Alzheimer disease and mortality: a 15-year epidemiological study.

BACKGROUND: Alzheimer disease (AD) is considered a leading cause of death, but few studies have examined the contribution of AD to mortality based on follow-up of representative US cohorts. OBJECTIVE: To examine mortality rates, duration of survival, causes of death, and the contribution of AD to the risk of mortality in an aging community-based cohort, controlling for other predictors. DESIGN: Fifteen-year prospective epidemiological study. Mortality rates per 1000 person-years and the population-attributable risk of mortality were determined. Cox proportional hazards models were used to estimate relative risk of mortality due to AD, adjusting for relevant covariates. Death certificates were abstracted for listed causes of death. SETTING: A largely blue-collar rural community in southwestern Pennsylvania. PARTICIPANTS: A community-based cohort of 1670 adults 65 years and older at study enrollment. MAIN OUTCOME MEASURE: Mortality. RESULTS: In the overall cohort, AD was a significant predictor of mortality, with a hazard ratio of 1.4 after adjusting for covariates. The population-attributable risk of mortality from AD was 4.9% based on the same model. Examining the sexes separately, AD increased mortality risk only among women. Death certificates of AD subjects were more likely to list dementia/AD, other brain disorders, pneumonia, and dehydration, and less likely to include cancer. CONCLUSIONS: Alzheimer disease was responsible for 4.9% of the deaths in this elderly cohort. Alzheimer disease increased the risk of mortality 40% in the cohort as a whole and separately in women but not in men. The mean (SD) duration of survival with AD was 5.9 (3.7) years, and longer with earlier age at onset.

Gambling participation and social support among older adults: a longitudinal community study.

The purpose of this preliminary study was to examine associations between leaving home to engage in bingo or gambling activity and indices of physical and mental health and social support among a representative community cohort of 1016 elderly people. Cross-sectional and longitudinal data gathered from a prospective epidemiological study in a rural, low socio-economic status, area of Pennsylvania was employed. The cohort had a mean age of 78.8 (SD = 5.1) (range 71-97) and participated in three consecutive biennial "waves" of data collection. Nearly half (47.7) of the cohort reported gambling. To predict gambling, the independent variables included age, sex, education, employment, social support, depressive symptoms, self-rated health, alcohol use, cigarette use, and cognitive functioning. In cross-sectional, univariate analyses, gambling was associated with younger age, sex (male), fewer years of education, greater social support, lower depression scores, better self-rated health, alcohol use in the past year, and higher cognitive functioning. In a cross-sectional multiple regression model, younger age, greater social support, and alcohol use in the past year remain strongly and independently associated with gambling activity. Longitudinally, age, sex, social support, alcohol use, and gambling are predictive of future gambling activity. The results revealed that gambling may offer a forum of social support to older adults who are often isolated as they age.

Detection and management of cognitive impairment in primary care: The Steel Valley Seniors Survey.

OBJECTIVES: To identify characteristics of older primary care patients who were cognitively impaired and who underwent mental status testing by their physicians. DESIGN: Cross-sectional and retrospective analysis. SETTING: Seven small-town primary care practices. PARTICIPANTS: A total of 1,107 patients with a mean+/-standard deviation age of 76.3+/-6.6, screened using the Mini-Mental State Examination (MMSE); medical records reviewed. MEASUREMENTS: Demographics, MMSE, medical record information. Odds ratios (OR) with 95% confidence intervals (CI), adjusted for age, sex, and education. RESULTS: Thirty-one percent of the sample had MMSE scores of less than 25. Among these patients, physicians documented memory loss in only 23% which was significantly more often than in the higher scoring group (OR=1.9, 95% CI=1.3-2.8), basic activity of daily living (ADL) impairment in 7.9% (OR=2.4, 95% CI=1.3-4.4), instrumental ADL (IADL) impairment in 6.7% (OR=2.2, 95% CI=1.1=4.2), dementia in 12.2% (OR=3.7, 95% CI=2.0-6.8), and prescription of cholinesterase inhibitors in 7.6% (OR=4.4, 95% CI=1.9-10.2). Physicians recorded mental status testing largely in patients with research MMSE scores of 24 to 28, significantly more often when they also documented memory loss (OR=3.8, 95% CI=2.5-5.6) or impaired IADLs (OR=2.7, 95% CI=1.4-5.2), diagnosed dementia (OR=4.9, 95% CI=2.8-8.6), referred to specialists (OR=6.3, 95% CI=2.5-16.2) or social services (OR=3.6, 95% CI=1.8-7.3), or prescribed cholinesterase inhibitors (OR=8.5, 95% CI=4.2-17.5). CONCLUSION: Physicians noted impairment in a minority of impaired patients. They tested mental status in those with documented cognitive and functional difficulties, in very mildly impaired patients, and in those for whom they intervened.