Changes in dietary intake during a 6-year follow-up of an older population.

OBJECTIVE: To examine prospective changes in food habits and nutrient intakes in a representative New Zealand sample of community dwelling adults aged 70 y and over. DESIGN: Longitudinal study with food intake data collected in 1988/89 and again in 1995/96. In an attempt to distinguish age, time and cohort effects, data were analysed longitudinally, cross-sectionally and time-sequentially. SUBJECTS: The sample for study consisted of all non-institutionalised people aged 70 years and over registered with the Mosgiel Health Centre in 1988. In 1988/89, 678 adults completed a dietary survey (85% of those eligible) and 248 adults participated again in 1995/96 (66% of those eligible). RESULTS: Energy intakes declined longitudinally in men only; however, this decline appeared not to be an aging effect as energy intake was not found to decrease with age cross-sectionally. Percentage of energy from protein increased by 0.7% in women (95% confidence interval 0.2-1.2) in both the longitudinal and time-sequential analysis, suggesting a time effect. The percentage of energy from saturated fat decreased 0.7% (95% confidence interval -1.4 to -0.1) and percentage of energy from polyunsaturated fat increased 0.4% (95% confidence interval 0.0-0.7) in women, and appears to be a time effect. However, the increase in saturated fat and decrease in polyunsaturated fat with advancing age seen cross-sectionally suggests a cohort effect also occurring. In 1995/96, more people were using margarine as a spread and vegetable oils to cook meat. Milk and milk product consumption increased (not significantly), and meat intake decreased significantly by 5 and 4 servings per month in men and women, respectively. There was an increase in the proportion of people who ate breakfast cereal at least once a week, and more women ate brown or wholemeal bread in 1995/96. CONCLUSION: Over the 6 y follow-up period studied, there was no indication of an age effect on nutrient intakes in adults aged 70 y and older; however, the changes occurring over time demonstrate that older adults, particularly women, are making changes towards healthier food choices.

Low blood pressure is not an independent determinant of survival in an elderly population.

The object of the study was to determine whether the increased mortality associated with low blood pressure in elderly people arises because of the adverse effects of hypotension or because of confounding variables. A community sample of 782 people aged 70 years and older was followed for 3 years. Blood pressure measurements were taken on initial assessment and hypotension was defined separately for systolic and diastolic pressures as a pressure less than the tenth percentile for the sample (systolic < or = 122 mmHg, diastolic < or = 68 mmHg). After 3 years 135 participants had died and of these 31 had low systolic or diastolic blood pressure at baseline. Low diastolic pressure was associated with an increased mortality over the 3 years (hazard ratio 1.85, 95% Confidence Interval 1.18-2.91). This increase in risk was explained by confounding variables. Low systolic pressure was not associated with increased mortality. The increased mortality of those with low blood pressure is explained by concurrent illness.

Control over future health in old age: characteristics of believers and sceptics.

In a cross-sectional study of a total population aged 70 years and over in a rural New Zealand township (sample size 682) we investigated factors which characterize those who felt they had a great deal of control and those who felt they had little or no control over future health. In a significant logistic regression model those with a feeling of a great deal of control over future health had a lower prevalence of chronic obstructive lung disease, higher prevalence of diabetes, took less alcohol, were more likely to be satisfied with bowel function, had a lower protein intake, were more likely to participate in strenuous to moderate activity and were less likely to have features of depression. Different perceptions of control were associated with significant differences in health practices and health status.

Disease, impairment, disability and social handicap: a community based study of people aged 70 years and over.

The aim of this research was to investigate the prevalence of disability in a total population-based sample aged 70 years and over, the social handicap resulting from the disability and the diseases and impairments contributing to disability in the most disabled subjects. From the initial sample of 856 subjects, 782 (91.4%) participated. Disability in the tasks examined varied from 1.3% of subjects unable to feed themselves to 24.4% unable to carry out housework. In the 74 most disabled subjects comorbidity was common. The major clinical disorders that contributed to impairment and disability were heart failure, osteoarthritis, stroke and dementia. Those who were disabled were considerably more likely to be handicapped than those not disabled (odds ratio 6.65, 95% confidence interval 4.73-9.36). When social support was considered, the estimated risk of handicap associated with disability ranged from 3.19 (95% CI 1.92-5.30) for the subset of subjects who had a spouse, to 52.00 (95% CI 4.03-670.6) for subjects without emotional support.

Is low blood pressure in elderly people just a consequence of heart disease and frailty?

Low blood pressure has been associated with increased mortality in older people, but it is unclear whether the hypotension is a risk in its own right or just a marker of disease. In this study we investigated the extent to which those in the lowest decile of systolic and diastolic pressures could be predicted by measures of cardiovascular disease and frailty. We studied 782 people 70 years and over drawn from the only group of general practices in a rural township. Hypotension was defined separately for systolic and diastolic blood pressures as a pressure less than the tenth percentile for the sample as a whole. This was a systolic pressure of < or = 122 mmHg and a diastolic pressure of < or = 68 mmHg. There was a significant relationship between low systolic blood pressure and male sex, history of myocardial infarction by questionnaire and low body mass index (BMI), and between low diastolic pressure and male sex, history of angina and myocardial infarction, use of one or more hypotensive drugs, low BMI, low corrected arm muscle area, low self-maintenance score and the use of two or more home services. There was no association with ECG abnormalities. In the multivariate analysis only 4.2% of those with low diastolic pressure and none of those with low systolic pressure could be correctly classified. Hypotension in old age is only partially explained by established cardiovascular disease and frailty.

Over 80 years and no evidence of coronary heart disease: characteristics of a survivor group.

OBJECTIVE: To determine factors that characterize those 80 years and over free of clinical coronary heart disease (CHD). DESIGN: Cross-sectional intergroup comparison. SETTING: Rural New Zealand town. SUBJECTS: All those 70 years and over registered with the sole health center. Seven hundred eighty-two subjects were seen, a 91.4% response rate. Subjects were divided by World Health Organization cardiovascular questionnaire criteria, history, examination, and coded 12-lead electrocardiogram into four groups: 1) those 70-79 years of age with evidence of CHD; 2) those 80 years and older with evidence of CHD; 3) those 70-79 years of age free of CHD; and 4) those 80 years and older free of clinical CHD. MEASUREMENTS: Mean values and distributions of cholesterol, high-density lipoprotein (HDL) cholesterol, apolipoproteins (apos), triglycerides, insulin, glucose, anthropometric measurements, and psychosocial variables. RESULTS: In the initial analysis of variance there was a significant difference in the mean values among the four groups for body mass index (BMI), HDL cholesterol, apo A1, and triglycerides. Using the Duncan procedure, the mean value of HDL cholesterol in the group 80 years and older with no evidence of clinical CHD was significantly higher than in each of the other groups. The group 80 years and older without clinical CHD had a significantly higher mean value for apo A1 and significantly lower mean values for triglycerides and BMI than the group 70-79 years old with CHD (p < 0.05). Three-factor analysis of variance showed those free of clinical CHD had significantly higher values of HDL cholesterol (P = 0.024) and apo A1 (P = 0.022), and lower values of BMI (P = 0.017) and triglycerides (P = 0.018) compared with those who had CHD after controlling for age and sex. Those 80 years and older had lower values of BMI (P = 0.001) and triglycerides (P = 0.018) than those 70-79 years old after controlling for CHD and sex. The group who were 80 years and older and free of clinical CHD had a significantly narrower distribution of values for insulin (P < 0.001), glucose (P = 0.001), diastolic blood pressure (P = 0.001), BMI (P = 0.001), and waist-hip ratio (P = 0.002) when compared with those 80 years and older with CHD; a significantly narrower distribution of values for insulin (P = 0.024), glucose (P = 0.003), and BMI (P = 0.002) when compared with those 79-79 years old with CHD and a significantly narrower distribution of glucose (P = 0.002) and BMI (P = 0.014) when compared with those 70-79 years old and free of clinical CHD. CONCLUSION: Those 80 years and older who were free of clinical CHD were characterized by differences in lipid and anthropometric values, particularly higher HDL cholesterol and apo A1 levels. Results were also consistent with this survivor group maintaining tighter homeostatic control over a number of variables.

Relation of age, exercise, anthropometric measurements, and diet with glucose and insulin levels in a population aged 70 years and over.

A community-based sample of people > or = 70 years from Mosgiel, New Zealand, was investigated to determine the relation of age, diet, exercise, drugs, and anthropometric measurements with glucose and insulin. From an initial sample of 856 subjects on August 1, 1988, 782 (91.4%) completed the questionnaires and physical examination. Glucose was estimated in 726 subjects and insulin in 607 subjects 2 hours after a standardized meal. In the multivariate analysis for women, glucose was related to age and exercise, and insulin was related to glucose levels, triceps skinfold thickness, and waist/hip ratios. In the multivariate analysis for men, none of the variables was related to glucose levels; insulin levels were related to glucose and waist/hip ratio. Impaired glucose tolerance in women was associated with high body mass index, waist/hip ratio, lower exercise levels, and the taking of thiazide drugs or oral steroids. In men, no significant model to identify those with impaired glucose tolerance could be developed. Glucose and insulin levels in women were related to age and external factors, particularly exercise and anthropometric measurements. In men, external factors were less clearly related to glucose and insulin levels, but this lack of association in men may be due to the smaller number of men in the sample, their younger age, and the narrower range of values found in the men.

Factors associated with constipation in a community based sample of people aged 70 years and over.

STUDY OBJECTIVE: The aim was to determine the prevalence and factors associated with constipation in elderly people. DESIGN: The study was a survey involving administration of a structured questionnaire, an interview, and a dietary assessment. SETTING: The survey was community based and the population studied was drawn from the practice records of all five general practitioners serving a rural township of 13,500 people. PARTICIPANTS: 778 (91.8%) of the 856 people aged 70 years and over registered with the five practitioners took part. MAIN RESULTS: 174 subjects had symptoms of infrequent bowel motions or frequent straining at stool or used laxatives regularly. Of this group, 34 had a bowel motion only every 3 d or less frequently and were considered to have constipation. Analysis of this subgroup showed that constipation was more common in women than men, increased with age, and was associated with the use of constipating drugs. Those whose bowels moved infrequently were a more frail group who were less physically active. Low intakes of dietary fibre, fruit, vegetables, bread and cereals, or fluid were not associated with an increased occurrence of constipation. There were 151 subjects who felt they were moderately constipated, but who had a bowel motion at least every 2 d. These people were more likely than the rest of the sample to use laxatives (55.6%), were more likely to take food for their bowels, to take hynoptics, and to regard their health as poor. CONCLUSIONS: About one third of people aged 70 years and over have some bowel problem such as infrequency, straining at stool, or frequent laxative use. Most modify their diet accordingly but laxative use remains high.

Informed consent for cardiopulmonary resuscitation in elderly patients.

OBJECT: to determine if a semistructured interview would enable elderly patients to give adequately informed consent for cardiopulmonary resuscitation (CPR). METHOD: one hundred consecutive patients admitted to Wakari assessment and rehabilitation unit for the elderly, who satisfied study criteria, were randomly allocated to receive a detailed discussion on CPR or to act as controls. Subsequently knowledge about CPR was tested in both groups. RESULTS: of the 49 study subjects, 27 (55%) wished to have CPR in the event of a cardiac arrest. After the interview knowledge about the CPR was significantly better in the study group than the controls, but there was still a lack of appreciation of the possible complications and an overly optimistic view of the likely outcome. CONCLUSIONS: careful explanation of the procedures involved in CPR does increase knowledge and assist in making an informed decision. However, the decision may still be based on poor understanding of the likely outcome and possible complications.

Anthropometric measurements as predictors of mortality in a community population aged 70 years and over.

Corrected arm muscle area (CAMA), triceps skin-fold thickness (TSF) and body mass index (BMI) were measured in a community sample of 758 people who were then followed for 40-46 months. Percentile values were calculated for each sex in 5-year age groups. The relative risk of death of those in the upper and lower percentiles was compared with those between the 10th and 90th percentiles, controlling for age and sex. Subjects below the 5th percentile for CAMA, TSF and BMI and between the 5th and 10th percentile for CAMA had a significantly increased risk of death. There was no increased risk of death in those subjects above the 90th percentile in any measurement. In the logistic regression model, both low CAMA and low TSF were associated with a significantly increased risk of subsequent mortality. Poor nutritional state shown by low muscle bulk and fat stores was an important predictor of mortality, but obesity had no adverse effect on survival.

Enhanced elimination of piroxicam by administration of activated charcoal or cholestyramine.

This study has compared the effect of repeated administration of charcoal and cholestyramine on the elimination of piroxicam. Eight young adults were given piroxicam as a single dose of 20 mg, on 3 separate occasions. On one of the occasions charcoal was also given. On another occasion cholestyramine was also administered. The mean elimination half-life after piroxicam alone was 53.1 h. This was reduced to 40.0 h by charcoal administration and to 29.6 h after administration of cholestyramine. In the second phase of the study 7 elderly subjects received piroxicam 20 mg for 14 days on two occasions. Cholestyramine administration at the end of one of the periods reduced the mean elimination half-life of piroxicam from 52.3 h to 27.3 h.

Alcohol use in a community-based sample of subjects aged 70 years and older.

The usual alcohol intake in a community-based sample of subjects aged 70 years and over was investigated. A sample of 825 subjects was drawn from the records of five general practices in a rural township and 774 subjects (93.8%) agreed to participate. A stratified sub-sample of subjects from the abstainers, infrequent, weekly, and daily drinkers was subsequently investigated in more detail. Men took alcohol more frequently than women and in greater quantities although frequency and amount decreased with age. The usual place for drinking was the home. The highest use of psychotropic drugs occurred in the abstainers, but this was significant for men only. When compared with drinking patterns in middle age, 60.1% of men and 30.3% of women said that they took less alcohol, while 7.4% of men and 11.1% of women said that they took more. The main reasons for decrease in alcohol intake were change in health and fewer social opportunities. The main reasons for increase in alcohol intake were more money and more time. Drinking was most commonly associated with social activities and few took alcohol to help cope with personal situations.