Frank J. Kohout

Two Shorter Forms of the CES-D Depression Symptoms Index

Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptom dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to show how scores from the briefer forms can be compared to those of the original.

Intercommunity variations in the association between social ties and mortality in the elderly: A comparative analysis of three communities☆

Identical measures of social ties obtained from three community-based cohorts aged 65 and over from East Boston, MA; New Haven, CT; and two rural counties in Iowa permit the first direct cross-community comparison of the hypothesis that social isolation increases 5-year mortality risks (1982 to 1987) for older men and women. In sex-specific proportional hazards analyses, social ties were significantly and inversely related to mortality independently of age in all three cohorts (e.g., relative hazard (RH) = 1.97 to 3.06 for men and women, comparing those with no ties to those with four types of ties). After controlling for age, pack-years of smoking, body mass, chronic conditions, angina, and physical and cognitive disability, social ties remain significant predictors of mortality risk for the men and women in New Haven (RH = 2.4 and 1.8) and for women in Iowa (RH = 1.9). For the men in Iowa (RH = 1.4) and the men and women in East Boston (RH = 1.0 and 1.3), the associations are weaker and nonsignificant.

Prevalence and Functional Correlates of Low Back Pain in the Elderly: The Iowa 65+ Rural Health Study

As part of an interview survey of a defined population of 3,097 rural persons 65 years and older (the Iowa 65+ Rural Health Study), the prevalence and functional correlates of specifically defined low back pain were studied. Low back pain was reported by 23.6 per cent of the women and 18.4 per cent of the men in the year prior to the survey, with prevalence rates declining with age. Forty per cent of those with low back pain noted its presence at the time of the interview. Over half had used analgesics. Use of medical and chiropractic services for this symptom was nearly 75 per cent; 25 per cent had at least one hospitalization directly related to low back pain and over 5 per cent had low back surgery. Limitation of walking, sitting, bending over, and performing household chores was reported by 15 to 40 per cent, and 21 per cent attributed sleep disturbance to the low back pain. Nearly 75 per cent of subjects with low back pain reported first onset of the problem prior to age 65, which has important implications for pathogenesis and prevention. The functional and clinical burdens of low back pain in this population of rural elderly were substantial and require further evaluation of risk factors and impact on health status. J Am Geriatr Soc 33:23, 1985

Depression among the rural elderly. A study of prevalence and correlates.

A large sample (N = 3159) of noninstitutionalized older adults (aged 65 to 105 years) residing in two rural Iowa counties participated in an assessment of a wide range of healthrelated factors, including depression. Prevalences of significant depressive symptomatology (9.0%; based on a modified version of the Center for Epidemiological Studies Depression Scale [CES-D]) and clinical depression (2.9%; based on self-report of Research Diagnostic Criteria [RDC]-like criteria) were low. The relationships between several demographic measures and the depression indices were examined. While expected sex differences were obtained for the CES-D, they were not found for the depression RDC. Subjects who lived alone and subjects with lower incomes were more at risk for depression. There was also evidence that being married and having a higher educational level were associated with lower risk for depression as measured by the CES-D (but not the RDC). The role of social support in rural communities was discussed as a factor contributing to the low rate of depression found in this study. The importance of sex, social support, and economic resources in accounting for depression among the elderly was also discussed.

Changes in the molar relationship between the deciduous and permanent dentitions: A longitudinal study

The purpose of this study was to describe the changes in the molar relationship from the deciduous dentition to the permanent dentition in 121 subjects from the Iowa Longitudinal Growth Study. In addition, an attempt was made to determine the association between the various dentofacial variables and the changes in the molar relationship in 55 persons (33 male and 22 female subjects) with normal occlusion. All subjects were evaluated at three stages of dental development: stage I, completion of the deciduous dentition (means age = 4.94 years); stage II, when permanent first molars initially erupt into occlusion (means age = 6.91 years); and stage III, at the completion of eruption of the permanent dentition excluding third molars (means age = 13.01 years). The following sets of variables were evaluated: molar relationship, mesiodistal crown diameters of single and groups of deciduous and permanent teeth, dental arch widths, arch lengths, and various cephalometric dentofacial variables. Correlation coefficients and regression analyses were used to assess the relationships between these measurements and the changes in the molar relationship from the deciduous to the permanent dentition. The findings indicate that of the 242 sides evaluated in the deciduous dentition, 61.6% developed into a Class I molar relationship, 34.3% into Class II, and 4.1% into Class III. Those sides that started with a distal step in the deciduous dentition proceeded to develop into a Class II molar relationship in the permanent dentition. Of the sides with a flush terminal plane relationship in the deciduous dentition, 56% progressed to a Class I molar relationship and 44% to Class II in the permanent dentition. The presence of a mesial step in the deciduous dentition indicates a greater probability for a Class I molar relationship and a lesser probability for a Class II molar relationship. In the 55 subjects who achieved normal occlusion, the magnitude of change in the molar relationship was 1.91 mm in male subjects and 1.64 mm in female subjects. On the average, these cases had a mesial step in the deciduous dentition of 0.8 mm in male subjects and 1.0 mm in female subjects. There was a favorable difference between the maxillary and mandibular leeway spaces of 1.3 mm in male subjects and 1.1 mm in female subjects. There was also a favorable decrease in the Wits appraisal of 1.2 mm in male subjects and 0.6 mm in female subjects.(ABSTRACT TRUNCATED AT 400 WORDS)

Relationship of free-recall memory to hypertension in the elderly. The Iowa 65+ Rural Health Study

The relationship between hypertension and performance on a test of free recall memory was explored in a geographically-defined population of free-living subjects 65 years and older. Those with diastolic but not isolated systolic hypertension had a significantly lower performance on the memory test, after controlling for general health status, antihypertensive medication use and other factors which might confound or modify this association. These findings from a population study confirm the results of prior investigations in smaller numbers of highly selected subjects and suggest that further study may lead to improved prevention of cognitive decline in the elderly.

Edentulism and oral health problems among elderly rural Iowans: the Iowa 65+ rural health study.

A household health interview survey of 3,673 noninstitutionalized people aged 65 and over in two rural Iowa counties included questions about loss of teeth, use of dentures, and presence of oral health problems. Edentulism rates were 10-15 per cent lower than those found a decade earlier in national health surveys. A log-linear analysis found that the best demographic predictors of edentulism were education, age, and marital status. Spouses tended to be of similar dentition status, i.e., both edentulous or both dentate. No association was found between the loss of teeth and prevalence of digestive problems. Only 7 per cent of the edentulous people felt they needed to visit a dentist, even though 70 per cent had not seen one for over five years. About 40 per cent had dentures that were over 20 years old, with half of these being over 30 years old. Many dentures were loose and causing soreness in the mouth or difficulty in eating. These elderly people appeared to expect some problems with dentures and oral pain and accepted them without feeling a need to seek treatment.

Infants' Fluoride Intake from Drinking Water Alone, and from Water Added to Formula, Beverages, and Food

In infants, the majority of total ingested fluoride is obtained from water, formula and beverages prepared with water, baby foods, and dietary fluoride supplements. Few studies have investigated the distribution of fluoride intake from these sources among young children at risk for dental fluorosis. The purpose of this study was to assess estimated water fluoride intake from different sources of water among a birth cohort studied longitudinally from birth until age 9 months. Parental reports were collected at 6 weeks, 3 months, 6 months, and 9 months of age for water, formula, beverage, and other dietary intake during the preceding week. Fluoride levels of home and child-care tap and bottled water sources were determined. This report estimates daily quantities of fluoride ingested only from water-both by itself and used to reconstitute formula, beverages, and food. Daily fluoride intake from water by itself ranged to 0.43 mg, with mean intakes < 0.05 mg. Water fluoride intake from reconstitution of concentrated infant formula ranged to 1.57 mg, with mean intakes by age from 0.18 to 0.31 mg. Fluoride intake from water added to juices and other beverages ranged to 0.67 mg, with means < 0.05 mg. Estimated total daily water fluoride intake ranged to 1.73 mg fluoride, with means from 0.29 to 0.38 mg.

Memory complaint and memory performance in the depressed elderly.

Depressed and nondepressed elderly subjects recruited in the context of a large epidemiological study of health were compared on measures of self-reported memory disturbance and an objective index of memory performance (free recall). Three groups were studied including (a) subjects meeting Research Diagnostic Criteria (RDC) for major depression, (b) subjects with high levels of self-reported depressive symptoms who did not meet RDC for major depression, and (c) subjects with low levels of self-reported depressive symptoms. Subjects with high depression symptom levels reported significantly higher levels of memory complaint than did subjects with low symptom levels. However, there were no differences in self-reported memory disturbance as a function of depression diagnosis. Further, there were no significant differences between groups on the free-recall measure, either as a function of symptom level or diagnosis. It is argued that symptom severity rather than diagnosis of depression is important in determining impairment in depressed elderly people.

Retirement satisfaction in the rural elderly.

This study investigated factors related to retirement satisfaction in a Midwestern rural population. Four major sets of variables were investigated: personal background factors; socialization for retirement; reasons for retirement; and social integration. Multiple regression showed that the most important predictors of retirement satisfaction were (1) quality of relationship and frequency of aid from confidants and relatives; (2) involvement in organizations; (3) health; and (4) financial status.