Longitudinal application of cognitive function measures in a defined population of community-dwelling elders.

The nature and extent of possible age-related changes in cognitive function have primarily been examined in nonrandom samples, and have not been well described in population-based studies. We examined longitudinal changes in performance on a mental status examination and recall and recognition memory tests in a population-based (n = 1953) study of community-dwelling elders. Advanced age was associated with poorer performance on all tests and more rapid decline longitudinally on the mental status and recall and recognition memory tests. Less-educated persons performed more poorly. Lower levels of educational attainment were predictive of more rapid declines on the mental status examination and recall memory test among women. Subsequent survivorship was associated with preserved performance on the mental status and recall memory tests. These findings suggest that there are age-associated changes in cognitive function, and have implications for population-based studies of cognitive function and survey research in general.

Blood lipid distributions in older persons. Prevalence and correlates of hyperlipidemia.

Distributions of blood total cholesterol, triglyceride, low-density-lipoprotein (LDL) cholesterol, and high-density-lipoprotein (HDL) cholesterol levels are presented for a geographically defined cohort of rural elderly Iowans, 71 to 102 years old. Cross-sectionally, women had higher levels of total and LDL cholesterol than men did, levels that declined with increasing age. Mean HDL cholesterol levels were also higher in women than in men, but remained relatively constant across the age range. Age- and sex-specific total, LDL, and HDL cholesterol levels were lower among participants residing in long-term-care facilities. HDL but not total cholesterol levels were lower in cigarette smokers and those with chronic illnesses, physical dependence, and poorer performance on physical function tests, and higher among those consuming alcohol. If subjected to the screening guidelines of the National Cholesterol Education Program, a majority of this population, having total cholesterol levels of 5.2 mmol/L (200 mg/dL) or higher, would require further evaluation for possible hyperlipidemia.

Conceptual problems in identifying risk factors for functional decline in the elderly: a commentary.

Assessment of risk factors for chronic disease and disability among the elderly is a complex issue. Findings may be affected by the age at which the putative risk factor was measured, interval between the time of measurement of risk and outcome, possibility of changing patterns of exposure throughout the life span, and selective survival. We illustrate the complexity of risk assessment with findings from the Iowa 65+ Rural Health Study on the relationship between body mass and changing physical function. In baseline cross-sectional analyses, both high and low body mass were associated with poorer function. In 6-year longitudinal analyses limited to persons who were functionally intact at baseline, high body mass was associated with poorer lower-extremity function but relatively preserved upper-extremity function. High body mass was also associated with elevated rates of transient impairments. Extremes of teenage body habitus were associated with impaired physical function in old age. Function was poorest among those with a lifetime history of high body mass, and changes in body mass were complexly associated with subsequent function. Thus conceptual and analytic models of chronic illness and disability need to consider multiple, changing exposures over the lifetime, as well as the impact of illness, disability, and their treatment on subsequent risk factor exposure.

Enhancing the utility of quantity-frequency measures of alcohol consumption with assessments of problem drinking in a population study. A methodologic note.

Although quantity-frequency measures of alcohol consumption have been successfully used in epidemiologic studies of alcohol use, other measures may enhance detection of alcohol-disease associations. We examined two measures of alcohol consumption (quantity-frequency and an item eliciting history of heavy drinking) in a population-based longitudinal study of community-dwelling elderly men (baseline n = 1155). The primary utility of the quantity-frequency measure was in separating those who never drink, current drinkers, and former drinkers. The health and functional status of former drinkers was typically poorest. When persons who had consumed alcohol in the month prior to interview were stratified by quartile of total amount of alcohol, there were few systematic differences among the strata. The screening question on heavy drinking, however, was successful in detecting persons who were at markedly increased risk of morbidity and mortality. Thus although quantity-frequency measures are analytically appealing, other measures in some circumstances may serve a supplementary role in detecting persons at risk for adverse outcomes and for understanding the effects of alcohol consumption.

Sleep patterns in rural elders: demographic, health, and psychobehavioral correlates.

Altered sleep patterns, including changes in bedtime, sleep latency, total sleep time, and arising time, have been reported to occur with increasing age. We examine self-reported sleep patterns in a geographically-defined population (n = 3097) of persons aged 65 years and older. Sleep patterns were characterized according to demographic variables, clinical conditions, and physical, psychological, and social functioning. Sleep latency and total hours of sleep increased with age, and older respondents went to bed earlier. The percentage of respondents who reported feeling rested in the morning decreased with age. Women went to bed later, had longer sleep latency, and fewer hours of sleep than men, and were less likely to report feeling rested than men. Sleep patterns were also related to educational attainment, self-perceived health status, physical functional status, psychotropic drug use, alcohol use, depressive symptoms, life satisfaction, and social and recreational activity level. This population study suggests that sleep problems among the elderly are sometimes associated with treatable health conditions and modifiable behavioral and environmental characteristics.

Demographic and health characteristics of elderly smokers: results from established populations for epidemiologic studies of the elderly.

Although smoking has been shown to be associated with excess morbidity and mortality, most studies have focused on young and middle-aged rather than elderly smokers. We examined the demographic characteristics and physical and psychological health of elderly cigarette smokers in four population-based studies (N = 3,673, 3,811, 2,811, and 4,165) of persons 65 years of age and older. Although there was substantial geographic variation in the percentages of smokers, the demographic and health characteristics of smokers were similar across the sites. Most women had never smoked, but most men were former or current smokers. The percentage of never smokers was highest in the "oldest old." Among the elderly ever smokers, men were more likely to have quit than women, and the relative percentage of former smokers increased with age. Current smokers were generally more likely to consume alcohol than never smokers. In this age group, cigarette smoking was typically associated with higher rates of physical disease and symptoms, poorer self-perceived health status, and higher levels of depressive symptoms. Based on these four large geographically diverse population surveys, cigarette smoking remains an important health burden and public health challenge among the elderly.

Geriatric assessment and driver functioning.

In this article, the sensory, cognitive, and motor function relevant to driving, their measurement, the epidemiology of age-associated functional impairments, and the relationship of functional impairments to both self-reported driving and the imposition of legal restrictions are reviewed. A number of issues remain to be resolved before the scientific basis for public policy recommendations on aging drivers is sufficiently sound. For example, although an association between various functional impairments and the imposition of restrictions was found, with the exception of visual impairments, which under Iowa law may require the imposition of restrictions, those aspects of functional impairment that precipitate state-imposed license restrictions cannot be identified by the authors. The authors' measures of functional status may serve as surrogates for other, more important variables. If so, it has implications for both prevention of impairment-associated restrictions and interventions occurring after restrictions have been imposed. One of the most important issues confronting clinicians, researchers, and regulators is the development of appropriate tests to screen for dysfunctional driving with safety risks. Whether an appropriate battery could be created from already-existing tests and questionnaires is unclear. Certainly it seems desirable to consider the issue of face validity and explore items more clearly related to driving, such as self-reported loss of concentration or difficulty with manipulating controls. Many of the current tests focus on low levels of cognitive and physical performance. Relatively severe impairments are clearly related to driving behavior, as the authors found. Relatively minor impairments also may have an impact on driving performance, however, and it is important to explore tests sensitive to these mild impairments. Finally, it is critical to conduct appropriate studies of the reliability, validity, sensitivity, and specificity of any proposed batteries. These studies should include representative samples of drivers and not just clinic populations or community volunteers. It is also important to include a number of assessments of driving. Although state records of accidents and violations are useful, not all accidents or violations are included in state records. From a public health standpoint, crashes are the outcome of interest, but their relatively low rates require large number s of research participants or relatively long study periods. More detailed driver assessments similar to those included in state on-the-road testing or course testing are also important.(ABSTRACT TRUNCATED AT 400 WORDS)

An unlearned foreign "accent" in a patient with aphasia.

Rarely, aphasics may develop what appears to be a foreign accent, as noted by Monrad-Kröhn whose Norwegian patient sounded German. We describe a right-handed native American who developed a foreign accent following damage to the left premotor region and white matter anterior to the head of the left caudate nucleus. Her aphasia was of the transcortical motor type. Both she and her parents were born in the USA, she never traveled outside the country and never learned a foreign language. Phonetic analysis of her voice taped prior to the stroke revealed normal speech with a midwestern accent. In contrast, analyses of her current spontaneous speech, repetition, and reading reveal shifts in vowels, e.g., /I/----/i/, /ae/----/a/; increased diphthonigization; and tense speech posture. These features, which were especially frequent in spontaneous speech, probably explain her "accent." Acoustic analysis of fundamental frequency contours of sentences read in different emotional tones revealed a restricted range and variability of the peaks and valleys.

Elderly men with histories of heavy drinking: correlates and consequences.

Recognition that the physical, psychological and social consequences of substance abuse may persist throughout the life span has led to increased study of the impact of lifetime drinking habits on the elderly. We examined the characteristics of elderly men with self-reported histories of having ever been heavy drinker (H+) in a population-based (N = 1,155, mean age = 73.7 years) longitudinal survey of community-dwelling elders; 10.4% of the men reported that they had been heavy drinkers at some time during their lives. H+ men were younger and less educated than non-heavy drinkers (H-) or never drinkers (N). Mortality was higher among H+ men who were current drinkers than among H- or N men. H+ men reported more major illnesses, poorer self-perceived health status, more physician visits, more depressive symptoms, lower levels of life satisfaction and smaller social networks than did H- or N men. Self-reported ability to perform activities of daily living and instrumental activities of daily living was poorest among H+ men, who also scored the lowest on a mental status examination. Thus, a history of having ever been a heavy drinker is predictive of widespread impairments in physical, psychological and social health and functioning among elderly men.

Health and social antecedents of relocation in rural elderly persons.

Sociodemographic, health, and psychobehavioral correlates of anticipated and actual relocation were examined in a geographically-defined rural elderly population (N = 3097). Intent to move was associated with higher levels of depressive symptoms. Of those responding, 4.8 percent moved between the baseline and one-year follow-up interviews. Disproportionally high numbers of women, persons over 84 years of age, those who lived alone, persons with lower incomes, and the less educated made noninstitutional moves. Actual noninstitutional relocation was associated with poorer physical functional status, poorer self-perceived health status, higher levels of depressive symptomatology and anxiety, and poorer life satisfaction at baseline. Death of spouse, marriage of offspring, and having someone move in with the respondent were associated with noninstitutional relocation, but retirement was not. The outcomes are generally consistent with Litwak and Longino's (1987) developmental model of relocation among elderly persons.

Data quality and age: health and psychobehavioral correlates of item nonresponse and inconsistent responses.

This study examined item nonresponse and inconsistent responses (IRs) and their health and psychobehavioral correlates in a population-based survey of adults 65 years and older. We administered an in-person questionnaire concerning physical, social, and psychological health to 1,155 men (mean age = 73.7 years) and 1,942 women (mean age = 74.8 years). Nonresponse rates varied with item topic, and "don't know" (DK) responses were more common than refusals. DKs increased with age of respondent, tended to be more common in women than men, and were associated with poorer physical, cognitive, and psychological functioning. Conversely, IRs increased with age among men but not women, but were also associated with poorer physical, cognitive, and psychological functioning. Results are discussed in terms of motivational and attentional factors, and their implications for survey research with the frail elderly and very old are noted.

Health status of older male prisoners: a comprehensive survey.

Although prison populations remain predominantly young, the number of older inmates in state and federal correctional facilities has been increasing. This report describes the results of a health survey of 119 male inmates 50 years of age and older residing in Iowa state correctional facilities. Subject's disease history included hypertension (40%), myocardial infarction (19%), and emphysema (18%). Most participants (97%) had missing teeth, 42% had gross physical functional impairments, and 70% smoked cigarettes. These findings have implications for health care provision and release planning.