Functional ability of community dwelling elderly. Criterion-related validity of a new measure of functional ability.

Criterion-related validity of a new measure of functional ability was conducted according to a causal model based on conceptual models employed in the area of rehabilitative and geriatric medicine. The criteria variables included concurrent diagnosed diseases, global self-rated health, drug consumption and general practitioner (GP) consultations. The measure of functional ability was developed with the intention of achieving a high degree of discrimination among a group of community dwelling elderly. Data were derived from a sample survey of 70-year-old men and women conducted in 1984 in the county of Copenhagen (Denmark). Altogether 366 men and 368 women participated in each of the two phases of the study--a comprehensive medical examination at the county hospital at Glostrup followed by a home visit conducted by an occupational therapist 1-2 weeks later. The analysis included four different unidimensional index scales of functional ability divided into two types, with reduced speed and tiredness as subdimensions. The two scale types were mobility function and lower limb function. Early losses of ability together with global self-rated health were treated as outcome measures of diagnosed chronic diseases. At the same time these outcome measures together with diagnosed diseases were considered to predict drug consumption and GP consultations. It was shown that functional ability as measured by the new index scales were strongly influenced by diagnosed diseases: arteriostenosis and osteoarthrosis in lower extremities, obesity, shoulder impairments and bronchitis among women, and glucose intolerance, arteriostenosis in lower extremities and shoulder impairments among men. Global self-rated health was strongly associated with the new functional ability rating system. Early losses of ability but not self-rated health was a strong predictor for drug consumption and frequent contacts with GP. It is concluded that the new measure of functional ability is suitable for health studies of community dwelling elderly, in particular as a summary statement of the individual's health status.

Abdominal pain in a 70-year-old Danish population. An epidemiological study of the prevalence and importance of abdominal pain.

In order to assess the prevalence and importance of abdominal pain in the elderly, an epidemiological study of a 70-year-old Danish population was carried out. Seventy two percent of 1119 randomly selected persons answered a questionnaire concerning abdominal pain. One year prevalence of abdominal pain was 28% among women and 17% among men (p < 0.01). Among those with abdominal pain no significant sex difference was found as regards location, severity, frequency, or medicine consumption. Eleven percent of the men and 19% of the women had abdominal pain which they considered to be of importance to their well-being in terms of frequency, severity, or need of medicine (sex difference: chi 2 = 10.18, df = 2, p < 0.01). Participants who had no abdominal pain judged their general health to be better than those who had experienced abdominal pain (p < 0.01). It is concluded that abdominal pain is frequent in a 70 year old population and influences the well-being of the subjects. Further studies are needed to evaluate whether subjects with abdominal pain have a poorer prognosis than subjects without.

Tiredness in daily activities at age 70 as a predictor of mortality during the next 10 years.

This study examined whether self-reported tiredness in mobility and activities of daily living is predictive of mortality, when controlled for global self-rated health, smoking, and socio-demographic factors. The investigation is part of the 1984 longitudinal study of the residents of Glostrup, Denmark, born in 1914, and included 734 men and women who were interviewed about mobility, activities of daily living, self-rated health, smoking, and socio-demographic factors, when they were 70 years old. Ten years later, in November 1994, information about deaths was obtained from the Central National Register. When controlled for the other variables tiredness in mobility was an independent predictor of mortality during the next 10 years among both women and men. The finding persisted when the analysis was performed on a restricted sample of non-disabled 70-year-old people. The results in the present study indicate that we have identified a subgroup of independent elderly people who are at risk of dying earlier than others.

Colon related symptoms in a 70-year-old Danish population.

The aim of the study was to assess (1) the prevalence of colon related symptoms among the elderly and (2) whether different definitions identify different subjects with Irritable Bowel Syndrome. The study was carried out in a random sample of 1119 70-year-old Danes of whom 72% answered a questionnaire concerning colon related symptoms. The number of bowel movements a week ranged from 0 to 21 among men and 1 to 28 among women, 5% limits were at < 3 or > 15 movements a week. The individual symptoms occurred with prevalences between 16 and 25% among men and 27 and 41% among the women. Abdominal pain, distension and borborygmi occurred significantly more often among women than men, whereas no sex difference was found for alternating stool consistency and number of bowel movements. According to the different definitions the prevalence of Irritable Bowel Syndrome varied from 0 to 18% among men and 4 to 32% among women. The subpopulations with Irritable Bowel Syndrome identified by various definitions had less than half of the subjects in common.

Snoring and risk of stroke and ischaemic heart disease in a 70 year old population. A 6-year follow-up study.

BACKGROUND: A number of studies have demonstrated an association between habitual snoring and cardiovascular morbidity and mortality. Control for the influence of potential confounders has been inadequate. To clarify the issue we examined the association between snoring and future risk of ischaemic heart disease (IHD) and stroke while controlling for the potential influence of major cardio- and cerebrovascular risk factors. METHODS: In all, 804 70 year old males and females were classified according to snoring habits. Alcohol and tobacco consumption, blood pressure, body mass index, social group, plasma lipids (triglycerides, cholesterol, high density lipoprotein), fasting blood glucose, plasma epinephrine and norepinephrine were determined at baseline. RESULTS: Over a 6-year period (1984-1990) 88 suffered an IHD episode, 60 had a stroke and 180 died. A slightly higher stroke incidence was found among snorers (relative risk [RR] = 1.8; (95% confidence interval: 1.1-3.6). When adjustments were made for the above confounders, no associations could be found between snoring and IHD, stroke or all-cause mortality. CONCLUSIONS: In a 70 year old population, snoring is not associated with an increased risk of IHD, stroke or all-cause mortality.

Nasal cancer and occupational exposures. Preliminary report of a joint Nordic case-referent study.

Nasal and sinus paranasal cancers have been associated with several occupational exposures, for example, dust from hardwood, nickel and unspecific agents occurring in the boot and shoe industry. A joint Danish-Finnish-Swedish case-referent investigation was initiated in 1977 to study further the connection between nasal and sinus paranasal cancers and various occupational exposures. All new cases of these cancers were collected from the national cancer registers (Finland & Sweden) or from hospitals (Denmark). Those still alive who agreed to the interview (N = 167) were individually matched for age and sex with patients with colonic or rectal cancer. A detailed telephone interview was performed according to a standardized procedure. Both the cases and referents thought that their condition was the one under study. The exposures were coded blindly by an experienced industrial hygienist. The results showed associations between nasal or sinus paranasal cancer and exposure to hardwood or mixed wood dust (discordant pairs 14/2); softwood dust alone (13/4); chromium 16/6); nickel (12/5, not significant); welding, flamecutting, and soldering (17/16); and lacquers and paints (12/0). Hardwood dust exposure showed a connection with adenocarcinoma. Softwood dust exposure alone was associated with epidermoid and anaplastic carcinomas. No associations were found for a number of exposures, including agricultural chemicals, textile dust, asbestos, quartz dust, organic solvents, and leather work. Possible exposure to formaldehyde was evenly distributed between the cases and referents.

Nasal and sinonasal cancer. Connection with occupational exposures in Denmark, Finland and Sweden.

A joint Danish-Finnish-Swedish case-referent investigation was initiated in 1977 in order to study the connection between nasal and sinonasal cancer and various occupational exposures. All new cases of nasal and sinonasal cancer were collected from the national cancer registers (Finland and Sweden) or from the hospitals (Denmark). Those still alive who agreed to an interview (N = 167) were individually matched for age and sex with patients with colonic or rectal cancer. A detailed telephone interview was made according to standardized forms. Both cases and referents thought that their condition was the one under study. The exposures were coded blindly by an industrial hygienist. The results showed associations between nasal and sinonasal cancer and exposure to (i) hardwood or mixed wood dust (discordant pairs 14: 2), (ii) softwood dust alone (13:4), (iii) chromium (16: 6), (iv) nickel (12: 5, not significant), (v) welding, flame-cutting and soldering (17: 6), and (vi) lacquers and paints (14: 0). The last finding was probably due to confounding from wood dust exposure. Hardwood dust exposure was associated with adenocarcinoma. Softwood dust exposure alone was associated with epidermoid and anaplastic carcinomas. No associations were found for a number of exposures, including agricultural chemicals, textile dust, asbestos, quartz dust, organic solvents and leather work. Possible exposure to formaldehyde was evenly distributed between the cases and referents.

Changes in functional ability from ages 70 to 75. A Danish longitudinal study.

The purpose of this article is (a) to describe changes in functional ability from the age of 70 to 75 years, (b) to examine whether a new functional ability measure is a good predictor of dependency, and (c) to examine whether sociodemographic factors are associated with transitions. The investigation is part of the longitudinal study of the 1914 population in Glostrup, Denmark, and comprised 576 men and women who were interviewed in their homes about functional ability, social situation, and so forth when they were 70 and 75 years old. Tiredness in mobility and daily activities measured by two functional ability scales at age 70 were independent predictors of need for help in mobility and daily activities at age 75. Among the sociodemographic variables, education among women and income among men were found to be independent predictors of dependency at age 75.

Functional ability at age 75: is there an impact of physical inactivity from middle age to early old age?

The aim of this study is to analyze the impact of physical inactivity from middle age to early old age on functional ability at age 75. Physical activity is measured both as cumulated activity from age 50 to 60 to 70 and at three separate points in time. Three hundred eighty-seven men and women born in 1914 and living in seven municipalities in the western part of the County of Copenhagen were followed for 25 years with examinations in 1964, 1974, 1984 and 1989. Analyses were conducted with physical inactivity as an independent variable (accumulated and separately for each point in time) and smoking, sex, school education, household composition, chronic disease at baseline and functional ability at age 70 as possible confounders. There was a strong association between physical inactivity at age 70 and disability at age 75. However, the analyses showed no effect of cumulated physical inactivity from age 50 to 60 to 70 on disability at age 75 when adjusting for functional ability at age 70. Physical inactivity is a risk factor for disability among old people. Thus, old people should be encouraged to take up and maintain physical training throughout the aging process.

What do 70-year-old men and women actually do? And what are they able to do? From the Glostrup survey in 1984.

The study includes an interview-based assessment of functional capacity in a random sample of 734 70-year-old people, and describes what they do, and what they are able to do. This was achieved by PADL and IADL assessment with a classification especially developed for elderly people addressing speed, frequency, tiredness and need for help, and the distinction between what the elderly do and what they are able to do. Great differences were found between PADL and IADL. All PADL were performed by nearly everyone while no IADL were performed by everybody. Unlike PADL, significant differences between men and women were found in nearly all IADL. Only a few elderly persons were unable to perform PADL, while considerably more were incapable of carrying out IADL without help.

Iron stores in 70-year-old Danish men and women. Evaluation in 469 individuals by serum ferritin and hemoglobin.

Iron status, including serum (S-) ferritin and hemoglobin (Hb) was assessed in a population survey of 469 old subjects (70 years of age; 254 men, 215 women); 7.9% of the participants had abnormal laboratory tests indicating diseases which might be connected with inappropriately high S-ferritin levels. Men had a median S-ferritin of 114 micrograms/L, 5-95 percentile 28-373 micrograms/L; 2.4% had values < 15 micrograms/L (i.e., depleted iron stores), 3.5% values from 15-30 micrograms/L (i.e., small iron stores), and 94.1% values > 30 micrograms/L (e.g., replete iron stores); 74.4% had values from 61-300 micrograms/L, and 8.7% values > 300 micrograms/L. Median Hb was 142 g/L (8.8 mmol/L), 5-95 percentile 124-158 g/L (7.7-9.8 mmol/L); Hb values < 129 g/L (8.0 mmol/L) were observed in 7.5%. Iron deficiency anemia (i.e., S-ferritin < 15 micrograms/L and Hb < 129 g/L) was seen in 0.39% of the men. Women had lower S-ferritin than men (p < 0.0001), median 81 micrograms/L, 5-95 percentile 20-273 micrograms/L; 3.3% had values < 15 micrograms/L, 9.3% values from 15-30 micrograms/L, and 87.4% values > 30 micrograms/L; 63.2% had values from 61-300 micrograms/L, and 3.7% values > 300 micrograms/L. Hb was lower in women than in men (p < 0.0001), median 132 g/L (8.2 mmol/L), 5-95 percentile 118-145 g/L (7.3-9.0 mmol/L); Hb values < 121 g/L (7.5 mmol/L) were seen in 6.5%. None of the women had iron deficiency anemia (i.e., S-ferritin < 15 micrograms/L and Hb < 121 g/L).

Resting venous plasma adrenalin in 70-year-old men correlated positively to survival in a population study: the significance of the physical working capacity.

OBJECTIVE: The aim of the study was to evaluate plasma noradrenaline (NA) and plasma adrenalin (A) as predictors of mortality in a population study. SUBJECTS: All subjects were 70 years of age in 1984. They were selected from the National Person Register. Altogether, 804 subjects participated in a comprehensive medical examination. INTERVENTIONS: Plasma NA and A were measured in blood samples collected after the subjects had rested in the supine position for 15 min. The subjects have now been followed for 7 years. MAIN OUTCOME MEASURES: Seven years later, 115 men and 63 women had died. RESULTS: Cox regression analysis showed that the mortality in the male group was positively correlated to plasma NA (P < 0.002) and inversely correlated to forced vital capacity (P < 0.0000) and plasma A (P < 0.02). A positive correlation was obtained between physical working capacity and plasma A. When an index of physical working capacity was included in the Cox regression analysis, both plasma NA and plasma A became insignificant, whereas a strong positive correlation appeared between physical working capacity and survival (P < 0.0000). Those who had low plasma A values in 1984 tended to die from cardiovascular diseases in the follow-up period, whereas in those who died from cancer, plasma A values were similar to those of the general population. CONCLUSIONS: Subjects with high plasma A values had the best survival rate during the 7 year follow-up period, probably because they also had the best physical working capacity. High plasma NA values, as expected, were associated with a reduced survival rate. Measurements of physical working capacity may be an inexpensive measure of probable survival in 70-year-old subjects.

Construct validation and the Rasch model: functional ability of healthy elderly people.

The purpose of this study was to test the construct validity of a measure of functional ability, developed with the intention of achieving a high degree of variability and capacity for discriminating among a group of healthy elderly people. Data were collected from 734 70-year-old people in Denmark in the county of Copenhagen. Functional ability was measured with the traditional activities of daily living and with a classification system developed specially for healthy elderly people. Construct validity was tested by the Rasch model for item analysis, addressing specifically the internal validity by assessing the homogeneity of items under different conditions. The results show that the proposed measure of functional ability is a combination of six different dimensions, divided into 3 types: mobility function, lower limb function and upper limb function. With regard to these three types decreased functional ability can appear by either tiredness or reduced speed.

Snoring, sympathetic activity and cardiovascular risk factors in a 70 year old population.

In order to describe the relation between snoring, cardiovascular risk factors, metabolic factors and sympathetitic activity, 804 70-year-old males and females were classified according to snoring habits and life-style factors (alcohol and tobacco consumption), blood pressure, body mass index (BMI), plasma lipids (triglycerides, cholesterol, high density lipoprotein), plasma catecholamines (epinephrine, norepinephrine), fasting blood glucose and glucose tolerance test (1 gram glucose per kg body weight given and blood glucose was measured 1 and 2 hours thereafter) were evaluated in all participants. Self-reported snoring was associated with gender (males showed higher prevalence than females, p < 0.05), alcohol consumption (p < 0.01), BMI (p < 0.001), systolic (p < 0.01) and diastolic (p < 0.05) blood pressure, glucose tolerance test (p < 0.01), plasma norepinephrine (p < 0.05) and partly with tobacco consumption (p = 0.08). No associations were found between snoring and fasting glucose, plasma lipids, plasma epinephrine or in the use of antihypertensive medication. In multivariate analysis, with forced entry of gender, BMI, physical activity, alcohol and tobacco consumption, the relation between snoring and blood pressure ceased; only systolic blood pressure was associated with snoring (p < 0.05). Snoring was still associated with plasma norepinephrine (p < 0.001) and abnormal glucose tolerance (p < 0.001). We conclude that, in a 70-year-old population, snoring is associated with gender, BMI and alcohol consumption. Snores showed higher plasma norepinephrine and abnormal glucose tolerance.

Irritable bowel syndrome and upper dyspepsia among the elderly: a study of symptom clusters in a random 70 year old population.

With the aim to assess the clustering of abdominal symptoms in a random population, data from a cohort study of a 70 year old Danish population were analysed. The cohort comprised 1,119 subjects of which 72% participated in a primary study and 91% of the survivors in a similar study five years later. The following clusters of symptoms were constantly associated. One group constituted abdominal distension, borborygmi, altering stool consistency and number of bowel movements. Pain relieved by bowel movement was associated with this cluster. Nausea and vomiting comprised another cluster. Heartburn/acid regurgitation did not show a consistent association to any other symptoms and may be considered as a cluster of it own. Pain characteristics traditionally related to upper dyspepsia did not specifically relate to any cluster. It is concluded that, in this 70-year-old population abdominal symptoms occur in clusters comparable to clusters in younger populations. The clusters, however, does not totally confirm the traditional concept of Upper Dyspepsia and Irritable Bowel Syndrome.

Snoring and atherosclerotic manifestations in a 70-year-old population.

A number of studies have demonstrated an association between habitual snoring and ischemic heart disease like angina pectoris, myocardial infarction and ischemic changes on the electrocardiography (ECG). Control for the influence of potential confounders has been inadequate. To further elucidate the issue we examined the association between self-assessed snoring and the relation to atherosclerotic manifestations. 804 70-year-old males and females were classified according to snoring habits. Alcohol and tobacco consumption, blood pressure, body mass index, social group, plasma lipids (triglycerides, cholesterol, high density lipoprotein), fasting blood glucose, glucose tolerance test, plasma epinephrine and norepinephrine were determined. Presence of angina pectoris, claudication intermittens, use of nitroglycerine were questioned, a resting ECG and a distal arterial pressure by use of doppler technique in the lower limbs were determined. Distal atherosclerotic manifestations was defined as complaints of claudication intermittens, pulselessness in one or more foot arteries or a foot/arm systolic pressure ratio < 0.90. ECG changes were classified in accordance to standard criteria (Minnesota codes) into positive ECG signs (Q/OS waves, S-T depressions, T-wave inversion or flattering or left bundle branch block) and definitive myocardial infarction. Snoring showed a weak positive correlation to positive ECG signs and definitive myocardial infarction, but after adjustments for the above confounders, no association was found between snoring and atherosclerotic manifestations. We conclude that, in a 70-year-old population, self-reported snoring is not associated with atherosclerotic manifestations.

The epidemiology of gallstones in a 70-year-old Danish population.

A random sample of 540 men and women aged 70 years who lived in the western part of Copenhagen County was drawn from the National Central Person Register. The response rate was 74.8% among men and 63.7% among women. Each subject had the gallbladder examined by ultrasonography. The prevalence of gallstone disease was 30.2% and 18.8% among women and men, respectively, being significantly higher among women. Prevalence was assessed in relation to different social and clinical variables. In the univariate analyses gallstone disease was significantly associated with familial occurrence of gallstone disease and high body mass index, whereas it was not significantly associated with social status, childbirths, age at menopause, usage of menopausal hormone therapy, abstinence from alcohol, history of smoking, slimming treatments, and physical activity. By means of a multivariate analysis the history of smoking was found to be significantly associated with gallstone disease when body mass index was taken into account. The significant sex difference disappeared when childbirths and age at menopause were included, which means that clinical variables specific for women in the fertile period could explain the sex difference in gallstone prevalence.

The measurement of instrumental ADL: content validity and construct validity.

A new measure of Instrumental Activities of Daily Living (IADL), which is able to discriminate among the large group of elderly who do not depend on help, was tested for content validity and construct validity. Most assessments of functional ability include Physical ADL (PADL) and Instrumental ADL (IADL). PADL-scales assess the basic capacity of persons to care for themselves. IADL-scales are used to assess somewhat higher levels of performance, such as the ability to perform household chores or go shopping. Data were collected from 734 70-year-old people in Denmark in the county of Copenhagen. The measure of Instrumental ADL included 30 activities in relation to tiredness and reduced speed. Construct validity was tested by the Rasch model for item analysis; internal validity was specifically addressed by assessing the homogeneity of items under different conditions. The Rasch item analysis of IADL showed that 14 items could be combined into two qualitatively different additive scales. The IADL-measure complies with demands for content validity, distinguishes between what the elderly actually do, and what they are capable of doing, and is a good discriminator among the group of elderly persons who do not depend on help. It is also possible to add the items in a valid way. However, to obtain valid IADL-scales, we omitted items that were highly relevant to especially elderly women, such as house-work items. We conclude that the criteria employed for this IADL-measure are somewhat contradictory.

Treatment of gastroduodenal ulcers with cimetidine in combination with low-dose propantheline.

Fifty-eight adult outpatients with endoscopically verified gastric, prepyloric or duodenal ulcers completed a double-blind trial of treatment with either cimetidine, 1 g daily, plus propantheline, 45 mg daily (group A) or cimetidine, 1 g daily, plus placebo (group B). After neither three nor six weeks of treatment was there any significant difference between the two groups with regard to ulcer healing or symptomatic relief. The ulcers of 22 (79%) of the 28 patients in group A and 25 (83%) of the 30 patients in group B were healed after six weeks, and 93% of the patients in both groups became painfree. We were thus not able to show any advantage in combining cimetidine treatment for ulcer healing with low-dose propantheline. In a small open trial the patients with healed ulcers received prophylactic treatment for 12 months with 1) cimetidine 800 mg daily, 2) cimetidine 400 mg at bedtime plus propantheline 45 mg daily or 3) propantheline 90 mg daily. No significant differences were found between the ulcer recurrence rates, but it cannot be excluded that a larger number of patients in each group might have yielded real differences.

Can readmission after stroke be prevented? Results of a randomized clinical study: a postdischarge follow-up service for stroke survivors.

BACKGROUND AND PURPOSE: About 50% of stroke survivors are discharged to their homes with lasting disability. Knowledge, however, of the importance of follow-up services that targets these patients is sparse. The purpose of the present study was to evaluate 2 models of follow-up intervention after discharge. The study hypothesis was that intervention could reduce readmission rates and institutionalization and prevent functional decline. We report the results regarding readmission. METHODS: This randomized study included 155 stroke patients with persistent impairment and disability who, after the completion of inpatient rehabilitation, were discharged to their homes. The patients were randomized to 1 of 2 follow-up interventions provided in addition to standard care or to standard aftercare. Fifty-four received follow-up home visits by a physician (INT1-HVP), 53 were provided instructions by a physiotherapist in their home (INT2-PI), and 48 received standard aftercare only (controls). Baseline characteristics for the 3 groups were comparable. Six months after discharge, data were obtained on readmission and institutionalization. RESULTS: The readmission rates within 6 months after discharge were significantly lower in the intervention groups than in the control group (INT1-HVP 26%, INT2-PI 34%, controls 44%; P=0.028). Multivariate analysis of readmission risk showed a significant favorable effect of intervention (INT1-HVP or INT2-PI) in interaction with length of hospital stay (P=0.0332), indicating that the effect of intervention was strongest for patients with a prolonged inpatient rehabilitation. CONCLUSIONS: Readmission is common among disabled stroke survivors. Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with long inpatient rehabilitation.