Bruce M. Burchett

Sensitivity and specificity of standardized screens of cognitive impairment and dementia among elderly black and white community residents

Six standardized published measures of cognitive function were evaluated as screens of dementia in a sample of 164 (83 black, 81 white) community residents aged 65 and over selected from the Duke University EPESE (Established Populations for Epidemiologic Studies of the Elderly), a biracial cohort of 4164 residents in a five county area of piedmont North Carolina. Of these 164 persons, 26 were subsequently diagnosed as demented. The weighted data from this sample represent the estimated performance of these measures among elderly blacks and whites in a five county area. The 6 measures evaluated in this study (specificity figures for blacks precede those for whites) were (1) Orientation-Memory-Concentration Test (38%, 79%), (2) Mental Status Questionnaire (71%, 96%), (3) Mini-Mental State (58%, 94%), (4) Storandt et al. Battery (42%, 69%), (5) Iowa Battery (26%, 69%) and (6) Kendrick Cognitive Tests (92%, 97%). All but the Kendrick Cognitive Tests showed substantial sensitivity (90-100%) in detecting the presence of dementia. The specificity of the tests was particularly poor for blacks. The briefer, simpler measures tended to have greater accuracy than the longer and more complex measures. With rare exceptions, the scores obtained on these screens correlated with race and education.

Depression in diabetes and obesity: Racial/ethnic/gender issues in older adults

OBJECTIVES This study focuses on the comorbidity between depression and diabetes, as well as depression and obesity, in a biracial community sample of older adults. METHODS The data are drawn from a cross-sectional survey of five counties in North Carolina, USA, part of a longitudinal study of morbidity and mortality among elders in the urban and rural south. During the first wave of the survey, 4162 persons 65+ years of age participated in an interview at their homes. During this interview, data were collected to assess demographics, functional status, cognitive status, depression and self-report of diabetes. In addition, subjects were asked to estimate their height and weight for the interviewers, from which data body mass index (BMI) was estimated. RESULTS In both uncontrolled and controlled analyses, female gender, lower education, functional impairment and cognitive impairment were associated with comorbid depression/diabetes and depression/high BMI. Age was not associated with comorbid depression/diabetes but younger age was associated with depression/cognitive impairment. African American race was strongly associated with depression/diabetes but not with depression/high BMI. CONCLUSIONS More studies of comorbidity in the general population should be implemented to determine the relationship between these comorbid conditions and risk factors. Longitudinal studies are especially needed.

The Effect of Comorbid Illness on Receipt of Cancer Screening by Older People

OBJECTIVES: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people.

Drug-Use Patterns among Black and Nonblack Community-Dwelling Elderly

OBJECTIVE: To describe and compare drug-use patterns among black and nonblack community-dwelling elderly. DESIGN: Survey. SETTING: Five-county urban and rural region in Piedmont, NC. PARTICIPANTS: Stratified probability household sample of 4164 community residents aged 65 or older from the Piedmont Health Survey of the Elderly (65 percent women, 54 percent black, mean age 73.56 ± 6.74 y). MAIN OUTCOME MEASURES: Prevalence of medication use and mean drug use; therapeutic medication category use. RESULTS: Data were weighted to represent the population in this geographic area. Fewer blacks reported the use of over-the-counter (OTC) medications and total medications than did nonblacks (66 vs. 76 percent and 88 vs. 92 percent, respectively; p<0.001). Compared with nonblacks, blacks reported using a lower mean number of prescription (2.02 vs. 2.35; p<0.001), OTC (1.12 vs. 1.42; p<0.001), and total (3.14 vs. 3.77; p<0.001) drugs. The therapeutic medication categories varied by race for prescription cardiovascular, analgesic, and central nervous system (CNS) drugs and OTC nutritional supplements. More nonblacks than blacks reported the use of analgesics (62.5 vs. 55.6 percent, respectively; p<0.001), CNS drugs (26.1 vs. 14.2 percent, respectively; p<0.001), nutritional supplements (27.5 vs. 16.9 percent, respectively; p<0.001), and gastrointestinal agents (29.0 vs. 23.5 percent, respectively; p<0.001). Blacks were more likely to report problems in managing their medications than were nonblacks (9.0 vs. 6.1 percent, respectively; p=0.001). CONCLUSIONS: Our data suggest that there are distinct racial differences in medication-use patterns among the elderly.

Race and Stress in the Incidence of Herpes Zoster in Older Adults

OBJECTIVES: To examine the effect of black race and acute (negative life events) and chronic (lack of social support) psychological stress on the risk of herpes zoster in late life.

Racial Differences in Use of Cancer Prevention Services Among Older Americans

CONTEXT: Racial differences in receipt of cancer prevention services may be related to poorer outcomes for minorities. Understanding reasons for such differences could help target appropriate interventions.

The Combined Effect of Visual Impairment and Cognitive Impairment on Disability in Older People

OBJECTIVES: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity.

Racial and Psychosocial Risk Factors for Herpes Zoster in the Elderly

The effects of black race and psychologic stress on the risk of acquiring herpes zoster in late life were examined. Subjects were participants of a stratified probability sample of community-dwelling persons > or = 65 years old. A comprehensive health survey was administered in 1986-1987 (P1), 1989-1990 (P2), and 1992-1994 (P3). Incident cases of zoster between P1 and P2 and P2 and P3 served as the dependent variables. Hypothesis-testing variables included race, negative life events, and measures of social support. Control variables included age, sex, education, cancer, other chronic diseases, hospitalization, activities of daily living, self-rated health, depression, and cigarette smoking. From P1 to P2, 1.4% of black and 3.4% of white subjects developed zoster (P < .001). From P2 to P3, 2.9% of black and 7.5% of white subjects developed zoster (P < .001). After controlling for variables, black subjects were significantly less likely to develop zoster than were white subjects (adjusted odds ratio, 0.37; 95% confidence interval, 0.26, 0.53; P = .0001). Most measures of stress were not significantly related to zoster; however, study limitations preclude definitive conclusions.

Identifying a national death index match.

Data from the National Death Index (NDI) are frequently used to determine survival status in epidemiologic or clinical studies. On the basis of selected information submitted by the investigator, NDI returns a file containing a set of candidate matches. Although NDI deems some matches as perfect, multiple candidate matches may be available for other cases. Working across data from the Duke University site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), NDI, and the Social Security Death Index (SSDI), the authors found that, for this Established Populations for Epidemiologic Studies of the Elderly cohort of 1,896 cases born before 1922 and alive as of January 1, 1999, a match on Social Security number plus additional personal information (specific combinations of last name, first name, month of birth, day of birth) resulted in agreement between NDI and Social Security Death Index dates of death 94.7% of the time, while comparable agreement was found for only 12.3% of candidate decedents who did not have the required combination of information. Thus, an easy to apply algorithm facilitates accurate identification of NDI matches.

Sociodemographic Characteristics of the Neighborhood and Depressive Symptoms in Older Adults: Using Multilevel Modeling in Geriatric Psychiatry

OBJECTIVE Neighborhood sociodemographic characteristics may be important to the mental health of older adults who have decreased mobility and fewer resources. Our objective was to examine the association between neighborhood context and level of depressive symptomatology in older adults in a diverse geographic region of central North Carolina. METHODS The sample included 2,998 adults 65 or older residing in 91 census tracts. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Neighborhoods were characterized by five census-based characteristics: socioeconomic disadvantage, socioeconomic advantage, racial/ethnic heterogeneity, residential stability, and age structure. RESULTS In ecologic level analyses, level of census tract socioeconomic disadvantage was associated with increased depressive symptoms. To determine whether neighborhood context was associated with depressive symptoms independently of individual characteristics, the authors used multilevel modeling. The authors examined the ability of each of five neighborhood (level 2) characteristics to predict a level 1 outcome (CES-D symptoms) controlling for the effects of individual (level 1) characteristics. Younger age, being widowed, lower income, and having some functional limitations were associated with increased depression symptoms conditional on census tract random effects. However, none of the neighborhood characteristics was significantly associated with depression symptoms, conditional on census tract random effects, either unadjusted or adjusted for individual characteristics. CONCLUSION Any observed association between neighborhood sociodemographic characteristics and individual depressive symptoms in our sample may reflect the characteristics of the individuals who reside in the neighborhood rather than the neighborhood characteristics themselves. The use of multilevel modeling is important to separate these effects.