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Objectives To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to determine the potential clinical relevance thereof. Design Qualitative study with semistructured face-to-face interviews. Setting A community pharmacy and a geriatric outpatient ward. Participants Community-dwelling people aged 70 and older (N = 59). Measurements Participants were interviewed at home. Two researchers coded the reported problems and management strategies independently according to a coding scheme. An expert panel classified the potential clinical relevance of every identified practical problem and associated management strategy using a 3-point scale. Results Two hundred eleven practical problems and 184 management strategies were identified. Ninety-five percent of the participants experienced one or more practical problems with the use of their medicines: problems reading and understanding the instructions for use, handling the outer packaging, handling the immediate packaging, completing preparation before use, and taking the medicine. For 10 participants, at least one of their problems, in combination with the applied management strategy, had potential clinical consequences and 11 cases (5% of the problems) had the potential to cause moderate or severe clinical deterioration. Conclusion Older people experience a number of practical problems using their medicines, and their strategies to manage these problems are sometimes suboptimal. These problems can lead to incorrect medication use with clinically relevant consequences. The findings pose a challenge for healthcare professionals, drug developers, and regulators to diminish these problems. [ABSTRACT FROM AUTHOR]

Objectives To determine whether there is a relationship between daily defined dose ( DDD) of antihypertensive drugs and the risk of falls. Design Prospective population-based cohort study. Setting Tasmanian Study of Cognition and Gait, Australia. Participants Participants aged 60 to 86 randomly selected from the electoral roll. Measurements Antihypertensive dose was quantified by estimating DDD, allowing standardized comparison of dosage between drug classes. Falls were identified prospectively over 12 months. The relative risk ( RR) of falls associated with DDD was estimated using log binomial regression adjusting for age, sex, body mass index, education, cardiovascular history, and other risk factors for falls. Results Participants (N = 409) had a mean age of 72.0 ± 6.9, and 56% were male. Mean baseline blood pressure was 142/80 mmHg, and 54% were taking antihypertensive medications. One hundred sixty-one participants (39%) fell over the 12 months. Those who fell were on a higher DDD of antihypertensives (1.51 ± 2.16 than those who did not (1.03 ± 1.42) ( P = .007). Higher DDD was independently associated with greater fall risk ( RR = 1.07, 95% confidence interval ( CI) = 1.02-1.11; P = .004), with a 48% greater risk in those with a DDD of more than 3 ( RR = 1.48, 95% CI = 1.06-2.08; P = .02), particularly in those with a history of stroke ( P for interaction .01). This effect remained even after excluding those not taking antihypertensives or stratifying according to presence of hypertension and medication use. Conclusion Higher dose of antihypertensive medication is independently associated with falls in older people, particularly in those with a history of previous stroke, and with more than three standard units conferring the highest risk. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which addresses cohort studies on older adults which reveal an association between negative age stereotypes and accelerated cellular aging, and it mentions research involving telomere length, cell divisions, and exposures to genotoxic and cytotoxic processes.

A letter to the editor is presented which addresses a population-based study on what the authors refer to as the factors that are associated with potentially inappropriate medication (PIM) use in elderly Koreans in an outpatient medical care setting, and it mentions drug prescription data.

Objectives To describe methodological approaches to population targeting and sampling and to summarize limitations of Internet-based questionnaires in older adults. Design Systematic literature review. Setting Studies using online questionnaires in older adult populations. Participants English-language articles using search terms for geriatric, age 65 and over, Internet survey, online survey, Internet questionnaire, and online questionnaire in Pub Med and EBSCO host between 1984 and July 2012. Inclusion criteria were study population mean age 65 and older and use of an online questionnaire for research. Review of 336 abstracts yielded 14 articles for full review by two investigators; 11 articles met inclusion criteria. Measurements Articles were extracted for study design and setting, participant characteristics, recruitment strategy, country, and study limitations. Results Eleven articles were published after 2001. Studies had populations with a mean age of 65 to 78, included descriptive and analytical designs, and were conducted in the United States, Australia, and Japan. Recruiting methods varied widely from paper fliers and personal e-mails to use of consumer marketing panels. Investigator-reported study limitations included the use of small convenience samples and limited generalizability. Conclusion Online questionnaires are a feasible method of surveying older adults in some geographic regions and for some subsets of older adults, but limited Internet access constrains recruiting methods and often limits study generalizability. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether medication reviews increase treatment with fracture-preventing drugs and decrease treatment with fall-risk-increasing drugs. Design Randomized controlled trial (1:1). Setting Departments of orthopedics, geriatrics, and medicine at Sahlgrenska University Hospital, Gothenburg, Sweden. Participants One hundred ninety-nine consecutive individuals with hip fracture aged 65 and older. Intervention Medication reviews, based on assessments of risks of falls and fractures, regarding fracture-preventing and fall-risk-increasing drugs, performed by a physician, conveyed orally and in written form to hospital physicians during the hospital stay, and to general practitioners after discharge. Measurements Primary outcomes were changes in treatment with fracture-preventing and fall-risk-increasing drugs 12 months after discharge. Secondary outcomes were falls, fractures, deaths, and physicians' attitudes toward the intervention. Results At admission, 26% of intervention and 29% of control participants were taking fracture-preventing drugs, and 12% and 11%, respectively, were taking bone-active drugs, predominantly bisphosphonates. After 12 months, 77% of intervention and 58% of control participants were taking fracture-preventing drugs ( P = .01), and 29% and 15%, respectively, were taking bone-active drugs ( P = .04). Mean number of fall-risk-increasing drugs per participants was 3.1 (intervention) and 3.1 (control) at admission and 2.9 (intervention) and 3.1 (control) at 12 months (P = .62). No significant differences in hard endpoints were found. The responding physicians (n = 65) appreciated the intervention; on a scale from 1 (very bad) to 6 (very good), the median rating was 5 (interquartile range ( IQR) 4-6) for the oral part and 5 ( IQR 4-5.5) for the text part. Conclusion Medication reviews performed and conveyed by a physician increased treatment with fracture-preventing drugs but did not significantly decrease treatment with fall-risk-increasing drugs in older adults with hip fracture. Prescribing physicians appreciated this intervention. [ABSTRACT FROM AUTHOR]

Objectives To investigate the association between serum 25-hydroxy vitamin D (25( OH) D) concentrations and respiratory diseases in older people. Design Cross-sectional, nationally representative sample. Setting Community. Participants Two thousand seventy noninstitutionalized adults aged 65 and older taking part in the Health Survey for England 2005. Measurements Serum 25( OH)D levels, self-reported long-term respiratory tract diseases, and covariates (age, sex, social class, season of examination, use of vitamin supplements, and physical health status). Results Participants with severe deficiency (25( OH)D < 35 nmol/L) had more than twice the risk of respiratory disease than those in the highest quartile of 25( OH) D status (>64 nmol/L), and those with moderate deficiency (second quartile: 25( OH) D 35-48.9 nmol/L) had 1.75 times greater odds of respiratory diseases, even after adjustment with covariates. Adjusted analysis showed that those in the third quartile (25( OH) D 49.0 to 63.9 nmol/L) also had a greater risk of respiratory disease (odds ratio = 1.63, 95% confidence interval = 1.04-2.57). Conclusion Low serum 25( OH)D concentrations are associated with respiratory disease. Ensuring adequate 25( OH)D levels is of public health importance for older populations living in northern latitudes and may be an effective way to prevent concurrent respiratory infections and related complications in older people. Further studies are required to investigate whether vitamin D supplementation may reduce the incidence and exacerbations of respiratory disease. [ABSTRACT FROM AUTHOR]

Objectives To determine whether excessive and often inappropriate or dangerous psychotropic drug dispensing to older adults is unique to care homes or is a continuation of community treatment. Design Population-based data-linkage study using prescription drug information. Setting Northern Ireland's national prescribing database and care home information from the national inspectorate. Participants Two hundred fifty thousand six hundred seventeen individuals aged 65 and older. Measurements Prescription information was extracted for all psychotropic drugs included in the British National Formulary ( BNF) categories 4.1.1, 4.1.2, and 4.2.2 (hypnotics, anxiolytics, and antipsychotics) dispensed over the study period. Repeated cross-sectional analysis was used to monitor changes in psychotropic drug dispensing over time. Results Psychotropic drug use was higher in care homes than the community; 20.3% of those in care homes were dispensed an antipsychotic in January 2009, compared with 1.1% of those in the community. People who entered care had higher use of psychotropic medications before entry than those who did not enter care, but this increased sharply in the month of admission and continued to rise. Antipsychotic drug dispensing increased from 8.2% before entry to 18.6% after entering care (risk ratio ( RR) = 2.26, 95% confidence interval ( CI)=1.96-2.59) and hypnotic drug dispensing from 14.8% to 26.3% ( RR=1.78, 95% CI=1.61-1.96). Conclusion A continuation of high use before entry cannot wholly explain the higher dispensing of psychotropic drugs to individuals in care homes. Although drug dispensing is high in older people in the community, it increases dramatically on entry to care. Routine medicine reviews are necessary in older people and are especially important during transitions of care. [ABSTRACT FROM AUTHOR]

Objectives To describe outcomes after unplanned hospital admission in older people and to determine whether disease trajectories in those admitted with ill-defined conditions (symptoms and signs) are distinct from other diagnostic groups and consistent with known disease trajectories. Design Longitudinal follow-up after a retrospective cross-sectional study of emergency admissions to general internal and geriatric medicine units in one hospital. Setting Acute hospital in southern England. Participants All people aged 65 and older with unplanned admissions to general internal and geriatric medicine inpatient units during 2002 (N = 5,312). Measurements Age, sex, comorbidity, presence of cognitive and mood disorders, residence, and primary diagnostic group at discharge. Outcomes were death up to 36 months from admission, any readmission, and readmission for ill-defined conditions up to 36 months after discharge. Results There were significant differences in death rates between the diagnostic groups, with mortality being highest in individuals with a primary diagnosis of cancer and lowest in the ill-defined conditions group. Nearly 83% of the ill-defined conditions group survived the follow-up period. Adjusted Cox proportional hazard models indicated that, when age, sex, comorbidity, residence, and cognitive and mood disorders were accounted for, the ill-defined condition group had a lower risk of death but a higher risk of subsequent readmissions for ill-defined conditions than any other group. Overall readmission risk was highest for individuals admitted for a respiratory condition but was similar in all other diagnostic groups. Conclusion The lower mortality risk associated with ill-defined conditions is consistent with chronic rather than acute needs, but the pattern of mortality and readmission is more consistent with the frailty than the chronic organ system failure illness trajectory, suggesting that functional support needs may be more important in this group of individuals. [ABSTRACT FROM AUTHOR]

Objectives To review the effectiveness of cognitive behavioral therapy ( CBT) for depression in older people, together with factors associated with its efficacy. Design Online literature databases and registers were searched for randomized controlled trials ( RCTs) of CBT for depression in older people. Random-effects meta-analysis and meta-regression were conducted. Setting Studies involving participants from the community and inpatient and outpatient clinical settings were included in the meta-analysis. Participants Older people with major or minor depression, dysthymia, or depressive symptoms. Measurements Evidence-based outcome measures of depression. Results Four hundred eighty-five studies were identified, of which 23 were included. At the end of the intervention, CBT was significantly more effective at reducing depressive symptoms (irrespective of whether rated by clinicians or participants) than treatment as usual ( TAU) or being on a waiting list but not than active controls. The same pattern of results was found for 6-month follow-up. At all other time-points, pooled effect sizes in favor of CBT were nonsignificant. Clinician-rated outcome measures resulted in larger effect sizes in favor of CBT than self-rated measures. No significant differences in efficacy were found between CBT and other treatment (pharmacotherapy and other psychotherapies). Meta-regression analyses revealed four factors that predicted effect sizes for comparisons between CBT and control conditions, including whether concurrent pharmacotherapy was allowed. Conclusion CBT for depression in older people is more effective than waiting list or TAU, but greater efficacy than active controls or other treatment has not been demonstrated. More high-quality RCTs comparing CBT with active controls need to be conducted before firm conclusions can be drawn about the efficacy of CBT for depression in older people. Other treatment approaches that could be contrasted with or augment CBT (e.g., pharmacotherapy) also need to be explored further. [ABSTRACT FROM AUTHOR]

Objectives To determine the effect of a dietary intervention and micronutrient supplementation on self-reported infections in older adults. Design A randomized, placebo-controlled intervention trial. Setting Community living older people in South Yorkshire, United Kingdom. Participants Two-hundred seventeen older adults aged 65 to 85. Intervention Participants were randomized to a dietary intervention, a daily micronutrient supplement, or placebo for 3 months, with a 3-month follow-up. Measurements Self-reported measures of infection were reported over the 6-month study period. Secondary outcome measures were nutritional status, dietary intake, quality of life, and depression. Results Self-reported measures of infection over the 6-month duration of the study were significantly different between the treatment groups. The number of weeks in which illness affected life and the number of general practitioner and hospital visits were significantly lower in the food and micronutrient groups than in the placebo group. The number of weeks in which symptoms of an infection were described was significantly lower in the food group than the placebo and micronutrient groups. Significant improvements in biomarkers of micronutrient status were achieved in the food and micronutrient groups and showed significantly greater change than observed in the placebo group. Significant improvement in dietary intakes was observed in the food group only. Conclusion Improving dietary intake and micronutrient status reduces the clinical impact of self-reported infections in older adults. [ABSTRACT FROM AUTHOR]

An operational definition of frailty is important for clinical care, research, and policy planning. The literature on the clinical definitions, screening tools, and severity measures of frailty were systematically reviewed as part of the Canadian Initiative on Frailty and Aging. Searches of MEDLINE from 1997 to 2009 were conducted, and reference lists of retrieved articles were pearled, to identify articles published in English and French on the identification of frailty in community-dwelling people aged 65 and older. Two independent reviewers extracted descriptive information on study populations, frailty criteria, and outcomes from the selected papers, and quality rankings were assigned. Of 4,334 articles retrieved from the searches and 70 articles retrieved from the pearling, 22 met study inclusion criteria. In the 22 articles, physical function, gait speed, and cognition were the most commonly used identifying components of frailty, and death, disability, and institutionalization were common outcomes. The prevalence of frailty ranged from 5% to 58%. Despite significant work over the past decade, a clear consensus definition of frailty does not emerge from the literature. The definition and outcomes that best suit the unique needs of the researchers, clinicians, or policy-makers conducting the screening determine the choice of a screening tool for frailty. Important areas for further research include whether disability should be considered a component or an outcome of frailty. In addition, the role of cognitive and mood elements in the frailty construct requires further clarification. [ABSTRACT FROM AUTHOR]

Objectives To test the feasibility and utility of a bedside geriatric assessment ( GA) to detect impairment in multiple geriatric domains in older adults initiating chemotherapy for acute myelogenous leukemia ( AML). Design Prospective observational cohort study. Setting Single academic institution. Participants Individuals aged 60 and older with newly diagnosed AML and planned chemotherapy. Measurements Bedside GA was performed during inpatient exmination for AML. GA measures included the modified Mini-Mental State Examination; Center for Epidemiologic Studies Depression Scale; Distress Thermometer, Pepper Assessment Tool for Disability (includes self- reported activities of daily living ( ADLs), instrumental ADLs, and mobility questions); Short Physical Performance Battery (includes timed 4-m walk, chair stands, standing balance); grip strength, and Hematopoietic Cell Transplantation Comorbidity Index. Results Of 54 participants (mean age 70.8 ± 6.4) eligible for this analysis, 92.6% completed the entire GA battery (mean time 44.0 ± 14 minutes). The following impairments were detected: cognitive impairment, 31.5%; depression, 38.9%; distress, 53.7%; impairment in ADLs, 48.2%; impaired physical performance, 53.7%; and comorbidity, 46.3%. Most were impaired in one (92.6%) or more (63%) functional domains. For the 38 participants rated as having good performance status according to standard oncologic assessment (Eastern Cooperative Oncology Performance Scale score ≤1), impairments in individual GA measures ranged from 23.7% to 50%. Significant variability in cognitive, emotional, and physical status was detected even after stratification according to tumor biology (cytogenetic risk group classification). Conclusion Inpatient GA was feasible and added new information to standard oncology assessment, which may be important for stratifying therapeutic risk in older adults with AML. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the effect of an inpatient geriatric consultation team (IGCT) on end points of interest in people with hip fracture: length of stay, functional status, mortality, new nursing home admission, and hospital readmission. DESIGN: Controlled trial based on assignment by convenience. SETTING: Trauma ward in a university hospital. PARTICIPANTS: One hundred seventy-one people with hip fracture aged 65 and older. INTERVENTION: Participants were assigned to a multidisciplinary geriatric intervention (n=94) or usual care (n=77) during hospitalization after hip fracture. MEASUREMENTS: End points were functional status, length of stay, mortality, new nursing home admission, and hospital readmission 6 weeks, 4 months, and 12 months after surgery. RESULTS: Mean length of stay was 11.1 ± 5.1 days in the intervention group and 12.4 ± 8.5 days in the control groups (P=.24). Complete adherence to IGCT recommendations was 56.8%. A significant benefit of intervention on functional status in univariate analyses (P=.02) 8 days after surgery disappeared in a linear mixed model. Participants with dementia had better functional status in a linear mixed model than those without (P=.03), but this effect was no longer significant after Bonferroni correction for multiple testing. After 6 weeks, 4 months, and 12 months, no between-group differences could be documented for mortality, new nursing home admission, or readmission rate. CONCLUSION: This trial could not document functional benefits of an IGCT intervention in people with hip fracture. More research is needed to investigate whether a more-intensive approach with more-direct control over patient management, more-specific recommendations, and more-intense education would be effective. [ABSTRACT FROM AUTHOR]

To examine the physical, mental, and cognitive function of centenarians. Descriptive study using a structured questionnaire and convenience sampling. Residential care facilities and private dwellings in Australia. A convenience sample of 188 centenarians. The Hospital Anxiety and Depression Scale (HADS) screened for anxiety and depression. The Katz Index of Independence in Activities of Daily Living (Katz ADL) was used to assess functional status. The Quality of Life Scale was used to assess quality of life. The Mini-Mental State Examination (MMSE) was used to screen for dementia. Structured responses were obtained for living arrangement, marital status, social relationships, and supports. Centenarians had regular contact with friends (59%), neighbors (62%), and families (72%); 54% were religious and 43.5% had received social supports. Average MMSE and Katz ADL scores were 21.5 and 3.7, respectively; 45% had scores on the MMSE indicative of dementia, 10% indicated anxiety and 14% depression on the HADS. Participants with poor ratings of health experienced higher rates of anxiety and depression than their healthier counterparts. In this convenience sample of Australian centenarians, anxiety and depression was relatively nonexistent, and most reported a high quality of life. This was despite objective deterioration in functional status, paralleling the aging process, and high dependence on others for everyday tasks. Potentially, this is suggestive of a unique ability within the sample to adapt to aging and its limitations. [ABSTRACT FROM AUTHOR]

To categorize the health problems of older Russians and identify the number of frail older adults using different approaches. Cross-sectional study. The Kolpino district of St. Petersburg. A random sample of 611 community-dwelling adults aged 65 and older was selected from a population-based register and stratified into two age groups (65-74, ≥75). Anthropometry, medical history, nutritional status, Physical Performance Battery, activities of daily living, grip strength, spirometry, renal function, 15-item Geriatric Depression Scale, Mini-Mental State Examination, and sense of coherence. The female:male ratio was 2.5:1; 19% were malnourished or at risk for malnutrition, and 78.6% presented with one to three chronic pathologies, with no differences according to age or sex. Problems with hearing (60.7%), vision (89.5%), and incontinence (40.9%) were highly prevalent. Moreover, 25.9% of the younger group (65-74) and 42.5% of the older group (≥75) were found to be at risk for depression. Mild to severe cognitive impairment was found in 34.5% of the participants, and 14.4% of those aged 65 to 74 and 33.0% of those aged 75 and older reported dependence in daily living activities. The prevalence of frailty assessed using different models varied from 21.1% to 43.9%. The Fried model revealed the strongest associations with the frailty outcomes (dependence and performance). No significant differences between the sexes were found in either age group ( P=.82), although the percentage of frail women increased with age ( P=.001). The findings emphasize the need for attention and resources to be shifted from disease-oriented to functional approaches in the older Russian population. The population studied is consistent with the Fried model, in which one in five older adults can be labeled as frail. [ABSTRACT FROM AUTHOR]

To empirically identify groupings of strength, physical performance, adiposity, and lean mass and test how such groupings of these interrelated measures may relate to disability risk. Prospective Health, Aging and Body Composition Study. Two U.S. clinical centers. One thousand two hundred sixty-three women and 1,221 men. Weight, strength (knee extension, grip); walking speed, chair stands, dual X-ray absorptiometry (fat and lean mass for total body, arm, and leg; percent fat), and thigh computed tomography scans (muscle area, muscle density). Analyses were stratified according to sex. Factor analysis reduced these variables into a smaller number of components, and proportional hazards models assessed risk of major disability for the components identified. In both sexes, factor analysis reduced the 14 individual variables into three components that explained 76% to 77% of the data variance: Factor 1, an adiposity component, with strong loading by fat mass, weight, and muscle density; Factor 2, a strength and lean body size component with strong loading by lean mass, weight, and strength; Factor 3, a physical performance component with positive loading by walking speed and chair stand performance. Factor 1 (adiposity) and Factor 3 (performance) but not Factor 2 (strength and lean body size) were associated with disability over 6.1±2.6 years. The adiposity and physical performance constructs but not the strength and lean body size construct were associated with disability risk, suggesting that adiposity and performance should be considered as risk factors for disability. [ABSTRACT FROM AUTHOR]

A substantial proportion of hospitalizations of nursing home (NH) residents may be avoidable. Medicare payment reforms, such as bundled payments for episodes of care and value-based purchasing, will change incentives that favor hospitalization but could result in care quality problems if NHs lack the resources and training to identify and manage acute conditions proactively. Interventions to Reduce Acute Care Transfers (INTERACT) II is a quality improvement intervention that includes a set of tools and strategies designed to assist NH staff in early identification, assessment, communication, and documentation about changes in resident status. INTERACT II was evaluated in 25 NHs in three states in a 6-month quality improvement initiative that provided tools, on-site education, and teleconferences every 2 weeks facilitated by an experienced nurse practitioner. There was a 17% reduction in self-reported hospital admissions in these 25 NHs from the same 6-month period in the previous year. The group of 17 NHs rated as engaged in the initiative had a 24% reduction, compared with 6% in the group of eight NHs rated as not engaged and 3% in a comparison group of 11 NHs. The average cost of the 6-month implementation was $7,700 per NH. The projected savings to Medicare in a 100-bed NH were approximately $125,000 per year. Despite challenges in implementation and caveats about the accuracy of self-reported hospitalization rates and the characteristics of the participating NHs, the trends in these results suggest that INTERACT II should be further evaluated in randomized controlled trials to determine its effect on avoidable hospitalizations and their related morbidity and cost. [ABSTRACT FROM AUTHOR]

Nursing home (NH) residents who have exacerbations of chronic health conditions or new illnesses must generally go the emergency department (ED) for health care, later returning to the nursing home when it is felt that they are no longer require acute care. Transfers between settings of care are referred to as transitions, and research has shown that residents are at risk of experiencing negative health outcomes during these periods. This article reports on a qualitative study of resident transfers between one NH and one ED in Canada. Data were collected using interviews, participant observation, and examination of institutional policies and standard practices. Three themes emerged from the data: (1) work of executing transfers; (2) creating and exchanging resident information; and (3) feelings of guilt but not being responsible about how residents' transfers occurred. Although completion of organization-specific forms consumed a considerable amount of practitioners' time, they contributed little to resident transfers or to the sharing of information. There is a need for integrated models of care that transcend settings and promote an understanding of the roles and responsibilities of practitioners working along the entire continuum of care. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether geriatric conditions and functional impairment are independent risk factors for adverse drug events (ADEs). DESIGN: Prospective cohort study. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: Three hundred seventy-seven veterans aged 65 and older and taking five or more medications. MEASUREMENTS: Geriatric conditions and functional status were assessed using participant interviews and structured assessments at study baseline. ADEs were elicited during participant interviews 3 and 12 months after study enrollment using validated methods. RESULTS: The strong majority (97%) of participants were male, with a mean age of 74±5; 123 (33%) had one or more dependencies in instrumental activities of daily living (IADLs). Over the 1-year study period, 126 participants (33%) developed 167 ADEs. Upon multivariable analysis, risk of ADEs was not associated with any of the geriatric conditions that there was sufficient power to evaluate, including IADL function, cognitive impairment, depression, visual impairment, incontinence, constipation, and a summative measure of geriatric burden comprising the above and history of falls or gait instability. In exploratory analyses, the strongest factor associated with ADEs was the number of drugs added to a participant's medication regimen during the 1-year study period (incidence rate ratio 1.11 per each added drug, 95% confidence interval=1.03-1.19). CONCLUSION: Common geriatric conditions and IADL function were not associated with ADEs in a predominantly male, older veteran population. Although it is important to consider the unique circumstances of each participant, excessive caution in prescribing to older adults with these geriatric conditions may not be warranted. [ABSTRACT FROM AUTHOR]

To quantify the associations between measures of oral health-related quality of life (OHRQoL) and life-space mobility (LSM) in community-dwelling older adults. Cross-sectional study using a 54-item OHRQoL questionnaire. Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Bibb, Hale, and Pickens (rural). The 288 dental study volunteers were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in community-dwelling adults aged 65 and older. Participants completed an in-home interview about their OHRQoL and LSM. Life-space was assessed by asking questions about where and how often participants got to areas ranging from the home to beyond town and the degree of independence in getting there. Unadjusted and adjusted regression models were used to quantify associations between OHRQoL and LSM. Other factors examined were age, race, sex, income, education, residence, transportation difficulty, marital status, depressive symptoms, and comorbidity. Unadjusted and adjusted analyses suggested significant associations between OHRQoL and LSM in oral functional limitation, oral pain and discomfort, oral disadvantage, and self-rated oral health. OHRQoL decrements that participants reported were associated with less LSM, suggesting that perceptions of oral well-being have a significant effect on mobility and the social participation of older adults. [ABSTRACT FROM AUTHOR]

To assess the strength of association between graded groups of oral health status and self-reported functional dependence in community-dwelling older adults. Population-based cross-sectional study. National Health and Nutritional Examination Survey (NHANES) 1999 to 2004. Three thousand eight hundred fifty-six participants aged 60 and older (mean age 71.2) without missing values in the examined correlates. Oral health status was evaluated according to edentulism, severity of periodontal disease, and recommendation of periodontal care and compared with that of healthy controls. Self-reported functional dependence was assessed according to 19 questions in five domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSAs), lower extremity mobility (LEM), and general physical activities (GPAs). After controlling for demographic and dental variables, health-related behaviors, C-reactive protein, and comorbidities, edentulism was significantly associated with disability in IADLs (odds ratio (OR)=1.58), LSAs (OR=1.63), LEM (OR=1.31), and GPAs (OR=1.45) compared with healthy controls. Likewise, severe periodontitis was associated with disability in IADLs (OR=1.58), LSAs (OR=1.70), and LEM (OR=1.63). The trends toward disability in IADLs, LSAs, LEM, and GPAs were statistically significant across increasing severity of oral health problems. Poor oral health, specifically edentulism and severe periodontitis, is associated with multiple domains of late-life disability, but a causal relationship cannot be established based on current study design. [ABSTRACT FROM AUTHOR]

To examine the effects of a month-long nap regimen using one of two durations (45 minutes or 2 hours) on nighttime sleep and waking function in a group of healthy older participants and to assess the degree to which healthy older individuals are willing and able to adhere to such napping regimens. Three laboratory sessions, with 2-week at-home recording interspersed, using a between-participants approach. Laboratory of Human Chronobiology at Weill Cornell Medical College and participants' homes. Twenty-two healthy men and women aged 50 to 88 (mean 70). Polysomnography (sleep electroencephalography), actigraphy, sleep diaries, neurobehavioral performance, sleep latency tests. With the exception of adherence to the protocol, there were few differences between short and long nap conditions. Napping had no negative effect on subsequent nighttime sleep quality or duration, resulting in a significant increase in 24-hour sleep amounts. Such increased sleep was associated with enhanced cognitive performance but had no effect on simple reaction time. Participants were generally able to adhere better to the 45-minute than the 2-hour nap regimen. A month-long, daily nap regimen may enhance waking function without negatively affecting nighttime sleep. Using 2-hour naps in such a regimen is unlikely to meet with acceptable adherence; a regimen of daily 1-hour naps may be more desirable for effectiveness and adherence. [ABSTRACT FROM AUTHOR]

To determine the prevalence of hypovitaminosis D (serum 25-hydroxyvitamin D<32 ng/mL; HVD) in a population of elderly veterans and conduct a preliminary assessment of the efficacy of supplementation with cholecalciferol in correcting HVD. Randomized, double-blind, placebo-controlled clinical trial. Geriatric clinic at the Bruce W. Carter Veterans Affairs Medical Center, Miami, Florida. Veterans aged 70 and older. Oral cholecalciferol 2,000 IU daily or placebo for 6 months. Serum calcium, 25-hydroxyvitamin D, parathyroid hormone, and 24-hour urinary calcium. Of the 34 participants who completed the study, 62% had HVD at baseline. In the treatment group, mean serum 25-hydroxyvitamin D level rose from 28.4±7.9 ng/mL at baseline to 42.7±10.5 ng/mL at the end of the trial, but levels remained less than 32 ng/mL in three of 17 (18%) of the participants. In the placebo group, the baseline level of 27.7±8.3 ng/mL remained unchanged (28.8±8.7 ng/mL). Supplementation did not alter serum or urinary calcium levels and did not result in any adverse events. These initial observations suggest that, in older veterans, cholecalciferol 2,000 IU daily for 6 months is generally safe and corrects HVD in most but not all individuals. [ABSTRACT FROM AUTHOR]

To estimate the likelihood of, and factors associated with, recovery from exhaustion in older adults. Secondary analysis of a cohort study. Six annual examinations in four U.S. communities. Four thousand five hundred eighty-four men and women aged 69 and older. Exhaustion was considered present when a participant responded 'a moderate amount' or 'most of the time' to either of two questions: 'How often have you had a hard time getting going?' and 'How often does everything seem an effort?' Of the 964 participants who originally reported exhaustion, 634 (65.8%) were exhaustion free at least once during follow-up. When data from all time points were considered, 48% of those who reported exhaustion were exhaustion free the following year. After adjustment for age, sex, race, education, and marital status, 1-year recovery was less likely in individuals with worse self-rated health and in those who were taking six or more medications or were obese, depressed, or had musculoskeletal pain or history of stroke. In proportional hazards models, the following risk factors were associated with more persistent exhaustion over 5 years: poor self-rated health, six or more medications, obesity, and depression. Recovery was not less likely in participants with a history of cancer or heart disease. Exhaustion is common in old age but is dynamic, even in those with a history of cancer and congestive heart failure. Recovery is especially likely in seniors who have a positive perception of their overall health, take few medications, and are not obese or depressed. These findings support the notion that resiliency is associated with physical and psychological well-being. [ABSTRACT FROM AUTHOR]

To assess the feasibility of cognitive screening in older veterans presenting for routine primary care. Quality improvement initiative. Seven Veterans Affairs Medical Centers. Veterans aged 70 and older without a prior diagnosis of cognitive impairment. Scores from 16 different versions of the Mini-Cog, a 5-point cognitive screen consisting of three-word recall (0-3 points) with a clock-drawing interference task (0 or 2 points). Five word lists were paired with three clock times and randomly ordered for presentation with the original Mini-Cog version. The conventional dementia screening cut point was increased to maximize sensitivity; to pass, patients had to draw the clock correctly and recall at least two of three words (score 4 or 5/5). Administering the Mini-Cog took 90 to 180 seconds. Of 8,342 veterans approached, 8,063 (96.7%) agreed to be screened; 2,081 (25.8%) scored less than 4 out of 5. Scores declined with age, but age did not predict pass or fail. Different word lists produced different screen failure rates, ranging from 21.2% to 33.4%. Five dementia specialists were unable to distinguish harder from easier lists. Different clock times accounted for 2% or less of the difference in failure rates. The Mini-Cog was quick and well accepted by older veterans. Many with no prior documentation of cognitive impairment failed the screen. Failure rates varied with the word list used, revealing that even apparently minor changes in test items affect screen results. Additional study is needed to establish the value of cognitive screening in shaping primary care of older veterans. [ABSTRACT FROM AUTHOR]

To evaluate the clinical features, treatments, stages, and survival in older adults with hepatocellular carcinoma (HCC). A consecutive case study with retrospective medical record review. University hospital (tertiary referral center) in Korea. Two hundred sixty-two participants with HCC diagnosed between May 1, 2003, and December 31, 2006. Clinical characteristics, treatments, four staging systems for HCC, and survival in older (≥65, n=113) and younger (<65, n=149) people with HCC. The older HCC group were less likely to have hepatitis B virus infection and diffuse tumors and had more comorbidities, poorer performance status, smaller tumor area, and multinodular disease. There were no significant differences between the two groups with regard to Child-Pugh-Turcotte score, Model for End Stage Liver Disease (MELD) score, Child class, alpha-fetoprotein levels, and tumor stage at diagnosis. Approximately 88% of subjects were treated regardless of age, but resection was performed less frequently in the older participants. Older participants with HCC had overall survival and liver-related mortality similar to those of the younger participants, although they had poorer performance, greater comorbidity, and less likelihood of receiving surgery than the younger patients. This study supports the effectiveness and safety of nonsurgical treatment for older adults with HCC. Further study is needed to elucidate the reasons for similar prognoses in the older adults in spite of the greater burdens of comorbidities and poorer performance status. [ABSTRACT FROM AUTHOR]

To examine the association between mobility levels of older hospitalized adults and functional outcomes. Prospective cohort study. A 900-bed teaching hospital in Israel. Five hundred twenty-five older (≥70) acute medical patients hospitalized for a nondisabling condition. In-hospital mobility was assessed using a previously validated scale. The main outcomes were decline from premorbid baseline functional status at discharge (activities of daily living (ADLs)) and at 1-month follow-up (ADLs and instrumental ADLs (IADLs)). Hospital mobility levels and functional outcomes were assessed according to prehospitalization functional trajectories. Logistic regressions were modeled for each outcome, controlling for functional status, morbidity, and demographic characteristics. Forty-six percent of participants had declined in ADLs at discharge and 49% at follow-up; 57% had declined in IADLs at follow-up. Mobility during hospitalization was twice as high in participants with no preadmission functional decline. Low versus high in-hospital mobility was associated with worse basic functional status at discharge (adjusted odds ratio (AOR)=18.03, 95% confidence interval (CI)=7.68-42.28) and at follow-up (AOR=4.72, 95% CI=1.98-11.28) and worse IADLs at follow-up (AOR=2.00, 95% CI=1.05-3.78). The association with poorer discharge functional outcomes was present in participants with preadmission functional decline (AOR for low vs high mobility=15.26, 95% CI=4.80-48.42) and in those who were functionally stable (AOR for low vs high mobility=10.12, 95% CI=2.28-44.92). In-hospital mobility is an important modifiable factor related to functional decline in older adults in immediate and short-term (1-month follow-up) functional outcomes. [ABSTRACT FROM AUTHOR]

To assess how influenza vaccination coverage in children is related to pneumonia and influenza (P&I) in older adults and whether sociodemographic factors modify these associations. Approximately 5 million hospitalization records from the Centers for Medicare and Medicaid Services for four influenza years (2002-2006) were abstracted. A single-year age distribution of rates of P&I hospitalization was estimated according to state for each influenza season; an exponential acceleration in the P&I rates with age was observed for each influenza season. State- and season-specific P&I rate accelerations were regressed against the percentage of vaccinated children, older adults, or both using mixed effects models. U.S. population, 2002 to 2006. U.S. population aged 65 and older. State-level influenza annual vaccination coverage data in children and older adults were obtained from the National Immunization Survey and the Behavioral Risk Factor Surveillance System, respectively. Child influenza vaccination coverage was negatively associated with age acceleration in P&I, whereas influenza vaccination in the older adults themselves was not significantly associated with P&I in older adults. Vaccination of children against influenza may induce herd immunity against influenza for older adults and has the potential to be more beneficial to older adults than the existing policy of preventing influenza by vaccinating older adults themselves. [ABSTRACT FROM AUTHOR]

To study tooth loss patterns in older adults with dementia. Retrospective longitudinal study. A community-based geriatric dental clinic in Minnesota. Four hundred ninety-one older adults who presented to the study clinic as new patients during the study period, remained dentate after finishing the initial treatment plan, and returned for care at least once thereafter were retrospectively selected. One hundred nineteen elderly people with International Classification of Diseases, Ninth Revision, codes 290.x, 294.1, or 331.2 or a plain-text diagnosis of dementia, Alzheimer's disease, or chronic brain syndrome in the medical history were considered having dementia. All existing dental conditions were treated before enrollment. Dental treatment was continually provided for all participants during follow-up. Tooth loss patterns, including time to first tooth loss, number of tooth loss events, and number of teeth lost per patient-year were estimated and compared for participants with and without dementia using Cox, Poisson, and negative-binomial regressions. Participants with dementia arrived with an average of 18 and those without dementia with an average of 20 teeth; 27% of remaining teeth in the group with dementia were decayed or retained roots, higher than in the group without dementia ( P<.001). Patterns of tooth loss did not significantly differ between the two groups; 11% of participants in both groups had lost teeth by 12 months of follow-up. By 48 months, 31% of participants without dementia and 37% of participants with dementia had lost at least one tooth ( P=.50). On average, 15% of participants in both groups lost at least one tooth each year. Mean numbers of teeth lost in 5 years were 1.21 for participants with dementia and 1.01 for participants without dementia ( P=.89). Based on data available in a community-based geriatric dental clinic, dementia was not associated with tooth loss. Although their oral health was poor at arrival, participants with dementia maintained their dentition as well as participants without dementia when dental treatment was provided. [ABSTRACT FROM AUTHOR]

To determine whether there are differences in emergency department (ED) pain assessment and treatment for older and younger adults. Retrospective observational cohort. Urban, academic tertiary care ED during July and December 2005. Adult patients with conditions warranting ED pain care. Age, Charlson comorbidity score, number of prior medications, sex, race and ethnicity, triage severity, degree of pain, treating clinician, and final ED diagnosis. Pain care process measures were pain assessment and treatment and time of activities. One thousand thirty-one ED visits met inclusion criteria; 92% of these had a documented pain assessment. Of those reporting pain, 41% had follow-up pain assessments, and 59% received analgesic medication (58% of these as opioids, 24% as nonsteroidal anti-inflammatory drugs (NSAIDs)). In adjusted analyses, there were no differences according to age in pain assessment and receiving any analgesic. Older patients (65-84) were less likely than younger patients (18-64) to receive opioid analgesics for moderate to severe (odds ratio (OR)=0.44, 95% confidence interval (CI)=0.22-0.88) and were more likely to more likely to receive NSAIDs for mild pain (OR=3.72, 95% CI=0.97-14.24). Older adults had a lower reduction of initial to final recorded pain scores ( P=.002). There appear to be differences in acute ED pain care for older and younger adults. Lower overall reduction of pain scores and less opioid use for the treatment of painful conditions in older patients highlight disparities of concern. Future studies should determine whether these differences represent inadequate ED pain care. [ABSTRACT FROM AUTHOR]

To determine the feasibility of using the American Board of Internal Medicine Care of the Vulnerable Elderly Practice Improvement Module (CoVE PIM) in an internal medicine residency program and to assess aggregate resident documentation of geriatric screening in continuity clinics. Needs assessment chart review for single-site pre-/postintervention study. Internal medicine resident primary care continuity clinics. Thirty-seven postgraduate year (PGY)-1 and PGY-2 internal medicine residents. Completion rate and time of CoVE PIM chart review, CoVE PIM user difficulty, and aggregate percentage of charts documenting geriatric screening measures. Sixty-five percent of residents completed the CoVE PIM in an average of 47 minutes (range 30-90 minutes); 72% of resident surveys rated the CoVE PIM as easy to use. Residents demonstrated very good documentation of chronic medical conditions, smoking status, height, weight, and blood pressure and poor documentation of falls and fall risk, hearing assessment, postural hypotension, balance, rigidity, bradykinesia, home safety assessment, seat belt counseling, code status, and surrogate decision-maker. The CoVE PIM can be used to assess aggregate resident performance of geriatric screening measures. In resident clinics, general adult screening performed by nurses is well documented, whereas geriatric-specific screening performed by physicians is poorly documented. [ABSTRACT FROM AUTHOR]

To investigate the associations between self-injury ideation and pain severity, pain control, and their combination in older adults receiving home care and to examine sex differences in the associations. Secondary data analysis, mixed-model repeated-measures design. Two publicly funded home care programs in Michigan. Elderly participants of home care programs (N=16,700). All participants received in-home assessments at baseline and every 3 months thereafter using a standardized instrument that included questions about self-injury ideation and pain experience. Assessment data collected over 1 year after baseline were used. Participants' average age was 77.5; 72.2% were female, and 81.4% were white. At baseline, 1.4% of the sample (2.1% of men and 1.2% of women) had self-injury ideation. The risk of self-injury ideation in men increased with pain severity (some pain: adjusted odds ratio (AOR)=1.88, 95% confidence interval (CI)=1.12-3.13; severe pain: AOR=2.36, 95% CI=1.29-4.30) and pain control (controlled by medication: AOR=1.81, 95% CI=1.08-3.04; uncontrolled by medication: AOR=3.39, 95% CI=1.45-7.95). Men with severe and uncontrolled pain were at especially high risk (AOR=4.10, 95% CI=1.37-12.28). No measures of pain were significantly associated with self-injury ideation in women. Sex differences in the association between pain severity and self-injury ideation were significant at P<.05. Pain in older adults receiving home care should be taken seriously and treated as one means to reduce risk of suicide. Pain assessment should include severity and control of pain. In men, complaints about pain should prompt questioning about self-injury ideation. [ABSTRACT FROM AUTHOR]

A review of the 51 longitudinal aging studies currently in the National Institute on Aging Database of Longitudinal Studies was conducted to identify major information gaps and areas for future research. Database information, which included posted study summaries, study details from principal investigators or directors of these projects, and more than 300 recent publications based on the studies, were reviewed to identify significant findings of each study. This review summarizes the main findings and identifies the need for future work within six broad study topics: cognitive function, socioeconomic status, health and physical performance, morbidity and mortality predictors, healthcare costs, and genetics. The percentages of these 51 studies addressing the four most common topics are as follows: cognitive function (44%), health and physical performance (51%), socioeconomic factors (55%), and predictors of morbidity/mortality (63%). Important areas not addressed to any major degree were healthcare costs and genetics. Only two studies reported findings on genetics or epigenetics of human aging, and only a single study reported on associations between aging and financial costs, especially healthcare costs, which have been postulated to be important determinants of care and life quality. The results of this review, together with the specific directions proposed by other investigators with longitudinal study expertise, will inform the strategic planning of future long-term studies of aging. [ABSTRACT FROM AUTHOR]

The natural history of life span cognitive performance and its late-life determinants have been studied from an array of perspectives. Significant insights come from psychological disciplines, including cognitive, developmental, and neuropsychology, as well as from medical specialties, such as geriatrics, neurology, psychiatry, neuroradiology, and neuropathology, that contribute to the growing interdisciplinary scientific field: cognitive neuroscience of aging. This survey of longitudinal studies of aging suggests that disease-oriented investigations commonly do not adequately consider normative cognitive changes, whereas developmental studies do not sufficiently measure and model nonnormative cognitive aging. This article argues for an integrative perspective that considers both of these influences on cognitive trajectories and presents a series of methodological concerns that have not been addressed comprehensively. Interdisciplinary methods from longitudinal observational studies should be leveraged to enable translational interventions to promote brain longevity. [ABSTRACT FROM AUTHOR]

Cost-effective recruitment of older adult study participants is essential to geriatric research. Because this age group is particularly challenging to recruit, careful planning and ongoing evaluation is important for successful participant recruitment and retention. Experienced recruitment staff should be involved in a study from the earliest planning stages through the active recruitment phase to the last randomization or enrollment visit. A number of participant burdens are unique to the elderly population. Recruitment staff should be trained to understand and assist with the needs of older research volunteers. Addressing these unique participant burdens can ensure successful study participant recruitment and retention in ongoing and future longitudinal studies on aging. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify the interrelationships and discriminatory value of a broad range of objectively measured explanatory risk factors for falls. DESIGN: Prospective cohort study with 12-month follow-up period. SETTING: Community sample. PARTICIPANTS: Five hundred community-dwelling people aged 70 to 90. MEASUREMENTS: All participants underwent assessments on medical, disability, physical, cognitive, and psychological measures. Fallers were defined as people who had at least one injurious fall or at least two noninjurious falls during a 12-month follow-up period. RESULTS: Univariate regression analyses identified the following fall risk factors: disability, poor performance on physical tests, depressive symptoms, poor executive function, concern about falling, and previous falls. Classification and regression tree analysis revealed that balance-related impairments were critical predictors of falls. In those with good balance, disability and exercise levels influenced future fall risk—people in the lowest and the highest exercise tertiles were at greater risk. In those with impaired balance, different risk factors predicted greater fall risk—poor executive function, poor dynamic balance, and low exercise levels. Absolute risks for falls ranged from 11% in those with no risk factors to 54% in the highest-risk group. CONCLUSIONS: A classification and regression tree approach highlighted interrelationships and discriminatory value of important explanatory fall risk factors. The information may prove useful in clinical settings to assist in tailoring interventions to maximize the potential benefit of falls prevention strategies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To estimate the dose-related risk of injuries in older adults associated with the use of low-, medium-, and high-potency opioids. DESIGN: Historical population-based cohort study: 2001 to 2003. SETTING: Quebec, Canada's, universal healthcare system. PARTICIPANTS: Four hundred three thousand three hundred thirty-nine adults aged 65 and older. MEASUREMENTS: Population-based health databases were used to measure preexisting risk factors for injuries in 2001/02 and drug use and injuries during follow-up (2003). Type and dose of opioids were measured as time-dependent variables, as were other drugs that may increase the risk of injury from sedating side-effects or hypotension. The risk of injury per one adult dose increase in opioid dose was estimated using multivariate Cox proportional hazards models. RESULTS: During the follow-up year, 50.7% of the study population were prescribed drugs with sedating side effects, 15.3% were prescribed an opioid, 20.7% were concurrently using more than one sedating medication, and 3.7% were treated for an injury, fractures (55.1%) being the most common. After adjusting for concurrent drug use and baseline risk factors, low- (hazard ratio (HR)=1.36, 95% confidence interval (CI)=1.33–1.39) and intermediate-potency (HR=1.05, 95% CI=1.02–1.07) opioids were associated with the risk of injury. Use of codeine combinations was associated with the highest risk of injury, a 127% greater risk (HR=2.27, 95% CI=2.21–2.34) per one adult dose increase. (The mean World Health Organization standardized dose in the study population was 1.71 ± 0.85 adult doses.) CONCLUSION: Opioids increase the risk of injury in older adults, particularly codeine combinations. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To provide pooled data on the prevalence of malnutrition in elderly people as evaluated using the Mini Nutritional Assessment (MNA). DESIGN: Retrospective pooled analysis of previously published datasets. SETTING: Hospital, rehabilitation, nursing home, community. PARTICIPANTS: Four thousand five hundred seven people (75.2% female) with a mean age of 82.3. MEASUREMENTS: The prevalence of malnutrition in the combined database and in the four settings was examined. RESULTS: Twenty-four data sets with information on full MNA classification from researchers from 12 countries were submitted. In the combined database, the prevalence of malnutrition was 22.8%, with considerable differences between the settings (rehabilitation, 50.5%; hospital, 38.7%; nursing home, 13.8%; community, 5.8%). In the combined database, the “at risk” group had a prevalence of 46.2%. Consequently, approximately two-thirds of study participants were at nutritional risk or malnourished. CONCLUSION: The MNA has gained worldwide acceptance and shows a high prevalence of malnutrition in different settings, except for the community. Because of its specific geriatric focus, the MNA should be recommended as the basis for nutritional evaluation in older people. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the efficacy of a zoster vaccine on herpes zoster (HR)-related interference with activities of daily living (ADLs) and health-related quality of life (HRQL). DESIGN: Randomized double-blind placebo controlled trial. SETTING: Twenty-two U.S. sites. PARTICIPANTS: Thirty eight thousand five hundred forty-six women and men aged 60 and olcer. MEASUREMENTS: HZ burden of interference with ADLs and HRQL using ratings from the Zoster Brief Pain Inventory (ZBPI) and Medical Outcomes Study 12-item Short Form Survey (SF-12) mental component summary (MCS) and physical component summary (PCS) scores. Vaccine efficacy was calculated for the modified-intention-to-treat trial population and solely in participants who developed HZ. RESULTS: For the modified-intention-to-treat population, the overall zoster vaccine efficacy was 66% (95% confidence interval (CI)=55–74%) for ZBPI ADL burden of interference score and 55% (95% CI=48–61%) for both the SF-12 MCS and PCS scores. Of participants who developed HZ, zoster vaccine reduced the ZBPI ADL burden of interference score by 31% (95% CI=12–51%) and did not significantly reduce the effect on HRQL. CONCLUSIONS: Zoster vaccine reduced the burden of HZ-related interference with ADLs in the population of vaccinees and in vaccinees who developed HZ. Zoster vaccine reduced the effect of HZ on HRQL in the population of vaccinees but not in vaccinees who developed HZ. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the relationship between visceral fat area (VFA) evaluated using computed tomography (CT) scans and the number of metabolic risk factors in older adults. DESIGN: Cross-sectional study SETTING: A community clinic in Tokyo, Japan. PARTICIPANTS: Two hundred eighteen individuals aged 65 and older without impairments in activities of daily living who underwent geriatric health examination (63 men, mean age 74.5 ± 7.1; 155 women, mean age 75.3 ± 6.7). MEASUREMENTS: VFA was obtained from a cross-sectional image at umbilical level in the supine position using CT scanning. Metabolic syndrome components except waist circumference were measured using the criteria of the International Diabetes Federation. RESULTS: There was a positive correlation between VFA and number of metabolic risk factors in men and women. Multiple regression analysis demonstrated that only VFA was significantly correlated with number of risk factors in men, whereas age and VFA were significantly correlated in women; body mass index was not correlated with number of metabolic risk factors in men or women. Dyslipidemia and high blood glucose were associated with higher VFA, but high blood pressure was not. There was a negative correlation between VFA and serum adiponectin level and a positive correlation between VFA and homeostasis model assessment of insulin resistance. CONCLUSION: Visceral fat accumulation is associated with metabolic risk factor clustering even in the elderly population. These results have clinical implications for the management of obesity in older adults. [ABSTRACT FROM AUTHOR]

At the American Geriatrics Society 2008 Annual Meeting, representatives of two geriatric societies, the European Union Geriatric Medicine Societies and the American Geriatrics Society, and two regulatory agencies, the U.S. Food and Drug Administration and the European Medicine Agency, conducted a roundtable discussion aimed at reviewing the participation of older people in clinical trials. This article summarizes the important issues discussed at the meeting. Historically, regulatory agencies started to promote the inclusion of older participants in clinical trials in the late 1980s. The identification of the causes of delay in including older participants in clinical trials, as well as of the ongoing bias against including older participants with multiple comorbidities, is important to help geriatricians fight against age discrimination in clinical trials. To overcome this problem, geriatrics societies and regulatory agencies must work together to propose new definitions, study designs, and technologies aimed at improving the evaluation of drugs in older people with multiple comorbidities and polypharmacy. [ABSTRACT FROM AUTHOR]

There is growing interest in using patient-directed incentives to change health-related behaviors. Advocates of incentive programs have proposed an ambitious research agenda for moving patient incentive programs forward. The unique cognitive and psychological features of older adults, however, present a challenge to this agenda. In particular, age-related changes in emotional regulation, executive function, and cognitive capacities, and a preference for collaborative decision-making raise questions about the suitability of these programs, particularly the structure of current financial incentives, for older adults. Differences in decision-making in older adults need to be accounted for in the design and implementation of financial incentive programs. Financial incentive programs adjusted to characteristics of older adult populations may be more likely to improve the lives of older persons and the economic success of programs that serve them. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine subjective ratings of quality of life (QoL) in older adults with advanced illness. DESIGN: Observational cohort study with interviews at least every 4 months for up to 2 years conducted between December 1999 and December 2002. SETTING: Participants' homes. PARTICIPANTS: One hundred eighty-five community-dwelling individuals aged 60 and older with advanced cancer, heart failure, or chronic obstructive pulmonary disease. MEASUREMENTS: Participants were asked how they would rate their overall QoL. RESULTS: Of participants who died, 46% reported good or best possible QoL at their final interview, 21% reported improvement in QoL from their penultimate to final interview, and 39% reported no change. Forty-nine percent of participants reported two or more changes in the direction of their QoL trajectories (e.g., QoL improved then declined). As measured over time in a multivariable longitudinal regression analysis, greater activity of daily living disability (adjusted odds ratio (AOR)=0.85, 95% confidence interval (CI)=0.75–0.95) and depressed mood (AOR=0.42, 95%CI=0.27–0.66) were associated with poorer QoL, whereas better self-rated health (AOR=4.79, 95% CI=2.99–7.69) and having grown closer to one's church (AOR=1.99, 95% CI=1.17–3.39) were associated with better QoL. CONCLUSION: Although declining QoL is not an inevitable consequence of advancing illness, individuals' ratings of QoL are highly variable over time, suggesting that temporary factors may influence subjective QoL. Functional status, depression, and connection to one's religious community are shared determinants of QoL. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the predictive value of five performance-based measures for the onset of difficulty in activities of daily living (ADLs). DESIGN: A prospective cohort study; home visits every 6 months for 18 months. SETTING: Community-based. PARTICIPANTS: Community-dwelling older adults, n=110, (mean age 80.3±7.0; range 67–98) who reported no difficulty in basic ADLs. MEASUREMENTS: The Short Physical Performance Battery (SPPB), gait speed, Berg Balance Scale (BBS), grip strength, and Timed Up and Go Test (TUG) were evaluated at baseline. Seven ADL items were assessed at baseline and 6, 12, and 18 months. The onset of ADL disability was self-report of difficulty in any of the seven ADL items. Logistic regression models were fitted for each of the physical performance measures to predict onset of ADL difficulty at 6, 12, and 18 months. RESULTS: After controlling for age, comorbid conditions, and sex, the BBS was the most consistent and best predictor for the onset of ADL difficulty over an 18-month period (6 months, c-statistic=0.725, (95% confidence interval (CI)=0.60–0.85; 12 months, c-statistic=0.840 95% CI=0.75, 0.93; 18 months, c-statistic=0.821, 95% CI=0.71, 0.93). The SPPB showed excellent predictive value for the onset of difficulty at 12 months. Ninety-five, 89, and 75 older adults completed the 6, 12, and 18-month follow-up visits, respectively. CONCLUSION: BBS, followed by SPPB, TUG, gait speed, and grip strength, were predictive of the onset of ADL difficulty over an 18-month period in community-dwelling older adults. Screening nondisabled older adults with simple performance tests could allow clinicians to identify those at risk for ADL difficulty and may help to detect early functional decline. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the prevalence and correlates of nocturia in community-dwelling older adults. DESIGN: Planned secondary analysis of cross-sectional data from the University of Alabama at Birmingham Study of Aging population-based survey. SETTING: Participants' homes. PARTICIPANTS: One thousand older adults (aged 65–106) recruited from Medicare beneficiary lists between 1999 and 2001. The sample was selected to include 25% each African-American women, African-American men, white women, and white men. MEASUREMENTS: In-person interviews included sociodemographic information, medical history, Mini-Mental State Examination (MMSE) score, and measurement of body mass index (BMI). Nocturia was defined in the main analyses as rising two or more times per night to void. RESULTS: Nocturia was more common in men than women (63.2% vs 53.8%, odds ratio (OR)=1.48, 95% confidence interval (CI)=1.15–1.91, P=.003) and more common in African Americans than whites (66.3% vs 50.9%, OR=1.89, 95% CI=1.46–2.45, P<.001). In multiple backward elimination regression analysis in men, nocturia was significantly associated with African-American race (OR=1.54) and BMI (OR=1.22 per 5 kg/m2). Higher MMSE score was protective (OR=0.96). In women, nocturia was associated with older age (OR=1.21 per 5 years), African-American race (OR=1.64), history of any urine leakage (OR=2.17), swelling in feet and legs (OR=1.67), and hypertension (OR=1.62). Higher education was protective (OR=0.92). CONCLUSION: Nocturia in community-dwelling older adults is a common symptom associated with male sex, African-American race, and some medical conditions. Given the significant morbidity associated with nocturia, any evaluation of lower urinary tract symptoms should include assessment for the presence of nocturia. [ABSTRACT FROM AUTHOR]

Clinical studies often face the difficult problem of how to account for participants who die without experiencing the study outcome of interest. In a geriatric population with considerable comorbidities, the competing risk of death is especially high. Traditional approaches to describe risk of disease include Kaplan-Meier survival analysis and Cox proportional hazards regression, but these methods can overestimate risk of disease by failing to account for the competing risk of death. This report discusses traditional survival analysis and competing risk analysis as used to estimate risk of disease in geriatric studies. Furthermore, it illustrates a competing risk approach to estimate risk of second hip fracture in the Framingham Osteoporosis Study and compares the results with traditional survival analysis. In this example, survival analysis overestimated the 5-year risk of second hip fracture by 37% and the 10-year risk by 75% compared with competing risk estimates. In studies of older individuals in which a substantial number of participants die during a long follow-up, the cumulative incidence competing risk estimate and competing risk regression should be used to determine incidence and effect estimates. Use of a competing risk approach is critical to accurately determining disease risk for elderly individuals and therefore best inform clinical decision-making. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe retention according to age and visit type (clinic, home, telephone) and to determine characteristics associated with visit types for a longitudinal epidemiological study in older adults. DESIGN: Longitudinal cohort study. SETTING: Four U.S. clinical sites. PARTICIPANTS: Five thousand eight hundred eighty-eight Cardiovascular Health Study (CHS) participants aged 65 to 100 at 1989/90 or 1992/93 enrollment (58.6% female; 15.7% black). CHS participants were contacted every 6 months, with annual assessments through 1999 and in 2005/06 for the All Stars Study visit of the CHS cohort (aged 77–102; 66.5% female; 16.6% black). MEASUREMENTS: All annual contacts through 1999 (n=43,772) and for the 2005/06 visit (n=1,942). RESULTS: CHS had 43,772 total participant contacts from 1989 to 1999: 34,582 clinic visits (79.0%), 2,238 refusals (5.1%), 4,401 telephone visits (10.1%), 1,811 home visits (4.1%), and 740 other types (1.7%). In 2005/06, the All Stars participants of the CHS cohort had 36.6% clinic, 22.3% home, and 41.1% telephone visits. Compared with participants aged 65 to 69, odds ratios of not attending a CHS clinic visit were 1.82 (95% confidence interval (CI)=1.54–2.13), 2.94 (95% CI=2.45–3.57), 4.55 (95% CI=3.70–5.56), and 9.09 (95% CI=7.69–11.11) for those aged 70 to 74, 75 to 79, 80 to 84, and 85 and older, respectively, in sex-adjusted regression. In multivariable regression, participants with a 2005/06 clinic visit were younger, more likely to be male and in good health, and had had better cognitive and physical function 7 years earlier than participants with other visit types. Participants with home, telephone, and missing visits were similar on characteristics measured 7 years earlier. CONCLUSION: Offering home, telephone, and proxy visits are essential to optimizing follow-up of aging cohorts. Home visits increased in-person retention from 36.5% to 58.8% and diversified the cohort with respect to age, health, and physical functioning. [ABSTRACT FROM AUTHOR]