Risk factors for Alzheimer's disease: a population-based, longitudinal study in Manitoba, Canada.

BACKGROUND: Current knowledge of risk factors for Alzheimer's disease (AD) is limited. Data from a longitudinal, population-based study of dementia in Manitoba, Canada were used to investigate risk factors for AD. METHODS: Cognitively intact subjects completed a risk factor questionnaire assessing sociodemographic, genetic, environmental, medical and lifestyle exposures. Five years later, 36 subjects had developed AD and 658 remained cognitively intact. RESULTS: Older subjects or those who had fewer years of education were at greater risk of AD. After adjusting for age, education and sex, occupational exposure to fumigants/ defoliants was a significant risk factor for AD (relative risk [RR] = 4.35; 95% CI : 1.05--17.90). A history of migraines increased the risk of AD (RR = 3.49; 95% CI : 1.39--8.77); an even stronger effect was noted among women. Self-reported memory loss at baseline was associated with subsequent development of AD (RR = 5.15; 95% CI : 2.36--11.27). Vaccinations and occupational exposure to excessive noise reduced the risk of AD. CONCLUSIONS: Some well-known risk factors for AD were confirmed in this study and potential new risk factors were identified. The association of AD with a history of migraines and occupational exposure to defoliants/fumigants is of particular interest because these are biologically plausible risk factors.

Cognitive impairment, disruptive behaviors, and home care utilization.

Disruptive behaviors by an elder with cognitive impairment, such as violence, abrupt mood swings, and overt inappropriate sexual behaviors have been known to create caregiver distress, but little is known about how these behaviors may influence the use of home care services by that elder or their informal caregiver. The purpose of this study is to explore the associations between type of cognitive impairment (cognitive impairment with no dementia, and dementia), selected disruptive behaviors, and the use of four home care services (homemaking/cleaning, personal care, in-home nursing, home-delivered meals). Secondary data analysis from the 1991-1992 Manitoba Study on Health and Aging data set was conducted, using a sample of 124 community-dwelling elders and their unpaid caregivers. Multivariate analysis revealed that disruptive behaviors were significantly associated with the use of two services: personal care and home-delivered meals. Being cognitively impaired with dementia was significant for only home-delivered meals. Overall functional status of the elder emerged as a consistent predictor.

Lay explanations of chronic illness in later life.

This study explores lay explanations of chronic illness in later life. More specifically, perceived causes, treatment strategies, and perceived outcomes of arthritis and heart/circulatory problems from the perspective of older adults who have such problems are examined. Variations in these explanations according to selected sociodemographic and health status characteristics are explored. Among the arthritis sufferers, the most prevalent explanations were physical work/working conditions, age, and injury, whereas those with heart/circulatory problems most often explained the cause as due to tension/stress, physiology, or heredity. A variety of treatments were identified, including doing nothing, seeking or continuing medical treatment, altering lifestyle, and using folk remedies. Selected sociodemographic and health status characteristics appear important for understanding explanations about arthritis, although it is primarily health status indicators that emerge for heart/circulatory problems. Directions for future research are highlighted.

Community-dwelling older adults' attributions about falls.

OBJECTIVE: To examine the extent to which 162 older adults attributed the cause of their fall to their own limitations and to their surroundings, and the relationship of these attributions with selected sociodemographic, health-related, locus of control, and fall-related characteristics. DESIGN: A stratified (by age > or = 65, gender, and area of residence) random sample; needs assessment survey on products and services to enhance independent living among older adults; included section on falls. SETTING: Community-dwelling individuals in both urban and rural settings. PARTICIPANTS: Potential respondents were drawn from the Manitoba Health database. Overall refusal rate was 22%. Final number of 1,406 participants were interviewed; 162 of these participants reported a fall. MAIN MEASURES: Outcome measures were: (1) the extent to which the fall was attributed to "own limitations" (internal attribution), and (2) the extent to which the fall was attributed to "surroundings" (external attribution). RESULTS: There is diversity in the extent to which individuals attribute falls to internal and external causes. Stepwise regression analyses indicated those reporting poorer self-rated health (p < .001); having dexterity difficulties (p < .01); and living in an apartment (p < .05) were more likely to attribute the fall to their own limitations. Those reporting better self-rated health (p < .01); and falling outdoors (p < .01) were more likely to attribute the fall to the surroundings. CONCLUSIONS: Fall attributions need to be more fully examined in the context of self-rated health and fall prevention programs.

The balance of exchange in instrumental support with network members outside the household.

The exchange of six types of instrumental support with individuals outside the household was examined using data from the 1990 Canadian General Social Survey. The balance of exchange within the network as a whole was considered in relation to age, gender, social class, availability of social relationships, and health status. The findings reveal the complexity of examining the provision and receipt of support simultaneously. Results are generally consistent with propositions under exchange theory regarding the association between age and reciprocity, depending on assumptions made about the nature of exchange. Implications for future research are discussed.

Gender differences in disability, assistance, and subjective well-being in later life.

This study focused on gender differences in functional disability among older adults, their reliance on personal assistance and technical aids, and relationships among the use of these sources of assistance, functional disability, and subjective feelings of well-being. The analyses employ data from interviews conducted with 1,406 community-dwelling elders living in Manitoba, Canada. The results reveal (a) greater disability and somewhat greater use of personal assistance among women, and (b) differences between men and women in relationships between both personal and technical resources and subjective feelings of well-being across levels of functional disability.

Use of health services in later life: the influence of health beliefs.

This study examined the influence of health beliefs on the use of various health services by elderly individuals, employing Andersen-Newman's framework of predisposing, enabling, and need factors. Data are from a random sample of 743 individuals aged 60 and over living in Winnipeg, Canada. Need factors emerge as the strongest correlates of physician visits, hospitalization, and overall service use. The degree of medical skepticism appears to exert some influence on utilization, particularly in regard to physician visits. A stronger belief in the value of health maintenance activities is associated with the use of a greater number of services overall, suggesting that preventive health beliefs may promote use of the health care system. Generally health locus of control appears to be unrelated to health service utilization. Implications for further research are discussed.

Self-care in health and in illness.

This paper focuses on self-care, both expectations and actual behaviours, as health behaviour and as illness behaviour among a random sample of elderly individuals living in the community in a Canadian city (n = 743). The conceptualization of both health and illness behaviour follows Mechanic's (1,2) definition of illness behaviour as selective, interpretive, and evaluative. The data reveal a gap between intentions and behaviours, with elderly individuals de-emphasizing the importance of self-care and overemphasizing the importance of professional contact in their intentions compared with their behaviours. Further, self-care as health and as illness behaviour are uncorrelated with one another. Virtually all individuals engage in some health maintenance behaviours. Approximately two-thirds engage in self-care or do nothing as an initial response to common ailments. While different correlates emerge for each, health beliefs are significantly related, irrespective of whether it is health or illness behaviour.