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Little is known about the use of psychotherapy to treat common mental disorders in a major city in a middle-income country. Our data come from in-home interviews with a stratified random sample of 2000 community residents aged 18 to 65 years in the city of São Paulo, Brazil. The information obtained included sociodemographic characteristics; psychotropic drugs; mental status; and lifetime, previous 12 months, and current use of psychotherapy. Logistic regression was used to examine determinants of use of psychotherapy. Of the sample, 22.7 met General Health Questionnaire–12 criteria for common mental disorders. Lifetime, previous 12 months, and current use of psychotherapy were reported by 14.6, 4.6, and 2.3 of the sample, respectively. Users typically were women, were more educated, had higher income, were not married, were unemployed, and had common mental disorders. Further analysis found that 47 (with higher education and income) paid out-of-pocket, and 53 used psychotropic medication. Psychotherapy does not seem to be the preferred treatment of common mental disorders.

The objective of this study was to examine the prevalence and characteristics of adult psychotropic medication use in São Paulo, Brazil. Information on lifetime and 12-month psychotropic medication use, and psychiatric status was obtained from a representative sample of 2000 adults aged 18–65 years in São Paulo, Brazil. Lifetime and 12-month use of psychotropic medications was 16.8 and 7.1, respectively. Of the 22.8 of patients with current psychiatric problems, 29.5 reported lifetime use and 15.8 (5.6 of the sample) reported 12-month use (anxiolytics: 2.7, antidepressants: 1.8, alternative medicines: 0.9, antipsychotics: 0.4, mood stabilizers: 0.4, hypnotics: 0.3; multiple class use occurred). The most frequent prescribers were psychiatrists and general practitioners. Determinants of use included identification as a psychiatric case (four-fold increased odds), being female (three-fold increase), age (4–5 per additional year), and lower odds if married. Education, employment status, and birth in São Paulo were not associated with use. Income did not affect anxiolytic use, but antidepressant and alternative medicine use was associated with higher income. These results show that psychotropic drug use was comparatively low. Only 15.8 of patients with psychiatric problems reported recent psychotropic use. Comparable with other studies, use was greater among women and increased with age.

To determine whether, as mandated by Brazilian law, health care (outpatient care, hospitalization) among older community residents is based on health-related criteria and not on other characteristics.

BACKGROUND Since increased oxidative stress may impair cognition and be a risk factor for dementia, there has been interest in determining whether use of antioxidants could protect against such events.OBJECTIVE To determine whether supplement use of vitamins C and/or E in a community-based sample of older African American and white individuals delayed incident dementia or Alzheimer's disease (AD).METHODS We selected a subgroup from the Duke Established Populations for Epidemiologic Studies of the Elderly, a longitudinal study of community-representative persons aged 65–105 years living in 5 adjacent counties in North Carolina, and followed them for dementia (1986–1987 through June 2000). Information gathered during in-home interviews included sociodemographic characteristics, health status, health service use, and vitamin use. Diagnosis of dementia and AD was based on evaluations using the clinical and neuropsychological batteries of the Consortium to Establish a Registry for Alzheimer's Disease, with final determination by consensus agreement of specialists using Diagnostic and Statistical Manual of Mental Disorders, third revision, and National Institute for Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders criteria.RESULTS Of 616 persons initially dementia-free (mean age 73 y; 62% female; 62% African American), 141 developed dementia, of whom 93 developed AD. Increased age and mobility problems were risk factors for dementia (only age for AD), while an increased number of outpatient visits reduced the likelihood of developing dementia. Neither use of any vitamins C and/or E (used by 8% of subjects at baseline) nor high-dose use reduced the time to dementia or AD.CONCLUSIONS In this community in the southeastern US where vitamin supplement use is low, use of vitamins C and/or E did not delay the incidence of dementia or AD.

Norms for cognitive measures used to assess dementia are scant for minority groups, in particular for older Japanese Americans. Using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychology Battery, we compared the baseline performance of demented and nondemented Japanese Americans. Participants came from two harmonized epidemiological studies of dementia which were examined separately: the Kame Project, Seattle (350 men and women; 201 nondemented), age 65 and older; Honolulu-Asia Aging Study (HAAS), Hawaii (418 men; 120 nondemented), age 71 and older. The measures examined were Verbal Fluency; abbreviated Boston Naming; constructional praxis; and Word List Learning, Recall, and Recognition. Within each study, the CERAD measures distinguished between nondemented participants and those with mild cognitive impairment. Among persons with dementia, average level of performance decreased as severity of dementia increased. Determinants of score (age, education, language of administration, stage of dementia) varied between the two studies. Among Japanese Americans, the CERAD Neuropsychology Battery distinguished nondemented persons from those with dementia, but was less consistent in distinguishing levels of severity of dementia. This battery is useful for comparative epidemiological studies of dementia in minority populations. (JINS, 2005, 11, 192–201.)

We have tried, with only partial success, to confirm findings in a recently reported study in this journal on the relationship of APOE genotype to mortality in community representative Hispanics (n = 659), Whites (n = 272), and African-Americans (n = 450), aged 65 and over, living in Northern Manhattan, New York. That study found that using proportional hazards models adjusted for sex and lipid levels, Hispanics and Whites with the E2/E3 genotype, but not African-Americans, had the lowest mortality risk. Those under age 75 had risks comparable to those over age 75, suggesting minimal survivor bias. Nearly 50% of the mortality risk associated with the APOE genotype appeared to act through heart disease, diabetes, and stroke. The current study of African-Americans (n = 1,083) and Whites (n = 915) aged 71 and over living in the more rural Southeastern US, found no protective effect of the E2/E3 genotype for either African-Americans or Whites. Among younger Whites (age 71–75), point estimates suggested that the E2/E3 genotype might be protective, but at a nonsignificant level; self-reported African-American race, but not genotype, was a risk factor for mortality in this age group. Neither lipid level nor health condition attenuated the effect of APOE genotype. Differences in findings may reflect issues of sampling, age, the relative distribution of the APOE alleles, or some other factor. Until such time as studies use truly representative samples and include younger ages, findings in this area must be treated with caution. © 2003 Wiley-Liss, Inc.

The predictive validity of Drug Utilization Review DUR and drugstoavoid criteria in elders is unknown.

This study examined inappropriate drug use defined by updated criteria among respondents in the second and third in‐person waves of the Duke Established Populations for Epidemiologic Studies of the Elderly. Information about sociodemographics, health status, access to health care, and drug use was determined by in‐home interviews. Drug use was coded for therapeutic class and appropriateness by applying explicit criteria. Among participants, 27% of the second and 22.5% of the third in‐person wave took one or more inappropriate agents. Of these drugs, the most common therapeutic classes were central nervous system and cardiovascular. Longitudinal multivariate analyses found that persons taking several prescription drugs, those having continuity of care, those who previously took inappropriate drugs, and those with many health visits were most likely (p<0.05) to use inappropriate drugs. We conclude that inappropriate drug use is common among community‐dwelling elderly.

Objective: To evaluate the relation between benzodiazepine use and cognitive function among community-dwelling elderly.Methods: This prospective cohort study included 2765 self-reporting subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly. The subjects were cognitively intact at baseline (1986–1987) and alive at follow-up data collection 3 years later. Cognitive function was assessed with the Short Portable Mental Status Questionnaire (unimpaired versus impaired and change in score) and on the basis of the number of errors on the individual domains of the Orientation-Memory-Concentration Test. Benzodiazepine use was determined during in-home interviews and classified by dose, half-life, and duration. Covariates included demographic characteristics, health status, and health behaviors.Results: After control for covariates, current users of benzodiazepine made more errors on the memory test (beta coefficient, 0.35; 95% confidence interval [CI], 0.10 to 0.61) than nonusers. Further assessment of the negative effects on memory among current users suggested a dose response in which users taking the recommended or higher dose made more errors (beta coefficient, 0.57; 95% CI, 0.26 to 0.88) and a duration response in which long-term users made more errors (beta coefficient, 0.39; 95% CI, 0.05 to 0.73) than nonusers. Users of agents with long half-lives and users of agents with short half-lives both had increased memory impairment (beta coefficient, 0.32; 95% CI, 0.01 to 0.64 and beta coefficient, 0.38; 95% CI, 0.02 to 0.75, respectively) relative to nonusers. Previous benzodiazepine use was unrelated to memory problems, and current and previous benzodiazepine use was unrelated to level of cognitive functioning as measured with the other 4 tests.Conclusions: The results suggested that current benzodiazepine use, especially in recommended or higher doses, is associated with worse memory among community-dwelling elderly.

OBJECTIVE: To determine the equivalence of two screens of cognitive functioning: the Short Portable Mental Status Questionnaire (SPMSQ) and the Orientation‐Memory‐Concentration (OMC) test.

OBJECTIVE: To describe and compare drug-use patterns among black and nonblack community-dwelling elderly.DESIGN: Survey.SETTING: Five-county urban and rural region in Piedmont, NC.PARTICIPANTS: Stratified probability household sample of 4164 community residents aged 65 or older from the Piedmont Health Survey of the Elderly (65 percent women, 54 percent black, mean age 73.56 ± 6.74 y).MAIN OUTCOME MEASURES: Prevalence of medication use and mean drug use; therapeutic medication category use.RESULTS: Data were weighted to represent the population in this geographic area. Fewer blacks reported the use of over-the-counter (OTC) medications and total medications than did nonblacks (66 vs. 76 percent and 88 vs. 92 percent, respectively; p<0.001). Compared with nonblacks, blacks reported using a lower mean number of prescription (2.02 vs. 2.35; p<0.001), OTC (1.12 vs. 1.42; p<0.001), and total (3.14 vs. 3.77; p<0.001) drugs. The therapeutic medication categories varied by race for prescription cardiovascular, analgesic, and central nervous system (CNS) drugs and OTC nutritional supplements. More nonblacks than blacks reported the use of analgesics (62.5 vs. 55.6 percent, respectively; p<0.001), CNS drugs (26.1 vs. 14.2 percent, respectively; p<0.001), nutritional supplements (27.5 vs. 16.9 percent, respectively; p<0.001), and gastrointestinal agents (29.0 vs. 23.5 percent, respectively; p<0.001). Blacks were more likely to report problems in managing their medications than were nonblacks (9.0 vs. 6.1 percent, respectively; p=0.001).CONCLUSIONS: Our data suggest that there are distinct racial differences in medication-use patterns among the elderly.

OBJECTIVE: To identify minimal sets of Mini-Mental State Examination (MMSE) items that can distinguish normal control subjects from patients with mild Alzheimer's disease (AD), patients with mild from those with moderate AD, and those with moderate from those with severe AD. DESIGN: Two randomly selected equivalent half samples. Results of logistic regression analysis from data from the first half of the sample were confirmed by receiver operating characteristic curves on the second half. SETTING: Memory disorders clinics at major medical centers in the United States affiliated with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). PARTICIPANTS: White, normal control subjects (n=412) and patients with AD (n=621) who met CERAD criteria; nonwhite subjects (n=165) and persons with missing data (n=27) were excluded. MAIN OUTCOME MEASURES: Three four-item sets of MMSE items that discriminate, respectively, (1) normal controls from patients with mild AD, (2) patients with mild from those with moderate AD, and (3) patients with moderate from those with severe AD. RESULTS: The MMSE items discriminating normal controls from patients with mild AD were day, date, recall of apple, and recall of penny; those discriminating patients with mild from those with moderate AD were month, city, spelling world backward, and county; and those discriminating patients with moderate from those with severe AD were floor of building, repeating the word table, naming watch, and folding paper in half. Performance on the first two four-item sets was comparable with that of the full MMSE; the third set distinguished patients with moderate from those with severe AD better than chance. CONCLUSIONS: A minimum set of MMSE items can effectively discriminate normal controls from patients with mild AD and between successive levels of severity of AD. Data apply only to white patients with AD. Performance in minorities, more heterogeneous groups, or normal subjects with questionable cognitive status has not been assessed.

Objective:To determine if there is a relationship between body mass index and the ability to perform the usual activities of living in a sample of community‐dwelling elderly.

Information obtained from a highly selected group of healthy, financially secure male university faculty retirees indicates that nearly all work for pay after retiring. Continued working does not seem to be contingent upon the ready availability of jobs, but is related to a personal dislike of retirement, intending to work after that event, active pre-retirement involvement in work, and the presence of younger friends who are working. We have suggested that work after retirement can be conceptualized as due to a mutually reinforcing interaction among the variables examined.

• The Mini-Mental State Examination (MMSE) and the Blessed Orientaion-Memory-Concentration test (BOMC), a sixitem derivative of the Blessed Information-Memory-Concentration Test, were each administered to 36 patients with a clinical diagnosis of Alzheimer's disease. In 24 patients, both tests were readministered a month later. The correlation between the MMSE and BOMC was -0.83 with a test-retest correlation of 0.89 (MMSE) and 0.77 (BOMC). Factor analysis indicated that the multiple MMSE cognitive components could be explained by two factors, which together accounted for 66% of the variance. These factors are conceptually similar to the components of the BOMC, and so may explain the substantial correlation between the two tests. Since these cognitive status tests seem to be equivalent for Alzheimer patients, the briefer measure (BOMC), which offers additional advantages, may be preferred.

Although multidimensional functional assessment may be the route of choice in determining the personal status of the elderly and the services they need, the majority of the elderly are well and competent, making it hard to justify routine extensive assessment with its attendant costs. Described herein is a brief, valid, and reliable five‐item screener based on instrumental activities of daily living which can rapidly identify elderly community residents with impaired functional capacity, and which, because of its substantial correlation with physical health (r= .54 to .55), mental health (r= .54 to .60), and predictability of death can identify those for whom more extensive assessment is warranted. Use of such a brief screener should result in better targeting of elderly in need of service, facilitate coordinated and efficient health care delivery, and maintain the functional independence of the elderly.

The Older Americans Resources and Services (OARS) methodology was designed to assess functional capacity in five dimensions (social resources, economic resources, mental health, physical health, and activities of daily living) and to measure use of and need for 24 types of generic services. The OARS questionnaire now has been used in more than 150 research and practice settings. Recent refinements in the OARS methodology include new information about validity and reliability, computerized summary ratings for the five dimensions of functional status, and eleven scales that measure specific aspects of functioning within the five dimensions. This paper describes the conceptual foundation, appropriate uses, psychometric properties, and recent refinements in the OARS methodology. Empirical data from a geriatric clinic population are used for purposes of illustration. The paper presents an assessment of the strengths and limitations of the OARS methodology based on more than a decade of experience. Particular attention is paid to the degree to which the measures of functional status can be related to health service use measures to inform geriatric research and practice.

Follow-up information from three groups of older persons (community residents, clinic clients, the institutionalized) confirms and extends data presented by Youmans and Yarrow [1] indicating that increasing interdependence among different areas of functioning increases with age, possibly resulting in increased vulnerability in time of loss. Some implications of these findings were indicated.

OBJECTIVE: To examine patterns and factors associated with overall and suboptimal analgesic use among community-dwelling elderly.DESIGN: Cross-sectional survey.SETTING: Five-county urban and rural region in Piedmont, NC.PARTICIPANTS: A stratified random sample from the Duke Established Populations for Epidemiologic Studies of the Elderly of 3973 participants aged 65 years or older.MAIN OUTCOME MEASURES: Use of any analgesic medication, suboptimal analgesic use (taking 2 or more analgesics from the same class, using 3 or more analgesics concurrently, or use of an analgesic that has a major interaction with another drug).RESULTS: Analgesics were used by 60.4% of the participants. Use was more likely for those who had physical functional impairment, a history of cardiovascular disease, one or more health visits in the previous year, or were female. Use was less likely for older participants and for African-Americans with adequate financial status. Suboptimal use occurred for 9.2% of analgesic users. Therapeutic duplication was more likely in those who were depressed, needed help with basic activities of daily living, or used alcohol, and was less likely in those with adequate financial status. Multiple analgesic use was more likely in those who were depressed, had impaired physical functional status, had one or more health visits in the previous year, were African-American (of either sex), or were white women. Only two persons had a potential major analgesic-drug interaction.CONCLUSIONS: Suboptimal analgesic use is common in community-dwelling elderly, and its risk is consistently increased in those who are depressed or have impaired functional status.

A rapid means of validly assessing the presence or absence of organic brain impairment among the elderly is valuable for clinicians whose practice includes geriatric patients. Two such measures are the Mental Status Questionnaire (MSQ) and the Short Portable Mental Status Questionnaire (SPMSQ). The similarity of content of these two 10‐item questionnaires has led to the suggestion that their capacity to identify organic impairment may be similar. The question was examined in this study. Data were obtained on 83 elderly community residents on whom the validity of the SPMSQ had been tested. In 29 the diagnosis was organic brain syndrome (OBS), and the other 54 were classified as non‐OBS. After making minor changes in the scoring of the SPMSQ to improve discriminability (omissions were scored as errors), the MSQ and the SPMSQ were found to be equivalent in discriminating power. Both questionnaires accurately identified almost all (96 percent) of the non‐OBS subjects but missed nearly half of the subjects with a diagnosis of OBS. Item analysis indicated that two items in the MSQ and three items in the SPMSQ could explain nearly as much variance as did the total set of items. Thus the capacities of these two scales to identify the presence of diagnosed OBS among elderly community residents appeared to be equivalent. If test brevity is desired, the questionnaires could be made still shorter, with little loss of effectiveness.

Objective:The objective of this study was to assess the relationship of disability (activities of daily living [ADL] and instrumental ADL [IADL]), self-rated health (SRH), and 6-year mortality with co-existing impairments in vision (self-rated), hearing (self-rated), and/or cognition (Short Portable Mental Status Questionnaire) in older adults. Method:The study sample comprised of 3,871 participants from the North Carolina Established Populations for Epidemiologic Studies of the Elderly study (NC EPESE). Results:Persons with all three impairments had increased odds of ADL/IADL disability and low SRH. Participants with combined visual and cognitive impairments had increased odds of mortality. Whereas sensory impairments were associated with poor SRH, cognitive impairment was not unless both sensory impairments were present. Conclusion:Co-existent sensory and cognitive impairments were associated with higher risk of impaired functional status. Self-rated auditory impairment alone was not associated with higher odds of death, but mortality was linked to visual and, particularly, cognitive impairment, alone or combined.

The Social Security Administrations Longitudinal Retirement History Study, which is designed to study the process and impact of retirement in the U.S., is described briefly. Particular attention is paid to the sample, the information obtained and its reliability and validity, the usability of the data, and to drawbacks inherent in the limited time span allocated to data gathering. This paper is intended to acquaint those interested in retirement and the life cycle with this major data set, and facilitate its use.

Responses of a randomly selected group of employees who were questioned about their attitudes concerning a proposed retirement planning program indicated that while there was almost universal agreement that such a program was desirable and age 45 an appropriate one at which to start, attendance would differ markedly with occupational status. Regardless of age, upper occupational status persons showed no interest, older (i.e., over age 44) middle-occupational status persons are more interested than are younger, but lower occupational status employees of all ages said they would attend such a program. The latter being the case, it was suggested that a retirement planning program which was also concerned with improving the present situation might be more beneficial than one which concentrated on post-retirement life.

In trying to determine why, when there is no financial need, some men are more likely to work after retirement than are others, six areas are considered: personal background, sociological factors, the perceived place of work, cognitive and physiological capabilities, attitude to work and retirement, and personality factors. While factors in any one of these areas may influence retirement work, because older persons must have proven capability at work and also because ability is related to doing good work, those who work after retirement will probably be among the more capable workers, have high interest and involvement in work and work-related activities, little interest in other matters, and have a stronger attraction to work than to retirement. Other matters will only be relevant insofar as they affect the individuals ability to work well.