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Jochanan Stessman

Publications and source records attributed to Jochanan Stessman.

At least 19 recordsLinked to original sources
PubMed2006

Closure of a home hospital program: impact on hospitalization rates.

Home hospitalization (HH), as a substitute to in-patient care, is an area of growing interest, particularly amongst the elderly. Debate nonetheless exists concerning its economic justification. This study describes a natural experiment that arose following spending cuts and closure of the 400 patient Jerusalem HH program. It examines the hypothesis that HH closure would cause increasing geriatric and general medical hospital utilization amongst the 45,000 beneficiaries of the Jerusalem Clalit Health Fund (HMO) aged 65 years and over. Hospitalization rates were measured prior to and following HH closure, and analysis of variance confirmed the significance of the differences in both geriatric (p<0.0001) and general medical hospitalization rates (p=0.02) over the study period. Linear regression analyses of the hospitalization rates prior to HH closure were performed to determine the expected trajectory of hospitalization rates following HH closure. The observed hospital utilization in the year following HH closure cost 6.2 million US dollars in excess of predicted expenditure; closure of the HH resulted in the saving of 1.3 million USdollars. The ratio of direct increased costs to savings was 5:1 thus confirming the hypothesis that HH closure would result in increased hospital utilization rates among the local elderly population.

Aged↗
PubMed2006

Usefulness of nocturia as a mortality risk factor for coronary heart disease among persons born in 1920 or 1921.

Cardiovascular events are clustered in the morning hours, after increases in blood pressure and heart rate that accompany awakening and arising. Similar hemodynamic changes occur during the night after nocturnal awakening and getting up. Such changes are common among older patients who have nocturia frequently and rise to urinate. We tested the hypothesis that nocturia may be associated with increased mortality in a population sample of 456 subjects born from 1920 to 1921, examined in 1990, and followed for total mortality until 2002. At baseline, they were questioned about nocturia (> or =2 times at night) as part of a detailed questionnaire and examination. Twelve-year survival was significantly lower (61% vs 72%, p = 0.0206) among subjects reporting nocturia (n = 160, 64% men) compared with those without nocturia (n = 296, 50% men). After accounting for numerous confounders, a proportional hazard model determined the mortality hazard ratio (HR) for nocturia alone to be 0.89 (95% confidence interval [CI] 0.55 to 1.43). The interaction between nocturia and previous coronary heart disease (CHD) was highly significant (p <0.0001), with an interaction variable HR of 2.16 (95% CI 1.01 to 4.61). Survival of patients who had CHD with nocturia (n = 54) versus those without nocturia (n = 65) was 44% versus 66% (p = 0.0201). Among patients with CHD, the mortality HR for nocturia was 2.11 (95% CI 1.16 to 4.00). In conclusion, nocturia is a significant independent predictor of mortality among 70-year-old patients with known CHD and thus warrants special attention.

Aged, 80 and over↗
PubMed2006

Chronic back pain among the elderly: prevalence, associations, and predictors.

STUDY DESIGN: A longitudinal age homogeneous cohort study. OBJECTIVE: To describe the prevalence, nature, and predictors of chronic back pain (CBP) in older people. SUMMARY OF BACKGROUND DATA: CBP is a growing source of morbidity among the elderly. Few longitudinal studies exist, and its time course and predictors are largely undefined. METHODS: The Jerusalem Longitudinal Study assessed 277 subjects aged 70 years at baseline and 77 years at follow-up. Data collection included back pain symptoms, psychosocial, functional, and physical domains. RESULTS: The prevalence of CBP increased from 44% to 58% at ages 70 and 77 years, respectively, while frequency and severity decreased. CBP was associated with female gender, economic difficulties, loneliness, fatigue, poor self-rated health, dependence in activities of daily living, joint pain, and obesity. Depression was associated at age 70 years, and unemployment, not leaving the house for leisure, poor sleep satisfaction, hypertension, and osteoporosis were at age 77 years. Predictors of CBP at age 77 years were female gender, loneliness, joint pain, hypertension, and preexisting CBP. Unemployment and not leaving the house for leisure showed a trend toward significance. CONCLUSION: CBP is increasingly common in the elderly. Psychosocial factors, female gender, hypertension, and existing joint pain identify individuals most at risk.

Age Factors↗
PubMed2006

Aspirin prophylaxis and the prevalence of anaemia.

BACKGROUND: Anaemia and vascular disease are both common amongst the elderly and frequently co-exist. Whilst a consensus exists concerning the benefits of low-dose aspirin in reducing risk from atheromatous disease, nonetheless concerns arise in view of its harmful effect on gastric mucosa and its influence upon haemostasis, with the possibility of subsequent gastrointestinal bleeding. This study examined the relationship between chronic low-dose aspirin therapy and the presence of anaemia. SETTING: A cross-sectional study of a representative cohort of 464 community-dwelling subjects aged 77 years. METHODS: Subjects underwent comprehensive assessment of psychosocial, functional, medical and laboratory variables. In accordance with the World Health Organization criteria, anaemia was defined as less than 13 g/dl for men and 12 g/dl for women. RESULTS: Chronic low-dose aspirin use was found amongst 29% of the 227 women and 38% of the 237 males (P = 0.026). Aspirin use was significantly associated with hypertension, ischaemic heart disease and diabetes mellitus. Anaemia was 42% less common among aspirin users, a statistically robust finding (OR 2.44, 95%CI 1.28-4.66) according to logistic regression analysis which included the confounding variables of gender, education, diabetes, hypertension, heart disease, peptic diseases, antipeptic therapy and smoking. Similarly, no association was observed between aspirin use and reduced serum iron or iron saturation, reduced mean corpuscular haemoglobin or mean corpuscular volume. CONCLUSIONS: Chronic low-dose aspirin use amongst an elderly cohort was associated with increased likelihood of normal haemoglobin.

Aged↗
PubMed2006

Global sleep satisfaction of older people: the Jerusalem Cohort Study.

OBJECTIVES: To describe the nature of global sleep satisfaction (GSS) of older people and the factors associated with it. DESIGN: A 7-year follow-up of an age-homogenous cohort. SETTING: Community based. PARTICIPANTS: Two hundred ninety subjects aged 70 at baseline and 77 at follow-up. MEASUREMENTS: Self-reported sleep domains and a comprehensive assessment of health variables, including psychosocial, physical, and functional factors, at ages 70 and 77. RESULTS: GSS was found to be poor in 25% of subjects at ages 70 and 77, with an estimated average annual remission rate of 7% and an annual incidence of 2.4%. Poor GSS at ages 70 and 77 was significantly associated with difficulty falling asleep, awakening feeling tired, two or more nocturnal awakenings, and taking sleeping tablets. Significant cross-sectional associations were found at age 70 and 77 between poor GSS and poor self-rated health, general fatigue, depression, dependence in one or more activities of daily living, and low level of physical activity. In a regression analysis, risk factors at age 70 for subsequent poor GSS were loneliness, depression, poor self-rated health, economic difficulties, back pain, obesity, and prior poor GSS. The only significant long-term association was between poor GSS and poor self-rated health. GSS did not influence mortality data. CONCLUSION: Poor GSS in older people is common and chronic. Its chief determinants are loneliness, depression, poor self-rated health, economic difficulties, back pain, and obesity. It predicts poor self-rated health but not increased mortality.

Age Factors↗
PubMed2006

Low alanine aminotransferase activity in older people is associated with greater long-term mortality.

OBJECTIVES: To find possible association between liver enzymes and mortality in older people. DESIGN: A prospective cohort study. SETTING: Jerusalem. PARTICIPANTS: A systematically selected representative sample of 455 70-year-old ambulatory individuals was prospectively followed for 12 years. MEASUREMENTS: An extensive social and medical profile was developed at age 70 using a detailed interview and physical and ancillary examination. Information on mortality was obtained annually. Differences in survival between subjects stratified according to liver enzyme levels were assessed using the Kaplan-Meier method. Multivariable survival analyses using a Cox proportional hazards model were performed to determine the association between liver enzyme levels at age 70 and mortality over 12 years. RESULTS: Median alanine aminotransferase (ALT) activity of the study population was 11.00 U/L for women and 13.00 U/L for men. Twelve-year survival rates for women with ALT below and above the median levels were similar (78%). For men, these rates were 54% and 65%, respectively (P < .001). Proportional hazards models demonstrated that this greater mortality risk was independent of numerous common risk factors for mortality (hazard ratio (HR) = 1.5, 95% confidence interval (CI) = 1.08-2.19). Adding an interaction between sex and low ALT to the model demonstrated a higher risk of mortality for men with low ALT levels (HR = 2.42, 95% CI = 1.15-5.08). No such risk was demonstrated for the other liver enzymes. CONCLUSION: ALT activity represents a strong and independent surrogate marker for mortality in community-dwelling elderly men.

Aged↗
PubMed2005

Acetylcholinesterase/paraoxonase interactions increase the risk of insecticide-induced Parkinson's disease.

Exposure to agricultural insecticides, together with yet incompletely understood predisposing genotype/phenotype elements, notably increase the risk of Parkinson's disease. Here, we report findings attributing the increased risk in an insecticide-exposed rural area in Israel to interacting debilitating polymorphisms in the ACHE/PON1 locus and corresponding expression variations. Polymorphisms that debilitate PON1 activity and cause impaired AChE overproduction under anticholinesterase exposure were strongly overrepresented in patients from agriculturally exposed areas, indicating that they confer risk of Parkinson's disease. Supporting this notion, serum AChE and PON1 activities were both selectively and significantly lower in patients than in healthy individuals and in carriers of the risky polymorphisms as compared with other Parkinsonian patients. Our findings suggest that inherited interactive weakness of AChE and PON1 expression increases the insecticide-induced occurrence of Parkinson's disease.

Acetylcholinesterase↗
PubMed2005

The impact of visual impairment on health, function and mortality.

BACKGROUND AND AIMS: Our aim was to determine the impact of visual impairment on self-rated health, function and mortality amongst a community-dwelling elderly cohort. METHODS: The study design was prospective and longitudinal, subjects being taken from an age-homogeneous, community-dwelling cohort comprising 452 subjects aged 70 in 1990 and 839 subjects aged 77 in 1998. Comprehensive data were collected by structured interviews and medical examinations carried out during home visits. Data included each subject's demographic and socio-economic profile, medical history, physical findings, functional status and self-rated health status. Visual acuity was measured using a Snellen chart and visual impairment was defined as best-eye corrected visual acuity of 20/40 or worse on Snellen chart testing. RESULTS: Measured and self-reported visual impairment correlated closely, and were significantly more prevalent amongst subjects with low education and poor financial status. Visually impaired subjects showed significantly greater dependence in ADL and IADL, poor self-rated health, less ability to rely on friends, increased loneliness and, in men aged 77, increased visits to the emergency room and hospital admissions. Visual impairment at age 70 significantly predicted poor self-rated health (p=0.029, OR 2.36, 95% CI 1.09-5.10), dependence in ADL (p=0.007, OR 2.91, 95% CI 1.34-6.33), general tiredness (p=0.037, OR 2.40, 95% CI 1.06-5.44), and mortality, with a two-and-a-half-fold increase in risk of death at seven years (p=0.0017,OR 2.84, 95% CI 1.48-5.46). CONCLUSIONS: Visual impairment in the elderly increases the risk of social, functional and medical decline.

Aged↗
PubMed2005

Working late: the impact of work after 70 on longevity, health and function.

BACKGROUND AND AIMS: Although many older persons choose to postpone retirement, the health consequences of this decision are still debated. This study aimed at determining the impact of continued employment on life-style, well-being, health and survival in a cohort of community-dwelling 70-year-olds. METHODS: A longitudinal study of a homogeneously aged cohort was conducted in two stages. Data from extensive interviews, physical examinations and clinical laboratory information were obtained from west Jerusalem residents born in 1920-1 through home-based examinations. In 1990-1, 162 women and 218 men were examined, at age 70, and in 1997-8, 390 women and 398 men at age 77. Two hundred and thirty one subjects participated in both study stages and were available for longitudinal analysis. For each subject at each study stage, a comprehensive profile detailed social characteristics, including life-style and personal functions, and medical status including illnesses and use of medical services. At each stage, employed subjects were compared with those who neither worked for compensation nor as volunteers. Logistic regression compared health outcomes at age 77 for subjects who worked at age 70 with those of subjects who had not. RESULTS: At age 70, 37 women and 98 men were gainfully employed, whereas 125 women and 120 men did not work. At age 77, wage-earners numbered 26 women and 95 men, and non-workers 364 women and 303 men. In the cross-sectional analyses at ages 70 and 77, work correlated with better perceived health and greater independence for both women and men. Independent of pre-existing economic difficulties, education, illnesses, functional dependence and self-assessed health, workers at age 70 after seven years were in better health (OR 2.12, 95% CI 1.04, 4.30), had more ADL independence, (OR 2.60, 95% CI 1.08, 6.29) and increased survival rates (OR 2.13, 95% CI 1.06, 4.28). CONCLUSIONS: Independent of baseline status, working at age 70 correlates with health, self-sufficiency and longevity.

Activities of Daily Living↗
PubMed2005

Strategies to enhance longevity and independent function: the Jerusalem Longitudinal Study.

PURPOSE: To analyze the impact of medical and social factors on survival and function from age 70 to 82 and point to possible genetic basis for differences. MATERIALS AND METHODS: Longitudinal, cohort study of a representative sample of Jerusalem residents, born 1920-1921. At age 70, 463 subjects underwent a thorough interview eliciting social determinants as well as a medical history and examination and laboratory investigation. At age 77,265 of the survivors, 71%, were re-examined. In 2002, all death certificates in Israel were reviewed. End points were performance of basic and advanced tasks with ease at age 77 and survival to age 82 or life span in subjects who had succumbed. The independent influence of each factor was tested using logistic regression. RESULTS: 89.6% of women were alive after 6 years and 77.4% after 12. Survival for men was 79.9% and 59.8%, respectively. Social factors predominated in the correlation with longer life: financial security, p=.0004; volunteer activity, p=.0002; regular exercise, p=.0002; positive self-assessed health, p<.0001; and activities of daily living (ADL) independence, p<.0001. Less striking but significant correlation for longevity was noted for avoiding naps, p=.04 and instrumental activities of daily living (IADL) independence, p=.048. Medical conditions associated with increased mortality included diabetes, p<.0001; coronary artery disease, p=.0002; impaired vision, p=.0007; and renal insufficiency, p=.008. Anemia and disturbed sleep did not independently correlate with mortality while the association with hypertension did not reach statistical significance, p=.056. In a regression to determine the independent impact of medical and social factors on mortality, unimpaired renal function, good vision, avoiding afternoon naps, volunteer or compensated work, physical activity and IADL independence all correlated with improved survival. Moreover, good vision, volunteer work or work for pay and physical activity were independently associated with continued ADL independence after 7 years. CONCLUSIONS: These findings highlight the ability of social, economic and functional factors to modify genetic influence on survival and function. Increased physical and social activity is an important tool to lengthen the span of robust function. The role of heredity in determining function and mortality may be expressed through diverse pathways.

Activities of Daily Living↗
PubMed2005

Candidate genes associated with ageing and life expectancy in the Jerusalem longitudinal study.

In an exploratory study, 11 common polymorphisms were examined for contributing to longevity including: apolipoprotein E (apoE), methylenetetrahydrofolate reductase (MTHFR), cathepsin D (CAD), superoxide dismutase 2 (SOD2), angiotensinogen (AGT) and insulin-like growth factor 2 (IGF2), Leiden factor 7, p53 oncogene, dopamine D4 receptor (DRD4) and the serotonin transporter (SERT). Genotype and allele frequencies of these genes were compared in 224 older (75 years) Jewish Jerusalem residents of Ashkenazi ethnicity to a group of 441 younger subjects (22 years). Nominally significant results provide suggestive evidence in the Ashkenazi group that apoE, MHTFR, SOD2, IGF2 ApaI, and factor VII are risk factors for a single outcome, survival to 75. Overall, the more genetically homogenous Ashkenazi ethnic group showed evidence for association in five genes examined suggesting that future studies in this population would gainfully focus on this ethnic group.

Adolescent↗
PubMed2005

The siesta and mortality: twelve years of prospective observations in 70-year-olds.

STUDY OBJECTIVE: To examine effect of siesta on mortality. DESIGN: A 12 years prospective cohort. SETTING: Population sample. PARTICIPANTS: Residents of Jerusalem (n=455), 70 year olds. INTERVENTIONS: N/A. RESULTS: There were more males in the group with the siesta (n=276), 68% and more (16%) past myocardial infarction than those without the siesta, 6% (n=179) p < 0.01. After 12 years 147 subjects died. Survival was 64% in people practicing the siesta, and 74%, who did not p = 0.005. In a Cox proportional hazard model, that included many confounding factors hazard ratio (HR) for mortality was 1.6 95% confidence interval (CI) 1.2-2.7, for those who napped. After exclusion of the 19 subjects who died during the first 2 years of follow-up, the hazard ratio was not materially altered, HR of 1.6 95% CI, 1.0-2.6. CONCLUSION: Although causality is not clear, the siesta appears to be a significantly independent mortality predictor.

Aged↗
PubMed2003

Sex differences in the effect of heart rate on mortality in the elderly.

OBJECTIVES: To examine the association between heart rate and mortality risk in the elderly. DESIGN: Longitudinal cohort. SETTING: Outpatient. PARTICIPANTS: Four hundred twenty-two people, aged 70 upon entry, were surveyed and followed for 6 years. MEASUREMENTS: Pulse rate was measured manually, while sitting and standing, and heart rate was measured from electrocardiogram recordings. The population was divided into quartiles of heart rate, with the top quartile comprising those with heart rate greater than 77 beats per minute (bpm) and the bottom quartile those with heart rate less than 60 bpm. RESULTS: After controlling for possible confounders, there was a clear correlation (r) between heart rate and all-cause mortality in elderly women (r=0.25, P=.0003). The correlation in women was observed using the three different methods for measuring heart rate. Heart rate was associated with all-cause and cardiovascular mortality. There was no relationship between heart rate and level of exercise or smoking status. In multiple regression analysis, the increased risk of death in the women was independent of previous cardiovascular or cerebrovascular disease, hypertension, anemia, congestive heart failure, smoking, and level of exercise or activities of daily living (relative odds ratio (ROR)=3.37, 95% confidence interval (CI)=0.96-11.8). When women using beta-blockers were excluded, this relationship became even stronger (ROR=8.5, 95% CI=1.19-60.1). CONCLUSION: Elevated heart rate is related to increased mortality in elderly women, thus representing a simple index of general health status in this population. Elevated heart rate did not predict mortality in elderly men.

Activities of Daily Living↗
PubMed2002

The siesta and mortality in the elderly: effect of rest without sleep and daytime sleep duration.

STUDY OBJECTIVE: To examine the effects of daytime rest without sleep and duration of the siesta on mortality. DESIGN: Longitudinal observation. SETTING AND PARTICIPANTS: Population sample of 442 community-dwelling 70-year-old subjects examined both at home and in a geriatric hospital. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Overall mortality for those who neither rested nor slept was 9.3%, for those who rested without sleep 10.9%, and for those who slept 19%, p<0.02. Males had higher mortality (19%) than females (10%), p<0.006. Rest without sleep had no effect on mortality: in males, 13%, 21%, 18% for no rest, rest of less than one hour, or more than one hour with respective 8%, 6% and 4% in females. However, daytime sleep in males of more than one hour had 28.2% mortality, whereas sleep of one hour or less had 13.6% mortality, p=0.02. In females mortality rate was not different by sleep duration: 16% and 13.6% for those who slept for one hour or less, or more than one hour, respectively. In a multivariate analysis in females, a siesta of one hour or less was associated with risk odds ratio (ROR) of 4.67 and 95% confidence interval (CI) 1.22-17.80 and of one to two hours, ROR was 5.57 and 95% CI 1.05-29.49. For males, siesta of less than one hour was not associated with excess risk, ROR 0.9 and 95% CI 0.39-2.38; a siesta of one to two hours with ROR of 2.61 and 95% CI 1.01-6.80; and two hours or more ROR 13.6 and 95% CI 0.98-2.10. CONCLUSIONS: Rest without sleep is not associated with excess risk of mortality. However, siesta of one to two hours is associated with increased mortality in males whereas, in women, a siesta of less than one hours confers the excess risk.

Aged↗