Hearing Impairment and Incident Frailty in Later Life: The Health in Men Study (HIMS).

OBJECTIVES: This study is designed to determine if hearing loss is associated with increased risk of frailty in later life. DESIGN: A prospective cohort study. SETTING AND PARTICIPANTS: We retrieved data of a community sample of men aged 70 years and above living in the metropolitan region of Perth, Western Australia. 3,285 participants who were free of frailty at the beginning of the study were followed for up to 17 years. Data were retrieved from the Health in Men Study (HIMS) and the Western Australian Data Linkage System (WADLS). MEASUREMENTS: Hearing loss was defined by self-report or by diagnosis recorded in the WADLS. Incident frailty was assessed using the Hospital Frailty Risk Score (HFRS). RESULTS: A total of 2,348 (71.5%) men developed frailty during follow up. The adjusted hazard ratio was 1.03 (95% CI: 0.95-1.12). The majority of the participants became frail by age 90 regardless of hearing condition. The time point where half of the group become frail was delayed by 14.4 months for men without hearing loss compared with hearing impaired men. CONCLUSIONS: Hearing loss is not associated with incident frailty in men aged 70 years or older when frailty was measured by HFRS. However, this statistically non-significant result could be due to the low sensitivity of study measures. Also, we found a trend that men with hearing loss were more likely to develop frailty compared with their normal-hearing peers, suggesting a potential association between hearing loss and frailty.

Management of cardiac arrest survivors in UK intensive care units: a survey of practice.

BACKGROUND: Cardiac arrest is a common presentation to intensive care units. There is evidence that management protocols between hospitals differ and that this variation is mirrored in patient outcomes between institutions, with standardised treatment protocols improving outcomes within individual units. It has been postulated that regionalisation of services may improve outcomes as has been shown in trauma, burns and stroke patients, however a national protocol has not been a focus for research. The objective of our study was to ascertain current management strategies for comatose post cardiac arrest survivors in intensive care in the United Kingdom. METHOD: A telephone survey was carried out to establish the management of comatose post cardiac arrest survivors in UK intensive care units. All 235 UK intensive care units were contacted and 208 responses (89%) were received. RESULTS: A treatment protocol is used in 172 units (82.7%). Emergency cardiology services were available 24 hours a day, 7 days a week in 54 (26%) hospitals; most units (123, 55.8%) transfer patients out for urgent coronary angiography. A ventilator care bundle is used in 197 units (94.7%) and 189 units (90.9%) have a policy for temperature management. Target temperature, duration and method of temperature control and rate of rewarming differ between units. Access to neurophysiology investigations was poor with 91 units (43.8%) reporting no availability. CONCLUSIONS: Our results show that treatments available vary considerably between different UK institutions with only 28 units (13.5%) able to offer all aspects of care. This suggests the need for 'cardiac arrest care bundles' and regional centres to ensure cardiac arrests survivors have access to appropriate care.

Homocysteine, methylenetetrahydrofolate reductase C677T polymorphism and cognitive impairment: the health in men study.

High total plasma homocysteine (tHcy) has been associated with cognitive impairment in later life, but it is unclear if this association is causal or is due to confounding. The C677T polymorphism of the 5,10 methylenetetrahydrofolate reductase gene (MTHFR) increases basal tHcy, but its contribution to cognitive impairment has not been established. We designed this study to determine if tHcy is causally related to cognitive impairment in later life by investigating its association with high tHcy and the MTHFR-C677T polymorphism. We recruited 1778 older men from the Health in Men Study cohort and established caseness on the basis of the participants' scores on a Telephone Interview for Cognitive Status score 27 in 2008. Exposure to tHcy, gene status and other variables of interest were obtained from assessments 4-7 years earlier. Multivariate logistic regression showed that the odds of cognitive impairment increased with a doubling of tHcy (adjusted odds ratio, OR 1.36; 95% confidence interval, 95% CI 1.02-1.82). Compared with the wild CC genotype, participants with the MTHFR-TT genotype had 46% greater odds of cognitive impairment (OR 1.46, 95% CI 1.01-2.11, P=0.043). The results of this study are consistent with, but do not prove the hypothesis that high tHcy causes cognitive impairment in later life.

Vitamins B(12), B(6), and folic acid for cognition in older men.

OBJECTIVE: To investigate whether supplementing older men with vitamins B(12), B(6), and folic acid improves cognitive function. METHODS: The investigators recruited 299 community-representative hypertensive men 75 years and older to a randomized, double-blind controlled clinical trial of folic acid, vitamin B(6), and B(12) supplementation vs placebo over 2 years. The primary outcome of interest was the change in the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog). A secondary aim of the study was to determine if supplementation with vitamins decreased the risk of cognitive impairment and dementia over 8 years. RESULTS: The groups were well-balanced for demographic and biochemical parameters. There was no difference in the ADAS-cog change from baseline to 24 months between the placebo (0.8, SD 4.0) and vitamins group (0.7, SD 3.4). The adjusted scores in the treatment groups did not differ over time (placebo 0.2 lower, z = 0.71, p = 0.478). There was a nonsignificant 28% decrease in the risk of cognitive impairment (odds ratio 0.72, 95% confidence interval 0.25-2.09) and dementia (hazard ratio 0.72, 95% confidence interval 0.29-1.78) over 8 years of follow-up. CONCLUSIONS: The daily supplementation of vitamins B(12), B(6), and folic acid does not benefit cognitive function in older men, nor does it reduce the risk of cognitive impairment or dementia. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that vitamin supplementation with daily doses of 500 µg [DOSAGE ERROR CORRECTED] of B(12), 2 mg of folic acid, and 25 mg of B(6) over 2 years does not improve cognitive function in hypertensive men aged 75 and older.

Use of automobile restraining devices for infants.

Use of crash-tested and approved restraining devices for infants was studied in relationship to parents' locus of control, knowledge scores, and demographic data. Of 66 mothers who provided complete data, 19 (29 percent) owned and made proper use of the devices. Thirty-four mothers (52 percent) owned devices but did not use them properly.