an exercise program.

Preventive health care among older women in an academic primary care practice

PURPOSE

We sought to examine the use of preventive health services among older women and to assess how age and illness burden influence care patterns.

METHODS

The charts of 299 women aged > or =80 and 229 women aged 65-79 years who did not have dementia or terminal illness at 1 academic primary care practice in Boston were reviewed between July and December 2005 to determine receipt of screening tests (e.g., mammography), counseling on healthy lifestyle (e.g., exercise), and/or geriatric health issues (e.g., incontinence), and immunizations. Illness burden was quantified using the Charlson Comorbidity Index (CCI).

RESULTS

Women aged > or =80 were more likely than women aged 65-79 to have a CCI of > or =3 (24.0% vs. 16.7%) and were less likely to receive all screening tests. However, receipt of mammography (47.8%) and colon cancer screening (51.2%) was still common among women aged > or =80 and was not targeted to older women in good health. Women aged > or =80 were less likely to be screened for depression (adjusted relative risk [aRR] 0.6; 95% confidence interval [CI], 0.5-0.8), osteoporosis (aRR, 0.6; 95% CI, 0.5-0.9), or counseled about exercise (aRR 0.8; 95% CI, 0.6-0.9) than younger women, but were more likely to receive counseling about falls (aRR 1.9; 95% CI, 1.4-2.6) and/or incontinence (aRR 1.8; 95% CI, 1.2-2.6). However notes documenting discussions about mood (28.6%), exercise (40.0%), falls (28.8%), or incontinence (20.8%) were low among all women.

CONCLUSION

In a comprehensive review of preventive health measures for elderly women, many in poor health were screened for cancer. Meanwhile, many older women were not screened for depression or counseled about exercise, falls, or incontinence. There is a need to improve delivery of preventive health care to older women.

Diet and physical activity of U.S. adults with heart disease following preventive advice

BACKGROUND

The extent to which persons with heart disease have been told to engage in and follow recommended preventive lifestyle actions is unknown.

METHODS

Receipt of advice for and levels of reported fruit and vegetable intake and physical activity were analyzed among people with heart disease in 25 states/territories in the 2003 Behavioral Risk Factor Surveillance System, a telephone-based survey of US adults.

RESULTS

Overall, 7392 of 113,795 people reported a heart attack or coronary heart disease. Among these, 54.4% of respondents with heart disease were told to eat more fruits and vegetables; 24.7% met recommended 5 servings per day. In multivariable analyses, those told to eat more fruits and vegetables were somewhat more likely than those not advised to meet recommended intake (Odds ratio [OR] 1.30, confidence interval [CI]: 1.10-1.55). Some 53.2% were told to be more physically active; 33.2% met recommended physical activity levels and 30.8% were sedentary. In multivariable analyses, having been told to engage in physical activity was not related to the likelihood of meeting recommended levels (OR: 1.09, 95%; CI: 0.93-1.27). In sub-analyses, receipt of cardiac rehabilitation after heart attack was associated with meeting both dietary (OR: 1.50, CI 1.18-1.92) and activity recommended levels (OR 1.47, CI 1.20-1.82).

CONCLUSION

Dietary and physical activity advice and patient actions remain suboptimal. Further efforts to identify effective patient education techniques and barriers to behavior change are needed to improve secondary prevention of heart disease.

Effects of high-intensity combined training on women over 65

BACKGROUND

Many studies have sought to assess the effects of physical exercise on older people, but there is little scientific evidence concerning its effects on subjects' quality of life and cognitive function. Besides, there is a need to know how well the elderly can tolerate combined exercise programs of great intensity and frequency, without risking their health.

OBJECTIVES

To determine whether older people are able to do a high-intensity combined program of physical exercise, and to analyze its effects at a conditional, cognitive and functional level as well as on their quality of life.

METHODS

Sixty-two community-dwelling women older than 65 took part in a randomized trial, with subjects assigned to a combined program of aquatic exercise plus high-intensity strength training (group 1), or plus calisthenic training (group 2). Group 2 training consisted of several aerobic, mobility and flexibility exercises; group 1 training consisted of 7 exercises targeting the major muscle groups of the body, performed on exercise machines at an intensity of 75% of 1 repetition maximum. Both groups trained 5 days a week during 5 months. Quality of life, cognitive function, and functional level were assessed by means of validated questionnaires. Conditional evaluations included static and dynamic strength, balance, flexibility, and aerobic capacity.

RESULTS

No participant withdrew for adverse effects during the program or at the end. Both groups obtained a significant improvement in their quality of life and cognitive function, as well as in their balance and flexibility level, whereas only group 1 improved their static and dynamic strength significantly.

CONCLUSION

Older women can take part in high-frequency, high-intensity training programs with no risk to their health while experiencing improvements to their quality of life, cognitive function, degree of independence and physical fitness.