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OBJECTIVES: To evaluate the association between hypothyroidism, and the health status of older Hispanic and non-Hispanic white (NHW) men and women. To accomplish this, we determined the prevalences of the treated and untreated conditions and examined the associations between an elevated serum thyroid stimulating hormone (TSH) and cognitive and affective (mood) functions and the prevalences of symptoms and comorbidity, specifically coronary heart disease (CHD), diabetes, hypertension, and hyperlipidemia. DESIGN AND SETTING: A cross-sectional study of equal numbers of Hispanic and NHW men and women selected randomly from the Health Care Financing Administration (Medicare) rolls and recruited for a home interview followed by a 4-hour interview/examination in a senior health clinic. PARTICIPANTS: 883 volunteers, mean age 74.1 years, participated in interviews/examinations MEASUREMENTS: Serum TSH was determined in 825 participants responding to questions about thyroid replacement therapy. Serum free thyroxine (free T4) concentrations were determined in 139 participants with elevated TSH concentrations (>4.6 μU/mL). Symptoms, cognitive tests, a screen for depression, comorbidities (e.g., CHD), and risk factors (e.g., lipid abnormalities, diabetes, and hypertension) were compared in participants with high versus normal TSH values. RESULTS: Subclinical hypothyroidism is more common in women than in men and in non-Hispanic white women compared with Hispanic women. No differences were observed between participants with TSH elevations from 4.7 to 10 μU/mL and those with normal TSH concentrations, and only a few differences were observed in those with TSH concentrations above 10. CONCLUSIONS: Subclinical hypothyroidism is a common condition in community-living older people, especially women. However, it appeared to have no effect on any of the measures of health status utilized until serum TSH concentrations exceeded 10 μU/mL, and even then the effects were rarely significant. J Am Geriatr Soc 47:703–709, 1999.

In the past two decades, a number of geriatric assessment instruments have been developed to aid in the diagnosis and treatment of high-risk elderly patients; tools are available to assess physical health, functional ability, psychological health, and socioeconomic and environmental changes with age. However, too little attention has been given to identifying those elderly who would benefit from early detection of malnutrition. The Mini Nutritional Assessment instrument was designed and validated in a series of studies to assess which geriatric patients are at risk for malnutrition. Nutrition assessment using this instrument takes approximately 15 minutes and can easily be administered by health professionals in geriatric clinics, and at admission to hospitals and/or nursing homes for early detection of patients who could be helped by nutrition intervention.

BAUMGARTNER, RICHARD N., ROBERT R. ROSS, DEBRA L. WATERS, WILLIAM M. BROOKS, JOHN E. MORLEY, GEORGE D. MONTOYA, AND PHILIP J. GARRY. Serum leptin in elderly people: associations with sex hormones, insulin, and adipose tissue volumes. Obes Res. Objective There are few data for associations of serum leptin with body fat, fat distribution, sex hormones, or fasting insulin in elderly adults. We hypothesized that the sex difference in serum leptin concentrations would disappear after adjustment for subcutaneous, but not visceral body fat. Serum leptin would not be associated with sex hormone concentrations or serum fasting insulin after adjusting for body fat and fat distribution. Research Methods and Procedures Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) volumes were measured using magnetic resonance imaging in a cross-sectional sample of 56 nondiabetic, elderly men and women aged 64 years to 94 years. Serum leptin, sex hormones (testosterone and estrone), sex hormone-binding globulin, and fasting insulin were also measured. Nine women were taking hormone replacement, and five men were clinically hypogonadal. Results Leptin was significantly associated with both SAT and VAT in each sex. Adjustment for SAT reduced the sex difference in leptin by 56%, but adjustment for VAT increased the difference by 25%. Leptin was not associated with serum estrone or hormone replacement therapy in the women, but had a significant, negative association with testosterone in the men that was independent of SAT, but not VAT. Leptin was significantly associated with fasting insulin in both sexes independent of age, sex hormones, sex hormone-binding globulin, VAT and SAT. Discussion Sex difference in serum leptin is partly explained by different amounts of SAT. Studies including both men and women should adjust for SAT rather than total body fat that includes VAT. The sex difference in serum leptin is not due to estrogen, but may be partly explained by testosterone. Testosterone is negatively associated with leptin in men, but the association is confounded with VAT. Leptin is associated with fasting insulin in non-diabetic elderly men and women independent of body fat, fat distribution. or sex hormones.

OBJECTIVE: To test the hypothesis that one-leg balance is a significant predictor of falls and injurious falls. DESIGN: Analysis of data from a longitudinal cohort study. SUBJECTS: Healthy, community-living volunteers older than age 60 enrolled in the Albuquerque Falls Study and followed for 3 years (N = 316; mean age 73 years). MAIN OUTCOME MEASURES: Falls and injurious falls detected via reports every other month. INDEPENDENT VARIABLES: Baseline measures of demographics, history, physical examination, Iowa Self Assessment Inventory, balance and gait assesessment, and one-leg balance (ability to stand unassisted for 5 seconds on one leg). RESULTS: At baseline, 84.5% of subjects could perform one-leg balance. (Impairment was associated with older age and gait abnormalities.) Over the 3-year follow-up, 71% experienced a fall and 22% an injurious fall. The only independent significant predictor of all falls using logistic regression was age greater than 73. However, impaired one-leg balance was the only significant independent predictor of injurious falls (relative risk: 2.13; 95% CI: 1.04, 4.34;P = .03). CONCLUSION: One-leg balance appears to be a significant and easy-to-administer predictor of injurious falls, but not of all falls. In our study, it was the strongest individual predictor. However, no single factor seems to be accurate enough to be relied on as a sole predictor of fall risk or fall injury risk because so many diverse factors are involved in falling.

Several cross-sectional studies have shown a decline in alcohol intake with increasing age. Longitudinal studies have failed to confirm this trend, which suggests that cohort effects may account for the reported decline. To address this, both cross-sectional and longitudinal analyses of alcohol use in 270 healthy elderly persons over a seven-year period (1980-1987) were performed. Alcohol consumption was assessed by three-day diet records. One hundred sixty-five subjects (61.1%) remained in the study until 1987; 143 (53%) completed diet records for every year. Longitudinal analysis showed a statistically significant decline in the percent of subjects consuming any alcohol over time (slope = -2% per year; 95% confidence interval -2.8, -1.1%). A cross-sectional analysis of the 1980 data revealed a similar decline in percent drinkers with increasing age (slope = -2.7% per year; 95% confidence interval -4.4, -1.1%). Mean alcohol intake for those who continued to drink did not change over time except among heavy drinkers (consumption of greater than 30 g per day in 1980), who did show a significant decline in mean alcohol intake (P = .02). Thus, in our population the decline in percent of drinkers with age found by a cross-sectional analysis was confirmed in longitudinal analyses, suggesting that this represents a true age-related decline rather than a cohort effect. Language: en

Changes in body composition are known to occur with old age, but there is limited knowledge of the normal values rates of change in anthropometric indices of body composition or the distribution of these changes in the elderly. In the present study, 98 elderly white men and 122 elderly white women were followed prospectively for 6 years. These participants were divided into 5-years cohorts on the basis of age at the start of the study in 1980. Separate linear regressions of triceps skinfold thickness, midarm circumference, midarm muscle area, and weight divided by stature squared on age were computed for each participant. The mean annual changes or slopes for these indices were small for each sex. A loss of subcutaneous adipose tissue was indicated with age, but the effects of compression or measurement error may hamper the detection of changes in indices of body composition in the elderly.

Depletion of body iron stores is a major factor limiting regular blood donations by menstruating females. To determine if regular iron supplementation would solve this problem, we conducted a double-blind study in which menstruating female donors were randomly placed into one of three groups: one taking 39 mg elemental iron, a second taking 39 mg of iron plus 75 mg vitamin C, and a third taking 100 mg vitamin C daily. The women were requested to donate every 8 weeks for at least 1 year. Blood samples were taken on each donation for measurements of hemoglobin, total iron binding capacity (TIBC), and ferritin. In the two groups taking iron supplements hemoglobin and ferritin increased from baseline values and the TIBC decreased. The vitamin C control group showed decreases from baseline for hemoglobin and ferritin and increases in TIBC. Differences between groups taking iron supplements and the group not taking supplements were highly significant. Drop-out from the study was due to various causes; however, iron intolerance was uncommon. Minimal daily iron supplementation was beneficial in maintaining body iron stores and hemoglobin levels in menstruating females on a schedule of blood donation as often as every 8 weeks.

Iron status was determined in 280 free-living and healthy elderly men (n = 131) and women (n = 149) by assessing dietary and supplemental iron intake as well as ten biochemical measures of iron nutriture (erythrocyte count, hemoglobin level, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, plasma iron level, total iron-binding capacity, per cent transferrin saturation, and ferritin level). Subject ages ranged from 60 to 93 years with a median age of 72 years for both women and men. For comparison purposes, iron status measures in an unselected group of younger men (n = 107) and women (n = 164) between the ages of 20 and 39 years were also obtained. None of the elderly women and only two (1.2 per cent) of the younger women had low hemoglobin levels (less than 12.0 g/dl). Three (2.3 per cent) of the elderly men and none of the younger men had low hemoglobin levels (less than 14 g/dl). Other iron status measures revealed that anemia or iron deficiency was no more prevalent in the healthy elderly population than in the younger adult population when identical criteria were used to assess iron nutriture. The genesis of anemia often seen in the elderly is not completely understood. Reported evidence suggests the presence of anemia in the elderly is a result of overall reduction of hematopoietic reserves. Because of the potentially serious consequences of this assumption about anemia to the treatment of the elderly, the authors critically review some of the studies that have been designed in the past to determine the prevalence and etiology of anemia in the aged. They suggest that health status, race, socioeconomic status, diet, and region are more important than age as explanations for the high prevalence of anemia seen in many previous studies.

We have not employed a rigid statistical interpretation of the data in this report because, as Botwinick and Arenberg pointed out, the time span of a study (if short enough) and the number of independent observations (if small enough) can affect statistical significance. In the present study, the time span was only 6 years, and the males, as well as the females, were grouped into a single age cohort. These limitations do not allow us to assess true time effects. Nevertheless, we attributed the differences noted between the cross-sectional and longitudinal slopes to a time effect, that is, to a secular trend, over the span of the study. This conclusion was based on the following line of reasoning: First, we assumed that there were no significant cohort effects in the population considered in the present study. This assumption was supported by results from the Baltimore Longitudinal Study of Aging, where no cohort effects were found. (In the Baltimore study, 180 males were followed over a period of 15 years, and the age range covered 40 years.) Second, we documented evidence that the participants in the present study actively limited their cholesterol and fat intake because of their keen awareness of an association between cholesterol intake and coronary heart disease as reported in the lay press over the past 10 years. In the healthy male population considered in the present study, we determined that there was a decrease in daily energy intake of approximately 12 kcal/year. We based this determination on the average of the cross-sectional analysis as we attributed much of the negative effect noted in the longitudinal analysis, as stated above, to a secular trend. Aging had a much lower negative effect on energy intake in the female population, being approximately 4 kcal/year. The decrease in protein intake with age was higher in males (1.1 g/day/year) than in females (0.6 g/day/year). This finding parallels the large negative effect of aging in energy intake noted for males compared with females. The same sex difference was noted for carbohydrate intake between males and females (-0.4 and -0.2 g/day/year, respectively). The cross-sectional findings for fat intake are unremarkable for the males (no change) as well as for the females (only -0.1 g/day/year).(ABSTRACT TRUNCATED AT 250 WORDS)