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The incidence of food allergy is increasing globally and whilst there is consensus that dietitians should be involved in its management, the roles that dietitians should fulfil differ between different guidelines and the description of tasks remains unclear. Currently, no Swiss guideline exists to assist dietitians in counselling children with food allergies. There is a need for recommendations that will guide dietitians through the counselling process. The aim of this project was to create a practice guideline for dietary counselling of children with food allergy. Practice guidelines were developed following the Academy of Nutrition and Dietetics stepwise approach. The process consisted of six steps: (1) Determine the scope of the guideline. (2) Conduct a systematic review. (3) Draft the guideline recommendations using the Nutrition Care Process (NCP) as a framework. (4) Finalise the guideline during a face-to-face meeting. (5) Conduct internal and external review and revise accordingly. (6) Publish guideline. The process resulted in 25 recommendations for dietary counselling. Most recommendations are based on expert opinion only, due to the lack of studies in this field and showed similar levels of consensus between the expert group and external review by allergists. However, there were nine recommendations where the consensus differed. This guideline provides a comprehensive guide to dietary counselling for food allergy by dietitians in Switzerland. It will inform best practice and improve patient-centred care and encourage a consistent approach, but it will need to be reviewed and updated as more robust evidence is produced.

Objectives: Questions exist about using mass mailings to recruit representative samples to participate in clinical trials. The MESA Prevention Study (Medical, Epidemiologic and Social Aspects of Aging), a randomized controlled clinical trial to prevent urinary incontinence (UI), utilized a mass mailing recruitment procedure to recruit a representative sample of women to participate in a behavioral modification program. This paper seeks to expand the literature of mass mailing recruitment strategies for prevention studies by describing the procedures used to recruit healthy, continent, post-menopausal women aged 55–80 years. Methods: Sociodemographic data collected from recruited subjects is compared with on-line national census data to evaluate the representativeness of the sample recruited from a purchased mailing list. Results: The mass mailing procedure resulted in 3.3% positive response. Of those that returned a positive response, 37.6% were deemed eligible at first screening. Comparisons of study demographic data with state and county census data indicate that the sample obtained was representative of the communities. Conclusions: The mass mailing strategy was an effective means of recruiting a representative sample of women, aged 55–80. Short falls and recommendations for successful community sample recruitment strategies for clinical trials in older adult women are elaborated upon.

Objective: We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outcomes, and costs of dementia and ‘cognitive impairment, not demented’ (CIND) using a unique study design based on the nationally representative Health and Retirement Study (HRS). We also illustrate potential uses of the ADAMS data and provide information to interested researchers on obtaining ADAMS and HRS data. Methods: The ADAMS is the first population-based study of dementia in the United States to include subjects from all regions of the country, while at the same time using a single standardized diagnostic protocol in a community-based sample. A sample of 856 individuals age 70 or older who were participants in the ongoing HRS received an extensive in-home clinical and neuropsychological assessment to determine a diagnosis of normal, CIND, or dementia. Within the CIND and dementia categories, subcategories (e.g. Alzheimer’s disease, vascular dementia) were assigned to denote the etiology of cognitive impairment. Conclusion: Linking the ADAMS dementia clinical assessment data to the wealth of available longitudinal HRS data on health, health care utilization, informal care, and economic resources and behavior, will provide a unique opportunity to study the onset of CIND and dementia in a nationally representative population-based sample, as well as the risk factors, prevalence, outcomes, and costs of CIND and dementia.

Using three waves of Health and Retirement Study data, this study investigated whether (a) self-reported physician-diagnosed diabetes prior to 1994 predicted weight loss between 1994 and 1996 in adults who were aged 51 to 61 and relatively healthy but overweight in 1992 (n = 2,642) and (b) socioeconomic status influenced that relationship. The authors found that these overweight middle-aged adults were at least 50% more likely to report that they lost at least 10 pounds of excess body weight if they had been diagnosed with diabetes than if they had not. Furthermore, the authors found that neither education nor net worth predicted weight loss in these adults. Identifying the social, psychological, and physiological mechanisms linking chronic conditions and health behaviors can inform policy makers and health care providers and enhance the development of effective interventions to prevent or reduce health risks in middle-aged and older adults.

The number of older individuals with dementia will likely increase significantly in the next decades, but there is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by cognitively impaired individuals and their families. We used data from the 1993 and 1995 Asset and Health Dynamics Study, a nationally representative longitudinal survey of older Americans, to determine the OOPE for individuals with and without dementia. Dementia was identified in 1993 using a modified version of the Telephone Interview for Cognitive Status for self-respondents, and proxy assessment of memory and judgment for proxy respondents. In 1995, respondents reported OOPE over the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. The adjusted mean annual OOPE was 1,350 US dollars for those without dementia, 2,150 US dollars for those with mild/moderate dementia, and 3,010 US dollars for those with severe dementia (p < 0.01). Expenditures for hospital/nursing home care (1,770 per year US dollars) and prescription medications (800 per year US dollars) were the largest OOPE components for those with severe dementia. We conclude that dementia is independently associated with significantly higher OOPE for medical care compared with those with normal cognitive function. Severe dementia is associated with a doubling of OOPE, mainly due to higher payments for long-term care. Given that the number of older Americans with dementia will likely increase significantly in the coming decades, changes in public funding aimed at reducing OOPE for both long-term care and prescription medications would have considerable impact on individuals with dementia and their families.

Understanding the epidemiology (distribution and determinants) of urinary incontinence (UI), as well as its natural history is a very important issue. In this article, we discuss prevalence, incidence, natural history, and the variations that may be related to race and ethnicity. We focus on epidemiologic population comprising community-dwelling women who are not institutionalized. Our review clearly shows that there is a lack of advanced epidemiologic analyses. Variables that better characterize UI include frequency measure, quantity of urine loss, duration, type, and severity. These factors should be incorporated into basic study design so that more advanced and informative analyses may be conducted.

The Epidemiologic Issues in Urinary Incontinence: Current Databases and Future Collaborations Symposium included an international group of 29 investigators from 10 countries. The purpose of the symposium was to discuss the current understanding and knowledge gaps of prevalence, incidence, associated risk factors, and treatment outcomes for incontinence in women. During the symposium, investigators identified existing large databases and ongoing studies that provide substantive information on specific incontinence research questions. The investigators were able to form an international collaborative research working group and identify potential collaborative projects to further research on the epidemiology of urinary incontinence and bladder dysfunction.

OBJECTIVES: To examine the rates and correlates of depressive symptoms and syndromal depression in people with self-reported heart failure participating in a community study of people aged 70 and older. DESIGN: Cross-sectional. SETTING: Community-based epidemiological study of older people from the continental United States. PARTICIPANTS: Six thousand one hundred twenty-five older people participating in the longitudinal study of Assets and Health Dynamics. Participants had to be born in 1923 or earlier. MEASUREMENTS: The short-form Composite International Diagnostic Interview assessed syndromal depression, and a revised version of the Center for Epidemiologic Studies—Depression scale assessed depressive symptoms. Medical illness was based on self-report. The authors compared the rates of syndromal depression and individual depressive symptoms in people with self-reported heart failure (n = 199) with those in people with other heart conditions (n = 1,856) and with no heart conditions (n = 4,070). RESULTS: Eleven percent of those with heart failure met criteria for syndromal depression, compared with 4.8% of people with other heart conditions and 3.2% of those with no heart conditions. The association between heart failure and depression held even after controlling for disability, reported fatigue and breathlessness, and number of comorbid chronic illnesses. CONCLUSION: Community-living older people with self-reported heart failure were at approximately twice the risk for syndromal depression of the rest of the community. Although fatigue and functional disability were also related to depression in this sample, these variables did not account for the association between syndromal depression and self-reported heart failure.

Older age is a time of life when major life tasks such as work and raising children have typically been completed. As a consequence, the daily demands for involvement in their social environment have lessened for older adults. It is believed that, because of their many possible benefits, social activities ultimately promote physical and mental health in older age. These propositions have captured the imagination of gerontologists and geriatricians for decades. Surprisingly, the body of relevant research is not plentiful. In this article we selectively review the theory and empirical support surrounding social engagement and its health consequences in older age.

To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals.Multivariate regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people aged 70 and older (N = 7,443).Community-dwelling older people.National population-based sample of community-dwelling older people.Weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads.Thirteen percent of men and 24% of women reported incontinence. After adjusting for sociodemographics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours (P.001). Women in these groups received 5.9, 7.6, and 10.7 hours (P.001), respectively. The additional yearly cost of informal care associated with incontinence was $1,700 and $4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the additional yearly cost was $700 and $2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care.The quantity of informal caregiving for older people with incontinence and its associated economic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the significant informal caregiving costs associated with this condition.

Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia.Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443).National population-based sample of the community-dwelling elderly.Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status.After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P.001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P.001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

Objectives. This study examined whether changes in driving patterns—driving cessation and reduction—have negative consequences for the depressive symptoms of older Americans and whether these consequences are mitigated for people with a spouse who drives. Methods. The project used data from 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Depressive symptoms were assessed with an abbreviated Center for Epidemiologic Studies-Depression scale. Using 2 models, the project examined how driving cessation and reduction that occurred between Waves 1 and 2 contributed to increases in depressive symptoms between Waves 2 and 3. The first model included the entire sample ( N � 5,239), and the second model focused on drivers only ( n � 3,543). A third model added interaction terms to the analysis to consider whether respondents who stopped driving but had a spouse who drove were less at risk of worsening depressive symptoms. Results. Respondents who stopped driving had greater risk of worsening depressive symptoms. Drivers who restricted their driving distances before the study began also had greater risk of worsening depressive symptoms, but seemingly less so than the respondents who stopped driving altogether. For respondents who stopped driving, having a spouse available to drive them did not mitigate the risk of worsening symptoms. Discussion. Changes in driving patterns can be deleterious for older people’s depressive symptoms. Initiatives for assisting older people should focus on strategies that help them retain driving skills, that prepare them for the possible transition from driver to ex-driver, and that ensure that they have access to mental health therapies if driving changes are imminent.

Although millions of individuals have symptoms suggestive of overactive bladder (OAB), few ever seek or receive medical treatment for their condition.The purpose of this study was to describe coping strategies and health care-seeking behavior in a community-based sample of adults with symptoms suggestive of OAB.A cross-sectional household telephone survey of an age- and sex-stratified sample of adults was conducted. The survey consisted of general health-related questions as well as questions related to OAB symptoms. A total of 4896 adults completed the interview Respondents were considered to have OAB if they reportedor = 1 symptom of urinary urgency, frequency, or urge incontinence. A follow-up questionnaire was then mailed to a subsample of the telephone interview respondents. The mailed questionnaire contained questions related to type and severity of OAB symptoms, coping strategies, medical care/treatment, feelings/beliefs about OAB, and quality of life. Half of the phone respondents with urinary incontinence (n = 638) and a random sample of all other phone respondents received the mailed questionnaire (n = 873); 1,034 questionnaires were returned.Of the respondents with OAB, 69.6% triedor = 1 nonmedical coping strategy. Respondents with incontinent OAB were significantly more likely than those with continent OAB or those with no OAB (controls) to use nonmedical coping strategies (incontinent OAB, 76.1%; continent OAB, 59.0%; controls, 31.9%; P0.001). Fewer than half of the respondents with OAB (43.5%) had spoken with a provider about OAB in the previous 12 months. Medical consultation was associated with sex, type and severity of OAB, number of nonmedical coping strategies tried, number of OAB information sources consulted, inclination to try new OAB medications, and feelings/beliefs about OAB. In 90% of patient-provider discussions about OAB, the patient initiated the topic.Individuals manage symptoms suggestive of OAB primarily by using nonmedical coping strategies rather than consulting health care providers. Results of this study support the need for improved clinical recognition of OAB and increased patient-provider communication about this condition.

OBJECTIVE: Incontinence-specific and generic measures of well-being were regressed on potential predictors to identify incontinent respondents at risk for psychosocial distress and to understand the relationship between urinary incontinence (UI) and other determinants of social and emotional status. DESIGN: Survey data were collected May 1994 through April 1996. SETTING: Telephone interviews as a supplement to a nationally representative monthly consumer survey. PARTICIPANTS: Analyses were based on 1,116 continent and 206 incontinent respondents age 40 and older. MEASUREMENTS: Incontinent respondents self-reported the extent to which urine loss restricted social activities or affected their feelings about themselves. All respondents were asked whether they felt depressed, lonely, or sad. Covariates included sex, age, race, education, social desirability, health status, frequency of urine loss, quantity of loss, and urgency. RESULTS: The majority of incontinent respondents reported that urine loss did not restrict activities or diminish self-esteem. Incontinent respondents who were younger, male, less educated, lower in social desirability, in poorer health, or losing greater quantities of urine were more likely to report psychosocial distress, although these correlates were not consistently significant. Compared with continent respondents, significantly higher percentages of incontinent respondents reported feeling depressed, lonely, or sad. In the multivariate models, incontinence retained an independent association with loneliness, but not with sadness or depression. CONCLUSION: Even though the direct psychosocial impact of urine loss may be minor in many cases, UI is associated with a constellation of physical and behavioral factors that can impose a social and emotional burden. This suggests that UI cannot be adequately evaluated or treated without consideration of the patient's overall quality of life.

This study examined the demographic, medical, and psychiatric correlates of hallucinations and paranoid delusions reported by proxy informants for 822 elders aged 70 or older. This sample comprised people who were deemed unable to complete a direct interview in a large nationwide study of aging. Marital status, trouble with vision, and cognitive impairment were associated with report of both paranoid delusions and hallucinations. Depressive symptoms and stroke were associated with hallucinations only. These results suggest that inadequate external stimulation in the elderly leads to psychotic experiences.

Objectives. To assess, by means of a survey, the impact of the symptoms of overactive bladder (urinary frequency, urgency, and urge incontinence) on the quality of life in a community-based sample of the U.S. population. Methods. A telephone survey was conducted in the United States among an age and sex-stratified sample of 4896 noninstitutionalized adults 18 years of age and older. From the responses to the telephone survey, a total of 483 individuals with symptoms of overactive bladder and 191 controls completed a mailed follow-up questionnaire to assess their quality of life using the Medical Outcomes Study Short-Form 20. Results. After adjustment for age, sex, and the use of medical care, the greatest differences in the quality-of-life scores between the patients with incontinent overactive bladders and the controls were in the health perception (17.6 points; P

Background. Few studies have investigated the prevalence and severity of urinary incontinence in older African American women. Comparisons of findings with those for older Caucasian women could provide important clues to the etiology of uri­ nary incontinence and be used in planning screening programs and treatment services. Methods. Data are from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. A nation­ ally representative sample of noninstitutionalized adults 70 years of age and older was interviewed. African Americans were oversampled to ensure that there would be enough minority respondents to compare findings across racial groups. Results. A statistically significant relationship was found between race and urinary incontinence in the previous year: 23.02% of the Caucasian women reported incontinence, compared with 16.17% of the African American women. Other factors that appear to increase the likelihood of incontinence include education, age, functional impairment, sensory impairment, stroke, body mass, and reporting by a proxy. Race was not related to the severity (as measured by frequency) of urine loss among incontinent older women. Conclusion. This study identifies or confirms important risk factors for self-reported urinary incontinence in a national con­ text, and suggests factors leading to protection from incontinence. Race is found to relate to incontinence, with older African American women reporting a lower prevalence.

This study examines the psychometric properties of two new abbreviated versions of standard measures of depression, a revised eight-item Center for Epidemiological Studies--Depression Scale (CES-D) and a short-form Composite International Diagnostic Interview (short-form CIDI). A sample of 6,133 elders, age 70 years or older, completed both measures as part of the Asset and Health Dynamics Study of the Oldest Old. The revised CES-D had an internal consistency and factor structure comparable to that of prior versions of the CES-D. The sources of discordance between the two measures were examined and the two measures were compared on self-report of four clinical variables: medical illness, physician diagnosis, psychiatric treatment, and antidepressant or tranquilizer use. Both measures were associated with self-report of physician diagnosis and psychiatric treatment. Respondents positive for depression on the CES-D reported higher rates of antidepressant use. Respondents positive on the short-form CIDI only did not report more antidepressant use than nondepressed respondents.

Four measurement models of the structure of motivation to volunteer were evaluated in 2 samples of older (minimum age = 50 years), active volunteers. Motivation to volunteer was assessed with the Volunteer Functions Inventory. Whereas no support was found for either unidimensional or bipartite models, qualified support was observed for both 6-factor and 2nd-order factor models. The best fit of the data was obtained with the 6-factor model of motivation to volunteer (career, enhancement, protective, social, understanding, and values). Contrary to the prediction derived from the 2nd-order factor model, the 6 volunteer motives were differentially related to demographic variables and number of hours spent volunteering for the organization during the past year. Implications for assessing motivation to volunteer among older adults and recruiting older adults as volunteers are discussed.

The present investigation examined the participation of adults in a broad array of productive activities. Data are from two waves of a national household survey of adults 25 years and older in the U.S. conducted in 1986 and again in 1989. The purpose of this study was to describe stability and change in involvement in productive activity. Results demonstrate a great deal of stability in participation across the two waves. Some change in participation was detected, however, and analy­ ses revealed that age and gender were associated with change in several activities.

We reported that difficult bladder emptying symptoms are prevalent in elderly men. Urodynamic tests were conducted among 94 volunteer male respondents identified from our Medical Epidemiologic and Social Aspects of Aging Study in Washtenaw County, Michigan. Urine flow rates were significantly slower among men with symptoms compared to those without symptoms; however, significant overlap exists. Voiding pressures were not significantly different between respondents with and without difficult bladder emptying symptoms. The results of voiding pressure flow studies on all respondents regardless of whether they have symptoms revealed 41% with an obstructive pattern (high pressure and poor flow), 28.2% with an underactive pattern (low pressure and low flow), 20.5% with a mixed pattern (high pressure and normal flow) and 10.3% with a normal pattern. Symptoms hesitancy was more reflective of weaker detrusor pressure and straining pattern. From these results we conclude that symptoms and flow rates should not be used as the sole criterion to diagnose obstruction but, rather, they should be included in the entire spectrum of clinical information needed to arrive at a clinical diagnosis.

The definition of personal productivity based on paid work is expanded to include many forms of unpaid work. The productivity of these forms of unpaid work is estimated empirically, using several economic approaches (an opportunity cost approach, a market price approach, and a value-added approach) and one noneconomic approach. Additionally, two methods of dealing with selection bias when estimating opportunity costs for nonemployed persons are compared. These different approaches all document the extent to which many of the activities (such as housework, formal volunteer work, or informal help to relatives and friends) that are often performed without pay by older Americans or women are actually productive because they produce goods and services to which a market value can be imputed. Using this expanded definition to describe the productive contribution of men and women at different ages provides a much needed correction to existing social statistics: Women contribute in major ways to U.S. productivity, as do older adults, although to a lesser degree. These findings challenge the stereotypic view of older Americans as unproductive and mere burdens on society. Data were from a 1986 cross-sectional survey of 3,617 adults representative of those 25 years old and older living in the coterminous United States.

Although diuretics have been implicated as a cause oJ urinary incontinence, no evidence has been presented prior to this report to confirm such a relationship. Our epidemiologic survey oJ 1,956 respondents sixty years of age and older in Washtenaw County, Michigan, revealed 24.6 percent oJ men and 36.9 percent oJ women were current users oJ a diuretic medication. Comparisons between users and non-users of diuretics and continence and in- continence status revealed no significant diJJerence in the prevalence Of incon- tinence in either gender. However, when male respondents who had cystomet- ric examinations were analyzed, it was found that diuretic users who have uninhibited detrusor contractions (UDC) had a significantly higher prevalence of urinary incontinence (85.7%) when compared with non-users with UDC (25 %) (p = 0.009)/Among men who did not have UDC, use or non-use of diuretics showed a similar relationship but did not reach statistical significance (p = O. 085). There were too Jew female respondents with UDC to make mean- ingful analysis in this group.

Although cough transmission pressures to the bladder and urethra are now being measured as part of the evaluation of an incontinent woman, there has not been a comprehensive study specifically focused among continent and incontinent non-institutionalized elderly women in order to understand the meaning of such measurements. To determine the characteristics and significance of the cough transmission pressures to the bladder and urethra, measurements were obtained from 69 continent and 100 incontinent elderly female respondents as part of an extensive urodynamic testing. Results showed that during coughing in the standing position, the increase in bladder pressure is significantly stronger among stress incontinent respondents than among continent and non-stress incontinent respondents (p = 0.0022). The increase in urethral pressure in the same group is marginally significant (p = 0.066). The mean transmission pressure ratio (urethral pressure ÷ bladder pressure) is less than 100% in all groups. They were higher among continent respondents (90%) and non-stress incontinent respondents (97%) than stress incontinent respondents (83%); however, the mean values between the 3 groups were not significantly different. The mean cough transmission pressures were significantly higher among chronic coughers than non-chronic coughers. When controlled for chronic coughing, the stress incontinent respondents have a significantly higher bladder pressure than continent and non-stress incontinent respondents. Significance of these findings in relation to the mechanisms of female geriatric incontinence are presented.

This study determines whether prevalence and predictors of nursing home admission changed in the 1990s, during a period of dramatic changes in the service provision for and medical care of chronic impairments. Data from the 1993-2000 surveys of the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, a longitudinal and nationally representative sample, were used. Proportional hazard models were used to determine the effects of dementia, physical functioning, clinical conditions, and sociodemographics on the likelihood of nursing home admission. Of the 6,676 respondents, 17% were admitted to a nursing home. Models excluding functional impairment demonstrated significant effects of chronic medical conditions and dementia on the risk of institutionalization. After controlling for functional impairment, dementia still had significant and strong effects on institutionalization but clinical conditions did not, suggesting that the impact of dementia goes beyond its effect on physical functioning. Nursing home admissions did not decrease during the study period, and the impact of dementia on the risk of nursing home admission did not decrease. Interventions for individuals with dementia should impact the behavioral aspects of the condition and slow disease progression in addition to improving physical functioning.

We determined whether a behavioral modification program (BMP) taught to groups of continent older women would decrease the incidence of urinary incontinence, increase pelvic muscle strength and improve voiding control.We performed a randomized, controlled trial comparing a BMP treatment group to a control, no treatment group in ambulatory, postmenopausal, continent women (0 to 5 days of incontinent episodes in the previous year) 55 years and older who were followed for 12 months. Qualified volunteers from 4 Michigan counties were randomly assigned to a control or a treatment group, consisting of a 2-hour classroom presentation on BMP followed 2 to 4 weeks later with individualized evaluation to test knowledge, adherence and skills in behavioral techniques, and brief reinforcement of the technique as needed. Followup was done by telephone and mail every 3 months except month 12, when all participants underwent final clinical evaluation. Outcome measures were continence status, pelvic floor muscle strength and voiding frequency/intervoid interval.A total of 195 control and 164 treated participants completed the study. Baseline data on the 2 groups were not statistically different. At 12 months the treatment group was statistically significantly better than the control group in continence status (p = 0.01), pelvic muscle strength (pressure score p = 0.0003 and displacement score p0.0001), improved voiding frequency (p0.0001) and intervoid interval (p0.0001).To our knowledge we report the first randomized, controlled trial of BMP for preventing urinary incontinence in older women. It demonstrated feasibility and efficacy in improving continence status, pelvic muscle strength and voiding control as long as a year after treatment.

To determine whether relatives and others can provide valid information about the dates of survey respondents' deaths, informants' reports were compared with death certificates for 328 deceased respondents from the MESA study of older adults. About two-thirds (64.6%) of the informants accurately reported the complete date of death. A somewhat larger percentage (70.4%) correctly reported the day of death, whereas 86.9% and 89.6% remembered the year and month, respectively. The percentage of correct reports varies by the relationship between informant and respondent. Also, the findings suggest that women are more accurate reporters than are men, and that the percentage of accurate reports is greater for longer-term relationships.

Objective. This study investigates cohort differences in cognitive functioning among Americans aged 70 or older in 1993, 1995, 1998, and 2000. Methods. The study draws on self-respondent data from four waves of the Asset and Health Dynamics Among the Oldest Old Study and the Health and Retirement Study surveys collected between 1993 and 2000. Cognitive performance scores for each of four components (immediate recall, delayed recall, serial 7s, and mental status) and their sum are compared across cohorts, unadjusted and with adjustments for survey design features and demographic characteristics. Results. Unadjusted scores suggest cohort improvements in several components of cognitive functioning between 1993 and 1998, and little change between 1998 and 2000. However, these improvements largely disappear after confounding features of the survey design (changes in age distribution of the sample across waves and prior exposure to the cognitive tests) and changes in the demographic composition of the sample (race, ethnicity, and gender) are adjusted for. Discussion. There appears to have been little improvement of cognitive functioning across recent cohorts of older Americans. However, the study points out the complexities of using panel data to study cohort differences, particularly when the measures of interest are likely influenced by prior wave participation. Future studies based on other data sources are needed.

Objective: To understand the role of cognitive impairment and depressive symptoms on functional outcomes of stroke and diabetes. Evaluation approaches to functional outcomes have rarely focused on the presence of specific comorbidities, particularly those involving mental health disorders. Methods: Data are from the AHEAD cohort of the Health and Retirement Study (HRS), a nationally representative panel of persons 70+ years of age in 1993. Analyses are limited to 5,646 self-respondents for whom functional outcome data are available in 1995. Additive and interactive multiple regression models are compared for each outcome and focal condition combination. Results: The additive model is sufficient for the majority of outcome and focal condition combinations. The interaction term is significant in 4 of 12 comparisons. Discussion: Stroke, diabetes, cognitive impairment, and depressive symptoms exhibit strong independent effects on physical functioning. Support for the hypothesis that cognitive impairment and depression exacerbate the impact of stroke and diabetes is more limited.

The impacts of the productive social activities of volunteer and paid work on health have rarely been investigated among the oldest Americans despite a recent claim for their beneficial effect (Rowe and Kahn 1998). This paper used data from Waves 3 and 4 of the Asset and Health Dynamics among the Oldest Old (AHEAD) Study to (1) investigate the impact of these activities on health measured as self-reported health and activities of daily living (ADL) functioning limitations and to (2) explore possible causal mechanisms. Using multinomial logistic regression analysis, amounts of volunteer and paid work over a minimum of 100 annual hours self-reported at Wave 3 were related to poor health and death as competing risks measured at Wave 4, controlling for health measured at Wave 2 and for other predictors of poor health and death. Findings suggest that performing more than 100 annual hours of volunteer work and of paid work have independent and significant protective effects against subsequent poor health and death. Additional analyses suggest that the quantity of volunteer and paid work beyond 100 annual hours is not related to health outcomes and that physical exercise and mental health measured as cognitive functioning and depressive symptoms explain not entirely overlapping parts of the relationship between productive activities and health.

Objective:To determine whether self-reports of urinary incontinence are influenced by the context in which survey questions are presented. Variation in the extent to which surveys promote complete and accurate reporting may help explain the wide range of published prevalence estimates. Methods:Respondents to a nationally representative telephone survey were randomly assigned one of two questionnaire forms. Both forms contained the same incontinence question. One form included an introduction and follow-up probe, which acknowledged the embarrassment of discussing incontinence and stressed the importance of thorough reporting. Results:Use of the introduction and probe produced a significantly higher prevalence rate, with the effect varying by respondent’s age. Discussion:The prevalence of incontinence is likely to be underestimated unless studies attend to the possibility of biased reporting. The finding of a form by age interaction suggests the importance of survey context in studies of risk factors, as well as in prevalence studies.

PURPOSE: This paper was concerned with patterns of individual-level, longitudinal change in depressive symptoms and factors related to those patterns among Americans 70+ years of age. Two types of depressive symptoms were considered, somatic and mood symptoms. The paper focused on whether the patterns of change and the risk factors for these two types of symptoms differed, as we might expect among old and oldest-old adults. METHODS: The analytic sample included self-respondents of the 1993–1995 Asset and Health Dynamics among the Oldest Old (AHEAD) study who were born in 1923 or earlier. Depressive symptoms were assessed using an abbreviated Center for Epidemiologic Studies-Depression (CES-D) Scale. The analyses involved examination of respondents' change scores in depressive symptoms and multivariate models using ordinary least squares (OLS) and seemingly unrelated regressions (SUR). RESULTS: In aggregate, somatic symptoms were more common than mood symptoms initially and over time. Despite differences in aggregate rates, AHEAD respondents' individual-level patterns of change for the two types of symptoms were similar; i.e., stability was the principal trend (53–60%), followed by improvement (21–26%). A number of factors related to change in one aspect of depressive symptoms and not the other, or had greater effects on one aspect of depressive symptoms than the other; e.g., physical health had greater effects on somatic than mood symptoms. CONCLUSIONS: This study suggests that, in investigations of the course and risk factors for depressive symptoms among people 70+ years of age, it is important to separate somatic symptoms from mood symptoms; their etiology may differ. In general, factors reflecting respondents' social milieu (e.g., bereavement, residential relocation) may have greater effects on mood than somatic symptoms, whereas certain factors representing physical health may have greater effects on somatic symptoms.

OBJECTIVES: The ability of older people to estimate their own memory, often referred to as “metamemory,” has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person's metamemory is mostly accurate, whereas others have demonstrated little relationship between memory complaint and actual impairment. This study examines memory complaint in a large national sample of older people aged ≥70. DESIGN: A longitudinal cohort study with two waves of data collection spaced 2 years apart. SETTING: A nationwide random sample of community-dwelling older persons. PARTICIPANTS: A total of 5444 community-dwelling persons aged ≥70 and their spouses. MEASUREMENTS: Participants were asked if they believed their memory was excellent, very good, good, fair, or poor. They were then administered a cognitive assessment derived from the Mini-Mental Status Exam. RESULTS: In general, people's assessment of their memory corresponded with their actual performance on cognitive measures. However, large portions of the sample inaccurately assessed their memory skills. People who reported depressive symptoms and had impairment in activities of daily living were more likely to state that their memory was impaired, although they performed very well on cognitive measures. CONCLUSIONS: The conditions that skew people's self-assessment are the ones most likely to bring them into contact with healthcare professionals. This may give clinicians the general impression that older people cannot assess their own cognitive skills. However, poor metamemory appears to be a characteristic of a specific subgroup of older persons, not necessarily characteristic of the general population.

This chapter summarizes current knowledge about urinary incontinence (UI). UI is defined by symptoms that are caused by a number of underlying pathologies. In recognition of the two major types of UI, the International Continence Society definition also includes definitions of stress and urge types of incontinence. Symptoms of urge incontinence are UI associated with a strong and sudden desire to void. Urge incontinence often results from involuntary contractions of the smooth muscle in the bladder wall that can be identified through uro-dynamic testing. Symptoms of stress urinary incontinence are UI associated with physical activities such as coughing, sneezing, and laughing that increase intra-abdominal pressure. Stress urinary incontinence typically is caused by a weak sphincter or by displacement of the urethra and bladder neck during exertion. Surgery can be an appropriate treatment for selected incontinent women (and men) for whom more conservative measures are not feasible or were not successful. It is generally reserved for patients with obstruction or with stress incontinence due to urethral hypermobility and/or intrinsic sphincter deficiency. Surgery for the management of urge incontinence is not common and is usually considered only for highly symptomatic patients for whom other options have failed.

The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse's death predicted bereavement-related depression.

Although a number of authors have proposed that older volunteers should benefit in terms of better health and well-being, few researchers have examined the issue empirically to see whether this is true. The purpose of this article is to build on this literature by empirically examining the association between volunteering and mortality among older adults.Using data from a nationally representative sample, we use Cox proportional hazards regression to estimate the effects of volunteering on the rate of mortality among persons aged 65 and older.We find that volunteering has a protective effect on mortality among those who volunteered for one organization or for forty hours or less over the past year. We further find that the protective effects of volunteering are strongest for respondents who report low levels of informal social interaction and who do not live alone.We discuss the possibility that the curvilinear relationship we observe between volunteering and mortality is due to a combination of factors, including self-identity, role strain, and meaningfulness. Other research using more precise data is needed to determine whether these ideas are supportable.

As the US population ages, there is a growing need for information about the urologic health problems facing older adults. In conjunction with findings from clinical studies and basic research on biological mechanisms, the epidemiologic approach offers insights on the prevalence, etiology, and impact of these geriatric conditions. This information can provide the basis for planning health care services and intervention programs. The authors discuss trends associated with population aging and the challenges posed by the epidemiologic study of older adults. Also reviewed are current findings on the prevalence, incidence, and correlates of urinary incontinence and other common urologic symptoms.

Objective To determine whether mortality is independently associated with urinary incontinence. Design 6-year prospective study that started in 1983/84. Setting A Midwestern County. Participants Probability sample of 1956 community-residing persons 60 years of age and older in 1983/84. Measurements The independent variables of urinary incontinence, its types and severity, were measured by survey self-report, which was validated with clinical exams. The control variables of age, education, and health status were also self-reported. The dependent variable of death was established during follow-up interviews from reports of previously designated contact persons. Results Neither incontinence status nor its severity level or types were found to be positively associated with 6-year mortality in logistic regression analyses that adjusted for age, education, and health status. Conclusion Whereas urinary incontinence can be an embarrassing and socially debilitating condition, it does not itself predict or contribute to mortality.

Most urodynamic tests currently in use in the evaluation of female urinary incontinence have not been applied to a community-based sample to determine their specificity. In this study of a random sample of noninstitutionalized elderly, 258 self-reported continent and 198 self-reported incontinent women sixty years and older, who participated in a household survey, underwent a clinic evaluation (history, physical examination, and urinalysis); of these, 67 continent and 100 incontinent female respondents underwent urodynamic testing. The uroflowmetry, cystometry, and supine static urethral pressure profilometry (UPP) findings did not differ significantly between continent and incontinent subjects (whether based on a self-report or a clinician's diagnosis of urinary continence status). Standing static and dynamic UPP and lateral eystography showed significant differences between self-reported continent and incontinent respondents. The provocative stress test significantly distinguishes continence from incontinence, and stress incontinence from other types. The sensitivity of the provocative stress test was 39.5 percent, whereas its specificity is 98.5 percent. Urodynamic testing including uroflow study, static UPP, and lateral eystography should not be used as a screening test but rather selectively as a confirmatory test, and to determine the therapeutic approach, and to assess the outcome of therapy.

A probability sample of noninstitutionalized elderly people in Washtenaw County,Michigan was interviewed to determine the relationship between urinary incontinence and various health conditions. The results show that between both male and female respondents physical mobility problems specific neurologic symptoms, lower urinary tract problems, bowel problems, respiratory problems, and history of genital surgery are more prevalent among those who are incontinent than among those who are continent. Additional factors associated with incontinence in females are: history of parent and sibling incontinence, incontinence either during pregnancy or postpartum hearing problems, use of female hormones, and vaginal infections. Incontinence among males is associated with vision problems and a history of and symptoms of cardiovascular disease These findings suggest urinary incontinence is part of a complex and multifactorial problem. Further studies are needed to confirm and explain these findings.

The view that urinary incontinence is an unfortunate but inevitable concomitant of aging is being dispelled by the growing research effort directed to this condition. Many causes are readily identifiable and reversible. Along with more sophisticated techniques for diagnosing and treating involuntary urine loss comes increasing interest in the epidemiology of the condition and its potential impact on quality of life. The topic of urinary incontinence has become truly multidisciplinary—as evidenced in this review by the addition of psychosocial factors to the medical aspects emphasized in the previous Annual Review chapter (Krane & Siroky, 1981).