Daily physical activity and menopausal hot flashes: applying a novel within-person approach to demonstrate individual differences.

BACKGROUND: Physical activity (PA) may be a useful tool in the management of menopausal hot flashes (HFs) but findings are generally inconsistent. There are few well-designed and sufficiently powered RCTs. Applying a longitudinal within-person approach offers an alternative way to examine the PA-HFs relationship which enables complete accommodation of inter-individual differences. OBJECTIVES: Aprospective daily diary study which applied experience sampling methods and time series modeling techniques investigated, at the within-person level, the relationship between objectively measured daily PA of varying intensities and self-reported menopausal HFs. METHODS: Twenty-four symptomatic middle-aged women (M age=50.4; SD=4.9) completed fitness, body composition and hormonal status screening, and reported on daily HFs using an electronic PDA device across one menstrual cycle or for 30 days (if postmenopausal). Daily PA and PA intensity was measured using accelerometry and subjects completed a battery of psychological measures. RESULTS: Within person analysis identified significant relations between PA and HFs in 50% of subjects, although the specific PA indicators that predicted HFs varied, both in terms of direction and magnitude. Perceived control over HFs was the variable that most consistently differentiated between women for whom more PA was associated with fewer HFs as compared to those for whom more PA was associated with more HFs, but other individual difference characteristics such as affect, depressive symptoms, and anxiety were identified. CONCLUSIONS: There is great individual variation in the way daily PA impacts self-reported HFs. Affective outcomes and perceived control may help potentially explain this variability.

Depressed mood but not fatigue mediate the relationship between physical activity and perceived stress in middle-aged women.

OBJECTIVE: To determine whether depressed mood and fatigue mediate the relationships between physical activity, body mass index, menopausal hot flashes, and perceived stress. METHOD: This study is a secondary analysis of data obtained from a sub-sample of peri- and postmenopausal women (N=212) from the TREMIN Research Program on Women's Health. RESULTS: The hypothesized mediational model was tested using path analysis within a structural equation modeling framework in Mplus Version 5.1. In unadjusted analysis, the relationships between physical activity, menopausal hot flashes, and perceived stress were mediated by depressed mood; fatigue mediated the relationships between hot flashes, body mass index, and perceived stress. When adjusting for age, insomnia, menopausal and hormone use status, the mediational effects of depressed mood on stress remained significant only for physical activity, and fatigue mediated the relationship between hot flashes and stress. The adjusted model explained 70% of variance in perceived stress, 82% of variance in depressed mood, and 81% of variance in fatigue. CONCLUSION: Depressed mood may partially explain the relationship between physical activity and perceived stress in middle-aged women, however further studies are needed to corroborate causality.

The role of medication use and health on the decision to quit drinking among older adults.

OBJECTIVE: To determine the extent to which changes in medication use and health influence the decision to quit drinking among older adults. METHOD: The sample consisted of 8,883 elderly enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PA-PACE) program who completed surveys in 2000 and 2002. Survey data were linked with prescription claims to examine medication and health factors associated with drinking cessation between baseline and follow-up. RESULTS: Overall, 3.9% of those using alcohol at baseline quit drinking during the study period. Logistic regression results showed that individuals who initiated antipsychotic (OR = 2.92) and antineoplastic therapies (OR = 2.67) were the most likely to quit drinking. DISCUSSION: These findings support the hypothesis that elderly quit drinking in response to ill health. Results have implications for alcohol interventions in older adults and underscore the importance of separating former drinkers from lifetime abstainers in the study of alcohol-health relationships.

Potential for alcohol and prescription drug interactions in older people.

OBJECTIVES: To examine the patterns and prevalence of concomitant alcohol and alcohol-interactive (AI) drug use in older people. DESIGN: Cross-sectional analysis of survey and prescription claims data. SETTING: The Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PA-PACE) program, a state-funded program providing prescription benefits to older people with low to moderate incomes. PARTICIPANTS: A total of 83,321 PA-PACE cardholders (age range 65-106) who were using any prescription medications at the time of survey completion. MEASUREMENTS: All AI drugs were identified using a database of medication warning labels obtained from First DataBank. Prescription drug claims were used to characterize AI drug exposure according to therapeutic class of prescription drug use. A mail survey of PA-PACE cardholders was used to examine alcohol use, as well as sociodemographic and health factors associated with concomitant use of alcohol and AI drugs. RESULTS: Seventy-seven percent of all prescription drug users were exposed to AI medications, with significant variation in exposure and concomitant alcohol use according to therapeutic class. Overall, 19% of AI drug users reported concomitant alcohol use, compared with 26% of non-AI drug users (P<.001). Multinomial logistic regression analyses showed that certain groups of older people, including younger older people, men, and those with higher educational levels, were at greater risk for concomitant exposure to alcohol and AI drugs. CONCLUSION: Many older people use alcohol in combination with AI prescription drugs. Clinicians should warn every patient who is prescribed an AI drug about alcohol-drug interactions, especially those at high risk for concomitant exposure.

Changes in elderly women's health-related quality of life following discontinuation of hormone replacement therapy.

BACKGROUND: Many women have discontinued hormone replacement therapy (HRT) in view of recent findings. The goal of this study was to determine if HRT discontinuation is associated with changes in health-related quality of life (HRQOL) in elderly women. METHODS: We studied women enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) program, linking prescription claims with data from a longitudinal mail survey. HRQOL measures included the number of days out of the last 30 that physical health was not good and analogous measures for mental health, pain, and interference with activities, as well as a composite "healthy days" measure developed by CDC. Longitudinal analyses focused on 2,357 women who completed surveys in both 2002 and 2003, and who used HRT at baseline (mean age = 75.5, range = 65-102). Propensity scores were used to match HRT continuers and discontinuers according to HRT type, demographics, and baseline HRQOL. Analysis of covariance was used to compare HRQOL change in continuers and discontinuers. RESULTS: Between 2002 and 2003, 43% of HRT users discontinued therapy. Analysis of covariance to examine HRQOL change revealed complex interactions with age. Discontinuers aged 65-74 reported greater increases in days in which mental health was not good (p < .05), fewer "healthy days" (p < .05), more days in which health interfered with activities (p < .01), and more days with pain (p < .01). Among women aged 75-84, HRT discontinuers reported more days in which physical health was not good (p < .01); no other significant effects were observed in this group. Relative to HRT continuers, discontinuers aged 85 and older experienced apparent HRQOL improvements following cessation, with fewer days in which physical health was not good (p < .01), fewer days of poor mental health (p < .05), and more "healthy days" (p < .01). CONCLUSIONS: These results suggest that there are substantial age differences in response to HRT discontinuation. While women aged 65-74 experienced apparent declines in HRQOL following HRT cessation, women aged 85 and older experienced relative improvements. The HRQOL declines observed among younger women underscore the importance of communication between clinicians and patients throughout the discontinuation process. These results also demonstrate the value of HRQOL surveillance as a component of health program administration.

Health-related quality of life and health service use among older adults with osteoarthritis.

OBJECTIVE: To examine the relationship between health-related quality of life (HRQOL) and health service use among older adults with osteoarthritis (OA). METHODS: Subjects were 9,043 Medicare-enrolled survey respondents with a prior International Classification of Diseases, Ninth Revision code for OA. Analyses examined the relationship of 5 Centers for Disease Control and Prevention HRQOL items (general health, mental health, pain, activity limitation, and sleep) to physician visits, prescription analgesic or antiinflammatory use, and arthroplasty during 1 year of followup. RESULTS: In analyses controlling for demographic and health-related variables, greater pain frequency was associated with increased odds of visiting a physician, using analgesic or antiinflammatory drugs, and having arthroplasty (P < 0.001). Poorer general health was associated with increased odds of analgesic or antiinflammatory use but decreased odds of arthroplasty (P < 0.01). More days of activity limitation and poor mental health were associated with decreased odds of analgesic or antiinflammatory use (P < 0.01). CONCLUSION: These HRQOL variables, especially pain frequency, can be valuable tools for estimating future health care use among older adults with OA.

Health-related quality of life among older adults with arthritis.

BACKGROUND: Health-related quality of life (HRQOL) is a key outcome in arthritis, but few population-based studies have examined the relationship of specific arthritic conditions, such as osteoarthritis (OA) and rheumatoid arthritis (RA) with HRQOL. METHODS: Older adults in Pennsylvania completed a mail version of the Centers for Disease Control and Prevention (CDC) HRQOL modules. Medicare data were used to identify subjects with OA, RA, and no arthritis diagnosis. We compared HRQOL responses among these groups, and we also examined relationships of demographic characteristics to HRQOL among subjects with arthritis. RESULTS: In analyses controlling for demographic characteristics and comorbidity, subjects with OA and RA had poorer scores than those without arthritis on all HRQOL items, including general health, physical health, mental health, activity limitation, pain, sleep, and feeling healthy and full of energy. HRQOL scores were also lower for those with RA compared to OA. Among individuals with arthritis, all subject characteristics (including age, race, sex, nursing home residence, marital status, income, and comorbid illnesses) were significantly related to at least one HRQOL item. Older age, nursing home residence, and greater comorbidity were the most consistently associated with poorer HRQOL. CONCLUSIONS: Results of this study show that both OA and RA have a significant impact on multiple dimensions of HRQOL among older adults. Results also suggest the CDC HRQOL items are suitable for use among older adults and in mail surveys. Due to the rising number of older adults in many countries, the public health burden of arthritis is expected to increase dramatically. Efforts are needed to enhance access to medical care and disseminate self-management interventions for arthritis.

Gender differences in NSAID use among older adults with osteoarthritis.

BACKGROUND: Nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed medications for the treatment of osteoarthritis (OA). Little is known about whether there are important gender differences in NSAID use among patients with OA. OBJECTIVE: To examine gender differences in patterns of NSAID use among older adults (>or=65 y) with OA. METHODS: Subjects (n = 11298) were members of a statewide prescription drug plan who responded to a health-related quality-of-life (HRQOL) survey in 1997 and had a physician diagnosis of OA. Gender differences in patterns of NSAID use were examined over a 2-year period. RESULTS: Approximately one-third of the participants filled at least 1 NSAID prescription during the study. Women were significantly more likely to be prescribed an NSAID than men (37% vs. 30%), had a greater total days' supply of NSAIDs, and were more frequently prescribed NSAIDs with greater degrees of cyclooxygenase-2 selectivity. These gender differences persisted in statistical analyses controlling for demographic factors, HRQOL, and gastrointestinal (GI) risk factors. CONCLUSIONS: Results of this study showed significant gender differences in patterns of NSAID use, and these differences were independent of the risk for GI adverse effects and self-reported symptoms. Further research is needed to examine reasons for these gender variations, as well as their impact on the quality of symptom management.

Gender and health: a study of older unlike-sex twins.

OBJECTIVES: The primary goal of this study was to assess gender differences in various measures of health conditions, symptoms, and self-rated health among older persons by comparing brothers and sisters in a sample of unlike-sex twins. METHODS: All living pairs of unlike-sex twins born between 1906 and 1925 were identified through the Swedish Twin Registry and sent surveys assessing health and other factors. This population-based sample consisted of 605 twin pairs. Paired sample t tests were used to analyze gender differences in health-related measures, including a three-level measure of health problems based on physicians' ratings. RESULTS: Women had more total health conditions, not life-threatening health conditions, somewhat life-threatening cardiovascular conditions, and physical and psychological symptoms. Men had more very life-threatening health conditions and cardiovascular conditions. No gender differences were found in somewhat life-threatening health conditions, total cardiovascular conditions, or self-rated health. DISCUSSION: Important gender differences and similarities in health were found using an unlike-sex twin design that reduced variability due to background characteristics. This design also minimized problems caused by gender differences in survival. Research on gender and health in older persons requires more detailed approaches to address the complexity of this topic.

Relationship of health-related quality of life to health care utilization and mortality among older adults.

BACKGROUND AND AIMS: This investigation examined the ability of a four-item Health-Related Quality of Life (HRQOL) scale to predict short-term (30-day) and long-term (1-year) physician visits, hospitalization, and mortality among older adults. METHODS: Subjects included 84065 individuals aged 65 and older who completed a mail version of the Centers for Diseases Control's Behavioral Risk Factor Surveillance System (BRFSS) Core HRQOL Module. HRQOL dimensions represented by the module include global self-rated general health, recent physical health, recent mental health, and recent activity limitation. RESULTS: In analysis of covariance models controlling for demographic factors and comorbidity, the number of physician visits within 30 days and 1 year differed significantly across categories of each HRQOL item. In Cox regression models controlling for the same covariates, all four HRQOL questions were significant predictors of 30-day and 1-year hospitalization and mortality. CONCLUSIONS: These results signify that all four dimensions of HRQOL represented by the BRFSS Core HRQOL Module are important predictors of both short-term and long-term adverse health events among older adults. This brief scale may be particularly useful for assessing the health of older adults in clinical settings and large-scale epidemiological studies.