OBJECTIVES: To examine the association between serum parathyroid hormone (PTH) levels and incident falls in older adults with diabetes mellitus.
DESIGN: Longitudinal analysis of incident falls over 1 ...year in a substudy of participants with diabetes mellitus in the Health, Aging and Body Composition Study.
SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee.
PARTICIPANTS: Well‐functioning, community‐dwelling black and white adults aged 70 to 79 with diabetes mellitus (N=472).
MEASUREMENTS: Measured baseline serum PTH. Self‐report of falls over the subsequent 12 months. Baseline physical performance and self‐reported demographic, behavioral, and health status measures including kidney function, chronic conditions, and medication use.
RESULTS: One‐third (30.3%) of participants reported falling over 1 year of follow‐up. Mean baseline serum PTH was 53.5±30.0 pg/mL in nonfallers and 62.6±46.2 pg/mL in fallers (P=.01). For every 1 standard deviation (36 pg/mL) increment in baseline serum PTH, there was approximately a 30% greater likelihood of reporting a fall in the subsequent year, after adjusting for age, sex, race, field center, alcohol consumption, body mass index, physical activity, and winter or spring season (adjusted odds ratio (aOR)=1.30, 95% confidence interval (CI)=1.06–1.59). Further adjustment for kidney function, chronic conditions, medication and supplement use, and physical performance attenuated the association slightly (aOR=1.26, 95% CI=1.01–1.58). A trend remained after additional adjustment for reported falls in the previous year.
CONCLUSION: Higher serum PTH was associated with incident falls in older, well‐functioning men and women with diabetes mellitus. Further investigation aimed at understanding the underlying mechanism for the association between serum PTH and falls is needed.
Background Although malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these ...populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger. Methods Children with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission. Results Among the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9%) children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses. Conclusions These data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data.
Medication complexity is a large determinant of adherence. Few studies have explored the relationship between cognitive impairment and medication complexity.
To evaluate whether cognitive impairment ...is associated with medication complexity for prescription and over-the-counter (OTC) medications.
In this cross-sectional analysis, we studied the association between cognitive impairment and the complexity of prescription and OTC drug regimens. Baseline participants were from the Health, Aging and Body Composition study, consisting of 3075 well-functioning 70- to 79-year-old black and white men and women. Cognitive impairment was defined by having a Modified Mini-Mental State Examination score <80. The complexity of prescription and OTC (including supplements/herbals) medications was assessed using a modified version of the Medication Regimen Complexity Index (mMRCI). The mMRCI score increases with complexity of dosage forms, number of medications, pill burden, and nondaily dosing.
The mean (SD) age was 74 (2.9) years (n = 3055; 52% female, 41% black). The median prescription mMRCI score was 6 (range 0-66). The median OTC mMRCI score was 4 (range 0-71). Adjusting for health status, demographics, and access to care, medication complexity was lower in participants with cognitive impairment for prescription (adjusted RR 0.89; 95% CI 0.80 to 0.99) and OTC medications (adjusted RR 0.76; 95% CI 0.64 to 0.93) compared to those without cognitive impairment. The number of prescription medications was not different, but the number of OTC drugs was lower for those with cognitive impairment.
In this cohort of well-functioning older adults, those with cognitive impairment had lower prescription complexity due to less-complex dosage forms, pill burden, or daily dosing. OTC complexity was also lower, primarily due to a lower number of OTC drugs. The results of this study show that further research on medication complexity and adherence and health outcomes in cognitively impaired individuals is warranted.
Family Involvement in End-of-Life Hospital Care Tschann, Jeanne M.; Kaufman, Sharon R.; Micco, Guy P.
Journal of the American Geriatrics Society (JAGS),
June 2003, Letnik:
51, Številka:
6
Journal Article
Recenzirano
Odprti dostop
OBJECTIVES: To examine whether the end‐of‐life treatment provided to hospitalized patients differed for those who had a family member present at death and those who did not.
DESIGN: A retrospective ...cohort analysis.
SETTING: An urban community hospital.
PARTICIPANTS: All 370 inpatients who died during a 1‐year period.
MEASUREMENTS: Medical records were examined for whether life‐support treatments were provided or withdrawn, occurrence and timing of do‐not‐resuscitate (DNR) orders, and use of comfort measures such as narcotics and sedation.
RESULTS: DNR orders were written for 85% of patients. For patients who had a DNR order written, the average time from the DNR order to death was 4.8 days. Only 26% of patients had one or more treatments withdrawn. Sixty‐seven percent of patients received narcotics before death, and 22% received sedatives. Patients aged 75 and older and African Americans were less likely to have a family member present at death. After adjusting for age and ethnicity, patients who had a family member present at death were more likely to have DNR orders written, to have treatments withdrawn, and to receive narcotics before death. Patients with a family member present at death also had a shorter time to death after DNR orders were written.
CONCLUSION: The presence of a family member at death appears to be an indirect measure of family involvement during patients' hospitalization. Family involvement before death may reduce the use of technology and increase the use of comfort care as patients die.
Background: Recent evidence suggests that the rate of carbohydrate digestion and absorption may influence the development of type 2 diabetes.
Objective: The aim of this study was to examine ...associations of dietary glycemic index and glycemic load with predictors of type 2 diabetes in older adults.
Design: This study evaluated cross-sectional relations of dietary glycemic index and glycemic load with measures of glucose metabolism and body fat distribution in participants of the Health, Aging and Body Composition Study, a prospective cohort study of adults aged 70–80 y (n = 2248).
Results: In men, dietary glycemic index was positively associated with 2-h glucose (P for trend = 0.04) and fasting insulin (P for trend = 0.004), inversely associated with thigh intramuscular fat (P for trend = 0.02), and not significantly associated with fasting glucose, glycated hemoglobin, or visceral abdominal fat. Dietary glycemic load was inversely associated in men with visceral abdominal fat (P for trend = 0.02) and not significantly associated with fasting glucose, 2-h glucose, glycated hemoglobin, fasting insulin, or thigh intramuscular fat. In women, although dietary glycemic index and load were not significantly related to any measures of glucose metabolism or body fat distribution, the association between dietary glycemic index and 2-h glucose was nearly significant (P for trend = 0.06).
Conclusion: The findings of this cross-sectional study indicate an association between dietary glycemic index and selected predictors of type 2 diabetes in older adults, particularly in men.
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