Patricia Sawyer

Incidence and risk factors for fecal incontinence in black and white older adults: a population-based study.

OBJECTIVES: To determine the incidence of fecal incontinence (FI) in community‐dwelling older adults and identify risk factors associated with incident FI.

The UAB Study of Aging: background and insights into life-space mobility among older Americans in rural and urban settings

With the aging of the US population, the proportion of African–Americans will increase and older adults in rural areas will become more isolated. Gender differences in health and function can be expected to be worse in historically underserved populations. Maintenance or improvement of mobility is critical to maintaining not only quality of life, but also physical and mental health. The University of Albama at Birmingham Study of Aging was designed to understand racial differences in mobility among older adults, and the study cohort is balanced by race, gender and rural–urban residence. Thus, the study can provide insights into the impact of aging on the health and function of African–American and white men and women in both rural and urban areas. The study demonstrates that mobility is a complex functional domain impacted by sociodemographic, general-health and mental-status factors. As modifiable risk factors of life-space mobility decline are identified, this will lead to the development and testing of...

Population Based Study of Incidence and Predictors of Urinary Incontinence in Black and White Older Adults

PURPOSE We determined the incidence and predictors of incident urinary incontinence over 3 years in community dwelling older adults. MATERIALS AND METHODS A population based, prospective cohort study was conducted with a random sample of Medicare beneficiaries stratified to be 50% black, 50% men and 50% rural. In-home baseline assessment included standardized questionnaires and short physical performance battery. Three annual followup interviews were conducted by telephone. Incontinence was defined as any degree of incontinence occurring at least once a month in the last 6 months. RESULTS Participants were 490 women and 496 men 65 to 106 years old (mean age 75). Prevalence of incontinence at baseline was 41% in women and 27% in men. Three-year incidence of incontinence was 29% (84 of 290) in women and 24% (86 of 363) in men. There were no differences by race in prevalent or incident incontinence. In multivariable logistic regression models for women, significant independent baseline predictors of new incontinence included stroke (OR 3.4, p = 0.011), less than monthly incontinence (OR 3.3, p = 0.001), past or current postmenopausal estrogen (OR 2.3, p <0.006), slower time to stand from a chair 5 times (OR 1.3, p <0.045) and higher Geriatric Depression Scale Score (OR 1.2, p = 0.016). For men significant independent baseline predictors of new incontinence included less than monthly incontinence (OR 4.2, p <0.001) and lower score on the composite Physical Performance Score (OR 1.2, p <0.001). CONCLUSIONS Prevalence of incontinence among community dwelling older adults was high with an additional 29% of women and 24% of men reporting incident incontinence over 3 years of followup. Infrequent incontinence is a strong risk factor for developing at least monthly incontinence in both men and women.

Prevalence and correlates of nocturia in community-dwelling older adults.

OBJECTIVES: To determine the prevalence and correlates of nocturia in community‐dwelling older adults.

Impact of Chronic Kidney Disease on Activities of Daily Living in Community-Dwelling Older Adults

BACKGROUND Although chronic kidney disease (CKD) is associated with poor physical function, less is known about the longitudinal association between CKD and the decline of instrumental activities of daily living (IADL) and basic activities of daily living (BADL) among community-dwelling older adults. METHODS Participants were part of the prospective observational University of Alabama at Birmingham Study of Aging (n = 357). CKD was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) using the Modification of Diet in Renal Disease equation. Primary outcomes were IADL and BADL decline defined as an increase in the number of activities for which participants reported difficulty after 2 years. Forward stepwise logistic regression was used to determine associations of baseline CKD and functional decline. RESULTS Participants had a mean age of 77.4 (SD = 5.8) years, 41% were African American, and 52% women. IADL decline occurred in 35% of those with CKD and 17% of those without (unadjusted odds ratio, 2.62, 95% confidence intervals [95% CI], 1.59-4.30, p < .001). BADL decline occurred in 20% and 7% of those with and without CKD, respectively (unadjusted odds ratio, 3.37; 95% CI, 1.73-6.57; p < .001). Multivariable-adjusted odds ratios (95% CIs) for CKD-associated IADL and BADL decline were 1.83 (1.06-3.17, p =.030) and 2.46 (1.19-5.12, p = .016), respectively. CKD Stage ≥3B (estimated glomerular filtration rate <45 mL/min/1.73 m(2)) was associated with higher multivariable-adjusted odds of both IADL (3.12, 95% CI, 1.38-7.06, p = .006) and BADL (3.78, 95% CI, 1.36-9.77, p = .006) decline. CONCLUSION In community-dwelling older adults, CKD is associated with IADL and BADL decline.

Correlates of Urinary, Fecal, and Dual Incontinence in Older African‐American and White Men and Women

OBJECTIVES: To determine prevalence and correlates of urinary (UI), fecal (FI), and dual (DI) incontinence in community‐dwelling older adults.

Dietary patterns and diet quality among diverse older adults: The university of Alabama at Birmingham study of aging

ObjectivesTo characterize dietary patterns among a diverse sample of older adults (≥ 65 years).DesignCross-sectional.SettingFive counties in west central Alabama.ParticipantsCommunity-dwelling Medicare beneficiaries (N=416; 76.8 ±5.2 years, 56% female, 39% African American) in the University of Alabama at Birmingham (UAB) Study of Aging.MeasurementsDietary data collected via three, unannounced 24-hour dietary recalls was used to identify dietary patterns. Foods were aggregated into 13 groups. Finite mixture modeling (FMM) was used to classify individuals into three dietary patterns. Differences across dietary patterns for nutrient intakes, sociodemographic, and anthropometric measurements were examined using chi-square and general linear models.ResultsThree dietary patterns were derived. A “More healthful” dietary pattern, with relatively higher intakes of fruit, vegetables, whole grains, eggs, nuts, legumes and dairy, was associated with lower energy density, higher quality diets as determined by Healthy Eating Index (HEI)-2005 scores and higher intakes of fiber, folate, vitamins C and B6, calcium, iron, magnesium, and zinc. The “Westernlike” pattern was defined by an intake of starchy vegetables, refined grains, meats, fried poultry and fish, oils and fats and was associated with lower HEI-2005 scores. The “Low produce, high sweets” pattern was characterized by high saturated fat, and low dietary fiber and vitamin C intakes. The strongest predictors of better diet quality were female gender and non-Hispanic white race.ConclusionThe dietary patterns identified may provide a useful basis on which to base dietary interventions targeted at older adults. Examination of nutrient intakes regardless of the dietary pattern suggests that older adults are not meeting nutrient recommendations and should continue to be encouraged to choose high quality diets.

Religiousness and Longitudinal Trajectories in Elders' Functional Status

The purpose of this study was to examine the effects of religiousness on the trajectories of difficulties with activities of daily living (ADLs) and instrumental ADLs (IADLs) in community-dwelling older adults over a three-year period. Seven waves of data from the University of Alabama at Birmingham Study of Aging were analyzed using a hierarchical linear modeling method. The study was based on the 784 participants who completed interviews every six months between December 1999 and February 2004. Frequent religious service attendance was associated with fewer ADL difficulties and IADL difficulties at baseline. Furthermore, religious service attendance predicted slower increases for frequent churchgoers and steeper increases for less frequent churchgoers in IADL difficulties, controlling for variables related to demographics and resources. Religious service attendance was independently associated with ADL and IADL difficulties cross-sectionally. However, significant protective effects of religious service attendance were identified longitudinally only for the IADL trajectory.

Life‐Space Mobility in Mexican Americans Aged 75 and Older

To examine the factors associated with life‐space mobility in older Mexican Americans.

Predicting the trajectories of depressive symptoms among southern community-dwelling older adults: The role of religiosity

Background: This study examined the effects of religiosity on the trajectories of depressive symptoms in a sample of community-dwelling older adults over a four-year period in a Southern state in the US. Methods: Data from the University of Alabama at Birmingham (UAB) Study of Aging were analyzed using a hierarchical linear modeling (HLM) method. This study involved 1000 participants aged 65 and above (M age = 75 at baseline, SD = 5.97) and data were collected annually from 1999 to 2003. The Geriatric Depression Scale measured depressive symptoms; the Duke University Religion Index measured religious service attendance, prayer, and intrinsic religiosity; and control variables included sociodemographics, health, and social and economic factors. Results: The HLM analysis indicated a curvilinear trajectory of depressive symptoms over time. At baseline, participants who attended religious services more frequently tended to report fewer depressive symptoms. Participants with the highest levels of intrinsic religiosity at baseline experienced a steady decline in the number of depressive symptoms over the four-year period, while those with lower levels of intrinsic religiosity experienced a short-term decline followed by an increase in the number of depressive symptoms. Implications: In addition to facilitating access to health, social support and financial resources for older adults, service professionals might consider culturally appropriate, patient-centered interventions that boost the salutary effects of intrinsic religiosity on depressive symptoms.