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Background: Current information on the epidemiology of physical inactivity among older adults is lacking, making it difficult to target the inactive and to plan for interventions to ameliorate adverse effects. Objectives: To present statewide representative findings on the prevalence of physical inactivity among older community residents, its correlates and associated health service use. Methods: A representative non-institutionalized random sample of 6963 individuals in Rio Grande do Sul, Brazil, aged ≥60 years, was interviewed face-to-face. Information was obtained on demographic characteristics, social resources, health conditions and behaviors, health service use, and physical inactivity. Controlled logistic regression was used to determine the association of physical inactivity with these characteristics. Results: Overall, 62% reported no regular physical activity. Physical inactivity was significantly more prevalent among women, older persons, those with lower education and income, Afro-Brazilians (73%; White: 61%; “other”: 64%), those no longer married, and was associated with multiple individual health conditions and impaired activities of daily living (ADL). In adjusted analyses, associations remained for sociodemographic characteristics, social participation, impaired self-rated health, ADL, vision, and depression (odds ratios (OR) 1.2–1.7). Physically inactive respondents were less likely to report outpatient visits (OR 0.81), but more likely to be hospitalized (OR 1.41). Conclusions: Physical inactivity is highly prevalent, particularly among Afro -Brazilians. It is associated with adverse sociodemographic characteristics; lack of social interaction; and poor self-rated health, ADL, vision, and depression; although not with other health conditions. Self-care may be neglected, resulting in hospitalization. [ABSTRACT FROM AUTHOR]

Objective: Information on dependency level of elderly in rapidly aging developing countries is limited, but this is needed to ascertain the extent of need for help with activities of daily living (ADLs). Method: In-person information was obtained in 1995 from a statewide survey of representative community residents ≥60 years of age in the state of Rio Grande do Sul, Brazil (N = 7,040), on demographic characteristics, health conditions, social ties, health behaviors, and ADL performance. Results: Nearly 40% needed help with one or more ADLs. In controlled analyses, need for help approximately doubled with each succeeding decade. Increased education and income and regular physical activity reduced risk. Selected health conditions (stroke, depression, poor self-rated health) were consistently associated with need for help. Discussion: A large proportion of noninstitutionalized elderly have ADL problems. In addition to health care, interventions promoting equity of access to education and economic opportunity could reduce ADL dependency in coming generations. [ABSTRACT FROM AUTHOR]

We examined the effects of use of low charge, integrated and comprehensive health care services (Veterans Administration (VA) health care system) on health care service use and health-related outcomes. Data came from the 10-year (1986/87-1996/97) Duke Established Populations for Epidemiologic Studies of the Elderly, with 159 men aged 65-85 who primarily used VA health services compared with 1,100 men aged 65-85 who did not. In controlled analyses, no differences were found between the two groups on number of OTC medications used, or in speed or likelihood of entering a nursing home. However, veterans who primarily used the VA health care system reported more outpatient visits and prescription drugs, and increased likelihood of using an adjunct health care provider; entry into a hospital was quicker, and number of hospitalizations was greater. Although health status was controlled, because of eligibility requirements it remains possible that veterans were sicker. Nevertheless, no differences were found in health outcome (functional status or mortality). Readier access to better integrated health services appears to result in increased use of health services controlled by the health care provider, but not of services requiring the recipient's relocation, while functional status and mortality attained equivalence. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether some health behaviors of older people (e.g., obtaining cancer screens) have a limited and others (e.g., exercise) have a broad association with population-level health status 4 to 6 years later. DESIGN: Longitudinal cohort. SETTING: North Carolina five-county urban and rural area. PARTICIPANTS: Representative community residents aged 71 and older (Duke Established Populations for Epidemiologic Studies of the Elderly; African American, n=1,256; white, n=974) who provided information on cancer screening and health behaviors. MEASUREMENTS: Demographics, health conditions, functional status, health service use, health insurance. Dependent measures were functional status and self-rated health 4 years later, hospitalization within 4 years, and death within 6 years. Data were analyzed using descriptive statistics, multivariable logistic regression, and Cox proportional hazards. RESULTS: In fully adjusted analyses, cancer screening had no significant protective association with functional status, self-rated health, hospitalization, or death. Smoking was a risk factor for hospitalization (odds ratio (OR)=1.48, 95% confidence interval (CI)=1.07–2.05), and death (hazard rate (HR)=1.81, 95% CI=1.47–2.23). Sufficient food reduced hospitalization (OR=0.38, 95% CI=0.15–0.94) and mortality (HR=0.70, 95% CI=0.49–1.02). Regular exercise protected against poor mobility (OR=0.56, 95% CI=0.41–0.77), and poor self-rated health (OR=0.61, 95% CI=0.45–0.82). Lower activity level increased the hazard of death (HR=1.18, 95% CI=1.03–1.36). CONCLUSION: Disease-specific screens are important at an individual level but, because of low incidence of condition and comorbidity, may not be associated with population-level health 4 to 6 years later. Practice of health behaviors with a broader focus is associated, at a population level, with better functional status and self-rated health and lower rates of hospitalization and death 4 to 6 years later. [ABSTRACT FROM AUTHOR]

To determine the prevalence and predictors of antidiabetic medication use over a 10-year period in a general population of African-American and white community-dwelling elderly. Survey. Five adjacent counties (one urban and four rural) in the Piedmont area of North Carolina. Those aged 65 and older present at the baseline (n=4,136), second (n=3,234), third (n=2,508), and fourth (n=1,633) in-person waves of the Duke Established Populations for Epidemiologic Studies of the Elderly. The use of six discrete categories of antidiabetic medications (insulin, first-generation oral sulfonylureas, second-generation oral sulfonylureas, metformin, oral combination therapy, and insulin combination therapy) was determined. Multivariate analyses, using weighted data adjusted for sampling design, were conducted to assess the association between antidiabetic medication use and race and other sociodemographic, health-status, and access-to-healthcare factors at baseline and 10 years later. Antidiabetic medications were taken by 21.4% of the population at baseline; this increased to 28.1% at the 10-year follow-up ( P<.001). Insulin was the most commonly used drug at baseline (7.9%). The use of second-generation sulfonylureas increased, and use of first-generation sulfonylureas decreased over the 10-year time period. Combination antidiabetic therapy and metformin use was infrequent throughout the study. Multivariate analyses revealed that, at baseline, African Americans were nearly twice as likely (adjusted odds ratio (AOR)=1.93, 95% confidence interval (CI)=1.46–2.54) to receive any antidiabetic medication as their white counterparts. Other significant ( P<.05) factors were hypertension (AOR=1.38, 95% CI=1.03–1.84), stroke (AOR=1.98, 95% CI=1.43–2.73), one or more mobility difficulties (AOR=1.29, 95% CI=1.01–1.66), continuity of care (AOR=1.74, 95% CI=1.20–2.54), and multiple doctor visits (1–4 visits, AOR=1.69, 95% CI=1.08–2.65; ≥5 visits, AOR=3.15, 95% CI=1.95–5.07). Being underweight (AOR=0.45, 95% CI=0.30–0.67) and being cognitively impaired (AOR=0.60, 95% CI=0.41–0.87) were factors significantly ( P<.05) associated with a decreased risk of antidiabetic medication use. At the 10-year follow-up, similar trends were seen associating these sociodemographic, health-status, and access-to-healthcare factors with antidiabetic medication use. Antidiabetic medication use is common and increases over time for community-dwelling elderly. Race is significantly associated with antidiabetic medication use, even after controlling for other sociodemographic, health-status, and access-to-healthcare variables. [ABSTRACT FROM AUTHOR]

Objectives: The ε4 allele of apolipoprotein E (APOE) has been associated with health-related outcomes that may adversely affect quality of life (QOL) in older adults. In the absence of published information, we sought to determine whether the ε4 allele was associated with subjective QOL across 5 parameters in a community sample of older adults. Design: Prospective cohort study. Setting: Community-based sample of older adults in North Carolina (Duke site of the Established Populations for Epidemiologic Studies of the Elderly [Duke EPESE]). Participants: Self-responding genotyped sample members (n = 1,880) of whom 1,254 provided longitudinal data. Measurements: APOE genotype and five newly constructed, reliable, and valid measures of subjective QOL derived from the Duke EPESE questionnaire. The 5 parameters measured were social, economic, mental and physical health, and functional status. Control variables included age, gender, race (African American or White), education and urban/rural residence. Results: Among those with good baseline QOL, there was no significant association between the ε4 allele and any of the parameters of subjective QOL in longitudinal analyses. In controlled longitudinal analysis, older age women predicted poorer functional status; being African American, and reporting lower education predicted poorer subjective economic well-being; and being African American predicted better self-assessed mental health. Conclusions: This study is among the first to explore the association of the ε4 allele with overall QOL. Considered from a public health perspective, these findings challenge the uncritical assumption that the presence of this susceptibility gene in the population implies an excess burden of poor QOL. The findings do not contradict the previous association of ε4 with Alzheimer's disease (AD) and other conditions. Such conditions continue to merit full attention. [ABSTRACT FROM AUTHOR]

Change in self-reported physical function was examined using baseline and 5 years of follow-up data between 1982 and 1991 from the four Established Populations for Epidemiologic Studies of the Elderly studies. In East Boston, Massachusetts (n = 3, 809), lowa and Washington Counties, lowa (n = 3, 673), New Haven, Connecticut (n = 2, 812), and North Carolina (n = 4, 163), noninstitutionalized persons aged 65 years and older were asked a series of questions to assess their physical function: a modified Katz Activities of Daily Living (ADL) scale, three items from the Rosow-Breslau Functional Health Scale, and questions on physical performance, adapted from Nagi, as well as information on demographic, social, and health characteristics. Longitudinal statistical analyses (random effects and Markov transition models) were used to evaluate improvement, stability, and deterioration in functional ability at both an individual and a population level over multiple years of data. The average decline in physical function associated with age was found to be greater than previous cross-sectional studies have suggested, and the rate of decline increased with increasing age. Considerable individual variation was evident. Although many people experienced declines, a smaller but substantial portion experienced recovery. Women reported a greater rate of decline in physical function and were less likely to recover from disability. Am J Epidemiol 1996; 143: 766–78. [ABSTRACT FROM AUTHOR]

Objectives:In high income, developed countries, health status tends to improve as income increases, but primarily through the 50th-66th percentile of income. It is unclear whether the same limitation holds in middle income countries, and for both general assessments of health and specific conditions. Methods:Data were obtained from Brazil, a middle income country. In-person interviews with a representative sample of community residents age ≥60 (N=6963), in the southern state of Rio Grande do Sul, obtained information on demographic characteristics including household income and number of persons supported, general health status (self-rated health, functional status), depression, and seven physician-diagnosed, self-reported health conditions. Analyses used household income (adjusted for number supported and economies of scale) together with higher order income terms, and controlled for demographics and comorbidities, to ascertain nonlinearity between income and general and specific health measures. Results:In fully controlled analyses income was associated with general measures of health (linearly with self-rated health, nonlinearly with functional status). For specific health measures there was a consistent linear association with depression, pulmonary disorders, renal disorders, and sensory impairment. For musculoskeletal, cardiovascular (negative association), and gastrointestinal disorders this association no longer held when comorbidities were controlled. There was no association with diabetes. Conclusion:Contrary to findings in high income countries, the association of household-size-adjusted income with health was generally linear, sometimes negative, and sometimes absent when comorbidities were controlled. [ABSTRACT FROM AUTHOR]