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PubMed2005

Factors associated with time to neonatal diarrhoea in French beef calves.

A prospective study was carried out on 92 randomly selected beef herds in the Midi-Pyrenees region in France. The objective was to determine factors associated with time to neonatal gastroenteritis. By taking into account the "intra-herd" correlation in failure time (in the semiparametric Cox model), we identified 12 management risk factors associated with hazard of diarrhoea. Some previously have been identified, but "new" risk factors were feeding of corn silage and the incidence of diarrhoea in the last season. We used the two main approaches which are often reviewed: marginal and frailty Cox models. Our results show that these two models give different parameter estimates, so the choice of the model remains crucial.

Animal Husbandry↗

PubMed2005

Temporal and spatial analysis of the 1999 outbreak of acute clinical infectious bursal disease in broiler flocks in Denmark.

The objective of this study was to describe the spatial and temporal dynamics of the 1999 outbreak of acute clinical infectious bursal disease (IBD) in broiler chicken farms in Denmark. The analysis was performed using data from all broiler farms located in the Jutland peninsula and the island of Funen (168 municipalities). The Moran's index I, K-functions and scan statistics were used to describe the dynamics of the epidemic. In addition, spatially correlated survival analyses were performed and the posterior frailties were mapped to identify areas with high or low survival times. From January to October 1999, a total of 43 farms (81 flocks) out of a total of 299 farms (2970 flocks) in 110 municipalities were infected with IBD. The outbreak developed more or less simultaneously in two regions, one in the north and the other in the center of the study area. The space-time descriptive methods suggested that the cases were more likely to occur during a short period of time and over relatively short distances, indicating that local factors facilitated the spread of the virus. For instance, the highest risk, as estimated by the K-function, was within 20 km and 20 days. The risk of transmission peaked in July and remained high until the end of the study. The spatially correlated survival analysis identified municipalities with low survival times that roughly corresponded to the clusters found using scan statistics. The analysis for the full hierarchical structure of the dataset identified variation (i.e. clustering) at the farm and municipality levels.

Animals↗

PubMed2006

A prospective study of the effect of Neospora caninum and BVDV infections on bovine abortions in a dairy herd in Arequipa, Peru.

We used a prospective seroepidemiological approach to investigate endemic abortion in a dairy herd in Arequipa, Peru, and its association with Neospora caninum and bovine viral-diarrhoea virus (BVDV) infections. Between January 2002 and March 2004, 1094 pregnancies were confirmed in 538 cows. Of these, 137 pregnancies (13%) in 121 cows ended in abortion. The serological status to N. caninum was assessed using a single serological screening, whereas BVDV status was assessed at the herd level through consecutive samplings of young stock. Cox proportional-hazards models were used to estimate the effect of N. caninum and BVDV on the hazard of early (between day 42 and day 100 in gestation), and late (after day 100) abortions, respectively. Serological status to N. caninum was included as a dichotomous variable, and the effect of BVDV estimated at the herd level, as a time-dependent seasonal effect. Because data from repeated pregnancies were included, we considered possible lack of independence between observations and included frailty effects into the models. Our models also considered the possible confounding by parity and animal origin. Only multiparity was associated with the hazard of early abortion (HR=2.8 compared to nulliparous heifers). N. caninum seropositivity significantly affected the hazard of late abortion, but interacted with parity. The HRs for Neospora-positive animals were 6.4, 3.7 and 1.9, respectively, for nulliparous heifers, first-lactation cows and multiparous cows. Evidence of BVDV circulating (or not) among the young stock was not associated with abortions, but few cows in this herd were susceptible to incident infection.

Abortion, Veterinary↗

PubMed2006

Effect of eprinomectin pour-on treatment around calving on reproduction parameters in adult dairy cows with limited outdoor exposure.

The objective of this study was to investigate if treatment of cows with eprinomectin around calving had any beneficial effects on the calving to first artificial insemination interval, calving to conception interval, and number of services per conception in totally- and semi-confined dairy herds. In totally-confined herds lactating- and dry-cows were housed throughout the summer and had no access to pasture. In semi-confined herds lactating- and dry-cows had limited outdoor exposure to a small pasture or paddock but were still fed a ration that met all their nutritional requirements. The study was carried out between February 2002 and February 2003 in 35 herds (2381 cows) located in Quebec, Ontario and Minnesota (USA) participating in a larger clinical trial. The herds kept electronic reproduction records. Cows were randomly allocated to receive eprinomectin or a placebo, with treatment being administered on or close to the day of calving. Monthly bulk tank milk samples from each farm were tested with an indirect ELISA using a crude Ostertagia ostertagi antigen and these data were averaged over the study year. The optical density ratio (ODR) values were then dichotomized into high and low using a cut-point of 0.50. Treatment effects were analyzed using Cox proportional hazards survival models with herd frailty effects for calving to conception and calving to first service intervals. Aalen's linear hazards model was used to investigate time-varying effects in the Cox models. A random effects poisson regression model was used to model the number of services per conception. Other predictor variables tested in the models were lactation number, calving season, study site, peak milk production, ODR and the lactating- and dry-cow housing variables. Overall, there was no significant effect of treatment on the three indices of reproductive performance. The effect of season of calving depended on how much time had passed since calving. Presumably this effect reflected a seasonal effect at the time of breeding. Hazard of conception in younger cows was higher than in older cows. Early bred cows tended to have a higher number of inseminations per conception than those bred late. The results of the study suggested that eprinomectin treatment at calving was not beneficial to reproduction.

Animal Husbandry↗

PubMedDate not supplied

A conceptual framework for end-of-life care: a reconsideration of factors influencing the integrity of the human person.

In this article, we examine emerging themes in the research and theoretical literature on care at the end of life to develop a conceptual framework to guide further research in this area. The integrity of the human person is the organizing concept, and the spiritual domain is at the core of the psychological, physical, and functional domains. This framework extends beyond previous frameworks for care at the end of life by including the relationship of the health professional and the health care organization to the integrity of the person. Also, outcomes in this framework extend beyond quality of life and comfort to include patient decision-making methods and achievement of life goals. Attention is given to the cultural dimension of personhood in our multicultural society, and the definition of end of life is expanded to include both the acute phase of terminal illness and the frailty of health associated with advanced age.

Activities of Daily Living↗

PubMed2004

High dose rate afterloading intraluminal brachytherapy for advanced inoperable rectal carcinoma.

BACKGROUND AND PURPOSE: High dose rate intraluminal brachytherapy for tumours of the rectal and anal canal which were inoperable either because of the age and frailty of the patient or because of advanced disease has been evaluated. PATIENTS AND METHODS: In a retrospective review of 50 consecutive patients the two main indications for brachytherapy were as part of a radical radiation programme in those unfit for major surgery (26 patients) or as palliation for advanced or metastatic disease (22 patients). Radical treatment was either sole treatment delivering 6 Gy fraction 2 to 3 times weekly up to 36 Gy or as a boost of 12 Gy after 45 Gy in 25 fractions external beam chemoradiation. Palliative treatments were given predominantly as a single dose of 10 Gy. RESULTS: This was predominantly a group of frail elderly patients with a median age of 82 years (range 35-91). Local tumour response was seen in 21/25 assessable patients with 14 complete responses. Median survival for the entire population was 6 months (range 1-54 months); in patients treated with 'radical' intent this was 25 months (range 1.5-54) and in the palliative group 7.2 months (range 1-37). The most common presenting symptom was bleeding per rectum for which a 64% response rate was obtained with 57% complete responses. Mucous discharge responded in 64% with 28% complete responses. The median duration of response was 7 months. CONCLUSION: Intraluminal HDR brachytherapy is an effective local treatment for patients otherwise unfit for radical surgery both as a component of radical treatment, or as a simple single palliative procedure.

Adenocarcinoma↗

PubMed2006

Mexican American elders have similar severities of COPD despite less tobacco exposure than European American elders.

INTRODUCTION: Hispanics are the fastest growing ethnicity of the US population and the largest subset includes those of Mexican origin. Hispanics, including Mexican Americans (MAs), consistently report less tobacco exposure than European Americans (EAs), but limited data are available regarding differences in the clinical characteristics, severity of airflow obstruction, and functional status between MAs and EAs with chronic obstructive pulmonary disease (COPD). METHODS: Participants in a community-based study of aging and frailty among MAs and EAs, San Antonio Longitudinal Study of Aging, underwent spirometry. Participants with spirometry values consistent with COPD by Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria are described here. RESULTS: Thirty-four percent (248/721) of the participants who underwent spirometry had evidence of GOLD Stages 1-4 COPD. Significantly more MAs with COPD reported being never smokers compared to EAs with COPD. Among those with COPD who also smoked, MAs reported significantly less tobacco exposure than EAs (15.7 vs. 32.4 pack-years, respectively), but both groups had surprisingly similar severities of airflow obstruction. Additionally, MAs had worse functional status and perceived health than did EAs. CONCLUSIONS: Despite significantly less exposure to tobacco smoke, MAs with COPD had a similar degree of obstruction to airflow compared with EAs with COPD. Healthcare providers should have a high index of suspicion for COPD in MAs who are exposed to even small amounts of cigarette smoke.

Aged↗

PubMed2006

Determinants of hospital closure in South Korea: use of a hierarchical generalized linear model.

Understanding causes of hospital closure is important if hospitals are to survive and continue to fulfill their missions as the center for health care in their neighborhoods. Knowing which hospitals are most susceptible to closure can be of great use for hospital administrators and others interested in hospital performance. Although prior studies have identified a range of factors associated with increased risk of hospital closure, most are US-based and do not directly relate to health care systems in other countries. We examined determinants of hospital closure in a nationally representative sample: 805 hospitals established in South Korea before 1996 were examined-hospitals established in 1996 or after were excluded. Major organizational changes (survival vs. closure) were followed for all South Korean hospitals from 1996 through 2002. With the use of a hierarchical generalized linear model, a frailty model was used to control correlation among repeated measurements for risk factors for hospital closure. Results showed that ownership and hospital size were significantly associated with hospital closure. Urban hospitals were less likely to close than rural hospitals. However, the urban location of a hospital was not associated with hospital closure after adjustment for the proportion of elderly. Two measures for hospital competition (competitive beds and 1-Hirshman--Herfindalh index) were positively associated with risk of hospital closure before and after adjustment for confounders. In addition, annual 10% change in competitive beds was significantly predictive of hospital closure. In conclusion, yearly trends in hospital competition as well as the level of hospital competition each year affected hospital survival. Future studies need to examine the contribution of internal factors such as management strategies and financial status to hospital closure in South Korea.

Economics, Hospital↗

PubMed2006

Chaperoning steroid hormone action.

Those that efface themselves in the action tend to be forgotten. But molecular chaperones are always there, often serving as equal partners. Because of their intrinsic functional frailty, a large number of signaling molecules have come to depend on molecular chaperones, notably the Hsp90 chaperone machine. This applies to the subset of nuclear receptors that converts steroid hormone signals to transcriptional outputs. Steroid receptors appear to rely on the Hsp90 machine for folding, regulation of the allosteric switch and recycling. This review discusses the complexities of the chaperone machinery and the diversity of regulatory options afforded by this assistance for hormone action.

Animals↗

PubMed2006

A study on reproductive performance and related factors of zebu cows in pastoral herds in a semi-arid area of Tanzania.

A prospective longitudinal study was carried out from September 2001 to June 2004 in three adjacent villages in a semi-arid area of Tanzania. The objectives of this study were to measure the intervals between calving and either resumption of cyclical activity or confirmation of pregnancy, to estimate calving intervals, and to investigate the effect of factors assumed to be related to postpartum reproductive performance. A total of 275 lactation periods from 177 Tanzanian Shorthorn Zebu cows managed in a traditional pastoral system in 46 households were initially included. Animals were initially screened for brucelosis and thereafter examined by palpation per rectum at 2-week intervals. Body condition score (scale 1 to 5) was assessed and girth measurement (cm) taken. Occurrence of other reproductive events such as calving, abortion, death of calf, culling and reason for culling were recorded. In a subset of 98 lactation periods from 91 cows milk samples for progesterone (P4) determination were collected twice per week from day 7 after calving to the time of confirmed pregnancy or until milk production ceased before pregnancy. The data were analysed both univariately and in multivariable Cox proportional hazard (frailty) models. The mean (+/-S.E.M.) calving interval was 500+/-13.6 days. Positive reactors in the brucellosis test were 15.6% of the tested animals. Milk P4 analysis showed the rate of abortion/late embryo loss to be 14.3%. Calf mortality rates varied between 14.6 and 17.4%. A positive relationship was found between the outcome variables likelihood of cyclical activity and likelihood of pregnancy in the Cox model, and the explanatory variables: parity and body condition score (BCS) at calving. A negative relationship was found between the outcome variables, and the explanatory variables: maximum BCS loss and calf survival/mortality. Calving in the rainy season was associated with an increased likelihood of pregnancy.

Animals↗

PubMed2002

Inflammation and coagulation factors in persons > 65 years of age with symptoms of depression but without evidence of myocardial ischemia.

Depression is associated with increased cardiovascular disease, but the underlying mechanisms are not well understood. This study examines associations of depressive symptoms with inflammation and coagulation factors in persons aged > 65 years. Blood samples were obtained from 4,268 subjects free of cardiovascular disease (age 72.4 +/- 5.5 years, 2,623 women). Inflammation markers were C-reactive protein (CRP), white blood cell (WBC) count, total platelet count, and albumin; coagulation factors included factors VIIc and VIIIc and fibrinogen. Depression was assessed with the Center for Epidemiologic Studies Depression scale, and states of energy depletion with a validated exhaustion index. Statistical adjustments were made for risk factors (age, sex, race, systolic blood pressure, smoking status, diabetes mellitus) and physical measures of frailty (isometric handgrip, timed 15-feet walk test, activity level). Depression was associated with elevated CRP (3.31 +/- 0.10 vs 3.51 +/- 0.21 mg/L), WBC (6.14 +/- 0.03 vs 6.43 +/- 0.11 10(6)/L), fibrinogen (319 +/- 1 vs 326 +/- 3 mg/dl), and factor VIIc (124.6 +/- 0.6% vs 127.2 +/- 1.3%; all p <0.05). Exhaustion also was related to elevated inflammation and coagulation markers (p < 0.05). Exhausted men had markedly elevated CRP levels (6.82 +/- 2.10 mg/L) versus nonexhausted men (3.05 +/- 0.16: p = 0.007). After adjustment for control variables, exhaustion remained associated with albumin (p = 0.033), fibrinogen (p = 0.017), CRP (p = 0.066), and WBC (p = 0.060), whereas associations of depressive symptoms with biochemistry measures lost statistical significance. Thus, depression and exhaustion are associated with low-grade inflammation and elevated coagulation factors in persons aged > 65 years.

Aged↗

PubMed2003

Coagulation and activation of inflammatory pathways in the development of functional decline and mortality in the elderly.

PURPOSE: This study was performed to determine the effects of markers of inflammation (interleukin 6) and coagulation (D-dimer) on mortality and functional status in older persons. METHODS: Subjects were selected for the Duke Established Populations for Epidemiologic Studies of the Elderly. In 1992, 2569 subjects (age >71 years) were interviewed, of whom 1,723 had interleukin-6 and D-dimer measurements. Values of interleukin 6 and D-dimer were categorized into quartiles. Outcomes were mortality (through 5 years) and functional status (through 4 years). Relative risks were estimated with proportional hazards models that adjusted for potential confounders. RESULTS: The relative risk of mortality was 1.28 (95% confidence interval [CI]: 0.98 to 1.69; P = 0.06) for those with only interleukin-6 levels in the highest quartile, 1.53 (95% CI: 1.18 to 1.97; P = 0.001) for subjects with only D-dimer levels in the highest quartile, and 2.00 (95% CI: 1.53 to 2.62; P = 0.0001) for those with levels of both in the highest quartile, as compared with those who were not in either of the highest quartiles. Those with high interleukin-6 and high D-dimer levels had the greatest declines in all measures of function. CONCLUSION: Activation of the coagulation and inflammatory pathways is associated with mortality and decline in function, and may be part of the explanation for the development of a frailty phenotype in the elderly.

Activities of Daily Living↗

PubMed2003

Elevated levels of tumor necrosis factor alpha and mortality in centenarians.

BACKGROUND: Aging is accompanied by low-grade inflammation. Tumor necrosis factor (TNF) alpha initiates the cytokine cascade, and high levels are associated with dementia and atherosclerosis in persons aged 100 years. We hypothesized that TNF-alpha was also a prognostic marker for all-cause mortality in these persons. METHODS: We enrolled 126 subjects at or around the time of their 100th birthday. Plasma levels of TNF-alpha, interleukin (IL)-6, IL-8, and C-reactive protein were measured at baseline, and we determined the associations between the markers of inflammation and mortality during the subsequent 5 years. RESULTS: Only 9 subjects were alive after 5 years. Elevated levels of TNF-alpha were associated with mortality in both men and women (hazard ratio = 1.34 per SD of 2.81 pg/mL; 95% confidence interval: 1.12 to 1.60, P = 0.001). Levels of IL-6 and IL-8 did not affect survival; levels of C-reactive protein were not associated with mortality when levels of TNF-alpha were included in the analysis. Dementia and cardiovascular diseases represented the major causes of comorbid conditions at baseline. TNF-alpha was still associated with mortality in multivariate models that included these parameters as confounders. CONCLUSION: TNF-alpha was an independent prognostic marker for mortality in persons aged 100 years, suggesting that it has specific biological effects and is a marker of frailty in the very elderly.

Aged↗

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↗

PubMed2000

Long-term home exercise program: effect in women at high risk of fracture.

OBJECTIVE: To determine whether a better outcome in terms of physical frailty could be achieved with a regular home exercise program in women at high risk of fracture. DESIGN: Prospective long-term observational study. SETTING: Outpatient clinic of physical medicine and rehabilitation. PARTICIPANTS: Women with a history of postmenopausal fractures and an age-adjusted low bone mass, as determined 7 to 12 years earlier. INTERVENTION: Home exercise program. OUTCOME MEASURES: Thirty-three women were followed. The exercise group and control group were compared with regard to fracture rates, episodes of falling, neuromuscular performance (one-leg stance, chair rise, body sway, tandem walk, tapping test), and bone mineral density (BMD). RESULTS: Twenty-five women with a mean age of 73.8+/-5.7 yrs appeared for the investigation. An exercise program had been prescribed in 19 women, and six served as controls. Seven women of the exercise group (36.8%) regularly performed the exercises. No differences between participants of the groups in terms of fracture rates, falling episodes, neuromuscular performance, and BMD were observed. CONCLUSION: It appears that a home exercise program does not affect the outcome of postmenopausal women at high risk of fracture.

Aged↗

PubMed2003

State of the art in geriatric rehabilitation. Part II: clinical challenges.

OBJECTIVES: To examine common clinical problems in geriatric rehabilitation and to make recommendations for current practice based on evidence from the literature. DATA SOURCES: A CINAHL database and 2 MEDLINE searches were conducted for 1980 to 2001. A fourth search was completed by using the Cochrane database. STUDY SELECTION: One author reviewed the references for relevance and another for quality. A total of 336 articles were considered relevant. Excluded articles were unrelated to geriatric rehabilitation or were anecdotal or descriptive reports on a small number of patients. DATA EXTRACTION: The following areas were the major geriatric rehabilitation subtopics identified in the search: frailty, comprehensive geriatric assessment, admission screening, assessment tools, interdisciplinary teams, hip fracture, stroke, nutrition, dementia, and depression. This article focuses on the latter 5 subtopics. The literature was reviewed by using a level-of-evidence framework. Level 1 evidence was a randomized controlled trial (RCT) or meta-analysis or systematic review of RCTs. Level 2 evidence included controlled trials without randomization, cohort, or case-control studies. Level 3 evidence involved consensus statements from experts, descriptive studies, or reports of expert committees. DATA SYNTHESIS: Of the 336 articles evaluated, 108 were level 1, 39 were level 2, and 189 were level 3. Recommendations were made for each subtopic according to the level of evidence in the specific area. In cases in which several articles were written on a topic with similar conclusions, we selected the articles with the strongest level of evidence, thereby reducing the total number of references. CONCLUSIONS: Frail older patients with hip fracture should receive geriatric rehabilitation. They should also be screened for nutrition, cognition, and depression. Older persons should receive nutritional supplementation when malnourished. If severe dysphagia occurs in stroke patients, gastrostomy tube feeding is superior to nasogastric tube feeding.

Aged↗

PubMed1998

Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders?

BACKGROUND: Strength loss is strongly associated with functional decline and is reversible with exercise. The effect of increased strength on function has not been clearly established. The purpose of this study was to determine whether strength gain is associated with improvement in physical performance and disability. METHODS: One hundred functionally impaired community-dwelling men and women (77.6 +/- 7.6 yrs) were tested at baseline and outcome for lower extremity strength, physical performance, and disability. After random group assignment, exercise participants received strengthening exercises in their homes three times a week for 10 weeks while control subjects continued their normal activities. Using multiple regression techniques, the relationship between strength gain and improvement in physical performance and disability was assessed, controlling for age, depression, and baseline strength. RESULTS: A significant impact of strength gain on mobility skills (p = .0009) was found. The impact of strength gain on chair rise performance was significant in participants who were more impaired (p = .04). Strength gain was associated with gain in gait speed (p = .02) and in falls efficacy (p = .05), but not with other balance, endurance, or disability measures. CONCLUSIONS: Lower extremity strength gain is associated with gains in chair rise performance, gait speed, and in mobility tasks such as gait, transfers, stooping, and stair climbing, but not with improved endurance, balance, or disability. Strength gain is also associated with improvement in confidence in mobility. Factors that may influence the ability of strength gain to affect function are initial level of frailty and specificity of exercise. These results support the idea that strength training is an intervention that can potentially improve physical health status in many frail elders.

Activities of Daily Living↗

PubMed2000

Dehydroepiandrosterone sulfate and psychiatric measures in a frail, elderly residential care population.

BACKGROUND: Previous reports have found low levels of dehydroepiandrosterone sulfate (DHEA-S) in association with physical illness, and with frailty in the elderly. In a preliminary study, we also found low DHEA-S associated with increased disability and number of pain sites. However, we found the opposite relationship between DHEA-S and cognitive impairment. Therefore, we conducted a study of a second sample to confirm this unexpected finding and the expected inverse correlations between DHEA-S levels and increased disability and number of pain sites. METHODS: Psychiatric symptoms and disorders were correlated with DHEA-S and related steroid levels in a second convenience sample in the nursing home population. RESULTS: This sample confirmed the previous finding of a positive association of cognitive impairment with higher DHEA-S levels but the inverse association of DHEA-S levels with the numbers of pain sensations did not reach statistical significance. Cognitive impairment was also positively associated with higher dehydroepiandrosterone (DHEA) and estradiol levels (women only). Cortisol levels were inversely associated with depressive symptoms. CONCLUSIONS: The anomalous positive correlation between cognitive dysfunction and DHEA-S levels, and the inverse correlation between cortisol levels and depressive symptoms, suggests that the relationships between psychiatric symptomatology and levels of steroids that are part of the hypothalamic-pituitary adrenal axis are different in the frail elderly population from that of younger and heartier populations.

Aged↗