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Biomedical subjects

L Ferrucci

Publications and source records attributed to L Ferrucci.

At least 91 records · Page 5Linked to original sources
PubMed1998

Black/white differences in the relationship between MMSE scores and disability: the Women's Health and Aging Study.

The purpose of this article is to examine Black/White differences among older women in the relationship between physical functional difficulties and variations in cognitive status, measured within the low to high normal range of the Mini-Mental State Examination (MMSE). We studied 3,585 women with MMSE scores of 18 and above from a population-based random sample of 3,841 community-dwelling women aged 65 and older living in East Baltimore, Maryland. Trained interviewers administered the MMSE and obtained information on demographics, medical conditions, and functional difficulties. Prevalence of any functional difficulty was 43.3% in Whites and 48.5% in Blacks, who were 25% of the study sample. After adjusting for age and education, a significant trend for increasing functional difficulty with decreasing MMSE scores was found in White women but not in Black women. Since no explanation for these racial differences could be identified, these findings suggest that the MMSE may not be a valid predictor of functional difficulty in Black women who score > or = 18 on the instrument.

Black or African American↗
PubMed1998

Is self-rated health comparable across cultures and genders?

Self-rated health is a frequently used health indicator, but there is little data on its comparability across cultures. We employed samples from Tampere, Finland, and Florence, Italy, of the European Longitudinal Study on Aging to examine the cultural and gender differences in self-rated health. Personal interview data was used and vital status ascertained after 7 years. After adjusting for several health-related variables, we found no substantial difference in self-rated health between genders, although women in Florence were three times and men in Florence four times more likely to report good self-rated health than men in Tampere. The correlational structure of self-rated health was similar in both areas. The significant graded association between self-rated health and mortality in both areas was mostly explained by other health indicators included in a multivariate model. Results suggest that self-rated health is a useful summary of physical health, but it may predict mortality better in men than in women and be sensitive to cultural environment. Therefore, direct gender and cultural comparisons of self-rated health should be made with caution.

Aged↗
PubMed1998

Constant hierarchic patterns of physical functioning across seven populations in five countries.

This research was aimed at identifying critical steps in the decline in physical function that often parallels aging. Six basic and nine instrumental activities of daily living (ADLs) were classified into four domains of disability characterized by specific underlying physical impairment. The hierarchical order of this classification was verified in two random samples representative of the older home-dwelling population. The concordance level of disability and results of performance-based measures of physical function were also tested. Finally, the cross-cultural reliability of the model was verified in seven population-based samples of older persons living in five European countries. In older persons the disabling process follows a general pattern of progression based on a typical sequence of impairments.

Activities of Daily Living↗
PubMed1998

Emotional vitality among disabled older women: the Women's Health and Aging Study.

OBJECTIVE: To examine correlates of high overall level of emotional functioning (emotional vitality) in disabled older women. DESIGN: A community-based study: The Women's Health and Aging Study. POPULATION: A total of 1002 moderately to severely disabled women aged 65 and older living in the community. MEASUREMENTS: Emotional vitality was defined as having a high sense of personal mastery, being happy, and having low depressive symptomatology and anxiety. Correlations with demographics, health status, and social context were examined. RESULTS: Despite their physical disabilities, 35% of the 1002 disabled older women were emotionally vital. The percent of emotionally vital women declined with increasing severity of disability. After adjustment for disability status, a significantly increased likelihood for being emotionally vital was found for black race (OR=1.69) and for having higher income (OR=1.77), better cognition (OR=2.36), no vision problems (OR=1.61), adequate emotional support (OR=2.54), and many face-to-face contacts (OR=1.64). Having more than one negative life event reduced the likelihood of emotional vitality (OR=0.57). CONCLUSION: A substantial proportion of even the most disabled older women can be described as emotionally vital. Findings also suggest that emotional vitality is not solely a function of stable, enduring individual characteristics but that health status, disability, and sociodemographic context also have an influence on emotional vitality.

Aged↗
PubMed1997

Increase of chromosomal aberrations induced by ionising radiation in peripheral blood lymphocytes of civil aviation pilots and crew members.

This study inquires if there is an increase of chromosomal aberrations by ionising radiation of cosmic origin in civil pilots and flight-crew members. Totals of 37,208 exposed cells and 10,950 control cells, from 192 and 55 donors respectively, were scored averaging 200 observations per subject. The analysis showed the increase of dicentric and ring chromosomes in peripheral blood lymphocytes of the flight personnel. The difference of the total aberration frequencies between exposed and control was statistically significant.

Adult↗
PubMed1997

Clarifying the direct relation between total cholesterol levels and death from coronary heart disease in older persons.

BACKGROUND: The importance of total cholesterol level as a risk factor for coronary heart disease in older adults is controversial. OBJECTIVE: To determine whether findings showing that total cholesterol level is not an important risk factor for coronary heart disease in older adults are the result of inadequate adjustment for co-occurring diseases and frailty. DESIGN: Multicenter, longitudinal study with 5-year follow-up for death. PARTICIPANTS: 4066 men and women from East Boston, Massachusetts; Iowa and Washington counties, Iowa; and New Haven, Connecticut. MEASUREMENTS: In 1988, participants were interviewed about their health status and had blood samples taken. Mortality follow-up was through 1992. RESULTS: In analyses that included all fatal coronary heart disease events (252 deaths) and did not adjust for risk factors for coronary heart disease and measures of frailty, persons with the lowest total cholesterol levels (< or = 4.15 mmol/L [< or = 160 mg/dL]) had the highest rate of death from coronary heart disease, whereas those with elevated total cholesterol levels (> or = 6.20 mmol/L [> or = 240 mg/dL]) seemed to have a lower risk for death from coronary heart disease (P for trend = 0.04). After adjustment for established risk factors for coronary heart disease and markers of poor health (including chronic conditions, low serum iron and albumin levels) and exclusion of 44 deaths from coronary heart disease that occurred within the first year, elevated total cholesterol levels predicted increased risk for death from coronary heart disease, and the risk for death from coronary heart disease decreased as cholesterol levels decreased (P for trend = 0.005). CONCLUSIONS: Elevated total cholesterol level is a risk factor for death from coronary heart disease in older adults, and the apparent adverse effects associated with low cholesterol levels are secondary to comorbidity and frailty. This suggests that excluding older persons from cholesterol screening is inappropriate, but interpretation of screening results in older persons requires clinical judgment. Results from controlled clinical trials are needed to clarify this issue.

Aged↗
PubMed1997

Hospital diagnoses, Medicare charges, and nursing home admissions in the year when older persons become severely disabled.

OBJECTIVE: To characterize hospital diagnoses, procedures and charges, and nursing home admissions in the year when older persons become severely disabled, comparing those in whom severe disability develops rapidly with those in whom disability develops gradually. DESIGN: A prospective, population-based cohort study with at least 6 annual interviews beginning in 1982. SETTING: A total of 3 communities: East Boston, Mass, New Haven, Conn, and Iowa and Washington counties in Iowa. SUBJECTS: A total of 6070 persons at least 70 years old with at least 1 interview after the fourth annual follow-up and without evidence of previous severe disability, defined as disability in 3 or more activities of daily living (ADLs). MAIN OUTCOME MEASURES: Characteristics associated with development of severe disability after the fourth annual follow-up, in which the disability is classified as catastrophic disability if the individual did not report any ADL disability in the 2 interviews prior to severe disability onset or as progressive disability if the individual had previous disability in 1 or 2 ADLs. RESULTS: In the year during which severe disability developed, hospitalizations were documented for 72.1% of those developing catastrophic disability and for 48.6% of those developing progressive disability. In the corresponding year, only 14.7% of those who were stable with no disability and 22.3% of those with some disability were hospitalized. The 6 most frequent principal discharge diagnoses included stroke, hip fracture, congestive heart failure, and pneumonia in both severe disability subsets; coronary heart disease and cancer in catastrophic disability; and diabetes and dehydration in progressive disability. These diagnoses occurred in 49% of those with catastrophic disability and 25% of those with progressive disability. In both severe disability subsets, the oldest patients received less intensive hospital care as indicated by charges for surgery, diagnostics, and rehabilitation and by the percentage who received major diagnostic procedures; they were also more often admitted to nursing homes. CONCLUSIONS: In the year when they become severely disabled, a large proportion of older persons are hospitalized for a small group of diseases. Hospital-based interventions aimed at reducing the severity and functional consequences of these diseases could have a large impact on reduction of severe disability.

Activities of Daily Living↗
PubMed1997

Serum iron level, coronary artery disease, and all-cause mortality in older men and women.

The association between iron levels and coronary artery disease (CAD) mortality is controversial. Whereas most data show no association, some have raised the possibility of a causal role, while others have suggested a protective effect of iron on CAD. To address these possibilities, we examined the association between serum iron and CAD, cardiovascular disease, and all-cause mortality in a large cohort of 3,936 persons aged > or =71 years who completed an interview, had a serum iron determination, and survived at least 1 year after baseline. The median follow-up time was 4.4 years. Serum iron levels were categorized according to sex-specific quartiles. Relative risks (RR) and 95% confidence intervals (CI) were calculated from proportional-hazards regression models adjusted for age, race, education, creatinine, serum albumin, serum lipids, use of iron supplementation, smoking, use of alcohol, blood pressure, body mass index, and presence of chronic conditions. There was a gradual decrease in the RRs of CAD, cardiovascular disease, and all-cause mortality with increasing serum iron levels (all tests for trend, p <0.05). Men in the highest iron quartile were one fifth as likely to die of CAD as men in the lowest iron quartile (RR 0.22; 95% CI 0.11 to 0.48), and women in the highest quartile had half the risk of women in the lowest quartile (RR 0.48; 95% CI 0.27 to 0.87). When compared with the lowest quartile, risk of all-cause mortality was 38% lower in men in the highest iron quartile (RR 0.62; 95% CI 0.46 to 0.85) and 28% lower in women in the highest quartile (RR 0.72; 95% CI 0.53 to 0.96). Results of similar strength and magnitude were observed for cardiovascular disease mortality and in analyses that excluded the first 3 years of follow-up. In this large cohort of persons aged > or =71 years, there was consistent evidence of increasing risk of mortality at lower serum iron levels. In fact, lower serum iron levels were associated with an increased risk of CAD, cardiovascular disease, and all-cause mortality. The results are compatible with the possibility that in an older population, there is an inverse association between serum iron levels and risk of mortality.

Age Factors↗
PubMed1997

Formal education as an effect modifier of the relationship between Mini-Mental State Examination score and IADLs disability in the older population.

The objective of this retrospective, case-series study was to examine the relationship between disability in Instrumental Activities of Daily Living (IADLs) and cognitive impairment measured by the Mini-Mental State Examination (MMSE), and how this relationship was influenced by different levels of formal education. The setting of the study was the Cognitive Disorders Center of the Local Sanitary Unit (USL) No. 4 in Prato (Italy). Independence in IADL was strongly related to MMSE scores. A score of less than 24 at the MMSE was predictive of disability in at least one IADL with 0.82 sensitivity and 0.73 specificity. However, when only people with a very low level of formal education were considered, the best threshold predicting IADL disability was 17 (sensitivity 0.76, specificity 0.75). Thus, scholastic achievement is an effect modifier of the relationship between cognitive status, as measured by the MMSE, and IADL disability. Subjects with low education level and poor performance at the MMSE are often independent in activities making demand on cognitive function, such as IADLs. These results suggest that a lower MMSE cut-off score should be considered when screening for cognitive impairment in these persons.

Activities of Daily Living↗
PubMed1997

Co-occurrence of disadvantage conditions in elderly subjects with depressive symptoms.

The aim of this survey study is to describe the association of symptomatic depression with the co-occurrence of psycho-social, functional, and somatic disadvantage conditions in 390 over 70 subjects living at home. The most disadvantaged tertile of various conditions (age, social support, cognition, social interactions, self evaluation of health, disability, number of diseases, and somatic symptoms) was associated with greater risk of symptomatic depression. A subset of conditions that might be causally related to depression (age, social support, financial welfare, diseases, and disability) was used to divide subjects into five levels of increasing multiple disadvantage conditions (MDC). Increasing severity of MDC level was associated with greater risk of symptomatic depression even after adjustment for gender and all five conditions used to define MDC levels (odds ratios ranging from 2.7 to 11.3).

Activities of Daily Living↗
PubMed1997

Item re-scaling of an Italian version of the sickness impact profile: effect of age and profession of the observers.

An Italian version of the Sickness Impact Profile (SIP) obtained by professional and nonprofessional translators was checked for cross-cultural equivalence using a back-translation method followed by two scaling studies. The first scaling study involved 30 health professionals who ranked the items within each category for severity of dysfunction. By comparing Italian and US average ranks, 14 highly discordant items were identified. A revised translation was evaluated in a new study involving 120 observers stratified by age (< 65 versus > or = 65 years) and profession (health versus non health professionals) into 4 groups of the same size. The Italian and American item rank orders were almost equivalent, independently of the age and profession of the observers (93% of the ranks showing differences < 2), suggesting that this Italian version of SIP is cross-culturally unbiased. However, older age was associated with higher variability in the rank orders, and some caution is required for use in the geriatric population.

Adult↗
PubMed1997

The effect of chronic diseases on physical function. Comparison between activities of daily living scales and the Physical Performance Test.

AIM: to verify the capacity of basic and instrumental activities of daily living (BADL and IADL) disability scales and of a performance-based test (Physical Performance Test; PPT) to detect the effect on the functional capacity of several common chronic conditions in elderly people. METHOD: a cross-sectional survey of the entire population aged 70 and over, living in Ospitaletto (Brescia, northern Italy)-549 subjects; 89.6% of the eligible population; 179 males and 370 females-was carried out in 1992. A multi-dimensional questionnaire administered at the subject's home was used to collect information on demographics, presence of several common chronic diseases and BADL and IADL. Objective physical capacity was assessed using the PPT. RESULTS: only cognitive deterioration and depression were independently associated with disability, as detected by BADL or IADL scales. Cognitive deterioration, stroke, parkinsonism, heart disease and hearing and visual loss were independently associated with PPT. The performance at PPT remained statistically associated with most of the same diseases when the analysis was restricted to subjects with no BADL or IADL disability. CONCLUSION: a performance-based measure, such as PPT, may detect a functional limitation before it becomes measurable by traditional self-reported BADL and IADL scales.

Activities of Daily Living↗
PubMed1997

Departures from linearity in the relationship between measures of muscular strength and physical performance of the lower extremities: the Women's Health and Aging Study.

BACKGROUND: Sarcopenia, an age-related reduction in muscular mass and strength, may cause a decline in physical functioning and subsequent loss of autonomy. It has been suggested that strength is associated with lower extremity function mainly in the lower portion of the range of strength. Identifying the threshold under which strength is most critical to function may help in targeting groups who may benefit most from exercise interventions. METHODS: The study uses data from the Women's Health and Aging Study. The study population, recruited by screening a population-based sample aged 65 years and older, comprised 1,002 women who represent the one-third most disabled women without severe cognitive impairment living in the community. Knee extensor and hip flexor strength were assessed using a hand-held dynamometer. Lower extremity performance was evaluated using tests of walking, standing balance, and rising from a chair. RESULTS: Among women tested for strength (n = 892), those who could walk (97%), do the side-by-side stand (87%), or complete 5 chair stands (74%) had significantly greater strength. Walking speed was linearly associated with knee extensor strength over the entire range of strength, but its association with hip strength was limited to values below 15 kg. Time for five chair stands was associated with knee extensor and hip flexor strength below 10 and 15 kg, respectively, and no significant association was detected above these values. Stronger women were more likely to hold balance for 10 sec in the side-by-side, semi-tandem, and tandem positions. The percentage of the variance in performance explained by strength alone was always lower than 20%. CONCLUSIONS: In this population, which does not include the strongest older women, there is a departure from linearity in the relationship between muscular strength and some measures of lower extremity performance.

Aged↗
PubMed1997

Apolipoprotein E epsilon 2 allele and risk of stroke in the older population.

BACKGROUND AND PURPOSE: There is evidence for a role of apolipoprotein E (apoE) in atherosclerosis. Coronary heart disease morbidity is higher in persons carrying an epsilon 4 allele and lower in those carrying an epsilon 2 allele, but the effect on cerebrovascular disease is controversial. We estimated the risk of stroke associated with different apoE genotypes in older persons. METHODS: At the sixth annual follow-up of the Iowa cohort of the Established Populations for Epidemiologic Studies of the Elderly, 1664 persons aged > or = 71 years and free of stroke were genotyped for apo E. Occurrence of ischemic strokes was prospectively assessed from subsequent hospital discharge records and death certificates. RESULTS: One hundred fifty persons had an ischemic stroke over the subsequent 5 years (21.2 per 1000 person-years). The presence of epsilon 3 and epsilon 4 did not influence stroke risk. Among persons aged < 80 years at the time of genotyping, epsilon 2 carriers had lower risk of incident stroke, while no effect was detected in the older group. Compared with epsilon 2 carriers aged 70 to 79 years (reference group), those in the same age group and not carrying an epsilon 2 had 2.6-fold higher risk of incident stroke, and those aged > or = 80 years had even higher risk of stroke but without any difference according to presence/absence of epsilon 2 (relative risks 3.6 and 3.3). Results remained substantially unchanged when adjusted for potential confounders and in models estimating the effect of apoE polymorphism on the risk of developing a stroke at ages between 70 and 79 years (56 events) and separately at ages > or = 80 years (94 events). CONCLUSIONS: The conditioning influence of age on the protection conferred by the apoE epsilon 2 allele on stroke risk may account for previous controversies. This hypothesis should be verified in a population with a wider age range.

Aged↗
PubMed1997

The impact of disability in older women.

As the size of the older population grows and mortality rates continue to decline, an unprecedented number of women will live to very old age. Recent research has provided a better understanding of the impact of disability in the older population, risk factors for disability, and the consequences of disability. Older women have consistently been found to have higher prevalence rates of disability than men of the same age. This difference does not result from women developing disability more often than men, but rather surviving longer with their disabilities. This effect may be explained at least in part by the differences in the diseases underlying disability in older women and men. Interventions that can reduce the burden of disability in the aging population are now being explored. In the next century, it will be increasingly important to develop new prevention and treatment strategies that address the functional consequences of chronic disease in the population of women living to older and older ages.

Activities of Daily Living↗
PubMed1996

Calcium-channel blockade and incidence of cancer in aged populations.

BACKGROUND: Calcium-channel blockers can alter apoptosis, a mechanism for destruction of cancer cells. We examined whether the long-term use of calcium-channel blockers is associated with an increased risk of cancer. METHODS: Between 1988 and 1992 we carried out a prospective cohort study of 5052 people aged 71 years or more and who lived in three regions of Massachusetts, Iowa, and Connecticut USA. Those taking calcium-channel blockers (n = 451) were compared with all other participants (n = 4601). The incidence of cancer was assessed by survey of hospital discharge diagnoses and causes of death. These outcomes were validated by the cancer registry in the one region where it was available. Demographic variables, disability, cigarette smoking, alcohol consumption, blood pressure, body-mass index, use of other drugs, hospital admissions for other causes, and comorbidity were all assessed as possible confounding factors. FINDINGS: The hazard ratio for cancer associated with calcium-channel blockers (1549 person-years, 47 events) compared with those not taking calcium-channel blockers (17225 person-years, 373 events) was 1.72 (95% CI 1.27-2.34, p = 0.0005), after adjustment for confounding factors. A significant dose-response gradient was found. Hazard ratios associated with verapamil, diltiazem, and nifedipine did not differ significantly from each other. The results remained unchanged in community-specific analyses. The association between calcium-channel blockers and cancer was found with most of the common cancers. INTERPRETATION: Calcium-channel blockers were associated with a general increased risk of cancer in the study populations, which suggested a common mechanism. These observational findings should be confirmed by other studies.

Aged↗
PubMed1996

Validation of a multidimensional evaluation scale for use in elderly cancer patients.

BACKGROUND: Although aging is one of the most important risk factors for cancer, elderly patients tend to be excluded from cancer clinical trials, only on the basis of chronologic age. Performance Status (PS) has been used widely to select adult patients for entry into clinical trials, but it does not include a comprehensive evaluation of various age-related factors in the elderly. This study was designed to assess the reliability and validity of a multidimensional geriatric assessment protocol for elderly patients with cancer. METHODS: Thirty consecutive elderly patients (> or = 65 years), diagnosed with hematologic neoplasia or solid tumors and undergoing chemotherapy or radiotherapy, were given a specifically structured multidimensional questionnaire (MACE) three times during one week by two different physicians. MACE was intended to collect information on demographics, socioeconomic status, cognitive status, depression, physical performance, disability, and tumor characteristics. In parallel with MACE, information was collected by means of the Sickness Impact Profile (SIP). RESULTS: Both for inter-rater and test-retest reliability, the values of the intraclass correlation coefficient (ICC) were generally higher than 0.7. Disability, cognitive status, depressive symptoms, and the number of days spent in bed sick in the last two weeks were markedly correlated with the global, physical, and social SIP score. Disability alone explained 70% of the variance in the SIP global score, 83% of the variance in the SIP physical score, and 45% of the variance in the SIP psychosocial score. MACE proved to be applicable in a reasonable amount of time (around 30 minutes) for a medical oncology ward. CONCLUSIONS: These data indicate that this structured evaluation of functional status is feasible and reliable. MACE is therefore proposed as a clinical research tool to avoid arbitrary decisions on patient selection for enrollment in clinical trials, to favor uniform monitoring of treatment, and to allow a better comparison of results.

Aged↗