Depression as a correlate of functional status of community-dwelling older adults: utilizing a short-version of 5-item Geriatric Depression Scale as a screening tool.

UNLABELLED: Depression has been known to be associated with functional limitations in elderly populations and screening is an effective preventive approach. The purpose of this study was to examine the contribution of depression in explaining the functional status of community-dwelling older adults and to explore the utility of a short version 5-item Geriatric Depression Scale (GDS-5) as a screening tool. DESIGN: Cross-sectional survey Settings: Six hospitals and communities served by home-delivery meal programs Participants: 529 individuals aged 60 years and older. MEASUREMENTS: Using structured survey questionnaires, key variables including demographics, depression status, and two domains of functional status assessed by basic Activities of Daily Living (ADL) /Instrumental ADL (IADL) and mini-mental status (MMSE) were collected. To determine the unique contribution of depression in explaining functional status of participating older adults, hierarchical multiple regression was conducted. RESULTS: The model explained 18 % of the total variance in physical function and 21 % of the total variance in cognitive function. Race/ethnicity and depression were significant predictors of functional status. In particular, entry of the depression variable resulted in a significant R square change of 7%, accounting for a unique portion of the ADL/IADL variance. In terms of cognitive function measured by MMSE, entry of the depression variable showed a small, but significant change. Older adults who were ethnic minorities and had depression were significantly more likely to report poor perceived physical and cognitive function. Hierarchical multiple regressions revealed that some personal factors such as age, education, race/ethnicity contributed to the explanatory model, and depressive symptoms significantly explained additional variance. GDS-5 was less reliable (Cronbach's alpha= 0.5) to assess depressive symptoms in this study. CONCLUSION: Depression was a significant contributing factor to functional limitations of older adults. A short 5-item version of the GDS could be used to screen older adults, but two-tiered GDS-5/15 would be better alternative tool.

Dietary patterns, insulin sensitivity and inflammation in older adults.

BACKGROUND/OBJECTIVES: Several studies have linked dietary patterns to insulin sensitivity and systemic inflammation, which affect risk of multiple chronic diseases. The purpose of this study was to investigate the dietary patterns of a cohort of older adults, and to examine relationships of dietary patterns with markers of insulin sensitivity and systemic inflammation. SUBJECTS/METHODS: The Health, Aging and Body Composition (Health ABC) Study is a prospective cohort study of 3075 older adults. In Health ABC, multiple indicators of glucose metabolism and systemic inflammation were assessed. Food intake was estimated with a modified Block food frequency questionnaire. In this study, dietary patterns of 1751 participants with complete data were derived by cluster analysis. RESULTS: Six clusters were identified, including a 'healthy foods' cluster, characterized by higher intake of low-fat dairy products, fruit, whole grains, poultry, fish and vegetables. In the main analysis, the 'healthy foods' cluster had significantly lower fasting insulin and homeostasis model assessment of insulin resistance values than the 'breakfast cereal' and 'high-fat dairy products' clusters, and lower fasting glucose than the 'high-fat dairy products' cluster (P≤0.05). No differences were found in 2-h glucose. With respect to inflammation, the 'healthy foods' cluster had lower interleukin-6 than the 'sweets and desserts' and 'high-fat dairy products' clusters, and no differences were seen in C-reactive protein or tumor necrosis factor-α. CONCLUSIONS: A dietary pattern high in low-fat dairy products, fruit, whole grains, poultry, fish and vegetables may be associated with greater insulin sensitivity and lower systemic inflammation in older adults.

Factors associated with errors in self-reported height and weight in older adults.

OBJECTIVES: Describe the distribution and direction of self-reported versus measured height and weight using variables associated with aging such as cognition, health status, age, and bone mineral density (BMD), and examine the effect of these measurement differences on body mass index (BMI) classification. DESIGN: Data was derived from the third National Health and Nutrition Examination Survey (NHANESIII) conducted from 1988-1994, a nationwide probability sample. PARTICIPANTS: 4,590 non-institutionalized older adults aged 60 and older. MEASUREMENTS: Self-reported and measured height and weight, demographic and lifestyle characteristics, BMD, and subscales from the Mini Mental State Exam were used. Values were considered correct if self-reported height was within one inch of measured height, self-reported weight was within 5 lbs of measured weight, and self-reported BMI was within the same classification as measured BMI. RESULTS: Over-reported height increased with age in both men and women, occurring in 70% of those aged 80 and older. Compared to people with normal BMD, a significantly higher proportion of osteoporotic men (76% versus 47%, P<0.001) and women (52% versus 35%, P<0.001) over-reported their height. Additionally, significant misclassifications of self-reported height and weight occurred among people in poor health and those with poor performances on memory and calculation tests. Nevertheless, there was agreement in BMI classification among almost 80% of the population and among 90% of individuals in the healthy BMI category. CONCLUSION: This study suggests that among an older population, self-reported height and weight may be strongly related to age-associated changes in health status, cognition and BMD.

Dietary quality and social contact among a nationally representative sample of the older adult population in the United States.

BACKGROUND: To design appropriate health promotion programs for older adults, it is important to understand risk factors that influence dietary intake and quality. OBJECTIVE: Examine, by frequency and source of social contact, characteristics of a representative sample of older adults and, associations between these social contacts and quality of dietary intake. DESIGN: Data of 3194 participants in NHANES III, ages 65 years and over, were analyzed. A summary score for social contact was developed based on frequency of telephone contact; get together with friends, relatives and neighbors; attendance at religious services; and attendance at club meetings. Dietary intake measures included, Healthy Eating Index (HEI) scores, calorie and nutrient intakes. Demographic, lifestyle and social variables were examined in association with social contact in logistic regressions. Associations between social contact and dietary intake were examined using linear regression. RESULTS: Compared to men and women with 4 social contacts (HEI = 69.2 and 72.7)), those with one, two or three social contacts had significantly lower HEI scores (HEI of men = 62.6, 64.8, 67.5 and HEI for women = 65.7, 68.4, 70.3, respectively), consumed fewer calories and fewer servings of vegetables, fruit and variety when controlled for age and ethnicity. Associations were greatly attenuated when demographic and lifestyle variables were controlled for. Being a smoker, self-reporting poor health and needing help with personal or routine care were associated with lower social contact. CONCLUSIONS: Dietary intake is affected by a variety of factors including frequency of social contact. Outreach and screening, by community-based programs, may result in social and health benefits.

The epidemiology of recent involuntary weight loss in the United States population.

BACKGROUND: Although recent involuntary weight loss (RIWL) has been associated with mortality, no national studies described the prevalence among the general population, characteristics and long-term outcomes of people with RIWL. METHODS: The authors analyzed data from the NHANES II Mortality Study of 5838 individuals 50-74.9 years old who between 1976-1980 underwent a physical examination that included height and weight measurements, biochemical tests and responded to questions about involuntary weight loss within the past six months. Vital status was determined through 1992. Logistic regression was used to examine characteristics associated with RIWL and Cox proportional hazard modeling was used to measure associations between RIWL and mortality. RESULTS: 13.3% of the population reported RIWL with 6.9% reporting > or = 5% RIWL. Obese individuals were at significantly higher risk of RIWL of > or = 5% compared to those with BMI 19-24.9 (OR=1.57. 95% CI: 1.13, 2.18). Other significant risk factors for RIWL included; poor self-reported health, cancer, high white blood cell count, low albumin and low hemoglobin levels, age and current smoking status. RIWL of > or = 5% was significantly associated with mortality (RR=1.24, 95% CI: 1.01, 1.53). CONCLUSION: In summary, RIWL is fairly common among community-dwelling older adults, occurs disproportionately among obese individuals, is associated with characteristics of poor health and independently associated with mortality. These results indicate that RIWL needs to be considered an adverse health indicator even among obese individuals and despite the absence of several clinical indicators of disease.

Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III.

Subclinical vitamin D deficiency may be common in certain subgroups in the U.S., but to date vitamin D data from other groups in the population have not been available. We used serum 25-hydroxyvitamin D (25-OHD) data from 18,875 individuals examined in the Third National Health and Nutrition Examination Survey (NHANES III 1988-1994) to assess the vitamin D status of selected groups of the noninstitutionalized U.S. adolescent and adult population. Serum 25-OHD levels were measured by a radioimmunoassay kit (DiaSorin, Inc., Stillwater, MN; normal range 22.5-94 nmol/L). Because physical exams are performed in mobile vans in NHANES, data could not be collected in northern latitudes during the winter; instead data were collected in northern latitudes during summer and in southern latitudes in winter. To address this season-latitude aspect of the NHANES design, we stratified the sample into two seasonal subpopulations (winter/lower latitude and summer/higher latitude) before examining vitamin D status. Less than 1% of the winter/lower latitude subpopulation had vitamin D deficiency (25-OHD <17.5 nmol/L). However, the prevalence of vitamin D insufficiency in this group ranged from 1%-5% with 25-OHD <25 nmol/L to 25%-57% with 25-OHD <62.5 nmol/L, even though the median latitude for this subsample (32 degrees N) was considerably lower than the latitude at which vitamin D is not synthesized during winter months (approximately 42 degrees N). With the exception of elderly women, prevalence rates of vitamin D insufficiency were lower in the summer/higher latitude subpopulation (<1%-3% with 25-OHD <25 nmol/L to 21%-49% with 25-OHD <62.5 nmol/L). Mean 25-OHD levels were highest in non-Hispanic whites, intermediate in Mexican Americans, and lowest in non-Hispanic blacks. Our findings suggest that vitamin D deficiency is unlikely in the two seasonal subpopulations of noninstitutionalized adolescents and adults that can be validly assessed in NHANES III. However, vitamin D insufficiency is more common in these two seasonal subpopulations. Of particular interest is that insufficiency occurred fairly frequently in younger individuals, especially in the winter/lower latitude subsample. Our findings support continued monitoring of this vitamin in the U.S. population.

Estrogen replacement therapy and incidence of self-reported physician-diagnosed arthritis.

BACKGROUND: This longitudinal study examined the association between use of estrogen replacement therapy and incidence of self-reported, physician-diagnosed arthritis. METHODS: Data of 2,416 postmenopausal women who participated in the National Health and Nutrition Examination Survey Epidemiological Follow-Up Study were used in this study. Women, free of self-reported arthritis at entry into study and for 3 years thereafter, were questioned about use of estrogen and physician-diagnosed arthritis at each of the follow-up waves of study. Proportional hazard regression models were used for the analysis. RESULTS: Use of ERT was found to be associated with higher risk of incident arthritis, after adjusting for potential confounders (RR = 1.61, CI 1.37-1.89). Whenever use of ERT was replaced by duration of use in the regression model, ERT users for a year or less significantly increased their risk of incident arthritis (RR = 1.37, CI 1.07-1.74). The risk increased by 30 and 96% with hormone use for 1 to 4 and 4 to 10 years, respectively, and by 104% with hormone use for 10 or more years. CONCLUSION: Results suggest that users of ERT were at higher risk of developing arthritis and the longer the use of the hormone, the higher the risk.

Body mass index, weight change, and incidence of self-reported physician-diagnosed arthritis among women.

OBJECTIVES: This study examined the relationship between body mass index (BMI), weight change, and arthritis in women. METHODS: Data were taken from the 1982-1984 National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study of 3617 women, aged 25 to 74 years. RESULTS: Women with a BMI greater than 32 at initial interview were at significantly higher risk of developing arthritis than women with a BMI of 19 to 21.9. Compared with stable-weight women with a BMI of less than 25, women who were obese at initial interview (BMI > 29) and who subsequently maintained their weight or gained more than 10% of their body weight were at significantly higher risk of developing arthritis. CONCLUSIONS: Attaining and maintaining a healthy weight may reduce the risk of developing arthritis.

Nutrition Screening Initiative Checklist may be a better awareness/educational tool than a screening one.

OBJECTIVE: To evaluate the Nutrition Screening Initiative (NSI) checklist as a screening and an awareness/educational tool in an elderly population. DESIGN: Epidemiologic follow-up study. Information similar to the questions of the NSI checklist was collected by the Nutrition Status Survey of Boston elders between 1981 and 1984. Vital status of volunteers was obtained during 8 to 12 years of follow-up. SUBJECTS/SETTING: Community-dwelling men (n = 200) and women (n = 381) aged 60 years and older who participated in the survey. STATISTICAL ANALYSES PERFORMED: Multivariate analysis was used to assess the association between mortality and each of the NSI-similar questions and the cumulative score, which is the sum of the values assigned to each question. Attributable risk percent, a measure of association, was calculated to measure the percentage of deaths that could potentially be prevented if the risk factors or their consequences were eliminated. RESULTS: Eating meals alone, problems biting or chewing, difficulties with shopping or cooking, and taking more than three medications per day were positively associated with mortality (P < .05). The cumulative score, although significant, was a weaker predictor of mortality. Attributable risk percent of mortality was 19.9% and 51.2% for men and women, respectively. APPLICATIONS/CONCLUSIONS: Some but not all of the individual questions of the NSI checklist equivalent were significantly associated with mortality and identify specific problems that may have a long-term negative effect yet may be missed if the cumulative score were the sole criterion for screening people. The attributable risk percent suggests that the checklist may be best used as an awareness/educational tool as intended originally and could have an important public health effect on early death of community-dwelling elderly people.

Carotenoids, vitamins C and E, and mortality in an elderly population.

In 1981-1984, the nutritional status of 747 noninstitutionalized Massachusetts residents aged 60 years and over was assessed. Nine to 12 years later, the vital status of these subjects was determined. The data of a subset of 725 community-dwelling volunteers was used to examine associations between mortality and the nutrient antioxidants (carotenoids and vitamins C and E) in plasma, diet, and supplements. Results indicated that subjects with plasma vitamin C levels in the middle and high quintiles had a lower overall mortality (relative risk (RR) = 0.64, 95% confidence interval (CI) 0.44-0.94 and RR = 0.54, 95% CI 0.32-0.90, respectively) than those in the lowest quintile even after adjustment for potential confounders. These associations were largely due to reduced mortality from heart disease. Subjects in the highest quintile of total intake of vitamin C also had a significantly lower risk of overall mortality (RR = 0.55, 95% CI 0.32-0.93) and mortality from heart disease (RR = 0.38, 95% CI 0.19-0.75) than did those in the lowest quintile after potential confounders were controlled for. Intake of vegetables was inversely associated with overall mortality (p for trend = 0.003) and mortality from heart disease (p for trend = 0.04). No other significant associations were observed. In conclusion, the results indicate that high intakes and plasma levels of vitamin C and frequent consumption of vegetables may be protective against early mortality and mortality from heart disease.

Use of albumin as a predictor of mortality in community dwelling and institutionalized elderly populations.

This study was undertaken to identify variables that could explain the association between low albumin and a 9- to 12-year mortality follow-up among 287 community- dwelling and 176 institutionalized people aged 60 years and over. A wide array of nutrition assessment variables was simultaneously examined in this population to identify confounders of the association. The results show that the risk of mortality for subjects with albumin values of 40 g/liter and over was 0.46 of the risk for those with albumin values below 40 g/liter, after controlling for the confounders age, blood urea nitrogen, triglyceride, history of diseases, and inability to shop owing to medical conditions. Similarly, albumin was also inversely associated with mortality among institutionalized subjects even after controlling for the confounders age, sex, blood urea nitrogen, transferrin, and history of stroke. However, the association was no longer significant among the institutionalized population once the deaths that occurred within the first 3 years after study participation were eliminated. The results indicate that albumin is a long-term predictor of mortality among noninstitutionalized subjects and increased mortality is not only a result of age, history of chronic diseases, medication use, or protein intake. Among institutionalized subjects, albumin appeared to be a short-term predictor of mortality.

Dietary intakes and biochemical indicators of nutritional status in an elderly, institutionalized population.

A dietary and biochemical assessment of the nutritional status of 260 elderly men and women, 60-101 y (average 80.5 y), was conducted in 15 long-term-care facilities in the Boston area. Subjects were free of clinically apparent terminal or wasting illness. Nutrient intakes were comparable to those in a simultaneously studied free-living population as were most biochemical markers of nutrient status. Although no specific nutrient deficiencies were identified, blood levels of vitamin A and retinol-binding protein in males and of zinc in both sexes were lower in this institutionalized group than in the free-living subjects. Hematologic indices, albumin, prealbumin, and transferrin levels were also lower than in noninstitutionalized elderly populations. These differences may reflect the greater prevalence of chronic diseases and medication use in a long-term-care population. However, there is no evidence that institutionalization in itself leads to impairment of nutritional status.