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Aims: To classify the different types of anemia among moderately to severely disabled women living in the community and examine the relationship between types of anemia and mortality. Methods: We studied anemia in 688 women, ≥65 years, in the Women's Health and Aging Study I, a population-based study of moderately to severely disabled older women living in the community in Baltimore, Maryland. Anemia was defined by World Health Organization criteria. Causes of anemia were classified as due to nutritional deficiencies (iron, folate, and B12 deficiencies), anemia of chronic inflammation, anemia with renal disease, and unexplained anemia. Results: 147 of 688 (21.4%) women were anemic (hemoglobin <12 g/dL). Of the 147 anemic women, 22 (15.0%) had anemia due to nutritional causes, 45 (30.6%) had anemia due to chronic inflammation, 29 (19. 7%) had anemia and renal disease, and 51 (34.7%) had unexplained anemia. The proportions of those who died over five years among non-anemic women and women with anemia due to nutritional causes, chronic inflammation, renal disease, and unexplained anemia were 26.1%, 18.2%, 38.6%, 64.3%, and 33.3%, respectively (p<0.0001). Compared with non-anemic women, those with anemia and renal disease (I-IR 1.99, 95% CI 1.18-3.35, p=0.009) and anemia of chronic inflammation (FIR 1.69, 95% CI 1.00-2.84, p=0.05) had higher risk of death. Conclusions: Anemia is common among moderately to severely disabled older women living in the community, and about one-third of the anemia is unexplained. Anemia with renal disease and anemia of chronic inflammation are associated with a higher mortality. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate relationships between white blood cell (WBC) count and interleukin-6 (IL-6) and prevalent frailty. DESIGN: Cross-sectional study. SETTING: Two population-based studies, the Women's Health and Aging Studies (WHAS) I and II, Baltimore, Maryland. PARTICIPANTS: Five hundred fifty-eight women aged 65 to 101 from WHAS I and 548 women aged 70 to 79 from the merged WHAS I and II cohorts. MEASUREMENTS: Frailty was determined using validated screening criteria. WBC counts and IL-6 levels were measured using standard laboratory methods. Odds ratios (ORs) for frailty were evaluated across tertiles of baseline WBC counts and IL-6 levels, adjusting for age, race, education, body mass index, and smoking status. RESULTS: In WHAS I, those in the top tertile of WBC count and IL-6 had ORs of 4.25 (95% confidence interval (CI)=1.89–9.58) and 3.98 (95% CI=1.76–9.00), respectively, for frailty (both P<.001). In the combined models, participants in the top tertile of WBC count had an OR of 3.15 (95% CI=1.34–7.41), adjusting for IL-6 ( P<.01), and those in the top tertile of IL-6 had an OR of 2.81 (95% CI=1.19–6.64), adjusting for WBC count ( P<.05). Furthermore, participants in the top tertiles of WBC count and IL-6 had an OR of 9.85 (95% CI=3.04–31.99), and those in the middle/top tertiles had an OR of 5.40 (95% CI=1.83–15.92) ( P<.001, trend test) for frailty. These results were validated in the merged WHAS I and II. CONCLUSION: Higher WBC counts and IL-6 levels were independently associated with prevalent frailty in community-dwelling older women. [ABSTRACT FROM AUTHOR]

The article examines whether metabolic syndrome and its physiologic determinants are associated with incident frailty. Physiologic determinants include insulin resistance as measured by homeostasis model assessment score, increased inflammation and coagulation factor levels and elevated blood pressure.

Background: The relationship between total cholesterol levels and dementia is unclear. Objective: To compare the natural history of change in total cholesterol across 26 years between men who did and did not develop dementia 3 years after the last measurement. Design, Setting, and Participants: In the Honolulu-Asia Aging Study, 1027 Japanese American men had total cholesterol levels assayed on 5 occasions between 1965 and 1993 and were screened for dementia on 2 occasions between 1991 and 1996. Main Outcome Measure: The slope of 26-year change in serum total cholesterol levels was estimated by a repeated-measures analysis and was compared between men with incident dementia (n = 56) and those without dementia (n = 971) at the end of the follow-up period Results: Cholesterol levels in men with dementia and, in particular, those with Alzheimer disease had declined at least 15 years before the diagnosis and remained lower than cholesterol levels in men without dementia throughout that period. The difference in slopes was robust to adjustment for potential confounding factors, including vascular risk factors, weight change, alcohol intake, and use of lipid-lowering agents. Conclusion: A decline in serum total cholesterol levels may be associated with early stages in the development of dementia. [ABSTRACT FROM AUTHOR]

Background. Physical activity is important for maintaining functional independence of older persons, especially for those with existing functional deficits. Since such deficits may pose barriers to activity, it would be instructive to examine activity patterns in relation to specific types of deficits to determine the amount and type of physical activity older women pursue. This study sought to identify categories of functional deficits associated with activity levels and evaluated the potential for older women to increase their physical activity levels. Methods. Community-dwelling women, aged 70-79 years, from the Women's Health and Aging Studies I and II (N = 710), were assessed for self-reported physical activity, functional deficits and chronic conditions, along with objective measures of muscle strength. Both type (household chores, exercise, and recreational activity) and amount of physical activity (min/wk) were examined. Meeting physical activity recommendations was defined as ≥ 150 minutes per week of moderate intensity physical activity, and inactivity was defined as no weekly moderate intensity physical activity. Hierarchical categories of functional deficits were based on self-reported difficulty in four functional domains (i.e., mobility/exercise tolerance, upper extremity, higher functioning, and self-care), and self-reports ranged from no difficulty to difficulty in all four domains. Results. The prevalence of inactivity and meeting activity recommendations were 14.4% and 12.7%, respectively. Severity of functional deficits was associated with increased risk of inactivity (adjusted odds ratios [ORsadj] = 3.14-17.61) and reduced likelihood of meeting activity recommendations (ORsadj = .11-.40). Even among those with higher functioning or self-care difficulties, 30% reported walking for exercise. Conclusion. There was evidence that older women with functional deficits can remain physically active. However, for some of these women, meeting the recommended levels of activity may be unrealistic. Efforts to increase physical activity levels among older adults should include treatment or management of functional deficits, chronic conditions, and poor strength. [ABSTRACT FROM AUTHOR]

Abstract  There is compelling evidence supporting the benefits of increased regular physical activity in older adults. The Experience Corps program in Baltimore MD was designed in part as a community based approach to increasing physical activity that would also appeal to older adults who have historically not utilized health promotion programs. The Baltimore Experience Corps program places older volunteers in public elementary schools for 15 h a week in roles designed to improve the academic outcomes of children and, simultaneously, increase the physical, cognitive and social activity of volunteers. This paper reports on the change in physical activity levels among older adults associated with participation in the Baltimore Experience Corps. In a pilot randomized controlled evaluation, older adults were randomly assigned to Experience Corps (EC participants) or a waiting list control group. Ages ranged from 59–86 years, 96% were African American, 94% were women, and 84% had annual incomes less than $15,000. EC participants were required to serve ≥15 h a week. At follow-up after 4–8 months, an analysis of 113 randomized volunteers revealed 53% of the EC participants were more active than the previous year by self-report, as compared to 23% of the controls (p<0.01). When adjusted for age, gender and education, there was a trend toward increased physical activity in the EC participants as calculated by a kilocalorie per week increase of 40%, versus a 16% decrease in the controls (p=0.49). EC participants who reported “low activity” at baseline experienced an average 110% increase in their physical activity at follow-up. Among the controls who were in the “low activity” group at baseline, there was, on average, only a 12% increase in physical activity (p=0.03). Among those who were previously active, there was no significant difference (p=0.30). The pilot results suggest that a high intensity volunteer program that is designed as a health promotion intervention can lead, in the short-term, to significant improvements in the level of physical activity of previously inactive older adult volunteers. [ABSTRACT FROM AUTHOR]

Background. Dehydroepiandrosterone sulfate (DHEAS) is an endogenously produced sex steroid that has been hypothesized to have anti-aging effects. Low DHEAS levels are associated with mortality in older men, but the relationship between DHEAS levels and mortality in women is not clearly defined. Methods. The relationship between serum DHEAS level and 5-year mortality was analyzed in a cohort of 53- disabled women aged 65-100 years enrolled in the Women's Health and Aging Study I (WHAS I). Using Cox proportional hazard models, we calculated multivariate-adjusted mortality risks by DHEAS quartiles and by DHEAS continuously, allowing for a nonlinear relationship. We also examined cause specific mortality. Results. We found a U-shaped relationship between DHEAS level and mortality. After adjusting for multiple covariates, women in the lop and bottom DHEAS quartiles had a more than 2 fold higher 5-year mortality than did those in the middle quartiles (hazard ratio, 2.15; 95% confidence interval [CI], 1.17-3.98 for the top quartile and 2.05: 95% CI, 1.27 3.32 for the bottom quartile, each compared to the third quartile). Women with higher DHEAS levels tended to have greater cancer mortality, whereas those with lower DHEAS tended to have greater cardiovascular mortality. Conclusion. Disabled older women with either low or high levels of DHEAS are at greater risk for death than arc those with intermediate levels. More research is needed to determine if targeted dehydroepiandrosterone supplementation would provide clinical benefit to disabled older women. [ABSTRACT FROM AUTHOR]

Anemia is common among older adults, and a substantial proportionof anemia in the older population is of indeterminate cause. Low seleniumlevels have been associated with anemia in animals, but this relationshiphas not been well characterized in humans. The objective was to determinewhether low serum selenium concentrations are associated with anemiaamong older women. We conducted a cross-sectional analysis of participantsin the Women's Health and Aging Studies, a population-based sampleof women living in the community in Baltimore, MD, USA. Of 632women, aged 70-79 yr, 14.1% of women were anemic (hemoglobin <120g/L). The prevalence of anemia among women in the lowest to highestquartile of serum selenium was 22.4%, 14.6%, 11.9% and 6.6%, respectively(p < 0.0001). An increase in loge selenium was associated with a reduced risk of anemia (odds ratio per 1 SD increase = 0.63, 95% confidence interval = 0.47-0.84), adjusting for age, education, chronic diseases, iron status, and serum interleukin-6. We conclude that low serum selenium is independently associated with anemia among older women living in the community. [ABSTRACT FROM AUTHOR]

Objective. We investigated the relationship of micronutrient deficiencies with the frailty syndrome in older women living in the community. Methods. Frailty status and serum micronutrients were assessed in a cross-sectional study of 754 women. 70-80 years old, from the Women's Health and Aging Studies I and II. Results. Among nonfrail, prefrail, and frail women, respectively, geometric mean serum concentrations were 1.842, 1.593, and 1.376 µmol/L for total carotenoids (p < .001); 2.66. 2.51, and 2.43 µmol/L for retinol (p = .04): 50.9. 47.4. and 43.8 nmol/L for 25-hydroxyvitamin D (p = .019): 43.0. 35.8, and 30.9 nmol/L lot vitamin B6, (p = .002); and 10.2, 9.3, and 8.7 ng/mL for folate (p .03). Frail women were more likely to have at least two or more micronutrient deficiencies (p = .05). The age-adjusted odds ratios of being frail were significantly higher for those participants whose micronutrient concentrations were in the lowest quartile compared to the top three quartiles for total carotenoids, α-tocopherol. 25-hydroxyvitamin D, and vitamin B6. The association between nutrients and frailty was strongest for β,-carotene, lutein/zeaxanthin, and total carotenoids (odds ratio ranging from 1.82 to 2.45, p = .05), after adjusting for age, sociodemographic status, smoking status, and body mass index. Conclusion. Frail women are more likely to have relatively low serum carotenoid and micronutrient concentrations and are more likely to have multiple micronutrient deficiencies. Future longitudinal studies are needed to examine the relationships between micronutrient concentrations and frailty in older women. [ABSTRACT FROM AUTHOR]

Background. "Frailty" is an adverse, primarily gerontologic, health condition regarded as frequent with aging and having severe consequences. Although clinicians claim that the extremes of frailty can be easily recognized, a standardized definition of frailty has proved elusive until recently. This article evaluates the cross-validity, criterion validity, and internal validity in the Women's Health and Aging Studies (WHAS) of a discrete measure of frailty recently validated in the Cardiovascular Health Study (CHS). Methods. The frailty measure developed in CHS was delineated in the WHAS data sets. Using latent class analysis, we evaluated whether criteria composing the measure aggregate into a syndrome. We verified the criterion validity of the measure by testing whether participants defined as frail were more likely than others to develop adverse geriatric outcomes or to die. Results. The distributions of frailty in the WHAS and CHS were comparable. In latent class analyses, the measures demonstrated strong internal validity vis à vis stated theory characterizing frailty as a medical syndrome. In proportional hazards models, frail women had a higher risk of developing activities of daily living (ADL) and/or instrumental ADL disability, institutionalization, and death, independently of multiple potentially confounding factors. Conclusions. The findings of this study are consistent with the widely held theory that conceptualizes frailty as a syndrome. The frailty definition developed in the CHS is applicable across diverse population samples and identifies a profile of high risk of multiple adverse outcomes. [ABSTRACT FROM AUTHOR]

Background. Changes in self-reported function in older adults are known to occur in the 2 weeks prior to, during, and in the first few months after hospitalization. The long-term outcome of hospitalization on functional status in disabled older adults is not known. The objective of this study was to determine whether hospitalization predicts long-term Activities of Daily Living (ADL) dependence in previously ADL independent, although disabled, older women. Methods. The Women's Health and Aging Study I is a population-based, prospective cohort study of disabled, community-dwelling women ≥65 years old. We evaluated participants who were independent in ADLs at baseline and excluded women with incident stroke, lower extremity joint surgery, amputation, or hip fracture. We examined the association between self-reported incident hospitalization at three consecutive 6-month intervals and incident dependence in at least one ADL at 18 months (n = 595). Results. Of 595 women evaluated, 32% had at least one hospitalization. Women who were hospitalized were more likely to become dependent in ADLs than were women who were not hospitalized (17% vs 8%, p = .001). In a multivariate model, hospitalization was independently predictive of development of ADL dependence that persisted at 18 months after baseline (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.7-5.8), adjusting for age, race, education, baseline walking speed, difficulty with ADLs, self-reported health status, depressive symptoms, cognitive status, and presence of congestive heart failure, diabetes, or pulmonary disease. Increasing numbers of 6-month intervals with hospitalizations were independently predictive of higher risk in an adjusted model: one (OR, 2.3; 95% CI, 1.1-4.6), two (OR, 5.8: 95% CI, 2.4-14.4), and three (OR, 12.5; 95% CI, 2.7-57.6). Conclusions. These results suggest that hospitalization has an independent and dose-response effect on loss of ADL independence in disabled older women over an 18-month period. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess relationships between vision (contrast sensitivity, stereopsis, visual acuity) and a performance-based measure of ability to implement new medications. DESIGN: Cross-sectional study, analysis; prospective cohort SETTING: Community-based. PARTICIPANTS: Three hundred thirty-five participants aged 73 to 82 in Year 3 of the Women's Health and Aging Study II, a representative sample of the two-thirds least-disabled community-dwelling women. MEASUREMENTS: Hopkins Medication Schedule Pillbox Ratio., a joint measure of accuracy and time, and a performance-based measure of ability to implement a prescription. Participants received written and verbal instructions for taking two medications and were directed to place pills in a pillbox accordingly. Vision assessments: contrast sensitivity (Pelli-Robson letter sensitivity chart), stereopsis (Randot Circles), and visual acuity (Early Treatment Diabetic Retinopathy Study eye chart). RESULTS: Forty-four percent (148/335) of women incorrectly placed one or both medications. Each vision measure was positively associated with Pillbox Ratio scores and varied with cognition and time to completion. Better visual acuity, contrast sensitivity, and stereopsis were each associated with better performance in women with poor cognition who filled the pillbox quickly. Additionally, better visual acuity was associated with better performance in participants with good cognition who filled the pillbox slowly; better stereopsis was associated with better performance in participants with poor cognition who filled the pillbox slowly and whose stereoacuity was below normal. CONCLUSION: Visual acuity, contrast sensitivity, and stereopsis should be considered potential risk factors for impaired ability to implement a medication regimen in older adults. Future research should investigate the role of vision, including contrast sensitivity and stereopsis, on performance of other instrumental activities of daily living. [ABSTRACT FROM AUTHOR]

Background. Interleukin-6 (IL-6) is an inflammatory biomediator, and age-related increases in IL-6 levels are associated with osteoporosis, sarcopenia, disability, and mortality in older adults. Although white blood cells (WBC), or leukocytes, are known to produce IL-6 in vitro, their in vivo relationship with circulating IL-6 levels is not well established. Methods. In this cross-sectional analysis of data from the Women's Health and Aging Study I, the authors evaluated the relationships of total WBC and WBC differential (neutrophil, monocyte, lymphocyte, eosinophil, and basophil) counts to circulating IL-6 levels in 619 community-dwelling older women. Potential associations of age, race, and cigarette smoking with total and differential WBC counts and IL-6 levels were also assessed. Results. Except for lymphocyte and basophil counts, significant associations of total WBC, neutrophil, monocyte, and eosinophil counts with IL-6 levels were identified. These associations remained highly significant after adjustment for age, race, and smoking status. Total WBC, neutrophil, monocyte, and eosinophil counts had significant stepwise increases in four escalating quartiles of IL-6 levels. In addition, age, race, and cigarette smoking were differentially associated with total and differential WBC counts and IL-6 levels. Conclusions. Positive in vivo associations of total WBC and its specific subpopulations were identified, including neutrophils, monocytes, and eosinophils, with circulating IL-6 levels in community-dwelling older women. These findings suggest significant contributions of WBC and its subpopulations to circulating IL-6 levels and potential effects from chronic elevation of IL-6 levels to the function of these circulating immune cells that warrant further investigation. [ABSTRACT FROM AUTHOR]

Background. Medications often represent the first line of defense in preventing or delaying the progression of chronic diseases. The health implications of improper medication compliance, and failure to identify it, are considerable. The authors thus developed and validated the Hopkins Medication Schedule (HMS), a new objective test of one's ability to understand and implement a routine prescription medication. Methods. The authors gave a hypothetical physician's prescription for two common medications (antibiotics and aspirin) to 360 high-functioning, community-dwelling, older participants in the Women's Health and Aging Study II and asked them to fill in a daily schedule for taking these medications and to fill in the compartments of a daily pillbox. These scored and timed performances were evaluated for their ability to predict concurrent and 3-year participant-reported difficulty in performing instrumental activities of daily living (IADLs) and for their associations with memory and attention. Results. Although fewer than 2% of participants reported difficulty in taking medications, nearly 22% were completely unable to complete the schedule, fill the pillbox, or both. The 7% of participants who reported difficulty in any IADL also performed poorly on the HMS. In addition, performance on the schedule and the pillbox predicted concurrent difficulty. In adjusted regression analyses, the schedule was most highly associated with memory and the pillbox with learning and executive function. Conclusions. The HMS had concurrent validity for participant-reported IADL difficulty. Furthermore, in community-dwelling older women who largely reported no difficulty in taking medications, the HMS identified nearly 22% who could not write or implement a routine medication regimen. This standardized measure may identify those at increased risk for poor medication adherence and, more broadly, IADL difficulty. [ABSTRACT FROM AUTHOR]

To examine the associations between hemoglobin (Hb) concentration and (1) 5-year all-cause mortality and (2) serum erythropoietin (EPO), as the basis for the identification of data-driven thresholds, and to assess the clinical relevance of mildly low Hb.Prospective study.Population based.Community-dwelling women aged 65 and older with moderate-to-severe disability—Women's Health and Aging Study I, Baltimore, Maryland, 1992–2000.Proportional hazards regression was used to model the relationship between baseline Hb (available for 686 subjects) and time to death. A generalized linear model was used to assess the cross-sectional association between Hb and EPO in 641 subjects.A curvilinear slope of steady mortality decrease up to the Hb threshold of 13.9 g/dL was observed. Hb of 11 g/dL was independently associated with greater mortality than the World Health Organization (WHO) low-normal cutoff of Hb of 12 g/dL (hazard ratio (HR)=1.2, 95% confidence interval (CI)=1.1–1.4), whereas Hb of 14 g/dL was linked to 24% lower mortality (HR=0.76, 95% CI=0.63–0.92), after comprehensive adjustment for major health status and disease-burden indicators. A curvilinear, statistically significant slope of steady EPO decrease with increasing Hb up to the threshold of 14.3 g/dL was consistently observed.The meaningfully lower mortality risk with higher Hb levels provides empirical evidence against the notion that Hb currently perceived as mildly low is clinically benign. Furthermore, the mortality risk gradient observed even within the WHO normal Hb range suggests that Hb levels higher than what is currently recommended might offer clinical advantage. The relationship between Hb and EPO provided supporting physiological evidence for this hypothesis. [ABSTRACT FROM AUTHOR]

Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes. Little is known about the behavioral antecedents of frailty. In this study, the authors hypothesized that constriction of life space identifies older adults at risk for frailty, potentially a marker of already-decreased physiologic reserve. The authors analyzed the 3-year (1992–1995) cumulative incidence of frailty using a previously validated clinical phenotype in relation to baseline life-space constriction among 599 community-dwelling women aged 65 years or older who were not frail at baseline. Frailty-free mortality (i.e., death prior to observation of frailty) was treated as a competing risk. Multivariate survival models showed that, compared with women who left the neighborhood four or more times per week, those who left the neighborhood less frequently were 1.7 times (95% confidence interval: 1.1, 2.4; p p < 0.01), after adjustment for chronic disease, physical disability, and psychosocial factors. Together, these data suggest that a slightly constricted life space may be a marker and/or risk factor for the development of frailty that may prove useful as a screening tool or a target of intervention. [ABSTRACT FROM AUTHOR]

Aims: Examining online social interactions along with patterns of video gaming behaviors and game addiction symptoms has the potential to enrich our understanding of disorders related to excessive video game play., Methods: We performed latent class analysis in a sample of 9733 adolescents based on heavy use of games, social networking and instant messaging, and game addiction symptoms. We used latent class regression to determine associations between classes, psychosocial well-being and friendship quality., Results: We identified two types of heavy gaming classes that differed in probability of online social interaction. Classes with more online social interaction reported fewer problematic gaming symptoms than those with less online social interaction. Most adolescents estimated to be in heavy gaming classes had more depressive symptoms than normative classes. Male non-social gamers had more social anxiety. Female social gamers had less social anxiety and loneliness, but lower self-esteem. Friendship quality attenuated depression in some male social gamers, but strengthened associations with loneliness in some male non-social gamers., Conclusions: In adolescents, symptoms of video game addiction depend not only on video game play but also on concurrent levels of online communication, and those who are very socially active online report fewer symptoms of game addiction.