Maggie Kuchibhatla

Depressive symptoms, menopausal status, and climacteric symptoms in women at midlife.

Objective Previous studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy. Design Cross-sectional survey. Setting Community sample. Methods Data are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999. Measures Depression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women’s reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause. Results There were 168 women (28.9%) who reported a high level (≥10) of depressive symptoms when the abbreviated CES-D was used. In a logistic-regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms. Conclusions In this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.

Exercise to improve spinal flexibility and function for people with parkinson's disease : A randomized, controlled trial

OBJECTIVES: The effectiveness of an exercise intervention for people in early and midstage Parkinsons disease (stages 2 and 3 of Hoehn and Yahr) in improving spinal flexibility and physical performance in a sample of community‐dwelling older people is described.

Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders

Background. The predictive validity of Drug Utilization Review (DUR) and drugs‐to‐avoid criteria in elders is unknown. Objectives. To evaluate the relationship between use of inappropriate drugs as determined by these explicit criteria and mortality and decline in functional status in community dwelling elders. Research Design. Cohort study. Subjects. The fourth wave (3234 participants) of the Duke Established Populations for Epidemiologic Studies of the Elderly. Measures. Two sets of inappropriate drug‐use criteria: (1) DUR with respect to dosage, duplication, drug‐drug interactions, duration, and drug‐disease interactions; and (2) Beers‐modified criteria regarding drugs‐to‐avoid were applied to drug use reported in an in‐home interview. Death was identified from the National Death Index; change in four functional status measures (basic self‐care, intermediate self‐care, complex self‐management, physical function) was determined during the following 3 years. Results. Use of inappropriate drugs identified by either set of criteria was not significantly associated with mortality. The drugs‐to‐avoid criteria identified no significant associations between use of these drugs and decline in functional status. With DUR criteria, however, the association between use of inappropriate drugs and basic self‐care was significant and pronounced among those with drug‐drug or drug‐disease interaction problems (Adj. OR 2.04; 95% CI 1.32‐3.16). Conclusions. Identifying the impact of inappropriate drug use may depend on the criteria applied. Further studies are needed that measure additional outcomes and use alternate measures of inappropriate drug use.

Inappropriate Drug Use Among Community-Dwelling Elderly

This study examined inappropriate drug use defined by updated criteria among respondents in the second and third in‐person waves of the Duke Established Populations for Epidemiologic Studies of the Elderly. Information about sociodemographics, health status, access to health care, and drug use was determined by in‐home interviews. Drug use was coded for therapeutic class and appropriateness by applying explicit criteria. Among participants, 27% of the second and 22.5% of the third in‐person wave took one or more inappropriate agents. Of these drugs, the most common therapeutic classes were central nervous system and cardiovascular. Longitudinal multivariate analyses found that persons taking several prescription drugs, those having continuity of care, those who previously took inappropriate drugs, and those with many health visits were most likely (p<0.05) to use inappropriate drugs. We conclude that inappropriate drug use is common among community‐dwelling elderly.

TEST‐RETEST RELIABILITY OF THE PITTSBURGH SLEEP QUALITY INDEX IN NURSING HOME RESIDENTS

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Kinematic characterization of standing reach: comparison of younger vs. older subjects

OBJECTIVE To characterize typical spinal motions that occur during standing reach and to describe differences in spinal motions and center of pressure displacements during reach between younger and older healthy adults. DESIGN Exploratory, cross sectional investigation utilizing video motion and biomechanics force platform analysis. BACKGROUND Standing reach provides a means for assessing both arm function and balance control in the context of a common functional activity. The interaction between age-related declines in spinal mobility and the spinal motion occurring during reach is poorly understood. The characterization of spinal motions during task performance for healthy subjects of different age groups is an important first step for understanding the relationship between impairments and physical performance in disabled populations. METHODS Thirty-four subjects ages 20-36 and 33 subjects ages 60-76 participated. Video motion and force plate analysis were used to characterize spinal motion and center of pressure displacements during the functional reach test for younger and older subjects. RESULTS Spinal motion during standing reach was characterized by forward trunk flexion, lateral trunk flexion, thoracolumbar rotation, and lower body rotation. Younger and older subjects differed (P = 0.05) in the amount of forward trunk flexion and thoracolumbar rotation which occurred but not lower body rotation. Younger subjects displaced their center of pressure further forward (P = 0.0001) and through a greater percentage of their initial base of support (P = 0.0001) than older subjects. CONCLUSION This study provides the first multiplanar characterization of spinal motion used during standing reach. Significant differences for a number of variables existed between younger and older subjects.

Factors that disturb sleep in nursing home residents

The purpose of this cross-sectional survey was to examine subjective sleep quality, and identify factors that disturb sleep in cognitively intact nursing home (NH) residents. We interviewed 51 cognitively intact NH residents using a validated instrument, the Pittsburgh Sleep Quality Index (PSQI). Questions regarding the environment, symptoms suggestive of restless leg syndrome, and periodic leg movements were also asked. Three individuals were unable to answer all the questions and, therefore, analyses were performed on 48 subjects. Seventy-three percent of the subjects were identified as “poor” sleepers based upon a total PSQI score >5. Factors that disturbed the residents’ sleep three or more times a week were: nocturia (71%), environment-related noise or light (38%), pain (33%), feeling too hot (6%) and leg cramps (6%). On multiple regression analysis, poor sleep correlated with depressive symptoms and comorbidity, not with age or gender. Poor sleep quality is common among cognitively intact NH residents. In our study, nocturia, environmental factors and pain were the most commonly perceived causes of sleep disturbance. Poor sleep independently correlated with depressive symptoms and comorbidity. These findings should be kept in mind when evaluating sleep complaints in the nursing home.

The effect of spousal caregiving and bereavement on depressive symptoms

The objective of the study was to determine whether spousal caregiving and bereavement increases caregiver depressive symptoms. We followed 1,967 community-dwelling elderly couples from the 1993 Health and Retirement Study (HRS) until 2002 (five bi-annual surveys) or death. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CESD) scale. Adjusted depressive symptoms were higher for females for three of the four caregiving arrangements tested (as were unadjusted baseline levels). Depressive symptoms were lowest when neither spouse received caregiving (adjusted CESD of 2.97 for males; 3.44 for females, p < 0.001). They were highest when females provided care to their husband with assistance from another caregiver, (4.01) compared to (3.37; p < 0.001) when males so cared for their wife. A gender by caregiving arrangements interaction was not significant (p = 0.13), showing no differential effect of caregiving on CESD by gender. Depressive symptoms peaked for bereaved spouses within three months of spousal death (4.67; p < 0.001) but declined steadily to 2.75 (p < 0.001) more than 15 months after death. Depressive symptoms initially increased for the community spouse after institutionalization of the care recipient, but later declined. We conclude that caregiving increases depressive symptoms in the caregiver, but does not have a differential effect by gender. Increases in depressive symptoms following bereavement are short-term.

Comparison of methods for analyzing longitudinal binary outcomes: cognitive status as an example

Longitudinal data generate correlated observations. Ignoring correlation can lead to incorrect estimation of standard errors, resulting in incorrect inferences of parameters. In the example used here, standard logistic regression, a population-averaged (PA) model fit using generalized estimating equations (GEE), and random-intercept models are used to model binary outcomes at baseline, three and six years later. The outcomes indicate cognitive impairment versus no cognitive impairment in a sample of community dwelling elders. The models include both time-invariant (age, gender) and time-varying (time, interactions with time) covariates. The absolute estimates from random-intercept models are larger than those of both standard logistic and GEE models. Compared to the model fit using GEE that accounts for time dependency, standard logistic regression models overestimate standard errors of time-varying covariates (such as time, and time by problems with activities of daily living), and underestimate the standard errors of time-invariant covariates (such as age and gender). The standard errors from the random-intercept model are larger than those from logistic regression and GEE models. The choice of models, GEE or random-intercept, depends on the research question and the nature of the covariates. Population-averaged methods are appropriate when between-subjects effects are of interest, and random-effects are useful when subject-specific effects are important.

Alternative statistical approaches to identifying dementia in a community-dwelling sample

Little attention has been paid to examining the extent to which alternative statistical models may facilitate identification of persons with dementia. Using a sub-sample of the Duke Established Populations for Epidemiologic Studies of the Elderly, two analytical approaches were compared: logistic regression (which focuses on identifying specific characteristics predictive here of dementia), and recursive partitioning methods using tree-based models (which permit identification of the characteristics of those groups with high dementing disorder). In the stepwise multiple logistic regression model which included as potential predictors, gender, age, history of chronic health conditions, scales of basic and instrumental activities of daily living (IADL), and cognitive status, only IADL and cognitive status were significant predictors, with cognitive status the single most important factor. The classification tree approach, which permits identification of the characteristics of those groups with particularly high dementia rates, identified cognitive status as the most important criterion for dementia (as did logistic regression analysis). Among those without cognitive impairment, older age was a risk factor, confirming findings consistently reported in the literature. Among the cognitively impaired, IADL was an important risk factor. Those with five or more IADL problems were further classified into two risk groups, based on number of ADL problems. While classification tree analysis encourages identification of groups at risk, logistic regression encourages targeting of specific characteristics.