Showing papers by "Jeff D. Williamson published in 2001"

Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis.

Abstract: Background: The prevention of disability in activities of daily living (ADL) may prolong older persons’ autonomy (older persons are defined in this study as those aged 60 years). However, proved preventive strategies for ADL disability are lacking. A sedentary lifestyle is an important cause of disability. This study examines whether an exercise program can prevent ADL disability. Methods: A 2-center, randomized, single-blind, controlled trial was conducted in which participants were assigned to an aerobic exercise program, a resistance exercise program, or an attention control group. Of the 439 community-dwelling persons aged 60 years or older with knee osteoarthritis originally recruited, the 250 participants initially free of ADL disability were used for this study. Incident ADL disability, defined as developing difficulty in transferring from a bed to a chair, eating, dressing, using the toilet, or bathing, was assessed quarterly during 18 months of follow-up. Results: The cumulative incidence of ADL disability was lower in the exercise groups (37.1%) than in the attention control group (52.5%) (P = .02). After adjustment for demographics and baseline physical function, the relative risk of incident ADL disability for assignment to exercise was 0.57 (95% confidence interval, 0.38-0.85; P=.006). Both exercise programs prevented ADL disability; the relative risks were 0.60 (95% confidence interval, 0.38-0.97; P=.04) for resistance exercise and 0.53 (95% confidence interval, 0.33-0.85; P=.009) for aerobic exercise. The lowest ADL disability risks were found for participants with the highest compliance to exercise. Conclusions: Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee osteoarthritis. Exercise may be an effective strategy for preventing ADL disability and, consequently, may prolong older persons’ autonomy. Arch Intern Med. 2001;161:2309-2316

Financial difficulty in acquiring food among elderly disabled women: results from the Women's Health and Aging Study.

Abstract: OBJECTIVES: This study described the prevalence and characteristics of financial difficulty acquiring food and its relation to nutritional biomarkers in older disabled women. METHODS: Baseline data were analyzed from the Women's Health and Aging Study, a population-based survey of 1002 community-dwelling, disabled women 65 years and older from Baltimore, Md. RESULTS: Minority women (49.5%) were more likely than White women (13.4%) to report financial difficulty acquiring food (odds ratio [OR] = 6.2, 95% confidence interval [CI] = 4.5, 8.6). Of the women reporting financial difficulty acquiring food, only 19.3% received food stamps and fewer than 7% participated in food assistance programs. Women reporting financial difficulty acquiring food had higher levels of psychologic depression than women not reporting such difficulty. Greater likelihood of financial difficulty acquiring food was associated with poorer quality of life and physical performance among White women and with more medical conditions among minority women. Finally, anemia (hemoglobin < 120 g/L) was associated with financial difficulty acquiring food (age-adjusted OR = 2.9, 95% CI = 1.9, 4.3). CONCLUSIONS: Financial difficulty acquiring food was common, and receipt of nutritional services was rare, in community-dwelling, older disabled women. Nutrition assistance programs for the elderly should reexamine their effectiveness in preventing nutritional deficits in older disabled women.

Patterns of Self-Rated Health in Older Adults Before and After Sentinel Health Events

Abstract: OBJECTIVES: To describe and compare patterns of change in self-rated health for older adults before death and before and after stroke, myocardial infarction, congestive heart failure, cardiac procedure, hospital admission for cancer, and hip fracture. DESIGN: “Event cohort,” measuring time in months before and after the event. SETTING: Four U.S. communities. PARTICIPANTS: 5888 participants in the Cardiovascular Health Study (CHS), sampled from Medicare rolls and followed up to 8 years. Mean age at baseline was 73. MEASUREMENTS: Self-rated health, including a category for death, assessed at 6-month intervals, and ascertainment of events. METHODS: We examined the percentage that was healthy each month in the 5 years before death and in the 2 years before and after the other events, and compared the patterns to a “no event” group and to one another, using graphs and linear regression. RESULTS: For people who died, health status declined slowly until about 9 months before death, when it dropped steeply. Comparing persons equally far from death, health was unrelated to age, but men and whites were healthier than women and blacks. Health for other events declined before the event, dropped steeply at the event, showed some recovery, and then declined further after the event. About 65% to 80% of the subjects were healthy 2 years before their event, but only 35% to 65% were healthy two years afterwards. Patterns were similar although less extreme for the “no event” group. CONCLUSION: Visualizing trajectories of health helps us understand how serious health events changes health. Conclusions about change must be drawn with care because of a variety of possible biases. We have described the

Treatment of Isolated Systolic Hypertension Is Most Effective in Older Patients With High-Risk Profile

Abstract: Background Although present guidelines suggest that treatment of hypertension is more effective in patients with multiple risk factors and higher risk of cardiovascular events, this hypothesis was never verified in older patients with systolic hypertension. Methods and Results Using data from the Systolic Hypertension in the Elderly Program, we calculated the global cardiovascular risk score according to the American Heart Association Multiple Risk Factor Assessment Equation in 4,189 participants free of cardiovascular disease (CVD) and in 264 participants with CVD at baseline. In the placebo group, rates of cardiovascular events over 4.5 years were progressively higher according to higher quartiles of CVD risk. The protection conferred by treatment was similar across quartiles of risk. However, the numbers needed to treat (NNTs) to prevent one cardiovascular event were progressively smaller according to higher cardiovascular risk quartiles. In participants with baseline CVD, the NNTs to prevent one cardi...

Blood Pressure Control & Incident Disability in Older Women:

Abstract: P54 Cardiovascular disease is associated with disability & high B/P is a risk factor for CVD. Data is lacking on the relationship between B/P and disability and on the potential benefit of aggressi...