Biomedical subjects

Jack Guralnik

Publications and source records attributed to Jack Guralnik.

7 recordsLinked to original sources

PubMed2007

What level of alcohol consumption is hazardous for older people? Functioning and mortality in U.S. and English national cohorts.

OBJECTIVES: To estimate disability plus mortality risks in older people according to level of alcohol intake. DESIGN: Two population-based cohort studies. SETTING: The Health and Retirement Study (United States) and the English Longitudinal Study of Aging (England). PARTICIPANTS: Thirteen thousand three hundred thirty-three individuals aged 65 and older followed for 4 to 5 years. MEASUREMENTS: Difficulties with activities of daily living (ADLs), instrumental activities of daily living (IADLs), poor cognitive function, and mortality. RESULTS: One-tenth (10.8%) of U.S. men, 28.6% of English men, 2.9% of U.S. women, and 10.3% of English women drank more than the U.S. National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older. Odds ratios (ORs) of disability, or disability plus mortality, in subjects drinking an average of more than one to two drinks per day were similar to ORs in subjects drinking an average of more than none to one drink per day. For example, those drinking more than one to two drinks per day at baseline had an OR of 1.0 (95% confidence interval (CI)=0.8-1.2) for ADL problems, 0.7 (95% CI=0.6-1.0) for IADL problems, and 0.8 (95% CI=0.6-1.1) for poor cognitive function. Findings were robust across alternative models. The shape of the relationship between alcohol consumption and risk of disability was similar in men and women. CONCLUSION: Functioning and mortality outcomes in older people with alcohol intakes above U.S. recommended levels for the old but within recommendations for younger adults are not poor. More empirical evidence of net benefit is needed to support screening and intervention efforts in community-living older people with no specific contraindications who drink more than one to two drinks per day.

Accidental Falls↗

PubMed2006

DHEAS levels and mortality in disabled older women: the Women's Health and Aging Study I.

BACKGROUND: Dehydroepiandrosterone sulfate (DHEAS) is an endogenously produced sex steroid that has been hypothesized to have anti-aging effects. Low DHEAS levels are associated with mortality in older men, but the relationship between DHEAS levels and mortality in women is not clearly defined. METHODS: The relationship between serum DHEAS level and 5-year mortality was analyzed in a cohort of 539 disabled women aged 65-100 years enrolled in the Women's Health and Aging Study I (WHAS I). Using Cox proportional hazard models, we calculated multivariate-adjusted mortality risks by DHEAS quartiles and by DHEAS continuously, allowing for a nonlinear relationship. We also examined cause-specific mortality. RESULTS: We found a U-shaped relationship between DHEAS level and mortality. After adjusting for multiple covariates, women in the top and bottom DHEAS quartiles had a more than 2-fold higher 5-year mortality than did those in the middle quartiles (hazard ratio, 2.15; 95% confidence interval [CI], 1.17-3.98 for the top quartile and 2.05; 95% CI, 1.27-3.32 for the bottom quartile, each compared to the third quartile). Women with higher DHEAS levels tended to have greater cancer mortality, whereas those with lower DHEAS tended to have greater cardiovascular mortality. CONCLUSION: Disabled older women with either low or high levels of DHEAS are at greater risk for death than are those with intermediate levels. More research is needed to determine if targeted dehydroepiandrosterone supplementation would provide clinical benefit to disabled older women.

Aged↗

PubMed2006

Lower extremity physical performance and use of compensatory strategies for mobility.

OBJECTIVES: To compare measured lower extremity physical performance in the clinic with the methods used to carry out mobility tasks at home and to identify key factors influencing day-to-day task performance. DESIGN: Cross-sectional analysis of the Women's Health and Aging Study I. SETTING: Community-dwelling female residents of Baltimore, Maryland. PARTICIPANTS: One thousand two cognitively intact women aged 65 and older with moderate to severe physical limitations. MEASUREMENTS: Compensatory strategies reportedly used for mobility in the home, distinguishing between use of no compensatory strategies, behavioral changes only, durable medical equipment (DME) with or without behavioral change, and human help; measured lower extremity (LE) physical performance (gait speed, timed chair stands, balance). RESULTS: There was a statistically significant difference in LE physical performance between women using the four types of compensatory strategy (P < .001). Women who used DME for mobility in the home had worse performance than those using human help who in turn had worse performance than those with behavioral changes only; women reporting no compensatory strategies for in-home mobility performed best. Sequential multivariate logistic regressions identified several factors other than LE physical performance that were associated with use of specific compensatory strategies. Medical conditions, education, and environmental barriers influenced whether compensatory strategies were used at all, whereas income, contact with health providers, and availability of help in the home influenced the type of compensatory strategy. CONCLUSION: Physical abilities are an important factor influencing use of compensatory strategies for mobility, but several other factors also influence the ways that women adapt to mobility limitations.

Activities of Daily Living↗

PubMed2006

Performance-based measures of physical function for high-function populations.

OBJECTIVES: To improve and broaden the applicability of performance-based measures of function for use in clinical and research settings. DESIGN: Cross-sectional repeated-measures study. SETTING: Research clinic. PARTICIPANTS: Population-based sample of Japanese Americans without significant functional impairments aged 35 to 55 and 56 to 71 (N=203). MEASUREMENTS: Performance-based measures of physical function, including range of standard tests, newer automated measures of balance and strength and data on cognitive function, lifestyle, medical history, and physical activity. RESULTS: Of the nonplatform balance measures, only the one-leg stand was reliable (reliability coefficient (rc) =0.69) and able to discriminate between functional levels. Combining the Fourth National Health and Nutrition Examination Survey protocol of folded arm position while standing on a foam pad with the more-sophisticated balance platform test had the highest reliability and discrimination. With the strength chair, high rcs (0.88-0.96) were found for upper and lower extremity tests. Timed chair stands, a test of lower extremity and central strength were reliable. The 6-minute walk had a high rc (0.90). CONCLUSION: Many performance tests used today are not reliable. Only a few discriminate between the most highly functioning individuals and individuals with good function. Thus, a new recommended battery includes unassisted single-leg stand, balance platform "foam pad, eyes closed," elbow flexion and knee extension strength (strength chair), grip strength, timed chair stands, and the 6-minute walk. These simple performance-based tests have good reliability and discrimination across the range of function and can be used in most clinical and research settings to quickly assess global functional level.

Adult↗

PubMed2005

Structural adaptations to bone loss in aging men and women.

INTRODUCTION: Bone apposition on the subperiosteal surface and bone loss from the endocortical surface during aging establish the external diameter, total cross-sectional area (tCSA), cortical thickness (Ct.Th) and the distance the cortex is placed from the neutral axis of a long bone, all determinants of bone strength. We tested the hypothesis that sex-related differences in these processes produces a sexual dimorphism in tibial fragility. METHODS: The above traits were assessed in 688 women and 561 men (20-102 years old) using peripheral QCT. RESULTS: Total and medullary areas were greater in young adult men than young adult women. As age advanced, in men, tCSA area increased by 0.79 SD, and medullary area increased by 0.54 SD so that cortical area, cortical thickness and minimum and maximum moments of inertia (Imin and Imax) were similar at all ages. In women, tCSA increased by 0.2 SD, while medullary area increased by 2.6 SD so that cortical area and thickness and the moments of inertia diminished. Cortical apparent volumetric bone mineral density (vBMD) declined more in women (by 3.1 SD) than men (by 0.5 SD). In both sexes, the lower the cortical apparent vBMD, the higher the tCSA (women R2 = 0.13, men R2 = 0.16, both P < 0.0001), whereas the lower the Ct.Th, the lower the tCSA (women R2 = 0.30, men R2 = 0.32, both P < 0.0001). CONCLUSIONS: Bone loss reduces cortical thickness and increases intracortical porosity. These changes tend to be compensated for by periosteal apposition in both sexes but more greatly in men than in women, perhaps because this mechanism may be ineffective when cortical thinning is severe.

Adaptation, Physiological↗

PubMed2005

Female hip fracture patients had poorer performance-based functioning than community-dwelling peers over 2-year follow-up period.

BACKGROUND AND OBJECTIVES: Compare performance-based functioning over 2 years among elderly women hip fracture patients vs. community-dwelling older women. METHODS AND SETTING: 268 hip fracture patients from eight hospitals in Baltimore, MD, in 1990-1991, and 486 respondents from the Women's Health and Aging Study I (WHAS I) were assessed prospectively at 6-month intervals for 2 years. Usual and rapid walking speeds, and chair rise time, were calculated and standardized to the baseline distribution of the WHAS subsample. RESULTS: At baseline, all respondents were aged 65+ years, White, cognitively intact, and could walk across a room independently. Hip fracture patients had significantly poorer functioning than WHAS respondents at each follow-up interview through 24 months postfracture. The difference was greatest at 6 months: mean walking speed for hip fracture patients was approximately one standard deviation lower than for WHAS respondents for usual pace (adjusted difference = -1.06, 95% confidence interval (CI) = -1.22, -0.89) and rapid pace (adjusted difference = -0.95, 95% CI = -1.13, -0.79). These differences were most pronounced among respondents who were aged 80+ years or had comorbid conditions. CONCLUSION: Elderly women had poorer performance-based functioning over 2 years following hip fracture than would be expected by normal aging in same-aged women.

Activities of Daily Living↗

PubMed2005

Anemia in older adults.

PURPOSE OF REVIEW: Anemia is common in older adults and is an independent predictor for increased morbidity and mortality in several disease states. Older persons with anemia suffer hospitalization, physical decline, and disability at higher rates than those people without anemia. RECENT FINDINGS: The prevalence and causes of anemia in community-dwelling older persons in the US were evaluated in the third National Health and Nutrition Examination Survey (NHANES) 1988-1994. In persons 65 years and older, anemia was present in 11.0% of men and 10.2% of women, with the prevalence rising to over 20% in people 85 years and older. One third of the cases were due to nutritional deficiencies, and one third was due to chronic illness, including but not limited to chronic kidney disease. About one third of the cases of anemia remain unexplained. Anemia is also prognostic for diminished physical performance and loss of mobility in people 65 years and older. A recent report suggests that the prevalence of anemia is even higher in elderly persons living in nursing homes. The data suggest that the risk of mortality and loss of mobility even extends to levels of hemoglobin normally considered low normal by WHO criteria, raising the question about optimal hemoglobin levels in the elderly. SUMMARY: Anemia is a common modifiable predictor of poor medical outcome in older adults and, as such, should be actively managed. Clinical studies are necessary to assess the effect of treatment of anemia on outcomes specific to the elderly, like disability.

Aged↗