Relative weight and mobility: a longitudinal study in a biracial population of older adults.

PURPOSE: We examined the association of relative weight with mobility and changes in mobility over time and whether these associations differed by race. METHODS: Data come from a prospective, population-based, observational study of adults aged 65 years or older. Mobility outcomes were assessed at baseline and two follow-up interviews at 3-year intervals. The study included 4195 participants with a mean age of 73.8 +/- 6.3 (SD) years; 61.4% were women, and 60.9% were black. Assessment of mobility included a brief self-report instrument and a performance-based walk test. Body mass index (BMI, kilograms per square meter) was used as a measure of relative weight. We used generalized estimating equation models to examine change in mobility outcomes over time as a function of BMI. RESULTS: Average BMI was 26.6 +/- 5.7 kg/m(2), with 34.0% overweight and 23.4% obese. BMI showed a significant curvilinear association with mobility outcomes at baseline (p < 0.001), but was not associated with change in mobility during follow-up. Maximum mobility levels occurred at a significantly higher level of BMI among blacks than whites. CONCLUSIONS: Higher levels of BMI may lead to mobility impairments earlier in life, but there is little evidence that they increase the rate of decline in mobility in older age itself.

Dementia and elder abuse.

Dementia and elder abuse are relatively common and under-diagnosed geriatric syndromes. A unique relationship is observed when the two entities coexist. Special issues can confound the care of the dementia patient suspected of being abused. Impaired language or motor abilities to communicate abusive situations to a third party, lack of decisional capacity to address the abusive situation, disinhibited behavior that contributes to a cycle of violence, and coincident depression of the abused elder complicate the diagnosis and management of elder abuse. Education of the caregiver and attention to caregiver stress, including depression, may prevent onset and perpetuation of abuse.

The elderly patient with chronic kidney disease.

The elderly are a fast growing population in the United States, and they have a high prevalence of chronic kidney disease. The elderly are particularly susceptible to kidney damage from age-related declines in glomerular filtration as well as kidney damage from chronic disease states such as diabetes mellitus, hypertension, glomerular, and tubulointerstitial disorders. A significant number of elderly individuals are reaching end-stage renal disease that require renal replacement therapy. This expanding population provides a challenge for health-care providers because the elderly are often referred late to a nephrologist, have a shortened survival on renal replacement therapy as compared with younger individuals, and suffer from more comorbidities such as cardiovascular disease, malnutrition, and hearing and visual disabilities. The elderly also have difficulties with dialysis vascular access and often are not candidates for renal transplantation. Despite these obstacles, age alone is not a justification for withholding diagnostic or therapeutic interventions, because many elderly individuals have an improvement in their quality of life and social support once their kidney disease is identified and treated.