Showing papers by "Jack M. Guralnik published in 1997"

Disability in Older Adults: Evidence Regarding Significance, Etiology, and Risk

Abstract: OBJECTIVES: This article synthesizes and assesses current evidence about the importance of physical disability to older adults It then considers the applications of research findings to clinical geriatrics practice RESULTS: Physical disability is a major adverse health outcome associated with aging Certain subgroups of older adults, including individuals with mobility difficulty, with preclinical functional changes, and persons who are hospitalized, are at particularly high risk of becoming disabled or experiencing disability progression The major underlying causes of physical disability are chronic diseases, including both acute events, such as hip fracture and stroke and slowly progressive diseases such as arthritis and heart disease These diseases appear to have task-specific effects; understanding this may assist in setting treatment and prevention goals Comorbidity, particularly certain combinations of chronic diseases, is a strong risk factor for disability in itself Recent trials indicate that clinical interventions may be able to prevent onset or progression of disability CONCLUSIONS: Available evidence now suggests clinical approaches to both treatment and prevention of disability and directions for defining optimal clinical care for the future

Hospital diagnoses, Medicare charges, and nursing home admissions in the year when older persons become severely disabled.

Abstract: Objective. —To characterize hospital diagnoses, procedures and charges, and nursing home admissions in the year when older persons become severely disabled, comparing those in whom severe disability develops rapidly with those in whom disability develops gradually. Design. —A prospective, population-based cohort study with at least 6 annual interviews beginning in 1982. Setting. —A total of 3 communities: East Boston, Mass, New Haven, Conn, and Iowa and Washington counties in Iowa. Subjects. —A total of 6070 persons at least 70 years old with at least 1 interview after the fourth annual follow-up and without evidence of previous severe disability, defined as disability in 3 or more activities of daily living (ADLs). Main Outcome Measures. —Characteristics associated with development of severe disability after the fourth annual follow-up, in which the disability is classified as catastrophic disability if the individual did not report any ADL disability in the 2 interviews prior to severe disability onset or as progressive disability if the individual had previous disability in 1 or 2 ADLs. Results. —In the year during which severe disability developed, hospitalizations were documented for 72.1% of those developing catastrophic disability and for 48.6% of those developing progressive disability. In the corresponding year, only 14.7% of those who were stable with no disability and 22.3% of those with some disability were hospitalized. The 6 most frequent principal discharge diagnoses included stroke, hip fracture, congestive heart failure, and pneumonia in both severe disability subsets; coronary heart disease and cancer in catastrophic disability; and diabetes and dehydration in progressive disability. These diagnoses occurred in 49% of those with catastrophic disability and 25% of those with progressive disability. In both severe disability subsets, the oldest patients received less intensive hospital care as indicated by charges for surgery, diagnostics, and rehabilitation and by the percentage who received major diagnostic procedures; they were also more often admitted to nursing homes. Conclusions. —In the year when they become severely disabled, a large proportion of older persons are hospitalized for a small group of diseases. Hospital-based interventions aimed at reducing the severity and functional consequences of these diseases could have a large impact on reduction of severe disability.

Clarifying the Direct Relation between Total Cholesterol Levels and Death from Coronary Heart Disease in Older Persons

Abstract: Background: The importance of total cholesterol level as a risk factor for coronary heart disease in older adults is controversial. Objective: To determine whether findings showing that total chole...

Methodology and Feasibility of a Home-Based Examination in Disabled Older Women: The Women's Health and Aging Study

Abstract: 3The Johns Hopkins University Medical Institutions, Baltimore. Background. To ascertain disease and functional capacity in community-resident disabled older women in the Women's Health and Aging Study (WHAS), a prospective investigation of the causes and course of disability, a home-based standardized physical examination and performance test battery were developed. Thirty-nine tests were administered, 9 by a lay interviewer and 30 by a nurse. This scope and intensity of testing had not been performed previously in a home environment or on such a functionally limited population. Thus, substantial developmental work was required. This report describes the administrative procedures and field experience for each exam component, highlighting innovations pertinent to home administration. Methods. Exclusion criteria, safety issues, administration time, completion rates, and reasons for incomplete data are reported. Administration time is based on 30 exams conducted over a 3-week period 90% of the way through baseline data collection. Completion status was determined using all 1,002 participants and is categorized as follows: complete; partial; not done, health; not done, other; and refused. Results. Seventy-two percent of the screened, eligible respondents completed the 30-min interviewer-administered physical assessment and the 2-hr, 10-min nurse examination. Classifiable data were obtained for 90% of participants on 36 examination items. Lower completion rates were obtained on the other three tests primarily due to exclusions for health-related conditions; environmental constraints and participant refusal were minimal. Conclusion. Extensive, research-oriented physical evaluation can be successfully and safely performed in a home setting. In future studies, home-based examination may be preferable, as participation in the WHAS examination substantially exceeded rates for clinic-based exams in similar populations.

The impact of disability in older women.

Abstract: As the size of the older population grows and mortality rates continue to decline, an unprecedented number of women will live to very old age. Recent research has provided a better understanding of the impact of disability in the older population, risk factors for disability, and the consequences of disability. Older women have consistently been found to have higher prevalence rates of disability than men of the same age. This difference does not result from women developing disability more often than men, but rather surviving longer with their disabilities. This effect may be explained at least in part by the differences in the diseases underlying disability in older women and men. Interventions that can reduce the burden of disability in the aging population are now being explored. In the next century, it will be increasingly important to develop new prevention and treatment strategies that address the functional consequences of chronic disease in the population of women living to older and older ages.

Apolipoprotein E ε2 Allele and Risk of Stroke in the Older Population

Abstract: Background and Purpose There is evidence for a role of apolipoprotein E (apoE) in atherosclerosis. Coronary heart disease morbidity is higher in persons carrying an e4 allele and lower in those carrying an e2 allele, but the effect on cerebrovascular disease is controversial. We estimated the risk of stroke associated with different apoE genotypes in older persons. Methods At the sixth annual follow-up of the Iowa cohort of the Established Populations for Epidemiologic Studies of the Elderly, 1664 persons aged ≥71 years and free of stroke were genotyped for apo E. Occurrence of ischemic strokes was prospectively assessed from subsequent hospital discharge records and death certificates. Results One hundred fifty persons had an ischemic stroke over the subsequent 5 years (21.2 per 1000 person-years). The presence of e3 and e4 did not influence stroke risk. Among persons aged <80 years at the time of genotyping, e2 carriers had lower risk of incident stroke, while no effect was detected in the older group. Compared with e2 carriers aged 70 to 79 years (reference group), those in the same age group and not carrying an e2 had 2.6-fold higher risk of incident stroke, and those aged ≥80 years had even higher risks of stroke but without any difference according to presence/absence of e2 (relative risks 3.6 and 3.3). Results remained substantially unchanged when adjusted for potential confounders and in models estimating the effect of apoE polymorphism on the risk of developing a stroke at ages between 70 and 79 years (56 events) and separately at ages ≥80 years (94 events). Conclusions The conditioning influence of age on the protection conferred by the apoE e2 allele on stroke risk may account for previous controversies. This hypothesis should be verified in a population with a wider age range.