OBJECTIVES:To determine the association between vision and hearing impairment and subsequent cognitive and functional decline in community-residing older women. DESIGN: Prospective cohort study. SETTING: Four metropolitan areas of the United States. PARTICIPANTS: A total of 6,112 women aged 69 and older participating in the Study of Osteoporotic Fractures (SOF) between 1992 and 1994. MEASUREMENTS: Five thousand three hundred fortyfive participants had hearing measured, 1,668 had visual acuity measured, and 1,636 had both measured. Visual impairment was defined as corrected vision worse than 20/40. Hearing impairment was defined as the inability to hear a tone of 40 dB or greater at 2,000 hertz. Participants completed the modified Mini-Mental State Examination and/or a functional status assessment at baseline and follow-up. Cognitive and functional decline were defined as the amount of decline from baseline to follow-up that exceeded the observed average change in scores by at least 1 standard deviation. RESULTS: About one-sixth (15.7%) of the sample had cognitive decline; 10.1% had functional decline. In multivariate models adjusted for sociodemographic characteristics and chronic conditions, vision impairment at baseline was associated with cognitive (odds ratio (OR) 5 1.78, 95% confidence interval (CI) 5 1.21-2.61) and functional (OR 5 1.79, 95% CI 5 1.15-2.79) decline. Hearing impairment was not associated with cognitive or functional decline. Combined impairment was associated with the greatest odds for cognitive (OR 5 2.19, 95% CI 5 1.26-3.81) and functional (OR 5 1.87, 95% CI 5 1.01-3.47) decline. CONCLUSION: Sensory impairment is associated with cognitive and functional decline in older women. Studies are needed to determine whether treatment of vision and hearing impairment can decrease the risk for cognitive and functional decline. J Am Geriatr Soc 52: [1996][1997][1998][1999][2000][2001][2002] 2004. Key words: vision impairment; hearing impairment; cognitive status; functional status; aged V isual impairment and hearing loss are chronic and potentially treatable conditions that disproportionately affect the elderly. Difficulty seeing, even in those with glasses, increases steadily with age, and is estimated at 4% of older persons aged 65 to 74 to 16% of those aged 80 to 84 in the United States.1 Similarly, it has been estimated that more than half of those aged 60 and older experience hearing impairment.2 Undertreatment of sensory impairment in the elderly is common; uncorrected refractive error and unoperated age-related cataract together account for more than half of all visual impairment in older persons, 1 and up to 70% of hearing impairment in the elderly is not treated with hearing aids.3 Undoubtedly, these correctable deficits affect daily activities, such as reading or communicating with others, and global quality of life. 4There is growing evidence that sensory deficits in the elderly may have a profound effect on multiple health outcomes. Vision 5-9 and hearing 7,8 impairment have been associ...

OBJECTIVES:To measure expectations regarding aging among community-residing-older adults, identify characteristics associated with having low expectations regarding aging, and examine whether expectations regarding aging are associated with healthcare-seeking beliefs for age-associated conditions. DESIGN: Self-administered mail survey. SETTING: Greater Los Angeles. PARTICIPANTS: Four hundred twenty-nine of 588 (73%) randomly selected community-residing adults aged 65 to 100 (mean age 76) cared for by 20 primary care physicians; 54% were women, and 76% were white. MEASUREMENTS: T he Expectations Regarding AgingSurvey, a validated survey measuring expectations regarding aging; 13 items measuring care seeking beliefs; and validated measures of health status. RESULTS: More than 50% of participants felt it was an expected part of aging to become depressed, to become more dependent, to have more aches and pains, to have less ability to have sex, and to have less energy. After adjusting for sociodemographic and health characteristics using multivariate regression, older age was independently associated with lower expectations regarding aging ( P Ͻ . 001), as was having lower physical and mental health-related quality of life. Having lower expectations regarding aging was independently associated with placing less importance on seeking health care ( P ϭ .049). CONCLUSIONS: Most older adults in this sample did not expect to achieve the model of successful aging in which high cognitive and physical functioning is maintained. Older age was independently associated with lower expectations regarding aging. Furthermore, having low expectations regarding aging was independently associated with not believing it important to seek health care.

The ERA-12 demonstrated acceptable reliability and validity to estimate expectations regarding aging.

There is a need for a psychometrically sound measure of the stigma experienced by diverse persons living with HIV/AIDS (PLHA). The goal of this study was to develop and evaluate a multidimentional measure of internalized HIV stigma that captures stigma related to treatment and other aspects of the disease among sociodemographically diverse PLHA. We developed a 28-item measure of internalized HIV stigma composed of four scales based on previous qualitative work. Internal consistency reliability estimates in a sample of 202 PLHA was 0.93 for the overall measure, and exceeded 0.85 for three of the four stigma scales. Items discriminated well across scales, and correlations of the scales with shame, social support, and mental health supported construct validity. This measure should prove useful to investigators examining in the role of stigma in HIV treatment and health outcomes, and evaluating interventions designed to mitigate the impacts of stigma on PLHA.

OBJECTIVE To examine the association between allostatic load (AL), an index of multisystem physiological dysregulation, and frailty development over a 3-year follow-up in a sample of older adults. DESIGN Longitudinal cohort study. SETTING Community. PARTICIPANTS High-functioning men and women aged 70–79 at study entry. MEASUREMENTS Multisystem physiological dysregulation, or AL, was assessed according to 13 biomarkers of cardiovascular, endocrine, immune, and metabolic function. An AL score was computed as the total number of biomarkers for which participant values fell into high-risk biomarker quartiles. Frailty status (not frail, intermediate frail, frail) was determined according to the total number of five indicators of frailty: weight loss, exhaustion, weak grip, slow gait, and low physical activity. The association between level of AL at baseline and frailty status 3 years later was examined using ordinal logistic regression in 803 participants not frail at baseline. RESULTS In a multivariable model adjusting for sociodemographic, health, and behavioral characteristics, each 1-unit increase in AL at baseline was associated with a 10% greater likelihood of frailty at the 3-year follow-up (cumulative adjusted odds ratio = 1.10, 95% confidence interval = 1.03–1.19). CONCLUSION These findings support the hypothesis that dysregulation across multiple physiological systems is associated with greater risk of frailty. Greater levels of multisystem physiological dysregulation may serve as a warning sign of frailty development in later life.

Background End-of-life medical expenditures exceed costs during other periods, vary across regions, and are likely to be unsustainable. Identifying determinants of expenditure variation may reveal opportunities for reducing costs. Objectives To 1) identify patient-level determinants of Medicare expenditures at end-of-life and 2) determine these factors’ contributions to expenditure variation while accounting for regional characteristics. We hypothesized that race/ethnicity, social support and functional status are independently associated with treatment intensity, controlling for regional characteristics, and that individual characteristics account for a substantial proportion of expenditure variation. Design Using Health and Retirement Study (HRS), Medicare claims and Dartmouth Atlas of Health Care data, we modeled relationships between expenditures and patient and regional characteristics. Participants and Setting HRS decedents 65.5 years or older (n=2394), 2000–2006. Measurement Medicare expenditures in last 6 months of life were estimated in a series of 2-level multivariable regression models including 1) patient, 2) regional, and 3) patient and regional characteristics. Results Decline in function (rate ratio 1.64, 95%CI 1.46–1.83), Hispanic ethnicity (1.50, 1.22–1.85), African American race (1.43, 1.25–1.64), and certain chronic diseases including diabetes (1.16, 1.06–1.27), were associated with higher expenditures. Nearby family (0.90, 0.82–0.98) and dementia (0.78, 0.71–0.87) were associated with lower expenditures and advance care planning had no association. Regional characteristics, including end-of-life practice patterns (1.09, 1.06–1.14) and hospitals beds per capita (1.01, 1.00–1.02), were associated with higher expenditures. Patient characteristics explained 10% of overall variance and retained statistically significant relationships with expenditures after controlling for regional characteristics. Limitations Decedent sample, proxy informants, large proportion of variation remains unexplained. Conclusions Patient characteristics: functional decline, race/ethnicity, chronic disease, and nearby family, are important determinants of expenditures at end-of-life, independent of regional characteristics.

Stigma profoundly affects the lives of people with HIV/AIDS. Fear of being identified as having HIV or AIDS may discourage a person from getting tested, from accessing medical services and medications, and from disclosing their HIV status to family and friends. In the present study, we use focus groups to identify the most salient domains of stigma and the coping strategies that may be common to a group of diverse, low-income women and men living with HIV in Los Angeles, CA (n = 48). We also explore the impact of stigma on health and healthcare among HIV positive persons in our sample. Results indicate that the most salient domains of stigma include: blame and stereotypes of HIV, fear of contagion, disclosure of a stigmatized role, and renegotiating social contracts. We use the analysis to develop a framework where stigma is viewed as a social process composed of the struggle for both internal change (self-acceptance) and reintegration into the community. We discuss implications of HIV-related stigma for the mental and physical health of HIV-positive women and men and suggestions for possible interventions to address stigma in the healthcare setting.

Background: New strategies to increase physical activity among sedentary older adults are urgently needed. Objective: To examine whether low expectations regarding aging (age‐expectations) are associated with low physical activity levels among older adults. Design: Cross‐sectional survey. Participants: Six hundred and thirty‐six English‐ and Spanish‐speaking adults aged 65 years and above attending 14 community‐based senior centers in the Los Angeles region. Over 44% were non‐Latino whites, 15% were African American, and 36% were Latino. The mean age was 77 years (range 65 to 100). Measurements: Self‐administered written surveys including previously tested measures of age‐expectations and physical activity level in the previous week. Results: Over 38% of participants reported <30 minutes of moderate‐vigorous physical activity in the previous week. Older adults with lower age‐expectations were more likely to report this very low level of physical activity than those with high age‐expectations, even after controlling for the independent effect of age, sex, ethnicity, level of education, physical and mental health–related quality of life, comorbidity, activities of daily living impairment, depressive symptoms, self‐efficacy, survey language, and clustering at the senior center. Compared with the quintile of participants having the highest age‐expectations, participants with the lowest quintile of age‐expectations had an adjusted odds ratio of 2.6 (95% confidence intervals: 1.5, 4.5) of reporting <30 minutes of moderate‐vigorous physical activity in the previous week. Conclusions: In this diverse sample of older adults recruited from senior centers, low age‐expectations are independently associated with very low levels of physical activity. Harboring low age‐expectations may act as a barrier to physical activity among sedentary older adults.