Impaired Vision and the Ability to Take Medications Windham, Beverly Gwen; Griswold, Michael E.; Fried, Linda P. ...
Journal of the American Geriatrics Society (JAGS),
July 2005, Volume:
53, Issue:
7
Journal Article
Peer reviewed
Objectives: To assess relationships between vision (contrast sensitivity, stereopsis, visual acuity) and a performance‐based measure of ability to implement new medications.
Design: Cross‐sectional ...analysis; prospective cohort study.
Setting: Community‐based.
Participants: Three hundred thirty‐five participants aged 73 to 82 in Year 3 of the Women's Health and Aging Study II, a representative sample of the two‐thirds least‐disabled community‐dwelling women.
Measurements: Hopkins Medication Schedule Pillbox Ratio, a joint measure of accuracy and time, and a performance‐based measure of ability to implement a prescription. Participants received written and verbal instructions for taking two medications and were directed to place pills in a pillbox accordingly. Vision assessments: contrast sensitivity (Pelli‐Robson letter sensitivity chart), stereopsis (Randot Circles), and visual acuity (Early Treatment Diabetic Retinopathy Study eye chart).
Results: Forty‐four percent (148/335) of women incorrectly placed one or both medications. Each vision measure was positively associated with Pillbox Ratio scores and varied with cognition and time to completion. Better visual acuity, contrast sensitivity, and stereopsis were each associated with better performance in women with poor cognition who filled the pillbox quickly. Additionally, better visual acuity was associated with better performance in participants with good cognition who filled the pillbox slowly; better stereopsis was associated with better performance in participants with poor cognition who filled the pillbox slowly and whose stereoacuity was below normal.
Conclusion: Visual acuity, contrast sensitivity, and stereopsis should be considered potential risk factors for impaired ability to implement a medication regimen in older adults. Future research should investigate the role of vision, including contrast sensitivity and stereopsis, on performance of other instrumental activities of daily living.
Introduction
Slower mobility is associated with mild cognitive impairment (MCI) and dementia. We examined the interaction of endurance with gait speed on prevalent MCI and dementia.
Methods
...Cross‐sectional multinomial regression in the ARIC cohort (n = 2844 participants; 71 to 94 years; 44% men; 18% Black persons) with cognitive status (normal/MCI/dementia), 4 m gait speed, and endurance (2 minute walk 2MW).
Results
Faster gait speed (up to but not above 1 m/s) and better 2MW were separately associated with lower dementia risk. Good performance in both (2MW = 200 m, gait speed = 1.2 m/s) was associated with 99% lower dementia (Relative Prevalence Ratio RPR = 0.01 95% CI: 0.0 to 0.06) and 73% lower MCI, RPR = 0.27 (0.15 to 0.48) compared to poor performance in both (2MW = 100 m, gait speed = 0.8 m/s). Models incorporating a gait speed‐by‐2MW interaction term outperformed gait speed‐only models (P < .001).
Discussion
Gait speed relationships with dementia diminish at faster gait speeds. Combining endurance with gait speed may yield more sensitive markers of MCI and dementia than gait speed alone.
Background
There is a need for continued surveillance of diabetes‐related functional disability. In the present study, we examined associations between diabetes, hyperglycemia, and the burden of ...functional disability in a community‐based population.
Methods
A cross‐sectional analysis was conducted of 5035 participants who attended Visit 5 (2011–13) of the Atherosclerosis Risk in Communities study. Functional disability was dichotomously defined by any self‐reported difficulty performing 12 tasks essential to independent living grouped into four functional domains. Associations of diagnosed diabetes (via self‐report) and undiagnosed diabetes and prediabetes (via HbA1c) with functional disability were evaluated using Poisson regression.
Results
Participants had a mean age of 75 years, 42 % were male, 22 % were Black, and 31 % had diagnosed diabetes. Those with diagnosed diabetes had a significantly greater burden of functional disability than those without diabetes, even after adjustment for demographics, health behaviors, and comorbidities: prevalence ratios (95 % confidence intervals) were 1.24 (1.15, 1.34) for lower extremity mobility, 1.14 (1.07, 1.21) for general physical activities, 1.33 (1.16, 1.52) for instrumental activities of daily living (ADL), and 1.46 (1.24, 1.73) for ADL (all P < 0.05). The associations of undiagnosed diabetes and prediabetes with disability were not statistically significant (all P > 0.05).
Conclusions
Among older adults, the burden of functional disability associated with diabetes was not entirely explained by known risk factors, including comorbidities. Hyperglycemia below the threshold for the diagnosis of diabetes was not associated with disability. Research into effective strategies for the prevention of functional disability among older adults with diabetes is needed.
Abstract
Background
There is a need for continued surveillance of diabetes‐related functional disability. In the present study, we examined associations between diabetes, hyperglycemia, and the ...burden of functional disability in a community‐based population.
Methods
A cross‐sectional analysis was conducted of 5035 participants who attended Visit 5 (2011–13) of the Atherosclerosis Risk in Communities study. Functional disability was dichotomously defined by any self‐reported difficulty performing 12 tasks essential to independent living grouped into four functional domains. Associations of diagnosed diabetes (via self‐report) and undiagnosed diabetes and prediabetes (via HbA1c) with functional disability were evaluated using Poisson regression.
Results
Participants had a mean age of 75 years, 42 % were male, 22 % were Black, and 31 % had diagnosed diabetes. Those with diagnosed diabetes had a significantly greater burden of functional disability than those without diabetes, even after adjustment for demographics, health behaviors, and comorbidities: prevalence ratios (95 % confidence intervals) were 1.24 (1.15, 1.34) for lower extremity mobility, 1.14 (1.07, 1.21) for general physical activities, 1.33 (1.16, 1.52) for instrumental activities of daily living (ADL), and 1.46 (1.24, 1.73) for ADL (all
P
< 0.05). The associations of undiagnosed diabetes and prediabetes with disability were not statistically significant (all
P
> 0.05).
Conclusions
Among older adults, the burden of functional disability associated with diabetes was not entirely explained by known risk factors, including comorbidities. Hyperglycemia below the threshold for the diagnosis of diabetes was not associated with disability. Research into effective strategies for the prevention of functional disability among older adults with diabetes is needed.
It has been well documented that vestibular-mediated cardiovascular regulation plays an important role in maintaining stable blood pressure (BP) during postural changes. But the underlying neural ...mechanisms remain to be elucidated. In particular, because the vestibular stimulation employed in previous animal studies activated both semicircular canals and otolith organs, the contributions of the otolith system has not been studied selectively. The goal of the present study was to characterize cardiovascular responses to natural otolith stimulation in awake rats that were subjected to pure linear motion. In any of the four directions tested, transient linear motion produced a short-latency ( approximately 520 ms) increase in mean BP with a peak of 8.27 +/- 0.66 mmHg and was followed by a decrease in BP. There was an initial small biphasic response in heart rate (HR) that was followed by a longer duration increase. The short-latency increase in BP was absent in rats that were pentobarbital sodium anesthetized or that were labyrinthectomized bilaterally, but it was unaffected by baroreceptor denervation, indicating that it was of otolith origin. The increase in BP was linear acceleration intensity dependent and was not affected by absence of visual cues. Furthermore, the BP response was attenuated by inactivation of the medial and inferior vestibular nuclei by microinjections of muscimol, indicating that the otolith-driven cardiovascular responses are mediated by the neurons in these areas. These results not only demonstrate the otolith specific influences on the cardiovascular system but also they establish the first rodent model for examining the neural mechanisms underlying the otolith-mediated cardiovascular regulation.
PDF
