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Background. To ascertain accuracy of self-reported height, weight (and hence body mass index) in African American and white women and men older than 70 years of age. Method. The sample consisted of cognitively intact participants at the third in-person wave (1992-1993) of the Duke Established Populations for Epidemiologic Studies of the Elderly (age 71 and older, N = 1761; residents of five adjacent counties, one urban, four rural). During in-person, in-home interviews using trained interviewers, height and weight were self-reported (and measured later in the same visit using a standardized protocol), and information were obtained on race, sex, and age. Results. Accuracy of self-reported height and weight was high (intraclass correlation coefficient 0.85 and 0.97, respectively) but differed as a function of race and age. On average, all groups overestimated their height; whereas (non-Hispanic) white men and women underestimated their weight, African Americans overestimated their weight. Overestimation of height and weight was more marked in persons 85 years and older. Specificity for overweight (body mass index [kg/ [m.sup.2]] [greater than or equal to] 25) and obesity (body mass index [greater than or equal to] 30) ranged from 0.90 to 0.99 for African Americans and whites, but sensitivity was better for African Americans (overweight: 0.81, obesity: 0.89), than for whites (0.66 and 0.57, respectively). Conclusions. Height and weight self-reported by African Americans and whites over the age of 70 can be used in epidemiological studies, with greater caution needed for self-reports of whites, and of persons 85 years of age or older. Key Words: Height--Weight--Body mass index--Elderly--African American. doi: 10.1093/gerona/glq096

Purpose: The aim of this study was to ascertain whether the determinants of death differ as a function of type of analysis in a representative sample of older African American and White people with comparable mortality rates. Design and Methods: Participants included all African American (n = 2,261) and White (n = 1,875) people at the Duke site of the Established Populations for Epidemiological Studies of the Elderly. Baseline information used to predict mortality 12 years later included demographic, health, and functional characteristics. Mortality (55% for African American people and 54% for White people) was determined through the National Death Index. Cox proportional hazards models, logistic regression, and tree-based classification analysis were used (separately for African American and White people) to identify risk factors for mortality. Results: Risk factors for mortality were comparable, but the constellation of characteristics indicating higher risk for death differed between African American and White people. Implications: Proportional hazards and logistic regression identified risk factors in general; tree-based classification models identified the characteristics of groups at risk. The analysis used may influence the type and manner of intervention. Key Words: Proportional hazards models, Logistic regression, Classification tree analysis, Racial differences

Background. Few studies have examined the relationship of race to falls. This study evaluated the association between potential risk factors and falls in a representative sample of 1049 African American and 1947 white participants of the second in-person wave of the Duke Established Populations for Epidemiologic Studies of the Elderly. Methods. Information about sociodemographic characteristics, health-related behaviors, health status, visual function, and drug use was determined during baseline in-home interviews. Three years later, falls in the previous 12 months were assessed by self-report. Results. One or more falls occurred in 22.2% of the participants. Nearly half the fallers reported more than one fall. Multivariable analysis revealed that African Americans were less likely than whites to have any fall (adjusted odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62-0.94). Increased age and education, arthritis, diabetes, and history of broken bones were also significant (p < .05) independent risk factors for any fall. In multivariable analyses comparing those with two or more falls to those with none, again, increased age and education, arthritis, and diabetes were significant (p < .05) independent risk factors while smoking was protective. Race was not a significant predictor of multiple falls (adjusted OR 0.90, 95% CI 0.64-1.26). Conclusions. Similar sociodemographic characteristics and health problems appear to be important risk factors for any and multiple falls in community-dwelling African American and white elderly residents, with white elders at greater risk of one-time falls.

Purpose: The goal of this study was to determine whether the [epsilon]4 allele of apolipoprotein E is predictive of mortality in a community-based sample. Design and Methods: Of the stratified random household sample of 4,162 participants age 65 years and older enrolled in the Duke site of the Established Populations for Epidemiologic Studies of the Elderly, those included in the present study were the 1,998 who were genotyped for apolipoprotein E (alleles [epsilon]2, [epsilon]3, and [epsilon]4) six years after baseline, and for whom survival status eight years later was known by search of the National Death Index. Information on demographic characteristics, physical and mental health status, functional status, and health services use was determined by structured questionnaires administered in person in the home. Results: The [epsilon]4 allele did not predict mortality for the group as a whole, or for those who were cognitively impaired. It did predict mortality for those who reported having had a heart attack or stroke. Implications: The apolipoprotein [epsilon]4 allele--although a risk factor for Alzheimer's disease, heart disease, and stroke--was only found to be a risk factor for mortality for those community residents who had had a heart attack or stroke. Otherwise, for this community-based sample, 71 years of age and older, it did not predict time to death and was not a risk factor for mortality. Key Words: Apolipoprotein E, Mortality, Race, African American, White

Objectives. This study examines the relationship between the lack of private supplemental health insurance coverage and the development of disability among adults aged 65 and olden Methods. Data are from the baseline and six follow-up waves of the Duke Established Populations for Epidemiologic Studies of the Elderly survey (N = 4,000). Discrete-time hazard models were used to estimate the impact of insurance coverage and other risk factors on the incidence of disability among those unimpaired at baseline. Results. Controlling for education, income, and other potential confounders, the odds of developing disability were 35-49% higher among those without private coverage. Insurance coverage also statistically explained part of the increased risk of disability among low-income persons. Discussion. The results indicate that changes in health insurance coverage as well as in individual behaviors may be needed to reduce disability generally and disability among the socioeconomically disadvantaged, in particular.

Introduction Investigation of medication use patterns in a population (or pharmaco-epidemiology) is useful for describing variations in medication use and potentially detecting overuse or underuse of medications [1]. Pharmaco-epidemiological studies [...]

Introduction Elderly people are substantial consumers of medications [1-7]. Community-based surveys reveal that they take an average of 2.7 to 3.9 prescription and nonprescription medications [3, 5-7]. While medications can [...]

The dynamic nature of household composition in a population of elderly persons, with particular focus on Black-White and urban-rural differences, is described in this study. The Duke EPESE is a stratified, random household sample (N = 4,162) of elderly persons in a five-county mixed urban-rural area of North Carolina with respondents contacted annually to report on health and social factors. Between 1986 and 1990, 35 percent of the households underwent some change in composition, with 14-percent contracting and/or expanding more than once. Where elders lived alone and where married elders lived with the spouse and/or others, Black elders were significantly more likely to experience a net expansion of their household than were White elders of the same age, gender, socioeconomic, and functional status. Elderly residents of rural areas who lived alone were slightly more likely to add one or more persons to their households than were comparable elderly urban residents. No additional risk of household instability was noted in sociodemographic or health-related subgroups by race or residence. Future analyses should examine the outcomes of instability.

Purpose of Study: To maximize respondent participation in a study of the prevalence, incidence, and natural history of dementia. Design and Methods: Clinical research nurses were trained to carry out evaluations for dementia in the home. We describe the assessment and training procedures used and note the advantages and drawbacks of this approach. Results: Nurse identification of the presence of dementia agreed well with that of medical specialists (kappa = 0.84), but was slightly poorer regarding type of dementia (kappa = 0.71). Implications: Use of nurses for such activity need not be limited to epidemiological studies, but is relevant also in clinical practice. Key Words: Diagnosis, Dementia, In-home evaluation

Background. Comorbidity is common in elderly persons. Its extent, correlates, and life-threatening impact in representative community residents are unclear. Methods. Self-reported information of physician-diagnosed coronary artery disease (CAD), cerebrovascular disease (CVD), diabetes, and cancer was obtained annually between 1986-87 and 1992-93, and hypertension was obtained triennially from the participants of the Duke Established Populations for Epidemiologic Studies of the Elderly, a stratified multistage sample of 4126 Black and White community residents aged 65-100, living in a five-county area of North Carolina. Date of death was obtained from death certificates identified through search of the National Death Index. Statistical procedures included descriptive statistics, logistic regression, and survival analysis. Results. Of this sample, 57% reported hypertension, 20% diabetes, 15% CAD, 9% cancer, and 9% CVD; 29% reported none of these conditions, whereas 29% reported two or more. Demographic characteristics were not related to comorbidity with CVD or cancer. Increased education tended to be protective. The effect of age, gender, and race varied with condition. At baseline there was substantial comorbidity among hypertension, CAD, CVD, and diabetes, but not with cancer. Hypertension, CVD, and diabetes were risk factors for CAD, whereas diabetes was a risk factor for CVD. After controlling for demographic characteristics, all health conditions except hypertension were predictive of 6-year mortality, as was the presence of comorbidity. Conclusion. We found significant comorbidity in older persons who have hypertension, CAD, CVD, or diabetes; particular risk of developing comorbidity, particularly CAD, among those with hypertension, CVD, and diabetes; and risk of CVD in those with diabetes. With the exception of hypertension, these conditions, and comorbidity per se, are life-threatening.