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Objectives To explore the association between a newly developed cumulative laboratory-based frailty index ( FI) and intrinsic (personal) and extrinsic (social, environmental) characteristics. Design Cross-sectional longitudinal study. Setting The third and fourth waves of the community-representative, five-county, 10-year Duke Established Populations for Epidemiologic Studies of the Elderly study, carried out in a health service-rich area. Participants Cognitively intact survivors of the third wave (N = 1,740), who provided blood samples for standard laboratory work. Measurements Biomarkers (n = 28) were measured to develop a cumulative deficit laboratory test-based FI (Duke FI) derived from standard laboratory tests: SMAC-24 chemistry panel, high-density lipoprotein cholesterol panel, and complete blood count. Information was gathered on scales assessing intrinsic characteristics (personal locus of control, life satisfaction, self-esteem, depressive symptomatology) and extrinsic characteristics (support received from and provided to family and friends, stressful life events, neighborhood disadvantage). Results The newly developed Duke FI had content, construct, concurrent, and predictive validity. In addition to sex, race, and income, the Duke FI was associated at the intrinsic level with locus of control, self-esteem, life satisfaction, and depressive symptomatology (each P < .01) and at the extrinsic level with provision ( P < .01) and with receipt of instrumental help ( P < .10), social stressors ( P < .03), and neighborhood disadvantage ( P < .01) in unadjusted analysis; race fully explained neighborhood disadvantage. Conclusion Intrinsic (personality) characteristics and personally close extrinsic characteristics (contacts with family and friends, personal stressors) are associated with laboratory test-based frailty, as is neighborhood disadvantage, although in this accessible, health service-rich environment, race fully explained association with neighborhood disadvantage, suggesting that interventions to reduce frailty in residents in such an environment should pay particular attention to characteristics that immediately affect the individual. [ABSTRACT FROM AUTHOR]

Recall of the four-item constructional praxis measure was a later addition to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery. Norms for this measure, based on cognitively intact African Americans age ≥70 (Indianapolis-Ibadan Dementia Project, N = 372), European American participants age ≥66 (Cache County Study of Memory, Health and Aging, N = 507), and European American CERAD clinic controls age ≥50 (N = 182), are presented here. Performance varied by site; by sex, education, and age (African Americans in Indianapolis); education and age (Cache County European Americans); and only age (CERAD European American controls). Performance declined with increased age, within age with less education, and was poorer for women. Means, standard deviations, and percentiles are presented separately for each sample. [ABSTRACT FROM PUBLISHER]

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]

Focuses on a study which evaluated the association between potential risk factors and falls in a sample of Afro-American and White elderly persons in Piedmont region of North Carolina. Reference to the Duke Established Populations for Epidemiologic Studies of the Elderly; Methodology of the study; Characteristics of subjects; Factors associated with multiple falls; Analysis of findings.

OBJECTIVES: To determine whether there are racial/ethnic differences regarding the relationship of level of blood pressure to change in cognitive function in older people. DESIGN: Longitudinal data 1986 to 1989 on representative, older, community-residing African Americans and whites. Blood pressure levels were assessed and a brief screen of cognitive functioning, the Short Portable Mental Status Questionnaire (SPMSQ), was performed at baseline and 3 years later. SETTING: Five contiguous counties in the Piedmont area of North Carolina. PARTICIPANTS: African-American (n = 2,260) and white (n = 1,876) participants in the Duke Established Populations for Epidemiologic Studies of the Elderly, aged 65 to 105 at baseline. MEASUREMENTS: The outcome measure was change in SPMSQ score over 3 years. Covariates included age; education; gender; self-reported diabetes mellitus, stroke, heart attack, current smoking, and depressive symptomatology; and use of antihypertensive medication. The primary independent variable was measured blood pressure. RESULTS: In unadjusted analyses, a statistically significant U-shaped relationship was found between systolic (but not diastolic) blood pressure levels and change in SPMSQ score over a 3-year period for older white men and women. No such relationships were found between these blood pressure measurements and change in SPMSQ score in older African Americans. These findings remained after adjustment for initial SPMSQ score, demographic characteristics, and use of antihypertensive medication. There were no significant interactions between race and blood pressure on change in cognitive function. CONCLUSION: Decline in cognitive function was associated with extremes of systolic blood pressure in older white people. Although a similar but muted nonsignificant association was found in older African Americans, the curves for the two groups were not significantly different. Further studies in older African Americans are needed. J Am Geriatr... [ABSTRACT FROM AUTHOR]

Determines the inappropriate drug prescribing by expert from the National Consensus panel drug utilization for community-dwelling older people in North Carolina. Evaluation on drug-drug interaction; Analysis by multivariate to weigh data in sampling design; Identification on the class of benzodiazepines and nonsteroidal antiinflammatory drugs.

OBJECTIVES: To determine whether cognitive decline associated with the apolipoprotein E (APOE) ℇ4 allele is different in older African Americans than it is in Caucasians. DESIGN: Performance on a brief screen of cognitive functioning was examined at baseline (N = 1,891) and 4 years later (N = 1,389) to determine the extent to which the presence of APOE ℇ4 affected level of and change in performance, and whether this differed as a function of race, age, initial score, and change in score. SETTING: Five adjacent counties in the Piedmont area of North Carolina. PARTICIPANTS: In 1986, a stratified random household sample of community residents age 65 and older (n = 4,162; 54% African-American, 45% Caucasian, 1% other race) formed the Duke Established Populations for Epidemiologic Studies of the Elderly. Of those available at the sixth annual wave, 76% were genotyped, with 1,891 providing baseline data on this wave, and the available survivors (n = 1,389) providing longitudinal data 4 years later. MEASUREMENTS: The Short Portable Mental Status Questionnaire (SPMSQ), a brief screen of cognitive functioning, was administered to all subjects on both occasions. We examined score at baseline and cognitive decline (i.e., increase of 2+ errors) at follow-up. Control measures included demographic characteristics, health behaviors, health and functional status, and medication use. APOE status was coded as ℇ4 present versus absent. RESULTS: APOE ℇ4 was significantly and uniquely related to lower score at baseline and significantly increased the odds of cognitive decline by 59%. There was no statistically significant interaction between APOE ℇ4 and age, race, initial SPMSQ score, or SPMSQ score at follow-up. [ABSTRACT FROM AUTHOR]

Objectives. To examine and compare concomitants of prescription and nonprescription drug use of Black and White community-dwelling elderly. Methods. Information on prescription and nonprescription drug use, demographic and health characteristics, and use of health services was obtained from a probability-based sample of Black (n = 2152) and White (n = 1821) community-resident elderly in the Piedmont area of North Carolina. Descriptive statistics were calculated. Linear regression, in which sample weights and design effects were taken into account, was used for the final models. Results. For prescription drug use, 37% and 32% of the variance was explained for Whites and Blacks, respectively (6% and 5% for nonprescription drugs). Health status and use of medical services were the strongest predictors of prescription drug use for both races (with Medigap insurance also important for Whites and Medicaid important for Blacks). Demographic characteristics and self-assessed health were significant factors in the use of nonprescription drugs. Race independently predicted use of both types of drugs but explained only a small proportion of the variance. Conclusions. Health status and use of health services are importantly related to prescription drug use. Non-prescription drug use is difficult to explain. [ABSTRACT FROM AUTHOR]

Provides information on the Longitudinal Retirement History Survey (LRHS) by the U.S. Social Security Administration. Significance of the LRHS; Details of the LRHS sampling; Review of LRHS-based publications.

Highlights a study which analyzed the relationship between the lack of private supplemental health insurance coverage and disability development in adults in the United States. Details on supplemental health insurance; Information on Medicare; Methodology used to conduct the study; Results of the study.

Data from the National Death Index (NDI) are frequently used to determine survival status in epidemiologic or clinical studies. On the basis of selected information submitted by the investigator, NDI returns a file containing a set of candidate matches. Although NDI deems some matches as perfect, multiple candidate matches may be available for other cases. Working across data from the Duke University site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), NDI, and the Social Security Death Index (SSDI), the authors found that, for this Established Populations for Epidemiologic Studies of the Elderly cohort of 1,896 cases born before 1922 and alive as of January 1, 1999, a match on Social Security number plus additional personal information (specific combinations of last name, first name, month of birth, day of birth) resulted in agreement between NDI and Social Security Death Index dates of death 94.7% of the time, while comparable agreement was found for only 12.3% of candidate decedents who did not have the required combination of information. Thus, an easy to apply algorithm facilitates accurate identification of NDI matches.

There is concern that life is curtailed when patients with Alzheimer's disease (AD) are institutionalized. To determine whether placement in a nursing home reduces their remaining years of life, we examined the experience of White patients with AD (n=890) enrolled in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Proportional hazards survival analysis using the landmark approach (with the landmark set to 12 months after CERAD entry and reevaluated at succeeding 6-month time intervals through 5 years) indicated that longevity at home and in the nursing home was comparable. Thus, in these patients enrolled at tertiary care medical centers, living at home or in a nursing home did not affect time to death. These data suggest that when home care is no longer feasible, families and nurses counseling them should not feel that they are curtailing life by placing an AD patient in a nursing home.

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.

Objective: The purpose of this study is to evaluate whether the use of medications with urological activity (UA) is associated with self-reported difficulty in control of urination., Methods: This is a cross-sectional study using data from the Duke Established Populations for Epidemiologic Studies of the Elderly., Results: Difficulty holding urine was reported by 49.5% of men and 54.0% of the women. Overall, 50.9% of men and 72.7% of the women took one or more medications with UA. Multivariable logistic regression for men revealed that neither use of any medication with UA (Adjusted [Adj.] Odds Ratio [OR] 1.12, 95% confidence interval [CI] 0.84-1.50) nor the number of medications with UA used was associated with urinary difficulties (Adj. OR 1.08, 95% CI 0.97-1.21). For women, there was a significant association (p < .05) between use of any medication with UA and reported urinary difficulty (Adj. OR = 1.31, 95% CI = 1.05-1.62)., Discussion: Medications with UA may be related to difficulty in controlling urine among community-dwelling elderly women.

Norms for cognitive measures used to assess dementia are scant for minority groups, in particular for older Japanese Americans. Using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychology Battery, we compared the baseline performance of demented and nondemented Japanese Americans. Participants came from two harmonized epidemiological studies of dementia which were examined separately: the Kame Project, Seattle (350 men and women; 201 nondemented), age 65 and older; Honolulu-Asia Aging Study (HAAS), Hawaii (418 men; 120 nondemented), age 71 and older. The measures examined were Verbal Fluency; abbreviated Boston Naming; constructional praxis; and Word List Learning, Recall, and Recognition. Within each study, the CERAD measures distinguished between nondemented participants and those with mild cognitive impairment. Among persons with dementia, average level of performance decreased as severity of dementia increased. Determinants of score (age, education, language of administration, stage of dementia) varied between the two studies. Among Japanese Americans, the CERAD Neuropsychology Battery distinguished nondemented persons from those with dementia, but was less consistent in distinguishing levels of severity of dementia. This battery is useful for comparative epidemiological studies of dementia in minority populations.

We linked Medicare claims data to information on 417 patients with a clinical diagnosis of Alzheimer's disease in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) to determine what proportion of them were identified as having Alzheimer's disease (AD) in Medicare claims records. Seventy-nine percent of these patients were identified as having AD using 5 years of claims data; 87% were identified as demented when a broader set of ICD-9-CM codes was used. An Anderson-Gill counting process approach was used to model the "hazard" of patients being identified as having AD in Medicare claims data. CERAD patients with mild dementia were less likely to be identified in the claims data as having AD. Once identified in Medicare claims as having AD, patients were more likely to be so identified again. When using only the physician supplier and institutional outpatient files, approximately 75% of CERAD patients were identified as having AD; hospital files used alone identified less than one-third (29%) of the CERAD patients as having AD. The data indicate that at least 3 consecutive years of physician supplier and physician outpatient claim files should be used to identify Medicare beneficiaries with AD using Medicare claims.

Purpose: The goal of this study was to determine whether the epsilon4 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 epsilon2, epsilon3, and epsilon4) 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 epsilon4 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 epsilon4 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.