Biomedical subjects

Avron Spiro

Publications and source records attributed to Avron Spiro.

At least 19 recordsLinked to original sources

PubMed2007

Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study.

CONTEXT: Various correlates of posttraumatic stress disorder (PTSD), such as high levels of sympathetic activation and hypothalamic-pituitary-adrenal axis dysregulation, have been linked to arterial damage and coronary heart disease (CHD) risk. While psychological disturbance is frequently found among patients with cardiac disease, whether psychological problems precede or occur as a result of having a potentially fatal disease is not clear. To our knowledge, no prospective studies to date have evaluated whether PTSD is associated with increased risk of CHD. OBJECTIVE: To test the hypothesis that high levels of PTSD symptoms may increase CHD risk, using 2 different measures of PTSD. DESIGN: Prospective cohort study. SETTING: Community-dwelling men from the Greater Boston, Mass, area who served in the military. PARTICIPANTS: Data are from the Veterans Affairs Normative Aging Study. Men who completed either the Mississippi Scale for Combat-Related PTSD in 1990 (n = 1002) or the Keane PTSD scale in 1986 (n = 944) were included in the study. MAIN OUTCOME MEASURE: Incident CHD occurring during follow-up through May 2001. RESULTS: Levels of PTSD symptoms in this cohort were low to moderate. Men with preexisting CHD at baseline were excluded, and PTSD was measured with the Mississippi Scale for Combat-Related PTSD. For each SD increase in symptom level, men had age-adjusted relative risks of 1.26 (95% confidence interval, 1.05-1.51) for nonfatal myocardial infarction and fatal CHD combined and 1.21 (95% confidence interval, 1.05-1.41) for all of the CHD outcomes combined (nonfatal myocardial infarction, fatal CHD, and angina). Findings were replicated using the Keane PTSD scale and somewhat strengthened after controlling for levels of depressive symptoms. CONCLUSIONS: To our knowledge, this is the first study to demonstrate a prospective association between PTSD symptoms and CHD even after controlling for depressive symptoms. These results suggest that a higher level of PTSD symptoms may increase the risk of incident CHD in older men.

Adult↗

PubMed2007

Cumulative lead exposure and cognitive performance among elderly men.

BACKGROUND: Recent evidence suggests that cumulative lead exposure among adults in nonoccupational settings can adversely affect cognitive function. Which cognitive domains are affected has not been explored in detail. METHODS: We used nonlinear spline regressions and linear repeated-measures analysis to assess the association between scores on a battery of cognitive tests over time and both blood and bone lead concentrations in the Normative Aging Study, a cohort of community-dwelling elderly men. Bone lead was measured from 1991 through 1999 with K-shell x-ray fluorescence. A total of 1089 men with a mean (+/-standard deviation) age of 68.7 (+/-7.4) years with blood lead measurements, 761 of whom also had valid bone lead measurements, completed at least one of a battery of cognitive tests. Approximately 3.5 years later, 69% of the men had at least one repeat test. Cognitive testing was performed from 1993 through 2001. RESULTS: On a cross-sectional basis, there was little association between blood or bone lead and cognitive test scores. Change in performance over time on virtually all tests worsened as bone lead increased, with the most robust effects on performance and reaction time scores on visuospatial/visuomotor tests. CONCLUSIONS: Low-level cumulative exposure to lead in nonoccupational settings may adversely affect cognitive function, particularly in the visuospatial/visuomotor domain.

Age Factors↗

PubMed2006

Daily stressors and memory failures in a naturalistic setting: findings from the VA Normative Aging Study.

Laboratory studies of stress and memory have generally found that people with more stress tend to have poorer cognitive performance. The present investigation examined the relationship between stressors and memory failures in a naturalistic setting via a daily diary study of 333 older adults in the VA Normative Aging Study. Multilevel models indicated that on days when people experienced stressors, particularly interpersonal stressors, they were more likely to report memory failures. These stressors were also associated with an increase in memory failures from one day to the next. The findings may be important for preventions to mitigate age-related cognitive decline.

Activities of Daily Living↗

PubMed2006

Coping, affect, and the metabolic syndrome in older men: how does coping get under the skin?

The metabolic syndrome is a complex construct with interrelated factors of obesity, blood pressure, lipids, and glucose. It is a risk factor for a number of chronic diseases in late life. This study tested a model in which the relationship between stress and the metabolic syndrome was mediated by appraisal, coping, and affect. Data were collected from 518 male participants in the Normative Aging Study (X(age) = 68.17 years). The model was partially confirmed. Relationships among stress, appraisal, coping, and affect were valenced along positive and negative pathways. However, affect was not directly related to the metabolic syndrome. The metabolic syndrome was related to positive coping as operationalized by self-regulatory strategies. The results of this study suggest that the influence of coping on physical health may occur through emotional regulation.

Adaptation, Psychological↗

PubMed2006

Risk-adjusted mortality as an indicator of outcomes: comparison of the Medicare Advantage Program with the Veterans' Health Administration.

BACKGROUND: The Medicare Advantage Program (MAP) and the Veterans' Health Administration (VHA) currently provide many services that benefit the elderly, and a comparative study of their risk-adjusted mortality rates has the potential to provide important information regarding these 2 systems of care. OBJECTIVE: The objective of this retrospective study was to compare mortality rates between the MAP and the VHA after controlling for case-mix differences. SUBJECTS: This study consisted of 584,294 MAP patients and 420,514 VHA patients. MEASURES: We used the Death Master File to ascertain the vital status of each study subject over approximately 4 years. We used Cox regression models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the MAP compared with VHA patients. RESULTS: The average age for male MAP patients was 73.8 years (+/- 5.6) and for male VHA patients was 74.05 years (+/- 6.3). Unadjusted mortality rates of males for VHA and MAP were 25.7% and 22.8%, respectively, over approximately 4 years (P < 0.0001), respectively. The case-mix of VHA patients, however, was sicker than those from MAP. After adjusting for case-mix, the HR for mortality in the MAP was significantly higher than that in the VHA (HR, 1.404; 95% CI = 1.383-1.426). We obtained similar results when we compared the mortality rates of females for VHA and MAP. CONCLUSIONS: After adjusting for their higher prevalence of chronic disease and worse self-reported health, mortality rates were lower for patients cared for in the VHA compared with those in the MAP. Further studies should examine what differences in care structures and processes contribute to lower mortality in the VHA.

Aged↗

PubMed2006

Development and validation of a psychiatric case-mix system.

BACKGROUND: Although difficulties in applying risk-adjustment measures to mental health populations are increasingly evident, a model designed specifically for patients with psychiatric disorders has never been developed. OBJECTIVE: Our objective was to develop and validate a case-mix classification system, the "PsyCMS," for predicting concurrent and future mental health (MH) and substance abuse (SA) healthcare costs and utilization. SUBJECTS: Subjects included 914,225 veterans who used Veterans Administration (VA) healthcare services during fiscal year 1999 (FY99) with any MH/SA diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] codes 290.00-312.99, 316.00-316.99). METHODS: We derived diagnostic categories from ICD-CM codes using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition definitions, clinical input, and empiric analyses. Weighted least-squares regression models were developed for concurrent (FY99) and prospective (FY00) MH/SA costs and utilization. We compared the predictive ability of the PsyCMS with several case-mix systems, including adjusted clinical groups, diagnostic cost groups, and the chronic illness and disability payment system. Model performance was evaluated using R-squares and mean absolute prediction errors (MAPEs). RESULTS: Patients with MH/SA diagnoses comprised 29.6% of individuals seen in the VA during FY99. The PsyCMS accounted for a distinct proportion of the variance in concurrent and prospective MH/SA costs (R=0.11 and 0.06, respectively), outpatient MH/SA utilization (R=0.25 and 0.07), and inpatient MH/SA utilization (R=0.13 and 0.05). The PsyCMS performed better than other case-mix systems examined with slightly higher R-squares and lower MAPEs. CONCLUSIONS: The PsyCMS has clinically meaningful categories, demonstrates good predictive ability for modeling concurrent and prospective MH/SA costs and utilization, and thus represents a useful method for predicting mental health costs and utilization.

Aged↗

PubMed2005

Suppressed hostility predicted hypertension incidence among middle-aged men: the normative aging study.

This study tested whether suppressed hostility predicted incident hypertension (HTN) in initially nonhypertensive men, using prospective data from the Normative Aging Study. Six hundred twenty-seven men who completed the MMPI and participated in a subsequent laboratory assessment were included in the study. The Cook-Medley Hostility scale (Ho), a suppression factor, and other risk factors were used to predict incident HTN over a 3-year period. Logistic regression showed a significant three-way interaction among Ho, suppression, and age in predicting incident HTN. Among middle-aged men (<or=60 years) with higher suppression, a 1-point decrease in the Ho score was associated with an 18% increase in HTN risk. This relationship remained significant after controlling for relevant risk factors. Among older participants, the HoxSuppression interaction was not predictive of HTN incidence. These results provide support for the Suppressed Hostility hypothesis in middle-aged men.

Adult↗

PubMed2005

Combined effect of the metabolic syndrome and hostility on the incidence of myocardial infarction (the Normative Aging Study).

A growing body of evidence suggests that the metabolic syndrome and hostility are independent risk factors for the development of coronary heart disease. However, few studies have examined the combined effect of the metabolic syndrome and hostility on the incidence of myocardial infarction (MI). We examined prospectively the relation among the metabolic syndrome, hostility, and the incidence of MI in healthy, older men (mean +/- SD 59.7 +/- 7.2 years) who participated in the Normative Aging Study. Seven hundred fifty-four men who were diagnosed as not having coronary heart disease and diabetes mellitus were included in the present study. Men were assigned to 1 of 4 risk-factor groups based on the presence or absence of the metabolic syndrome and low or high hostility. Hierarchical logistic regression was used to assess the multivariate risk of developing a MI. The incidence of MI was 11.3% (n = 85) over an average follow-up period of 13.8 years. After adjusting for potential covariates, risk-factor group significantly predicted the incidence of MI (odds ratio 1.59, 95% confidence interval 1.29 to 1.96, p <0.0001). The effect was strongest among patients who had the metabolic syndrome and high levels of hostility, with this subgroup showing a fourfold increase in the odds of developing a MI (odds ratio 4.21, 95% confidence interval 2.21 to 8.04, p = 0.0001). In conclusion, it appears that hostility may provide additional prognostic information to the assessment of coronary heart disease risk in patients with the metabolic syndrome and should routinely be evaluated as part of a comprehensive risk factor assessment.

Age Distribution↗

PubMed2005

A longitudinal study of retirement in older male veterans.

In this study, the authors examined the effect of retirement on psychological and physical symptoms in 404 older male veterans who were taking part in an ongoing longitudinal study. Hierarchical linear modeling was used to analyze symptom trajectories from preretirement, peri-retirement, and postretirement periods in veterans with either lifetime full or partial posttraumatic stress disorder (PTSD), trauma exposure only, or no traumatic exposure. As expected, the PTSD group experienced greater increases in psychological and physical symptoms during retirement, relative to the other groups. Retirement due to poor health in the PTSD group did not account for the findings regarding physical symptoms. Results indicate that clinicians should recognize and address the potential for older individuals with PTSD to experience difficulties during retirement.

Adult↗

PubMed2005

Change in life satisfaction during adulthood: findings from the veterans affairs normative aging study.

Change in life satisfaction was modeled over a 22-year period in 1,927 men. A curvilinear relationship emerged. Growth-curve models indicated that life satisfaction peaked at age 65 and then declined, but showed significant individual differences in rate of change. Extraversion predicted variability in change, with higher levels associated with a high and flat life satisfaction trajectory. Time-varying physical health and marital status were associated with higher life satisfaction. Proximity to death was associated with a decline in life satisfaction. On measurement occasions that were within 1 year before death, trajectories showed steeper decline, and this effect was not attributable to declines in self-rated physical health. The findings are at odds with prior (cross-sectional) research showing that subjective well-being improves with aging.

Adult↗

PubMed2005

Effects of age and hypertension status on cognition: the Veterans Affairs Normative Aging Study.

The authors examined the influence of age and hypertensive status (normotensive, controlled, untreated, or uncontrolled) on several cognitive tests via multiple regression in 357 nondemented, community-dwelling older men (mean age=67 years) whose hypertensive status was stable over 3 years and who had no medical comorbidities. Age was negatively associated with performance on all but 1 test. Age interacted with hypertensive status on verbal fluency and word list immediate recall; older uncontrolled hypertensives exhibited significantly larger age decrements on these tests compared with normotensives. These findings suggest that uncontrolled hypertension produces specific cognitive deficits beyond those attributable to age alone. These and previous findings illustrate that health conditions such as hypertension should be regularly considered in studies of "normal" cognitive aging.

Age Factors↗

PubMed2005

High homocysteine and low B vitamins predict cognitive decline in aging men: the Veterans Affairs Normative Aging Study.

BACKGROUND: Elevated homocysteine concentrations may contribute to cognitive impairment. Most elevations in homocysteine result from inadequate folate, vitamin B-12, or vitamin B-6 intake. It is not clear whether the observed associations between homocysteine and cognitive measures are causal or whether they are due to homocysteine, to independent actions of the B vitamins, or to both. OBJECTIVE: We aimed to assess the individual and independent effects of baseline plasma homocysteine, folate, vitamin B-12, and vitamin B-6 and of dietary B vitamin intakes on 3-y changes in cognitive measures in 321 aging men. DESIGN: Participants were from the Veterans Affairs Normative Aging Study. Cognitive function was assessed with the Mini-Mental State Examination and on the basis of measures of memory, verbal fluency, and constructional praxis, which were adapted from the revised Wechsler Adult Intelligence Scale and the Consortium to Establish a Registry for Alzheimer's Disease batteries at 2 time points. At baseline, dietary intakes were assessed with a food-frequency questionnaire, and blood was drawn for the measurement of B vitamins and homocysteine. RESULTS: Over a mean 3-y follow-up, declines in constructional praxis, measured by spatial copying, were significantly associated with plasma homocysteine, folate, and vitamins B-6 and B-12 and with the dietary intake of each vitamin. Folate (plasma and dietary) remained independently protective against a decline in spatial copying score after adjustment for other vitamins and for plasma homocysteine. Dietary folate was also protective against a decline in verbal fluency. A high homocysteine concentration was associated with a decline in recall memory. CONCLUSIONS: Low B vitamin and high homocysteine concentrations predict cognitive decline. Spatial copying measures appear to be most sensitive to these effects in a general population of aging men.

Aged↗

PubMed2005

Comprehensive health status assessment of centenarians: results from the 1999 large health survey of veteran enrollees.

BACKGROUND: Information on the health status of centenarians provides a means for understanding the health care needs of this growing population. Therefore, we examined the health status of a national cohort of centenarian veteran enrollees. METHODS: Ninety-three centenarian veteran enrollees returned a complete health history questionnaire, which included questions about sociodemographic information, age-associated conditions, health behaviors, health-related quality of life as measured by the Veterans SF-36, and change in health status. RESULTS: Centenarian veteran enrollees are a group with major impairment across multiple dimensions of health-related quality of life despite having a relatively low prevalence of diseases. They had considerable physical limitations as reflected by their physical health summary scores (26.2 +/- 8.3). However, their mental health was comparatively good (mental health summary score 44.1 +/- 12.5). Compared to younger elderly veterans (ages 85-99), centenarians had a lower prevalence of hypertension, angina or myocardial infarction, diabetes, and chronic low back pain (p <.05). Centenarians had significantly worse physical functioning, role physical, vitality, and social functioning scores than did younger elderly veterans. The two groups did not differ in their general health, bodily pain, role emotional, and mental health scores. Centenarians did not perceive much decline in their physical or mental health during the preceding year. CONCLUSIONS: Centenarian veteran enrollees are a group with a low number of age-associated diseases and good mental health despite substantial physical limitations. These results support future studies of services directed toward improvement of function as opposed to those focused solely on the treatment of diseases.

Activities of Daily Living↗

PubMed2004

Cumulative lead exposure and prospective change in cognition among elderly men: the VA Normative Aging Study.

Lead exposure has been found to affect cognitive function in several different populations. Whether chronic low-level environmental exposure to lead results in cognitive decline among adults has not been examined. The authors assessed the relation between biomarkers of lead exposure and change in Mini-Mental State Examination (MMSE) scores in the Normative Aging Study, a cohort of elderly US men. Bone lead was measured with K-shell x-ray fluorescence. A total of 466 men aged 67.4 (standard deviation, 6.6) years took the MMSE on two occasions that were an average of 3.5 (standard deviation, 1.1) years apart during the period 1993-2001 and had bone lead concentrations measured during the period 1991-2002. A one-interquartile range (20 microg/g of bone mineral) higher patella bone lead concentration was associated with a change in MMSE score of -0.24 (95% confidence interval: -0.44, -0.05) after adjustment for age, education, smoking, alcohol intake, and time between MMSE tests. This effect is approximately equivalent to that of aging 5 years in relation to the baseline MMSE score in study data. The association with tibia lead was weaker and that with blood lead was absent. The data suggest that higher patella bone lead levels, a marker of mobilizable accumulated lead burden, are associated with a steeper decline over time in performance on the MMSE test among nonoccupationally exposed elderly men.

Adult↗

PubMed2004

Burden of medical illness in women with depression and posttraumatic stress disorder.

BACKGROUND: Depression and posttraumatic stress disorder (PTSD) are important women's health issues. Depression is known to be associated with poor physical health; however, associations between physical health and PTSD, a common comorbidity of depression, have received less attention. OBJECTIVES: To examine number of medical symptoms and physical health status in women with PTSD across age strata and benchmark them against those of women with depression alone or with neither depression nor PTSD. METHODS: A random sample of Veterans Health Administration enrollees received a mailed survey in 1999-2000 (response rate, 63%). The 30 865 women respondents were categorized according to whether a health care provider had ever told them that they had PTSD, depression (without PTSD), or neither. Outcomes were self-reported medical conditions and physical health status measured with the Veterans SF-36 instrument, a version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) modified for use in veteran populations. RESULTS: Across age strata, women with PTSD (n = 4348) had more medical conditions and worse physical health status (physical functioning, role limitations due to physical problems, bodily pain, and energy/vitality scales from the Veterans SF-36) than women with depression alone (n = 7580) or neither (n = 18 937). In age-adjusted analyses, the Physical Component Summary score was on average 3.4 points lower in women with depression alone and 6.3 points lower in women with PTSD than in women with neither (P<.001). CONCLUSIONS: Posttraumatic stress disorder is associated with a greater burden of medical illness than is seen with depression alone. The presence of PTSD may account for an important component of the excess medical morbidity and functional status limitations seen in women with depression.

Adult↗

PubMed2004

Comparison of patient-based oral health outcome measures.

OBJECTIVES: This project examined psychometric characteristics of four measures of oral-specific health-related quality of life. METHODS: We selected participants from two samples of community-dwelling male veterans from Boston (USA): (1) 538 users of VA outpatient medical care from the Veterans Health Study (VHS: mean age = 62); and (2) 211 relatively healthy men from the VA Dental Longitudinal Study (DLS: mean age = 70). Patient-based measures included the Geriatric Oral Health Assessment Instrument, the Oral Health Impact Profile (OHIP), the Oral Health-related Quality of Life instrument and the single-item self-report of oral health. Clinical variables included number of teeth, coronal decayed surfaces (CDS), a modification of the Root Caries Index (RCI_D), and the Community Periodontal Index of Treatment Need (CPITN). RESULTS: Cronbach's alpha ranged from 0.73 to 0.97. Percent of participants with floor and ceiling scores varied widely by instrument and by item. Patient-based measures were associated with all clinical measures in the combined sample. Number of teeth was associated with patient-based measures (p < 0.001). However, CDS, RCI_D and CPITN scores were associated with patient-based scores in the VHS but not in the DLS. The Geriatric Oral Health Assessment Instrument, the OHIP, the Oral Health-related Quality of Life instrument were strongly linearly related to the single-item global self-report of oral health (p < 0.0001). CONCLUSION: All multi-item measures have high internal consistency and all are valid for measuring oral-specific health-related quality of life.

Aged↗

PubMed2004

Alcohol dependence, other psychiatric disorders, and health-related quality of life: a replication study in a large random sample of enrollees in the Veterans Health Administration.

The purpose of this study was to investigate the relationship between alcohol dependence and health-related quality of life (HRQoL) in people with and without other selected psychiatric disorders. A sample of 127,308 Veterans Health Administration enrollees completed a survey that included questions about alcohol use and the Veterans SF-36, a well-validated measure of HRQoL. In addition, a Veterans Administration database was used to obtain respondents' past-year history of alcohol dependence and other psychiatric disorders. Comorbid psychiatric disorders significantly moderated or attenuated the relationship between alcohol dependence and HRQoL. Respondents with a history of alcohol dependence plus one or more other psychiatric disorders had significantly lower HRQoL in domains pertaining to psychological and social functioning than respondents with alcohol dependence only. Effect size differences (mean differences of clinical groups/pooled standard deviation) were large (greater than 0.80 of one standard deviation). Respondents with a history of alcohol dependence only vs. no history of alcohol dependence had poorer HRQoL. Effect size differences were small to moderate (between 0.20 and 0.50 of one standard deviation). Findings highlight the important moderating influence of comorbid psychiatric disorders in the relationship between alcohol dependence and HRQoL. As comorbid psychiatric disorders are often associated with poorer treatment outcome, findings also provide strong corroboration for the importance of treating other psychiatric disorders concurrently with alcohol dependence.

Alcohol Drinking↗

PubMed2004

Change in object naming ability during adulthood.

Using longitudinal data on the Boston Naming Test ( Kaplan, Goodglass, & Weintraub, 1983) collected over 20 years from healthy individuals aged 30 to 94, we examined change in lexical retrieval with age, gender, education, and their interactions. We compared results between random-effects longitudinal and traditional cross-sectional models. Random-effects modeling revealed significant linear and quadratic change in lexical retrieval with age; it also showed a Gender x Education interaction, indicating poorest performance for women with less education. Cross-sectional analyses produced greater estimates of change with age than did longitudinal analyses.

Adult↗