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Biomedical subjects

L F Berkman

Publications and source records attributed to L F Berkman.

At least 19 recordsLinked to original sources
PubMed1997

Gender differences in the comparison of self-reported disability and performance measures.

BACKGROUND: Gender differences in functioning among older adults have been well documented. Differential reporting of functional problems by men and women may contribute to this observed difference. The purpose of this study was to examine the gender differences in functional ability by comparing self-reported function to observed performance of physical tasks. METHODS: In 1988, 1,458 men and women ages 71 and older from the New Haven site of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) self-reported activities of daily living (ADL) disability and functional limitations. Subjects' ability to perform 7 tasks was observed. Gender differentials in "accurate" and "inaccurate" reporting were determined by examining comparable self-reports and performance measures. Logistic regression determined how much of the gender differential in self-reported function was explained by performance ability. RESULTS: More women than men reported disability and functional limitation, and women had poorer performance scores for every task. Compared to similar performance items, self-reports of function were accurate for the majority of men and women. However, among those who inaccurately reported function, more men than women underreported disability and more women than men overreported disability. Overall performance explains all of the gender difference in ADL disability and most of the difference in functional limitation. CONCLUSIONS: These results suggest that both men and women generally report their disability accurately, and women's higher prevalence of reported functional problems is probably a reflection of true disability for most disability measures.

Activities of Daily Living↗
PubMed1996

Prestroke physical function predicts stroke outcomes in the elderly.

OBJECTIVE: To determine whether physical function before stroke is an independent predictor of physical function and institutionalization 6 months after discharge from hospital in elderly stroke patients. DESIGN: Population-based prospective cohort design where incidence of stroke was monitored from 1982 through 1988. Baseline demographic and health information including prestroke function was collected prospectively. Eligible subjects who had a stroke were interviewed 6 months after discharge from hospital to assess outcomes. SETTING: New Haven, Connecticut. PATIENTS: Subjects were recruited from an initial sample of 2,812 older adults. Of 79 subjects who survived a first stroke at 6 months postdischarge, complete follow-up data were obtained on 63 subjects. MAIN OUTCOME MEASURE: Physical function as measured by the Katz scale and institutionalization. RESULTS: Fewer limitations in activities of daily living before stroke were associated with fewer limitation in physical function after stroke controlling for stroke severity and other relevant health and sociodemographic conditions (p < .01). Fewer limitations in gross mobility function before stroke were also independently associated with a lower risk of institutionalization (p < .05). CONCLUSION: This study provides useful information in assessing the prognosis of elderly stroke patients upon admission to hospital. It also supports the concept of general frailty being a risk factor for poorer health and institutionalization overall in aged persons. Studies have shown that factors related to physical frailty, such as decline in muscle function, can be reversed. The effect of interventions aimed at improving the physical function of the elderly on stroke incidence, stroke outcomes, and all-cause mortality, however, needs to be determined.

Activities of Daily Living↗
PubMed1996

Sex differences in survival after myocardial infarction in older adults: a community-based approach.

OBJECTIVE: To determine sex differences in survival after myocardial infarction in older individuals. DESIGN: Prospective cohort study based on a community sample of older individuals. All patients were followed for 1 year after hospital admission. SETTING: Two hospitals in New Haven, Connecticut. PARTICIPANTS: The study included 103 women and 120 men who were participants in the New Haven, CT cohort of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) program and who were diagnosed with myocardial infarction between the inception of the community study in 1982 and December 31, 1992. The mean age of women was 79.3 and of men, 77.3. MEASUREMENTS: Data on clinical characteristics were abstracted from medical records. Sociodemographic, psychosocial, and physical function information was derived from the EPESE interview preceding the infarction. The main outcome measure was all-cause mortality, for which three end points were used: early mortality (first 30 days), late mortality (1-year mortality among survivors of the first 30 days), and overall mortality (1-year mortality from admission in the whole sample). RESULTS: Mortality in the first 30 days did not differ significantly in the two sexes. The relative risk (RR) of death in women compared with men was 0.85 (95% confidence interval [CI], 0.49-1.47) before multivariable adjustment; this was unchanged after adjustment for demographic factors, comorbidity, functional status, psychosocial factors, and clinical severity (RR, 0.85, 95% CI, 0.41-1.76). Among survivors of 30 days, women were almost two times more likely to survive at 1 year compared with men, both before multivariable adjustment (RR, 0.56, 95% CI, 0.31-1.02) and after controlling for demographic factors, comorbidity, physical function, psychosocial factors, clinical severity on admission, and hospital complications (RR, 0.44 ; 95% CI, 0.20-0.99). Analyses involving 1-year follow-up from admission for the entire sample yielded intermediate results. CONCLUSION: There was little difference in mortality in the first 30 days after myocardial infarction between older men and women, but when the early deaths were excluded, women showed an increased survival compared with men in the first year after the myocardial infarction.

Aged↗
PubMed1995

HDL cholesterol predicts coronary heart disease mortality in older persons.

OBJECTIVES: To examine the relationship of total cholesterol and high-density lipoprotein cholesterol (HDL-C) with coronary heart disease (CHD) mortality and with occurrence of new CHD events in persons aged 71 years and older. DESIGN: Prospective cohort study with a median of 4.4 years of follow-up. SETTING: East Boston, Mass; New Haven, Conn; and Iowa and Washington counties, Iowa. PARTICIPANTS: A total of 2527 women and 1377 men who completed an interview, had serum lipid determinations, and survived at least 1 year. New CHD events were evaluated in persons with no CHD history or hospitalization. MAIN OUTCOME MEASURES: Death due to CHD (ICD-9 codes 410 through 414 as underlying cause of death); new occurrence of CHD events (fatal CHD or hospitalization with CHD [ICD-9 codes 410 through 414]). RESULTS: After adjustment for established CHD risk factors, the relative risk (RR) of death due to CHD for those with low HDL-C (< 0.90 mmol/L [< 35 mg/dL]) compared with the reference group (HDL-C > or = 1.55 mmol/L [> or = 60 mg/dL]) was 2.5 (95% confidence interval [CI], 1.6 to 4.0). Elevated risk was present in subgroups aged 71 through 80 years (RR, 4.1; 95% CI, 1.9 to 8.8) and over 80 years (RR, 1.8; 95% CI, 0.99 to 3.4), and in men and women. Low HDL-C predicted an increased risk of occurrence of new CHD events (RR, 1.4; 95% CI, 1.1 to 2.0), with similar but nonsignificant results in subgroups of men and women. Total cholesterol was less consistently associated with CHD mortality than HDL-C. When we compared individuals with total cholesterol of at least 6.20 mmol/L (240 mg/dL) with the reference group with total cholesterol of 4.16 to 5.19 mmol/L (161 to 199 mg/dL), a significant risk of CHD mortality was seen for women (RR 1.8; 95% CI, 1.03 to 3.0) but not for men (RR, 1.0; 95% CI, 0.5 to 2.0). In the total population, for each 1-unit increase in the total cholesterol/HDL-C ratio there was a 17% increase in the risk of CHD death that was statistically significant. CONCLUSIONS: Low HDL-C predicts CHD mortality and occurrence of new CHD events in persons older than 70 years. Elevated total cholesterol was not found to be associated with CHD mortality in older men, but may be a risk factor for CHD in older women.

Age Factors↗
PubMed1995

Sex differences in mortality after myocardial infarction. Is there evidence for an increased risk for women?

BACKGROUND: A number of studies have indicated that women who have a myocardial infarction have higher mortality rates than men. The purpose of the present study was to review the literature on sex differences in mortality after myocardial infarction to determine whether female sex is independently associated with lower survival. METHODS AND RESULTS: Reports were identified mainly through a MEDLINE search of the English-language literature from January 1966 through June 1994. Studies included were those comparing mortality after myocardial infarction between men and women, controlling at least for age and with more than 30 outcome events. After duplicate patient series were eliminated, 27 reports were included in our review. Crude rates were higher in women than in men during the early phase (in-hospital or first month), but control for age alone or in combination with other factors reduced sex differences in almost all studies. Unadjusted mortality rates among the survivors of the early phase were similar for men and women in most studies, and control for age and other factors resulted in an increased survival rate in women compared with men in several investigations, particularly those with a follow-up of > 1 year. CONCLUSIONS: Much of the increased early mortality after myocardial infarction in women is explained by the older age and more unfavorable risk characteristics of the women. In the long run, when differences in age and other risk factors are controlled for, women tend to have an improved survival compared with men.

Aged↗
PubMed1995

Cognitive functioning and the incidence of limitations in activities of daily living in an elderly community sample.

Although it is well-known that cognitive impairment in the elderly is usually accompanied by limitations in activities of daily living (ADL), it is not known whether cognitive impairment predicts the onset of new ADL limitations. The purpose of this analysis was to determine whether poor scores on a brief measure of cognitive functioning at baseline (1982) would predict the onset of persistent limitations in ADL during the subsequent 3 years, in a probability sample of community-dwelling elderly persons living in New Haven, Connecticut, who were initially free of ADL limitations (n = 1,856). Cognitive functioning was assessed with Pfeiffer's Short Portable Mental Status Questionnaire. Persistent incident ADL limitations were defined as the onset of one or more ADL limitations after 1982, with no subsequent reports of zero ADL limitations. Compared with persons who scored zero to one errors on the Short Portable Mental Status Questionnaire at baseline, persistent, incident ADL limitations occurred more frequently in persons who scored four or more errors (odds ratio for males = 2.72, 95% confidence interval 1.36-5.43; odds ratio for females = 2.60, 95% confidence interval 1.52-4.44) after adjustment for the confounding effects of housing type, age, race, history of chronic health conditions, and incident health conditions. These results suggest that knowledge of scores on brief cognitive function tests can be used to forecast service needs and to develop intervention programs to prepare for the possible onset of ADL limitations.

Activities of Daily Living↗
PubMed1995

Self-esteem and neuroendocrine response to challenge: MacArthur studies of successful aging.

The role of self-esteem in modulating patterns of neuroendocrine response to challenge at older ages was examined in 16 healthy 70-yr-olds. Responses to two challenges were examined: (1) a driving simulation designed to reflect a 'real life' challenge situation; and (2) a pharmacologic, corticotropin-releasing-hormone (CRH) challenge (1 micrograms/kg). Both challenges evoked significant elevations in cortisol and adrenocorticotropic hormone (ACTH). Levels of self-esteem were significantly and negatively associated with peak elevations in cortisol in response to the driving simulation challenge (r = -0.51, p = 0.04). ACTH responses showed similar trends (r = -0.41, p = 0.12). Self-esteem levels were not correlated with responses to the CRH challenge. These data indicate that psychological characteristics such as self-esteem may play a role in modulating patterns of neuroendocrine response to cognitive/behavioral challenges in everyday life in older individuals.

Activities of Daily Living↗
PubMed1995

Behavioral and psychosocial predictors of physical performance: MacArthur studies of successful aging.

BACKGROUND: Performance-based measures of physical performance are examined for an older cohort of relatively high-functioning men and women. The influences of baseline behavioral, social, and psychological characteristics on patterns of change in performance over 2.5 years are examined. METHODS: A cohort of relatively high-functioning men and women, aged 70-79, identified in 1988 by subsampling from three community-based studies on the basis of physical and cognitive function. Baseline assessments included physical performance, sociodemographic characteristics, health status, and behavioral, social, and psychological characteristics. A summary measure of physical performance was developed from tests of balance, gait, lower body strength and coordination, and manual dexterity. In-home assessments were repeated at follow-up in 1991. RESULTS: Linear regression models were used to identify significant behavioral, social, and psychological predictors of better performance at follow-up, controlling for known sociodemographic and health status predictors. Significant, independent associations with better performance were found for participation in moderate and/or strenuous exercise activity and greater frequency of emotional support from social networks, particularly among those reporting low frequency of instrumental support. These effects remained significant independent of incident health conditions during follow-up. None of the psychological characteristics was a significant predictor. CONCLUSIONS: Maintenance of better physical performance within a high-functioning cohort is influenced by prior exercise behavior and social network emotional support. Observed patterns of both decline and improvement in performance suggest that older age is not uniformly associated with declines. Predictors of better performance identified here may offer potential for effective interventions to promote more successful aging.

Aged↗
PubMed1995

Interrelationships of peak expiratory flow rate with physical and cognitive function in the elderly: MacArthur Foundation studies of aging.

BACKGROUND: Peak expiratory flow rate (PEFR) is correlated with several measures of health in the elderly, including physical and cognitive function. It is unclear, however, whether these relationships persist among the non-frail. METHODS: The Community-based Studies of the MacArthur Foundation Research Network on Successful Aging included measures of PEFR using a mini-Wright peak flow meter on a sample of 1,354 subjects selected from those aged 70-79 in three population samples. Subjects were chosen on the basis of simple measures of physical and cognitive function (high = 1192; medium = 80; low = 82), and were given a series of more detailed tests. RESULTS: Residual PEFR, adjusted for age, sex, height, weight, and smoking, was highly correlated (p < .001) with several physical performance measures, including number of steps in a tandem walk, number of seconds in a single leg stand, times to turn in a circle, write one's name, and walk 10 feet at a fast pace, foot-tapping (time per tap), and hand grip strength. The strongest association was evident for a combination of six physical function items. Residual PEFR was also correlated with cognitive performance, including tests of similarities, naming, spatial recognition, memory, and figure drawing. The strongest association was present for a combined measure. These associations persisted in analyses restricted to those in the "high" function group as well as with no history of previous myocardial infarction, stroke, or cancer. Residual PEFR also exhibited a strong independent association with urinary norepinephrine, as measured in 12-hour overnight urine specimens. This relation did not appear to be mediated by smoking or medication use.

Aged↗
PubMed1995

Change in productive activity in late adulthood: MacArthur studies of successful aging.

Both cross-sectional comparisons and patterns of change in productive activities among members of the MacArthur Successful Aging cohort were examined. The data came from a three-site longitudinal study of community-dwelling adults aged 70-79. The highest functioning cohort (n = 1,192) was found to be significantly more productive than a comparison group of medium- and low-functioning respondents at baseline in four of five domains examined. In longitudinal models, we tested several hypotheses regarding the determinants of change in levels of productive activity over a three-year period. Overall, 15.1 percent (n = 162) of the cohort became less productive, while another 12.7 percent (n = 136) became more productive. Risk factors for decline in productivity included hospital admission and stroke. Age, functional disability, marriage, and increased mastery were protective against declines. Conversely, Blacks, those who were more satisfied with life at baseline, and those reporting increased mastery were more likely to increase their productivity.

Activities of Daily Living↗
PubMed1995

Functional disability among elderly blacks and whites in two diverse areas: the New Haven and North Carolina EPESE. Established Populations for the Epidemiologic Studies of the Elderly.

This study examines the prevalence of functional disability (limitation in at least one basic activity of daily living) among elderly Black and White community residents in the New Haven (n = 2812) and North Carolina (n = 4162) sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). In New Haven, elderly Blacks, particularly women below age 75, had a higher prevalence of disability compared with Whites, which was partially attributable to a higher prevalence of chronic conditions. In North Carolina, Blacks had only a slightly higher risk of being disabled than Whites, and this was fully accounted for by differences in socioeconomic status. Black-White differences in the prevalence of functional disability reveal geographic variation.

Activities of Daily Living↗
PubMed1994

Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years.

OBJECTIVES: To determine whether elevated serum cholesterol level is associated with all-cause mortality, mortality from coronary heart disease, or hospitalization for acute myocardial infarction and unstable angina in persons older than 70 years. Also, to evaluate the association between low levels of high-density lipoprotein cholesterol (HDL-C) and elevated ratio of serum cholesterol to HDL-C with these outcomes. DESIGN: Prospective, community-based cohort study with yearly interviews. PARTICIPANTS: A total of 997 subjects who were interviewed in 1988 as part of the New Haven, Conn, cohort of the Established Population for the Epidemiologic Study of the Elderly (EPESE) and consented to have blood drawn. MAIN OUTCOME MEASURES: The risk factor-adjusted odds ratios of the 4-year incidence of all-cause mortality, mortality from coronary heart disease, and hospitalization for myocardial infarction or unstable angina were calculated for the following: subjects with total serum cholesterol levels greater than or equal to 6.20 mmol/L (> or = 240 mg/dL) compared with subjects with cholesterol levels less than 5.20 mmol/L (< 200 mg/dL); subjects in the lowest tertile of HDL-C level compared with those in the highest tertile; and subjects in the highest tertile of the ratio of total serum cholesterol to HDL-C level compared with those in the lowest tertile. RESULTS: Elevated total serum cholesterol level, low HDL-C, and high total serum cholesterol to HDL-C ratio were not associated with a significantly higher rate of all-cause mortality, coronary heart disease mortality, or hospitalization for myocardial infarction or unstable angina after adjustment for cardiovascular risk factors. The risk factor-adjusted odds ratio for all-cause mortality was 0.99 (95% confidence interval [CI], 0.56 to 2.69) for the group who had cholesterol levels greater than or equal to 6.20 mmol/L (> or = 240 mg/dL) compared with the group that had levels less than 5.20 mmol/L (< 200 mg/dL); 1.00 (95% CI, 0.59 to 1.70) for the group in the lowest tertile of HDL-C compared with those in the highest tertile; and 1.03 (95% CK, 0.62 to 1.71) for subjects in the highest tertile of the ratio of total serum cholesterol to HDL-C compared with those in the lowest tertile. CONCLUSIONS: Our findings do not support the hypothesis that hypercholesterolemia or low HDL-C are important risk factors for all-cause mortality, coronary heart disease mortality, or hospitalization for myocardial infarction or unstable angina in this cohort of persons older than 70 years.

Aged↗
PubMed1994

Genetic susceptibility to death from coronary heart disease in a study of twins.

BACKGROUND: A family history of premature coronary heart disease has long been thought to be a risk factor for coronary heart disease. Using data from 26 years of follow-up of 21,004 Swedish twins born between 1886 and 1925, we investigated this issue further by assessing the risk of death from coronary heart disease in pairs of monozygotic and dizygotic twins. METHODS: The study population consisted of 3298 monozygotic and 5964 dizygotic male twins and 4012 monozygotic and 7730 dizygotic female twins. The age at which one twin died of coronary heart disease was used as the primary independent variable to predict the risk of death from coronary heart disease in the other twin. Information about other risk factors was obtained from questionnaires administered in 1961 and 1963. Actuarial life-table analysis was used to estimate the cumulative probability of death from coronary heart disease. Relative-hazard estimates were obtained from a multivariate survival analysis. RESULTS: Among the men, the relative hazard of death from coronary heart disease when one's twin died of coronary heart disease before the age of 55 years, as compared with the hazard when one's twin did not die before 55, was 8.1 (95 percent confidence interval, 2.7 to 24.5) for monozygotic twins and 3.8 (1.4 to 10.5) for dizygotic twins. Among the women, when one's twin died of coronary heart disease before the age of 65 years, the relative hazard was 15.0 (95 percent confidence interval, 7.1 to 31.9) for monozygotic twins and 2.6 (1.0 to 7.1) for dizygotic twins. Among both the men and the women, whether monozygotic or dizygotic twins, the magnitude of the relative hazard decreased as the age at which one's twin died of coronary heart disease increased. The ratio of the relative-hazard estimate for the monozygotic twins to the estimate for the dizygotic twins approached 1 with increasing age. These relative hazards were little influenced by other risk factors for coronary heart disease. CONCLUSIONS: Our findings suggest that at younger ages, death from coronary heart disease is influenced by genetic factors in both women and men. The results also imply that the genetic effect decreases at older ages.

Adult↗
PubMed1994

Validation and use of performance measures of functioning in a non-disabled older population: MacArthur studies of successful aging.

Assessment of physical functioning in older persons has generally focused on identifying and characterizing subjects at the disabled end of the functional spectrum. This paper examines the validity of objective, standardized performance measures of physical functioning in characterizing the hierarchy of functioning in non-disabled, higher functioning older persons. Data are from 1192 participants aged 70-79 years in The MacArthur Research Network on Successful Aging Field Study. Participants were drawn from three community-based populations and represented the upper tertile of functioning, based on cognitive and physical screening assessments. The cohort showed a great deal of heterogeneity on most of the performance measures of functioning that were used. Several analyses provided evidence that this variability was not random and that the performance measures were valid measures of functioning in this cohort: 1) individual performance measures showed a moderate degree of correlation with each other; 2) a summary measure of performance showed an association with chronic diseases and other factors known to be associated with health status; and 3) a larger group than expected by chance alone was found to be functioning at the very highest level.

Age Distribution↗
PubMed1994

Social support and physical disability in older people after hospitalization: a prospective study.

This prospective study examines the effects of social support on physical disability in older people. Hospital monitoring identified longitudinal study participants who were admitted for hip fracture (n = 84), stroke (n = 79), or myocardial infarction (n = 106). Interviews before the illness and at 6 weeks and 6 months after admission assessed social support and physical disability; medical records indicated illness severity and comorbidity. The number of emotional support providers and the adequacy of task support were higher after hospitalization. Medical factors and premorbid emotional support predicted disability at 6 weeks; not needing support was associated with less disability than needing and receiving adequate support. Task support adequacy at 6 weeks predicted less disability at 6 months. The results reveal a dynamic relationship between social support and recovery.

Activities of Daily Living↗
PubMed1994

Plasma homovanillic acid and performance on motor and cognitive tasks in community-dwelling elderly: MacArthur studies of successful aging.

To investigate the dopaminergic correlates of the aging-related motor and cognitive deficits, the dopamine metabolite homovanillic acid (HVA) in plasma was studied in a community-dwelling elderly cohort (n = 141). The results showed that hand-signature time (HST), a measure of bradykinesia, correlated negatively with plasma HVA (r = -0.24, p < .007). Similarities task performance showed a trend-level positive correlation with plasma HVA (r = 0.15, p = .08). Because plasma HVA is derived from several sources including central dopaminergic neurons and both central and peripheral noradrenergic neurons, the noradrenergic metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) in plasma was also measured to indirectly estimate the relationships, with HVA originating from noradrenergic metabolism. Plasma MHPG significantly correlated with similarities scores (r = 0.34, p < .001) but not with HST. The results suggested that the association of HVA with prolonged HST may be related to central dopamine metabolism, but its association with similarities scores may be due to noradrenergic metabolism. The results raise the possibility that prolonged HST may be an indicator of preclinical brain dopamine loss in the elderly.

Aged↗
PubMed1994

A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.

BACKGROUND: A short battery of physical performance tests was used to assess lower extremity function in more than 5,000 persons age 71 years and older in three communities. METHODS: Balance, gait, strength, and endurance were evaluated by examining ability to stand with the feet together in the side-by-side, semi-tandem, and tandem positions, time to walk 8 feet, and time to rise from a chair and return to the seated position 5 times. RESULTS: A wide distribution of performance was observed for each test. Each test and a summary performance scale, created by summing categorical rankings of performance on each test, were strongly associated with self-report of disability. Both self-report items and performance tests were independent predictors of short-term mortality and nursing home admission in multivariate analyses. However, evidence is presented that the performance tests provide information not available from self-report items. Of particular importance is the finding that in those at the high end of the functional spectrum, who reported almost no disability, the performance test scores distinguished a gradient of risk for mortality and nursing home admission. Additionally, within subgroups with identical self-report profiles, there were systematic differences in physical performance related to age and sex. CONCLUSION: This study provides evidence that performance measures can validly characterize older persons across a broad spectrum of lower extremity function. Performance and self-report measures may complement each other in providing useful information about functional status.

Activities of Daily Living↗