Evaluation of a brief low-cost intervention to improve antiretroviral treatment decisions.

An earlier pilot study found that US DHHS guidelines for antiretroviral treatment were not being successfully implemented (Mann et al., 2000). A brief and inexpensive intervention (visual aid checklist) was developed with the assistance of HIV-expert physicians in order to aid HIV/AIDS health care providers' and their patients' decisions about antiretroviral therapy. The visual aid checklist consisted of a two-page coloured diagram and explanation of key concepts (T-cell, viral load and resistance) and a checklist of the benefits and risks of antiretroviral therapy. Twenty adult HIV-positive subjects and eight health care providers were studied. Ten subjects were observed with their providers without the intervention being used, and then ten subjects were observed with the intervention. A pre-/post-test format was used to assess the patients' antiretroviral knowledge, patient-provider discussion of the DHHS guidelines, and provider satisfaction with the intervention. No differences in baseline HIV knowledge were found between the two groups. Results showed that patients in the intervention condition had greater knowledge of the benefits and risks of antiretroviral therapy than patients in the control condition. Providers reported that the intervention was useful in aiding and encouraging communication as well as conveying knowledge.

A randomized trial of weighted vest use in ambulatory older adults: strength, performance, and quality of life outcomes.

BACKGROUND: Lower extremity weakness is a major risk factor for falls and hip fractures. Aging muscle is capable of responding to strengthening techniques. Strategies for providing accessible, inexpensive, safe, and effective strengthening programs for older adults are needed. OBJECTIVE: To evaluate whether use of a weighted vest improved strength, physical performance, markers of bone turnover, or health-related quality of life. DESIGN: A 27-week randomized, controlled, unmasked clinical trial. The primary outcome was peak isokinetic knee extensor strength at follow-up, adjusted for baseline strength. SETTING: Home-based program. PARTICIPANTS: A total of 62 women and men, mean age 74 years. INTERVENTIONS: Subjects were randomized to: no vest (n = 21), 3% body weight (BW) vest (n = 19), or 5% BW vest (n = 22). The vest is a nylon garment with pockets that are loaded with adjustable weights. The vest was prescribed for 2 hours daily, 4 days per week. No specific physical activities were mandated. MEASUREMENTS: All measures were made at baseline and 27 weeks. These included: knee strength and endurance by isokinetic dynamometer; timed physical performance tests; serum osteocalcin and urinary N-telopeptides; and health-related quality of life scales. RESULTS: Follow-up values of muscular strength and endurance, physical performance, bone turnover markers, and health-related quality of life did not differ by treatment assignment. The final study visit was attended by 19 (90%), 15 (80%), and 20 (91%) of the control, 3%, and 5% groups, respectively. Three permanent discontinuations of vest use occurred. CONCLUSIONS: Weighted vest use did not result in improvement in multiple domains of strength and function and did not affect bone turnover markers. We conclude that the training stimulus afforded by the vest (at the dosage tested) was below the required amount to produce strength gains or bone stimulation.

The prognostic value of sensory impairment in older persons.

OBJECTIVES: To determine the relationships between visual and hearing impairment and subsequent functional dependence and mortality among community-dwelling older persons. DESIGN: A Prospective, cohort study. SETTING: Community-based. PARTICIPANTS: A total of 5444 men and women aged 55 to 74 years at baseline. MEASUREMENTS: Self-reported and measured visual impairment, self-reported and measured hearing impairment, self-reported and measured combined sensory impairment, 10-year mortality, and dependency in activities of daily living (ADL), instrumental ADL (IADL), and Rosow-Breslau (RB) function. RESULTS: In multiply-adjusted models, adjusting for length of follow-up, socio-demographic characteristics, and chronic conditions, only measured visual impairment was predictive of mortality. Measured visual impairment was also predictive of 10-year ADL and IADL dependence; measured hearing impairment was predictive of RB dependence. Self-reported visual impairment predicted functional impairment on all scales at 10 years, although self-reported hearing impairment predicted only subsequent RB dependence. Measured combined impairment was associated with the highest risk of 10-year functional dependence. CONCLUSIONS: Sensory impairment is predictive of subsequent functional impairment in older persons.

Drinking habits among older persons: findings from the NHANES I Epidemiologic Followup Study (1982-84). National Health and Nutrition Examination Survey.

OBJECTIVES: To describe alcohol use and its sociodemographic correlates among persons aged 65 years and older in a US probability sample. DESIGN: Cross-sectional analysis of a national probability sample-based cohort study. SETTING: Multiple sites throughout the United States. PARTICIPANTS: A total of 3448 persons aged 65 and older who participated in the first wave of the NHANES I Epidemiologic Followup Study (1982-84). MEASUREMENTS: We describe the alcohol use behaviors and demographic characteristics of 3448 persons aged 65 and older. Least squares regression models were used to assess associations between older persons' sociodemographic characteristics and alcohol use. RESULTS: Sixty percent of the sample reported having 12 or more drinks of alcohol in at least 1 year of their lives. Seventy-nine percent of these older drinkers were currently drinking. Twenty-five percent of all drinkers drank daily (31% men, 19% women). Using gender-specific definitions (men >2 drinks/day; women >1 drink/day), 16% of men drinking alcohol and 15% of women drinking alcohol were heavy drinkers. Younger age, male gender, and higher income were associated with greater alcohol use. CONCLUSIONS: Most older persons who ever drank alcohol in their lifetimes were currently drinking. In addition, a substantial number of older persons were drinking currently at levels that may place them at risk of adverse health consequences.

Hearing loss in community-dwelling older persons: national prevalence data and identification using simple questions.

OBJECTIVE: To estimate the prevalence of hearing loss among community-dwelling older persons according to clinical criteria and to develop a brief self-report screening instrument to detect hearing loss. DESIGN: Survey. SETTING: National probability sample of noninstitutionalized older persons. PARTICIPANTS: A total of 2506 persons aged 55 to 74 who participated in the National Health and Nutrition Examination Survey. MAIN OUTCOME MEASURES: Hearing loss as defined by Ventry and Weinstein (VW) criteria and by the High Frequency Pure-Tone Average (HFPTA) scale. RESULTS: Hearing loss by VW criteria was present in 14.2% and by HFPTA criteria in 35.1% of those surveyed. The prevalence increased with advancing age and was higher among men and those with less education. A logistic regression model identified six independent factors for hearing loss by VW criteria: age > or = 70 years (adjusted odds-ratio (AOR) 2.7, 95% confidence interval (95% CI) 1.6, 4.4), male gender (AOR 3.0, 95% CI 1.9, 4.8), < or = 12th grade education (AOR 3.8, 95% CI 1.8, 7.7), having seen a doctor for deafness or hearing loss (AOR 8.9, 95% CI 5.3, 14.9), unable to hear a whisper across a room (AOR 3.2, 95% CI 2.0, 5.1), and unable to hear a normal voice across a room (AOR 6.2, 95% CI 2.6, 14.9). A clinical scale based on the logistic model had 80% sensitivity and 80% specificity in predicting hearing loss using VW criteria and 59% sensitivity and 88% specificity in predicting hearing loss using HFPTA criteria. CONCLUSIONS: Hearing loss, as defined by two clinical criteria, is common and can be screened for accurately using simple questions that assess sociodemographic and hearing-related characteristics.

Correlates of hypoalbuminemia in community-dwelling older persons.

To identify easily ascertainable sociodemographic and health characteristics that are associated with hypoalbuminemia in community-dwelling older persons, we used data from the first National Health and Nutrition Examination Survey. This population-based stratified probability sample survey included 4728 persons aged 55-74 y. We defined hypoalbuminemia in two ways: < 35 g/L (1.2% of the sample) or < or = 38 g/L (7.9% of the sample) and used multivariate logistic models to identify independent predictors of hypoalbuminemia. Older age; receiving welfare; a condition interfering with eating; vomiting > or = 3 d/mo; previous surgery for gastrointestinal tumor; self-reported heart failure; recurring cough attacks; feeling tired or wornout; edentulous, fair, or poor condition of teeth; little or no exercise; a low-salt diet; trouble chewing meat; self-reported protein albumin, blood, or sugar in urine; and current cigarette smoking were independently associated with albuminemia (< or = 38 g/L) or progressively lower albumin concentrations < 40 g/L. Persons with 3-5 of these factors (51.5% of the sample) had an odds ratio of 2.73 (95% CI: 1.64, 4.54) and those with > or = 6 factors (9.4% of the sample) had an odds ratio of 6.44 (95% CI: 3.49, 11.86) of albuminemia < or = 38 g/L compared with those with 0-2 risk factors (39.1% of the sample). These findings suggest that several easily assessed sociodemographic, lifestyle, and disease-related factors are associated with hypoalbuminemia and might be valuable items to include on general health surveys to identify older persons who have this marker of poor health status.

Does estrogen prevent skin aging? Results from the First National Health and Nutrition Examination Survey (NHANES I)

OBJECTIVE: To evaluate the relation between noncontraceptive estrogen use and skin wrinkling, dryness, and atrophy. DESIGN: Cross-sectional analysis of a national probability sample-based cohort study. SETTING: Multiple community sites throughout the United States. PARTICIPANTS: Postmenopausal women (n = 3875) aged 40 years and older at baseline. MEASUREMENTS: Skin conditions (wrinkling, dryness, and atrophy) were ascertained using a uniform clinical examination by trained dermatology resident physicians. Self-reported use of estrogen before the baseline examination, sunlight exposure, and smoking history were obtained by standardized interview. Body mass index, a measure of weight in kilograms divided by the square of the height in meters, was evaluated in uniform examination clothing. RESULTS: Mean (+/-SD) age of the participants was 61.6 (+/-9.0) years and mean (+/-SD) number of years since menopause was 15.6 (+/-9.4). Most were white (83.7%), the remainder being African American (15.9%) or another race (0.4%). Atrophy was present in 499 (16.2%), dry skin in 1132 (36.2%), and wrinkled skin in 880 women (28.2%). The prevalence of all 3 skin conditions was lower in African American women compared with white women. Information on hormone use was available for 3403 participants (88%). Among all women, after adjustment for age, body mass index, and sunlight exposure, estrogen use was associated with a statistically significant decrease in the likelihood of senile dry skin (odds ratio, 0.76; 95% confidence interval, 0.60-0.97). The odds of wrinkling were substantially lower in estrogen users, adjusted for age, body mass index, and sun exposure (odds ratio, 0.68; 95% confidence interval, 0.52-0.89) and additionally for smoking (odds ratio, 0.67; 95% confidence interval, 0.44-1.01). In multivariable models, estrogen use was not associated with skin atrophy. CONCLUSION: These results strongly suggest that estrogen use prevents dry skin and skin wrinkling, thus extending the potential benefits of postmenopausal estrogen therapy to include protection against selected age- and menopause-associated dermatologic conditions.