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Objective: Research has shown an association between depression and functional limitations in older adults. Our aim was to explore the latent traits of trajectories of limitations in mobility and instrumental activities of daily living (IADL) tasks in a sample of older adults diagnosed with major depression.Methods: Participants were 248 patients enrolled in a naturalistic depression treatment study. Mobility/IADL tasks included walking one-fourth mile, going up/down stairs, getting around the neighborhood, shopping, handling money, taking care of children, cleaning house, preparing meals and doing yardwork/gardening. Latent class trajectory analysis was used to identify classes of mobility/IADL function over a 4-year period. Class membership was then used to predict functional status over time.Results: Using time as the only predictor, three latent class trajectories were identified: (1) Patients with few mobility/IADL limitations (42%), (2) Patients with considerable mobility/IADL limitations (37%) and (3) Patients with basically no limitations (21%). The classes differed primarily in their initial functional status, with some immediate improvement followed by no further change for patients in Classes 1 and 2 and a stable course for patients in Class 3. In a repeated measures mixed model controlling for potential confounders, class was a significant predictor of functional status. The effect of baseline depression score, cognitive status, self-perceived health and sex on mobility/IADL score differed by class.Conclusions: These findings show systematic variability in functional status over time among older patients with major depression, indicating that a single trajectory may not reflect the pattern for all patients. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The goals of this study were to (1) determine whether level of social support and living situation predicted emergency department (ED) use among older adults and (2) identify correlates of ED visits according to whether the patient was admitted to the hospital. Methods: Secondary analysis of a longitudinal, prospective study was conducted. Results: In adjusted analyses, subjects who lived alone were 60% more likely to visit the ED than those who lived solely with their spouse. Neither type nor level of social support as measured by the Duke Social Support Index predicted ED use. Indicators of poor physical health (prior hospitalization, poorer self-rated health, and functional disability) were predictors of ED visits that resulted in hospitalization; however, these were not significantly associated with outpatient ED visits. Discussion: Older adults who live alone are more likely to visit the ED. Additional study is needed to understand the determinants of outpatient ED visits. [Copyright &y& Elsevier]

Objective: To investigate the one-month prevalence of depression morbidity and its association with sociodemographic characteristics, health and functional status, and use of health services in community residents aged 60 years and over in Brazil. Methods: This study used a cross-sectional design of face-to-face interviews (N= 7,040) in Rio Grande do Sul State, Brazil. Participants were household residents aged 60 years and older. Measurements included the Short Psychiatric Evaluation Schedule (six-item version) and questionnaire that assessed sociodemographic characteristics, self-reported health status, systemic illnesses, activities of daily living (ADL), use of medical services, and social support. Results: The overall prevalence of depression morbidity was 22% (men: 18%, women: 25.2%). In controlled analyses, younger age, low income, rural origin, never or no longer married, poor self-rated health, presence of systemic illnesses, visual, hearing, or ADL impairments, hospitalization in the past 12 months, and lack of exercise or employment were significantly associated with depression morbidity, whereas living alone was nearly so associated. Gender, education, minority race, or outpatient visits in the previous six months were not associated with depression morbidity. Conclusion: The overall prevalence of depression morbidity was among the highest previously reported for older persons. In controlled analyses, prevalence declined as age increased, and rates were higher for those with lower income and poorer social, health, and functional status, but did not differ significantly by gender, education, or race/ethnicity. Increased attention should be paid to identifying depression morbidity in those with adverse circumstances and to identifying ameliorating interventions. [ABSTRACT FROM AUTHOR]

Objective: To compare a family informant's report of memory loss in an older family member to standardized clinical diagnoses of cognitive impairment.Setting: Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), a 10-year longitudinal study of community dwellers aged 65 and greater in five counties of North Carolina.Participants: A stratified random sample of potentially demented participants was selected from the second wave of the Duke EPESE using responses to a brief cognitive screen. A neuropsychological battery was administered to these participants, and their family informants were asked whether they recognized memory loss in the participant. One hundred fifty-seven participants completed the full evaluation and also had an available family informant.Main Outcome Measures: Family informant's report of memory loss (yes, no, sometimes) compared to expert consensus diagnosis of cognitive impairment or dementia.Results: There was poor concordance between the clinical diagnoses of cognitive impairment or dementia and the family informant's recognition of memory loss (kappa=-0.05; P=.74). When informants reported memory loss, 30% of participants were found not to have a cognitive loss. Among participants in whom family informants reported no memory loss, 75% were diagnosed with dementia or cognitive impairment (sensitivity, 0.70, 95% confidence interval [CI], 0.61 to 0.78; specificity, 0.24, 95% CI, 0.13 to 0.40; positive predictive value, 70%; negative predictive value, 25%).Conclusions: Asking family members about memory loss in a patient may be an unreliable strategy to detect dementia. [ABSTRACT FROM AUTHOR]

Purpose Previous studies have reported mixed results regarding the use of histamine2 receptor antagonist use and cognitive function. This study evaluated the relationship between the use of histamine2 receptor antagonists and cognitive decline among community dwelling elderly. Methods This cohort study included 2082 subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly who were not cognitively impaired at baseline (1989/90). Histamine2 receptor antagonist use was determined during in-home interviews. Cognitive function was assessed at 3 and 7 years after baseline by two measures: (1) incident cognitive impairment defined by the short portable mental status questionnaire (SPMSQ); and (2) cognitive decline (increase in two or more SPMSQ errors). Analyzes used multivariable discrete-time hazard models with weighted data adjusted for sampling design and controlled for demographic, health behavior characteristics and health status. Results At baseline, nearly 5% of participants used a histamine2 receptor antagonist. During follow-up, incident cognitive impairment occurred in 24.0%, whereas 34.5% increased by two or more errors on the SPMSQ. In multivariable models, current histamine2 receptor antagonist users compared to never users had a higher risk for cognitive impairment (Adj. RR 1.51; 95%CI 0.93-2.47) and for decline in performance (increase of two or more errors) on the SPMSQ (Adj. RR 1.24; 95%CI 0.74-2.08). A nonsignificant increased risk of cognitive impairment and decline with either higher dose or short-term use was found whereas a nonsignificant protective effect on cognitive decline with current long-term use was seen. Conclusions These results suggest no beneficial effects, and perhaps a detrimental effect, of histamine2 receptor antagonist use on cognitive function in community dwelling elderly. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study uses Lawton’s model of “the good life” to examine whether the Apolipoprote in E-ε4 genotype functions as a risk factor not only for specific diseases but also for a misfit between elders’ personal needs and their physical and social environments. A biracial cohort of communitydwelling elders from five North Carolina Piedmont counties was assessed annually for 10 years. Six-year survivors (N = 2,076) were genotyped for this retrospective-prospective cohort study. Compared to those in whom this allele was absent, participants with the 4 allele were not different in social or residential resources, social behavioral competence, or perceived quality of resources. Exposed elders had an excess 10-year adjusted risk of institutionalization of 1.72 (95% CI = 1.29, 2.29), totally mediated by cognitive problems. The threat of the APOE 4 genotype to person-environment fit is mediated by cognitive problems, a finding that has focused but important implications for residential decision making in late life. [ABSTRACT FROM PUBLISHER]

Studies whether the determinants of death differ as a function of type analysis in a representative sample of old African American and white people with comparable mortality rates. Analytical approaches used in the study; Demographic variables selected for the analyses; Use of the tree-based classification analyses.

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.

Presents a study which determined whether the *epsilon4 allele of apolipoprotein E is predictive of mortality in a community-based sample. Allelic forms of the apolipoprotein E; Presence of the *epsilon4 allele; Characteristics of the sample and relationship of the characteristics to death.

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.

The Social Security Administration's Longitudinal Retirement History Survey, based on a national random sample (initial age 58-63) of men (N = 8131) and unmarried women (N = 3021) is a six-wave, 10-year study (1969-1979) of the process and impact of retirement. It seeks extensive information in all personal areas that could be affected by or have an effect on retirement (employment matters; retirement issues; health; life satisfaction; social involvement; financial; and spouse data). To facilitate use of this rich data source we have developed for each wave of LRHS valid and reliable cross-wave-equivalent scales measuring functional status in five areas: social, economic, life satisfaction, physical health, and activities of daily living. The conceptualization and operationalization of these scales, and examination of their reliability and validity, are described. Examples are given of their uses individually, and in combination to provide an overall view of personal functioning. [ABSTRACT FROM AUTHOR]

Efficient and effective utilization of an archival data set is facilitated by adequate identification of the sample used visa vis issues to be investigated; adequate documentation; accurate, accessible data sets; identification of potential interrelationships among data sets; and provision for disseminating user experience to the network of potential users. The Data Archive for Aging and Adult Development at Duke University has cooperated with SSA to insure that the Longitudinal Retirement History Study (LRHS) data set meets these conditions. This article reviews the experience with the LRHS data set at Duke and illustrates the application of a technique for classification of LRHS subjects in terms of capacity for independent functioning. This computer-based technique, adapted from Duke's OARS Multidimensional Functional Assessment procedure, extends the potential relevance of LRHS data to public policy issues regarding health and welfare services. [ABSTRACT FROM AUTHOR]

This study compared the odds of becoming disabled and recovering from disability among blacks and whites aged 65 years and over in two sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE) project. The authors examined the influence of mortality differences, socioeconomic status, and health-related factors on racial differences in risk of disability and recovery. A Markov model was employed using nine waves of data from the New Haven, Connecticut, site (529 blacks, 2,219 whites) and seven waves of the North Carolina (Piedmont) site (2,260 blacks, 1,876 whites), collected between 1982 and 1992. Blacks below age 75 years had an increased risk of developing disability relative to whites in New Haven (odds ratio (OR) at age 65 years = 3.33,95% confidence interval (CI) 2.13–5.22) as well as in North Carolina (OR at age 65 years = 1.58,95% CI 1.25–1.99). This excess risk diminished with increasing age, and crossed over in New Haven (OR at age 85 years = 0.45,95% CI 0.22–0.95), but not in North Carolina (OR at age 85 years = 1.22,95% CI 0.98–1.51). Adjustment for socioeconomic and health-related factors only partially reduced the excess disability risk among blacks below age 75 years in New Haven, but eliminated the difference in disability risk between blacks and whites in North Carolina. Blacks below age 75 years also had higher mortality risks at both sites. There were no consistent racial differences in recovery from disability. Am J Epidemiol 1997;145:488–97. [ABSTRACT FROM AUTHOR]

The Social Security Administration's Longitudinal Retirement History Study, which is designed to study the process and impact of retirement in the U.S., is described briefly. Particular attention is paid to the sample, the information obtained and its reliability and validity, the usability of the data, and to drawbacks inherent in the limited time span allocated to data gathering. This paper is intended to acquaint those interested in retirement and the life cycle with this major data set, and facilitate its use. [ABSTRACT FROM PUBLISHER]

Information obtained from a highly selected group of healthy, financially secure male university faculty retirees indicates that nearly all work for pay after retiring. Continued working does not seem to be contingent upon the ready availability of jobs, but is related to a personal dislike of retirement, intending to work after that event, active pre-retirement involvement in work, and the presence of younger friends who are working. We have suggested that work after retirement can be conceptualized as due to a mutually reinforcing interaction among the variables examined. [ABSTRACT FROM PUBLISHER]

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]

Predictors of retirement among men were analyzed using data from seven longitudinal studies, multiple definitions of retirement, multivariate analyses, and unbiased statistical techniques. Results show that the predictors of retirement vary depending on how retirement is defined. The strongest predictors of objective retirement among men over age 65 (i.e., employed less than full-time and receiving a pension) are structural factors such as socioeconomic status and job characteristics. The strongest predictors of early retirement (i.e., retiring before age 65) and of age at retirement include both structural factors and subjective factors, such as self-rated health and attitudes. When retirement is defined by amount of employment, job characteristics are more important predictors than all the others combined. [ABSTRACT FROM PUBLISHER]

This report outlines the development, validity, and reliability of part A of the OARS multidimensional Functional Assessment Questionnaire. Part A permits assessment of individuals' functioning on each of five dimensions (social, economic, mental health, physical health and self-care capacity), the detailed information in each area being summarized on a 6-point rating scale by a rater. Content and consensual validity were ensured by the manner of construction. Information on criterion validity was obtained for all dimensions except social. The criterion used and their associated kendall's tau values were: an objective economic scale (.62); ratings based on personal interviews by geropsychiatrists (.60); physician's associates (.82); and physical therapists (.89). For 11 geographically dispersed raters from research and clinic settings, intraclass correlational coefficients, based on 30 subjects, ranged from .66 on physical health to .87 in self-care capacity; 74% of the ratings were in complete agreement, 24% differed by one point. [ABSTRACT FROM PUBLISHER]

This article examines the internal distinctions and populational generality in the sociological theory of balance by sociologist F. Heider. Heider's theory is, perhaps, the simplest of all the related balance theories. The article concentrates on this particular theory, paying especial attention to certain discriminations which are made in it, but which have been disregarded in some of the later theories, in order to determine the usefulness of these distinctions. Heider distinguishes between person and object entities, and between sentiment and unit relations. While the various balance theories tend to differ in the particular types of situation in which they are interested, they all agree that the balanced state is the preferred one, and suggest that such preference is widespread in the general population. Heider has expressed uncertainty about the application of balance theory to non-normal persons, suggesting that preference for the balanced state may only characterize normal persons. In this article, Heider's theory of balance was examined in order to determine whether the differentiations of entities and of relations made in this theory are necessary, and whether preference for the balanced state is general over different classes of subjects.

Responses of a randomly selected group of employees who were questioned about their attitudes concerning a proposed retirement planning program indicated that while there was almost universal agreement that such a program was desirable and age 45 an appropriate one at which to start, attendance would differ markedly with occupational status. Regardless of age, upper occupational status persons showed no interest, older (i.e., over age 44) middle-occupational status persons are more interested than are younger, but lower occupational status employees of all ages said they would attend such a program. The latter being the case, it was suggested that a retirement planning program which was also concerned with improving the present situation might be more beneficial than one which concentrated on post-retirement life. [ABSTRACT FROM PUBLISHER]

In trying to determine why, when there is no financial need, some men are more likely to work after retirement than are others, six areas are considered: personal background, sociological factors, the perceived place of work, cognitive and physiological capabilities, attitude to work and retirement, and personality factors. While factors in any one of these areas may influence retirement work, because older persons must have proven capability at work and also because ability is related to doing good work, those who work after retirement will probably be among the more capable workers, have high interest and involvement in work and work-related activities, little interest in other matters, and have a stronger attraction to work than to retirement. Other matters will only be relevant insofar as they affect the individual's ability to work well. [ABSTRACT FROM PUBLISHER]

Focus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, (2) decline, and (3) recovery of personal self-maintenance activities over six years in an older, community representative, African American and white sample. Longitudinal study, analyses included descriptive statistics and repeated measures proportional hazards. Community-representative participants of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), unimpaired at baseline (n = 3187; 46% white, 54% African American; 64% female, 36% male), followed annually for up to 6 years. Data included information on basic activities of daily living (BADL), demographic characteristics, health status, social services provided and received, household size, neighborhood safety, and survival status. Over 6 years, ∼75% remained unimpaired, of whom 30% were unimpaired when they dropped out or died. Of ∼25% who became impaired, just under half recovered. Controlled analyses indicated that those who became impaired were in poorer health, younger, and more likely to be African American. Characteristics of recovery included younger age, not hospitalized in the previous year, and larger household size. Maintenance of health status facilitated continued unimpaired BADL. While decline was associated with poorer health, younger age, and being African American, recovery was also associated with younger age, together with larger household size, and no further deterioration in health as measured here. Maintenance of good health is preferred, but following decline in functioning, increased effort to improve health and avoid further decline, which takes into account not only physical but also personal social conditions, is needed. [ABSTRACT FROM AUTHOR]