Glenn V. Ostir

Emotional Well-Being Predicts Subsequent Functional Independence and Survival

OBJECTIVE: To determine whether positive affect has an independent effect on functional status, mobility, and survival in an older Mexican American sample.

The association between emotional well-being and the incidence of stroke in older adults

Objective Individuals with high levels of depressive symptoms have an increased risk of many illnesses, including stroke. Measures of depressive symptoms include questions about the presence of negative affect, such as sadness, as well as the absence of positive affect, such as happiness and optimism. We assessed whether positive or negative affect, or both, predicted risk of stroke. Methods Data were from a 6-year prospective cohort study of a population-based sample of 2478 older whites and blacks from five counties in North Carolina who reported no history of stroke at the baseline interview. Baseline, in-person interviews were conducted to gather information on sociodemographic, psychosocial, and health-related characteristics of subjects. Thereafter interviews were conducted annually for 6 years. Results Increasing scores on the modified version of the Center for Epidemiological Studies Depression Scale (CES-D) were significantly associated with stroke incidence for the overall sample (relative risk [RR] = 1.04 for each one-point increase, 95% confidence interval [CI] = 1.01–1.09) over the 6-year follow-up period after adjusting for sociodemographic characteristics, blood pressure, body mass index, smoking status, and selected chronic diseases. Positive affect score demonstrated a strong inverse association with stroke incidence (RR = 0.74, 95% CI = 0.62–0.88). Conclusions Increasing scores on the modified CES-D are related to an increased risk of stroke, whereas high levels of positive affect seem to protect against stroke in older adults.

Reliability and sensitivity to change assessed for a summary measure of lower body function. Results from the Women's Health and Aging Study

A summary performance measure comprised of a hierarchical balance task, a 4-meter walk, and five repetitive chair stands is increasingly being used as a predictor of independent living for older persons. The reliability and sensitivity to change of this summary performance measure have not been investigated, however. Because a measure can be reliable while being unresponsive to change, this study presents information on both the reliability and sensitivity to change for the summary performance measure. This is a 3-year prospective cohort study of 1,002 moderately to severely disabled older women. Short- and long-term reliability was assessed by intraclass correlation coefficients (ICC). Sensitivity to change was assessed by slope differences for three age categories (65-74, 75-84, and >or=85) over six 6-month follow-up periods. Sensitivity to change was also assessed by summary performance change scores for those who did and did not suffer from one of four medical events [myocardial infarction (MI), stroke, hip fracture, or congestive heart failure (CHF)] at follow-up. The summary performance measure showed excellent reliability. Intraclass correlation coefficients ranged from 0.88 to 0.92 for measures made 1 week apart. The 6-month average intraclass correlation coefficient was 0.77 (range 0.72-0.79). The summary performance measure was also highly responsive to change. Subjects who suffered an incident MI, stroke, hip fracture, or CHF at follow-up were significantly more likely to have poorer summary performance change scores (-2.25) compared with those who did not have one of these medical events (-0.24). Additionally, subjects who suffered one of these events improved their summary performance scores in the following assessment period by 0.72. With increasing utilization of the summary performance measure by researchers and clinicians it is important that the measurement properties of this instrument are known. Our results show that the summary performance measure has excellent reliability and is highly sensitive to change.

Handgrip Strength and Mortality in Older Mexican Americans

OBJECTIVES: To examine the association between handgrip strength and mortality in older Mexican American men and women.

Neighbourhood composition and depressive symptoms among older Mexican Americans

Study objective: Research suggests that economically disadvantaged neighbourhoods confer an increased risk of depression to their residents. Little research has been reported about the association between ethnic group concentration and depression. This study investigated the association between neighbourhood poverty and neighbourhood percentage Mexican American and depressive symptoms for older Mexican Americans in the south western United States. Design: A population based study of older non-institutionalised Mexican Americans from the baseline assessment (1993/94) of the Hispanic established population for the epidemiologic study of the elderly (H-EPESE) merged with 1990 census data. Setting: Five south western states in the United States. Participants: 3050 Mexican Americans aged 65 years or older. Main results: There was a strong correlation between the percentage of neighbourhood residents living in poverty and the percentage who were Mexican American (r = 0.62; p<0.001). Percentage neighbourhood poverty and percentage Mexican American had significant and opposite effects on level of depressive symptoms among older Mexican Americans. After adjusting for demographic and other individual level factors, each 10% increase in neighbourhood population in poverty was associated with a 0.763 (95% CI 0.06 to 1.47) increase in CES-D score, while each 10% increase in Mexican American neighbourhood population was associated with a −0.548 (95% CI −0.96 to −0.13) unit decrease in CES-D score among older Mexican Americans residing in their neighbourhoods. Conclusions: The findings suggest a sociocultural advantage conferred by high density Mexican American neighbourhoods, and suggest the need to include community level factors along with individual level factors in community based epidemiological health studies.

Assessing walking speed in clinical research: a systematic review

OBJECTIVE To provide a systematic review and describe how assessments of walking speed are reported in the health care literature. METHODS MEDLINE electronic database and bibliographies of select articles were searched for terms describing walking speed and distances walked. The search was limited to English language journals from 1996 to 2006. The initial title search yielded 793 articles. A review of the abstracts reduced the number to 154 articles. Of these, 108 provided sufficient information for inclusion in the current review. RESULTS Of the 108 studies included in the review 61 were descriptive, 39 intervention and 8 randomized controlled trials. Neurological (n=55) and geriatric (n=27) were the two most frequent participant groups in the studies reviewed. Instruction to walk at a usual or normal speed was reported in 55 of the studies, while 31 studies did not describe speed instructions. A static (standing) start was slightly more common than a dynamic (rolling) start (30 vs 26 studies); however, half of the studies did not describe the starting protocol. Walking 10, 6 and 4 m was the most common distances used, and reported in 37, 20 and 11 studies respectively. Only four studies included information on whether verbal encouragement was given during the walking task. CONCLUSIONS Tests of walking speed have been used in a wide range of populations. However, methodologies and descriptions of walking tests vary widely from study to study, which makes comparison difficult. There is a need to find consensus for a standardized walking test methodology.

Effect of Depression on Diagnosis, Treatment, and Survival of Older Women with Breast Cancer

Objectives: To assess the effect of a prior diagnosis of depression on the diagnosis, treatment, and survival of older women with breast cancer.

Onset of Frailty in Older Adults and the Protective Role of Positive Affect

The aim of this study was to examine the longitudinal association between positive affect and onset of frailty for 1,558 initially nonfrail older Mexican Americans from the Hispanic Established Populations for Epidemiological Studies of the Elderly database. The incidence of frailty increased 7.9% during the 7-year follow-up period. High positive affect was found to significantly lower the risk of frailty. Each unit increase in baseline positive affect score was associated with a 3% decreased risk of frailty after adjusting for relevant risk factors. Findings add to a growing positive psychology literature by showing that positive affect is protective against the functional and physical decline associated with frailty.

Androgen Treatment and Muscle Strength in Elderly Men: A Meta‐Analysis

OBJECTIVES: To review published, randomized trials examining the effect of androgen treatment on muscle strength in older men.

Frailty in Older Mexican Americans

Objectives: To identify sociodemographic characteristics and health performance variables associated with frailty in older Mexican Americans.