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Older Community-dwelling Adults (older + community-dwelling_adult)
Selected AbstractsMultitasking: Association Between Poorer Performance and a History of Recurrent FallsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2007Kimberly A. Faulkner PhD OBJECTIVES: To examine the association between poorer performance on concurrent walking and reaction time and recurrent falls. DESIGN: Cross-sectional analysis. SETTING: Community. PARTICIPANTS: Three hundred seventy-seven older community-dwelling adults (mean age±standard deviation 78±3). MEASUREMENTS: Reaction times on push-button and visual-spatial decision tasks were assessed while seated and while walking a 20-m course (straight walk) and a 20-m course with a turn at 10 m (turn walk). Walking times were recorded while walking only and while performing a reaction-time response. Dual-task performance was calculated as the percentage change in task times when done in dual-task versus single-task conditions. A history of recurrent falls (,2 vs ,1 falls) in the prior 12 months was self-reported. Multivariate logistic regression models were used to predict the standardized odds ratios (ORs) of recurrent falls history. The standardized unit for dual-task performance ORs was interquartile range/2. RESULTS: On the push-button task during the turn walk, poorer reaction time response (slower) was associated with 28% lower (P=.04) odds of recurrent fall history. On the visual-spatial task, poorer walking-time response (slower) was associated with 34% (P=.02) and 42% (P=.01) higher odds of recurrent falls history on the straight and turn walks, respectively. CONCLUSION: These findings suggest that walking more slowly in response to a visual-spatial decision task may identify individuals at risk for multiple falls. Prospective studies are needed to confirm the prognostic value of poor walking responses in a dual-task setting for multiple falls. [source] Prevalence and Correlates of Fecal Incontinence in Community-Dwelling Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2005Patricia S. Goode MD Objectives: To determine prevalence and correlates of fecal incontinence in older community-dwelling adults. Design: A cross-sectional, population-based survey. Setting: Participants interviewed at home in three rural and two urban counties in Alabama from 1999 to 2001. Participants: The University of Alabama at Birmingham Study of Aging enlisted 1,000 participants from the state Medicare beneficiary lists. The sample was selected to include 25% black men, 25% white men, 25% black women, and 25% white women. Measurements: The survey included sociodemographic information, medical conditions, health behaviors, life-space assessment (mobility), and self-reported health status. Fecal incontinence was defined as an affirmative response to the question "In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?" Severity was classified as mild if reported less than once a month and moderate to severe if reported once a month or greater. Results: The prevalence of fecal incontinence in the sample was 12.0% (12.4% in men, 11.6% in women; P=.33). Mean age±standard deviation was 75.3±6.7 and ranged from 65 to 106. In a forward stepwise logistic regression analysis, the following factors were significantly associated with the presence of fecal incontinence in women: chronic diarrhea (odds ratio (OR)=4.55, 95% confidence interval (CI)=2.03,10.20), urinary incontinence (OR=2.65, 95% CI=1.34,5.25), hysterectomy with ovary removal (OR=1.93, 95% CI=1.06,3.54), poor self-perceived health status (OR=1.88, 95% CI=1.01,3.50), and higher Charlson comorbidity score (OR=1.29, 95% CI=1.07,1.55). The following factors were significantly associated with fecal incontinence in men: chronic diarrhea (OR=6.08, 95% CI=2.29,16.16), swelling in the feet and legs (OR=3.49, 95% CI=1.80,6.76), transient ischemic attack/ministroke (OR=3.11, 95% CI=1.30,7.41), Geriatric Depression Scale score greater than 5 (OR=2.83, 95% CI=1.27,6.28), living alone (OR=2.38, 95% CI=1.23,4.62), prostate disease (OR=2.29, 95% CI=1.04,5.02), and poor self-perceived health (OR=2.18, 95% CI=1.13,4.20). The following were found to be associated with increased frequency of fecal incontinence in women: chronic diarrhea (OR=6.39, 95% CI=2.25,18.14), poor self-perceived health (OR=5.37, 95% CI=1.75,16.55), and urinary incontinence (OR=4.96, 95% CI=1.41,17.43). In men, chronic diarrhea (OR=5.38, 95% CI=1.77,16.30), poor self-perceived health (OR=3.91, 95% CI=1.39,11.02), lower extremity swelling (OR=2.86, 95% CI=1.20,6.81), and decreased assisted life-space mobility (OR=0.73, 95% CI=0.49,0.80) were associated with more frequent fecal incontinence. Conclusion: In community-dwelling older adults, fecal incontinence is a common condition associated with chronic diarrhea, multiple health problems, and poor self-perceived health. Fecal incontinence should be included in the review of systems for older patients. [source] Potentially Inappropriate Prescribing in Ontario Community-Dwelling Older Adults and Nursing Home ResidentsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2004Christopher J. Lane BASc Objectives: To compare patterns of potentially inappropriate drug therapy prescribing in community-dwelling older adults and nursing home residents in Ontario, Canada. Design: A retrospective cohort study using administrative databases. Setting: Ontario community and nursing home facilities. Participants: All 1,275,619 older adults aged 66 and older in Ontario (1,216,900 community-dwelling and 58,719 nursing home residents) who were dispensed at least one prescription from the comprehensive provincial drug plan in 2001. In Ontario, the provision of clinical pharmacy services is mandated in the nursing home setting. No comparable program exists for older adults in the community setting. Measurements: Potentially inappropriate drug prescribing was compared between community-dwelling and nursing home residents in two categories: those to always avoid and therapies considered rarely appropriate to prescribe. Results: Of the 1,275,619 adults in the cohort, nursing home residents were older (mean age±standard deviation=84.2±7.6 vs 75.0±6.5, P<.001), included more women (73.3% vs 57.7%, P<.001), had higher comorbidity scores (measured by the number of distinct drug therapies dispensed in the prior year (10.7±6.8 vs 7.2±5.7, P<.001) and Charlson comorbidity scores (1.4±1.6 vs 0.9±1.5, P<.001)) than community-dwelling individuals. Community-dwelling older adults were significantly more likely to be dispensed at least one drug therapy in the always avoid or rarely appropriate category than nursing home residents (3.3% vs 2.3%, P<.001). Using a logistic regression model that controlled for age, sex, and comorbidity (number of distinct drug therapies dispensed in the prior year), nursing home residents were close to half as likely to be dispensed one of these potentially inappropriate drug therapies as community-dwelling older adults (odds ratio=0.52, 95% confidence interval=0.49,0.55, P<.001). Conclusion: Potentially inappropriate drug therapy in the always avoid and rarely indicated categories is dispensed less often to nursing home residents than to older community-dwelling adults. Clinical pharmacist services, which are mandated in the nursing home setting, may be responsible for these differences in Ontario, Canada. [source] Synergistic association between alcohol intake and body mass index with serum alanine and aspartate aminotransferase levels in older adults: the Rancho Bernardo StudyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11-12 2009R. LOOMBA Summary Background The association between body-mass-index (BMI), alcohol consumption and their joint effect in increasing the risk of elevated serum alanine (ALT) and aspartate (AST) is unclear in older community-dwelling adults. Aim To determine the association between alcohol, BMI, and their combined effect with serum ALT and AST in older community-dwelling adults in the United States. Methods A cross-sectional, population-based study in participants (n = 2364) from the Rancho Bernardo Study (54% women; mean age: 70 years, BMI: 25 kg/m2, alcohol users: 63%) who attended a research visit in 1984,87. BMI was recorded by a trained nurse and alcohol use ascertained by a validated questionnaire. Odds-ratio (OR) and 95% confidence intervals (CI) of elevated serum ALT and AST (defined as ,30 U/L in men and ,19 U/L in women) were calculated for alcohol and BMI separately and their joint exposure using logistic regression models. Results In multivariate logistic regression models adjusted for age, alcohol use, total cholesterol, serum triglycerides, fasting plasma glucose, systolic blood pressure, and diabetes mellitus, obesity independently increased the odds of elevated ALT in this cohort of older men and women by 3.0 (95% CI, 1.7,5.3) and 1.8 (95% CI, 1.1,2.7) respectively. Joint effects of consuming >3 alcoholic drinks/day and obesity raised the odds of elevated ALT by 8.9 (95% CI, 2.4,33.1) and AST by 21-fold (95% CI, 2.6,170.1), demonstrating synergism. Obese participants had higher odds of elevated ALT even at 0 , 1 drink/day. Conclusions In older men and women, the combination of obesity with alcohol is synergistic in increasing the risk of liver injury. [source] The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studiesAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 1 2010Lori Letts Background/aim:,Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor. Methods:,Eight databases (1985,2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data. Results:,Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls. Cohort:,Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97,1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03,1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59,2.71) and institutional (OR = 1.77; 95% CI: 1.66,1.89) settings. Conclusions:,Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls. [source] | ||||||||||