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Stefano Volpato

Publications and source records attributed to Stefano Volpato.

At least 37 records · Page 2Linked to original sources
PubMed2005

[Alcohol consumption and circulating markers of inflammation].

Atherosclerosis, the leading cause of death in western countries, is a multifactiorial condition in which a local and low-grade inflammatory response plays an important role. Elevation in markers of inflammation prospectively defines risk of atherosclerotic complications and predicts all-cause mortality. Alcohol consumption has been related with all-cause mortality and cardiovascular risk with a J-shaped relationship, suggesting that alcohol consumption might have an antiinflammatory effect. This review assesses the current state of knowledge regarding the immunomodulatory effect of moderate alcohol consumption.

Alcohol Drinking↗
PubMed2004

Prescription of antithrombotic therapy in older patients hospitalized for transient ischemic attack and ischemic stroke: the GIFA study.

BACKGROUND AND PURPOSE: Antithrombotic therapy has been demonstrated as an effective tool for secondary ischemic stroke prevention. Nevertheless, scant data are available on actual prescription of this therapy in clinical practice. METHODS: A total of 17 337 patients admitted to geriatric and internal medicine wards participating in the study in the 1993 to 1998 survey period were analyzed. Patients with coded diagnoses of ischemic stroke and transient ischemic attack (TIA) were selected. Data recorded included demographic and clinical characteristics and medication prescription during hospital stay and at discharge. Logistic regression analyses were used to identify conditions associated with the prescription of antiplatelet or anticoagulant drugs. RESULTS: Among 946 patients with diagnosis of stroke or TIA (mean age 78 years), >40% was discharged without antithrombotic prescription. Conditions that made the prescription more unlikely were diagnosis of stroke (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.44 to 0.86), presence of anemia (OR: 0.70; 95% CI: 0.49 to 0.98), severe disability (OR: 0.48; 95% CI: 0.30 to 0.75), and cognitive impairment (OR: 0.58; 95% CI: 0.43 to 0.75). There was an independent and additive association of physical and cognitive status with antithrombotic therapy prescription. CONCLUSIONS: A high rate of patients affected by stroke or TIA are discharged from the hospital without antithrombotic therapy. The most important correlates of the likelihood of not receiving an antithrombotic medication were cognitive and functional status.

Acute Disease↗
PubMed2004

Relationship of alcohol intake with inflammatory markers and plasminogen activator inhibitor-1 in well-functioning older adults: the Health, Aging, and Body Composition study.

BACKGROUND: Increased levels of acute-phase reactants predict the onset of poor health outcomes. A U-shaped association has been reported between alcohol intake and health outcomes, which suggests that alcohol intake may modify levels of acute-phase reactants. We investigated the relationship between weekly alcohol intake and interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), and plasminogen activator inhibitor-1 (PAI-1). METHODS AND RESULTS: Data are from year 1 of the Health, Aging, and Body Composition study, a biracial cohort of 3075 well-functioning men and women aged 70 to 79 years, living in Memphis, Tenn, and Pittsburgh, Pa. The analysis included 2574 persons (51.2% women; 40.1% black) with complete data. After adjustment for age, race, smoking status, history of diabetes, history of cardiovascular disease, physical activity, high-density lipoprotein cholesterol, antiinflammatory medications, statins, and total fat mass, alcohol intake showed a J-shaped relationship with mean IL-6 (P for quadratic term <0.001) and CRP (P=0.014) levels. The association was consistent in both men and women. Compared with subjects who consumed 1 to 7 drinks per week, those who never drank had an increased likelihood of having high levels of both IL-6 and CRP, as did those who drank 8 or more drinks per week. We found no relationship between alcohol intake and levels of TNF-alpha and PAI-1 (P=0.137 and 0.08, respectively). CONCLUSIONS: In well-functioning older persons, light alcohol consumption is associated with lower levels of IL-6 and CRP. These results might suggest an additional biological explanation to the epidemiological link between moderate alcohol consumption and cardiovascular events.

Aged↗
PubMed2004

Patterns of disability related to diabetes mellitus in older women.

PURPOSE: To identify pattern(s) of disability related to diabetes in older women and to determine the extent to which disability is mediated by selected diabetes complications. METHODS: Cross-sectional analysis of data from a population-based study composed of a representative sample of 3570 noninstitutionalized women aged 65 years and older living in the Baltimore metropolitan area who agreed to be screened for the Women's Health and Aging Study. RESULTS: 483 (13.5%) of the women reported physician-diagnosed diabetes. Compared to women without diabetes, women with diabetes were significantly more likely to report difficulty in 14 of 15 daily tasks, including walking 2-3 blocks, lifting 10 pounds, using the telephone, and bathing (range of odds ratios [OR] 1.5-2.8; all p <.01). After adjustment for age, race, and marital status, women with diabetes were about twice as likely to report difficulty in any one of four functioning groups (mobility, upper extremity, higher functioning tasks, or self-care) (OR 2.2; 95% confidence interval [CI] 1.8-2.7), and over three times as likely to report difficulty in a group combining higher functioning and self-care tasks (OR 3.2; 95% CI 2.4-4.1). Adjustment for self-reported heart disease, stroke, high blood pressure, and visual problems did not attenuate these associations. CONCLUSIONS: Diabetes is strongly associated with a wide range of disabilities in older women. This association does not appear to be mediated by prevalent diabetes complications and risks, heart disease, high blood pressure, stroke, or eye disease. Other complications of diabetes (e.g., neuropathy, peripheral vascular disease) may mediate diabetes-associated disability in older adults.

Activities of Daily Living↗
PubMed2004

Low cholesterol levels are associated with short-term mortality in older patients with ischemic stroke.

BACKGROUND: The possible relationship between serum total cholesterol (TC) levels and outcome following ischemic stroke is still controversial. We evaluated the association between TC levels and 30-day mortality in a sample of older patients with acute ischemic stroke. METHODS: We enrolled 490 older patients with severe ischemic stroke consecutively admitted to University Hospital's Internal Medicine or Geriatrics Department. Stroke type was classified according to the Oxfordshire Community Stroke Project. The data recorded included clinical features, medical history, electrocardiogram, and blood analyses. Patients were divided into three groups by TC levels: group I (TC<4.1 mmol/L), group II (TC 4.1-5.2 mmol/L), and group III (TC>5.2 mmol/L). RESULTS: The overall mortality was 27.7%. Mortality was higher in patients with low TC levels (47.4%) compared with those with normal and high TC levels (23.0% and 24.1%, respectively). The odds ratio (OR) for short-term death was 2.17 (95% confidence interval [CI] 1.22-3.85) in group I compared with group III, after adjustment for age and gender. This result did not change after adjustment for possible confounders (OR 2.87; 95% CI 1.23-6.68). A similar trend was observed after adjustment for the Oxfordshire classification, age, and gender (OR 1.67; 95% CI 0.83-3.33). CONCLUSIONS: Short-term mortality following ischemic stroke is higher in older participants with low TC levels, independent of a large number of factors. Low TC levels might be useful in identifying frail older participants at high risk of stroke short-term mortality.

Aged↗
PubMed2004

Effect of DHEAS on skeletal muscle over the life span: the InCHIANTI study.

BACKGROUND: It has been suggested that the reduced production of dehydroepiandrosterone sulfate (DHEAS) may be partially responsible for the decline of muscle strength and mass that often occurs with aging. However, this hypothesis has been only tested in small series of normal volunteers, with little consideration for potential confounders. Using data from a representative sample of 558 men (20-95 years) we tested the hypothesis that circulating DHEAS is independently associated with muscle strength and mass. METHODS: Data are from InCHIANTI, an epidemiological study conducted in the Chianti geographic area (Tuscany, Italy). DHEAS serum levels were related to lower extremity muscle strength assessed by hand-held dynamometry and calf muscle area estimated from quantitative computerized tomography. Confounders included age, anthropometrics, physical activity, smoking, energy and alcohol intake, albumin, lipids, interleukin-6, comorbidity, depressive symptoms, and disability in activities of daily living. RESULTS: In fully adjusted models predicting lower extremity muscle strength and calf muscle area, we found significant age*log DHEAS interactions, suggesting that the relationship between DHEAS levels and muscle parameters differs across the life span. In age-stratified models adjusted for confounders, serum DHEAS was an independent predictor of muscle strength (p <.02) and mass (p <.01), but only for men between 60 and 79 years of age. After adjusting these models for serum-free or bioavailable testosterone, results were unchanged. CONCLUSIONS: In men aged 60-79 years, circulating DHEAS is an independent correlate of muscle strength and calf muscle area. The possible causal role of declining DHEAS in age-related sarcopenia should be further explored in longitudinal studies.

Adult↗
PubMed2004

Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents.

OBJECTIVES: To investigate the relationship between body composition (assessed using body mass index (BMI) and body cell mass (BCM)) and all-cause mortality in a sample of older nursing home residents. DESIGN: Prospective study with a median follow-up period of 3.5 years. SETTING: Istituto di Riposo per Anziani, Padua, Italy. PARTICIPANTS: A total of 344 participants (79.1% women) aged 65 and older at baseline. MEASUREMENTS: Anthropometric, nutritional, and metabolic parameters were measured at baseline. BCM was measured using tetrapolar bioelectric impedance analysis. Up to 4 years of follow-up data for vital status were available. Survival analysis was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models. RESULTS: During the follow-up period, there were 179 deaths. After adjustment for age and sex, subjects with low BMI and low BCM (lowest sex-specific tertiles) had significantly higher mortality than those with higher BMI or BCM levels. In a fully adjusted regression model, there was no association between BMI levels and risk of mortality, with subjects in the top tertile having the same likelihood of mortality as subjects in the lowest tertile (relative risk (RR)=0.94, 95% confidence interval (CI)=0.61-1.43). Conversely, there was a strong and significant inverse association between BCM levels and mortality (RR for tertile III=0.55, 95% CI=0.35-0.87; P<.01). Furthermore, participants who had high BCM had comparable survival rates in all BMI tertiles. CONCLUSION: In this sample of older nursing home residents, BCM was a strong and independent risk factor for mortality. BCM assessment might provide more useful prognostic information for clinicians than BMI.

Aged↗
PubMed2004

What constitutes normal hemoglobin concentration in community-dwelling disabled older women?

OBJECTIVES: To examine the associations between hemoglobin (Hb) concentration and (1) 5-year all-cause mortality and (2) serum erythropoietin (EPO), as the basis for the identification of data-driven thresholds, and to assess the clinical relevance of mildly low Hb. DESIGN: Prospective study. SETTING: Population based. PARTICIPANTS: Community-dwelling women aged 65 and older with moderate-to-severe disability--Women's Health and Aging Study I, Baltimore, Maryland, 1992-2000. METHODS: Proportional hazards regression was used to model the relationship between baseline Hb (available for 686 subjects) and time to death. A generalized linear model was used to assess the cross-sectional association between Hb and EPO in 641 subjects. RESULTS: A curvilinear slope of steady mortality decrease up to the Hb threshold of 13.9 g/dL was observed. Hb of 11 g/dL was independently associated with greater mortality than the World Health Organization (WHO) low-normal cutoff of Hb of 12 g/dL (hazard ratio (HR)=1.2, 95% confidence interval (CI)=1.1-1.4), whereas Hb of 14 g/dL was linked to 24% lower mortality (HR=0.76, 95% CI=0.63-0.92), after comprehensive adjustment for major health status and disease-burden indicators. A curvilinear, statistically significant slope of steady EPO decrease with increasing Hb up to the threshold of 14.3 g/dL was consistently observed. CONCLUSION: The meaningfully lower mortality risk with higher Hb levels provides empirical evidence against the notion that Hb currently perceived as mildly low is clinically benign. Furthermore, the mortality risk gradient observed even within the WHO normal Hb range suggests that Hb levels higher than what is currently recommended might offer clinical advantage. The relationship between Hb and EPO provided supporting physiological evidence for this hypothesis.

Aged↗
PubMed2004

Incidence of loss of ability to walk 400 meters in a functionally limited older population.

OBJECTIVES: To assess the incidence of and factors related to nondisabled but functionally limited older adults aged 75 to 85 years losing the ability to walk 400 m. DESIGN: Observational study with average follow-up of 21 months. SETTING: Community. PARTICIPANTS: At baseline, 101 persons with objective signs of functional limitations and intact cognitive function agreed to participate in the study. Of these, 81 were able to walk 400 m at baseline, and 62 participated in the follow-up examination. MEASUREMENTS: Mobility disability was defined as an inability to complete a 400-m walk test. At baseline, eligible participants (n=81) had the ability to walk 400 m, scored between 4 and 9 on the Short Physical Performance Battery (SPPB; range 0-12), and scored 18 or more on the Mini-Mental State Examination. Demographics, difficulty in daily activities, disease status, behavioral risk factors, and muscle strength were assessed at baseline and follow-up. RESULTS: Of 62 persons at follow-up, 21 (33.9%) developed incident mobility disability. The strongest predictors of loss of mobility were the time to complete the 400-m walk at baseline (odds ratio (OR)=1.6 per 1-minute difference, 95% confidence interval (CI)=1.04-2.45), and decline in SPPB score over the follow-up (OR=1.4 per 1-point difference, 95% CI=1.01-1.92). CONCLUSION: Older persons with functional limitations have a high rate of loss of ability to walk 400 m. The 400-m walk test is a highly relevant, discrete outcome that is an ideal target for testing preventive interventions in vulnerable older populations.

Activities of Daily Living↗
PubMed2004

Prescription of anti-oedema agents and short-term mortality in older patients with acute ischaemic stroke.

BACKGROUND AND OBJECTIVE: In Western countries, stroke is the third most common cause of death and one of the main causes of disability in individuals aged over 65 years. Mortality at 1 month after stroke is still high, at around 25-30%. Despite the widespread use of anti-oedema agents in clinical practice, there are only a few studies that have investigated the effect of these drugs on stroke outcome. In this study we evaluated the effect of intravenously administered glycerol or mannitol individually and in combination with corticosteroids, on short-term mortality (30 days). The sample included patients aged over 65 years who were admitted to hospital for acute ischaemic stroke. STUDY DESIGN: This was a retrospective cohort study. The odds ratio, estimated by means of multivariate logistic regression method, was used to compare short-term mortality risk across treatment groups after adjusting for possible confounders. METHODS: This study included 442 consecutive patients aged over 65 years with severe ischaemic stroke who were admitted to either the University School of Internal Medicine (Ferrara) or the Geriatric Department (Perugia), Italy, over a 4-year period (1996-2000). All patients underwent a computed tomography (CT) scan of the brain within 72 hours of admission. Stroke type was classified according to the system used by the Oxfordshire Community Stroke Project. The data recorded included: (i) clinical features of stroke; (ii) detailed medical history, including vascular risk factors (arterial hypertension, diabetes mellitus, atrial fibrillation, coronary heart disease, congestive heart failure, alcohol abuse, smoking, previous transient ischaemic attacks or stroke); (iii) 12-lead ECG; and (iv) routine blood analysis and urine tests. RESULTS: No reduction in short-term mortality risk was observed in patients treated with intravenous (IV) glycerol. However, an increase in short-term mortality risk was observed in the patients who were concurrently treated with IV corticosteroids. Similarly, treatment with mannitol did not reduce the risk of short-term mortality; however, concurrent treatment with IV corticosteroids did not show a significant rise in short-term mortality risk. When treatment with IV glycerol and mannitol was considered together, the treatment did not decrease short-term mortality risk, while concurrent therapy with corticosteroids was associated with an increase in short-term mortality risk. CONCLUSION: This study does not support the use of IV osmotic agents such as glycerol or mannitol in the prevention of short-term mortality in older patients with acute ischaemic stroke. Furthermore, our data suggest a possible harmful effect of IV corticosteroids on short-term mortality risk.

Aged↗
PubMed2003

Serum IL-1beta levels in health and disease: a population-based study. 'The InCHIANTI study'.

Interleukin-1 plays a role in normal homeostasis and in the inflammatory response which is deemed to be responsible for the development of major chronic diseases that are highly prevalent in the elderly. Aim of this study is to evaluate the factors influencing the serum levels of Interleukin-1 beta, in a large and representative population. Data were from the InCHIANTI project, a study of factors contributing to the decline of mobility in late life, which sampled people living in two sites in the surroundings of Florence. Blood samples were obtained from 1,292 participants and frozen aliquots were stored at -80 degrees C. The serum levels of several cytokines were measured by enzyme linked immunosorbent assay using an ultrasensitive commercial kit. Interleukin-1 beta serum levels were associated with congestive heart failure (p > 0.001) and angina (p = 0.02), with Ca2+ serum levels (p = 0.02), and with a history of dyslipidemia (p = 0.05). We found no association between serum IL-1beta level and age, sex, consumption of cardioactive drugs and serum levels of IL-1Ra, IL-6, sIL-6R, IL-10 and TNF-alpha. Our data could lend support to the hypothesis that IL-1beta is mainly involved in the functional alterations of cardiomyocytes under conditions marked by mononuclear cell infiltration and by downregulation of calcium.

Aging↗
PubMed2003

Serum cholesterol levels and in-hospital mortality in the elderly.

PURPOSE: Although total cholesterol levels among middle-aged persons correlate with long-term mortality from all causes, this association remains controversial in older persons. We explored whether total cholesterol levels were independently associated with in-hospital mortality among elderly patients. METHODS: We analyzed data from a large collaborative observational study, the Italian Group of Pharmacoepidemiology in the Elderly (GIFA), which collected data on hospitalized patients. A total of 6984 patients aged 65 years or older who had been admitted to 81 participating medical centers during four survey periods (from 1993 to 1998) were enrolled. Patients were divided into four groups based on total cholesterol levels at hospital admission: <160 mg/dL (n = 2115), 160 to 199 mg/dL (n = 2210), 200 to 239 mg/dL (n = 1719), and >or=240 mg/dL (n = 940). RESULTS: Patients (mean [+/- SD] age, 78 +/- 7 years) were hospitalized for an average of 15 +/- 10 days. The mean total cholesterol level was 186 +/- 49 mg/dL. A total of 202 patients died during hospitalization. Mortality was inversely related to cholesterol levels (<160 mg/dL: 5.2% [110/2115]; 160-199 mg/dL: 2.2% [49/2210]; 200-239 mg/dL: 1.6% [27/1719]; and >or=240 mg/dL: 1.7% [16/940]; P for linear trend <0.001). After adjustment for potential confounders (demographic characteristics, smoking, alcohol use, indicators of nutritional status, markers of frailty, and comorbid conditions), low cholesterol levels continued to be associated with in-hospital mortality. Compared with patients who had cholesterol levels <160 mg/dL, the odds ratios for in-hospital mortality were 0.49 (95% confidence interval [CI]: 0.34 to 0.70) for participants with cholesterol levels of 160 to 199 mg/dL, 0.41 (95% CI: 0.26 to 0.65) for those with cholesterol levels of 200 to 239 mg/dL, and 0.56 (95% CI: 0.32 to 0.98) for those with cholesterol levels >or=240 mg/dL. These estimates were similar after further adjustment for inflammatory markers and after excluding patients with liver disease. CONCLUSIONS: Among older hospitalized adults, low serum cholesterol levels appear to be an independent predictor of short-term mortality.

Age Factors↗
PubMed2003

Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism.

OBJECTIVES: To examine the association between muscle strength and total and cause-specific mortality and the plausible contributing factors to this association, such as presence of diseases commonly underlying mortality, inflammation, nutritional deficiency, physical inactivity, smoking, and depression. DESIGN: Prospective population-based cohort study with mortality surveillance over 5 years. SETTING: Elderly women residing in the eastern half of Baltimore, Maryland, and part of Baltimore County. PARTICIPANTS: Nine hundred nineteen moderately to severely disabled women aged 65 to 101 who participated in handgrip strength testing at baseline as part of the Women's Health and Aging Study. MEASUREMENTS: Cardiovascular disease (CVD), cancer, respiratory disease, other measures (not CVD, respiratory, or cancer), total mortality, handgrip strength, and interleukin-6. RESULTS: Over the 5-year follow-up, 336 deaths occurred: 149 due to CVD, 59 due to cancer, 38 due to respiratory disease, and 90 due to other diseases. The unadjusted relative risk (RR) of CVD mortality was 3.21 (95% confidence interval (CI) = 2.00-5.14) in the lowest and 1.88 (95% CI = 1.11-3.21) in the middle compared with the highest tertile of handgrip strength. The unadjusted RR of respiratory mortality was 2.38 (95% CI = 1.09-5.20) and other mortality 2.59 (95% CI = 1.59-4.20) in the lowest versus the highest grip-strength tertile. Cancer mortality was not associated with grip strength. After adjusting for age, race, body height, and weight, the RR of CVD mortality decreased to 2.17 (95% CI = 1.26-3.73) in the lowest and 1.56 (95% CI = 0.89-2.71) in the middle, with the highest grip-strength tertile as the reference. Further adjustments for multiple diseases, physical inactivity, smoking, interleukin-6, C-reactive protein, serum albumin, unintentional weight loss, and depressive symptoms did not materially change the risk estimates. Similar results were observed for all-cause mortality. CONCLUSION: In older disabled women, handgrip strength was a powerful predictor of cause-specific and total mortality. Presence of chronic diseases commonly underlying death or the mechanisms behind decline in muscle strength in chronic disease, such as inflammation, poor nutritional status, disuse, and depression, all of which are independent predictors of mortality, did not explain the association. Handgrip strength, an indicator of overall muscle strength, may predict mortality through mechanisms other than those leading from disease to muscle impairment. Grip strength tests may help identify patients at increased risk of deterioration of health.

Aged↗
PubMed2003

Lower extremity physical performance and hip bone mineral density in elderly black and white men and women: cross-sectional associations in the Health ABC Study.

BACKGROUND: Aging is characterized by declines in physical capacity and bone mineral density (BMD), both of which contribute to increased risk for fracture. However, it is unclear if these factors coexist or are independent in elderly people, and if a relationship does exist, whether it varies by sex and/or race. METHODS: Data are from 847 white women, 723 black women, 927 white men, and 544 black men aged 70-79 years participating in the Health Aging and Body Composition (ABC) Study, a cohort of well-functioning community-dwelling elders. BMD (g/cm(2)) of the hip (femoral neck and trochanter) was determined by dual X-ray absorptiometry. Physical capacity measures included knee extensor strength, repeated chair-stands, gait speed (6 m), walking endurance (400 m), and standing balance. RESULTS: In analyses of BMD as a continuous measure, BMD and physical performance were most consistently related at the trochanter in black women, even after adjusting for body size and several covariates including physical activity. For each performance measure, black women in the bottom quartile(s) had lower BMD than those in the top quartile(s). For the femoral neck, there was a significant association with performance tasks, except for the 400-m walk. In comparison, only chair-rise performance was related to BMD at the femoral neck, and knee extensor strength, chair-rise performance, and balance with the trochanter in white women. For white and black men, trends existed only for lower BMD in those with poorer knee extensor strength. CONCLUSIONS: In this cohort of well-functioning young-old seniors, physical capacity is only modestly related to BMD at the hip. The association was strongest in black women, who as a group exhibited the poorest functional capacity in the cohort. Our data show that, although both poorer physical performance and low BMD are risk factors for fracture, they remain largely independent in the well-functioning young-old, except in black women. This independence suggests that interventions to reduce fracture incidence should be targeted at improving both physical performance and bone density.

Absorptiometry, Photon↗
PubMed2003

Insulin-like growth factor I and interleukin-6 contribute synergistically to disability and mortality in older women.

The physiology of age-related functional decline is poorly understood, but may involve hormones and inflammation. We hypothesized that older women with both low IGF-I and high IL-6 levels are at high risk for disability and death. We assessed walking speed and disability in 718 women enrolled in the Women's Health and Aging Study I, a 3-yr cohort study with 5-yr mortality follow-up. Women with IGF-I levels in the lowest quartile and IL-6 levels in the highest quartile had significantly greater limitation in walking and disability in mobility tasks and instrumental activities of daily living than those with neither risk factor (adjusted odds ratios, 10.77, 5.14, and 3.66). Women with both risk factors were at greater risk for death (adjusted relative risk, 2.10) as well as incident walking limitation, mobility disability, and disability in activities of daily living compared with those with high IGF-I and low IL-6 levels. The combination of low IGF-I and high IL-6 levels confers a high risk for progressive disability and death in older women, suggesting an aggregate effect of dysregulation in endocrine and immune systems. The joint effects of IGF-I and IL-6 may be important targets for treatments to prevent or minimize disability associated with aging.

Activities of Daily Living↗
PubMed2003

Progression of lower-extremity disability in older women with diabetes: the Women's Health and Aging Study.

OBJECTIVE: Older patients with diabetes are more likely to have a higher prevalence of multiple risk factors for physical disability, as a result of diabetic complications. We evaluated the pace of decline in lower-extremity function and the risk for progression of disability in older women with diabetes. RESEARCH DESIGN AND METHODS: We conducted a 3-year longitudinal cohort study of a random sample of 729 physically impaired older women (age > or =65 years) living in the community (Baltimore, MD). Diabetes was ascertained by standard criteria. Self-reported functional status and objective performance measures were assessed at baseline and over six semiannual follow-up visits. RESULTS: The baseline prevalence of diabetes was 14.4%. After adjustment for age and compared with women without diabetes, those with diabetes had an RR of 1.8 (95% CI 1.3-2.5) for incident mobility disability and 1.6 (1.2-2.1) for incident activity of daily living disability. The increased incidence of new disability associated with diabetes was paralleled by a greater decline in objective measures of lower-extremity function. Adjustment for multiple risk factors for disability did not significantly attenuate the risk for disability associated with diabetes. CONCLUSIONS: In older patients, impaired lower-extremity function is a long-term diabetic complication. Comprehensive assessment of older diabetic patients should include a standardized evaluation of lower-extremity performance.

Activities of Daily Living↗
PubMed2002

Association between thyroid dysfunction and total cholesterol level in an older biracial population: the health, aging and body composition study.

BACKGROUND: Thyroid dysfunction increases with age. Less is known about the prevalence of thyroid disease in older black adults and whether an association between thyroid function and serum cholesterol level exists, as in older white adults. METHODS: A cross-sectional study of 2799 well functioning white and black participants, aged 70 to 79 years, were recruited for a population-based study. Participants underwent thyrotropin, free thyroxine, and total cholesterol testing; a medical history; and physical measurements. RESULTS: Among the entire cohort, 94% were euthyroid based on biochemical testing results. Approximately 10% were taking thyroid hormones. Subclinical hypothyroidism was the most prevalent disorder (3.1% of all participants not taking thyroid hormones), but black men and women had lower rates of this condition than white men and women. After excluding those taking thyroid or lipid medication and adjusting for potential confounders, an elevated thyrotropin level (>5.5 mIU/mL) was associated with a 9 mg/dL (0.23 mmol/L) higher cholesterol level, and a suppressed thyrotropin level (<0.35 mIU/mL) was associated with a 19 mg/dL (0.49 mmol/L) lower cholesterol level. CONCLUSION: Healthy community-dwelling older black adults have a lower prevalence of thyroid dysfunction compared with older white adults, but the association between increased thyrotropin and increased cholesterol levels is similar in both races.

Aged↗