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Thiazide diuretic agents lower the urinary excretion of calcium. Their use has been associated with increased bone density, but their role in preventing hip fracture has not been established. We prospectively studied the effect of thiazide diuretic agents on the incidence of hip fracture among 9518 men and women 65 years of age or older residing in three communities. At base line, 24 to 30 percent of the subjects were thiazide users. In the subsequent four years, 242 subjects had hip fractures. The incidence rates of hip fracture were lower among thiazide users than nonusers in each community; the Mantel-Haenszel relative risk of hip fracture, adjusted for community and age, was 0.63 (95 percent confidence interval, 0.46 to 0.86). The protective effect of the use of thiazides was independent of sex, age, impaired mobility, body-mass index, and current and former smoking status; the multivariate adjusted relative risk of hip fracture was 0.68 (95 percent confidence interval, 0.49 to 0.94). Furthermore, the protective effect was specific to thiazide diuretic agents, since there was no association between the use of antihypertensive medications other than thiazides and the risk of hip fracture. These prospective data suggest that in older men and women the use of thiazide diuretic agents is associated with a reduction of approximately one third in the risk of hip fracture.

Analysis of data from several adults reveals an enhancement in the rates of cardiovascular comorbidity and diabetes in individuals with intermittent claudication (IC) and susceptibility to smoking. Adults having IC, myocardial infarction and or stroke and a history of angina face higher chances of cardiovascular mortality. These observations imply the importance of IC in understanding cardiovascular problems in the elderly.

Elderly people with high blood cholesterol levels do not appear to be at increased risk for heart disease or death. Researchers interviewed and took blood samples from 997 people over age 70. Patients were divided into those with cholesterol levels less than 200 milligrams per deciliter (mg/dl), those with cholesterol levels between 200 mg/dl and 240 mg/dl, and those with cholesterol levels of 240 mg/dl or more. After a four-year follow-up, more women had high cholesterol levels than men while more men had low levels of high density lipoproteins than women. Women with the lowest cholesterol levels had the highest death rate while men in all cholesterol groups had similar rates of death. Independent of gender or heart diseases risk factors, patients with low, moderate, or high cholesterol levels did not have significantly different rates of chest pain or heart attack. The overall death rate and the death rate from heart disease were similar among patients with low, moderate, or high cholesterol levels., Objectives.--To determine whether elevated serum cholesterol level is associated with all-cause mortality, mortality from coronary heart disease, or hospitalization for acute myocardial infarction and unstable angina in persons older than 70 years. Also, to evaluate the association between low levels of high-density lipoprotein cholesterol (HDL-C) and elevated ratio of serum cholesterol to HDL-C with these outcomes. Design.--Prospective, community-based cohort study with ready interviews. Participants.--A total of 997 subjects who were interviewed in 1988 as part of the New Haven, Conn, cohort of the Established Population for the Epidemiologic Study of the Elderly (EPESE) and consented to have blood drawn. Main Outcome Measures.--The risk factor-adjusted odds ratios of the 4-year incidence of all-cause mortality, mortality from coronary heart disease, and hospitalization for myocardial infarction or unstable angina were calculated for the following: subjects with total serum cholesterol levels greater than or equal to 6.20 mmol/L ([greater than or equal to] 40 mg/dL) compared with subjects with cholesterol levels less tha mmol/L (

Synopsis Although diabetes is a common health problem of the elderly, the impact of diabetes on health and functioning in older persons is not well established. The purpose of this […]

Objectives. The purpose of this study was to test the hypothesis that overall and truncal adiposity increase the risk of stroke independent of their association with cardiovascular disease risk factors and other preexisting risk factors and other preexisting illnesses. Methods. Analyses were conducted of longitudinal data from a poor, biracial cohort of noninstitutionalized adults 65 to 74 years of age who participated in the Chicago Stroke Study from 1965 to 1970. Results. Ponderal index (cm/kg sup.1/3) and chest skinfold were significantly associated with systolic and diastolic blood pressure, serum cholesterol and triglycerides, plasma glucose, and smoking. Ponderal index was also associated with diabetes and risk of stroke. After potential confounders were controlled, the following variables showed significant independent associations with risk of stroke: Black race, female gender, and age 70+; hypertensive hear disease; and diabetes. Neither adiposity variable was associated with risk of stroke in the presence of these powerful predictors. Conclusions. Control of hypertension and diabetes continues to be important among older adults. Since excess adiposity seems to influence risk of stroke through its association with these disorders and other cardiovascular disease risk factors, control of weight and fat remains an important concern as well. (Am J Public Health. 1994;84:14-19), Obesity may be associated with a risk of stroke because of its role in high blood pressure, diabetes and other cardiovascular diseases. Researchers followed adults aged 65 to 74 years from 1965 until death, stroke or 1970 to evaluate obesity and the risk of stroke. During the follow-up period, 199 strokes occurred. Women had the highest level of overall obesity and had more fat surrounding the chest than men. Obesity and chest fat were associated with high blood pressure, blood cholesterol, blood triglycerides and blood sugar. Obesity was also related to a history of diabetes. Among adults less than 70 years of age, black men and women had more than two times the risk of stroke than white men. Among those 70 years or older, black women had the highest risk of stroke, approximately 3.5 times that of young white men. Black race, female gender, age, high blood pressure-related heart disease and diabetes were significantly associated with the risk of stroke.

A study which assessed the effect of premorbid psychosocial factors on physical function and institutionalization on aged stroke patients, six weeks after hospital discharge, showed that some psychological factors are very important in characterizing the intensity of the stroke. A stroke patients' involvement with his family and society is connected with his risk of falling ill and getting admitted in hospital.

A survey conducted in 1989 identified the risk factors for stopping driving and lowering of mileage among 1331 aged people in New Heaven, Ct. Old age, inadequate financial conditions, neurologic diseases, unemployment, catracts, functional disability and decreased rate of physical activity were the reasons which led people to stop driving. The social and economic conditions also influenced people to discontinue driving. Forty-two percent of the people included in the survey stated that they how drove fewer miles than five years before the survey.

Septicemia is the 13th leading cause of death in the United States and the second leading infectious cause of death. Among persons ages 65 or more years, septicemia was the […]

DESPITE GREAT PROGRESS against infectious disease in this century, pneumonia remains the leading infectious cause of death, particularly among older adults. Pneumonia-influenza is the fifth leading cause of death among […]

We examined longitudinal changes in smoking behavior among older adults in three community cohorts of the Established Populations for Epidemiologic Studies of the Elderly. Smoking prevalence declined from 15% at baseline to 9% during 6 years of follow-up. Annual smoking cessation and relapse rates were 10% and less than 1%, respectively. Interval diagnosis of myocardial infarction, stroke, or cancer increased subsequent smoking cessation but not relapse. Although smoking cessation around diagnosis is increased, primary prevention could yield greater benefits. (Am J Public Health. 1992; 82:1268-1271)

Despite the importance of kin in caring for older relatives, few studies have examined the relationship between the family network and the risk of nursing home placement. Data from a cohort of noninstitutionalized elderly persons living in New Haven in 1982 were used to predict nursing home admission through 1985. Logistic regression analyses show that older persons who have regular contact with kin have a lower risk of institutionalization. For men, the spouse is most important in reducing the risk of entry; for women, having regular contact with at least one family member--of any relation--reduces the risk of entry. (Am J Public Health. 1994;84:843-845), Elderly people who have regular contact with family members are less likely to require admission to a nursing home. A total of 2,812 non-institutionalized men and women aged 65 years and older were interviewed about nursing home admissions and family support networks in 1982. Data from annual interviews conducted between 1982 and 1985 were analyzed. For both women and men regular contact with a family member reduced the risk of nursing home admission. However, there were differences in risk factors between women and men. Women who had at least one family member with whom they had regular contact were significantly less likely to require nursing home admission than women who had no contact with relatives. Men with wives were significantly less likely to require nursing home admission than men without spouses. This relationship existed for men regardless of the size of the family network.

The cross-sectional relationship between physical activity, physical fitness, and measures of resting hemodynamic function and adiposity was examined in 11 women and 14 men, all of whom were in good health (M age = 69.3 yrs). Resting diastolic blood pressure (DBP) differed significantly by quartiles of both weekly energy expenditure and estimated VO2max. Subjects whose energy expenditure was above the 50th percentile had significantly lower DBP than Less active subjects, independent of age, gender, and VO2max, whereas those above the 75th percentile of VO2max had lower DBP and mean arterial pressure compared to less fit subjects, independent of age, gender, and weekly energy expenditure. There were no significant differences in the body mass index or percent body fat by quartile of weekly energy expenditure or estimated VO2max in the multivariable analysis. Mean waist- to-hip ratio (WHR) differed by level of weekly energy expenditure, independent of age, gender, and VO2max; individuals who reported a threshold of energy expenditure >&mn;6,099 kcal/wk had less relative abdominal fat than those reporting less activity. There were no significant independent differences in mean WHR or the central-to-peripheral skinfold ratio between quartiles of VO2max. [ABSTRACT FROM AUTHOR]

Atotal of 3,811 people over the age of 65 were interviewed about a variety of health and social problems. This data was reviewed to provide an estimate of the prevalence and severity of headache in this population, as well as to identify other variables that may correlate with headache. The subjects were asked if they experienced any headaches, frequent headaches, severe headaches, or migraine headaches. For the purposes of this study, a migraine headache was defined as a one-sided headache, associated with nausea or vomiting, or a preceding aura. In all categories, headaches were more common among women, and the incidence of headache declined with age. The features that correlated most strongly with headache were stress, mood, and personality. Headache was also associated with joint pain among these subjects. Although some studies have found an association between headache and numerous ailments of the eyes, ears, and teeth, the present study found a significant correlation only with eyesight; those with failing eyesight experienced more headaches. In this study, severe headaches and migraine headaches had the same spectrum of associations, supporting the notion that migraine headaches are simply very severe headaches. Some investigators feel, however, that migraine headaches are a distinct nosological entity, i.e. migraine headache should be a separate disease classification. Since the individuals included in this study remain under observation, it should be possible to examine any relationship between headache and the development of illness or increased risk of mortality in the future. (Consumer Summary produced by Reliance Medical Information, Inc.)