Search

Objectives To determine the association between objectively measured sleep and subsequent placement in a nursing home or a personal care home. Design Prospective cohort. Setting Participants' homes and sites of the Study of Osteoporotic Fractures. Participants One thousand six hundred sixty-four community-dwelling women with a mean age of 83 ± 4. Measurements At baseline, participants completed an average of 4 nights of wrist actigraphy; they provided data on place of residence at baseline and at follow-up, 5 years later. Results At baseline, participants had a mean total sleep time of 408 ± 72 minutes, mean wake after sleep onset of 71 ± 43 minutes, and mean sleep efficiency of 79 ± 11%. At follow-up, 71 (4%) were residing in a nursing home, and 127 (8%) were in a personal care home. Women with the most wake after sleep onset (by quartile) had more than twice the odds as those with the least of placement in a nursing home (adjusted odds ratio ( AOR) = 2.94, 95% confidence interval ( CI) = 1.34-6.44) or a personal care home ( AOR = 2.33, 95% CI = 1.26-4.30). Similarly, women with the lowest sleep efficiency had more than three times the odds as those with the highest of nursing home placement ( AOR = 3.25, 95% CI = 1.35, 7.82) and more than twice the odds of placement in a personal care home ( AOR = 2.38, 95% CI = 1.33, 4.24). There was no association between sleep duration and placement. Conclusion In very old community-dwelling women, greater wake after sleep onset and lower sleep efficiency are risk factors for placement in a nursing home or personal care home. Sleep duration alone does not appear to increase the risk of placement in these long-term care settings. [ABSTRACT FROM AUTHOR]

Objectives To examine the relationship between fruit and vegetable intake, physical activity, and all-cause mortality in older women. Design Six Cox proportional hazards models examined independent and additive relationships between physical activity, carotenoids, and all-cause mortality. Additional models tested whether physical activity and carotenoids were conjointly related to mortality. Models were adjusted for age, education, and race and ethnicity. Setting Baltimore, Maryland. Participants Seven hundred thirteen women aged 70 to 79 participating in the Women's Health and Aging Studies. Measurements Total serum carotenoids, a marker of fruit and vegetable intake, and physical activity were measured at baseline. Physical activity was measured according to kilocalorie expenditure. Results During 5 years of follow-up, 82 (11.5%) participants died. Measured continuously, physical activity improved survival ( HR = 0.52, 95% CI = 0.41-0.66, P < .001). The most active women were more likely to survive than the least physically active women ( HR = 0.28, 95% CI = 0.13-0.59, P < .001). Continuous measures of carotenoids improved survival ( HR = 0.67, 95% CI = 0.51-0.89, P = .01). Women in the highest tertile of total carotenoids were more likely to survive those in the lowest ( HR = 0.50, 95% CI = 0.27-0.91, P = .03). When examined in the same model, continuous measures of physical activity ( HR = 0.54, 95% CI = 0.42-0.68, P < .001) and carotenoids ( HR = 0.76, 95% CI = 0.59-0.98, P = .04) predicted survival during follow-up. Conclusion The combination of low total serum carotenoids and low physical activity, both modifiable risk factors, strongly predicted earlier mortality. These findings provide preliminary support that higher fruit and vegetable intake and exercise improve survival. [ABSTRACT FROM AUTHOR]

Objectives To examine the relationship between depressive symptoms and subjective and objective sleep in older women. Design Cross-sectional. Setting Four U. S. clinical centers. Participants Three thousand forty-five community-dwelling women aged 70 and older. Measurements Depressive symptoms were assessed using the Geriatric Depression Scale, categorizing participants as normal (0-2, reference), some depressive symptoms (3-5), or depressed (≥6). Subjective sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index ( PSQI) and Epworth Sleepiness Scale ( ESS). Objective sleep measures were assessed using wrist actigraphy. Results In multivariable-adjusted models, there were graded associations between greater level of depressive symptoms and worse subjective sleep quality and more subjective daytime sleepiness ( P-trends < .001). Women with some depressive symptoms (odds ratio ( OR) = 1.82, 95% confidence interval ( CI) = 1.48-2.24) and depressed ( OR = 2.84, 95% CI = 2.08-3.86) women had greater odds of reporting poor sleep ( PSQI>5). Women with some depressive symptoms ( OR = 1.97, 95% CI = 1.47-2.64) and depressed women ( OR = 1.70, 95% CI = 1.12-2.58) had greater odds of reporting excessive daytime sleepiness ( ESS>10). There were also graded associations between greater level of depressive symptoms and objectively measured wake after sleep onset ( WASO) ( P-trend = .03) and wake episodes longer than 5 minutes ( P-trend = .006). Depressed women had modestly higher odds of WASO of 1 hour or longer ( OR = 1.37, 95% CI = 1.03-1.83). Women with some depressive symptoms ( OR = 1.49, 95% CI = 1.19-1.86) and depressed women ( OR = 2.04, 95% CI = 1.52-2.74) had greater odds of being in the highest quartile for number of nap episodes longer than 5 minutes. No associations between depressive symptom level and prolonged sleep latency, poor sleep efficiency, or short or long total sleep time were found. Conclusion Greater depressive symptom levels were associated with more subjective sleep disturbance and objective evidence of sleep fragmentation and napping. [ABSTRACT FROM AUTHOR]

Objectives To determine effect size and acceptability of a multicomponent behavior and home repair intervention for low-income disabled older adults. Design Prospective randomized controlled pilot trial. Setting Participants' homes. Participants Forty low-income older adults with difficulties in one or more activities of daily living ( ADLs) or two or more instrumental activities of daily living ( IADLs). Intervention The Community Aging in Place, Advancing Better Living for Elders ( CAPABLE), coordinated occupational therapy, nursing, and handyman visits, was compared with attention-control visits. The intervention consisted of up to six visits with an occupational therapist, up to four visits with a nurse, and an average of $1,300 in handyman repairs and modifications. Each intervention participant received all components of the intervention clinically individualized to risk profile and goals. Each attention-control participant received the same number of visits as the intervention participants, involving sedentary activities of their choice. Measurement Primary outcome: difficulty in performing ADLs and IADLs. Secondary outcomes: health-related quality of life and falls efficacy. Results Thirty-five of 40 adults (87%) completed the 6-month trial, and 93% and 100% of the control and intervention group, respectively, stated that the study benefited them. The intervention group improved on all outcomes. When comparing mean change in the intervention group with mean change in the control group from baseline to follow-up, the CAPABLE intervention had effect sizes of 0.63 for reducing difficulty in ADLs, 0.62 for reducing difficulty in IADLs, 0.89 for quality of life, and 0.55 for falls efficacy. Conclusion The CAPABLE intervention was acceptable to participants and feasible to provide and showed promising results, suggesting that this multicomponent intervention to reduce disability should be evaluated in a larger trial. [ABSTRACT FROM AUTHOR]

Objectives To determine whether interleukin ( IL)-6 or soluble tumor necrosis factor alpha receptor 1 ( sTNF-α R1) is associated with depressive symptoms in the year after hip fracture. Design Prospective cohort. Setting Three Baltimore-area hospitals. Participants Community-dwelling women aged 65 and older admitted with a new, nonpathological fracture of the proximal femur (N = 134). Measurements Two, 6, and 12 months after fracture, serum was analyzed for IL-6 and sTNF-αR1, and depressive symptoms were measured using the 15-item Geriatric Depression Scale ( GDS). Generalized estimating equations were used to model the longitudinal relationship between IL-6, sTNF-α R1, and GDS score. Whether lower extremity function, as measured according to the Lower Extremity Gain Scale ( LEGS), explained the relationship between IL-6, sTNF-α R1, and GDS score was also examined. Results Participants in the highest categories of IL-6 (≥5.14 pg/mL) and sTNF-α R1 (≥2,421 pg/mL) had the highest GDS scores in the year after fracture ( P = .09 for both). Twelve months after fracture, those in the highest IL-6 and sTNF-α R1 categories had GDS scores that were on average 1.9 (95% confidence interval ( CI) = 0.4-3.4, P = .01) and 1.4 (95% CI = −0.1-3.0, P = .07) points higher than those in the lowest category, respectively. Adjusting for LEGS score, the mean difference in GDS scores for highest versus lowest IL-6 categories was 1.6 (95% CI = 0.2-3.0, P = .02) points at 12 months. Conclusion Results from these exploratory analyses support a role for inflammation in the pathophysiology of depressive symptoms after hip fracture. Depressive symptoms in the context of high cytokine levels may represent a sickness syndrome that is chronic in some individuals. Further research should establish the cause and effect of this relationship, as well as long-term correlates. [ABSTRACT FROM AUTHOR]

Objectives Based on a multifactorial model of delirium, to compare the types and magnitude of pre- and intraoperative predisposing factors for incident delirium in a stratified sample of individuals with and without preoperative dementia undergoing acute hip fracture repair. Design Prospective cohort study. Setting Academic medical center. Participants Four hundred twenty-five individuals with acute hip fracture and without delirium (mean age 80.2 ± 6.8, 73.2% female, 33.1% with probable dementia) admitted to a multidisciplinary hip fracture repair service. Measurements A research nurse assessed each participant for delirium based on the Confusion Assessment Method ( CAM) before study enrollment and from the second postoperative day until hospital discharge. Results The incidence of delirium was higher in the group with probable dementia (56%) than in the group without dementia (26%) ( P < .001). In the group without dementia (n = 284), age (odds ratio ( OR) = 1.07, 95% CI = 1.02-1.13), male sex ( OR = 2.81, 95% CI = 1.40-5.64), body mass index ( OR = 0.92, 95% CI = 0.86-0.99), number of medical comorbidities ( OR = 1.15, 95% CI = 1.01-1.32), and duration of surgery longer than 2 hours ( OR = 2.53, 95% CI = 1.20-4.88) were independently associated with postoperative delirium. In the group with probable dementia, only the lag time from the emergency department to operating room was significantly associated ( OR = 2.83, 95% CI = 1.24-2.25) with delirium. Conclusion Preoperative determination of dementia status is important for risk stratification for incident delirium after acute hip fracture repair surgery because types and magnitude of predisposing risk factors for postoperative delirium substantially differ based on preoperative dementia status. [ABSTRACT FROM AUTHOR]

Objectives To determine the relationship between opioid consumption and cognitive impairment after hip fracture repair. Design Prospective study of consecutive patients. Setting Johns Hopkins Bayview Medical Center, Baltimore, Maryland. Participants Two hundred thirty-six participants aged 65 and older undergoing hip fracture repair. Measurements Older adults without preoperative delirium who underwent hip fracture repair between April 2005 and July 2009 were followed for pain, opioid consumption, and postoperative delirium. Participants were tested for delirium using the Confusion Assessment Method preoperatively and midmorning on Postoperative Day 2. The nursing staff assessed pain on a numeric oral scale (range 0-10). Opioid analgesia was provided in response to pain at rest to achieve scores of 3 or less. Opioid consumption was analyzed with respect to the occurrence of incident postoperative delirium, presence of dementia, and other demographic variables. Results Of the 236 participants, 66 (28%) had dementia, and 213 (90%) received opioids postoperatively, including 55 (83%) with dementia and 158 (93%) without. There was no association between the use of any postoperative opioid and incident delirium ( P = .61) in participants with ( P = .33) and without ( P = .40) dementia. Dementia, but not postoperative delirium, was associated with less opioid use ( P < .001 for dementia; P = .12 for delirium; P = .04, for their interaction; Wald chi-square = 142.8, df = 7). Opioid dose ( P ≥ .59) on Postoperative Days 1 and 2 was not predictive of incident delirium. Dementia ( P < .001) and intensive care unit admission ( P = .006), not opioid consumption, were the most important predictors of incident postoperative delirium. Conclusion Concern for postoperative delirium should not prevent the use of opioid analgesic therapy sufficient to achieve a generally accepted level of comfort in individuals with or without preexisting cognitive impairment. [ABSTRACT FROM AUTHOR]