Gender differences in functioning for older adults in rural Bangladesh. The impact of differential reporting?

Association between serum zinc levels and basic physical functioning: secondary data analysis of NHANES 2011-14

Background

Serum zinc (Zn) levels have been shown to be associated with functional status; however, it is not clear whether this association differs by other sociodemographic characteristics. We examined the association between serum Zn levels and physical functioning difficulty in a representative sample of older adults in the US.

Design and methods

A cross-sectional study was conducted on participants 50 years and older from the 2011–12 and 2013–14 National Health and Nutrition Examination Surveys (n = 1136). Serum Zn levels were analyzed as tertiles. The main outcome of interest was physical functioning difficulty, defined as self-reported difficulty of basic physical functioning that included walking, transferring, dressing, and feeding.

Results

Mean Zn levels (SE) were 0.67(0.1), 0.81(0.1), and 0.98(0.1) μg/mL in the low, middle, and high Zn groups, respectively. Approximately 24.9% participants reported physical functioning difficulty. In the multivariable model, we found a significant multiplicative interaction between sex and serum Zn (P for interaction =0.028) and between education and serum Zn (P for interaction = 0.001) on basic physical functioning difficulty. The stratified analysis revealed that among men, compared to those with low serum Zn, the odds of having physical functioning difficulty were lower in men who had high serum Zn [aOR 0.43 (95% CI: 0.25–0.76)]. For women, compared to those with low serum Zn the odds of having physical functioning difficulty were higher in women who had middle serum Zn [aOR 2.67 (1.58–4.50)]. Among individuals with less than high school education, the odds of having physical functioning difficulty were lower in those who had middle serum Zn compared to those who had low serum Zn [aOR 0.48 (0.26–0.89)]. However, the odds of having physical functioning difficulty were higher in those who had middle serum Zn compared to those who had low serum Zn for individuals with high school [aOR 5.72 (1.92–17.00)] and beyond high school education [aOR 1.77 (1.05–2.97)], respectively.

Conclusion

Sex and educational attainment interact with serum Zn levels to influence basic physical functioning difficulty in older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-021-00461-z.

Gender differences in four-year incidence of self-reported and performance-based functional disability: The International Mobility in Aging Study

OBJECTIVES

To examine differences in incidence of functional disability between older women and men.

METHODS

2002 participants (65-74 years) were recruited in 2012 from Canada, Brazil, Colombia, and Albania, and re-assessed in 2016. Three measures of functional disability were used (1) Difficulty in any of five mobility-related Activities of Daily Living (ADL disability); (2) Self-reported difficulty climbing a flight of stairs or walking 400 m (mobility disability); and (3) Poor physical performance. We estimated the adjusted gender-specific incidence risk ratios (IRR) for each outcome in 2016.

RESULTS

In 2016, 1506 participants (52% women) were re-examined, 80% of the surviving cohort. Among those not disabled in 2012, seventy-four (12.9%) men developed ADL disability, while 105 (19.2%) developed mobility disability, and 97 (16.1%) developed poor physical performance. For women, numbers were higher 120 (21.4%) developed ADL disability, 117 (26.5%) developed mobility disability, and 140 (23.0%) developed poor physical performance. Compared to men, women had a higher adjusted incidence of self-reported ADL disability (IRR 1.4; 95% CI 1.04-1.88) and mobility disability (IRR 1.4; 95% CI 1.06-1.77), but not of poor physical performance (IRR 1.03; 95% CI 0.88-1.32).

CONCLUSIONS

Although women have a higher self-reported incidence of ADL and mobility disability than men, there was no significant difference in poor physical performance. Reasons for this discrepancy between self-reported and performance-based measures require further investigation. Understanding gender differences in functional disabilities can provide the basis for interventions to prevent mobility loss and minimize any gender gap.

Predictors of basic self-care and intermediate self-care functional disabilities among older adults in Ghana

The number of older adults in Ghana is growing rapidly. Associated with this growth, is the rise in age-related chronic diseases such as cardiovascular and musculoskeletal conditions. However, there is limited knowledge in the Ghanaian context on the effect of chronic diseases on functional disabilities among older adults. In this study, we examine the association between chronic diseases, socioeconomic status, and functional disabilities. Data from 4107 Ghanaian older adults (persons aged 50 years and above) who participated in the World Health Organization's Global Ageing and Adult Health survey (SAGE-Wave 1) were used to fit random effect multivariate logistic and complementary log-log regression. Stroke was significantly associated with difficulty in performing both basic self-care functions and intermediate self-care functions. Hypertension and arthritis, on the other hand, were associated with basic self-care functional disability only. Socioeconomically vulnerable groups such as females, those with less education and low-incomes were more likely to have functional disabilities associated with basic self-care and intermediate self-care activities. In order to reduce functional disabilities among older persons in Ghana, efforts should be aimed at reducing chronic conditions as well as improving socioeconomic status.

Variation in the Gender Gap in Inactive and Active Life Expectancy by the Definition of Inactivity Among Older Adults

OBJECTIVE

To assess variation in gender gap (female-male) in inactive life expectancy (IALE) and active life expectancy (ALE) by definition of inactivity.

METHOD

Inactivity, among older Singaporeans, was defined as follows: Scenario 1-health-related difficulty in activities of daily living (ADLs); Scenario 2-health-related difficulty in ADLs/instrumental ADLs (IADLs); Scenario 3-health-related difficulty in ADLs/IADLs or non-health-related non-performance of IADLs. Multistate life tables computed IALE and ALE at age 60, testing three hypotheses: In all scenarios, life expectancy, absolute and relative IALE, and absolute ALE are higher for females (Hypothesis 1 [H1]); gender gap in absolute and relative IALE expands, and in absolute ALE, it contracts in Scenario 2 versus 1 (Hypothesis 2 [H2]); gender gap in absolute and relative IALE decreases, and in absolute ALE, it increases in Scenario 3 versus 2 (Hypothesis 3 [H3]).

RESULTS

H1 was supported in Scenarios 1 and 3 but not Scenario 2. Both H2 and H3 were supported.

DISCUSSION

Definition of inactivity influences gender gap in IALE and ALE.

Gender differences in functional disability and self-care among seniors in Bangladesh

BACKGROUND

Disability among older adults is a public health concern. To date there are no in-depth and comprehensive analyses on older adults' disabilities in Bangladesh. This study investigated gender differences in the prevalence of disability and the socio-demographic factors associated with disability among older adults in Bangladesh.

METHODS

This research used a sample of 4176 elderly males and females aged 60 years and over from a nationally representative data set- Bangladesh's 2010 Household Income and Expenditure Survey. The study used both household level and individual level data and applied a wealth index, which was constructed based on household assets using principal component analysis. The Washington Group's short set of questions on disability were used to measure disability. Chi-square tests and ordinal logistic regression models were fit.

RESULTS

Forty-two percent of older had some form of functional disability, including 5% of elderly with severe/extreme functional disability. Seven percent of older adults had a self-care disability, including 3% of elderly with a severe/extreme form of self-care disability. Elderly females suffered from all the studied disabilities, including functional and self-care disabilities in higher percentages, and had higher odds ratios of having both functional disability and self-care disability compared to elderly males. The study also identified some significant factors affecting functional disability and self-care disability, namely age, having a chronic condition, wealth status and place of residence, including divisional differences.

CONCLUSIONS

Programs aimed at reducing functional disability among seniors, particularly elderly females, should be granted the highest priority in Bangladesh.

Gender difference in the prevalence and socio-demographic correlates of mobility disability among older adults in Nigeria

The aim of the current study is to examine gender differences in mobility disability among older people in Nigeria, and to explore factors associated with gender differences in mobility disability in later life. Data were used from the first (2010-2011) wave of the Nigeria General Household Survey-Panel, which included 3586 respondents aged 50 years and above. Mobility disability was assessed as self-reported difficulty in walking 100 m, walking 1 km, walking uphill, running, bending or stooping, and climbing stairs. Regression analyses were used to estimate the extent to which socio-demographic conditions contribute to gender differences in mobility disability. We observed a higher prevalence of mobility disability among women compared to men (20.1 vs. 12.5 %, P < 0.001). The prevalence ratios (PR) of mobility disability for women versus men was 1.61 (95 % CI 1.38-1.88, P < 0.001); after adjusting for age, marital status, place of residence, self-reported health status and cognitive difficulties, the PR was 1.55 (95 % CI 1.30-1.85, P < 0.001). In the fully adjusted model, mobility disability still remained significantly higher among women (PR 1.60, 95 % CI 1.32-1.93, P < 0.001). The marginal effects of socio-demographic and health factors were stronger for women than for men. Socio-demographic and health variables considered in this study explained between 19.3 % (men) and 22.3 % (women) of variance in mobility disability suggesting that additional factors beyond those considered in this study warrant further investigation, so that differences in mobility disability between older men and women in Nigeria can be fully understood.

Functional Performance and Associations between Performance Tests and Neurological Assessment Differ in Men and Women with Parkinson's Disease

BACKGROUND

Neurological assessment of a patient with Parkinson's disease (PD) is expected to reflect upon functional performance. As women are known to report more limitations even for same observed functional performance level, present study was designed to examine whether associations between neurological assessments and functional performance differ across genders.

METHODS

14 men and 14 women with PD participated. Functional performance was assessed by measuring walking speeds on 10-meter walk test (10MWT) and by performing timed-up-and-go-test (TUG). Neurological assessment included Hoehn and Yahr Scale (HY), Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Schwab and England Activities of Daily Living Scale (S-E), and Mini Mental State Examination (MMSE).

RESULTS

In women with PD, Kendall's tau-b correlation analyses revealed significant correlations between functional performance tests and neurological assessment measures, with the exception in MMSE. No corresponding associations were found for men, although they demonstrated better functional performance, as expected.

CONCLUSION

Men in similar clinical stage of the PD perform better on functional tests than women. Disease severity reflects upon functional performance differently in men and women with PD. Results indicate that when interpreting the assessment results of both functional performance and neurological assessment tests, the gender of the patient should be taken into consideration.

The mobility gap between older men and women: the embodiment of gender

OBJECTIVES

To present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies.

METHODS

Data are from surveys on random samples of people aged 65-74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios.

RESULTS

Age-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men.

DISCUSSION

Results provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age.

The status of men's health in Asia

OBJECTIVES

This study aims to compare health status and its risk factors between men and women who are from countries of different income status in Asia.

METHOD

We have included 47 Asian countries and 2 regions in this study. Life expectancy, mortality rate from communicable disease, non-communicable disease and injuries, the prevalence of non-communicable diseases risk factors and their trends were extracted from the WHO and respective governmental database. Subgroup analysis was performed based on country income groups.

RESULTS

Overall, men have shorter life expectancy and higher mortality rates compared to women. Men from higher-income countries lived longer compared to men from lower-income countries. There is a wide variation of male life expectancy in upper and lower middle income countries. The mean systolic blood pressure, fasting blood glucose and body mass index in Asia have also increased over the years.

CONCLUSION

This study confirms that Asian men have poorer health compared to women besides the growing concerns on NCD risk factors. The findings from this study calls for a concerted effort to find solutions in addressing men's health problems in Asia.

Gender differences in disability-free life expectancy at old ages in Bangladesh

OBJECTIVE

We examined gender differences in the prevalence of disability and Disability-free Life Expectancy (DFLE) for Bangladeshi older adults.

METHOD

We used data representing 4,189 elderly subjects aged 60 years and over from a nationally representative survey (Bangladesh's Household Income and Expenditure Survey-2010). The Sullivan method was used to compute DFLE.

RESULTS

Eyesight disability is prevalent among 28.94 and 36.47 men and women, respectively, and is the most prevalent type of disability in Bangladesh. Women have each disability and at least one disability in significantly higher percentages than men. At all ages, and in both numbers and proportion, women have longer life expectancy but shorter DFLE than men.

DISCUSSION

Attention should be given to the elderly, with special care devoted to elderly women. The findings of the current study have important implications for risk of disability and the need for, and use of, long-term care services.

The components of self-rated health among adults in Ouagadougou, Burkina Faso

Background

Although the relationship between self-rated health (SRH) and physical and mental health is well documented in developed countries, very few studies have analyzed this association in the developing world, particularly in Africa. In this study, we examine the associations of SRH with measures of physical and mental health (chronic diseases, functional limitations, and depression) among adults in Ouagadougou, Burkina Faso, and how these associations vary by sex, age, and education level.

Methods

This study was based on 2195 individuals aged 15 years or older who participated in a cross-sectional interviewer-administered health survey conducted in 2010 in areas of the Ouagadougou Health and Demographic Surveillance System. Logistic regression models were used to analyze the associations of poor SRH with chronic diseases, functional limitations, and depression, first in the whole sample and then stratified by sex, age, and education level.

Results

Poor SRH was strongly correlated with chronic diseases and functional limitations, but not with depression, suggesting that in this context, physical health probably makes up most of people’s perceptions of their health status. The effect of functional limitations on poor SRH increased with age, probably because the ability to circumvent or compensate for a disability diminishes with age. The effect of functional limitations was also stronger among the least educated, probably because physical integrity is more important for people who depend on it for their livelihood. In contrast, the effect of chronic diseases appeared to decrease with age. No variation by sex was observed in the associations of SRH with chronic diseases, functional limitations, or depression.

Conclusions

Our findings suggest that different subpopulations delineated by age and education level weight the components of health differently in their self-rated health in Ouagadougou, Burkina Faso. In-depth studies are needed to understand why and how these groups do so.

Differences in self-reported physical limitation among older women and men in Ismailia, Egypt

OBJECTIVES

This study explores the reasons for gender differences in self-reported physical limitation among older adults in Ismailia, Egypt.

METHOD

435 women and 448 men, 50 years and older in Ismailia, Egypt, participated in a social survey and tests of physical performance. Ordered logit models were estimated to compare unadjusted gender differences in reported disability with these differences adjusted sequentially for (a) age and objective measures of physical performance, (b) self-reported morbidities and health care use, and (c) social and economic attributes.

RESULTS

Compared with men, women more often reported higher levels of limitation in activities of daily living (ADLs), upper-extremity range of motion (ROM), and lower-extremity gross mobility (GM). Adjusting for age and objective measures of physical performance, women and men had similar odds of self-reporting difficulty with ADLs. With sequential adjustments for the remaining variables, women maintained significantly higher odds of self-reported difficulty with upper-extremity ROM and lower-extremity GM.

DISCUSSION

Cross-culturally, gender differences in self-reported disability may arise from objective and subjective perceptions of disability. Collectively, these results and those from prior studies in Bangladesh and the United States suggest that gender gaps in self-reported physical limitation may be associated with the degree of gender equality in society.

Association between muscle strength and metabolic syndrome in older Korean men and women: the Korean Longitudinal Study on Health and Aging

The objective of the study was to investigate the association between metabolic syndrome (MS) and muscle strength in community-dwelling older men and women in Korea. Korean men and women 65 years and older living in a single, typical South Korean city (n = 647) were enrolled in the Korean Longitudinal Study on Health and Aging study. The diagnosis of MS was evaluated according to the definition of the National Cholesterol Education Program Adult Treatment Panel III. Isokinetic muscle strength of the knee extensors, as determined by peak torque per body weight (newton meter per kilogram) and hand-grip strength per body weight (newton per kilogram), was measured. Participants without MS had greater leg muscle strength and grip strength per weight. The effect of MS on muscle strength was more prominent in men than in women in our study population. Only men showed a significant interaction between MS and age for muscle strength (P = .014), and the effect was greater in men aged 65 to 74 years compared with those older than 75 years (119.2 ± 31.2 vs 134.5 ± 24.3 N m/kg). Participants with MS had weaker knee extensor strength after controlling the covariates (β = -90.80, P = .003), and the interaction term (age × MS × male sex) was significant (β = 1.00, P = .017). Metabolic syndrome is associated with muscle weakness, and this relationship is particularly pronounced in men. Age can modify the impact of MS on muscle strength. Men aged 65 to 74 years with MS need a thorough assessment of muscle strength to prevent disability.

Social inequality in dynamic balance performance in an early old age Spanish population: the role of health and lifestyle associated factors

This study investigates the association between socioeconomic status (SES) and dynamic balance performance and whether lifestyle factors explained any possible associations. A total of 448 nondisabled individuals, age-range 54-75 years and enrolled in the Active Aging Longitudinal Study of Spain in 2006, constituted the study population. Baseline data of this cross-sectional study were obtained by personal interviews and objective measures of balance performance. The present study shows an educational gradient in poor dynamic balance, where individuals with no formal education had higher risk of poor balance, also after adjustment for age, gender, obesity and physical activity. In addition, obesity and sedentary physical activity were related to poor dynamic balance. The findings suggest an independent effect of both SES and behavioral factors on poor balance performance in the older Spanish population.

Gender differences in mobility disability during young, middle and older age in West African adults

The objective of this study was to assess the prevalence and the contribution of socio-demographic factors and chronic diseases to mobility disability in West African countries. Data were obtained from the World Health Survey (2002-2003) in which adults≥18 years participated, from Burkina Faso (n=4822), Mali (n=4230) and Senegal (n=3197). Participants reporting mild, moderate, severe, extreme difficulty or inability to move around were defined as having mobility disability. All estimates were corrected for sampling design. Association measures were estimated using logistic regression methods. Mobility disability was frequent at young ages (35-44 years old) in men and women, respectively: 17% and 23% in Burkina Faso, 12% and 23% in Mali and 22% and 34% in Senegal. Women had higher odds of mobility difficulty than men at every age group in the three countries: 1.34 (95%CI 1.06; 1.70) in Burkina Faso; 2.33 (95% CI 1.84; 2.71) in Mali and 1.82 (95%CI 1.41; 2.36) in Senegal. Controlling for socio-economic factors and chronic disease, these odds changed respectively to 0.94 (95%CI 0.70; 1.25), 2.19 (95%CI 1.61; 2.96) and 1.90 (95%CI 1.27; 2.84). These results constitute a benchmark for the study of trends of mobility disability in West Africa and could be used by policy planners.

Cognitive impairment predicts functional capacity in dementia-free patients with cardiovascular disease

BACKGROUND AND RESEARCH OBJECTIVE

A high proportion of elderly people with cardiovascular diseases and risk factors have mild forms of cognitive impairment, the functional impact of which is poorly understood. The aim of this study was to determine whether subtle cognitive impairment contributes to limitations in instrumental activities of daily living in this group and whether this association is independent of physical comorbidity and other potentially confounding factors.

SUBJECTS AND METHODS

Two hundred and nineteen nondemented patients were recruited from cardiovascular and diabetic hospital outpatient clinics. Functional dependence was assessed using the self-report version of the instrumental activities of daily living scale. Cognitive ability was assessed using the Montreal Cognitive Assessment (MoCA). Demographic and clinical information was collected via interview and a review of hospital records. Standard logistic regression was performed to identify factors independently associated with functional status.

RESULTS

Five variables (sex, cardiovascular disease burden, non-cardiovascular disease burden, cognitive status, and age) were independently associated with an increased likelihood of requiring assistance with 1 or more everyday activities. The likelihood of needing assistance increased 2.05 times (95% confidence interval [CI], 1.59-2.79) for each additional cardiovascular diagnosis present and 1.12 times (95% CI, 1.01-1.27) for every point lower on MoCA. Thus, in comparison to a person with a perfect MoCA score, a person who scored in the cognitively impaired range (<23) was 7.7 (CI, 7.07-8.89) times more likely to report that he/she required assistance with an everyday activity.

CONCLUSION

Cognitive impairments appear to reduce the ability to independently carry out routine daily tasks in patients with cardiovascular diseases and risk factors. Cognition should therefore be considered along with physical symptoms when assessing and responding to the support needs of this group.

Demographic and socioeconomic status differences in perceptions of difficulty with mobility in late life

OBJECTIVES

This study assesses whether socioeconomic and demographic differences in reported mobility limitations are attributable to differential perceptions of mobility difficulty that result in the differential use of response categories.

METHODS

Data come from the Social Environment and Biomarkers of Aging Study and its parent study, the Taiwan Longitudinal Study of Aging. Ordered probit models with person-specific cut-points are used to test whether, after controlling for underlying mobility using objective performance measures, cut-points for reporting mobility limitations vary across groups defined by demographic and socioeconomic characteristics.

RESULTS

Age is the only characteristic that is consistently associated with the location of the cut-points for reporting mobility difficulty: At the same level of underlying mobility difficulty, older adults are more likely than younger adults are to report difficulty with all tasks except short walks. Other variables showed differences but only for one specific activity, for example, urban residents are more likely to report difficulty running than are rural residents with the same underlying level of mobility function.

DISCUSSION

For most mobility activities, there are no systematic differences in the perception of difficulty by individual characteristics. Thus, for older Taiwanese adults, differences in mobility limitations associated with socioeconomic status are more likely to reflect underlying differences in function than differences in how these groups report the same capacity. The usual loss of mobility with age, however, reflects both a decrease in capacity and a lowering of the threshold for reporting difficulty.

Gender differences in physical disability among older adults in underprivileged communities in Lebanon

OBJECTIVE

To examine the role of health conditions, socioeconomic, and socioenvironmental factors in explaining gender differences in physical disability among older adults.

METHOD

We compared 412 women and 328 men residing in underprivileged communities in Lebanon on their activities of daily living (ADL), instrumental activities of daily living (IADL), and physical tasks (PT). Binary logistic regression analyses adjusting for possible explanatory covariates were conducted sequentially.

RESULTS

Women showed higher prevalence rates of ADL, IADL, and PT compared to men. Gender disparities in ADL disability were explained by chronic-disease risk factors and health conditions (OR = 1.46; 95% CI = 0.94-2.25). The odds of disability in IADL and PT remained significantly higher for women compared to men after accounting for all available covariates.

DISCUSSION

These results suggest underlying differences in functional status between women and men, yet, may have been influenced by the sensitivity of the measures to the social context and gendered environment surrounding daily activities.

Managing the aging man in Asia: a review

The aging man is becoming a major burden to Asian countries because of the current poor health status of Asian men and the aging Asian population. Life expectancy at birth for men is shorter than women by an average of 4 years in Asian countries and major causes of death are cardiovascular disease, cancers, injuries and infections. However, there are considerable variations between Asian countries because of great disparity in socioeconomic status. Male-specific disorders, such as male sexual health and urological conditions, are other major health burdens because they have a great impact on men's quality of life. More importantly, many risk factors to the causes of mortality and morbidities, such as high-risk behavior and smoking, can be improved with health promotion and early intervention. The current evidence suggests that the poor health status of men is the result of their poor health care utilization, negative health-seeking behavior, the adverse social environment for men and gender-insensitive health care delivery. However, much evidence is still needed as Asian countries have great diversity in culture, societal values and men's needs. Asian time-tested wisdom on a balanced healthy lifestyle to longevity should be explored as potential men's health promotional programs. Taking into account Asian men's health-care needs, a gender-streamlined approach and man-friendly health care delivery should be on the national agenda in managing the aging man.

Sex disparities in self-reported physical functioning: true differences, reporting bias, or incomplete adjustment for confounding?

OBJECTIVES

To determine whether sex disparities in self-reported physical functioning remain after adjusting for potential confounding factors and to assess associations for possible reporting bias.

DESIGN

Cross-sectional survey.

SETTING

U.S. population of noninstitutionalized older adults.

PARTICIPANTS

Women and men aged 60 and older (N=5,396) who participated in the Third National Health and Nutrition Examination Survey.

MEASUREMENTS

Degree of self-reported limitation in 11 physical functions.

RESULTS

In unadjusted models, women reported more limitations than men in 10 of 11 tasks. In multivariate ordinal logistic regression models that included adjustment for age, race or ethnicity, education level, comorbidities, smoking, hemoglobin, serum albumin, knee pain, body mass index, skeletal muscle index, and physical performance tests, women reported more limitations only in lifting or carrying 10 pounds (adjusted odds ratio=2.03, 95% confidence interval=1.45-2.84). There was no evidence of systematic reporting differences between men and women for limitations in lifting or carrying 10 pounds relative to the degree of limitation predicted by the model.

CONCLUSION

Older women have similar degrees of self-reported limitation in physical functioning as older men of the same age, health, and physical abilities.

Gender Differences in Functional Health and Mortality Among the Chinese Elderly: Testing an Exposure Versus Vulnerability Hypothesis

In this study, the authors focused on older adults in Beijing with three objectives: to examine gender differences in functional health and mortality at the end of a five-year study period, controlling for initial functional health; to determine the extent to which these differences were a function of exposure versus vulnerability to risk factors; and to analyze the relative importance of social, economic, and psychological risk factors in explaining gender differences. The results show that women were more likely to survive and to be functionally dependent at follow-up compared with men among those functionally independent at baseline. No significant differences among those who were initially dependent were apparent. Differential vulnerability to risk factors, more so than exposure, explained the variation in health outcomes across gender. Smoking, a lack of formal education, a lack of health insurance, a low sense of control, stressful events, and rural living played large roles in explaining the differences.

Correlates of post-hospital physical function at 1 year in skilled nursing facility residents

AIM

This paper is a report of a study to examine the relationship between health-related admission factors and post-hospital physical function at 3, 6, 9 and 12 months in older adult nursing facility residents.

BACKGROUND

Physical functional decline is a significant health problem for older adults and has far-reaching effects. In particular, the immediate post-hospital period is a high-risk time, because shortened hospital stays make it likely that older patients are discharged in a state of incomplete recovery.

METHOD

Data spanning from July 2002 to June 2005 were extracted from a comprehensive assessment tool, the Minimum Data Set, for 38,591 beneficiaries of a federal health insurance programme covering older adults in the Midwestern region of the United States of America. We investigated relationships between admission factors and post-hospital physical function at 3, 6, 9 and 12 months. The admission factors were health-related variables assessed at the time of skilled nursing facility admission from an acute care hospital.

FINDINGS

The most important admission factors related to post-hospital physical function at 3, 6, 9 and 12 months were baseline physical function, urinary incontinence and pressure ulcer. Cognitive impairment at admission demonstrated a stronger relationship with poor physical function as resident length of stay increased.

CONCLUSION

Nurses in skilled nursing facilities should screen post-hospital older adults for risk of physical functional decline at admission using identified admission factors. For continuous nursing care, older adults need to be assessed at least once a month during the first 3 months after hospital discharge.

Education, gender, and functional transitions among Indonesian elderly

Consistent and robust associations between education and health have been found for older adults in developed countries, with effects generally being stronger for men than for women. Tests of the association in developing countries are still limited, existing results are inconsistent, and variations by gender have not been examined. Using two waves of data (1993 and 1997) from the Indonesian Family Life Survey, this analysis examines the association between education and functional transitions over a 4-year period and investigates gender differences in the association. A review of past evidence leads us to speculate that the association may be weaker among Indonesian elderly than among elderly in developed countries, particularly for women. This is because the elderly in Indonesia have substantially lower levels of education, lower returns on education from the labor market, and weaker linkages between education and factors that are considered to more directly influence health, including health-related behaviors and receipt of social support. Our results indicate that associations between education and functional transition depend upon gender and functional status at the beginning of the study period. Specifically, education is significantly associated with functional outcome for men who were functionally healthy at baseline, but not for women or those who were functionally limited. The conclusion speculates on the possible mechanisms behind these diverse findings.

Use of emergency departments by elderly patients in a city of Western Turkey

OBJECTIVE

To evaluate the reasons behind the demographic characteristics of patients presented to emergency departments.

METHODS

The entire patient records of all the hospitals' emergency departments in the city of Eskisehir were retrospectively assessed in this study. The study was conducted between the years 1998 and 2000. Data were evaluated using chi2, t-tests, and percent rates.

RESULTS

Of 608,528 patients visiting the emergency departments, 79 123 (13.0%) were elderly patients. The treatment and discharge rate was 78.3%. Mean admission rate was 21.2%. The death rate during the visits was 0.4%. The proportion of the five most frequently seen diseases was 41.9%.

CONCLUSION

Demographical trends show that emergency department visits by elderly patients would increase in time. So, in Turkey, emergency department staff should be trained to provide for the special needs of this population in emergency departments.

Frequency of and Factors Associated With Contact Lens Dissatisfaction and Discontinuation

PURPOSE

To determine the frequency of and factors associated with contact lens dissatisfaction and discontinuation.

METHODS

A cross-sectional survey of 730 subjects was conducted using a self-administered survey instrument. The survey collected information about present age and sex, history of contact lens wear, types of lenses worn, age at starting wear, current wearing schedule (hours per day, days per week), self-perceived contact lens satisfaction, and contact lens-related problems. A variety of statistical analyses including analysis of variance, logistic regression, and repeated-measures logistic regression were used to model the data.

RESULTS

Current or previous experience with contact lenses was reported by 453 (62%) of the subjects. Of these subjects, 119 (26.3%) reported that contact lenses were not the ideal form of visual correction for them (contact lens dissatisfaction) and another 109 (24.1%) had permanently discontinued contact lens wear. Dissatisfied contact lens wearers had reduced self-reported wearing times compared with satisfied contact lens wearers. Previous lens wearers were more likely than current lens wearers to be men, older (by approximately 9.5 years), have started contact lens wear at a later age (approximately 4-5 years later), and have tried either rigid or both soft and rigid lenses. The primary self-reported reason for both contact lens dissatisfaction and discontinuation was ocular symptoms (dryness and discomfort), followed by preference for another corrective modality.

CONCLUSION

A significant number of contact lens wearers are not satisfied with contact lenses and are at risk for discontinuation.

Sociodemographic differences in quality of life in rheumatoid arthritis

Assessment of health-related quality of life (HR-QOL) in people with rheumatoid arthritis (RA) has become important in health research and can inform clinical care. Many studies have found sociodemographic differences in the HR-QOL of people with RA, and interpreting these differences can be challenging. Biological, health disparity, reporting and assessment instrument differences are a few of the possible explanations that should be considered when interpreting results. Our review of the evidence of sociodemographic differences in HR-QOL in people with RA produced 34 articles describing 49 studies.Typically, patients with RA who were older, female, less educated, non-employed and/or less affluent tended to have significantly lower HR-QOL than other groups. Some evidence also indicated that people with RA who are non-White or who live in rural settings may also tend to have lower HR-QOL scores, but the number of studies supporting these findings was sparse. Researchers and clinicians can optimise their assessment of HR-QOL by finding well validated instruments for the context they are working in. Additional research is needed to identify the exact causes of HR-QOL differences so that quality treatment can be provided to those in need.

Identifying the relationship among mental status, functional independence and mobility level in Turkish institutionalized elderly: gender differences

The purpose of this study was to examine gender differences in older people living at a rest home in terms of functional independence, mental status and mobility level and to describe the relationship among the three outcome variables. One hundred and thirty-three elderly people (60 women, 73 men), aged 65 years and above were included in the study. The average age was 75.3 +/- 6.7 years (range, 65-90 years). Mental status was assessed using the Hodkinson Mental Test (HMT). Functional independence was measured using Functional Independence Measurement (FIM). Mobility level was evaluated using the Rivermead Mobility Index (RMI). Elderly women had lower scores regarding all the outcome variables when compared to older men. The older men had higher cognitive performance than women. In addition, women were at low level of mobility and depended upon the daily living activities (p < 0.05). Both genders showed a significant negative correlation between mental status and functional independence or mobility level, while the correlation between functional independence and mobility level was significantly positive. The data showed that mental impairment decreases both functional status and mobility level of the institutionalized elderly people. Gender difference was found to be an important factor affecting the outcome variables of the study.

Differences in disability among older women and men in Egypt and Tunisia

Research on child survival and health has indicated disparities between boys and girls in selected Middle Eastern countries. Health disparities in later life are understudied in this region. In this article, we examine differences between women and men in later-life activity limitation in Egypt and Tunisia. Difficulty executing physical tasks is more common for women than for men in both study sites, although differences are smaller after adjustment for underlying illness. Differences in the difficulty of executing physical tasks also are sensitive to environmental controls in variable ways across the study sites. The findings caution against the sole use of reported disability in comparative studies of gender and aging.

Gender and use of health care among older adults in Egypt and Tunisia

In Western industrialized countries, women report using health services more often than do men. We explore the applicability of existing theory to explain gender differences in use of health care among older adults in Egypt and Tunisia, where females have received less health care than males in early life. Findings show that women report visiting providers and using medications more often than do men; however, adjusted odds of visiting doctors are comparable for women and men in Tunisia and lower for women than men in Egypt. Odds of using health care are higher for women than men among those reporting no morbidity or functional impairment, but these relative odds diminish or reverse among those reporting multiple morbidities or severe impairments. The contributions of subjective and objective illness, quality of social support, and availability of services on gender differences in care in later life should be assessed in these and other settings where girls' excess mortality persists.

Self-reported health among older Bangladeshis: how good a health indicator is it?

PURPOSE

This study examines the value of self-reported health (SRH) as an indicator of underlying health status in a developing country setting.

DESIGN AND METHODS

Logistic regression methods with adjustments for multistage sampling are used to examine the factors associated with SRH in 2,921 men and women aged 50 and older in rural Bangladesh.

RESULTS

SRH incorporates multiple dimensions of health status (including physical disability assessed by measured physical performance; self-reported limitations in activities of daily living, or ADLs; self-reported chronic morbidity; and self-reported acute morbidity), severity, comorbidity, and trajectory in a similar fashion for both men and women and for different age groups. Older individuals are more likely to report poor SRH than their younger counterparts, and women report significantly worse SRH than their male peers at each age group. In both cases, this disadvantage can be fully accounted for by differences in measured physical performance, ADL limitations, and chronic and acute morbidity.

IMPLICATIONS

Among older Bangladeshis, SRH is an easily recorded, multifaceted, nuanced indicator of underlying health status that is significantly associated with measured physical performance. Moreover, SRH appears to be independent of age- and gender-related norms.

Gender and disability among older adults in north and South India: differences associated with coresidence and marriage

Women in most settings are more likely than men to experience as well as report poor health and functional disabilities. Studies in the economically advanced countries (as in the US) have also shown an association between gender, marital status and health and disability. However, there is very little information about gender differentials in disability among the elderly in developing countries, especially those in South Asia. Also, little is known about the association between gender, marital status, coresidence with sons, and disability among older adults in these countries. This study uses data from the National Family Health Survey conducted in India in 1991-1992 to assess the gender disparities in functional health among persons 55 years and older and to compare the situation in the northern and southern parts of the country. Using logistic regression analysis, this study examines the relation between marital status, living arrangements and functional status of older adults in the states of Uttar Pradesh and Haryana in the north and Kerala and Tamil Nadu in the south. The results confirm a female disadvantage in physical impairments in the northern states, although these differences are not significant in the south. Marital status and coresidence with sons is associated with impairments and these associations show interesting interactions.