Sandra L. Reynolds

Effect of obesity on falls, injury, and disability.

To examine the effect of obesity on the propensity of older adults to fall, sustain a fall‐related injury, and develop disability in activities of daily living (ADLs) after a fall.

Driving Status and Three-Year Mortality Among Community-Dwelling Older Adults

BACKGROUND Driving cessation can lead to myriad negative consequences for older adults. The purpose of these analyses was to examine driving status as a predictor of mortality among community-dwelling older adults. METHODS This prospective cohort study included 660 community-dwelling adults ranging in age between 63 and 97 years. Between 2000 and 2004, participants completed performance-based assessments of vision, cognition, and physical abilities and indexes of health, depression, self-efficacy, and driving habits. Follow-up telephone interviews were completed approximately 3 years later. RESULTS Among community-dwelling older adults, older age, health, poor near visual acuity, depressive symptoms, compromised cognitive status, and being a nondriver are associated with increased risk for a 3-year mortality. Nondrivers were four to six times more likely to die than drivers during the subsequent 3-year period. CONCLUSIONS The ability to drive represents both a sign of cherished independence and underlying health and well-being for older adults. Retaining this ability is an important health concern in the United States.

Observing the onset of disability in older adults

One of the greatest threats to the ability of older adults to live independently is the onset of disability in activities adults perform in their daily lives, such as dressing, eating, toileting, managing ones money, preparing meals and so on. This article examines the onset of disability in older adult Americans using three waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (1993, 1995, 1998; n=4228). We use medical/demographic factors (arthritis, heart disease, diabetes; age, gender, race/ethnicity, wealth), baseline characteristics (affect, cognition, health behaviors, medical insurance), and time-varying covariates (changes in chronic conditions and baseline characteristics) to predict the onset of activities of daily living (ADLs) and instrumental activities of daily living (IADLs) disability, individually and in the aggregate, over time. We find the onset of ADL and IADL disability is a complex process, suggesting important roles for medical, demographic, social, psychological, and behavioral triggers, specifically negative affect, higher body weight, and by the lack of vigorous exercise. We also find that individual ADL and IADL impairments are predicted by a variety of different factors, suggesting that summary measures of disability may be masking a wealth of potentially useful interventions. In general, public health efforts in the area of controlling obesity and treating depressive symptoms should be supported.

The Impact of Depressive Symptoms and Chronic Diseases on Active Life Expectancy in Older Americans

OBJECTIVES The authors prospectively examined whether depressive symptoms (DS) in older adults negatively affected active live expectancy (ALE), or remaining years free of disability, and mortality, independently and in the presence of chronic diseases, and after stratification by gender. DESIGN Prospective cohort study, first three waves (1993-1998) of the Asset and Health Dynamics Among the Oldest Old. SETTING DATA COLLECTION University of Michigan; analysis: University of South Florida. PARTICIPANTS Nationally representative sample of community-dwelling adults age 70 and older (N = 7,381). MEASUREMENTS DS (Center for Epidemiological Studies Depression, 8-item version), self-reported cancer, diabetes, heart disease, or stroke, difficulty with activities of daily living, death, and estimates of total, active, and disabled life expectancy. RESULTS DS reduced ALE by 6.5 years for young-old men (age 70), 3.2 years for old-old men (age 85), 4.2 years for young-old women, and 2.2 years for old-old women, and these effects remained significant at all ages and across gender even after controlling for chronic disease, the one exception being DS and cancer in old-old women. DS also reduced total life expectancy significantly, although controlling for some chronic diseases (particularly cancer and stroke) eliminated the effect of DS across age and gender groups. CONCLUSION Depressive symptoms represent a serious and distinct threat to independent functioning in older adults. Whether experienced alone, or in combination with chronic diseases, depressive symptoms shorten ALE substantially. Timely diagnosis and treatment of depressive symptoms in older adults may delay the onset of disability and improve the quality of life.

DO MEDICAL CONDITIONS AFFECT COGNITION IN OLDER ADULTS

Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings.

Family Issues in End-of-life Decision Making and End-of-life Care

Family members are involved in every aspect of end-of-life decision making and care. The present article reviews family involvement in providing care during chronic and terminal illness, in discussions and plans for advance directives, in decision making during chronic illness, in executing advance directives and making critical decisions near the end of life, and the long-lasting effects of caregiving and difficult decisions on the family member during bereavement. Although legal standards and much of the research on end of life emphasize individual decision making and the value of autonomy, end-of-life care and decisions should be increasingly understood within a family context. There is also increasing need to study how issues of race, ethnicity, and culture affect end-of-life care and decisions within families.

Thinking ahead: factors associated with executing advance directives.

Objectives: This article examines why older adults do or do not execute advance directives Methods: Secondary data analysis was conducted on data from the Charlotte County (Florida) Healthy Aging Study, on 451 adults who were relatively healthy and affluent. Exploratory logistic regressions were conducted on the probability that respondents had executed advance directives. Results: Findings indicated that increasing age and higher income were the most consistent indicators of having executed an advance directive. Also, individuals reporting taking more prescription medications were more likely to have all the advance directives, except the durable power of attorney for health care. Reporting more negative life events was predictive of having executed the durable power of attorney for health care. Discussion: These findings suggest that in addition to awareness of advance directives, demographic, health, and situational factors may affect the willingness of older adults to execute advance directives. Further research should examine other, more representative, samples to confirm these findings.

The Impact of Obesity and Arthritis on Active Life Expectancy in Older Americans

This article examines the relationship of obesity and arthritis to length of life and length of disabled life in older American men and women. Secondary data analysis is conducted on three waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (n = 7,381). Using integrated Markov chains, total, active, and disabled life expectancy in Americans aged ≥70 is estimated, with and without obesity and arthritis. Results indicate that neither obesity nor arthritis is related to the length of life for older men and women, alone or in combination. However, both conditions are significantly individually associated with increased length of disabled life in older men (1.4 years attributable to obesity; 1.2 years to arthritis at age 70; P < 0.05) and women (1.7 years attributable to obesity; 2.1 years to arthritis at age 70; P < 0.05). In addition, the combination of the two is significantly related to decreased active life, with nearly 50 and 60% of remaining life for 70‐year‐old men and women lived with disability, respectively (P < 0.05). Coupled with the fact that both obesity and arthritis are growing in prevalence, these findings represent one of the few clearly negative health trends in older adults today. These results should provide incentives for health‐care professionals to make concerted efforts to address both conditions in clinical settings.

A Tale of Two Countries---the United States and Japan: Are Differences in Health Due to Differences in Overweight?

Background Despite similar standards of living and health care systems for older persons, there are marked differences in the relative health of the elderly populations in the United States (US) and Japan. We explore the association of overweight and obesity with these health disparities. Methods Data on older adults from the US National Health Interview Survey (1994) and the Longitudinal Study of Aging II (1994) were compared to similar data from the 1999-2001 Nihon University Japanese Longitudinal Study of Aging. Regression analyses for the 2 countries were conducted to examine the correlates of being overweight and obese, and the relationships of overweight and obesity with activities of daily living functioning, heart disease, arthritis, and diabetes. Results The prevalence of overweight and obesity is higher in the US than in Japan, as is the prevalence of heart disease, diabetes, arthritis, and functioning problems. Education level and marital status are predictors of overweight for older Americans but not for older Japanese people. Health behaviors affect weight in all groups. The prevalence of functioning problems and disease are more likely to be associated with being overweight in US men and women than in Japanese women, and are not associated with being overweight in Japanese men. Conclusion Despite similar standards of living and health care systems for older persons, the conditions associated with poor health differ in the US and Japan. Being overweight or obese appears to be related to more functioning problems and arthritis in the US than in Japan.

Cohort Differences in Adult Obesity in the United States: 1982-2002

Objectives: To examine the relative importance of broad social change, cohort-specific change, and population composition on trends in adult obesity over the past two decades. Methods: Using the National Health Interview Study from 1982 through 2002, 5-year birth cohorts are examined for differential trends in obesity. Logistic regression is used to separate out the effects of population composition from broad social change and cohort-specific change. Results: Results confirm that age-specific obesity rates have been increasing for successively born cohorts, indicating broad social change. There is little evidence for cohort-specific change, and only small effects of compositional change. Discussion: Although increasing diversity in the older population will probably result in higher rates of obesity in the future, increasingly sedentary lives and the uncertain impact of smoking cessation on weight outweigh population composition effects. More research is needed on the impact of lifestyle behaviors on the American population.