Can the Combined Use of Two Screening Instruments Improve the Predictive Power of Dependency in (Instrumental) Activities of Daily Living, Mortality and Hospitalization in Old Age?

BACKGROUND: Due to differences in the definition of frailty, many different screening instruments have been developed. However, the predictive validity of these instruments among community-dwelling older people remains uncertain. OBJECTIVE: To investigate whether combined (i.e. sequential or parallel) use of available frailty instruments improves the predictive power of dependency in (instrumental) activities of daily living ((I)ADL), mortality and hospitalization. DESIGN, SETTING AND PARTICIPANTS: A prospective cohort study with two-year follow-up was conducted among pre-frail and frail community-dwelling older people in the Netherlands. MEASUREMENTS: Four combinations of two highly specific frailty instruments (Frailty Phenotype, Frailty Index) and two highly sensitive instruments (Tilburg Frailty Indicator, Groningen Frailty Indicator) were investigated. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for all single instruments as well as for the four combinations, sequential and parallel. RESULTS: 2,420 individuals participated (mean age 76.3 ± 6.6 years, 60.5% female) in our study. Sequential use increased the levels of specificity, as expected, whereas the PPV hardly increased. Parallel use increased the levels of sensitivity, although the NPV hardly increased. CONCLUSIONS: Applying two frailty instruments sequential or parallel might not be a solution for achieving better predictions of frailty in community-dwelling older people. Our results show that the combination of different screening instruments does not improve predictive validity. However, as this is one of the first studies to investigate the combined use of screening instruments, we recommend further exploration of other combinations of instruments among other study populations.

Multimorbidity and its relation to subjective memory complaints in a large general population of older adults.

BACKGROUND: Multimorbidity has been suggested to be associated with a variety of negative health-related outcomes. The present study was designed to evaluate the association between multimorbidity and subjective memory complaints. METHODS: This cross-sectional study was based on data obtained from a postal survey designed by the Public Health Service (Gemeentelijke Gezondheids Dienst, GGD) involving 15,188 persons aged 55 years and over living independently in Limburg, the Netherlands. Multivariate logistic regression analyses, adjusted for potentially important covariates, were performed to evaluate the association between self-reported multimorbidity and three outcomes related to subjective memory complaints. RESULTS: Multimorbidity was indeed related to subjective memory complaints. The association between multimorbidity and subjective memory complaints was positively influenced by age. Moreover, multimorbidity was related to the degree of worrying about memory complaints in people who perceived themselves as forgetful. Multimorbidity was also associated with reporting a larger increase in these subjective memory complaints during the past year. In this latter case, multimorbidity had more prognostic capability in men than in women. Psychological distress was related to all three subjective memory-related outcome measures. CONCLUSIONS: In our sample, which was representative of the Dutch population, multimorbidity was associated with subjective memory complaints. The relationship between multimorbidity and subjective memory complaints differed between men and women and between age groups.

Regional differences in cardiovascular risk factor profile cannot fully explain differences in cardiovascular morbidity in the Netherlands: a comparison of two urban areas.

BACKGROUND: Our objective was to investigate whether a region in the south of the Netherlands (Heerlen/Kerkrade) had a high burden of cardiovascular disease in comparison with a nearby region (Maastricht) and the average Dutch population, respectively. We also wanted to determine if there are interregional differences in cardiovascular risk factor profile. DESIGN: Cross-sectional study. METHODS: Data from a nationwide registry (CBS) were used to analyse cardiovascular mortality in the two regions and the average in the Netherlands. Data from a primary care morbidity registration network (RNH) were used to compare cardiovascular morbidity and cardiovascular risk factors in both regions. A standardisation procedure was carried out for age and sex. Data were analysed using logistic regression analyses. RESULTS: The overall cardiovascular mortality rate was higher in the Heerlen/Kerkrade region (7.8 per thousand) compared with Maastricht (6.1 per thousand, OR=1.3, 95% CI 1.2-1.5) and the average in the Netherlands (5.7 per thousand). Similarly, most cardiovascular morbidity rates for Heerlen/Kerkrade were more elevated compared with the RNH overall and with Maastricht. Prevalence rates of risk factors such as diabetes mellitus (7.2%, OR=1.5, 95% CI 1.3-1.7) and overweight (10.8%, OR= 2.0, 95% CI 1.8-2.2) were significantly higher in the Heerlen/Kerkrade region compared with Maastricht. There were no differences with regard to hypertension (15.2%, OR=1.0, 95% CI 0.9-1.1). CONCLUSION: Heerlen/Kerkrade is indeed a region with a high burden of cardiovascular disease. Differences in morbidity between Heerlen/Kerkrade and Maastricht cannot be fully explained by differences in cardiovascular risk factor profile.

[No effect of aircraft crash near South Limburg (the Netherlands) on self-perceived health, but an increase in perceived environmental nuisance by the inhabitants]. / Geen invloed van een vliegtuigongeluk nabij Zuid-Limburg op de ervaren gezondheid van omwonenden, wel toename van de ervaren milieuhinder.

OBJECTIVE: To investigate the influence of an aircraft crash near the South of Limburg, the Netherlands, on the perceived physical and psychological health and annoyance of local residents. DESIGN: Controlled, blinded, follow-up questionnaire survey. METHOD: Three months before an aircraft crash occurred, randomly selected local residents and control subjects who lived approximately 20 km from the crash site were asked to complete a health questionnaire. The study was repeated one year after the crash. The aim of the survey was not mentioned in the questionnaire. The questionnaire asked about demographic features, physical health, psychological health and environmental nuisance. In the first survey, 544/926 (59%) questionnaires were successfully returned, and after the disaster this figure was 677/900 (75%). Linear regression modelling was used to check whether or not any differences in outcome were due to confounding demographic variables. RESULTS: There was no significant difference in the perceived physical and psychological health of local residents before and after the aircraft crash. A year after the crash, the nuisance level of aircraft noise reported by local residents had markedly increased. Aircraft noise was the major cause of disturbance. More than 1 in 3 residents perceived daily aircraft noise as a nuisance compared with 1 in 6 before the crash. The scores of local inhabitants for annoyance due to aircraft odour and dust doubled after the crash. Compared with control subjects, local inhabitants scored more than 20 times higher for annoyance due to aircraft odour and 40 times higher for annoyance due to dust. The reported nuisance caused by road traffic noise, odour and dust also increased, although to a lesser extent. CONCLUSION: Health was not influenced by the aircraft crash. A year after the crash, there was a strong drop in tolerance of aircraft nuisance. There was also a reduction in the tolerance of comparable nuisance due, for example, to road traffic, although this change was less marked.

Social resources and alcohol-related losses as predictors of help seeking among male problem drinkers.

OBJECTIVE: This study examined whether factors other than severity of alcohol-related problems add to the explanation of seeking help for drinking problems. METHOD: Help seeking was investigated by comparing male problem drinkers who applied for treatment with male chronic problem drinkers in the general population. Subjects were selected from an outpatient treatment center (n = 129) and from a panel of the general population (n = 86) in the Netherlands. A shortened version of Cahalan's problem-drinking index, including symptoms, social consequences, health problems and frequency of intoxication, was used to indicate the severity of problem drinking. It was hypothesized that in particular drinking problems that indicate losses (social consequences and health problems) were associated with help seeking. Furthermore, resources such as paid work, a spouse, high socioeconomic status, younger age and a "wet" social network were expected to facilitate the continuation of drinking behavior and drinking problems and the avoidance of help seeking. RESULTS: Social and health consequences were associated more strongly with seeking help than were symptoms of problem drinking and intoxication. The effects of type of alcohol-related problem, employment and age were as hypothesized. However, the hypotheses about marital status, socioeconomic status and social network characteristics could not be confirmed. CONCLUSIONS: The results suggest that in particular employed men and men of a younger age deserve attention with regards to detecting problem drinking and targeting prevention.

Changes in social roles as predictors of changes in drinking behaviour.

AIM: To assess the possible effects of changes in marital status, employment status and having children at home on alcohol consumption and the frequency of heavy drinking. With role theory as a starting point it was expected that a shift into more social roles would decrease consumption and heavy drinking while the shift away from social roles would be associated with an increase in consumption and heavy drinking. DESIGN: Prospective cohort study. SETTING: The province of Limburg, The Netherlands (1980-89). PARTICIPANTS: 1327 men and women aged 16-69 years at first measurement. MEASUREMENTS: Weekly consumption of standard units (10 g ethanol) of alcoholic beverages; frequency of drinking six units or more; self-reported social role. FINDINGS: The acquisition of a spouse role and a parental role but not an employment role was associated with a decrease in consumption or heavy drinking. The loss of the spouse role among women was associated with an increase in heavy drinking. Otherwise, losing a role was not linked with a change in consumption and heavy drinking. CONCLUSIONS: Limited support was found for the expectation that role transitions influence drinking behaviour. Our study suggests that other theories must be sought to explain social differences in drinking behaviour.

Changes in alcohol consumption in a general population in The Netherlands: a 9-year follow-up study.

Changes in drinking patterns are described for men and women and per age group using data from a 9-year follow-up study in The Netherlands (n = 1327). Aspects of drinking patterns in our study are drinking status, level of consumption and frequency of heavy drinking. The average consumption and average frequency of heavy drinking are used to examine changes at aggregate level. Changes at individual level are examined in terms of adopting certain drinking patterns (incidence) and continuing certain drinking patterns (chronicity). A small decrease is found in the proportion of drinkers for both sexes. Only women show a decrease in mean consumption. Average frequency of heavy drinking is stable for both sexes. At individual level, proportions of chronicity and incidence of drinking patterns are higher among men. Small aggregate changes in drinking patterns are accompanied by rather large shifts in individual's up-and-down level of consumption and frequency of heavy drinking. No or only very small period effects are observed and little evidence is found for a cohort effect among men. A negative association between incidence and age is found for drinking status among women, for low, moderate and high level of consumption and for heavy drinking for both sexes. In terms of chronicity, negative associations with age are found for drinking status of both sexes, and for high level of consumption and heavy drinking among men.