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Lifestyle risk factors are important precursors of old age disease and disability, and the population level impact of these factors likely differs across countries that vary in their economic growth and the attributes of the populations that adopt and abandon unhealthy lifestyles. This paper describes the stage of “lifestyle transition” among older adults in two countries with vastly different trajectories of socio-economic development. A series of hypotheses are proposed on the socioeconomic patterns of health risk factors that would be expected in the two countries, given their economic circumstances and the historical timing of policy interventions that were initiated to mitigate lifestyle risks in these populations. The paper compares the prevalence of smoking tobacco, drinking alcohol, obesity, and lack of physical exercise, as well as the socioeconomic and demographic covariates of these risk factors, among adults aged 55 and older in Mexico and the United States. The findings indicate that smoking- and physical-activity-related transitions toward healthier lifestyles are well under way among older adults in the United States but not in Mexico, whereas a trend toward reduced levels of obesity has just begun in the United States but not in Mexico. There is no evidence of a transition in heavy alcohol drinking in either country among older adults. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is the most common type of senile dementia, characterized by cognitive deficits related to degeneration of cholinergic neurons. The first anti-Alzheimer drugs approved by the Food and Drug Administration were the cholinesterase inhibitors (ChEIs), which are capable of improving cholinergic neurotransmission by inhibiting acetylcholinesterase. The most common ChEIs used to treat cognitive symptoms in mild to moderate AD are rivastigmine, galantamine, and donepezil. In particular, the lattermost drug has been widely used to treat AD patients worldwide because it is significantly less hepatotoxic and better tolerated than its predecessor, tetrahydroaminoacridine. It also demonstrates high selectivity towards acetylcholinesterase inhibition and has a long duration of action. The formulations available for donepezil are immediate release (5 or 10 mg), sustained release (23 mg), and orally disintegrating (5 or 10 mg) tablets, all of which are intended for oral-route administration. Since the oral donepezil therapy is associated with adverse events in the gastrointestinal system and in plasma fluctuations, an alternative route of administration, such as the transdermal one, has been recently attempted. The goal of this paper is to provide a critical overview of AD therapy with donepezil, focusing particularly on the advantages of the transdermal over the oral route of administration. [ABSTRACT FROM AUTHOR]

U.S. state and local governments have increasingly adopted restrictions on smoking in public places. This paper analyzes nationally representative databases, including the Nationwide Inpatient Sample, to compare short‐term changes in mortality and hospitalization rates in smoking‐restricted regions with control regions. In contrast with smaller regional studies, we find that smoking bans are not associated with statistically significant short‐term declines in mortality or hospital admissions for myocardial infarction or other diseases. An analysis simulating smaller studies using subsamples reveals that large short‐term increases in myocardial infarction incidence following a smoking ban are as common as the large decreases reported in the published literature. © 2010 by the Association for Public Policy Analysis and Management. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age in the United States. Moreover, RSV is being recognized more often as a significant cause of respiratory illness in older adults. Although RSV has been studied both clinically and in vitro, a quantitative understanding of the infection dynamics is still lacking. In this paper, we study the effect of uncertainty in the main parameters of a viral kinetics model of RSV. We first characterize the RSV replication cycle and extract parameter values by fitting the mathematical model to in vivo data from eight human subjects. We then use Monte Carlo numerical simulations to determine how uncertainty in the parameter values will affect model predictions. We find that uncertainty in the infection rate, eclipse phase duration, and infectious lifespan most affect the predicted dynamics of RSV. This study provides the first estimate of in vivo RSV infection parameters, helping to quantify RSV dynamics. Our assessment of the effect of uncertainty will help guide future experimental design to obtain more precise parameter values. [ABSTRACT FROM AUTHOR]

The article discusses research being done on screening for thyroid disease. It references a study by M. Helfand and C. C. Redfern published in a 1998 issue of the "Annals of Internal Medicine." The paper evaluated researches of office-based and population-based screening for thyroid dysfunction in persons older than 40 years. The research paper was written to support the position of the American College of Physicians on screening patients not suspected of having thyroid disease. The design and validity of the study are described in this article. The results of this study are also highlighted.

Background: Many older adults living with dementia have not been formally diagnosed. Even when clinicians document the diagnosis, patients and families may be unaware of the diagnosis. Knowledge of how individual characteristics affect detection and awareness of dementia is limited.Objective: To identify characteristics associated with dementia diagnosis and awareness of diagnosis.Design: Cross-sectional observational study.Participants: Five hundred eighty-five adults aged ≥ 65 in the National Health and Aging Trends Study who met assessment-based study criteria for probable dementia in 2011 and had 3 years of continuous, fee-for-service Medicare claims prior to 2011.Main Measures: Using multivariable logistic regression, we compared participants with undiagnosed versus diagnosed dementia (based on Medicare claims) on demographic, social/behavioral, functional, medical, and healthcare utilization characteristics. Among those diagnosed, we compared characteristics of participants unaware versus aware of the diagnosis (based on self or proxy report).Key Results: Among older adults with probable dementia, 58.7% were either undiagnosed (39.5%) or unaware of the diagnosis (19.2%). In adjusted analyses, individuals who were Hispanic (OR 2.48, 95% CI 1.19, 5.14), had less than high school education (OR 0.54 for at least high school education, 95% CI 0.32, 0.91), attended medical visits alone (OR 1.98, 95% CI 1.11, 3.51), or had fewer functional impairments (OR 0.79 for each impairment, 95% CI 0.69, 0.90) were more likely to be undiagnosed. Similarly, among those diagnosed, having less education (OR 0.42), attending medical visits alone (OR 1.97), and fewer functional impairments (OR 0.72) were associated with unawareness of diagnosis (all ps < 0.05).Conclusions: The majority of older adults with dementia are either undiagnosed or unaware of the diagnosis, suggesting shortcomings in detection and communication of dementia. Individuals who may benefit from targeted screening include racial/ethnic minorities and persons who have lower educational attainment, any functional impairment, or attend medical visits alone. [ABSTRACT FROM AUTHOR]

Objectives: This study examines changes in functional and activity limitations 1998–2012 for individuals 55–69. Methods: Logistic models are used to estimate trends in limitations in vision, hearing, physical and cognitive functioning, IADLs, and ADLs. Additional models assess the extent to which trends are associated with and differ by education, smoking, and BMI. Results: Changes in prevalence of limitations in vision, hearing, cognitive functioning, and ADLs are not statistically significant. Limitations in physical functioning declined by 0.37% per year. IADL limitations increased by 1.33% per year, but most of the increase occurred between 2008 and 2010/2012, and are associated with economic hardship during the Great Recession. Increases in education are especially beneficially associated with trends in limitations, but reductions in smoking also appear to be advantageous for some outcomes. Increases in BMI are associated with trends in physical functioning, IADL, and ADL limitation. Discussion: For Americans 55–69, functional and activity limitations were largely unchanged 1998–2012. Our results suggest that if educational attainment had not increased, most functional and activity limitations potentially could have worsened substantially. Future change in educational attainment is not expected to be so positive. Continued monitoring of trends in activity limitations might well include greater focus on the explanatory roles of environmental factors, including economic circumstances. [ABSTRACT FROM AUTHOR]

Background Back pain represents a substantial burden globally, ranking first in a recent assessment among causes of years lived with disability. Though back pain is widely studied among working age adults, there are gaps with respect to basic descriptive epidemiology among seniors, especially in the United States. Our goal was to describe how pain, function and healthrelated quality of life vary by demographic and geographic factors among seniors presenting to primary care providers with new episodes of care for back pain. Methods We examined baseline data from the Back pain Outcomes using Longitudinal Data (BOLD) registry, the largest inception cohort to date of seniors presenting to a primary care provider for back pain. The sample included 5,239 patients ⩾ 65 years old with a new primary care visit for back pain at three integrated health systems (Northern California Kaiser-Permanente, Henry Ford Health System [Detroit], and Harvard Vanguard Medical Associates [Boston]). We examined differences in patient characteristics across healthcare sites and associations of patient sociodemographic and clinical characteristics with baseline patient-reported measures of pain, function, and health-related quality of life. Results Patients differed across sites in demographic and other characteristics. The Detroit site had more African-American patients (50%) compared with the other sites (7-8%). The Boston site had more college graduates (68%) compared with Detroit (20%). Female sex, lower educational status, African-American race, and older age were associated with worse functional disability as measured by the Roland-Morris Disability Questionnaire. Except for age, these factors were also associated with worse pain. Conclusions Baseline pain and functional impairment varied substantially with a number of factors in the BOLD cohort. Healthcare site was an important factor. After controlling for healthcare site, lower education, female sex, African-American race, and older age were associated with worse physical disability and all of these factors except age were associated with worse pain. [ABSTRACT FROM AUTHOR]

Background: Testosterone levels naturally decline with age in men, often resulting in testosterone deficiency (hypogonadism). However, few studies have examined hypogonadal characteristics and treatment in older (⩾65 years) men. Objective: To compare data at baseline and after 12 months of testosterone replacement therapy (TRT) in hypogonadal men ⩾65 vs ,65 years old. Data for participants 65-74 vs ⩾75 years old were also compared. Methods: Data were from TRiUS (Testim Registry in the United States), which enrolled 849 hypogonadal men treated with Testim® 1% (50-100 mg testosterone gel/day) for the first time. Anthropometric, laboratory, and clinical measures were taken at baseline and 12 months, including primary outcomes of total testosterone (TT), free testosterone (FT), and prostate-specific antigen (PSA) levels. Comparisons of parameters were made using Fisher's exact test or analysis of variance. Nonparametric Spearman's ρ and first-order partial correlation coefficients adjusted for the effect of age were used to examine bivariate correlations among parameters. Results: Of the registry participants at baseline with available age information, 16% (133/845) were ⩾65 years old. They were similar to men ,65 years old in the duration of hypogonadism prior to enrollment (∼1 year), TT and FT levels at baseline, TT and FT levels at 12-month follow-up, and in reported compliance with treatment. Older patients were more likely to receive lower doses of TRT. PSA levels did not statistically differ between groups after 12 months of TRT (2.18 ± 2.18 ng/mL for ⩾65 vs 1.14 ± 0.84 ng/mL for ,65 years old, P = 0.1). Baseline values for the .75-year-old subcohort were not significantly different from subcohorts aged 65-74 years and ,65 years. Conclusion: Hypogonadal men ⩾65 years old showed significant benefit from TRT over 12 months, similar to that found for hypogonadal men ,65 years old. TRT was well tolerated in older patients, successfully increased testosterone level regardless of age, and did not significantly increase PSA levels in older men [ABSTRACT FROM AUTHOR]

The article discusses a study which classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of emergency departments (ED) episodes. The study distinguished three groups of older adults which figure prominently in the use of EDs across the U.S. Findings suggest that one group affects the general capacity of the ED to provide care as they persistently present with severe episodes.

Of the estimated 5.3 million people with Alzheimer's disease in the United States, more than half would be classified as having moderate or severe disease. Alzheimer's disease is a progressive disorder with the moderate to severe stages generally characterized by significant cognitive, functional, and behavioral dysfunction. Unsurprisingly, these advanced stages are often the most challenging for both patients and their caregivers/families. Symptomatic treatments for moderate to severe Alzheimer's disease are approved in the United States and include the acetylcholinesterase inhibitor donepezil and the glutamate receptor antagonist memantine. Progressive symptomatic decline is nevertheless inevitable even with the available therapies, and therefore additional treatment options are urgently needed for this segment of the Alzheimer's disease population. An immediaterelease formulation of donepezil has been available at an approved dose of 5-10 mg/d for the past decade. Recently, the United States Food and Drug Administration approved a higher-dose (23 mg/d) donepezil formulation, which provides more gradual systemic absorption, a longer time to maximum concentration (8 hours) versus the immediate-release formulation (3 hours), and higher daily concentrations. Herein, we review (1) the scientific data on the importance of cholinergic deficits in Alzheimer's disease treatment strategies, (2) the rationale for the use of higher-dose acetylcholinesterase inhibitors in patients with advanced disease, and (3) recent clinical evidence supporting the use of higher-dose donepezil in patients with moderate to severe Alzheimer's disease. [ABSTRACT FROM AUTHOR]

The article offers information on a study conducted by the author related to examine whether socioeconomic status (SES) and ethnicity/race are predictors of type 2 diabetes in older people of the U.S. it states that the study included people aged 65 or above and they were followed up to 16 years. It mentions that African Americans had lower cumulative odds of better health status over time than whites. It reports that race/ethnicity and SES were independent factors of diabetics

Purpose: the prevalence of obesity is rapidly increasing in older adults. Information is required about what interventions are effective in reducing obesity and influencing health outcomes in this age group. [ABSTRACT FROM PUBLISHER]

Health insurance characteristics shift at age 65 as most people become eligible for Medicare. We measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on weekdays and weekends. The age profiles of admissions and comorbidities for these patients are smooth at age 65, suggesting that the severity of illness is similar on either side of the Medicare threshold. In contrast, the number of procedures performed in hospitals and total list charges exhibit small but statistically significant discontinuities, implying that patients over 65 receive more services. We estimate a nearly 1-percentage-point drop in 7-day mortality for patients at age 65, equivalent to a 20% reduction in deaths for this severely ill patient group. The mortality gap persists for at least 9 months after admission. [ABSTRACT FROM AUTHOR]

Background and Objectives: Older African Americans are often under diagnosed and under treated for depression. Given that older African Americans are more likely than whites to identify spirituality as important in depression care, we sought to understand how spirituality may play a role in the way they conceptualize and deal with depression in order to inform possible interventions aimed at improving the acceptability and effectiveness of depression treatment.Design: Cross-sectional qualitative interview study of older African American primary care patients.Participants and Setting: Forty-seven older African American patients recruited from primary care practices in the Baltimore, MD area, interviewed in their homes.Measurements: Semi-structured interviews lasting approximately 60 minutes. Interviews were transcribed and themes related to spirituality in the context of discussing depression were identified using a grounded-theory approach.Main Results: Participants in this study held a faith-based explanatory model of depression with a particular emphasis on the cause of depression and what to do about it. Specifically, participants described depression as being due to a "loss of faith" and faith and spiritual/religious activities were thought to be empowering in the way they can work together with medical treatments to provide the strength for healing to occur.Conclusions: The older African Americans in this study described an intrinsically spiritual explanatory model of depression. Addressing spirituality in the clinical encounter may lead to improved detection of depression and treatments that are more congruent with patient's beliefs and values. [ABSTRACT FROM AUTHOR]

The article offers update on geriatric medicine in the U.S. It mentions that common geriatric conditions do not have well-evidenced detection strategies or treatments. It highlights recent key articles that have the potential to immediately improve or affect office practice by general internists. Moreover, it presents several studies of diseases including dementia, mobility problems, and osteoarthritis.

Objectives. We sought to determine whether an elevated burden of chronic kidney disease is found among disadvantaged groups living in the United States, Australia, and Thailand. Methods. We used data on participants 35 years or older for whom a valid serum creatinine measurement was available from studies in the United States, Thailand, and Australia. We used logistic regression to analyze the association of income, education, and employment with the prevalence of chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m²). Results. Age- and gender-adjusted odds of having chronic kidney disease were increased 86% for US Whites in the lowest income quartile versus the highest quartile (odds ratio [OR] = 1.86; 95% confidence interval [CI] = 1.27, 2.72). Odds were increased 2 times and 6 times, respectively, among unemployed (not retired) versus employed non-Hispanic Black and Mexican American participants (OR = 2.89; 95% CI = 1.53, 5.46; OR = 6.62; 95% CI = 1.94, 22.64. respectively). Similar associations were not evident for the Australian or Thai populations. Conclusions. Higher kidney disease prevalence among financially disadvantaged groups in the United States should be considered when chronic kidney disease prevention and management strategies are created. This approach is less likely to be of benefit to the Australian and Thai populations. [ABSTRACT FROM AUTHOR]

Some 20 million Americans over the age of 60 will soon be obese. As a result, they will likely suffer lower life-expectancy, higher disability, and higher health care costs. How much time do physicians spend with elders, especially obese elders, in helping them plan weight loss? This study, which analyzed 352 videotaped visits with elderly patients and their provider, has found that only a third of the visibly obese patients were counseled, and that the average time spent discussing the subject - if discussed - was 103 seconds. This is probably less than a fifth of the time needed to adequately counsel patients about weight loss. In addition, the study has found that both provider and patient characteristics determine if and how long discussion lasts. [ABSTRACT FROM AUTHOR]

The article presents information on several studies on age-related macular degeneration (AMD). According to the article, AMD is the most common cause of blindness in later life and affects a number of people in the U.S. Genetic linkage studies found that a locus on the long arm of Chromosome 1 was involved in the pathogenesis of AMD.

Background: Population heterogeneity may be a significant confounding factor hampering detection and verification of late onset Alzheimer's disease (LOAD) susceptibility genes. The Amish communities located in Indiana and Ohio are relatively isolated populations that may have increased power to detect disease susceptibility genes. Methods: We recently performed a genome scan of dementia in this population that detected several potential loci. However, analyses of these data are complicated by the highly consanguineous nature of these Amish pedigrees. Therefore we applied the Combinatorial Mismatch Scanning (CMS) method that compares identity by state (IBS) (under the presumption of identity by descent (IBD)) sharing in distantly related individuals from such populations where standard linkage and association analyses are difficult to implement. CMS compares allele sharing between individuals in affected and unaffected groups from founder populations. Comparisons between cases and controls were done using two Fisher's exact tests, one testing for excess in IBS allele frequency and the other testing for excess in IBS genotype frequency for 407 microsatellite markers. Results: In all, 13 dementia cases and 14 normal controls were identified who were not related at least through the grandparental generation. The examination of allele frequencies identified 24 markers (6%) nominally (p ≤ 0.05) associated with dementia; the most interesting (empiric p ≤ 0.005) markers were D3S1262, D5S211, and D19S1165. The examination of genotype frequencies identified 21 markers (5%) nominally (p ≤ 0.05) associated with dementia; the most significant markers were both located on chromosome 5 (D5S1480 and D5S211). Notably, one of these markers (D5S211) demonstrated differences (empiric p ≤ 0.005) under both tests. Conclusion: Our results provide the initial groundwork for identifying genes involved in late-onset Alzheimer's disease within the Amish community. Genes identified within this isolated population will likely play a role in a subset of lateonset AD cases across more general populations. Regions highlighted by markers demonstrating suggestive allelic and∕or genotypic differences will be the focus of more detailed examination to characterize their involvement in dementia. [ABSTRACT FROM AUTHOR]

Objective: To estimate all-cause hospitalizations, nursing home admissions, and deaths attributable to diabetes using a new methodology based on longitudinal data for a representative sample of older U.S. adults.Research Design and Methods: A simulation model, based on data from the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Followup Study, was used to represent the natural history of diabetes and control for a variety of baseline risk factors. The model was applied to 6,265 NHANES III adults aged 45-74 years. The prevalence of risk factors in NHANES III, fielded in 1988-1994, better represents today's adults.Results: For all NHANES III adults aged 45-74 years, a diagnosis of diabetes accounted for 8.6% of hospitalizations, 12.3% of nursing home admissions, and 10.3% of deaths in 1988-1994. For people with diabetes, diabetes alone was responsible for 43.4% of hospitalizations, 52.1% of nursing home admissions, and 47% of deaths. Adjusting for related cardiovascular conditions, which may provide more accurate estimates of attributable risks for people with diabetes, increased these estimates to 51.4, 57.1, and 56.8%, respectively.Conclusions: Risks of institutionalization and death attributable to diabetes are large. Efforts to translate recent trials of primary prevention into practice and continued efforts to prevent complications of diabetes could have a substantial impact on hospitalizations, nursing home admissions, and deaths and their societal costs. [ABSTRACT FROM AUTHOR]

Introduction: socio-economic differences in mobility disability prevalence in old age have been reported from the US and Europe. Brazil is characterised by gross socio-economic inequalities, but there have been no previous national data on disability prevalence. Aim: this study aimed to estimate disability rates and explore associations identifying the most significant socio-economic markers associated with mobility disability prevalence in old age in Brazil. Subjects and methods: a nationally representative sample of 28,943 people aged 60 years or over was interviewed, in the 1998 National Household Survey (PNAD), conducted by the Brazilian Institute of Geography and Statistics. Results: the prevalence rates of markers of mild, moderate and severe disability were higher in women than men, and increased with age. Prevalence rates of difficulty with personal care and medium distance walking were broadly similar to England, but far more Brazilians reported difficulty climbing stairs. In logistic regression analyses, the strongest markers associated with increased mobility disability prevalence were age, gender, lack of education and low income. Rural residence was also associated with reduced prevalence. Limited differences by region were present, and there were mixed effects for self-reported racial group for women. Conclusions: disability in the older population of Brazil shows familiar prevalence patterns by age and gender. Disparity in income and educational attainment in Brazil are the most important markers associated with group differences in mobility disability prevalence in old age. [ABSTRACT FROM AUTHOR]

The authors evaluated underascertainment bias in Hispanic mortality rates from population surveys linked to the US National Death Index (NDI). They compared vital status through 7 years ascertained from an NDI search and from active follow-up for 2,886 Mexican-American subjects, aged ≥65 years at baseline in 1993–1994, from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE). Estimates of NDI underascertainment were applied to mortality rate ratios for 66,667 older Mexican Americans and non-Hispanic Whites from the 1986–1994 National Health Interview Surveys linked to the NDI. The NDI and active follow-up agreed on vital status for 91.2% of Hispanic EPESE subjects. The NDI did not identify 177 deaths (20.7%) reported by proxies. Underascertainment was greater for women and when stratified by age and nativity. The ratios of proxy-reported to NDI mortality rates were 1.31 (95% confidence interval (CI): 1.06, 1.62) for immigrant men and 1.65 (95% CI: 1.32, 2.08) for immigrant women. Before adjustment, National Health Interview Surveys–NDI age-standardized mortality rate ratios comparing Mexican Americans with non-Hispanic Whites were 0.77 (95% CI: 0.65, 0.92) for men and 0.92 (95% CI: 0.77, 1.09) for women but were 0.84 and 1.18, respectively, with adjustment for underascertainment. Findings suggest that NDI-based Hispanic mortality rates may be understated. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a common and frequently disabling problem in older adults. Clinical guidelines emphasize the need to use multimodal therapies to manage persistent pain in this population. Pain self-management training is a multimodal therapy that has been found to be effective in young to middle-aged adult samples. This training includes education about pain as well as instruction and practice in several management techniques, including relaxation, physical exercise, modification of negative thoughts, and goal setting. Few studies have examined the effectiveness of this therapy in older adult samples. Methods/Design: This is a randomized, controlled trial to assess the effectiveness of a pain self-management training group intervention, as compared with an education-only control condition. Participants are recruited from retirement communities in the Pacific Northwest of the United States and must be 65 years or older and experience persistent, noncancer pain that limits their activities. The primary outcome is physical disability, as measured by the Roland-Morris Disability Questionnaire. Secondary outcomes are depression (Geriatric Depression Scale), pain intensity (Brief Pain Inventory), and pain-related interference with activities (Brief Pain Inventory). Randomization occurs by facility to minimize cross-contamination between groups. The target sample size is 273 enrolled, which assuming a 20% attrition rate at 12 months, will provide us with 84% power to detect a moderate effect size of .50 for the primary outcome. Discussion: Few studies have investigated the effects of multimodal pain self-management training among older adults. This randomized controlled trial is designed to assess the efficacy of a pain self-management program that incorporates physical and psychosocial pain coping skills among adults in the mid-old to old-old range. [ABSTRACT FROM AUTHOR]

I argue that the shift from manual to white-collar jobs and reduced exposure to infectious disease were important determinants of declines in chronic disease rates among older men from the early 1900s to the 1970s and 1980s. The average decline in chronic respiratory problems, valvular heart disease, arteriosclerosis, and joint and back problems was about 66%. Occupational shifts accounted for 29% of the decline; the decreased prevalence of infectious disease accounted for 18%; the remainder are unexplained. The duration of chronic conditions has remained unchanged since the early 1900s, but when disability is measured by difficulty in walking, men with chronic conditions are less disabled now than they were in the past. [ABSTRACT FROM AUTHOR]

Reviews literature concerning the changing epidemiology of AIDS among elderly in the United States. Report from the Centers for Disease Control and Prevention before 1989; Morbidity and mortality; Treatment and prevention.

A letter to the editor in response to the article "Ambient Air Pollution and Hospitalization for Congestive Heart Failure Among Elderly People in Seven Large US cities," by R. D. Morris, E. N. Naumova and R. L. Munasinghe and a response by Morris, Naumova and Munasinghe are presented.

As based on Bureau of the Census population projections and age-specific cancer incidence rates for 1985 to 1989 from the National Cancer Institute's Surveillance, Epidemiology and End Results program, the number of incident cancers diagnosed annually in the United States among persons aged 65 and over is projected to reach 1.5 million by the year 2030, or 2.4 times the number estimated for 1990. These projections, which may be conservative because birth cohort patterns (based on Connecticut rates) suggest possible future increases in incidence rates for ail cancer sites combined, have implications for planning expanded primary prevention efforts, such as smoking cessation (especially for women) and dietary modification programs, and for projecting health care needs and costs. [ABSTRACT FROM AUTHOR]

The article presents information on a study about the incidence of tuberculosis over the centuries in the U.S. Older people dying of tuberculosis has been a serious problem over centuries. One fourth of the people who have died from tuberculosis have been clinically diagnosed. Symptoms of tuberculosis in older people is less apparent which leads progression of the disease. The prolongation of diagnosis process heightens the risk of the disease becoming chronic. Infants, children, and youth can get infected by tubercle bacilli from tuberculosis infected cattle.

A prospective epidemiological study on a large population of elderly persons was carried out to investigate the incidence of cerebrovascular attack (stroke) and its relationship to other variables, particularly preexisting cardiovascular disease. [ABSTRACT FROM AUTHOR]

The article discusses a study that determined risk for West Nile virus (WNV) neuroinvasive disease (WNND) in North Dakota by testing plasma samples from blood donors for WNV immunoglobulin G (IgG). Infection rates were compared with reported WNV neuroinvasive disease incidence. It is estimated that 1 in 244 WNV infections develops into neuroinvasive disease and that risk is significantly increased among men and the elderly. It is also estimated that a total of almost 45,000 WNV infections occurred in North Dakota from its 1999 introduction to the U.S. through 2008.

To estimate the prevalence of carpal tunnel syndrome among US adults, data from the Occupational health Supplement of the 1988 National Health Interview Survey were analyzed. Based on a sample of 44 233 households (response rate, 91.5%). an estimated 1.55% (2.65 million) of 170 million adults self reported carpal tunnel syndrome in 1988. Females and Whites had a higher prevalence of self-reporting carpal tunnel syndrome than males and non-whites, respectively. Among 127 million adults who worked during the 12 months before the survey, 0.53% (0.68 million) reported that their "prolonged" hand discomfort was called carpal tunnel syndrome by a health care provider. [ABSTRACT FROM AUTHOR]

The article offers observation on the shortfall in hypertension control in the U.S. Hypertension remains the most prevalent medically treatable chronic condition among adult citizens, affecting more than 20 percent of the population. Low control rates reflects factors related to the population as well as to the health care delivery system. It suggests that concomitant approach to improving the quality of care may be periodic population surveys.

Data were obtained from the Health Care Financing Administration and the Department of Veterans Affairs (formerly called Veterans Administration) on all hospital discharges among the elderly population from 1984 through 1987 and combined with census estimates to calculate incidence rates of hip fracture for the elderly population of the United States. Rates for White women were the highest, reaching 35.4 per 1,000 per year among 95 year-olds, Comparably, White men, Black women, and Black men experienced similar age-related increases in risk, although of less magnitude and relatively less rate of change, respectively. [ABSTRACT FROM AUTHOR]

Obesity in middle and old age predicts mobility limitation; however, the cumulative effect of overweight and/or obesity over the adult life course is unknown. The association between overweight and/or obesity in young, middle, and late adulthood and its cumulative effect on incident mobility limitation was examined among community-dwelling US adults aged 70–79 years at baseline (1997–1998) in the Health, Aging and Body Composition Study (n = 2,845). Body mass index was calculated by using recalled weight at ages 25 and 50 years and measured weight at ages 70–79 years. Mobility limitation (difficulty walking 1/4 mile (0.4 km) or climbing 10 steps) was assessed semiannually over 7 years of follow-up and was reported by 43.0% of men and 53.7% of women. Men and women who were overweight or obese at all 3 time points had an increased risk of mobility limitation (hazard ratio = 1.61, 95% confidence interval: 1.25, 2.06 and hazard ratio = 2.85, 95% confidence interval: 2.15, 3.78, respectively) compared with those who were normal weight throughout. Furthermore, there was a significant graded response (P < 0.0001) on risk of mobility limitation for the cumulative effect of obesity in men and overweight and/or obesity in women. Onset of overweight and obesity in earlier life contributes to an increased risk of mobility limitation in old age. [ABSTRACT FROM AUTHOR]

Background: We investigated if personal socioeconomic position (SEP) factors and neighborhood characteristics were associated with incident mobility impairment in the elderly.Methods: We used data from the Cardiovascular Health Study, a longitudinal, population-based examination of coronary heart disease and stroke among persons aged 65 and older in the United States.Results: Among 3,684 persons without baseline mobility impairment, lower baseline SEP was associated with increased risk of incident mobility disability during the 10-year follow-up period, although the strengths of these associations varied by socioeconomic indicator and race/sex group.Conclusion: Among independent-living elderly, SEP affected development of mobility impairment into later life. Particular effort should be made to prevent or delay its onset among the elderly with low income, education, and/or who live in economically disadvantaged neighborhoods. [ABSTRACT FROM AUTHOR]

The article reports on the National Institute of Aging's announcement of funding for three Alzheimer's Disease Research Centers in the United States. The purpose of the program is to improve research on Alzheimer's disease by providing the resources and environment for collaborative, multidisciplinary studies. As part of the initiative, the centers will train scientists and health care professionals and offer consultation and education to Alzheimer patients and their families. The locations of the research centers are provided.