A pharmacoepidemiologic study of community-dwelling, disabled older women: Factors associated with medication use.

BACKGROUND: Although disabled older adults may be among the subpopulation of adults with the highest risk for adverse drug events (ADEs), reliable data on their use of medications are limited. OBJECTIVES: The aims of this study were to describe the extent and patterns of medication use in community-dwelling, disabled older women, and to identify factors associated with medication use in this population. METHODS: Cross-sectional analyses of baseline data on medication use from the Women's Health and Aging Study I (WHAS I) were performed. WHAS I was an observational study of 1002 community-dwelling women aged >or=65 years who self-reported difficulty in at least 2 of 4 domains of physical functioning (ie, upper-extremity functions, mobility, self-care, and higher functioning tasks needed for independent living in the community). After descriptive analyses of their prescription and over-the-counter (OTC) drugs, associations between participants' characteristics and medication utilization were determined, using generalized linear models. RESULTS: Of the 975 participants, 580 (59.5%) used >or=5 medications and 115 (11.8%) used >or=10 medications (prescriptions and OTCs). The mean number of medications used was 3.9 for prescription drugs and 1.9 for OTC drugs. Cardiovascular drugs and analgesics were the most frequently used prescription and OTC drugs, respectively. Participants with complete outcome and covariate data (n = 803) were included in the multivariate analyses. Cancer was associated with a 13% increase in total medication use (95% CI, 1.00-1.27). Multimorbidity (1.08; 95% CI, 1.02-1.15), frailty (1.13; 95% CI, 1.02-1.26), high Mini-Mental State Examination score (1.03; 95% CI, 1.01-1.05), congestive heart failure (CHF) (1.39; 95% CI, 1.23-1.58), angina (1.27; 95% CI, 1.12-1.44), chronic obstructive pulmonary disease (COPD) (1.20; 95% CI, 1.05-1.37), diabetes mellitus (DM) (1.24; 95% CI, 1.07-1.43), difficulty with shopping for personal items such as medicines and toiletries (1.20; 95% CI, 1.06-1.35), and possession of health insurance (1.21; 95% CI, 1.04-1.40) or a prescription plan (1.16; 95% CI, 1.05-1.29) were independently associated with increased use of prescription drugs. A diagnosis of osteoarthritis of the hands (1.29; 95% CI, 1.121.49) and having a spouse (1.19; 95% CI, 1.01-1.40) were associated with increased use of OTC drugs. Participants with DM (0.78; 95% CI, 0.65-0.94), African Americans (0.70; 95% CI, 0.60-0.82), and those who had difficulty shopping (0.85; 95% CI, 0.72-0.99) used fewer OTCs than did participants without these characteristics. CONCLUSIONS: Most of the disabled older women in this study took >=5 medications at baseline, potentially putting them at high risk for ADEs. Those with multimorbidity, frailty, CHF, angina, DM, COPD, cancer, and difficulty with instrumental activities of daily living are target subpopulations for polypharmacy intervention.

Soluble transferrin receptor as an indicator of iron deficiency in HIV-infected infants.

BACKGROUND: Iron deficiency is common in human immunodeficiency virus (HIV)-infected infants in sub-Saharan Africa. It is not known whether soluble transferrin receptor (sTfR) is a good indicator of iron deficiency in infants with HIV. METHODS: We evaluated sTfR as an indicator of iron deficiency in 134 HIV-infected 9-month-old infants in Kampala, Uganda. Ferritin <12 microg/L and microcytic, hypochromic anaemia were used as indicators of iron deficiency, respectively. The presence of inflammation was indicated by C-reactive protein >5 mg/L or alpha1-acid glycoprotein >1 g/L. RESULTS: Receiver operator characteristic curves showed that the area under the curve was 0.67 when sTfR receptor was compared with low ferritin and 0.71 when sTfR was compared with microcytic, hypochromic anaemia. The appropriate calculated cut-offs of sTfR >3.74 microg/mL (43.98 nmol/L) and >3.53 microg/mL (41.55 nmol/L) show adequate specificities of 60% and sensitivities of 63% and 69% for low ferritin and microcytic, hypochromic anaemia, respectively. C-reactive protein and alpha 1-acid glycoprotein were strongly correlated with serum ferritin (r=0.371 and r=0.458, respectively, both p<0.0001) but were not correlated with sTfR (r=0.009 and r= -0.003, respectively, both p=0.9). In all, 78.6% of infants had alpha l-acid glycoprotein >1 g/L and 54.7% had C-reactive protein >5 g/L. CONCLUSIONS: Soluble TfR appears to be an adequate indicator of iron deficiency in HIV-infected infants.

Paternal smoking is associated with increased risk of child malnutrition among poor urban families in Indonesia.

OBJECTIVE: Paternal smoking is highly prevalent in Asia, and tobacco may account for a large proportion of household expenditures among poor families. We sought to characterise the relationship between paternal smoking, child malnutrition and food expenditures. DESIGN: Data on smoking, household expenditures and child malnutrition were examined in a stratified multistage cluster sample of households in the Indonesia nutrition surveillance system. Main outcome measures were child wasting (weight-for-height Z-score < - 2), underweight (weight-for-age Z-score < - 2) and stunting (height-for-age Z-score < - 2), and severe wasting, underweight and stunting (defined by respective Z-scores < - 3). SETTING: In total, 175,583 households from urban slum areas in Indonesia. SUBJECTS: Children 0-59 months of age. RESULTS: The prevalence of paternal smoking was 73.8%. After adjusting for child gender and age, maternal age and education, and weekly per capita household expenditures, paternal smoking was associated with child stunting (odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.08-1.14, P < 0.0001), severe wasting (OR = 1.17, 95% CI 1.03-1.33, P = 0.018) and severe stunting (OR = 1.09, 95% CI 1.04-1.15, P < 0.001). In households where the father was a smoker, tobacco accounted for 22% of weekly per capita household expenditures, with less money spent on food compared with households in which the father was a non-smoker. CONCLUSIONS: Among poor families in urban slum areas of Indonesia, paternal smoking diverts household money from food to tobacco and exacerbates child malnutrition.

Vitamin and carotenoid status in older women: associations with the frailty syndrome.

OBJECTIVE: We investigated the relationship of micronutrient deficiencies with the frailty syndrome in older women living in the community. METHODS: Frailty status and serum micronutrients were assessed in a cross-sectional study of 754 women, 70-80 years old, from the Women's Health and Aging Studies I and II. RESULTS: Among nonfrail, prefrail, and frail women, respectively, geometric mean serum concentrations were 1.842, 1.593, and 1.376 micromol/L for total carotenoids (p <.001); 2.66, 2.51, and 2.43 micromol/L for retinol (p =.04); 50.9, 47.4, and 43.8 nmol/L for 25-hydroxyvitamin D (p =.019); 43.0, 35.8, and 30.9 nmol/L for vitamin B(6) (p =.002); and 10.2, 9.3, and 8.7 ng/mL for folate (p =.03). Frail women were more likely to have at least two or more micronutrient deficiencies (p =.05). The age-adjusted odds ratios of being frail were significantly higher for those participants whose micronutrient concentrations were in the lowest quartile compared to the top three quartiles for total carotenoids, alpha-tocopherol, 25-hydroxyvitamin D, and vitamin B(6). The association between nutrients and frailty was strongest for beta-carotene, lutein/zeaxanthin, and total carotenoids (odds ratio ranging from 1.82 to 2.45, p =.05), after adjusting for age, sociodemographic status, smoking status, and body mass index. CONCLUSION: Frail women are more likely to have relatively low serum carotenoid and micronutrient concentrations and are more likely to have multiple micronutrient deficiencies. Future longitudinal studies are needed to examine the relationships between micronutrient concentrations and frailty in older women.

Low serum selenium and total carotenoids predict mortality among older women living in the community: the women's health and aging studies.

Selenium and the carotenoids play an important role in antioxidant defenses and in the redox regulation involved in inflammation. We tested the hypothesis that low selenium and carotenoids predict mortality in older women living in the community. Women who were enrolled in the Women's Health and Aging Studies I and II in Baltimore, MD (n = 632; 70-79 y old) had serum selenium and carotenoids measured at baseline and were followed for mortality over 60 mo. Median (minimum, maximum) serum selenium and carotenoids were 1.53 (0.73, 2.51) micromol/L and 1.67 (0.13, 9.10) micromol/L; 14.1% of the women died. The 5 major causes of death were heart disease (32.6%), cancer (18.0%), stroke (9.0%), infection (6.7%), and chronic obstructive pulmonary disease (5.6%). Adjusting for age, education, smoking, BMI, poor appetite, and chronic diseases, higher serum selenium [hazard ratio (HR) 0.71, 95% CI 0.56-0.90/1 SD increase in log(e) selenium; P = 0.005] and higher serum total carotenoids (HR 0.77, 95% CI 0.64-0.84/1 SD increase in log(e) total carotenoids; P = 0.009) were associated with a lower risk of mortality. Women living in the community who have higher serum selenium and carotenoids are at a lower risk of death.

Iron status and anemia in a population-based study of women with and without disability living in the community: the Women's Health and Aging Studies.

Iron status and associated risk factors were assessed in a population-based study of 684 community-dwelling women, 70-79 years old. Iron deficiency, iron deficiency anemia, and elevated iron stores were found in 5.8%, 3.8%, and 9.0% of women, respectively. The prevalence of both anemia and iron deficiency anemia increased significantly with increasing disability.

Vitamin A deficiency, iron deficiency, and anemia among preschool children in the Republic of the Marshall Islands.

OBJECTIVE: We investigated the co-occurrence of vitamin A deficiency, iron deficiency, and anemia among young children in the Republic of the Marshall Islands. METHODS: Hemoglobin, serum retinol, and serum ferritin were assessed in the Republic of the Marshall Islands Vitamin A Deficiency Study, a community-based survey that involved 919 children ages 1 to 5 y. RESULTS: The proportion of children with vitamin A deficiency (serum retinol concentrations < 0.70 microM/L) was 59.9%. The prevalences of anemia (hemoglobin < 110 g/L), iron deficiency (serum ferritin < 12 microg/L), and iron deficiency anemia (iron deficiency and anemia) were 36.4%, 53.5%, and 23.8%, respectively. The proportion of children who had co-occurrence of vitamin A and iron deficiencies was 33.2%. The mean ages of children with and without vitamin A deficiency were 3.2 +/- 1.4 and 2.9 +/- 1.5 y, respectively (P = 0.01), and the mean ages of those with and without iron deficiency were 2.7 +/- 1.3 and 3.5 +/- 1.4 y, respectively (P < 0.0001). CONCLUSIONS: Children in the Republic of the Marshall Islands, ages 1 to 5 y, are at high risk of anemia, vitamin A deficiency, and iron deficiency, and one-third of these children had the co-occurrence of vitamin A and iron deficiencies. Further investigation is needed to identify risk factors and evaluate interventions to address vitamin A and iron deficiencies among children.

Carotenoid and vitamin E status are associated with indicators of sarcopenia among older women living in the community.

BACKGROUND AND AIMS: Oxidative stress may play a role in the pathogenesis of sarcopenia, and the relationship between dietary antioxidants and sarcopenia needs further elucidation. The aim was to determine whether dietary carotenoids and alpha-tocopherol are associated with sarcopenia, as indicated by low grip, hip, and knee strength. METHODS: Cross-sectional analyses were conducted on 669 non-disabled to severely disabled community-dwelling women aged 70 to 79 who participated in the Women's Health and Aging Studies. Plasma carotenoids and alpha-tocopherol were measured. Grip, hip, and knee strength were measured, and low strength was defined as the lowest tertile of each strength measure. RESULTS: Higher plasma concentrations of alpha-carotene, beta-carotene, beta-cryptoxanthin, and lutein/zeaxanthin were associated with reduced risk of low grip, hip, and knee strength. After adjusting for potential confounding factors such as age, race, smoking, cardiovascular disease, arthritis, and plasma interleukin-6 concentrations, there was an independent association for women in the highest compared with the lowest quartile of total carotenoids with low grip strength [Odds Ratios (OR) 0.34, 95% Confidence Interval (CI) 0.20-0.59], low hip strength (OR 0.28, 95% CI 0.16-0.48), and low knee strength (OR 0.45, 95% CI 0.27-0.75), and there was an independent association for women in the highest compared with the lowest quartile of alpha-tocopherol with low grip strength (OR 0.44, 95% CI 0.24-0.78) and low knee strength (OR 0.52, 95% CI 0.29-0.95). CONCLUSIONS: Higher carotenoid and alpha-tocopherol status were independently associated with higher strength measures. These data support the hypothesis that oxidative stress is associated with sarcopenia in older adults, but further longitudinal and interventional studies are needed to establish causality.