Tzuo-Yun Lan

Socio-demographic and health-related factors associated with cognitive impairment in the elderly in Taiwan

BackgroundCognitive impairment is an age-related condition as the rate of cognitive decline rapidly increases with aging. It is especially important to better understand factors involving in cognitive decline for the countries where the older population is growing rapidly. The aim of this study was to examine the association between socio-demographic and health-related factors and cognitive impairment in the elderly in Taiwan.MethodsWe analysed data from 2119 persons aged 65 years and over who participated in the 2005 National Health Interview Survey. Cognitive impairment was defined as having the score of the Mini Mental State Examination lower than 24. The χ2 test and multiple logistic regression models were used to evaluate the association between cognitive impairment and variables of socio-demography, chronic diseases, geriatric conditions, lifestyle, and dietary factors.ResultsThe prevalence of cognitive impairment was 22.2%. Results of multivariate analysis indicated that low education, being single, low social support, lower lipid level, history of stroke, physical inactivity, non-coffee drinking and poor physical function were associated with a higher risk of cognitive impairment.ConclusionMost of the characteristics in relation to cognitive impairment identified in our analysis are potentially modifiable. These results suggest that improving lifestyle behaviours such as regular exercise and increased social participation could help prevent or decrease the risk of cognitive impairment. Further investigations using longitudinal data are needed to clarify our findings.

Factors affecting the use of health examinations by the elderly in Taiwan.

This study evaluated the factors associated with use of health examinations by the elderly. Data were obtained from the 2005 National Health Interview Survey (NHIS) in Taiwan for 2,482 individuals aged 65 years or older. The Andersen model was used as the analytic framework, and all variables were categorized into four factors: predisposing, need, health-related behavioral, and enabling factors. The chi(2)-test and a hierarchical multiple logistic regression model were used to examine the association between these variables and the use of health examinations. Nearly half (46.8%) of the elderly had used the service previously. In the final model, those with older age, a spouse, Hakka origin, higher educational level, hypertension, bodily pain, and moderate to high exercise were more likely to use health examinations. On the other hand, older adults who usually used alternative medicine, were missing cognitive test results, were current smokers, and had functional limitations were less likely to use the service. The study results showed that the utilization rate of health examinations was low, suggesting that there is a need to increase its utilization through health education. Furthermore, the factors found in the study may be further used for promoting health examinations.

Trajectories of depression and their relationship with health status and social service use.

This longitudinal study was conducted between 1994 and 2004 in a cohort of Southern Taiwan community-living elderly residents. The study aims to explore the trajectories of depression and how these patterns differed between respondents who survived and those who died during data collection phases; this study also investigated how health status change and health/social service use predicted the different trajectories of depression. Eight hundred and ten participants had completed all six waves of the survey or were followed-up at each wave until death in the prospective study in Kaohsiung City. Depressive symptoms were evaluated by the Short Psychiatric Evaluation Schedule (SPES). Changes in levels of depression during the ageing process were identified. Different trajectories clearly reflected heterogeneity within depression and the association with mortality. The study highlighted that diabetes, gastrointestinal problems, heart disease and disability, whether at baseline or as new occurrences, were predictors of health decline. High uses of health/social services were also predictive of increased depression. These findings identified depression as a highly dynamic process, characterized by different trajectories of depression between states of no, mild and severe depression. Greater awareness of these various trajectories should potentially improve the prevention and/or management strategies of depression.

Risk factors for hip fracture in older adults: a case–control study in Taiwan

SummaryWe conducted a matched case–control study of hip fracture in older adults. Our findings suggest that hip fracture risk was determined by multiple factors. Older women characterized by low consumption of milk, peak flow rate, grip strength, and bone mineral density (BMD) had increased risk of hip fracture. Older men with impaired cognitive function and low BMD were also at higher risk of hip fracture.IntroductionMultiple factors contribute to low-trauma hip fracture in older adults. The aim of this study was to determine important characteristics of hip fracture in older population.MethodsA total of 228 patients with first low-trauma hip fracture were matched with 497 controls. All 77 potential risk factors of hip fracture organized into 13 groups were analyzed using conditional logistic regression.ResultsLow milk intake, peak flow rate, hand grip strength, and bone mineral density in women and low mini-mental state examination score and bone mineral density in men were further identified to be independently associated with elevated hip fracture risk.ConclusionsThe factors found in our study may help understand the etiology of hip fracture and be further adopted to evaluate the risk of hip fracture in community and clinical setting.

Apolipoprotein E genotype and risk of developing physical limitations in elderly people.

To the Editor: Apolipoprotein E (APOE) gene is one of the genes with a huge impact on longevity and successful aging. The APOE polymorphism has been associated with lipid or cognitive disorders, which may result in cardiovascular disease or Alzheimer’s disease.1 In older adults, stroke and cognitive impairment are all risk factors for physical disability. Thus more researches have been conducted to examine whether the APOE genotype is independently associated with physical limitations in the older population. While these studies 2–5 do improve our knowledge on the relationship between APOE gene and physical function in older adults, no attention has been paid to investigating the role of this gene in the development of functional decline at different stages. The progressive decline of physical function in older adults usually begins with the limitation of mobility function, continues to deteriorate into difficulty in coping with complex household works, and finally results in inability to complete self-care tasks.6 We conducted a prospective nested case-control study of genetic variation in the APOE gene and risk of deterioration in physical functioning in Taiwan, with a particular interest in the transitions of mobility, Instrumental Activities of Daily Living (IADL), and Activities of Daily Living (ADL) decline. Samples were from 924 study participants of the Social Environment and Biomarkers of Aging Study (SEBAS) in 2000.7 SEBAS included an in-home interview and a physical examination at the hospital. The in-home interview collected information on self-reports of physical limitations, demographic and social variables, and cognitive measures. Mobility includes 9 tasks involving general mobility function of upper and lower extremities. IADL covers six tasks involving living environment. ADL incorporates six personal care tasks. Mobility decline was defined as having no difficulty in all 21 tasks in 2000 but experiencing difficulty in at least one of the 9 mobility tasks in 2003. IADL decline was defined as having difficulty in at least one mobility task but no difficulty in all ADL and IADL tasks in 2000, but experiencing difficulty in at least one mobility and one IADL task but no difficulty in all ADL tasks in 2003. ADL decline was defined as having difficulty in at least one mobility and one IADL task but no difficulty in all ADL tasks in 2000, and experiencing difficulty in at least one mobility, one IADL, and one ADL task in 2003. The APOE genotyping was conducted using DNA extract obtained from whole blood. During the three years of follow-up, there were 91, 79, and 35 participants identified as having mobility, IADL, and ADL decline, respectively. For each subject with mobility, IADL, or ADL decline, one control subject without the specific decline was matched for age and sex. For example, one subject with only mobility difficulty in both the 2000 and the 2003 interviews was age- and sex- matched to the subject with IADL decline. Odds ratios (ORs) for subjects carrying e2 or e4 allele were estimated using conditional logistic regression adjusting for risk factors relevant to functional decline,8,9 including body mass index (BMI), heart disease, stroke, arthritis, cognitive impairment, and physical activity. Updated information of these covariates obtained from the 2003 interview was used in the adjusted models. Because physical function of cases at baseline had not deteriorated, the prevalence of disability-related diseases and factors including BMI, cognitive impairment, and physical activity was similar and tested without statistically significant differences between cases and controls. The distribution of all sixAPOE genotypes (e2/e2, e2/e3, e2/e4, e3/e3, e3/e4, and e4/e4) and frequencies of the three APOE alleles (e2, e3, and e4) were statistically insignificant between cases with controls for all three groups. Table 1 shows the risks of developing mobility, IADL, or ADL limitations for older adults with the e2 or e4 allele. The presence of APOEe2 or e4 allele was not related to the declines of physical functioning. Table 1 Associations between APOE alleles and risk of mobility, IADL, or ADL decline This lack of association is in agreement with findings from three similar studies using ADL tasks, 3 a mobility task only, 10 or a combination of mobility, IADL, and ADL as the measures of physical limitations. 4 The e4 allele has been linked with decreased longevity through developing cognitive impairment and cardiovascular disease, whereas the e2 allele increases longevity and promotes successful aging. 1 Although APOE plays an important role in aging process, both e2 and e4 alleles, based on our study results, do not have a direct link with the decline of physical function at different stages. It is possible that APOE may affect physical function indirectly through cognitive impairment and cardiovascular disease, and the association disappears when cardiovascular disease and cognitive function are all considered.

Prevalence and Risk Factors of Injurious Falls in community-dwellers Aged 12-64 in Taiwan

Objectives: To investigate the prevalence and risk factors of injurious falls across different age groups for community dwellers aged 12-64. Methods: Data analyzed were collected from the 2005 National Health Interview Survey (NHIS) in Taiwan. The characteristics of injurious falls by time/place of occurrence and their consequences are described. Uni-variate logistic regression and Chi-square (x^2) test were used to examine the association of injurious falls with: age, sex, marital status, self-perception of health, exercise, visual ability, chronic conditions, and if there was a requirement for the use of special aids and or appliances. Multivariate logistic regression models were established for age groups 12-24. 25-44 and 45-64. Results: Among 18,099 persons aged 12-64 who completed the interview, 991(5.6%) reported having injurious falls, and 84 of them received further hospitalization. The relationship between the prevalence of injurious falls and age was U-shaped. Multivariate logistic regression models for ages 12-24, 25-44 and 45-64 showed that participants who were female, had a positive self-perception of health, and had good to very good visual ability had a reduced risk of injurious falls. In contrast, respondents who were younger than 40-44, and who had souse form of exercise in the previous two weeks, as well as had at least one chronic condition, or required special aids/appliances showed an increased risk of injurious falls. Living with a spouse/partner was not significantly associated with injurious falls. Conclusions: The U-shaped relationship of the risk of injurious falls and age was in agreement with that of the preceding study. Risk factors of injurious falls varied across a variety of age groups. Our results suggest a life-cycle approach for fall related studies and prevention programs.

Physical Functioning and Health Care Costs in an Older Population in Taiwan

Objectives: Past research involving functional problems and medical utilization has been limited to earlier surveys, local people, women, or use of Activities of Daily Living (ADLs) as the only measure of functional status, and is rarely investigated in non-US countries. We sought to re-examine the effect of functional status on health care utilization in the elderly, using a recent health survey conducted in Taiwan. Methods: 2,243 community-dwelling residents 60 years of age and older in the 2001 National Health Interview Survey (NHIS) in Taiwan were analyzed. Physical function was assessed using six ADLs questions and nine questions involving mobility tasks. The NHIS data were merged with the National Health Insurance claim data. Multiple linear regression was used to model the relationship between functional status and health care costs. Results: A clear gradient relationship between functional status and expenses was observed, with a small proportion of people with declining function responsible for a large proportion of the expenses. Functional status was independently associated with health care expenditures in the multiple regression model. Conclusions: Results from this more recent, non-US, nationwide research support the notion that functional status has an independent contribution to total healthcare expenditures in the elderly across countries.

Health-related services use and the onset of functional disability: 10 year follow-up study

This study aimed to examine the effect of health-related service use on the development of functional disability in an older adult Taiwanese cohort. The sample population consisted of 871 participants without Instrumental Activities of Daily Living (IADL) disabilities, 1061 participants without Activities of Daily Living (ADL) disabilities and 817 participants without IADL and ADL disabilities at baseline. The onset of IADL and ADL disabilities were estimated as the follow-up survey year that these functional disabilities were first noted, or the follow-up survey year that the participant was noted as having died. A Cox proportional hazards model, with time-dependent covariates, was used to analyze the association between the time of onset of the functional disabilities and the health-related service use, after controlling for age, gender, education, marital status and time varying chronic disease status. This study found that an increase in the number of services used by the participants resulted in fewer IADL and ADL disabilities. Furthermore, participants who attended recreational programs, regular health examinations, and who received the information assistance and meal preparation were significantly less likely to develop disabilities. Participants who used one or more services were 55-77% less likely to be IADL disabled, and were 54-81% less likely to be ADL disabled, and were also 59-89% less likely to develop IADL and ADL disabilities as compared to those who used none. In the present study therefore, as the number of health services used increased the likelihood of developing a functional disability decreased.

A positive association between homeostasis model assessment of insulin resistance score and the Trp64Arg polymorphism of the β3-Adrenergic receptor gene in schizophrenia patients in Taiwan.

OBJECTIVE To investigate the possible association between the Trp64Arg polymorphism of the β3-adrenergic receptor gene and the homeostasis model assessment of insulin resistance (HOMA-IR) index in schizophrenia patients in Taiwan. METHOD A total of 203 inpatients who met DSM-IV diagnostic criteria for schizophrenia were recruited from a psychiatry center in Taiwan from September 2002 to August 2003. All patients had been treated with antipsychotics for at least 6 months. The genotyping of the Trp64Arg polymorphism of the β3-adrenergic receptor gene was done by the polymerase chain reaction-restriction fragment length polymorphism method with the restriction enzyme MvaI. The HOMA-IR index was used to indicate the degree of insulin resistance. RESULTS After adjusting for sex, age, and body mass index status, the association between the HOMA-IR index and the Trp64Arg polymorphism of the β3-adrenergic receptor gene was still positive (regression coefficient = -0.65, P = .033). CONCLUSIONS The polymorphism of the β3-adrenergic receptor gene may be related to the development of insulin resistance in chronic schizophrenia patients in Taiwan.

Time trends in and the determinants of disability among elderly Taiwanese, 1994-2004

S The Gerontological Society of America 63rd Annual Scientific Meeting November 19–23, 2010 New Orleans, LA Abstracts are arranged numerically by session and in the order of presentation within each session.s are arranged numerically by session and in the order of presentation within each session. 63rd Annual Scientific Meeting 1 SESSION 5 (PAPER) CAREGIVER HEALTH AND BURDEN CAREGIVING AND CLINICALLY-ASSESSED BIOLOGICAL RISK FACTORS: EVIDENCE FROM MIDUS II S. Kang, N. Marks, 1. University of Wisconsin-Madison, Madison, Wisconsin, 2. UW Institute on Aging, Madison, Wisconsin Guided by a life course perspective and biopsychosocial approach to health, this study aimed to add to a population perspective on caregiving and health-related biological risks of family caregiving by (1) examining how providing caregiving for a child, spouse, parent, or parent-in-law due to their illness or disability (in contrast to not providing caregiving for any kin or nonkin) is linked to allostatic load (a 15-item composite measure of biological risk) and three subscales of allostatic load (metabolic dysfunction, inflammatory dysfunction, hypothalamicpituitary-adrenal axis/sympathetic nervous system [HPA/SNS] dysfunction) among midlife and older adults, and (2) evaluating how gender might moderate the link between caregiving and health-related biological risks. Data from a subsample of MIDUS II (Midlife in the U. S., 2005) respondents ages 34 to 83 that were recruited for additional clinical and biological assessment (N = 1054) were used to estimate multivariate models that also adjusted for numerous sociodemographic factors. Results revealed that providing caregiving for a spouse was associated with a greater risk in metabolic dysfunction. Models evaluating moderation of caregiving risks to biological health by gender revealed that women who were providing caregiving for a parent-in-law reported higher levels of allostatic load and its subscale indicators of inflammatory dysfunction than their men peers. Overall, results suggest that caring for a spouse is linked to important biological health risk for women and men, and caring for a parent-in-law is linked to important biological health risk for women. CAREGIVING TO ADVANCED CHRONIC ILLNESS (CHF/COPD) PATIENTS A. Wilkinson, S. Berry, 1. School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Joondalup, Western Australia, Australia, 2. Rand Corporation, Santa Monica, California Background. The cost and responsibility for much of the care of seriously ill, elderly persons living in the community with advanced, eventually fatal, chronic illness has been shifted onto family members. Chronic organ system failure presents a distinct illness trajectory with an erratic and unpredictable course characterized by episodes of acute illness and periods of relative stability set against a background of gradual, progressive disability. Current caregiving research has not yet described the challenges, stresses, and rewards that accompany caregiving for individuals with advanced chronic organ system failure. This project sought to describe the factors that influence caregiver outcomes in caregiving to advanced CHF and COPD patients. Methods: We conducted a series of 9 focus groups (8-10 adults each), 18 years or older, who were currently providing care for a patient with advanced chronic CHF or COPD. Focus group discussion topics were identified from the literature Initial analysis resulted in a classification system for major topics derived from the material and a second analysis by both researchers determined a final set of themes. 65Results: Five major themes were identified: (1) how caregivers describe their experience, (2) prognosis/uncertainty impacts, (3) objective burden (tasks), (4) role conflict/reversal, and (5) subjective burden. Findings from this exploratory work suggest that interventions should provide information about topics of specific relevance to CHF/COPD caregivers (e.g., disease processes, prognosis, what to expect, symptom and self-management, and should address caregiver/patient social isolation. Details and implications for future research and intervention policy will be discussed. BEHAVIORAL PROBLEM SUBTYPES IN DEMENTIA AND EFFECTS ON INFORMAL CAREGIVER HEALTH, HEALTH BEHAVIORS, AND SERVICE USE J.M. Thorpe, C. Thorpe, 1. School of Pharmacy, University of Wisconsin Madison, Madison, Wisconsin, 2. School of Medicine & Public Health, University of Wisconsin Madison, Madison,