Multiple Chronic Diseases Associated With Tooth Loss Among the US Adult Population.

Background: Half of US adults aged 20-64 years have lost at least one permanent tooth; one in six adults aged 65 and over in the USA is edentulous. Tooth loss and edentulism interfere with nutritional intake and quality of life. Although selected chronic diseases (e.g., diabetes) have been identified as possible risk factors for tooth loss, data on multiple chronic diseases and on having two or more concurrent chronic diseases (multimorbidity) in relation to tooth loss are lacking. Therefore, this study aimed to assess the association between multiple chronic diseases, multimorbidity, and tooth loss in US adults. Methods: We performed a secondary data analysis using the US 2012 Behavioral Risk Factor Surveillance System (BRFSS), a national cross-sectional telephone survey studying health conditions and health behaviors among US adults (≥18 years) who are non-institutionalized residents. Variables were derived from the BRFSS Standard Core Questionnaire. Descriptive analysis including means, standard deviations (SDs), and percentages was calculated. Sample weights were applied. The stepwise multinomial logistic regression method was used to examine the relationship between several chronic diseases and tooth loss. Separate multinomial logistic regression models were used to examine the relationship between multimorbidity and tooth loss among all adults aged more than 18 years, adults aged 18-64 years, and adults aged more than 65 years, respectively. Results: Among the samples (n = 471,107, mean age 55 years, 60% female), 55% reported losing no tooth loss, 30% reported losing one to five teeth, 10% reported losing six or more but not all teeth, and 5% reported losing all teeth. After adjusting for demographic characteristics, socioeconomic status, smoking, BMI, and dental care, chronic diseases that were associated with edentulism were chronic obstructive pulmonary disease (COPD) [adjusted risk ratio (adj. RR) 2.18, 95% confidence interval (CI) 2.08-2.29]; diabetes (adj. RR 1.49, 95% CI 1.44-1.56); arthritis (adj. RR 1.49, 95% CI 1.44-1.54); cardiovascular disease (adj. RR 1.38, 95% CI 1.30-1.45); stroke (adj. RR 1.31, 95% CI 1.24-1.40); kidney disease (adj. RR 1.16, 95% CI 1.08-1.25); cancer (adj. RR 1.05, 95% CI 1.01-1.11); and asthma (adj. RR 1.07, 95% CI 1.02-1.12). For those who reported losing six or more teeth, the association remained significant for all the chronic diseases mentioned, albeit the magnitude of association appeared to be comparative or smaller. In addition, adults with multimorbidity were more likely to have tooth loss (loss of one to five teeth: adj. RR 1.17, 95% CI 1.14-1.19; loss of six or more teeth: adj. RR 1.78, 95% CI 1.73-1.82; edentulous: adj. RR 2.03, 95% CI 1.96-2.10). Conclusions: Multiple chronic diseases were associated with edentulism and tooth loss. People with multimorbidity are more likely to be edentulous than those with one or no chronic disease. The findings from this study will help to identify populations at increased risk for oral problems and nutritional deficits, thus the assessment of oral health should be evaluated further as an important component of chronic illness care.

Disparities in Preventive Oral Health Care and Periodontal Health Among Adults With Diabetes.

INTRODUCTION: People with diabetes are more vulnerable to periodontal disease than those without; thus, practicing preventive oral health care is an important part of diabetes self-care. Our objective was to examine disparities in preventive oral health care among US adults with diabetes. METHODS: We performed a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Periodontal examinations were conducted in adults aged 30 and older. We compared the weighted prevalence of periodontal disease and the practice of preventive oral health care, including practicing dental interproximal cleaning (flossing or using other interproximal cleaning devices) and use of preventive dental services, among people with and without diabetes. Multivariable logistic regressions were performed to examine the relationship between the presence of diabetes, periodontal disease, and preventive oral health care practices. RESULTS: Weighted prevalence of periodontal disease in the US population was higher among adults with diabetes than those without (58.0% vs 37.6%). This difference persisted after controlling for sociodemographic characteristics and smoking status. People with diabetes were more likely to have periodontal disease (adjusted odds ratio [aOR] 1.39; 95% CI, 1.17-1.65), less likely to practice daily interproximal cleaning (aOR 0.85; 95% CI, 0.75-0.95), and less likely to visit a dentist for preventive care in the past year (aOR 0.86; 95% CI, 0.76-0.96) than people without diabetes. CONCLUSION: Adults with diabetes reported suboptimal preventive oral health care behaviors in use of preventive dental services and interproximal dental cleaning than people without diabetes, despite their health disparity related to periodontal disease. Educating people to improve their preventive oral health care is essential for good oral health and diabetes self-management.

Temporal Trends and Familial Clustering of Ideal Cardiovascular Health in Parents and Offspring Over the Life Course: An Investigation Using The Framingham Heart Study.

Background Evidence suggests familial aggregation and intergenerational associations for individual cardiovascular health (CVH) metrics. Over a 53-year life course, we examined trends and association of CVH between parents and their offspring at similar mean ages. Methods and Results We conducted a series of cross-sectional analyses of the FHS (Framingham Heart Study). Parent-offspring pairs were assessed at exams where their mean age distributions were similar. Ideal CVH was defined using 5 CVH metrics: blood pressure (<120/<80 mm Hg), fasting blood glucose (<100 mg/dL), blood cholesterol (<200 mg/dL), body mass index (<25 kg/m2), and non-smoking. Joinpoint regression and Chi-squared test were used to assess linear trend; proportional-odds regression was used to examine the association between parents and offspring CVH. A total of 2637 parents were paired with 3119 biological offspring throughout 6 exam cycles. Similar patterns of declining ideal CVH with advancing age were observed in parents and offspring. Small proportions of parents (4%) and offspring (17%) achieved 5 CVH metrics at ideal levels (P-trend <0.001). Offspring of parents with poor CVH had more than twice the odds of having poor CVH (pooled odds ratio, 2.59; 95% CI, 1.98-3.40). Over time, elevated glucose levels and obesity doubled among the offspring and were the main drivers for declining ideal CVH trends. Conclusions Parental CVH was positively associated with offspring CVH. However, intergenerational CVH gains from declining smoking rates, cholesterol, and blood pressure were offset by rising offspring obesity and elevated glucose levels. This suggests an intergenerational phenotypic shift of risk factors and the need for a family-centered approach to cardiovascular care.

Persistence of pain quality in community-dwelling older adults with chronic non-cancer pain.

Longitudinal assessment of chronic geriatric pain is complicated by an age-associated plateau in pain severity and increase in widespread pain, calling for innovative measures such as pain quality descriptors that characterize how pain may feel. We characterized persistence of pain quality and its relation to severity, activity interference and distribution of sites, in a population-based sample of adults aged≥70 years with chronic pain (n = 398). Persistent pain quality was defined as reporting descriptors within the same category: sensory, cognitive/affective, or neuropathic at baseline and 18 months. A count variable indicated number of persistent categories. Pain quality was highly persistent. Adjusted for baseline covariates, individuals endorsing 3 persistent categories were 2-2.5x more likely to experience more widespread pain at 18 months compared to fewer persistent categories. No associations were noted in changes in pain severity or interference. A comprehensive pain assessment that includes diverse pain quality descriptors may improve individualized pain management.

Cost-effectiveness of the non-laboratory based Framingham algorithm in primary prevention of cardiovascular disease: A simulated analysis of a cohort of African American adults.

The non-lab Framingham algorithm, which substitute body mass index for lipids in the laboratory based (lab-based) Framingham algorithm, has been validated among African Americans (AAs). However, its cost-effectiveness and economic tradeoffs have not been evaluated. This study examines the incremental cost-effectiveness ratio (ICER) of two cardiovascular disease (CVD) prevention programs guided by the non-lab versus lab-based Framingham algorithm. We simulated the World Health Organization CVD prevention guidelines on a cohort of 2690 AA participants in the Atherosclerosis Risk in Communities (ARIC) cohort. Costs were estimated using Medicare fee schedules (diagnostic tests, drugs & visits), Bureau of Labor Statistics (RN wages), and estimates for managing incident CVD events. Outcomes were assumed to be true positive cases detected at a data driven treatment threshold. Both algorithms had the best balance of sensitivity/specificity at the moderate risk threshold (>10% risk). Over 12years, 82% and 77% of 401 incident CVD events were accurately predicted via the non-lab and lab-based Framingham algorithms, respectively. There were 20 fewer false negative cases in the non-lab approach translating into over $900,000 in savings over 12years. The ICER was -$57,153 for every extra CVD event prevented when using the non-lab algorithm. The approach guided by the non-lab Framingham strategy dominated the lab-based approach with respect to both costs and predictive ability. Consequently, the non-lab Framingham algorithm could potentially provide a highly effective screening tool at lower cost to address the high burden of CVD especially among AA and in resource-constrained settings where lab tests are unavailable.

Physical Activity Domains/Recommendations and Leukocyte Telomere Length in U.S. Adults.

PURPOSE: The purpose of this study was to examine the associations between different physical activity (PA) domains, PA recommendations, and leukocyte telomere length (LTL) using data from a nationally representative sample of U.S. adults in the National Health and Nutrition Examination Survey, 1999-2002. METHODS: A total of 6933 U.S. adults (3402 men, 3531 women; age range: 20-84 yr) who completed demographic, general health and PA questionnaires and provided a blood sample were included in the analyses. Multivariable-adjusted linear regression models were used to determine associations between PA (domain-specific PA [household/yard work PA, transportation PA, moderate leisure time PA (LTPA), and vigorous LTPA], total moderate PA and PA recommendation groups), and log-transformed LTL adjusting for age, gender, education, cigarette smoking, alcohol consumption, and body mass index. RESULTS: On average, an increase of 1 h·wk of vigorous LTPA was associated with a 0.31% (P < 0.001) longer LTL, and an increase of 1 h·wk of household/yard work PA was associated with a 0.21% (P = 0.03) shorter LTL while adjusted for sociodemographic and health behavior covariates. Neither transportation PA nor moderate LTPA was significantly associated with LTL. In addition, compared with not meeting the PA recommendation (<150 min·wk), exceeding the recommended PA levels (≥300 min·wk) was positively associated with longer LTL (P = 0.04), whereas there was no difference in telomere length between those not meeting versus those meeting the PA recommendation (150-299 min·wk). CONCLUSION: Greater engagement in vigorous LTPA and exceeding the PA recommendation may have a protective effect against telomere shortening. Future studies should examine the association between PA and LTL by exploring potential mediators such as sedentary behavior, genetics, nutrition, and chronic diseases.

Pain severity and pharmacologic pain management among community-living older adults: the MOBILIZE Boston study.

BACKGROUND: Concerns about polypharmacy and medication side effects contribute to undertreatment of geriatric pain. This study examines use and effects of pharmacologic treatment for persistent pain in older adults. METHODS: The MOBILIZE Boston Study included 765 adults aged ≥70 years, living in the Boston area, recruited from 2005 to 2008. We studied 599 participants who reported chronic pain at baseline. Pain severity, measured using the Brief Pain Inventory (BPI) severity subscale, was grouped as very mild (BPI <2), mild (BPI 2-3.99), and moderate to severe (BPI 4-10). Medications taken in the previous 2 weeks were recorded from medication bottles in the home interview. RESULTS: Half of participants reported using analgesic medications in the previous 2 weeks. Older adults with moderate to severe pain were more likely to use one or more analgesic medications daily than those with very mild pain (49 versus 11%, respectively). The most commonly used analgesic was acetaminophen (28%). Opioid analgesics were used daily by 5% of participants. Adjusted for health and demographic factors, pain severity was strongly associated with daily analgesic use (moderate-severe pain compared to very mild pain, adj. OR 7.19, 95% CI 4.02-12.9). Nearly one third of participants (30%) with moderate to severe pain felt they needed a stronger pain medication while 16% of this group were concerned they were using too much pain medication. CONCLUSION: Serious gaps persist in pain management particularly for older adults with the most severe chronic pain. Greater efforts are needed to understand barriers to effective pain management and self-management in the older population.

Health-related quality of life after surgical treatment in patients with non-small cell lung cancer: a systematic review.

INTRODUCTION: Surgical resection currently is the best available treatment to enhance long-term survival after non-small cell lung cancer (NSCLC). With the anticipated growth in the number of NSCLC survivors diagnosed through computed tomography screening, health-related quality of life (HR-QOL) as an endpoint of treatment will become increasingly important. This article is a systematic review of the literature regarding HR-QOL in patients after surgical treatment. METHODS: Three computerized databases (PubMed, Medline, and CINHAL) were used to identify relevant articles. Inclusion criteria were: empirical studies English language, assessment of HR-QOL after surgical treatment for stage I, II, or III NSCLC, and publication prior to January 2012. Data were abstracted and content analyses were used to synthesize the findings. RESULTS: Nineteen out of 337 studies were reviewed. The majority of participants (67%) had stable or improved mental HR-QOL at 6-months after surgery. Compared with the general population, however, NSCLC survivors have poorer mental HR-QOL. Compared to pre-surgical status, participants had worse physical function at 6-months after surgery and had decreased physical function up to 2-years after surgery. Pain, fatigue, dyspnea and coughing were the most prevalent symptoms. Increased levels of dyspnea and fatigue persisted for at least 2-years after surgery. Continued smoking, presence of comorbidities, extensive surgical resection, and use of adjuvant therapy were associated with lower HR-QOL. CONCLUSIONS: New interventions focused on smoking cessation, improving symptom control and physical function are needed to enhance HR-QOL after lung cancer surgery.

Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead.

BACKGROUND: Little information exists about what primary care physicians (PCPs) and patients experience if patients are invited to read their doctors' office notes. OBJECTIVE: To evaluate the effect on doctors and patients of facilitating patient access to visit notes over secure Internet portals. DESIGN: Quasi-experimental trial of PCPs and patient volunteers in a year-long program that provided patients with electronic links to their doctors' notes. SETTING: Primary care practices at Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Washington. PARTICIPANTS: 105 PCPs and 13,564 of their patients who had at least 1 completed note available during the intervention period. MEASUREMENTS: Portal use and electronic messaging by patients and surveys focusing on participants' perceptions of behaviors, benefits, and negative consequences. RESULTS: 11,155 [corrected] of 13,564 patients with visit notes available opened at least 1 note (84% at BIDMC, 82% [corrected] at GHS, and 47% at HMC). Of 5219 [corrected] patients who opened at least 1 note and completed a postintervention survey, 77% to 59% [corrected] across the 3 sites reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to 36% had privacy concerns; 1% to 8% reported that the notes caused confusion, worry, or offense; and 20% to 42% reported sharing notes with others. The volume of electronic messages from patients did not change. After the intervention, few doctors reported longer visits (0% to 5%) or more time addressing patients' questions outside of visits (0% to 8%), with practice size having little effect; 3% to 36% of doctors reported changing documentation content; and 0% to 21% reported taking more time writing notes. Looking ahead, 59% to 62% of patients believed that they should be able to add comments to a doctor's note. One out of 3 patients believed that they should be able to approve the notes' contents, but 85% to 96% of doctors did not agree. At the end of the experimental period, 99% of patients wanted open notes to continue and no doctor elected to stop. LIMITATIONS: Only 3 geographic areas were represented, and most participants were experienced in using portals. Doctors volunteering to participate and patients using portals and completing surveys may tend to offer favorable feedback, and the response rate of the patient surveys (41%) may further limit generalizability. CONCLUSION: Patients accessed visit notes frequently, a large majority reported clinically relevant benefits and minimal concerns, and virtually all patients wanted the practice to continue. With doctors experiencing no more than a modest effect on their work lives, open notes seem worthy of widespread adoption. PRIMARY FUNDING SOURCE: The Robert Wood Johnson Foundation, the Drane Family Fund, the Richard and Florence Koplow Charitable Foundation, and the National Cancer Institute.

Statin use and musculoskeletal pain among adults with and without arthritis.

BACKGROUND: Musculoskeletal symptoms are common adverse effects of statins, yet little is known about the prevalence of musculoskeletal pain and statin use in the general population. METHODS: We conducted a cross-sectional study of the National Health and Nutrition Examination Survey 1999-2004. We estimated the prevalence of self-reported musculoskeletal pain according to statin use and calculated prevalence ratio estimates of musculoskeletal pain obtained from adjusted multiple logistic regression modeling. RESULTS: Among 5170 participants without arthritis, the unadjusted prevalence of musculoskeletal pain was significantly higher for statin users reporting pain in any region (23% among statin users, 95% confidence interval [CI], 19-27, compared with 18% among those not using statins, 95% CI, 17-20; P=.02) and in the lower extremities (12% among statin users, 95% CI, 8-16, compared with 8% among those not using statins, 95% CI, 7-9; P=.02). Conversely, among 3058 participants with arthritis, statin use was not associated with higher musculoskeletal pain in any region. After controlling for confounders, among those without arthritis, statin use was associated with a significantly higher prevalence of musculoskeletal pain in any region, the lower back, and the lower extremities (adjusted prevalence ratios: 1.33 [CI, 1.06-1.67]; 1.47 [CI, 1.02-2.13]; 1.59 [CI, 1.12-2.22], respectively). Among participants with arthritis, no association was observed between musculoskeletal pain and statin use on adjusted analyses. CONCLUSION: In this population-based study, statin use was associated with a higher prevalence of musculoskeletal pain, particularly in the lower extremities, among individuals without arthritis. Evidence that statin use was associated with musculoskeletal pain among those with arthritis was lacking.

Obesity, race, and risk for death or functional decline among Medicare beneficiaries: a cohort study.

BACKGROUND: The adverse effect of obesity on health outcomes may be lower in older and African American adults than in the general U.S. population. OBJECTIVE: To examine and compare the relationship between obesity and all-cause mortality and functional decline among older U.S. adults. DESIGN: Longitudinal cohort study. SETTING: Secondary analysis of data from the 1994 to 2000 Medicare Current Beneficiary Surveys, linked to Medicare enrollment files through 22 April 2008. PARTICIPANTS: 20,975 community-dwelling participants in the 1994 to 2000 Medicare Current Beneficiary Surveys who were aged 65 years or older. MEASUREMENTS: All-cause mortality through 22 April 2008; new or worsening disability in performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in 2 years. RESULTS: 37% of the study sample were overweight (body mass index [BMI] of 25 to <30 kg/m(2)), 18% were obese (BMI ≥30 kg/m(2)), 48% died during the 14-year follow-up, and 27% had ADL and 43% had IADL disability at baseline. Among those without severe disability at baseline, 17% developed new or worsening ADL disability and 26% developed new or worsening IADL disability within 2 years. After adjustment, adults with a BMI of 35 kg/m(2) or greater were the only group above the normal BMI range who had a higher risk for mortality (hazard ratio, 1.49 [95% CI, 1.20 to 1.85] in men and 1.21 [CI, 1.06 to 1.39] in women, compared with the reference group [BMI of 22.0 to 24.9 kg/m(2)]; P for BMI-sex interaction = 0.003). In contrast, both overweight and obesity were associated with new or progressive ADL and IADL disability in a dose-dependent manner, particularly for white men and women. Significant interactions were detected between BMI and sex but not between BMI and race for any outcome, although risk estimates for ADL disability seemed attenuated in African American relative to white respondents. LIMITATION: This was an observational study, baseline data were self-reported, and the study had limited power to detect differences between white and African American respondents. CONCLUSION: Among older U.S. adults, obesity was not associated with mortality, except for those with at least moderately severe obesity. However, lower levels of obesity were associated with new or worsening disability within 2 years. Efforts to prevent disability in older adults should target those who are overweight or obese. PRIMARY FUNDING SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases.

Tender point count, pain, and mobility in the older population: the mobilize Boston study.

UNLABELLED: Prevalence of tender points (TP), and widespread pain and fibromyalgia, as well as the relationship between TP and widespread pain and mobility, was examined in 585 community-dwelling older adults (mean age 78.2 years, 63.4% female). Pain was based on location (none, single site, multisite, widespread). Mobility was measured by the Short Physical Performance Battery (SPPB), gait speed, and self-reported (S-R) mobility difficulty. Tender-point count and health characteristics (ie, BMI, chronic conditions, analgesic use, number of medications, depression, and blocks walked per week) were assessed. Several participants had 3 or more TP (22.1%) although prevalence of criteria-based fibromyalgia was low (.3%). Mobility was more limited in persons with higher tender-point counts. After adjustment for pain and other risk factors, higher tender-point count was associated with poorer SPPB performance (score < 10, aOR = 1.09 per TP, 95%CI, 1.01-1.17), and slow gait speed (< .784m/sec, aOR = 1.14 per TP, 95%CI, 1.05-1.24), but not with S-R mobility difficulty. S-R mobility difficulty was associated with more disseminated pain (multisite pain, aOR = 2.01, 95%CI, 1.21-3.34; widespread pain, aOR = 2.47, 95%CI, 1.09-5.62). These findings portray a significant mobility burden related to tender-point count and multisite and widespread pain in the older population. Future studies using longitudinal methods are warranted. PERSPECTIVE: Higher tender-point count, multisite pain, and widespread pain are common in community-dwelling older adults and associated with mobility problems. Both the manual tender-point exam and the McGill Pain Map may provide important yet different information about risks for mobility disability in older individuals.

Preventive health care among older women: missed opportunities and poor targeting.

BACKGROUND: Experts recommend that clinicians target mammography and colon cancer screening to individuals with at least 5 years life expectancy. Generally, immunizations and exercise counseling are recommended for all women aged > or =65 years, while Pap smears are generally not encouraged for these women. METHODS: We used the 2005 National Health Interview Survey to examine receipt of several preventive health measures simultaneously among community dwelling US women aged > or =65 years by age and health status. We used functional status, significant diseases, and perceived health to categorize women into those most likely to be in above-average, average, or below-average health status. We used age and health status to estimate life expectancy. RESULTS: Of 4683 participants, 25.8% were > or =80 years; 81.8% were non-Hispanic white; 21% were in above-average and 20% were in below-average health status. Receipt of mammography and colon cancer screening decreased with age and was not associated with health status for women aged > or =80 years. Nearly half (49%) of women aged > or =80 years in below-average health received mammography screening, while 19% of women aged 65-79 years in above-average health did not report receiving mammography. Nearly half of women aged 65-79 years (49%) in above-average health did not report receiving colon cancer screening. Pap smear screening was common among older women. Few (34%) reported receiving exercise counseling. Many did not report receiving pneumococcal (43%) or flu vaccinations (40%). CONCLUSIONS: In our comprehensive review of preventive health measures for older women, we found evidence to suggest a need to improve delivery and targeting of preventive health services.

Screening for chronic conditions using a patient internet portal: recruitment for an internet-based primary care intervention.

BACKGROUND: Patient Internet portals have created new opportunities for assessment and management of chronic conditions. OBJECTIVE: To conduct an online screening survey for a study recruitment using a secure patient Internet portal to identify primary care patients with untreated depression, chronic pain, or mobility difficulty before nonurgent office visits. DESIGN: Internet-based screening survey for a randomized trial. PARTICIPANTS: Patients who were registered portal users who had scheduled primary care appointments. APPROACH: Electronic study invitations via the portal were sent to 4,047 patients with scheduled visits to 34 primary care physicians participating in the study. After clicking on a link in the study invitation, patients were consecutively shown the study description, consent form, and lastly, the screening survey to determine final eligibility for study participation. RESULTS: Of the 2,113 (52%) patients who opened the study invitation, 1,001 consented online to join the study and 981 (98%) of these completed the screening survey. Of the respondents, 319 (33%) screened positive for 1 or more of the 3 conditions. CONCLUSIONS: The online screening survey conducted through the patient portal was effective in identifying patients with chronic conditions in advance of scheduled primary care visits for participation in an intervention study.

Does gynecologic surgery contribute to low back problems in later life? An analysis of the women's health and aging study.

OBJECTIVE: To examine whether women with potential injuries to the abdominal and pelvic musculature from past gynecologic surgery are at higher risk for low back pain (LBP). DESIGN: Cross-sectional population-based study. SETTING: Eastern region of the city and county of Baltimore, MD. PARTICIPANTS: Disabled women (N=1002) aged 65 and older, 448 of whom reported gynecologic surgery who were participants in the Women's Health and Aging Study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: LBP presence in the last year, LBP severity for the last month, and adjudicated lumbar diagnoses (disk disease, stenosis) were examined in relation to reports of surgical menopause or ovarian surgery adjusted for LBP risk factors. RESULTS: Women with surgical menopause experienced more moderate LBP (adjusted odds ratio [AOR]=1.59; 95% confidence interval [CI], 1.1-2.3) than women without surgical menopause. Women with ovarian surgery also experienced more moderate LBP than women without ovarian surgery, but this association was not statistically significant (AOR=1.39; 95% CI, 0.96-2.09). Gynecologic surgery was not associated with an increased likelihood of lumbar disk disease or stenosis. CONCLUSIONS: Surgical menopause may increase the risk of moderate LBP. Further research is needed to determine how gynecologic surgery might influence low back pathology. Abdominal and pelvic muscle rehabilitation after gynecologic surgery may provide protection from LBP later in life.

Advancing the taxonomy of disability in older adults.

BACKGROUND: Refinement of the traditional task-based classification of disability is needed to advance the field of disability research and to inform clinical practice. We propose an enhancement of the taxonomy of disability that incorporates information about symptoms and impairments that directly contribute to disability. In the first step of this new development, we present evidence to support five categories of disability related to pain, balance, weakness, endurance, and other symptoms. METHODS: The Women's Health and Aging Study, begun in 1992, was a population-based study of older disabled women living in the Eastern region of Baltimore and surrounds. In-home examinations were conducted every 6 months for 3 years. During the second examination, the 879 participants were asked the main symptom cause of their disability for each activity with which they had difficulty. Symptom causes of disability in activities of daily living were grouped into five nonmutually exclusive categories as stated above. Descriptive analyses were used to compare groups according to sociodemographic, health, disease, and physical performance information. RESULTS: Women with pain-related disability were younger, more obese, and had high prevalence of widespread pain and symptomatic osteoarthritis. Balance-related disability was related to having an age of 85 years or older, being Caucasian, and poor performance in tests of standing balance and gait. Women with weakness-related disability were older, more often African American and sedentary, had high prevalence of stroke and diabetes, and performed poorly in chair-stands and knee strength tests. Endurance-related disability was associated with low self-rated energy, depressive symptoms, smoking history, and lung and cardiovascular diseases. CONCLUSIONS: The proposed refinement of the taxonomy of disability describes a set of empirically derived symptom and impairment-related disability groupings that have criterion and face validity. Further research about symptom and impairment-related disability in other populations of older persons is warranted.

Change in muscle strength explains accelerated decline of physical function in older women with high interleukin-6 serum levels.

OBJECTIVES: To test whether accelerated sarcopenia in older persons with high interleukin (IL)-6 serum levels plays a role in the prospective association between inflammation and disability found in many studies. DESIGN: Cohort study of older women with moderate to severe disability. PARTICIPANTS: Six hundred twenty older women from the Women's Health and Aging Study in whom information on baseline IL-6 serum level was available. MEASUREMENTS: Self-report of functional status, objective measures of walking performance, and knee extensor strength were assessed at baseline and over six semiannual follow-up visits. Potential confounders were baseline age, race, body mass index, smoking, depression, and medical conditions. RESULTS: At baseline, women with high IL-6 were more often disabled and had lower walking speed. After adjusting for confounders, women in the highest IL-6 tertile (IL-6>3.10 pg/mL) were at higher risk of developing incident mobility disability (risk ratio (RR) = 1.50, 95% confidence interval (CI) = 1.01-2.27), disability in activities of daily living (RR = 1.41, 95% CI = 1.01-1.98), and severe limitation in walking (RR = 1.61, 95% CI = 1.09-2.38) and experienced steeper declines in walking speed (P <.001) than women in the lowest IL-6 tertile (IL-6 < or =1.78 pg/mL). Decline in knee extensor strength was also steeper, but differences across IL-6 tertiles were not significant. After adjusting for change over time in knee extensor strength, the association between high IL-6 and accelerated decline of physical function was no longer statistically significant. CONCLUSIONS: Older women with high IL-6 serum levels have a higher risk of developing physical disability and experience a steeper decline in walking ability than those with lower levels, which are partially explained by a parallel decline in muscle strength.

Musculoskeletal pain and risk for falls in older disabled women living in the community.

OBJECTIVES: To determine whether musculoskeletal pain increased risk for falls in older women with disabilities. DESIGN: Prospective population-based cohort study. SETTING: The city and county of the eastern area of Baltimore. PARTICIPANTS: One thousand two women aged 65 and older, participants in the Women's Health and Aging Study, representing the one-third of older women who were living at home with disabilities, followed semiannually for 3 years beginning in 1991. MEASUREMENTS: Pain was categorized into four groups according to severity and location. Widespread pain was defined as pain in the upper and lower extremities and in the axial skeletal region, with moderate to severe pain in at least one region (> or = 4 on a 10-point numeric rating scale, 10 = excruciating pain). Moderate to severe lower extremity pain that did not meet criteria for widespread pain was the next category. The reference category was no pain or mild pain in one site. The additional category of "other pain" was pain that did not fit into the other three groups. The occurrence of falls and fall-related injuries were assessed at each interview. RESULTS: Of the 940 women who participated in at least one follow-up examination, 39% fell in first year; of the survivors, 36% fell in Year 2, and 39% in Year 3. After adjusting for several major risk factors for falls, women with widespread pain had an increased likelihood of falling during follow-up (adjusted odds ratio (AOR) = 1.66, 95% confidence interval (CI) = 1.25-2.21) compared with those with no or mild pain in only one musculoskeletal site. Women who had other musculoskeletal pain but not widespread pain or lower extremity pain also had an increased risk of falls (AOR = 1.36, 95% CI = 1.02-1.82). Among women with musculoskeletal pain, risk for falls was lower in those who used daily analgesic medication. Risk for recurrent falls and self-reported fractures due to falls was also elevated in women with musculoskeletal pain, most consistently in women with widespread pain. CONCLUSIONS: Musculoskeletal pain, particularly widespread pain, is a substantial risk factor for falls in older women with disabilities. These findings add an important dimension to our understanding of the multifactorial processes leading to falls in older persons.