Causal analysis identifies small HDL particles and physical activity as key determinants of longevity of older adults.

Background: The hard endpoint of death is one of the most significant outcomes in both clinical practice and research settings. Our goal was to discover direct causes of longevity from medically accessible data.

Methods: Using a framework that combines local causal discovery algorithms with discovery of maximally predictive and compact feature sets (the "Markov boundaries" of the response) and equivalence classes, we examined 186 variables and their relationships with survival over 27 years in 1507 participants, aged ≥71 years, of the longitudinal, community-based D-EPESE study.

Determinants of Maintenance and Recovery of Function in a Representative Older Community-Resident Biracial Sample.

Objectives: Focus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, (2) decline, and (3) recovery of personal self-maintenance activities over six years in an older, community representative, African American and white sample.

Design: Longitudinal study, analyses included descriptive statistics and repeated measures proportional hazards.

Association of Co-Existing Impairments in Cognition and Self-Rated Vision and Hearing With Health Outcomes in Older Adults.

Objectives: To assess the relationship of disability (activities of daily living (ADL) and instrumental ADL (IADL)), self-rated health (SRH), and 6-year mortality with co-existing impairments in vision (self-rated), hearing (self-rated) and/or cognition (Short Portable Mental Status Questionnaire) in older adults.

Methods: The study sample was comprised of 3871 participants from the North Carolina Established Populations for Epidemiologic Studies of the Elderly study (NC EPESE).

Results: Persons with all three impairments had increased odds of ADL/IADL disability, and low SRH.

Psychotic experiences and risk of death in the general population: 24-27 year follow-up of the Epidemiologic Catchment Area study.

Background: Psychotic experiences are common in the general population and are associated with adverse psychiatric and social outcomes, even in the absence of a psychotic disorder.

Aims: To examine the association between psychotic experiences and mortality over a 24-27 year period.

Method: We used data on 15 049 adult participants from four sites of the Epidemiologic Catchment Area baseline survey in the USA in the early 1980s, linked to the National Death Index and other sources of vital status up until 2007.

The effectiveness of antidepressant monotherapy in a naturalistic outpatient setting.

Objective: To assess a representative sample of clinically depressed outpatients during acute treatment with antidepressant medication monotherapy to determine clinical outcomes and evaluate relationships between outcomes and selected baseline/treatment features.

Method: This naturalistic study examined data on outpatients at the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, from January 2000 through December 2010. Eligible patients (N = 1,722) had a diagnosis of clinical depression (major depressive disorder, dysthymic disorder, or depressive disorder not otherwise specified as defined in DSM-IV-TR).

Norms for CERAD constructional praxis recall.

Recall of the four-item constructional praxis measure was a later addition to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery. Norms for this measure, based on cognitively intact African Americans age ≥70 (Indianapolis-Ibadan Dementia Project, N=372), European American participants age ≥66 (Cache County Study of Memory, Health and Aging, N=507), and European American CERAD clinic controls age ≥50 (N = 182), are presented here. Performance varied by site; by sex, education, and age (African Americans in Indianapolis); education and age (Cache County European Americans); and only age (CERAD European American controls).

Identifying a national death index match.

Data from the National Death Index (NDI) are frequently used to determine survival status in epidemiologic or clinical studies. On the basis of selected information submitted by the investigator, NDI returns a file containing a set of candidate matches. Although NDI deems some matches as perfect, multiple candidate matches may be available for other cases.

Does lack of social support lead to more ED visits for older adults?

Objective: The goals of this study were to (1) determine whether level of social support and living situation predicted emergency department (ED) use among older adults and (2) identify correlates of ED visits according to whether the patient was admitted to the hospital.

Methods: Secondary analysis of a longitudinal, prospective study was conducted.

Results: In adjusted analyses, subjects who lived alone were 60% more likely to visit the ED than those who lived solely with their spouse.

The combined effect of visual impairment and cognitive impairment on disability in older people.

Objectives: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity.

Design: Prospective cohort.

Setting: North Carolina.

Health service use and outcome: comparison of low charge, integrated, comprehensive services with usual health care.

We examined the effects of use of low charge, integrated and comprehensive health care services (Veterans Administration (VA) health care system) on health care service use and health-related outcomes. Data came from the 10-year (1986/87-1996/97) Duke Established Populations for Epidemiologic Studies of the Elderly, with 159 men aged 65-85 who primarily used VA health services compared with 1,100 men aged 65-85 who did not. In controlled analyses, no differences were found between the two groups on number of OTC medications used, or in speed or likelihood of entering a nursing home.

Effect of cancer screening and desirable health behaviors on functional status, self-rated health, health service use and mortality.

Objectives: To determine whether some health behaviors of older people (e.g., obtaining cancer screens) have a limited and others (e.

Provider characteristics related to antidepressant use in older people.

Objectives: To determine whether the characteristics of the usual medical care providers of older antidepressant users changed between 1986 and 1997 with the introduction of selective serotonin reuptake inhibitors.

Design: Longitudinal study.

Setting: Five-county Piedmont area of North Carolina.

Sociodemographic characteristics of the neighborhood and depressive symptoms in older adults: using multilevel modeling in geriatric psychiatry.

Objective: Neighborhood sociodemographic characteristics may be important to the mental health of older adults who have decreased mobility and fewer resources. Our objective was to examine the association between neighborhood context and level of depressive symptomatology in older adults in a diverse geographic region of central North Carolina.

Methods: The sample included 2,998 adults 65 or older residing in 91 census tracts.

Patterns and predictors of smoking cessation in an elderly cohort.

Objectives: To identify subject characteristics that predict smoking cessation and describe patterns of cessation and recidivism in a cohort of elderly smokers.

Design: Prospective cohort study.

Setting: Piedmont region, North Carolina.

APOE epsilon4 as a predictor of subjective quality of life in a biracial older person community sample.

Unlabelled: The epsilon4 allele of apolipoprotein E (APOE) has been associated with health-related outcomes that may adversely affect quality of life (QOL) in older adults. In the absence of published information, we sought to determine whether the epsilon4 allele was associated with subjective QOL across 5 parameters in a community sample of older adults.

Design: Prospective cohort study.

Mortality and apolipoprotein E in African-American, and White elders: an attempted replication.

We have tried, with only partial success, to confirm findings in a recently reported study in this journal on the relationship of APOE genotype to mortality in community representative Hispanics (n = 659), Whites (n = 272), and African-Americans (n = 450), aged 65 and over, living in Northern Manhattan, New York. That study found that using proportional hazards models adjusted for sex and lipid levels, Hispanics and Whites with the E2/E3 genotype, but not African-Americans, had the lowest mortality risk. Those under age 75 had risks comparable to those over age 75, suggesting minimal survivor bias.

The effect of comorbid illness on receipt of cancer screening by older people.

Objectives: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people.

Design: Sixth annual follow-up of a community-based survey with 4,162 participants aged 65 and older at baseline in 1986.

Setting: Piedmont area of North Carolina.

Apolipoprotein E epsilon4 and risk of mortality in African American and white older community residents.

Purpose: The goal of this study was to determine whether the epsilon4 allele of apolipoprotein E is predictive of mortality in a community-based sample.

Design And Methods: Of the stratified random household sample of 4,162 participants age 65 years and older enrolled in the Duke site of the Established Populations for Epidemiologic Studies of the Elderly, those included in the present study were the 1,998 who were genotyped for apolipoprotein E (alleles epsilon2, epsilon3, and epsilon4) six years after baseline, and for whom survival status eight years later was known by search of the National Death Index. Information on demographic characteristics, physical and mental health status, functional status, and health services use was determined by structured questionnaires administered in person in the home.