Sex-related differences in the length of disability prior to death in older persons.

BACKGROUND AND AIMS: It is acknowledged that, in spite of their generally worse health, women live longer than men. However, whether women also enjoy longer disability-free lives is still unclear. Using data from a representative, Italian cohort followed for 6 years, this study aimed at estimating differences between men and women in the age of disability onset and in total survival. METHODS: In 1989, 651 persons aged > or = 65 years were interviewed and their medical status was assessed by a geriatrician. In 1995, the time of onset of disability was reconstructed by re-interviewing 392 survivors and collecting proxy information for 201 subjects who had died. No information was available for 58 subjects who refused to be re-interviewed or were lost to follow-up. Data on changes in functional status were also collected by proxy interview for 34 additional persons who had died during the follow-up period, although they had not been originally interviewed at baseline. RESULTS: Of the 235 deaths, 113 were men and 122 were women. On average, the age at death was 3.5 years higher among women than among men. However, the age at onset of disability was similar in the two sexes. In survival analysis in which age was the time variable, women were as likely as men to develop disability, but significantly less likely to die over the follow-up period. CONCLUSIONS: Compared with men, women experience longer disability before death. This may be due to sex-related differences in the lifetime prevalence of lethal vs. disabling diseases.

Cardiovascular remodeling is greater in isolated systolic hypertension than in diastolic hypertension in older adults: the Insufficienza Cardiaca negli Anziani Residenti (ICARE) a Dicomano Study.

OBJECTIVE: We investigated cardiac and vascular remodeling in an unselected older population with either diastolic hypertension (HTN) or isolated systolic hypertension (ISH). BACKGROUND: Isolated systolic hypertension accounts for a substantial proportion of hypertension in individuals older than 65 years and is strongly associated with an increased risk of cardiac and cerebrovascular events. The exact mechanisms underlying the increased risk associated with ISH and elevated pulse pressure (PP), in comparison with HTN, have not been extensively investigated. METHODS: Community-dwelling residents age >/=65 years in a small town in Italy (Dicomano) were enrolled. Untreated subjects considered in this study included 173 normotensive subjects (blood pressure [BP] <140/90 mm Hg), 95 subjects with HTN (diastolic BP >/=90 mm Hg), and 43 subjects with ISH (BP >/=160/<90 mm Hg). All subjects underwent extensive clinical examination, echocardiography, carotid ultrasonography, and carotid applanation tonometry. RESULTS: Subjects with ISH had higher left ventricular (LV) mass, which was independently related to PP but not to systolic or mean pressures. Both carotid wall cross-sectional area and vascular stiffness were greater in ISH patients than in HTN and normal subjects and were independently related to PP but not to systolic BP. In addition, ISH was associated with a higher prevalence of carotid plaque and more extensive carotid atherosclerosis. CONCLUSIONS: In our community-based elderly population, individuals with ISH had higher prevalences of LV hypertrophy and carotid atherosclerosis than subjects with HTN despite lower mean BP. These findings provide potential pathophysiologic mechanisms underlying the associations of ISH and PP with increased risk of cardiovascular morbidity and mortality.