Linda J. Romero

One‐Leg Balance Is an Important Predictor of Injurious Falls in Older Persons

OBJECTIVE: To test the hypothesis that one‐leg balance is a significant predictor of falls and injurious falls.

Changes in nutritional status and patterns of morbidity among free-living elderly persons: A 10-year longitudinal study☆

Nutritional intake appears to be an important factor contributing to aging. In the present study we describe changes in physical health related to nutritional intake among elderly persons in a 10-y longitudinal study. Among 304 healthy elderly participants (median age 72 y on entry into the study in 1980), 97 (34.2%) are still in good health 10 y later in 1990, 74 (26.5%) have become frail or sick, 54 (19.1%) have died, and 57 (20.1%) have dropped out of the study. Women with lower or higher energy intakes (in 1980 and 1981) than the current Recommended Daily Allowance (RDA; between 25 and 30 kcal/kg) were more likely to become frail or sick or to die in 1990 than those with energy intake in the midrange (below RDA, odds ratio (OR) = 3.3, confidence interval (CI) = 1.2-8.6; above RDA, OR = 3.4, CI: 1.1-10.7). Moreover, women with protein intakes greater than the midrange of 0.8-1.2 g/kg of body weight (1.20-1.76 g/kg in 1980 and 1981) tended to have fewer health problems over the next 10 y than those with protein intakes < 0.8 g/kg, suggesting that the mean protein requirement in elderly adults is greater than that established by the 1985 joint World Health Organization/ FAO/UNU Expert Committee. Moreover, a decrease in energy intake was greater in elderly persons who died or dropped out of the study because of illness.

Serum Vitamin B12, C and Folate Concentrations in the New Mexico Elder Health Survey: Correlations with Cognitive and Affective Functions

Objectives: 1) To compare serum vitamin B12, C and folate concentrations in a randomly selected sample of elderly (age 65 years or older) male and female Hispanics and nonHispanic whites (NHW) and 2) to examine associations between serum B12, C and folate concentrations compared to measures of cognitive and affective (depression) functions. Methods: Equal numbers of male and female Hispanics and NHW were randomly sampled from the Health Care Financing Administration (Medicare) registrant list for Bernalillo County, New Mexico, and asked to volunteer for a paid home interview followed by a paid comprehensive interview/examination covering health and health-related issues. In addition to serum determinations of B12, C and folate, associations were examined between these vitamins and measures of cognitive and affective functions. Results: Males and Hispanics had lower serum vitamin B12, C and folate concentrations than females and NHW respectively. Participants taking a multivitamin supplement (MVI) had higher serum vitamin concentrations than those not taking MVI. There were significant associations between serum folate concentrations and measures of cognitive function, not seen with B12 or C, nor between any of the vitamins and affective function. Conclusions: Hispanics, even after adjustments for gender, age, vitamin supplementation, vitamin content of dietary foods, education and household income, had lower serum concentrations of B12, C and folate than NHW. The most significant associations observed were those between serum folate and various measures of cognitive function, even after adjusting for presence of depression.

Subclinical Hypothyroidism in a Biethnic, Urban Community

OBJECTIVES: To evaluate the association between hypothyroidism, and the health status of older Hispanic and non‐Hispanic white (NHW) men and women. To accomplish this, we determined the prevalences of the treated and untreated conditions and examined the associations between an elevated serum thyroid stimulating hormone (TSH) and cognitive and affective (mood) functions and the prevalences of symptoms and comorbidity, specifically coronary heart disease (CHD), diabetes, hypertension, and hyperlipidemia.

Impact of Subclinical Hypothyroidism on Serum Total Homocysteine Concentrations, the Prevalence of Coronary Heart Disease (CHD), and CHD Risk Factors in the New Mexico Elder Health Survey

The serum/plasma total homocysteine (tHcy) concentration, now recognized as an independent risk factor for accelerated atherosclerotic disease, is increased in overtly hypothyroid patients, and it decreases with thyroid replacement therapy. Whether or not individuals with subclinical hypothyroidism also increase their tHcy concentrations, and whether this elevation might help to explain the increased prevalence of the atherosclerotic diseases observed in this condition, remains unclear. If individuals with subclinical hypothyroidism have higher tHcy concentrations than euthyroid subjects, there would be added incentive to treat this condition earlier. In this cross-sectional study (New Mexico Elder Health Survey) of a randomly selected sample of Medicare recipients (age > or =65 years), no significant difference in serum tHcy concentrations could be detected between the 112 participants with subclinical hypothyroidism (Groups 2 and 3) and the 643 participants with thyrotropin (TSH) values < or =4.6 microU/mL (Group 1) after adjusting for differences in gender, ethnicity, age, and serum concentrations of folate, vitamin B(12), and creatinine. Only those participants with the highest TSH levels (>10 microU/mL) (Group 3) had a significantly higher prevalence of coronary heart disease (CHD) when compared against Group 1 participants (p = 0.007). No consistent significant differences in the prevalences of CHD or in the CHD risk factors examined were observed when all participants with subclinical hypothyroidism (Groups 2 and 3 combined) were compared against Group 1 participants.

Prevalences of Type 2 Diabetes, the Insulin Resistance Syndrome, and Coronary Heart Disease in an Elderly, Biethnic Population

OBJECTIVE To compare the prevalences of type 2 diabetes, the various cardiovascular risk factors encompassing the insulin resistance syndrome (IRS), and coronary heart disease (CHD) in elderly Hispanics compared with non-Hispanic whites. RESEARCH DESIGN AND METHODS Elderly Hispanics (n = 414) and non-Hispanic whites (n = 469), randomly selected from the Medicare rolls of Bernalillo County (Albuquerque, NM; age ≥ 65 years), underwent a home interview followed by an interview/examination by a nurse-practitioner, nurse, and nutritionist that included an evaluation of glucose tolerance. Prevalences of total and central obesity, dyslipidemia, hypertension, and microalbuminuria also were determined. History of myocardial infarction, recent angina, and/or coronary bypass graft, and electrocardiograms (ECGs) were used to document CHD. RESULTS Elderly Hispanics had twice the prevalence of type 2 diabetes compared with non-Hispanic whites, but the prevalence of impaired glucose tolerance was not increased in Hispanics. Mean serum fasting and 2-h post-glucola insulin concentrations, fasting insulin resistance indexes, and HbA1c were higher in Hispanics. Hispanics were shorter, weighed less, and had more total body and central obesity. The higher prevalences of dyslipidemia in Hispanics could be explained by a higher prevalence of diabetes. The prevalences of hypertension and CHD were not different for the two ethnic groups. CONCLUSIONS Elderly Hispanics had twice the prevalence of diabetes and higher prevalences of cardiovascular risk factors associated with IRS. Prevalences of hypertension and CHD were similar in the two ethnic groups.

Neuropsychological Performance of Hispanic and Non-Hispanic Older Adults: An Epidemiologic Survey

Performance on a brief battery of neuropsychological tests was compared for 797 Hispanic and non-Hispanic white older adults (65-97 years) participating in a community-based epidemiological survey of Bernalillo County, New Mexico. Tests included measures of memory (Fuld Object Memory Evaluation), attention (Digit Span), verbal fluency (category naming), visuoconstruction (clock drawing), and psychomotor speed and cognitive flexibility (Color Trails). Statistically significant ethnic group differences were observed on all tests in analyses that also considered effects of age, education, gender, depressive symptoms, and a global measure of medical illness. Effect sizes were small for all measures except Digit Span and Color Trails. In dementia screening or other clinical cognitive assessment, separate ethnic group norms may be useful in interpreting results for these measures. Preliminary normative tables are provided for Hispanic older adults at two levels of age (65-74 years and 75-97 years) and four levels of education (0-6 years, 7-9 years, 10-12 years, and > 12 years).

Folate Nutrition and Older Adults: Challenges and Opportunities

Folate fortification of bread and grains has been directed to prevent neural tube birth defects. Research has also challenged previous concepts of folate nutritional status and suggested that folate may play a role in reducing the risk of vascular disease. Although folate status of many elderly people is adequate according to traditional, hematologic criteria, some elderly persons have elevated blood concentrations of the metabolite homocysteine, which indicates subclinical deficiency of folate or vitamin B-12. Higher homocysteine concentrations, even within the normal range, are associated with increased risk of vascular disease. Elderly people with better folate and vitamin B-12 status have lower homocysteine concentrations and may have lower risk for vascular disease. Although the new folate fortification rules provide the benefit of increasing folate in the food supply, they could be a risk for the elderly because excess folate intake can mask vitamin B-12 deficiency, thereby delaying diagnosis. Elderly people have a higher prevalence of vitamin B-12 deficiency as a result of absorption problems. Those deficient in vitamin B-12 should be treated to prevent irreversible neurologic damage. Modern approaches to screening the elderly include using higher cutoff points for serum vitamin B-12 and obtaining blood concentrations of the metabolite methylmalonic acid, which is elevated in deficiency of vitamin B-12 but not folate. To examine current folate intake and food sources, food frequency questionnaires were administered to 308 elderly volunteers aged 65 to 94 years. Mean (+/-standard error) folate intake from food was 299.6+/-5.8 microg/day. Supplements (median dose=400 microg/day) were consumed by 47% of participants. Only 3.2% of the sample had total folate intake greater than 1,000 microg/day, the recommended upper limit, and these were taking high-dose folate supplements (> or = 800 microg/day). Breakfast cereals provided 25.6% of folate intake; vegetables, 23.2%; fruit, 20.8%; refined breads/grains, 6.7%; dark bread, 5.0%; legumes/nuts, 5.9%; dairy products, 5.8%; meat/poultry/fish/eggs, 5.1%; other, 1.9%. Mean folate intake would increase 16.5% if enriched bread and grains were fortified. Such fortification could help some persons to lower serum homocysteine concentration and vascular disease risk. Dietitians should be aware of modern protocols for screening the elderly for vitamin B-12 deficiency.

Comparison of Energy and Nutrient Sources of Elderly Hispanics and Non-Hispanic Whites in New Mexico

OBJECTIVE Identification and comparison of frequently consumed foods and important food sources of energy, protein, total fat, vitamin A, vitamin C, vitamin E, vitamin B-6, folate, and calcium of elderly Hispanics and non-Hispanic whites. DESIGN Dietary intake data were collected using a modified Health Habits and History Questionnaire (a food frequency questionnaire) for 735 subjects who participated in the New Mexico Elder Health Survey. SUBJECTS The sample consisted of 330 Hispanics (176 men and 154 women) and 405 non-Hispanic whites (214 men and 191 women) between the ages of 65 and 96 years. Subjects were those with food frequency data among 883 participants who completed the clinical visit of the New Mexico Elder Health Survey. RESULTS Results show the top-ranked frequently consumed foods by gender and ethnicity and top-ranked food sources of energy and 8 nutrients. Regional foods were important sources of nutrients in the diets of both Hispanics and non-Hispanic whites, however, more so for the Hispanics. Chile sauces were notable sources of vitamin A, vitamin C, and folate among both groups. Both ethnic groups demonstrated selection of low-fat and skim milk and moderation in consumption of red meat. APPLICATIONS These data will be useful for designing nutrition education programs, for studying the relationship between diet and disease among elderly Hispanics and non-Hispanic whites, and for designing assessment instruments for the elderly and other ethnic populations.

Comparison of Cultural Bias in Two Cognitive Screening Instruments in Elderly Hispanic Patients in New Mexico

The authors compared the Mini-Mental State Examination (MMSE) and the Fuld Object-Memory Exam (FULD) in a Hispanic non-immigrant population in New Mexico. Results demonstrated that performance on the MMSE was affected by lower education and income levels. Performance on the FULD was not affected by these variables. Among persons with limited education and lower income, the FULD may provide a better means of screening for cognitive deficit than measures such as the MMSE.