Philip A. Greiner

The loss of independence in activities of daily living: the role of low normal cognitive function in elderly nuns.

OBJECTIVES This study investigated the role of low normal cognitive function in the subsequent loss of independence in activities of daily living. METHODS Of the 678 elderly nuns who-completed cognitive and physical function assessments in 1992/93, 575 were reassessed in 1993/94. Mini-Mental State Examination scores were divided into three categories and related to loss of independence in six activities of daily living. RESULTS Participants with low normal cognitive function at first assessment had twice the risk of losing independence in three activities of daily living by second assessment relative to those with high normal cognitive function. This relationship was largely due to a progression from low normal cognitive function at first assessment to impaired cognitive function at second assessment and was associated with an elevated risk of losing independence in the six activities. CONCLUSIONS Progression from low normal to impaired cognitive function was associated with loss of independence in activities of daily living. Thus low normal cognitive function could be viewed as an early warning of impending cognitive impairment and loss of physical function.

Hypertension and related lifestyle factors among persons living in rural Nicaragua

BACKGROUND Globally about 40% of adults are diagnosed with hypertension, with high-income countries having a lower prevalence than low-income countries. However, there are limited data about adult hypertension prevalence in Nicaragua. The purpose of this study was to determine the prevalence of hypertension in rural coffee farm workers. METHODS A convenience sample of 229 adult coffee farm workers was used. Blood pressure was measured using an established protocol and the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7) guidelines. RESULTS Nearly 60% of the sample reported at least one prior blood pressure measurement. Hypertension was detected in 16.7% of males and 26.3% of females (20.7% of the total). Prehypertension was detected in 59.3% of males and 27.7% of females (46.2% of the total). Of the men, 51.4% reported smoking at least some days and just over one third of the sample reported adding extra salt to their food. DISCUSSION While the prevalence of hypertension in this sample is lower than global estimates, almost half of the sample had prehypertension, demonstrating an area where health promotion efforts could be focused. Given the limited funding and resources often available in these areas, increasing disease prevention efforts (including health promotion and wellness programs) and establishing settings that provide outreach and education, may improve chronic disease management and prevent comorbidities from occurring.