The multiple-risk-factor intervention strategy resulted in a significant reduction in the risk of falling among elderly persons in the community. In addition, the proportion of persons who had the targeted risk factors for falling was reduced in the intervention group, as compared with the control group. Thus, risk-factor modification may partially explain the reduction in the risk of falling.
LDER AMERICANS COMprise about 13% of the US population, yet account for 18% of all suicide deaths. 1 Among adults who attempt suicide, the elderly are most likely to die as a result. 2 Recent national reports emphasize the public health need for intervention trials to reduce the risk for suicide in late life. 3,4 This article presents initial outcomes from the multisite, randomized trial known as PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial). PROSPECT tested the impact of a primary carebased intervention on reducing major risk factors for suicide in late life. Primary care practices were important to study because the majority of older adults who die by suicide have seen their physician within months of their death. 5,6 PROSPECT approached suicide risk reduction from a public health perspective by targeting factors that are strongly related to suicide risk, common in primary care, and malleable. 7 Depression is the principal risk factor for suicide Author Affiliations and Financial Disclosures are listed at the end of this article.
Geriatric major depression is twice as common in patients receiving home care as in those receiving primary care. Most depressions in patients receiving home care are untreated. The poor medical and functional status of these patients and the complex organizational structure of home health care pose a challenge for determining safe and effective strategies for treating depressed elderly home care patients.
The effects of social support and social networks may vary according to the individual's gender and baseline physical capabilities. Studies of functional decline among elderly persons should not ignore this population variation in the effects of social networks.
The relationship between social network structural and support characteristics and onset of new or recurrent activities of daily living (ADL) disability was examined in a cohort of older men and women. No significant protective effects were found for network structural or support characteristics. However, greater frequency of instrumental support was associated with significantly increased risk of ADL disability among men; a similar though nonsignificant pattern was seen among women. These findings indicate that receipt of more instrumental support may not have uniformly beneficial effects on functional status. They serve to underscore the need for more comprehensive research, examining both the positive and negative effects of social interactions on health and functioning.
Expansion of Medicare reimbursement to cover colon cancer screening was associated with an increased use of colonoscopy for Medicare beneficiaries, and for those who were diagnosed with colon cancer, an increased probability of being diagnosed at an early stage. The selective effect of the coverage change on proximal colon lesions suggests that increased use of whole-colon screening modalities such as colonoscopy may have played a pivotal role.
Among older persons, the association between frailty and spirometry-confirmed respiratory impairment has not yet been evaluated.
Using data on white participants aged 65–80 years (Cardiovascular Health Study, N=3,578), we evaluated cross-sectional and longitudinal associations between frailty and respiratory impairment, including their combined effect on mortality. Baseline assessments included frailty status (Fried-phenotype; non-frail, pre-frail, and frail) and spirometry. Outcomes included development of frailty features (pre-frail or frail) at Year-3 and respiratory impairment (airflow limitation or restrictive-pattern) at Year-4, and death (median follow-up, 13.2 years).
At baseline, 48.3% were pre-frail, 5.8% were frail, 13.8% had airflow limitation, and 9.3% had restrictive-pattern; 46.1% subsequently died. At baseline, pre-frail and frail were cross-sectionally associated with airflow limitation—adjusted odds ratio (OR) (95% confidence interval): 1.62 (1.29, 2.04) and 1.88 (1.15, 3.09), and restrictive-pattern—adjusted OR: 1.80 (1.37, 2.36) and 3.05 (1.91, 4.88), respectively. Longitudinally, participants with baseline frailty features had an increased likelihood of developing respiratory impairment―adjusted OR: 1.42 (1.11, 1.82). Conversely, participants with baseline respiratory impairment had an increased likelihood of developing frailty features—adjusted OR: 1.58 (1.17, 2.13). Mortality was highest among participants who were frail and had respiratory impairment—adjusted hazard ratio: 3.91 (2.93, 5.22), relative to those who were non-frail and had no respiratory impairment.
Frailty and respiratory impairment are strongly associated with one another and substantially increase the risk of death when both are present. Establishing these associations may inform interventions designed to reverse or prevent the progression of either condition and to reduce adverse outcomes.
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