Physical Function and Survival in Older Adults: A longitudinal study accounting for time-varying effects.

Purpose Of The Study: Variation in physical function in older adults over time raises several methodological challenges in the study of its association with survival, many of which have largely been overlooked in previous studies. The objective of this study is to examine the relationship between time-varying measures of physical function and survival in men and women aged 70 years and over, while accounting for the time-varying effects of health and lifestyle characteristics.

Methods: 1,846 women and 1,245 men in the Cardiovascular Health Study followed annually for up to 10 years beginning at age 70-74 years were included.

The association between physical function and proximity to death in older adults: a multilevel analysis of 4,150 decedents from the Cardiovascular Health Study.

Purpose: When examining whether poor physical function is a risk factor for imminent death in older adults, one challenge is the lack of a meaningful time origin, a time point on which the estimate of time-to-death is anchored. In this study, we overcame this challenge by discarding the traditional-and flawed-approach of survival analysis with "time since beginning of follow up" as the time variable, and instead used a novel analytic approach that uses time-to-death as a covariate to examine its association with physical function.

Methods: Physical function and other covariates were measured annually in the Cardiovascular Health Study on 4150 individuals followed up to their time of death.

Can a Healthy Lifestyle Compress the Disabled Period in Older Adults?

Objectives: To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life.

Design: Community-based cohort study of older adults followed from 1989 to 2015.

Setting: Four U.

Sex, Race, and Age Differences in Observed Years of Life, Healthy Life, and Able Life among Older Adults in The Cardiovascular Health Study.

Objective: Longevity fails to account for health and functional status during aging. We sought to quantify differences in years of total life, years of healthy life, and years of able life among groups defined by age, sex, and race.

Design: Primary analysis of a cohort study.

Brain imaging findings in elderly adults and years of life, healthy life, and able life over the ensuing 16 years: the Cardiovascular Health Study.

Objectives: To determine whether elderly people with different patterns of magnetic resonance imaging (MRI) findings have different long-term outcomes.

Design: Longitudinal cohort study.

Setting: Cardiovascular Health Study.

Decline in health for older adults: five-year change in 13 key measures of standardized health.

Background: The health of older adults declines over time, but there are many ways of measuring health. It is unclear whether all health measures decline at the same rate or whether some aspects of health are less sensitive to aging than others.

Methods: We compared the decline in 13 measures of physical, mental, and functional health from the Cardiovascular Health Study: hospitalization, bed days, cognition, extremity strength, feelings about life as a whole, satisfaction with the purpose of life, self-rated health, depression, digit symbol substitution test, grip strength, activities of daily living, instrumental activities of daily living, and gait speed.

Accommodation of missing data in supportive and palliative care clinical trials.

Purpose Of Review: Clinical trials to evaluate the supportive and palliative care treatments have some different missing data concerns than the other clinical trials. This study reviews the literature on missing data as it may apply to these trials.

Recent Findings: Prevention of missing data through study design and conduct is a recent area of focus.

A randomized trial to improve communication about end-of-life care among patients with COPD.

Objective: Patients with COPD consistently express a desire to discuss end-of-life care with clinicians, but these discussions rarely occur. We assessed whether an intervention using patient-specific feedback about preferences for discussing end-of-life care would improve the occurrence and quality of communication between patients with COPD and their clinicians.

Methods: We performed a cluster-randomized trial of clinicians and patients from the outpatient clinics at the Veterans Affairs Puget Sound Health Care System.

Identification of ovarian cancer symptoms in health insurance claims data.

Background: Women with ovarian cancer have reported abdominal/pelvic pain, bloating, difficulty eating or feeling full quickly, and urinary frequency/urgency prior to diagnosis. We explored these findings in a general population using a dataset of insured women aged 40-64 and investigated the potential effectiveness of a routine review of claims data as a prescreen to identify women at high risk for ovarian cancer.

Methods: Data from a large Washington State health insurer were merged with the Seattle-Puget Sound Surveillance, Epidemiology and End Results (SEER) cancer registry for 2000-2004.

Longitudinal Data with Follow-up Truncated by Death: Match the Analysis Method to Research Aims.

Diverse analysis approaches have been proposed to distinguish data missing due to death from nonresponse, and to summarize trajectories of longitudinal data truncated by death. We demonstrate how these analysis approaches arise from factorizations of the distribution of longitudinal data and survival information. Models are illustrated using cognitive functioning data for older adults.

Distance as a barrier to using a fitness-program benefit for managed Medicare enrollees.

This study evaluated the effect of distance on the likelihood of initiating and maintaining regular use of a fitness-program benefit in a population of managed Medicare seniors. We studied 8,162 participants and nonparticipants in a managed-care fitness-program benefit: a structured group exercise program or an unstructured health-club membership. Participants in both programs lived significantly closer to facilities than nonparticipants did (structured, p < .

Synchrony of change in depressive symptoms, health status, and quality of life in persons with clinical depression.

Background: Little is known about longitudinal associations among measures of depression, mental and physical health, and quality of life (QOL). We followed 982 clinically depressed persons to determine which measures changed and whether the change was synchronous with change in depressive symptoms.

Methods: Data were from the Longitudinal Investigation of Depression Outcomes (LIDO).

Public health surveillance of low-frequency populations.

Public health agencies often require data that address the needs of special populations, such as minority groups. Sources of surveillance data often contain insufficient numbers of subjects to fully inform health agencies. In this review, we address the problems of and potential approaches for situations with insufficient surveillance data.