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Biomedical subjects

J Guralnik

Publications and source records attributed to J Guralnik.

10 recordsLinked to original sources
PubMed2005

Serum antioxidants, inflammation, and total mortality in older women.

The inflammatory cytokine interleukin-6 (IL-6) has been linked to poor health outcomes in older adults. Oxidative stress triggers the production of IL-6, and antioxidant micronutrients play a critical role in decreasing this inflammatory response. The authors sought to identify the relations between serum levels of antioxidant nutrients and IL-6 and mortality in older women. Levels of alpha- and beta-carotene, lycopene, lutein/zeaxanthin, alpha-cryptoxanthin, total carotenoids, retinol, alpha-tocopherol, zinc, and selenium were measured at baseline in 619 participants in Women's Health and Aging Study I (Baltimore, Maryland, 1992-1998). IL-6 was measured at baseline and at follow-up 1 and 2 years later, and all-cause mortality was determined over a 5-year period. Participants with the highest serum levels of alpha-carotene, total carotenoids, and selenium were significantly less likely to be in the highest tertile of serum IL-6 at baseline (p < 0.0001). Those with the lowest levels of alpha- and beta-carotene, lutein/zeaxanthin, and total carotenoids were significantly more likely to have increasing IL-6 levels over a period of 2 years. Those with the lowest selenium levels had a significantly higher risk of total mortality over a period of 5 years (hazard ratio = 1.54, 95% confidence interval: 1.03, 2.32). These findings suggest that specific antioxidant nutrients may play an important role in suppressing IL-6 levels in disabled older women.

Aged↗
PubMed2001

Problem behavior in the last year of life: prevalence, risks, and care receipt in older Americans.

OBJECTIVES: To estimate the prevalence of problem behavior in the last year of life in older people and to explore risk factors and assess the effect of behaviors on access to care. DESIGN: Retrospective analysis of data from the 1993 National Mortality Followback Survey, conducted by the National Center for Health Statistics (NCHS). SETTING: Persons who resided and died in the United States (except South Dakota) in 1993. PARTICIPANTS: Seven thousand six hundred and eighty-four deaths in people age 65 and older were included, from which full informant interview data were available for 6,748 decedents (88%). MEASUREMENTS: Informant data were collected on frequency of complaints about behavior from family members, complaints from others in the community, bizarre behavior, destroying property, violent threats or attempts, and temper tantrums. RESULTS: Overall, 20% of decedents were reported as having any of the problem behaviors sometimes or often in the last year of life. Rates differed little by age at death or gender. Risks of having problem behaviors were higher for those with clinically diagnosed dementia, mental illness, alcohol abuse, and bronchitis or emphysema. A diagnosis of dementia had been made in 27% of those with behavior problems. Nursing homes or healthcare facilities were the usual residence of 32% of people with any behavior problems sometimes or often during their last year of life. Informants for decedents who had destroyed property or made violent threats were 2.3 times (95% confidence interval (CI) = 1.2-4.4) more likely to report that the subject had not received the care they had needed during the last year of life. CONCLUSION: Problem behavior is relatively common in older people in the last year of life and is not confined to nursing home residents or people suffering from dementia.

Age Distribution↗
PubMed1998

The prevalence and impact of self-reported hip fracture in elderly community-dwelling women: the Women's Health and Aging Study.

To estimate the prevalence and impact of self-reported hip fracture in elderly women an age-stratified random sample of 3841 community-dwelling women aged 65 years and above were interviewed to determine the occurrence of 13 chronic conditions and difficulty performing 15 tasks. Associations were examined using multiple logistic regression analysis. The weighted prevalence of hip fracture was 4.7 per 100. Prevalence increased with increasing age from 2.9 per 100 in women aged 65-74 years to 12.6 per 100 in women aged 85 years and above, and was higher in white women than black women. Women with hip fracture were significantly more likely to report concomitant Parkinson's disease (age-adjusted odds ratio [aOR] = 2.8) and stroke (aOR = 1.8). After adjustment for potential confounding variables, women with hip fracture were significantly more likely to report difficulty performing 11 activities that map into domains of mobility/exercise tolerance, self-care tasks and higher functioning domains. Hip fracture is common among elderly community-dwelling women and is associated with difficulty in performing activities of daily living.

Activities of Daily Living↗
PubMed1994

Association of visual impairment with mobility and physical function.

OBJECTIVE: To examine the association of distant vision and physical function in the population of older adults. DESIGN: Cross-sectional and cohort study. PARTICIPANTS: 5143 older residents of three communities (Established Populations for the Epidemiologic Studies of the Elderly) who were interviewed in 1988-89, including residents of two communities who were re-interviewed 15 months later (n = 3133, 97% of those eligible). MEASURES: Visual acuity screening, self-reported activities of daily living and mobility, and objective physical performance measures of balance, walking, and rising from a chair. RESULTS: Limitations in mobility, activities of daily living, and physical performance were associated with worse visual function. In prospective analyses controlling for potential confounders, participants with severe visual impairment had 3-fold higher odds of incident mobility and activity of daily living limitations than those with acuity of 20/40 or better (P < 0.001). In prospective analyses investigating the relationship of vision with improvement in function, those with poor vision were about half as likely to improve as those with better acuity, but this relationship was only statistically significant for improvement in mobility limitations. CONCLUSIONS: Distant visual function appears to play an important role in physical function, particularly for mobility. An intervention to improve vision in at-risk elders might preserve function and prevent disability; this warrants further investigation.

Activities of Daily Living↗
PubMed1992

Functional blindness and visual impairment in older adults from three communities.

PURPOSE: The purpose of this study is to examine the association of sociodemographic factors with functional blindness and visual impairment in an aged population. METHODS: Three population-based cohorts (East Boston, MA; New Haven, CT; and Iowa and Washington Counties, IA) of persons aged 71 years and older were screened for bilateral functional near and distant vision during an in-home interview in 1988. RESULTS: Screening was completed by 5335 participants. The prevalence of functional blindness increased with age, from 1% at age 71 to 74 years to 17% in those 90 years of age and older. Functional visual impairment increased from 7% at age 71 to 74 years to 39% in those 90 years of age and older. In multivariate analyses, residence in a nursing home, older age, glaucoma, insulin-requiring diabetes at baseline, East Boston site, history of cataract, and lower 1982 income were independent and significantly associated with both functional blindness and visual impairment. Age and nursing home residence were significantly (P < 0.05) more strongly associated with blindness (odds ratios 4.8 and 6.1, respectively) than they were with visual impairment. CONCLUSION: Functional blindness and visual impairment are quite prevalent among the oldest old and the institutionalized. The number of affected individuals will increase as the population ages and life expectancy increases. Although visual problems are associated with aging, nursing home residence, health problems, and socioeconomic conditions, they may be readily remediable and may lead to immediate improvements in quality of life.

Aged↗
PubMed1988

The decline in ischemic heart disease mortality: prospective evidence from the Alameda County Study.

The contribution of secular changes in the distribution of ischemic heart disease risk factors and medical care utilization to the decline in ischemic heart disease mortality was investigated using data collected on the nine-year ischemic heart disease mortality experience of two cohorts selected to be representative of Alameda County, California, in 1965 and 1974. With adjustment for age, sex, race, and baseline ischemic heart disease conditions and symptoms, there was a 45% decline in the nine-year odds of ischemic heart disease mortality between the two cohorts (1965/1974, odds ratio (OR) = 1.82, p = 0.0001). Further adjustment for cohort differences in the following ischemic heart disease risk factors did not explain the decline: smoking status, leisure-time physical activity, self-assessed physical activity, alcohol consumption, body mass index, or social network participation; neither did adjustment for measures of education, utilization of preventive medical care, availability of a regular physician or clinic, health insurance coverage, number of physician visits during the last 12 months, or occupation. There was no change in the estimated ischemic heart disease decline when all adjustment variables were included in a logistic model (1965/1974, OR = 1.81, p = 0.0002). These variables do not appear to explain the large decline in nine-year ischemic heart disease mortality between these two cohorts.

Adult↗
PubMed1987

Social network ties and mortality among the elderly in the Alameda County Study.

Seventeen-year mortality data from the Alameda County Study are used to examine the relative importance of social ties as predictors of survival at different ages, ranging from 38-94 years at baseline. Previous analyses of Alameda County data by Berkman and Syme (Am J Epidemiol 1979;109:186-204) have shown that such ties are significant predictors of lower nine-year mortality risk for persons aged less than 70 years at baseline. Proportional hazard analyses indicate that social ties are also significant predictors of lower 17-year mortality risks for those aged 70 and older after adjusting for age, sex, race, baseline health status, perceived health, depression, and health practices (relative hazard = 1.49 for Berkman-Syme Social Network Index; 95% confidence interval (CI) = 1.09-2.05). Comparisons of the relative importance of four types of social ties reveal an interesting shift across the age groups. Marital status assumes primary importance for those aged less than 60 years at baseline (relative hazard = 1.6 and 1.4 for those aged 38-49 and 50-59, respectively; 95% CI = 1.12-2.29 and 1.02-1.91, respectively). However, ties with close friends and/or relatives assume greater importance for those aged 60 and older (relative hazard = 1.17 comparing those reporting five or more contacts per month to the more socially isolated who report less than five such contacts per month; 95% CI = 0.98-1.89).

Adult↗
PubMed1987

Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors.

We studied the association between behavioral and demographic risk factors and 17-year mortality in members of the Alameda County (California) Study who were 60-94 years of age at baseline. In this age group, increased risk of death is associated with being male, smoking, having little leisure-time physical activity, deviating from moderate weight relative to height, and not regularly eating breakfast. These increased risks were independent of age, race, socioeconomic position (SEP), other behavioral risk factors, and baseline physical health status. Further examination of the group aged 70 or more revealed the same patterns of heightened risk.

Aged↗
PubMed1986

Transfusion-acquired hepatitis A in a premature infant with secondary nosocomial spread in an intensive care nursery.

An outbreak of hepatitis A involving 15 nurses, two premature infants, and the mother of one infant occurred in an intensive care nursery. The infants became infected after receiving blood transfusions from a donor who shortly thereafter experienced symptoms compatible with hepatitis A and was later found to have serologic evidence of acute hepatitis A. Hepatitis was not suspected clinically in the infants but was documented serologically. One of the infants had an ileostomy with liquid intestinal drainage. Her mother and most, if not all, of the nurses acquired hepatitis from this infant. All 15 nurses had contact with this infant, whereas only four nurses had contact with the second infant. The amount of contact nurses had with this infant clearly was related to their risk of infection. Nurses not actually assigned to this infant but who reported some contact had a significantly lower attack rate than those assigned to the infant. Among assigned nurses, those assigned to more than one shift had 4.7 times the risk of acquiring hepatitis than those assigned to one shift only. No specific nursing techniques or personal habits were documented as being significant risk factors in the infected group of nurses.

Adult↗