Residual Disability, Mortality, and Nursing Home Placement After Hip Fracture Over 2 Decades.

OBJECTIVE: To examine trends in 12-month postfracture residual disability, nursing home placement, and mortality among patients with a hip fracture between 1990 and 2011. DESIGN: Secondary analysis of 12-month outcomes from 3 cohort studies and control arms of 2 randomized controlled trials. SETTING: Original studies were conducted as part of the Baltimore Hip Studies (BHS). PARTICIPANTS: Community-dwelling patients ≥65 years of age hospitalized for surgical repair of a nonpathologic hip fracture (N=988). MAIN OUTCOME MEASURES: Twelve-month residual disability, mortality, and nursing home residency were examined in case-mix adjusted models by sex and study. Residual disability was calculated by subtracting prefracture scores of Lower Extremity Physical Activities of Daily Living from scores at 12 months postfracture. We also examined the proportion of individuals with a 12-month score higher than their prefracture score (residual disability>0). RESULTS: Only small improvements were seen in residual disability between 1990 and 2011. No significant differences were seen for men between BHS2 (enrollment 1990-1991; mean residual disability=3.1 activities; 95% confidence interval [CI], 2.16-4.10) and BHS7 (enrollment 2006-2011; mean=3.1 activities; 95% CI, 2.41-3.82). In women, residual disability significantly improved from BHS2 (mean=3.5 activities; 95% CI, 2.95-3.99) to BHS3 (enrollment 1992-1995; mean=2.7 activities; 95% CI, 2.01-3.30) with no significant improvements in later studies. After adjustment, a substantial proportion (91% of men and 79% of women) had a negative outcome (residual disability, died, or nursing home residence at 12 months) in the most recently completed study (BHS7). CONCLUSIONS: Over 2 decades, patients undergoing usual care post-hip fracture still had substantial residual disability. Additional clinical and research efforts are needed to determine how to improve hip fracture treatment, rehabilitation, and subsequent outcomes.

Persistence of depressive symptoms and gait speed recovery in older adults after hip fracture.

OBJECTIVE: Depression after hip fracture in older adults is associated with worse physical performance; however, depressive symptoms are dynamic, fluctuating during the recovery period. The study aim was to determine how the persistence of depressive symptoms over time cumulatively affects the recovery of physical performance. METHODS: Marginal structural models estimated the cumulative effect of persistence of depressive symptoms on gait speed during hip fracture recovery among older adults (n = 284) enrolled in the Baltimore Hip Studies 7th cohort. Depressive symptoms at baseline and at 2-month and 6-month postadmission for hip fracture were evaluated by using the Center for Epidemiological Studies Depression Scale, and persistence of symptoms was assessed as a time-averaged severity lagged to standardized 3 m gait speed at 2, 6, and 12 months. RESULTS: A 1-unit increase in time-averaged Center for Epidemiological Studies Depression score was associated with a mean difference in gait speed of -0.0076 standard deviations (95% confidence interval [CI]: -0.0184, 0.0032; P = .166). The association was largest in magnitude from baseline to 6 months: -0.0144 standard deviations (95% CI: -0.0303, 0.0015; P = 0.076). Associations for the other time intervals were smaller: -0.0028 standard deviations (95% CI: -0.0138, 0.0083; P = .621) at 2 months and -0.0121 standard deviations (95% CI: -0.0324, 0.0082; P = .238) at 12 months. CONCLUSION: Although not statistically significant, the magnitude of the numerical estimates suggests that expressing more depressive symptoms during the first 6 months after hip fracture has a meaningful impact on functional recovery.

Inpatient Walking Activity to Predict Readmission in Older Adults.

OBJECTIVE: To compare the 30-day readmission predictive power of in-hospital walking activity and in-hospital activities of daily living (ADLs) in older acutely ill patients. In addition, we sought to identify preliminary walking thresholds that could support the targeting of interventions aimed at minimizing rehospitalizations. DESIGN: Prospective, observational clinical cohort study. Step counts during hospitalization were assessed via accelerometry. ADL function was assessed within 48 hours of admission. SETTING: Acute care hospital. PARTICIPANTS: One hundred sixty-four ambulatory persons aged 65 years and older admitted to the hospital from the community with an acute medical illness. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Readmission back to the index hospital (yes vs no) within 30 days of discharge. RESULTS: Twenty-six patients (15.8%) were readmitted within 30 days of discharge. Walking activity during hospitalization was more strongly and significantly associated with 30-day readmission (odds ratio=0.90; 95% confidence interval, 0.82-0.98) than ADL function (odds ratio=0.45; 95% confidence interval, 0.14-1.45) after adjusting for relevant readmission risk factors. The predictive accuracy (area under the curve) was highest for models that included walking activity and changed little with the addition of ADLs. A walking threshold of 275 steps or more per day identified patients at reduced 30-day readmission risk. CONCLUSIONS: Walking activity was a stronger predictor of readmission than ADLs. Monitoring patient activity during hospitalization may provide clinicians with valuable information on early readmission risk not captured by measures of ADLs. Further study is needed to replicate these findings and monitor walking activity posthospitalization to further advance our understanding of readmission risk.

Cognitive health and risk of ED revisit in underserved older adults.

OBJECTIVE: The objective was to examine associations between cognitive health and unplanned emergency department (ED) revisits 30, 60, and 90 days after the initial visit. METHODS: Sociodemographic, clinical, and cognitive measures were collected on 110 white and African American adults, 65 years and older, who sought care in an inner-city ED. The information was collected via face-to-face interviews and review of the electronic medical record. Returns to the study-site ED 30, 60, and 90 days later were identified through a search of the electronic medical record. RESULTS: The sample was mostly female (70.9%) and African American (73.6%), with an average age of 75 years (SD = 7.4). About half (56.4%) had 12 or more years of formal schooling. The overall cognitive score of 17.5 (SD 5.1) was 4.5 points less than standardized norms for persons 65 years and older. Each 1-point increase in cognitive score was associated with 24% and 21% decreased odds of 60-day (odds ratio [OR] = 0.76; 95% confidence interval [CI], 0.57-1.00) and 90-day revisit to the ED (OR = 0.79; 95% CI, 0.62-0.99), respectively. Cognitive health and odds of 30-day revisit (OR = 0.96; 95% CI, 0.72-1.26) had a nonsignificant association. CONCLUSIONS: Our sample of older, mostly female African Americans showed poorer cognitive health compared with standardized norms. However, higher cognitive health scores were linked to lower risk for unplanned ED revisit 60 and 90 days later. A clearer understanding of biological and nonbiological pathways that connect cognitive health to revisit risk in disadvantaged older populations might improve health outcomes, including the avoidance of return trips to the ED.

Gait Speed and Dismobility in Older Adults.

OBJECTIVES: To classify hospitalized older patients with slow gait speed, and test the hypothesis that slow gait speed or dismobility is associated with increased mortality risk. DESIGN: Prospective study. SETTING: Acute care geriatric hospital unit. PARTICIPANTS: Older patients (N=289) admitted to a geriatric hospital unit. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Two-year survival determined by medical record review and a search of the National Death Index. RESULTS: Most of the older patients were women (61.6%) and non-Hispanic white (72.3%). A total of 213 older patients (73.7%) had gait speeds ≤0.6 m/s and were classified with dismobility; 17% (49/289) of the sample died during the 2-year follow-up. All but 5 deaths occurred in older patients with dismobility. Older patients with dismobility were more than 2.5 times as likely to die than those with gait speeds >.60 m/s (hazard ratio, 2.60; 95% confidence interval, 1.01-6.77), after adjusting for age, sex, race/ethnicity, and comorbidity. CONCLUSIONS: A simple and quick screen for gait speed was evaluated in this study of hospitalized older patients. A clinical classification of dismobility could provide the inpatient health care team with meaningful information about the older patients' underlying health conditions and future prognosis, and provides an opportunity to discuss and implement treatment options with patients and their families.

Pilot study examining the association between ambulatory activity and falls among hospitalized older adults.

OBJECTIVE: To examine the ambulatory activity of older patients who had a documented fall during hospitalization for acute illness. DESIGN: A retrospective case-control design was used in a pilot study of patients (n=10; ≥65y) who had a documented fall during their hospital stay and matched controls (n=25) who did not fall. SETTING: Acute care medical/surgical unit. PARTICIPANTS: Men and women 65 years and older who wore a step activity monitor while hospitalized. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fall incidents during the hospital stay were documented by the nurse in a standardized patient safety event report in accordance with hospital policy. The number of steps per 24-hour interval, time spent walking, and total number of activity episodes were determined for patients and controls. RESULTS: On average ± SD, patients who fell took 480.3 ± 432.2 steps per hospital day, spent 53.8 ± 36.9 minutes walking, and engaged in 25.8 ± 16.9 episodes of activity. Mean daily steps, time spent walking, and number of activity episodes for patients who did not fall were 680.1 ± 876.0, 50.1 ± 58.6, and 21.6 ± 23.8, respectively. Logistic regression results indicated no association between the fall outcome and mean daily steps (odds ratio=.95; 95% confidence interval, 0.84-1.06). CONCLUSIONS: Ambulatory activity among patients who fell varied widely. Mean daily steps, time spent walking, and number of episodes of activity were comparable with matched controls who did not fall. Patient falls were more likely to be associated with cognitive and hospital environmental factors than actual amount of walking.

Mexican Americans and frailty: findings from the Hispanic established populations epidemiologic studies of the elderly.

OBJECTIVES: We examined the prevalence of frailty among Mexican American older adults and explored the correlates associated with becoming frail to determine their affect on disability and morbidity in this population. METHODS: We studied the trajectory of frailty over 10 years in 2049 Mexican Americans participating in the Hispanic Established Populations Epidemiologic Studies of the Elderly. We constructed a frailty index based on weight loss, exhaustion, grip strength, walking speed, and physical activity and collected data on sociodemographic and health status, comorbidities, and functional measures of performance. RESULTS: The sample was 58% female, with a mean age of 74.43 years (SD = 6.04) at baseline. Fifty-five percent of participants at baseline and 75% of the surviving sample at follow-up (n = 777) were classified as prefrail or frail. Of persons identified as frail at baseline, 84% died by the end of follow-up. Baseline age, diabetes, arthritis, smoking status, body mass index, cognition, negative affect, and number of comorbid conditions were predictors of frailty at follow-up (R(2) = 0.29; P < .05). CONCLUSIONS: Further research into ways to reduce the number of Mexican American older adults who become frail and disabled and therefore lose their independence is needed. Future studies should continue to examine the trajectory of frailty as a dynamic process that includes psychosocial and cognitive components.

Ecological validity of the neuropsychological assessment battery screening module in post-acute brain injury rehabilitation.

PRIMARY OBJECTIVE: To assess the ecological validity of the Screening Module of the Neuropsychological Assessment Battery (NAB-SM) using the Functional Independence Measure (FIM). METHOD: Seventy individuals with moderate-to-severe traumatic brain injury at a residential post-acute rehabilitation facility were administered the FIM instrument and the NAB-SM upon admission. Hierarchical regression analysis was used to examine the relationship between the variables from these two assessment measures. RESULTS: Hierarchical models revealed that (1) the NAB-SM Total score was significantly associated with the FIM instrument Total score as well as the Motor and Cognition sub-scale scores, above and beyond the contribution of demographic variables, (2) the NAB-SM Language, Memory and Spatial domain scores were significantly associated with of the FIM instrument Cognition sub-scale score and (3) the NAB-SM Spatial domain score was significantly associated with of the FIM instrument Total and Motor sub-scale scores. CONCLUSIONS: The current findings support previous research and provide strong evidence for the ecological validity of the NAB-SM with regard to functional abilities as assessed by the FIM instrument.

Racial and ethnic differences in postacute rehabilitation outcomes after stroke in the United States.

BACKGROUND AND PURPOSE: Incidence, prevalence, and mortality for stroke vary by race and ethnicity with higher rates for blacks compared with non-Hispanic whites. Little information is available regarding differences in postacute care outcomes for racial and ethnic groups after a stroke. METHODS: A retrospective analysis was conducted of 161,692 patients from the Uniform Data System for Medical Rehabilitation who received inpatient medical rehabilitation after a first stroke in 2002 and 2003. Multivariable models examined the effects of race and ethnicity on length of stay, functional status, rehabilitation efficiency, and discharge setting. RESULTS: The mean age was 70.97 years (SD=12.87), 53% were female, and 76% were non-Hispanic white. Mean length of stay was similar for all groups ranging from 17.39 days (SD=10.86) to 17.93 (SD=10.59). Non-Hispanic white patients had higher admission and discharge functional status ratings compared with patients in the minority groups (P<0.01). Differences in functional status across racial/ethnic groups were related to age (F=20.49, P<0.001); the older the comparison group, the greater the difference in functional status. Non-Hispanic whites were discharged home less often than blacks (OR=0.64, 95% CI=0.62 to 0.66), Hispanics (OR=0.58, 95% CI=0.55 to 0.62), or other minority groups (OR=0.67, 95% CI=0.57 to 0.67). CONCLUSIONS: The findings suggest racial and ethnic disparities exist in postacute care outcomes for persons with stroke.

Associations between positive emotion and recovery of functional status following stroke.

OBJECTIVE: Accumulating evidence indicates the beneficial effects of positive emotion on health and general well-being in older age. Less evidence is available on whether positive emotion supports improvement in functional status after an acute medical event such as stroke. This study examined the association between positive emotion at discharge from inpatient medical rehabilitation and functional status 3 months later in persons with stroke. METHODS: A longitudinal study using information from the Stroke Recovery in Underserved Patients database. The study included 823 persons aged 55 years or older with stroke and admitted to an inpatient medical rehabilitation facility. Information was collected during inpatient medical rehabilitation stay and approximately 3 months after discharge. RESULTS: The mean age of the sample was 72.8 years (SD = 9.5), 51.5% were women and 53.8% were married. The sample was mostly non-Hispanic white (79.2%), followed by non-Hispanic black (15.0%) and Hispanic (5.8%). The average length of stay was 20.1 day (SD = 10.1). In multivariate regression analyses, discharge positive emotion score was significantly associated with higher overall functional status (b = 0.70, SE = 0.21, p = .001) as well as with higher motor (b = 0.37, SE = 0.17, p = .003) and cognitive (b = 0.30, SE = 0.05, p = .0001) status at 3-month follow-up after adjustment for relevant risk factors. CONCLUSIONS: Our results indicate positive emotion is associated with gains in functional status after stroke. Findings have implications for stroke recovery programs and suggest the need to include measures of positive emotion inpatient assessments.

Relationship between test methodology and mean velocity in timed walk tests: a review.

OBJECTIVE: To assess the degree to which test methodology affects outcomes in clinical evaluations of walking speed. DATA SOURCES: Medline database and reference lists from relevant articles. STUDY SELECTION: We conducted electronic searches by using various combinations of terms related to clinical evaluations of walking speed. Resultant abstracts were then reviewed, and the methods and results section of promising full-text articles were searched for detailed descriptions of walk-test methodologies and results. Ultimately, articles were limited to the most common participant groups, older adults (aged) and individuals with neurologic conditions (neuro). The final sample included 46 studies. DATA EXTRACTION: Three aspects of test methodology (pace, starting protocol, distance timed) were extracted for use as independent variables. Group mean age was extracted for use as a covariate. Group mean velocity was extracted for use as the dependent variable. Data were extracted by a single investigator. DATA SYNTHESIS: Usual and/or comfortable pace was reported nearly twice as often as fast pace in both groups. Static-start protocols were more frequently used in aged studies, whereas dynamic (ie, rolling) starts were more common in neuro studies. Distances of 6 and 10m were most common in aged and neuro studies, respectively. Multivariate analyses (analysis of covariance) showed that only pace was significantly related to the mean velocity in both groups (aged: pace, P<.01; starting protocol, P=.21; distance, P=.05; neuro: pace, P=.01; starting protocol, P=.63; distance, P=.49). However, methodology-related differences in the distribution (95% confidence intervals) of performance scores across certain clinical standards were noted within all 3 methodology variables. CONCLUSIONS: Clinical assessments of walking velocity are not conducted uniformly. Common methodologic factors may influence the clinical interpretation of walk performances. Universal walk-test methodology is warranted to improve intergroup comparisons and the development of useful clinical criteria and consensus norms.

Ethnic differences in discharge destination among older patients with traumatic brain injury.

UNLABELLED: Ethnic differences in discharge destination among older patients with traumatic brain injury. OBJECTIVE: To estimate the association between ethnicity and discharge destination in older patients with traumatic brain injury (TBI). DESIGN: A retrospective analysis. SETTING: Nationally representative sample of older patients from the Uniform Data System for Medical Rehabilitation in 2002 and 2003. PARTICIPANTS: Patients (N=9240) aged 65 years or older who received inpatient rehabilitation services for TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Discharge destination (home, assisted living facility, institution) and ethnicity (white, black, Hispanic). RESULTS: Multinomial logit models showed that older Hispanics (odds ratio [OR]=2.24; 95% confidence interval [CI], 1.66-3.02) and older blacks (OR=2; 95% CI, 1.55-2.59) with TBI were significantly more likely to be discharged home than older whites with TBI, after adjusting for relevant risk factors. Older blacks were also 78% less likely (OR=.22; 95% CI, .08-.60) to be discharged to an assisted living facility than whites after adjusting for relevant risk factors. CONCLUSIONS: Our findings indicate that older minority patients with TBI were significantly more likely to be discharged home than white patients with TBI. Studies are needed to investigate underlying factors associated with this ethnic difference.

Positive emotion following a stroke.

OBJECTIVE: Interest in exploring the positive emotional health of adults has increased. The current study investigated the positive emotion of adults with stroke at discharge from in-patient medical rehabilitation and 3 months post-discharge. DESIGN: A longitudinal study in which information was collected during in-patient medical rehabilitation stay and 3 months post-discharge. SUBJECTS: The study included 856 persons with stroke aged 55 years or older. RESULTS: Mean age for the sample was 72.5 years, 78.7% of subjects were non-Hispanic white and 51.9% were women. Mean length of hospital stay was 20.2 days. More than one-third of patients reported higher positive emotion over the 3-month follow-up, while 29.7% reported lower positive emotion. In addition to discharge positive emotion, 4 factors, including depression, level of education and motor and cognition functional status score, significantly predicted lower depression at 3-month follow-up. CONCLUSION: A large percentage of adults reported high positive emotion in the initial months following a stroke. This finding adds to work on stroke recovery and indicates the emotional resilience of adults when faced with a health challenge. Understanding the role of positive emotion in persons living with stroke may provide insight into long-term recovery.

Health related quality of life in older Mexican Americans with diabetes: a cross-sectional study.

BACKGROUND: The older Hispanic population of the U.S. is growing at a tremendous rate. While ethnic-related risk and complications of diabetes are widely-acknowledged for older Hispanics, less is known about how health related quality of life is affected in this population. METHODS: Cross-sectional study assessing differences in health related quality of life between older Mexican Americans with and without diabetes. Participants (n = 619) from the Hispanic Established Population for the Epidemiological Study of the Elderly were interviewed in their homes. The primary measure was the Medical Outcomes Study Short Form (SF-36). RESULTS: The sample was 59.6% female with a mean age of 78.3 (SD = 5.2) years. 31.2% (n = 193) of the participants were identified with diabetes. Individuals with diabetes had significantly (F = 19.35, p < .001) lower scores on the Physical Composite scale (mean = 37.50, SD = 12.69) of the SF-36 compared to persons without diabetes (mean = 43.04, SD = 12.22). There was no significant difference between persons with and without diabetes on the Mental Composite scale of the SF-36. CONCLUSION: Diabetes was associated with lower health related quality of life in older Mexican Americans. The physical components of health related quality of life uniformly differentiated those with diabetes from those without, whereas mental component scores were equivocal.

Hypertension in older adults and the role of positive emotions.

OBJECTIVE: Negative emotions have been linked to increases in blood pressure, but relations between positive emotion and blood pressure have not been investigated. Our aim was to test the hypothesis that high positive emotion would be associated with lower blood pressure in older adults. METHODS: A cross-sectional study included 2564 Mexican Americans aged 65 or older living in one of five southwestern states. Primary measures included blood pressure and positive emotion score. Data analyses included descriptive and categorical statistics and regression and cumulative logit analysis. RESULTS: The average age was 72.5 years, 52.8% were women, and 32.8% were on antihypertensive medication. For individuals not on antihypertensive medication, increasing positive emotion score was significantly associated with lower systolic (b = -0.35, standard error (SE) = 0.10) and diastolic (b = -0.56, SE = 0.07) blood pressure after adjusting for relevant risk factors; for those on antihypertensive medication, increasing positive emotion score was significantly associated with lower diastolic (b = -0.46, SE = 0.11) blood pressure, but not systolic blood pressure. Positive emotion was significantly associated with a four-level joint blood pressure variable. Each one-point increase in positive emotion score was associated with a 3% and 9% decreased odds of being in a higher blood pressure category for those on (odds ratio (OR) = 0.97; 95% confidence interval (CI) = 0.93-1.00) and not on (OR = 0.91; 95% CI = 0.89-0.93) antihypertensive medication, respectively. CONCLUSIONS: Findings indicate an association between high positive emotion and lower blood pressure among older Mexican Americans. Targeting the emotional health of older adults might be considered part of nonpharmacologic hypertension treatment programs or as part of adjunctive therapy for those on antihypertensive medication.

High anxiety is associated with an increased risk of death in an older tri-ethnic population.

BACKGROUND AND OBJECTIVES: The health consequences of anxiety in late life have not been adequately investigated. We sought to examine the association between anxiety and death in an older tri-ethnic population. METHODS: A longitudinal population-based study of 506 older noninstitutionalized non-Hispanic Whites, non-Hispanic Blacks, and Hispanics aged 75 years or older from Galveston County. RESULTS: Average age was 80.8 (SD 4.4) and 50.8% were women. Older non-Hispanic Whites (21.6%) reported the highest prevalence of anxiety, followed by Hispanics (12.4%) and non-Hispanic blacks (11.3%) (P=.0001). High anxiety was significantly associated with an increased hazard of all cause death (HR 1.52; 95% CI 1.02, 2.28) and cardiovascular death (HR 1.90; 95% CI 1.06, 3.36); and was associated with an increased hazard of cancer death (HR 2.38; 95% CI 0.88, 6.45) during 5-years of follow-up. CONCLUSION: There is a high prevalence of anxiety in late life. Our results indicate an association between anxiety and increased risk of death in persons aged 75 and older.

Cognitive status, body mass index, and hip fracture in older Hispanic adults.

OBJECTIVES: To examine the interactive effect of cognition and body weight on hip fracture. DESIGN: A 7-year (1993-2000) prospective cohort study. SETTING: Five southwestern states (Texas, New Mexico, Arizona, Colorado, and California). PARTICIPANTS: Noninstitutionalized Mexican Americans (N=2,653) aged 65 and older and free of hip fracture at baseline interview. MEASUREMENTS: Incidence of hip fracture at 2-, 5-, and 7-year follow-up interviews. Body weight and cognition were measured using body mass index (BMI) and Mini-Mental State Examination score, respectively. Covariates included sociodemographics, self-reported medical conditions, visual acuity, and Short Physical Performance Battery. RESULTS: A significant interaction between BMI and hip fracture was found in persons with cognitive impairment (hazard ratio =0.91, 95% confidence interval=0.85-0.98; P=.02), after adjusting for covariates. In the lowest BMI category, the hip fracture rate in cognitively impaired subjects was more than four times the hip fracture rate for subjects who were not cognitively impaired with the same BMI (34.6% vs 8.7%). Hip fracture rates in the highest BMI category were similar in persons with and without cognitive impairment (9.3% vs 6.1%). CONCLUSION: Low cognitive function increased the conditional association between BMI and hip fracture in older Mexican Americans. The relationship between BMI and cognition is potentially important in identifying persons at risk for hip fracture and supports the need to include cognitive and anthropometric measures in the assessment of hip fracture risk into osteoporosis screening programs.

Androgen treatment and muscle strength in elderly men: A meta-analysis.

OBJECTIVES: To review published, randomized trials examining the effect of androgen treatment on muscle strength in older men. DESIGN: Systematic review using meta-analysis procedures. SETTING: Computerized and manual searches. PARTICIPANTS: MEDLINE, EMBASE, CINAHL, and the Cochrane Register were searched for trials. Key words included testosterone, androgen, sarcopenia, muscle loss, aged, aging, elderly, older, geriatric, randomized controlled trials, and controlled clinical trials. Sixty-five nonoverlapping studies were found. Meta-analysis methods were used to evaluate the 11 randomized, double-blind trials. INTERVENTION: Testosterone or dihydrotestosterone (DHT) replacement therapy in healthy men aged 65 and older. MEASUREMENTS: Tests of muscle strength. RESULTS: The studies included 38 statistical comparisons. The mean g-index (g(i)) adjusted for sample size was 0.53 (95% confidence interval (CI) = 0.21-0.86). Subanalyses revealed larger effects for measures of lower extremity muscle strength (g(i) = 0.63, 95% CI = 0.03-1.28) than for upper extremity muscle strength (g(i) = 0.47, 95% CI = 0.12-0.84). A larger mean g-index was found for injected (g(i) = 0.95, 95% CI = 0.33-1.58) than topical (g(i) = 0.26, 95% CI = 0.08-0.42) or oral (g(i) = -0.21, 95% CI = -1.40-1.02) administration of testosterone/DHT. Effect sizes were related to study characteristics such as subject attrition and design-quality ratings. Sensitivity analyses revealed that the elimination of one study reduced the mean g-index from 0.53 to 0.23. CONCLUSION: The results suggest that testosterone/DHT therapy produced a moderate increase in muscle strength in men participating in 11 randomized trials. One study influenced the mean effect size.

Anxiety in persons 75 and older: findings from a tri-ethnic population.

PURPOSE: Little research has been reported about anxiety in older populations. We assessed the prevalence of anxiety and examined associations between anxiety and sociodemographic, physical, mental, and functional health characteristics in an older tri-ethnic population. DESIGN AND METHODS: A cross-sectional, population-based study of older, noninstitutionalized non-Hispanic Whites, non-Hispanic Blacks, and Hispanics was conducted from the baseline assessment of the Health of the Public (HoP) database. Measurements included a self-report anxiety scale and physical, mental, and functional health. Data were analyzed with general linear models and logistic regression models. RESULTS: Overall, 31.4% reported anxiety (score > or = 45); 32.3% of woman and 30.5% of men (P=.67). Older Hispanics (22.2%) reported the lowest prevalence of anxiety followed by non-Hispanic Blacks (26.6%) and non-Hispanic Whites (44.3%) (P=.0001). Common predictors of anxiety seen after linear and logistic regression included being married, White, and increasing number of medications and depressive symptoms. IMPLICATIONS: Anxiety is prevalent in older adults. The findings also indicate higher rates of anxiety in older non-Hispanic Whites compared with older non-Hispanic Blacks and Hispanics.