Predictive Value of the GLIM Criteria in Chinese Community-Dwelling and Institutionalized Older Adults Aged 70 Years and Over

OBJECTIVES

The Global Leadership Initiative on Malnutrition (GLIM) has recently published criteria for classifying malnutrition. This study investigated the associations between malnutrition and adverse outcomes, and identified which component(s) of the GLIM criteria is/are risk factor(s) of adverse outcomes in Chinese older adults.

DESIGN

A prospective cohort study of Chinese older adults in a healthy ageing study.

SETTING

Participants' place of residence.

PARTICIPANTS

Community-dwelling and institutionalized Chinese older adults aged ≥70 years living in Hong Kong.

MEASUREMENTS

Malnutrition at baseline was classified according to selected GLIM criteria. Adverse outcomes including poor self-rated health, functional limitation (Barthel Index), falls, frailty (FRAIL scale), hospitalization and mortality were assessed after a 3-year follow-up. Associations between malnutrition and components of selected GLIM criteria (weight loss, low body mass index (BMI), low muscle mass and disease burden) and each adverse outcome were examined using adjusted binary logistic regression and Cox proportional hazards model. Odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) are presented.

RESULTS

Data of 1576 community-dwelling (45.5% female, 78.1±6.5 years) and 427 institutionalized (69.6% female, 85.5±6.4 years) older adults were included at baseline. Among community-dwelling older adults, malnutrition was associated with frailty (n=899, OR: 2.44, 95% CI: 1.05-5.70) and mortality (n=1007, HR: 1.37, 95% CI: 1.12-1.66). No association was found for other outcomes. Among institutionalized older adults, malnutrition was not associated with any outcomes. Low BMI and low muscle mass were risk factors of frailty; while weight loss was a risk factor of mortality in community-dwelling older adults. Weight loss and disease burden were risk factors of mortality among institutionalized older adults.

CONCLUSION

The association between malnutrition and frailty and mortality was observed in community but not in institutional settings. Further studies are required to draw more definitive conclusions on the use of GLIM criteria in institutional settings.

Menopausal transition and changes of body composition: a prospective study in Chinese perimenopausal women

OBJECTIVES

Whether age or menopause per se influences fat distribution remains controversial. This study aimed to investigate the change of body composition, particularly body fat distribution, in relation to menopausal transition in a 30-month prospective study of perimenopausal women.

METHODS

A total of 438 community-based healthy women aged 44-55 years participated in the Hong Kong Perimenopausal Women Osteoporosis Study. Data were obtained at baseline, and at 9-, 18- and 30-month during the follow-up. Soft tissue measurements consisting of fat mass and lean muscle mass of the trunk and whole body were obtained by the dual energy X-ray absorptiometry. Percentage change of body measurements over the follow-up period was compared between women who remained premenopausal, those who went through menopausal transition, and those who were menopausal since baseline.

RESULTS

A slight decrease in the lean mass but an increase in the total fat mass and trunk fat mass (TFM) over the follow-up period were noted. Multivariate linear regression analysis showed that age was negatively associated with an increase in central obesity. Adjusted for the important predictors--age, age of menarche and education level, menopausal status was a significant and independent predictor of the decrease in lean mass and the increase in percent of body fat, TFM and trunk-leg fat mass ratio.

CONCLUSION

Our 30-month longitudinal study showed that menopause has an independent effect on an increase in fat mass, and an increase in central obesity in perimenopausal Chinese women.

Public health significance of the frailty index

BACKGROUND

A quantifiable indicator of frailty would be very useful in assessing the health state of older populations, as well as enable the effect of interventions to be evaluated over time.

METHODS

A total of 2032 people aged 70 years and over recruited by stratified random sampling, and information obtained regarding physical and functional health, and psychological factors. The frailty index (FI) was constructed from 62 variables. Associations between the FI, and changes in ADL score, mental score, and hospitalization days over a 10-year period were evaluated.

RESULTS

For the baseline to 3-year changes, a 0.10 increase in baseline FI is accompanied by a 0.499-point faster drop in ADL score, a 0.223-point faster decline in mental score, and 4.57-day faster increase in hospital days. For 3-10-year changes, frailty was a significant predictor only of changes in mental score, with results indicating that, on average, each increase of 0.10 in the baseline frailty index was associated with 0.613-point drop in mental score during this period. Chronological age and frailty had differential associations with those changes.

CONCLUSION

The FI is a valid indicator of morbidity and requirement for health and social services for ageing populations.

Change in bone mineral density and its determinants in pre- and perimenopausal Chinese women: the Hong Kong Perimenopausal Women Osteoporosis Study

This 30-month study investigating bone change and its determinants in 438 perimenopausal Chinese women revealed that the fastest bone loss occurred in women undergoing menopausal transition but maintenance of body weight and physical fitness were beneficial for bone health. Soy protein intake also seemed to exert a protective effect.

INTRODUCTION

This 30-month follow-up study aims to investigate change in bone mineral density and its determinants in Hong Kong Chinese perimenopausal women.

METHODS

Four hundred and thirty-eight women aged 45 to 55 years were recruited through random telephone dialing and primary care clinic. Bone mass, body composition, lifestyle measurements were obtained at baseline and at 9-, 18- and 30-month follow-ups. Univariate and stepwise multiple regression analyses were performed with the regression coefficients of BMD/C (derived from baseline and follow-up measurements) as the outcome variables. Menopausal status was classified as pre- or postmenopausal or transitional.

RESULTS

Menopausal status was the strongest determinant of bone changes. An annual bone loss of about 0.5% was observed among premenopausal, 2% to 2.5% among transitional, and about 1.5% in postmenopausal women. Multiple regression analyses, revealed that a positive regression slope of body weight was protective for follow-up bone loss at all sites. Number of pregnancy, soy protein intake and walking were protective for total body BMC. Higher baseline LM was also protective for neck of femur BMD.

CONCLUSION

Maintenance of body weight and physical fitness were observed to have a protective effect on for bone loss in Chinese perimenopausal women.

Influenza-like illness in residential care homes: a study of the incidence, aetiological agents, natural history and health resource utilisation

BACKGROUND

Influenza-like illness (ILI) among elderly people living in residential care homes (RCHEs) is a common cause for hospitalisation. A study was undertaken to examine the incidence, underlying aetiology, natural history and associated healthcare resource utilisation related to ILI in the RCHE population.

METHODS

A prospective study of ILI in four RCHEs in Shatin, Hong Kong was conducted from April 2006 to March 2007. Each RCHE was monitored daily for the occurrence of ILI and followed up until resolution of illness or death. Clinical features were recorded and sputum, nasopharyngeal aspirate, blood and urine specimens were examined for underlying aetiology.

RESULTS

259 episodes of ILI occurred in 194 subjects, with mild peaks in winter and summer, over a sustained level throughout the year. The infectious agent was identified in 61.4% of all episodes, comprising bacterial infection in 53.3% and viral in 46.7%. Multiple infections occurred in 16.2% of subjects. The most frequent organism was Streptococcus pneumoniae, followed by respiratory syncytial virus, Pseudomonas aeruginosa, metapneumovirus and parainfluenza virus types 1 and 3. Clinical features did not vary according to the underlying aetiology, the common presenting features being a decrease in general condition, cognitive and functional deterioration, and withholding of food in addition to fever and respiratory symptoms. Overall, mortality at 1 month/discharge was 9.7%. Infection with methicillin-resistant Staphylococcus aureus, low body mass index and poor function predisposed to mortality. No association was observed between influenza vaccination status and underlying aetiology, clinical features or outcome.

CONCLUSIONS

The clinical presentation of ILI is non-specific and is mainly due to bacterial and viral infections other than influenza in the RCHE population.

Influence of dietary pattern on the development of overweight in a Chinese population

OBJECTIVE

To examine dietary factors predisposing to overweight and obesity, taking into account age, gender, education level and physical activity.

DESIGN

Longitudinal population study.

SETTING

Community living subjects in Hong Kong.

SUBJECTS

One thousand and ten Chinese subjects participating in a territory wide dietary and cardiovascular risk factor prevalence survey in 1995-1996 were followed up for 5-9 years.

MEASUREMENTS

Body mass index (BMI) was measured. Information was collected on factors predisposing to development of overweight and obesity (age, gender, education level, physical activity, macronutrient intake, Mediterranean diet score and food variety), and the predisposing dietary factors examined, adjusted for other confounding factors, using logistic regression.

RESULTS

The 5-9-year incidence of overweight is 22.6% (BMI > or =23 kg/m2, 95% confidence interval (CI)=15.0-30.1%) or 11.5% (BMI > or =25 kg/m2, 95% CI=7.3-15.7%), and for obesity (BMI >/=30 kg/m2) is 0.6% (95% CI=-0.2-1.4%). The corresponding figures for women were 14.1% (95% CI=8.8-19.5%), 9.7% (95% CI=6.0-13.4%) and 3% (95% CI=1.3-4.8%). After adjusting for confounding factors (age, sex, education and physical activity), increased variety of snack consumption was associated with increased risk of developing overweight (BMI > or =23 kg/m2) in the Hong Kong Chinese population over a 5-9-year period.

CONCLUSION

Increased variety of snack consumption may predispose to weight gain over a 5-9-year period.

Social determinants of frailty

BACKGROUND

Frailty represents a body-wide set of a linked deterioration that occurs with ageing, but is susceptible to active intervention and is reversible. The concept of frailty should include broader environmental factors. A quantitative measure of frailty, the frailty index (FI), developed for elderly Canadians and shown to be valid for an elderly Chinese population, was examined for its association with socioeconomic, lifestyle, and social support network factors in an elderly Chinese cohort.

OBJECTIVE

2,032 people aged 70 years and over recruited by stratified random sampling of the population were surveyed in 1990-1991, and information obtained regarding physical and functional health, psychological factors, lifestyle, socioeconomic and social support factors. The FI was constructed from 62 variables covering cognitive, psychological and physical health, and tested for association with socioeconomic, lifestyle and social support factors using ANOVA and t test.

RESULTS

The mean FI for women was higher than for men (0.16 +/- 0.08, n = 1,033 vs. 0.13 +/- 0.08, n = 999, p < 0.001, t test). For men, increasing frailty was observed with non-white collar occupations, inadequate expenses, no or little exercise, abstinence from alcohol, few relatives or neighbours and no or infrequent participation in helping others. For women, little contact with relatives (rather than number of relatives), and absence of participation in community/religious activities were additional factors.

CONCLUSION

FI is influenced by social and environmental factors in keeping with the concept of frailty being multi-dimensional. Such a quantitative measure may be a useful indicator of the health of elderly populations as well as for public health measures to combat frailty.

Low staffing level is associated with malnutrition in long-term residential care homes

OBJECTIVE

To determine if staffing level is associated with poor nutrition in the long-term residential care setting, adjusting for other confounding factors.

DESIGN

Cross-sectional survey.

SETTING

In total, 14 residential care facilities in Hong Kong, stratified by nature (government subvention or for-profit) to reflect the overall proportion in Hong Kong.

SUBJECTS

A total of 1914 subjects were assessed, using the Resident Assessment Instrument (RAI) 2.0. The response rate was 95% (1820 subjects), of which 1699 subjects had complete nutritional information.

INTERVENTION

Body mass index (BMI) was calculated by weighing and height measurement, and arm span was used if the subject could not stand. Subjects who were receiving parenteral or enteral nutrition via nasogastric of enterostomy tubes were excluded. A history of weight loss of 5% in the past month or 10% in the past 6 months, leaving 25% of food uneaten, and BMI < 18.5 kg/m(2) were examined as nutritional indicators. Association with age, gender, functional disability, oral problems, taste problems, presence of physical diseases and psychological well-being was examined using chi(2)-test, and multiple logistic regression.

RESULTS

In all, 26% of residents had a BMI < 18.5 kg/m(2), with a higher prevalence in the for-profit homes. History of weight loss and the record that 25% of food was left uneaten were poor indicators of low BMI. Multivariate analysis showed that having chronic obstructive airways disease, requiring help with feeding, being female, older age, were factors associated with an increased risk of poor nutrition, while being independent in activities of daily living and higher staff levels were associated with a reduced risk.

CONCLUSION

Poor nutrition is a persistent problem in the long-term care setting, and inadequate staffing levels may be a reversible cause. However, resource limitations may render efforts at improvement difficult.

SPONSORSHIP

SK Yee Memorial Fund.

The relationship between COLI A1 polymorphisms (Sp 1) and COLI A2 polymorphisms (Eco R1 and Puv II) with bone mineral density in Chinese men and women

Polymerase chain reaction was used to amplify across variable restriction sites of the COLI A1 and COLI A2 genes that encode the alpha 1 and 2 subunits of type I collagen. The relationship between these polymorphisms and bone mineral density (BMD) was studied in 683 Chinese men and women. In 100 men and women, COLI A1 Sp1 polymorphism was not found, which was consistent with other previous studies in Asian populations. However a statistically significant relationship was observed between COLI A2 Eco R1 and Puv II genotypes among the Chinese men studied. The mean BMD was consistently lower in men of the EE and PP genotype (P < 0.05 by analysis of variance [ANOVA]) than in men of the ee and pp genotypes. However, no association between BMD and the Eco R1 or Puv II genotypes was observed in Chinese women (P > 0.05 by ANOVA). We conclude that the COLI Al Sp1 binding site is absent in Hong Kong Chinese, whereas the COLI A2 Eco R1 and Puv II genetic polymorphisms may be associated with the BMD of elderly Chinese men.

The epidemiology of cigarette smoking in Hong Kong Chinese women

BACKGROUND

Smoking in women is a well-recognized public health problem. In many developed countries, cigarette smoking is now the single most important preventable cause of premature death in women. There are relatively few data on the epidemiology of cigarette smoking in Asian women, and this study examined the prevalence of and factors predisposing Chinese women to smoke cigarettes in Hong Kong.

METHOD

A territory-wide random telephone survey of 26,716 households in Hong Kong was conducted. A total of 1064 current smokers and 291 ex-smokers were identified in these household, and in-depth interviews of 791 current smokers, 221 ex-smokers, and 1012 controls were conducted.

RESULTS

The prevalence of cigarette smoking was 4.5% in women who were 25 years or younger, 2.6% in women aged 46-65 years, and 2.2% in women aged 65 years or older. Sixty-four percent of current smokers started when they were 19 years or younger. The main reasons for the initiation of cigarette smoking were the influence of friends, curiosity, feeling bored, or being idle. Current smokers and ex-smokers tended to have positive images of women who smoked. The following risk factors were found to be significant for cigarette smoking: less than university education, unemployment, being divorced, having a husband who smoked, and a low score on the perceived harms of cigarette smoking.

CONCLUSION

Cigarette smoking is more prevalent in younger women in Hong Kong; and psychosocial issues should be addressed to prevent future epidemics.

Diet and glucose tolerance in a Chinese population

BACKGROUND

Associations between dietary factors and glucose tolerance observed in Caucasian populations may not be applicable to Chinese populations, since the traditional Chinese diet contains plentiful vegetables and is rice-based (which has a lower glycemic index than potatoes). To address this question, the dietary patterns in 988 Hong Kong Chinese subjects with normal and impaired glucose tolerance, and diabetes, were examined in a cross sectional survey to determine if there is any association between diet and glucose tolerance.

METHOD

A stratified random population sample of 988 subjects (488 male, 500 female) was recruited. A food frequency questionnaire was used to determine dietary intake, and glucose tolerance was examined using the glucose tolerance test and the WHO criteria used to classify subjects into the three glucose tolerance categories.

RESULTS

Using the standardized world population of Segi, the prevalence rate for DM was 6.6% for men and 5.7% for women; and for IGT 10.3% for men and 15.4% for women aged 30-64 y. Abnormal glucose tolerance is associated with female gender, older age, lower educational attainment and higher body mass index (BMI). No clear pattern of association with dietary factors was observed after adjusting for confounding factors. However, if subjects with BMI>or=25 kg/m(2) were excluded, an increase in mean consumption of rice/noodles/pasta per week was observed in the DM group, after adjusting for total energy intake and other confounding factors. No association between dietary variety, which has been linked with body fatness, and glucose tolerance, was observed.

CONCLUSION

Dietary habit may not be a strong risk factor for the development of glucose intolerance in Chinese populations, given the favorable features of the Chinese diet. The high consumption of rice in the DM subjects who are of normal BMI suggests that further studies examining glycemic indices of Chinese food items may be beneficial. Obesity still remains the most important predisposing factor.

Is waist circumference a useful measure in predicting health outcomes in the elderly?

OBJECTIVE

To examine the effect of age on the relationship between body mass index (BMI) and waist circumference (WC), and the usefulness of BMI, WC and waist-hip ratio (WHR) in predicting mortality and cardiovascular risk in the elderly population.

DESIGN

Longitudinal observational study of 36 months duration.

SUBJECTS AND METHOD

A stratified random sample of 2,032 Chinese subjects (990 male, 1,033 female) mean age (s.d.) 80.1 (7.5), interviewed and examined at baseline and after 36 months. Deaths and presence of diabetes mellitus and hypertension were documented. A younger data set of 1,010 subjects (500 male, 510 female), mean age (s.d.) 45.5 (11.6), was used for comparison of the BMI-WC relationship between younger and older subjects. In predicting outcomes using different values of BMI, WC and WHR, receiver operating characteristic curve analysis was used to derive cut-off values with optimal sensitivity and specificity, and the likelihood ratios for mortality, diabetes and hypertension for different anthropometric values were plotted.

RESULTS

The waist circumference values corresponding to BMI values of 25 and 30 kg/m(2) were higher in elderly (92 and 103 cm for men; 88 and 99 cm for women) compared with younger subjects (85 and 97 cm for men; 78 and 88 cm for women). BMI and WC are inversely associated with mortality, in both men and women, positively associated with diabetes in men but not in women. WC was positively associated with hypertension in men and women. WHR was not associated with any outcome measures. The anthropometric measurement at the point of intersection of the likelihood curves for mortality and diabetes may be considered the optimum value, being BMI=21 kg/m(2) for men and 25 kg/m(2) for women, WC between 80 and 85 cm, and WHR 0.88-0.90.

CONCLUSION

Waist measurement values for predicting health outcomes in elderly people aged 70 y and over are different compared with younger subjects, and have similar predictive accuracy compared with body mass index. Waist-hip ratio is not a useful predictor.

A 3-year follow-up study of social, lifestyle and health predictors of cognitive impairment in a Chinese older cohort

BACKGROUND

Longitudinal data on the older population in the Asian setting are limited. This paper reports the factors associated with the development of cognitive impairment (CI) in a cohort of Chinese elderly aged > or =70 years.

METHODS

The study cohort comprising 2030 subjects aged > or =70 years was assembled in 1991-1992 and followed for 36 months. Baseline information on cognitive function, as well as a number of social and health variables were obtained through face-to-face interview at the respondent's place of residence. The outcome variable was the development of CI among 988 cohort members who were initially free from CI, and who could be contacted at the 36-month follow-up. The instrument used to assess CI was based on the information/orientation part of the Clifton Assessment Procedure for the elderly (CAPE), using a cut-off point of 7.

RESULTS

Of the men, 6.7%, but 22.2% of women had CI at 3-year follow-up. The age-adjusted annual incidence of CI was 1.52% in men, and 6.37% in women. Multivariate logistic regression analysis showed that women had a 2.5-fold increased risk of having CI, compared with men. The risk increased by about 1.5-fold with every 5-year increase in age. Slow gait time, as assessed by the 16-foot walk, was a predictor of CI in both sexes (odds ratio [OR] = 1.03 per second increase, 95% CI : 1.0-1.07). Men residing in institutions had a 4.4-fold increased risk of having CI (95% CI : 1.7-11.1) compared with those residing in community, while the OR among women was 2.5 (95% CI : 1.3-4.9). Among women, no formal education increased the risk of having CI by 3.2-fold (95% CI : 1.8-5.5). Income dependency also increased the risk of CI by about fourfold, and no exercise at baseline was associated with a twofold increased risk of CI. Incident stroke during follow-up also increased the risk of CI (OR = 8.4, 95% CI : 1.2-59.4).

CONCLUSIONS

Older age and female sex were independent factors associated with CI. No formal education, slow gait time and institutionalization increased the risk of CI in both sexes. While education had a stronger effect in women, institutionalization had a stronger effect in men. Financial dependency, lack of exercise and incident stroke played a significant role in women.

Dietary habit of smokers in a Chinese population

The objective of this study is to determine whether smokers have unhealthy dietary habits with respect to cardiovascular diseases and cancer. An age and sex stratified random sample of the Hong Kong Chinese population aged 25 to 74 years (500 men, 510 women) was recruited. A dietary assessment using a food frequency method over a 7 day period, together with a lifestyle questionnaire was administered by a trained interviewer. Approximately half the men were smokers, while only 19/510 women smoked. Smoking was related to lower education level. Male smokers had a lower mean daily consumption of fruits, lower carbohydrate and carbohydrate percentage calorie intake, higher fat and fat percentage calorie intake, and higher vitamin D intake compared with non-smokers. However, the differences were small compared with reported differences in Caucasian populations. No difference in dietary pattern was noted between female smokers and non-smokers. Although there is a tendency for male smokers to have an unhealthy dietary pattern with respect to cardiovascular disease and cancer, the differences between smokers and non-smokers are small, and together with the favourable health features of the Chinese diet, this difference is unlikely to add to the risk of these diseases in smokers or be a confounding factor in examining the aetiology of smoke-related diseases in this population.

Epidemiology of health changes in older women in Hong Kong

This paper aims to present the baseline social, mental and functional characteristics, the changes of these characteristics over a 36-month follow-up period, and the issues and implications related to these changes, particularly in older women. The cohort comprising 2030 subjects aged 70 and above has been assembled by stratified disproportional random sampling. Registrants with the Old Age Allowance Scheme, which has over 90 percent coverage of the Hong Kong elderly population, was used to define the accessible population. Face-to-face interviews were conducted at the respondents' place of residence. A number of social and health variables were collected at baseline. The surviving subjects had been followed up at 36 months and repeated measurements of the baseline variables were obtained. Older women were over-represented by low level education, financial dependency, as well as residence in institutions. Women had higher prevalence as well as incidence of musculoskeletal problems. While there was a general decline in health and social support in the elderly cohort, we observed a preponderance of older female subjects with mental and functional decline over the follow-up period. An overrepresentation of female subjects with depressive symptoms at baseline and follow-up was also noted. The descriptive data have revealed a host of social and health changes over a three-year follow-up period. Women aged 80 years and above formed a particularly disadvantaged group. The results will have direct implications for the shaping of social and health policy for strategic planning of priorities in social and health care services.

Longitudinal changes in body mass index and body composition over 3 years and relationship to health outcomes in Hong Kong Chinese age 70 and older

OBJECTIVES

To determine longitudinal changes in body mass index (BMI) and body composition with age and the relationship between these changes with mortality, morbidity, functional capacity, and other health outcome measures.

DESIGN

A 3-year longitudinal study of a random sample of community-living subjects.

SETTING

Older Chinese in the Hong Kong Special Administrative Region of China.

PARTICIPANTS

Two thousand and thirty-two Chinese subjects age 70 and older recruited territory-wide by proportional random sampling.

MEASUREMENTS

Baseline information collected included medical history, self-perceived health, Barthel Index, Geriatric Depression Score, time taken to complete a 16-foot walk, height, weight, mid-arm circumference, arm skin-fold thickness, and waist/hip ratio. Body composition was calculated from prediction equation. Outcome measures included mortality, development of new diseases, Barthel Index, time taken for 16-foot walk, self-perceived health, and Geriatric Depression Score.

RESULTS

All parameters, with the exception of triceps skin-fold thickness in men, decreased, regardless of presence or absence of disease. The decrease in arm circumference, triceps skin-fold thickness, and total body fat (TBF) was greater in women than in men, whereas men had a greater decrease in fat-free mass (FFM). Even in the absence of disease, three times as many subjects lost > or =5kg in weight as gained > or =5kg (15% vs. 5%), and only age could be identified as a contributing factor to this weight loss. In the absence of disease, lower anthropometric indices were associated with greater mortality, development of new disease (in women only), dependency, and poor performance measure. Waist-hip ratio was not associated with mortality or any other health outcomes. Decrease in both FFM and TBF were associated with worse outcomes, the effect being more marked in women.

CONCLUSION

In the older population, changes in weight and body composition occur even in the absence of disease and are associated with mortality and physical functioning level. Weight loss rather than weight gain appears to be more important in this population, and promotion of life-style interventions targeted at weight maintenance would be important.

Risk factors for hip fracture in Asian men and women: the Asian osteoporosis study

The objectives of the Asian Osteoporosis Study (AOS) were to determine risk factors for hip fracture in men and women in four Asian countries, that is, Singapore, Malaysia, Thailand, and the Philippines. A total of 451 men and 725 women (aged 50 years and over) with hip fractures were compared with an equal number of community controls. A standardized questionnaire was administered by interview. The following relative risks (RRs) were found in women and men by multiple logistic regression: dietary calcium intake < 498 mg/day, 2.0 for women (95% CI, 1.5-2.8) and 1.5 for men (95% CI, 1.0-2.2); no load bearing activity in the immediate past, 2.0 for women (95% CI, 1.4-2.7) and 3.4 for men (95% CI, 2.3-5.1); no vigorous sport activities in young adulthood, 7.2 for women (95% CI, 4.0-13.0) and 2.4 for men (95% CI, 1.6-3.6); cigarette smoking, 1.5 for men (95% CI, 1.0-2.1); alcohol consumption 7 days a week, 2.9 for women (95% CI, 1.0-8.6) and 1.9 for men (95% CI, 1.1-3.2); fell twice or more in the last 12 months, 3.0 for women (95% CI, 1.8-4.8) and 3.4 for men (95% CI, 1.8-6.6); a history of fractures after 50 years of age, 1.8 for women (95% CI, 1.1-2.9) and 3.0 for men (95% CI, 1.6-5.6); a history of stroke, 3.8 for women (95% CI, 2.0-7.1) and 3.6 for men (95% CI, 1.8-7.1); use of sedatives, 2.5 for women (95% CI, 1.0-6.3) and 3.0 for men (95% CI, 1.0-9.7); and use of thyroid drugs, 7.1 for women (95% CI, 2.0-25.9) and 11.8 for men (95% CI, 1.3-106.0). Women who were 1.56 m or taller had an RR of 2.0 (95% CI, 1.3-3.0) for hip fracture and men who were 1.69 m or taller had an RR of 1.9 (95% CI, 1.2-3.1) for hip fracture. Based on these findings, primary preventive programs for hip fracture could be planned in Asia.

Factors associated with osteoarthritis of the hip and knee in Hong Kong Chinese: obesity, joint injury, and occupational activities

In 1998, a case-control study was conducted in Hong Kong on hospital patients with osteoarthritis of the hip (n = 138) and osteoarthritis of the knee (n = 658). Age- and sex-matched controls were recruited consecutively from general practice clinics in the same region. The following three risk factors were found to be associated with osteoarthritis of both the hip and the knee: first, a history of joint injury: for osteoarthritis of the hip, the odds ratio = 25.1 (95% confidence interval (CI): 3.5, 181) in men and 43.3 (95% CI: 11.7, 161) in women; for osteoarthritis of the knee, the odds ratio = 12.1 (95% CI: 3.4, 42.5) in men and 7.6 (95% CI: 3.8, 15.2) in women; second, climbing stairs frequently: for osteoarthritis of the hip, the odds ratio = 12.5 (95% CI: 1.5, 104.3) in men and 2.3 (95% CI: 0.6, 8.1) in women; for osteoarthritis of the knee, the odds ratio = 2.5 (95% CI: 1.0, 6.4) in men and 5.1 (95% CI: 2.5, 10.2) in women; third, lifting heavy weight frequently: for osteoarthritis of the hip, the odds ratio = 3.1 (95% CI: 0.7, 14.3) in men and 2.4 (95% CI: 1.1, 5.3) in women; for osteoarthritis of the knee, the odds ratio = 5.4 (95% CI: 2.4, 12.4) in men and 2.0 (95% CI: 1.2, 3.1) in women. In addition, subjects whose height and weight were in the highest quartile were at increased risk of osteoarthritis of the hip and knee, respectively (p < 0.05).

Vegetarianism and ischemic heart disease in older Chinese women

OBJECTIVE

This study compared the risk of ischemic heart disease among older vegetarian Chinese women with that of older non-vegetarian women.

METHODS

90 vegetarian Chinese women over 70 years old in Hong Kong were screened for ischemic heart disease by electrocardiogram (ECG) and cardiovascular questionnaire. They were compared with 90 non-vegetarian women of similar age examined in a previous local survey. The effects of confounding factors were adjusted by stepwise logistic regression analysis.

RESULTS

The percentages of subjects with ischemic heart disease defined by symptoms and ECG or by ECG alone were significantly lower in vegetarian women (p <0.005 and p<0.05 respectively). Vegetarians had lower serum cholesterol levels: more were old age home residents and were less likely to perform regular exercise. On stepwise logistic regression, using probable ischemic heart disease defined by questionnaire and ECG as outcome measure, vegetarianism was the only significant predictor (OR 0.3, 95%CI 0.1-0.6, p<0.005).

CONCLUSIONS

Vegetarian older Chinese women had lower risk of ischemic heart disease when compared with non-vegetarians. Apart from lower serum cholesterol levels, vegetarianism may have other protective factors against ischemic heart disease.

The prevalence of osteoporosis in the Hong Kong Chinese female population

OBJECTIVES

This paper aims to present population-based age-related bone mass values in the Hong Kong Chinese female population, and to assess the number and proportion of Chinese women considered osteoporotic according to the WHO diagnostic guidelines.

METHODS

A total of 769 community-based female subjects were recruited. Social demographic characteristics of these subjects were similar to the Hong Kong general population. All bone mass measurements were performed by means of a dual energy X-ray densitometry (Norland XR 26) at two sites: lumbar vertebrae L2-L4 and left hip. These values were expressed as T-scores, with reference to the mean bone mineral density (BMD) values of the group aged 21-40 years.

RESULTS

The study revealed that, in women aged 60 years and above, their mean BMD values are 30% lower than the young normal mean. The prevalence of osteoporosis at the spine increased dramatically from about 10% in the age group 50-59 to 45% in the group aged 60-69. In women aged 70 onwards, over half have osteoporosis at the hip. The prevalence of osteoporosis at the spine is relatively stable in the age groups above 60, while that for osteoporosis at the hip increased exponentially with age.

CONCLUSIONS

The prevalence of osteoporosis in Hong Kong women is comparable to that found in Caucasian populations. Prevention of osteoporosis, involving both immediate and long-term measures, and targeting at different age groups, are required to combat this serious public health problem in Hong Kong.

Influence of educational level and marital status on dietary intake, obesity and other cardiovascular risk factors in a Hong Kong Chinese population

OBJECTIVES

To examine the influence of education and marital status on dietary intake, body mass index, waist hip ratio, blood pressure, fasting and 2 h glucose, and lipid profile in adult Hong Kong Chinese.

DESIGN

Randomized age and sex stratified survey.

SUBJECTS

One thousand and ten subjects aged 25-74 y (500 men, 510 women) recruited for the 1995-96 Hong Kong Dietary and Cardiovascular Risk Prevalence Survey.

MEASUREMENTS

Dietary intake was estimated using a food frequency method. Information on education level and marital status was included in the questionnaire. Anthropometry and biochemical parameters were measured using standard methods.

RESULTS

After adjustment for age, higher levels of education are associated with higher percentage protein intake in men, higher percentage fat intake in women, higher nutrient density of fibre and calcium in both men and women, and higher nutrient density of protein, fat, niacin, vitamin D, and polyunsaturated fatty acid in women. Consumption of fruits was also higher in women, and that of dairy products higher in men. Body mass index and waist-hip ratio were lower with increasing levels of education in women, while lower mean systolic BP was observed in men. Single women had lower nutrient densities of vitamin D and iron, and lower consumption of vegetables and fish, compared with married women. Body mass index was lower in both single men and women. Single men had a better cardiovascular risk factor profile, in that diastolic BP, triglycerides and cholesterol/HDL ratio were lower, in addition to a lower body mass index.

CONCLUSION

Higher education level is associated with a healthier diet and lower prevalence of overweight.

Hospital readmission among older medical patients in Hong Kong

OBJECTIVE

To study the risk factors for hospital readmission among older medical patients in Hong Kong.

DESIGN

Cohort study.

SUBJECTS

1,204 consecutive hospital medical patients aged 70 years and over in Hong Kong.

PROCEDURES

Subjects were interviewed by a research nurse on discharge, and were followed up for six months.

OUTCOME

Unplanned hospital readmissions were identified and classified as avoidable or unavoidable. The risk factors for early (within 28 days), recurrent (three or more) and avoidable readmissions were studied by multiple logistic regression.

RESULTS

Four hundred and fifty-five patients (37.7%) had at least one readmission in six months; 18%, 6.4%, and 2.9% of subjects had early, recurrent and avoidable readmissions respectively. Recent hospital stay predicted all types of readmissions. Early readmission was predicted by length of stay, Barthel index (assessment of physical and mental function) and unresolved medical problems. Recurrence readmission was predicted by poor family support, residence in a home for the elderly and unresolved medical problems.

CONCLUSIONS

Hospital readmission may be prevented by ensuring adequate length of stay, so that medical problems are resolved before discharge.

Vitamin D receptor gene polymorphisms and bone mineral density in elderly Chinese men and women in Hong Kong

Although genetic factors have been strongly implicated in determining bone mineral density (BMD), the role of the vitamin D receptor (VDR) polymorphism remains controversial. An overall consensus is difficult, as the populations studied have been heterogeneous with respect to menopausal status and ethnicity. Moreover, some studies have examined only small populations, and relatively few studies have been conducted in Asian populations. There is mounting evidence that calcium homeostasis in Asian populations differs from that in Caucasians. This difference may be mediated, in part, through VDR effects. In a cross-sectional study we have examined the relationship between the VDR polymorphism and BMD in 272 women (mean age 75 years) and 237 men (mean age 73 years) of Chinese origin from Hong Kong. Consistent with other studies in Asian populations we found higher frequencies of the T, b and a alleles compared with those reported in Caucasian populations. Moreover, no significant difference in BMD was observed when subjects were grouped by a combination of the genotypes (bbAATT, bbAaTT, bbaaTT, BbAaTt, BbAATt). These results suggest that VDR polymorphism is not associated with BMD in elderly Hong Kong Chinese men and women.

Nutritional status of elderly Chinese vegetarians

AIM

To study the nutritional status of elderly Chinese vegetarians.

SUBJECTS AND METHOD

Dietary intake (using the 24-h recall method), anthropometric indices and some nutritional laboratory parameters were studied in 131 elderly Chinese vegetarian women with a mean age of 81 years. Data from age- and sex-matched omnivore subjects from previous elderly surveys were used for comparison.

RESULTS

Total energy, fat and protein calorie, thiamine, riboflavin and niacin intakes were lower in vegetarians than in non-vegetarians, while carbohydrate calorie, calcium, potassium, retinol equivalent and ascorbic acid intakes were higher. The 25th, 50th and 75th percentile for total body fat were lower and those for corrected arm muscle area were higher in vegetarians. Both urinary Na/Cr and K/Cr ratios were higher but the Na/K ratio was similar to that in non-vegetarians, as were mean systolic and diastolic blood pressures. Serum total cholesterol was lower, while serum triglyceride concentration was similar. The mean haemoglobin level was lower in vegetarians, the prevalence of anaemia being 30%, with deficiencies in B12 and/or iron accounting for 64% of the anaemia, compared with only 30% in non-vegetarians. Serum B12 concentration below the reference range occurred in 54% of the vegetarian subjects. Vegetarians also had a lower prevalence of a history of ischaemic heart disease; however, the prevalence of smoking was also lower.

CONCLUSION

While the Chinese vegetarian diet may result in a favourable risk-factor profile for ischaemic heart disease, it is deficient in many B vitamins and gives rise to a high frequency of nutritional anaemias.

Predictors of mobility decline: the Hong Kong old-old study

BACKGROUND

Old age is often accompanied by functional decline and loss of autonomy. This longitudinal study examines the factors associated with mobility decline among a Chinese elderly cohort aged 70 years and above.

METHODS

Analyses were carried out on data collected from 1,483 elderly subjects who were functionally mobile at baseline and survived the 18-month follow-up period. The outcome variable "mobility decline" was measured using the Barthel Activities of Daily Living Scale, which accesses subjects' ability to be independent in walking a distance of 50 meters and/or moving up and downstairs during the 18-month follow-up interview.

RESULTS

Multivariate backward stepwise logistic regression analysis revealed that the following baseline characteristics were independently associated with mobility decline during the follow-up period: increasing age (OR 1.4, 95% CI 1.2-1.6 for every 5-year increase in age), no formal level of education (OR 1.9, 95% CI 1.0-3.9), no current practice of exercise (OR 2.1, 95% CI 1.4-3.1), symptoms of palpitation (OR 1.7, 95% CI 1.1-2.8), body mass index [weight (kg)/height (m)2] below 20 (OR 1.7, 95% CI 1.1-2.6), and slow gait velocity (OR 1.12, 95% CI 1.09-1.16 per second increase in gait time). There was also significant association between the experience of falls during follow-up and mobility decline (OR = 2.9, 95% CI = 1.9-4.5).

CONCLUSION

Low body weight, lack of exercise, and falls during the follow-up period might serve as markers as to which subjects are at risk for mobility decline.

Dietary practices and lipid intake in relation to plasma lipid profile in Hong Kong Chinese

OBJECTIVE

To study dietary lipid intake and plasma lipid profile of the Hong Kong Chinese population as part of a territory wide survey on cardiovascular risk factors.

DESIGN

Randomised age and sex stratified survey.

SUBJECTS

1010 subjects aged 25-74 y (500 men, 510 women).

MEASUREMENTS

A food frequency method with food tables compiled for Hong Kong was used for nutrient quantitation, while a separate questionnaire was used to examine dietary practices. Plasma lipid profile was estimated using standard laboratory methods.

RESULTS

Total calorie, fat, saturated fatty acid (SFA), poly- and mono-unsaturated fatty acid (PUFA and MUFA), and cholesterol intake were higher in men; however when adjusted for caloric intake no difference was observed. Men had lower intake of PUFA as percentage of total energy had a higher Hegsted Score compared with women. Subjects consuming beans twice or more per week had lower total cholesterol and LDL-cholesterol concentrations. Overall, the population dietary intake was close to the ideal for cardiovascular health: percentage fat not greater than 30% of the total calorie intake, saturated fat intake not greater than 10% of calories, and cholesterol less than 180 mg/1000 Kcal.

CONCLUSION

The dietary pattern for Hong Kong Chinese appear to be satisfactory with respect to cardiovascular health.

Body composition and bone mineral density of Chinese women with vertebral fracture

This study was designed to compare the body composition and bone mineral density measurements (BMD) in Chinese women with vertebral fracture and normal controls. A total of 400 community dwelling Chinese women aged 70-79 years old were studied. Vertebral height ratios were calculated from lateral thoracic and lumbar spine X-rays and subjects were classified into definite cases (n = 122), doubtful cases (n = 138) and normal controls (n = 140). Bone mineral density and body composition measurements were made by dual X-ray densitometry. The height, fat mass, lean mass, and BMD at all sites were significantly lower in patients with definite fracture than normal controls. Nevertheless, BMD at the hip was more predictive of vertebral fracture than BMD at the spine, the odds ratio in the lowest quartile of hip BMD being 3.8 (95% C.I. = 1.3 to 10.9). Finally, the extent of spinal deformity was poorly predicted by a combination of the anthropometric and BMD measurements, as only 12% of the total variance in TD1 was accounted for.

The prevalence of and risk factors for neck pain in Hong Kong Chinese

BACKGROUND

Neck pain has been found to be a prevalent musculoskeletal complaint among Caucasians living in Europe and North America. The prevalence of and risk factors for this condition have not been studied among Chinese living in urbanised cities. The objective of this study was to describe the prevalence of and risk factors for neck pain in Hong Kong Chinese.

METHODS

A household survey was conducted in two housing blocks, one being government-subvented housing and the other being private housing. Eight hundred men and women who were 30 years and older were interviewed on the occurrence and characteristics of neck pain, occupations and recreational activities. The life-time and one-year prevalence of neck pain were calculated, and the odds ratio (OR) and 95 per cent confidence intervals (95 per cent CI) for various risk factors were derived by logistic regression.

RESULTS

The one-year prevalence of neck pain was 15 per cent and 17 per cent in men and women, respectively. The OR was 1.6 (95 per cent CI = 1.2-2.4) for living in private housing and 2.1 (95 per cent CI = 1.1-4.0) for working as managers and professionals. Subjects with neck pain spent more time reading and a history of trauma to the neck was a significant risk factor for subsequent pain (OR = 5.6, 95 per cent CI = 3.3-9.4).

CONCLUSION

Neck pain is a prevalent problem in Hong Kong Chinese, particularly among subjects of a high socioeconomic status. There was little association between life-style and neck pain, although subjects with neck pain spent more time in reading.

Risk factors for falls in the Chinese elderly population

BACKGROUND

Besides being the major cause of hip fracture, falls also have important consequences in injuries and mortality, especially in the elderly population. This study investigated the occurrence of and the correlates of falls in a cohort of Hong Kong Chinese elderly aged 70 years and above.

METHODS

The research was based on the baseline cross-sectional study of an age- and sex-stratified cohort consisting of 1,947 ambulatory subjects. The occurrence of falls was based on the previous 12 months. Logistic regression analysis was used to test the effect of each independent variable, adjusting for age and sex. Multivariate logistic regression analysis based on the backward elimination procedure was used for the final model.

RESULTS

Previous white-collar employment, poor self-perceived health, dizziness, slow gait velocity, difficulties in activities of daily living, non-practice of "morning walk," body mass index in the range of 20-24, use of local skin preparation, and presence of cerebrovascular disease were independently associated with falls. Smokers were found to have an independent decreased risk of falls. Neither age nor sex was significantly associated with falls after adjusting for the other explanatory variables.

CONCLUSIONS

The results from this population-based cross-sectional study form a basis for further prospective study on falls in the Chinese elderly population. Both intrinsic and extrinsic factors including circumstances and consequences of falls are important considerations in the strategy for the prevention of falls.

Dietary calcium intake, physical activity and the risk of vertebral fracture in Chinese

To study the relationship between dietary calcium intake, load-bearing activity, reproductive factors, anthropometric factors and vertebral fracture in Chinese, a case-control study was carried out on 481 women (aged 70-79 years) who lived in three housing blocks under the Geriatric Priority Housing Scheme in Shatin, Hong Kong. Lateral spine radiographs were taken from the T4 to L4 level. Definite and doubtful vertebral fractures were diagnosed when any of the three vertebral height (anterior to anterior, middle to posterior and posterior to posterior) ratios was 3 SD and 2-2.99 SD below the mean respectively. Women with one or more definite fractures were classified as definite cases, those with one or more doubtful fractures were classified as doubtful cases, and the rest as controls. The mean dietary calcium intake and load-bearing activities were obtained by interview, using a structured questionnaire. Detailed information on cigarette smoking, alcohol consumption and reproductive factors was also obtained. The grip strength, body weight and height were measured. Doubtful cases were found to differ little from the controls in their lifestyle and anthropometric factors. The odds ratio (OR) for being a definite case was 2.1 (95% CI = 1.1-3.9) when the dietary calcium intake was in the lowest quartile. The OR was 1.8 (95% CI = 0.8-4.4) for subjects who walked or exercised outdoors for less than an hour a day. Giving birth to or breast-feeding three children or more was protective against definite fracture. The definite cases were significantly lighter and shorter than controls; they also had a weaker grip strength. It is concluded that a low dietary calcium intake was significantly associated with an elevated risk of vertebral fracture, while the effect of infrequent load-bearing activity was uncertain. Giving birth to or breast-feeding three or more children was protective against vertebral fracture in our population.

Tuberculosis among elderly Chinese in residential homes: tuberculin reactivity and estimated prevalence

Objectives of this study were to determine the prevalence of positive tuberculin reactivity and associated factors among elderly nursing home residents in a population with a relatively high tuberculosis notification rate, to estimate the prevalence of active tuberculosis, and to assess tuberculin reactivity as a screening tool. A stratified, disproportional, randomized cluster sample of residents was selected and the Mantoux test (using 0.1 ml of 5 tuberculin units of purified protein derivative of tuberculin) carried out. All subjects with a positive test had a chest X-ray followed by sputum smear and culture if the X-ray was abnormal. Sputum examination was also carried out in a random sample of controls, matched for age and gender, drawn from subjects with a negative Mantoux test. Information regarding medical history, tobacco smoking habits, symptoms related to tuberculosis, and communal eating habits were gathered. Also anthropometric data were collected. Sixteen nursing homes in the catchment area of a major district hospital in Hong Kong comprising 587 residents (136 men, 451 women, mean age 80 +/- 8 years) participated in this study. The weighted prevalence of tuberculin reactivity was 43.8%. It was higher in men, among those who took their meals in a common area, in the younger age group, and in those with no previous history of hospitalization. No association was found between prevalence and duration of residence, smoking, skinfold thickness, past medical history, or any relevant symptoms. Following radiological and sputum examination, the estimated prevalence of active tuberculosis ranged from 1.2 to 2.6%. The sensitivity of the tuberculin test was 86, the specificity 30%. The prevalence of active tuberculosis in nursing homes in Hong Kong is high, but it is unclear whether cross-infection or poor health of the residents is the major contributing factor. Tuberculin skin testing does not appear to be a useful screening method in this population.

Influence of age, disease and disability on anthropometric indices in elderly Chinese aged 70 years and above

To determine the influence of age, disease and other factors on anthropometric indices in elderly subjects aged 70 years and above, body mass index (BMI), arm muscle circumference (AMC), corrected arm muscle area (CAMA), fat-free mass (FFM) and total body fat (TBF) were determined in a random sample of 990 Chinese men and 1,021 women aged 70 years and over stratified by age and sex. Old age, presence of disease, poor self-perceived health, poor functional ability, lower level of physical activity, lack of dentures, depression and cognitive impairment were all factors associated with lower anthropometric values. Haemoglobin, total cholesterol and walking speed were also associated factors, although the latter two factors became insignificant after adjusting for age. When subjects with a history of disease or cognitive impairment were excluded, an age-related decline in BMI, AMC, CAMA and TBF was still observed in men although FFM remained unchanged. However, in women, only TBF showed an age-related decline. It is concluded that in the old-old population, both age and disease affect anthropometric indices, the change being more marked in men.

Risk factor change in older persons, a perspective from Hong Kong: weight change and mortality

BACKGROUND

The influence of anthropometric measurements on mortality and longevity has been of interest to a number of investigators. However, although such measurements are not stable over time, few studies have attempted to account for such changes in longitudinal studies. The present study attempts to examine the relationship between weight change and mortality outcome.

METHODS

The research was based on a longitudinal study of a cohort of 1,056 Hong Kong Chinese men and women aged 70 and above. Among the 476 nonsmoking women at baseline, 374 with weight measurements both at baseline and at 24 months follow-up were included in the study. Proportional hazards analysis with adjustments for age and other physical and social factors was used to estimate the relative risk of mortality of the higher body mass index groups in relation to the lowest body mass index group and between the weight change groups.

RESULTS

Women belonging to the middle tertile of body mass index distribution had the lowest mortality. Those with a weight loss of more than 2 kg over the first 24 months follow-up had five times the risk of mortality at 40 months, even after adjusting for health and social conditions and baseline body mass index.

CONCLUSION

The results suggest that both the initial body weight and weight change during the follow-up period are important considerations in the study of the association between body weight and mortality.

Lipid profile in the Chinese old-old: comparison with younger age groups and relationship with some cardiovascular risk factors and presence of diseases

In a health survey of 2,032 elderly Hong Kong Chinese aged 70 years and over selected by stratified random sampling, a subset of 199 subjects (96 M, 103 F) were selected for a study of their lipid profile. No age and sex differences were observed in mean total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride concentrations in this subgroup. Compared with values from younger Chinese subjects from a previous survey, TC and LDL-C showed an age-related rise up till about 60 years, followed by a gradual decline. HDL-C concentrations showed little variation with age. Nonagenarians had a LDL/HDL ratio similar to subjects in the < 24 age group and lower than male subjects in the age 35-64 age group. HDL-C was lower in those with heart disease or hypertension. Other lipid parameters were not influenced by the presence of other chronic diseases, self-perceived health status, or cognitive impairment. TC was positively associated with the Barthel Index, a measure of functional ability. Positive associations between obesity indices and diastolic blood pressure, and TC, LDL-C, and triglycerides were present.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood pressure and 40 month mortality in elderly Chinese subjects aged 70 years and over

The association between blood pressure and 4 year mortality was examined in a cohort of 970 Chinese subjects aged 70 years and above. After adjusting for age, sex, body mass index, smoking habit, place of residence, and the presence of heart or chronic lung diseases, a U-shaped association between blood pressure and mortality was observed, the risks of mortality among subjects in the extreme quartiles being twice as high as those in the middle quartiles. Subjects with the lowest systolic blood pressure quartile also had a higher risk of developing functional limitations.

Open pelvic fractures

We reviewed 32 patients with open pelvic fractures treated over a 5-year period. Eleven patients had isolated fractures of the ilium and in 21 patients pelvic ring disruption was associated with a perineal laceration. Three patients died from massive haemorrhage soon after admission and one patient from severe sepsis. Early pelvic stabilization and meticulous attention to the soft tissue injury proved invaluable in the management of open unstable pelvic fractures.

Psychosomatic symptoms, social support and self worth among the elderly in Hong Kong

A prospective study to test the relationship between social support and health outcomes among the 1000 elderly Chinese subjects aged 70+ is being carried out in a Hong Kong New Town. This paper reports on the study factors related to psychosomatic complaints based on the first phase cross sectional data. Logistic regression analysis shows that being female, living in institutions, having a low level of social support and a low level of self worth independently increased the risk of developing a high level of psychosomatic symptoms. The relative risks for these factors range from 1.4 to 1.9 and all were significantly different from unity.