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Predictors of 10-year mortality in a population of community-dwelling Brazilian elderly: the Bambuí cohort study of aging
Lima-Costa, Maria Fernanda;Peixoto, Sergio Viana;Matos, Divane L.;Firmo, Josélia O. A.;Uch?a, Elizabeth;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011001500006
Abstract: we used data on 1,399 participants aged 60 and over from the bambuí cohort study of aging to examine predictors of mortality in a socioeconomically disadvantaged population. from 1997 to 2007, 599 participants died and 6.2% were lost to follow-up, leading to 12,415 person-years (pyrs) of observation. the death rate was 48.3 per 1,000 pyrs. age (adjusted hazard ratio [hr] = 1.40), male gender (hr = 1.80), never married (hr = 1.78) or a widow (hr = 1.26), poor self-rated health (hr = 1.31), inability to perform four or more activities of daily living (hr = 3.29), number of cardiovascular risk factors (hr = 1.51 for two and hr = 1.91 for three or more), trypanosoma cruzi infection (hr = 1.27), and number of medications (hr = 1.06) were each significantly (p < 0.05) and independently associated with mortality. the mini-mental state examination score showed a protective effect (hr = 0.96). except t. cruzi infection, other predictors of mortality were highly consistent with those found in more affluent elderly populations.
Dyslipidemia and the risk of incident hypertension in a population of community-dwelling Brazilian elderly: the Bambuí cohort study of aging
Freitas, Marco Polo Dias;Loyola Filho, Ant?nio Ignácio de;Lima-Costa, Maria Fernanda;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011001500005
Abstract: this study aimed to examine the prognostic value of lipid parameters for incident hypertension in elderly living in a community. the study included 306 (81% from total) persons aged > 60 years who were free of hypertension and of cardiovascular diseases at the baseline survey of the bambuí cohort study of aging. the cumulative incidence of hypertension over three years was 37.3%. the relative risk (rr) of incident hypertension decreased 0.92 for each unit of hdl-cholesterol (95%ci: 0.86-0.99) independent of several potential confounding factors. individuals with hdl-cholesterol in the top tercile (> 55mg/dl) had a risk of hypertension halve that those in the bottom tercile (rr = 0.54; 95%ci: 0.33-0.90). other lipid parameters had no significant effect on the outcome. high hdl-cholesterol showed an independent protective effect on subsequent development of hypertension in the elderly.
Energy expenditure through physical activity in a population of community-dwelling Brazilian elderly: cross-sectional evidences from the Bambuí cohort study of aging
Ramalho, Juciany Rodrigues de Oliveira;Lima-Costa, Maria Fernanda;Firmo, Josélia O. A.;Peixoto, Sérgio Viana;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011001500010
Abstract: the aim of this study was to estimate physical activity energy expenditure among older adults. the study comprised 1,585 residents in bambuí, minas gerais state, brazil, aged > 60 years (91% of the town's total elderly), and examined the frequency and duration of 23 types of physical activity among them. median energy expenditure was 975 met.min/week (1,195.8 among men and 803.1 among women), declining significantly with age in both sexes. the prevalence of sedentary lifestyles (< 450 met.min/week) was 31.2%. unhurried walking accounted for about 1/3 of total energy expenditure. multivariate analysis based on ordinal logistic regression showed inverse associations between energy expenditure and age and hospitalizations in both sexes. among men, inverse associations were observed with smoking, number of chronic diseases and number of medical appointments. these results emphasize the need for effective strategies to increase physical activity in older elderly, and underscore the high prevalence of walking in this group.
Birth cohort differences in anthropometric measures in the older elderly: the Bambuí cohort study of aging (1997 and 2008)
Sales, Aline Dayrell Ferreira;César, Cibele Comini;Lima-Costa, Maria Fernanda;Caiaffa, Waleska Teixeira;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011001500012
Abstract: the aim of this study was to evaluate the effect of birth cohort on nutritional status among older elderly (71-81 years old) from the bambuí cohort study of aging, conducted in brazil in 1997 and 2008. we compared the two birth cohorts - 1916-1926 (older cohort) and 1927-1937 (recent cohort) - considering body mass index (bmi = weight/height2), waist circumference (wc) and prevalence of overweight (bmi 3 27kg/m2). bmi (β = 0.09, 95%ci: 0.04, 0.15) and prevalence of overweight (pr = 1.02; 95%ci: 1.01; 1.03) were higher in the recent cohort than the earlier cohort, regardless of sex and schooling. no difference was observed in wc. stratified by sex, similar overall trends were observed for men, and wc was higher in the recent cohort. among women there was no difference in bmi and overweight, but wc was lower in the recent cohort. the cohort effect was greater among older men and, in the near future, may result in greater prevalence of overweight in this group.
Birth cohort differences in hypertension control in a Brazilian population of older elderly: the Bambuí cohort study of aging (1997 and 2008)
Firmo, Josélia O. A.;Peixoto, Sérgio Viana;Loyola Filho, Ant?nio Ignácio de;Uch?a, Elizabeth;Lima-Costa, Maria Fernanda;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011001500013
Abstract: we examined for cohort differences in hypertension control between participants in the bambuí cohort study of aging of aging born 1916-1926 and 1927-1937. participants included hypertensive elderly aged 71-81 at baseline (n = 313) and at 11th wave follow up (n = 484). prevalence of hypertension awareness (70.9% and 81.2%, respectively), median medical appointments in previous 12 months (2 and 3, respectively) and antihypertensive drug use (74.4% and 90.7% respectively) increased significantly from older to younger cohort. however, prevalence of appropriately controlled hypertension among those treated (< 140/< 90mmhg) was similar in both cohorts (44.6% and 40.1%, p = 0.255). multivariate analysis returned schooling as the only factor independently associated with appropriately controlled hypertension. despite increased medical appointments and drug use in the recent cohort, the prevalence of appropriately controlled hypertension remained as low as in the older cohort.
Temporal Predictors of Health-Related Quality of Life in Elderly People with Diabetes: Results of a German Cohort Study  [PDF]
Imad Maatouk, Beate Wild, Daniela Wesche, Wolfgang Herzog, Elke Raum, Heiko Müller, Dietrich Rothenbacher, Christa Stegmaier, Dieter Schellberg, Hermann Brenner
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0031088
Abstract: Background The aim of the study was to determine predictors that influence health-related quality of life (HRQOL) in a large cohort of elderly diabetes patients from primary care over a follow-up period of five years. Methods and Results At the baseline measurement of the ESTHER cohort study (2000–2002), 1375 out of 9953 participants suffered from diabetes (13.8%). 1057 of these diabetes patients responded to the second-follow up (2005–2007). HRQOL at baseline and follow-up was measured using the SF-12; mental component scores (MCS) and physical component scores (PCS) were calculated; multiple linear regression models were used to determine predictors of HRQOL at follow-up. As possible predictors for HRQOL, the following baseline variables were examined: treatment with insulin, glycated hemoglobin (HbA1c), number of diabetes related complications, number of comorbid diseases, Body-Mass-Index (BMI), depression and HRQOL. Regression analyses were adjusted for sociodemographic variables and smoking status. 1034 patients (97.8%) responded to the SF-12 both at baseline and after five years and were therefore included in the study. Regression analyses indicated that significant predictors of decreased MCS were a lower HRQOL, a higher number of diabetes related complications and a reported history of depression at baseline. Complications, BMI, smoking and HRQOL at baseline significantly predicted PCS at the five year follow-up. Conclusions Our findings expand evidence from previous cross-sectional data indicating that in elderly diabetes patients, depression, diabetes related complications, smoking and BMI are temporally predictive for HRQOL.
Birth cohort differences in cardiovascular risk factors in a Brazilian population of older elderly: the Bambuí cohort study of aging (1997 and 2008)
Freitas, Marco Polo Dias;Loyola Filho, Ant?nio Ignácio de;Lima-Costa, Maria Fernanda;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011001500011
Abstract: the aim of this study was to investigate whether cohort differences exist in the prevalence of cardiovascular risk factors among older elderly from the bambuí cohort study of aging. participants were those aged 71-81 years at two points in time a decade apart: 457 in 1997 (earlier cohort) and 553 in 2008 (recent cohort). the prevalence of hypertension (pr = 1.27; 95%ci: 1.19-1.36) and of diabetes mellitus (pr = 1.39; 95%ci: 1.06-1.83) was higher in the recent cohort compared to the earlier one, regardless of sex. the recent cohort had a lower prevalence of smoking (pr = 0.58; 95%ci: 0.42-0.80), and lower total cholesterol/hdl cholesterol ratio level (pr = 0.85; 95%ci: 0.80-0.89). there was a 136% increase in the pharmacologic treatment of diabetes and a 56% increase in pharmacologic management of hypertension in 2008 in comparison with 1997. overall, the number of cardiovascular risk factors in the recent cohort remained similar to that of the early cohort.
Self-reported predictors of depressive symptomatology in an elderly population with type 2 diabetes mellitus: a prospective cohort study
Manjiri D Pawaskar, Roger T Anderson, Rajesh Balkrishnan
Health and Quality of Life Outcomes , 2007, DOI: 10.1186/1477-7525-5-50
Abstract: A prospective cohort study was conducted by administrating health risk assessment questionnaire to elderly (≥65 years) with type 2 diabetes. Responses were linked with administrative claim's data. Data were obtained from elderly with type 2 diabetes who were enrolled in Medicare Health Maintenance Organization (HMO) in southeastern United States. The instrument collected information related to demographics, health status, medication use, and healthcare service utilization prior to enrollment. Responses were combined with the administrative claims data of HMO to obtain information on actual utilization of healthcare resources. The Short Form Center for Epidemiologic Studies Depression scale was used to assess depressive symptoms. Multivariable logistic regression analyses were conducted to determine predictor variables.Of 792 respondents, about 17% had depressive symptoms. Almost 96% of patients were using 1 or more antidiabetic medications. Overall, increased risk of depression was associated with lower health related quality of life (HRQoL) (OR: 0.97; 95% CI: 0.96–0.98) and higher impairments in instrumental activities of daily living (IADLs) (OR: 1.31; 95% CI: 1.14–0.52) in elderly patients. Poor health related quality of life (OR: 0.97, 95%CI: 0.95–0.99) was associated with higher risk of depression in patients on insulin therapy.Impairments in daily activities and lower HRQoL were predictors of depressive symptomatology in elderly with diabetes. Determinants of depression varied according to pharmacotherapeutic class of antidiabetic medications.Diabetes affects 20.8 million individuals and is considered as the sixth leading cause of death in the United States [1]. It poses an immense economic burden on the U.S. healthcare system costing around $100 billion annually [1]. Around 7 million elderly Americans suffer from type 2 diabetes mellitus. An elderly population in the United States is associated with maximum utilization of healthcare resources [2].Like diabete
Different equations for determining height among the elderly: the Bambuí cohort study of aging
Siqueira, Vanessa de Oliveira;Costa, Bruna Vieira de Lima;Lopes, Aline Cristine Souza;Santos, Luana Caroline dos;Lima-Costa, Maria Fernanda;Caiaffa, Waleska Teixeira;
Cadernos de Saúde Pública , 2012, DOI: 10.1590/S0102-311X2012000100013
Abstract: the aim of this study was to compare measured height with estimates of height derived from equations using half arm-span measurements and assess how this affects the calculation of the body mass index (bmi) among elderly individuals. direct height measurements of a subsample of elderly individuals from the baseline sample of the bambuí project were compared with estimates of height derived from equations proposed by bassey and the who. the data was analyzed using the mcnemar test, lin concordance correlation coefficient (ccc) and bland-altman method (p < 0.05). estimates of height using the who method showed a low ccc in relation to measured height. for bmi, the concordance was greater. however, with this method height was found to be underestimated so leading to the overestimation of bmi. the bassey equation showed high concordance with measured height in elderly people over 80 years of age. with respect to bmi, the who method resulted in a much greater prevalence of overweight, whereas the estimates derived from the bassey method did not differ from the results obtained from direct height measurement. height estimates using the bassey equation were similar to the results obtained from direct measurements, suggesting that this method is applicable.
Inappropriate medication use and risk of falls – A prospective study in a large community-dwelling elderly cohort
Sarah Berdot, Marion Bertrand, Jean-Fran?ois Dartigues, Annie Fourrier, Béatrice Tavernier, Karen Ritchie, Annick Alpérovitch
BMC Geriatrics , 2009, DOI: 10.1186/1471-2318-9-30
Abstract: The 3C Study is a multicentre prospective cohort study conducted in France with 4 years of follow-up. Non-institutionalized men and women aged 65 years or over (N = 6343) were randomly selected from electoral rolls. Data on socio-demographic, medical characteristics and medication use (based on self-reports and data from the national healthcare insurance) were collected. Use of inappropriate medication for elderly was defined from established criteria. Data about falls were collected at the two follow-up examinations (2 years and 4 years after baseline). The association between the exposure to inappropriate medications and the risk of falls was evaluated using multivariate models (Cox model and logistic regression).32% of subjects reported inappropriate medication use at baseline and 29% at least two of the three examinations; 22% had fallen 2 times or more during follow-up. Overall, inappropriate medication users had an increased risk of falling. This increase was mainly due to the use of long-acting benzodiazepines (adjusted odds ratio (OR) = 1.4, 95% confidence interval: [1.1–1.8], in both occasional and regular users), other inappropriate psychotropics (adjusted OR = 1.7 [1.7–2.7] in regular users), or medication with anticholinergic properties (adjusted OR = 1.6 [1.2–2.1] in regular users). Neither occasional, nor regular use of short- or intermediate-acting benzodiazepines was associated with an increased risk of falling. Further analysis in long-acting benzodiazepines users did not show any dose-effect relation between the number of prescriptions filled over a 3-year period and the risk of falling.Our study showed that use of inappropriate medications was associated with an increased risk of falling in elderly persons. This increase was mainly due to long-acting benzodiazepines and other inappropriate psychotropics, and to medications with anticholinergic properties.In the United States, more than one-third of all medications is consumed by persons aged 65 ye
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