1,721,035 research outputs found
Social inequalities in musculoskeletal ageing among community dwelling older men and women in the United Kingdom
No full textThe population of the United Kingdom (UK) is ageing; the already substantial burden of musculoskeletal disorders on health and social care systems will increase over time as the population ages. Social inequalities in health are well documented for the UK in general but little is known about social inequalities in musculoskeletal ageing. Using data from the 3,225 ‘young-old’ (age 59 to 73 years) community dwelling men and women who participated in the Hertfordshire Cohort Study, this thesis has explored social inequalities in musculoskeletal ageing: specifically, loss of muscle strength and physical function (PF); falls; Fried frailty; and osteoporosis. Socioeconomic position was characterised by age left full-time education, parental social class at birth and own social class in adulthood, and current material deprivation by housing tenure and car availability. Not owning one’s home was associated with lower grip strength and increased frailty prevalence among men and women and with poorer self-reported short-form 36 (SF-36) PF among men. Reduced car availability was associated with lower grip strength and poorer SF-36 PF among men and women and with increased falls and frailty prevalence among men. There was no convincing evidence for social inequalities in fracture, dual-energy x-ray absorptiometry (DXA) total femoral bone mineral density (BMD) and bone loss rate, or peripheral quantitative computed tomography (pQCT) strength strain indices for the radius or tibia. This thesis has argued that social variations in height, fat mass, diet and physical activity are likely to have mediated these results. Moreover, evidence for a social gradient in grip strength but not BMD is consistent with ageing skeletal muscle remaining highly responsive to physical activity in later life in a way that ageing bone does not; the impact of lifecourse customary and occupational physical activity on social inequalities in musculoskeletal ageing merits further research. The results presented in this thesis suggest that any clinical interventions designed to reduce the loss of muscle mass and function with age should be targeted proportionately across the social gradient; strategies to reduce fracture and osteoporosis should continue to have a universal population focus. Finally, this thesis suggests that there exists a subgroup of older men and women in the UK who face the multiple jeopardy of increased levels of material deprivation combined with greater loss of muscle strength and physical function; these men and women urgently need the government to commit to reform of the funding system for adult care and support
Raynaud's phenomenon, vibration-induced white finger, and difficulties in hearing
No full textBackground: An association has previously been reported between finger blanching and hearing difficulties, but only in workers with exposure to noise and hand transmitted vibration (HTV).Aims: To explore the association in a community sample, including cases who lacked occupational exposure to noise or HTV.Method: A questionnaire was mailed to 12 606 subjects aged 35–64 years, chosen at random from the age–sex registers of 34 British general practices. Inquiry was made about years of employment in noisy jobs, lifetime exposure to HTV, hearing difficulties and tinnitus, and lifetime history of cold induced finger blanching. Subjects were classed as having severe hearing difficulty if they used a hearing aid or found it difficult or impossible to hear conversation in a quiet room. Associations of finger blanching with hearing difficulties and tinnitus were analysed by logistic regression.Results: Among 8193 respondents were 185 who reported severe hearing difficulty and 1151 who reported finger blanching. After adjustment for age and years of work in noisy jobs, hearing difficulty was about twice as common in men and women who reported finger blanching, including those who had never been importantly exposed to noise and in those never exposed to HTV.Conclusions: These data support an association between finger blanching and hearing loss, which is not explained by confounding occupational exposure to noise, and suggest that it may extend to causes of blanching other than vibration induced white finger. Further investigations are warranted to confirm the association and explore possible mechanisms, such as sympathetic vasoconstriction in the cochlea
Cigarette smoking, occupational exposure to noise, and self reported hearing difficulties
No full textAims: To explore the interaction of smoking and occupational exposure to noise as risk factors for hearing difficulty in the general population.Methods: A questionnaire was mailed to 21 201 adults of working age, selected at random from the age-sex registers of 34 British general practices, and to 993 members of the armed services, randomly selected from pay records. Questions were asked about smoking habits, years spent in a noisy occupation, difficulty in hearing conversation, and wearing of a hearing aid. Associations of hearing difficulty with smoking habit were examined by logistic regression and compared across strata of noise exposure, with adjustment for potential confounders.Results: Around half of the respondents had ever smoked, and half of these still smoked. Among 10 418 who provided details on hearing, 348 were classed as having moderate and 311 as having severe hearing difficulty. Risk of hearing difficulty was 3–5-fold higher in those employed for >5 years in noisy work compared with those never employed in a noisy job. Within strata of noise exposure (including those who had never worked in a noisy job), ex- and current smokers had a higher risk of hearing difficulty than lifetime non-smokers. The additional risks were small compared with those of long term noise exposure, and the combination of effects was more consistent with an additive than a multiplicative interaction.Conclusions: Smoking may adversely affect hearing, and workers should be encouraged to refrain from both smoking and exposure to noise. However, the extra risk to hearing incurred by smoking in high ambient noise levels is small relative to that from the noise itself, which should be the main target for preventive measures
Occupational exposure to noise and the attributable burden of hearing difficulties in Great Britain
No full textAims: To determine the prevalence of self reported hearing difficulties and tinnitus in working aged people from the general population, and to estimate the risks from occupational exposure to noise and the number of attributable cases nationally.Methods: A questionnaire was mailed to 22 194 adults of working age selected at random from the age–sex registers of 34 British general practices (21 201 subjects) and from the central pay records of the British armed services (993 subjects). Information was collected on years of employment in a noisy job; and whether the respondent wore a hearing aid, had difficulty in hearing conversation, or had experienced persistent tinnitus over the past year. Associations of hearing difficulty and tinnitus with noise exposure were examined by logistic regression, with adjustment for age, sex, smoking habits, and frequent complaints of headaches, tiredness, or stress. The findings were expressed as prevalence ratios (PRs) with associated 95% confidence intervals (CIs). Attributable numbers were calculated from the relevant PRs and an estimate of the prevalence of occupational exposure to noise nationally.Results: Some 2% of subjects reported severe hearing difficulties (wearing a hearing aid or having great difficulty in both ears in hearing conversation in a quiet room). In men, the prevalence of this outcome rose steeply with age, from below 1% in those aged 16–24 years to 8% in those aged 55–64. The pattern was similar in women, but severe hearing loss was only about half as prevalent in the oldest age band. Tinnitus was far more common in subjects with hearing difficulties. In both sexes, after adjustment for age, the risk of severe hearing difficulty and persistent tinnitus rose with years spent in a noisy job. In men older than 35 years with 10 or more years of exposure, the PR for severe hearing difficulty was 3.8 (95% CI 2.4 to 6.2) and that for persistent tinnitus 2.6 (95% CI 2.0 to 3.4) in comparison with those who had never had a noisy job. Nationally, some 153 000 men and 26 000 women aged 35–64 years were estimated to have severe hearing difficulties attributable to noise at work. For persistent tinnitus the corresponding numbers were 266 000 and 84 000.Conclusions: Significant hearing difficulties and tinnitus are quite common in men from the older working age range. Both are strongly associated with years spent in a noisy occupation—a predominantly male exposure. The national burden of hearing difficulties attributable to noise at work is substantial
The SF-36: a simple, effective measure of mobility disability for epidemiological studies
No full textBackgroundMobility disability is a major problem in older people. Numerous scales exist for the measurement of disability but often these do not permit comparisons between study groups. The physical functioning (PF) domain of the established and widely used Short Form-36 (SF-36) questionnaire asks about limitations on ten mobility activities.ObjectivesTo describe prevalence of mobility disability in an elderly population, investigate the validity of the SF-36 PF score as a measure of mobility disability, and to establish age and sex specific norms for the PF score.MethodsWe explored relationships between the SF-36 PF score and objectively measured physical performance variables among 349 men and 280 women, 59-72 years of age, who participated in the Hertfordshire Cohort Study (HCS). Normative data were derived from the Health Survey for England (HSE) 1996.Results32% of men and 46% of women had at least some limitation in PF scale items. Poor SF-36 PF scores (lowest fifth of the gender-specific distribution) were related to: lower grip strength; longer timed-up-and-go, 3m walk, and chair rises test times in men and women; and lower quadriceps peak torque in women but not men. HSE normative data showed that median PF scores declined with increasing age in men and women.ConclusionOur results are consistent with the SF-36 PF score being a valid measure of mobility disability in epidemiological studies. This approach might be a first step towards enabling simple comparisons of prevalence of mobility disability between different studies of older people. The SF-36 PF score could usefully complement existing detailed schemes for classification of disability and it now requires validation against them
Is grip strength associated with length of stay in hospitalised older patients admitted to rehabilitation? Findings from the Southampton grip strength study
No full textBackground: identification of patients at risk of prolonged hospital stay allows staff to target interventions, provide informed prognosis and manage healthcare resources. Admission grip strength is associated with discharge outcomes in acute hospital settings.Objective: to explore the relationship between grip strength and length of stay in older rehabilitation in-patients.Design: single-centre prospective cohort study.Setting: community hospital rehabilitation ward.Subjects: one hundred and ten patients aged 70 years and over.Methods: data on age, height, weight, body mass index (BMI), co-morbidities, medication, residence, grip strength, physical function, cognitive function, frailty, falls, discharge destination and length of stay were recorded.Results: higher grip strength was associated with reduced length of stay, characterised by an increased likelihood of discharge to usual residence among male rehabilitation in-patients (hazard ratio 1.09 (95% confidence interval 1.01, 1.17) per kilo increase in grip strength, P = 0.02) after adjustment for age and size.Conclusions: this is the first prospective study to show that stronger grip strength, particularly among male in-patients, is associated with a shorter length of stay in a rehabilitation ward. This is important because it demonstrates that grip strength can be discriminatory among frailer people. Further research into the clinical applications of grip strength measurement in rehabilitation settings is needed
Serum insulin-like growth factor-I concentrations in late middle age: no association with birthweight in three UK cohorts
No full textBackground:
Small body size at birth and during infancy is associated with an increased risk of adult osteoporosis and cardiovascular disease. Fetal programming of the growth hormone–insulin-like growth factor (GH-IGF) axis may provide a mechanism for these epidemiological findings.Aims:
To determine whether measurements of GH and IGF-I in late middle age were related to size at birth and in infancy.Methods:
Overnight urinary GH excretion and fasting serum IGF-I were measured in 309 men and 193 women from Hertfordshire (born 1920–1930) for whom birthweight and weight at 1 year were recorded. Serum IGF-I was measured in men and women from Preston (n = 254, born 1935–1943) and Sheffield (n = 215, born 1939–1940) whose birthweight and other birth measurements were recorded.Results:
Urinary GH and serum IGF-I were not related to birthweight, other measurements at birth, or weight at 1 year.Conclusion:
In contrast to previous studies in children or young adults, these data do not support the hypothesis that IGF-I concentrations are programmed by intra-uterine events, as assessed by birthweight, in late middle age
Is measuring grip strength acceptable to older people? The Southampton Grip Strength Study
No full textObjectives: To evaluate the acceptability of grip strength measurement among older people in different healthcare settings. Design: A cross-sectional study with quantitative and qualitative data collection. Setting: Four healthcare settings in one town in southern England. Participants: 101 community hospital rehabilitation inpatients, 47 community physiotherapy referrals, 57 patients attending a Parkinson’s clinic at the hospital and 100 residents in care homes. Measurements: Grip strength, Barthel score, Mini Mental State Examination and outline questions on the grip measurement process were assessed on all participants. In-depth semi-structured interviews ascertained the views of a sub-sample of 20 participants on grip strength measurement. Results: The instructions were easily understood, most participants did not find the measurement painful or tiring, and almost all were prepared to repeat the assessment. Participants felt that this could be a useful and acceptable routine assessment, which some thought could be an opportunity to improve their health, while others were uncertain whether it would be helpful to be told that they were becoming weaker. Participants were generally accepting of medical assessments and felt that grip measurement was easy, unless there was a problem with an individual’s hand. Conclusions: This is the first study to demonstrate that grip strength measurement is acceptable to older people undergoing rehabilitation, living with a chronic neurological condition or resident in care homes. The high level of acceptability found among older people in different healthcare settings in this study supports the use of grip strength measurement in routine clinical practice
Understanding poor health behaviours as predictors of different types of hospital admission in older people: findings from the Hertfordshire Cohort Study
No full textBACKGROUND:Rates of hospital admission are increasing, particularly among older people. Poor health behaviours cluster but their combined impact on risk of hospital admission among older people in the UK is unknown.METHODS: 2997 community-dwelling men and women (aged 59-73) participated in the Hertfordshire Cohort Study (HCS). We scored (from 0 to 4) number of poor health behaviours engaged in at baseline (1998-2004) out of: current smoking, high weekly alcohol, low customary physical activity and poor diet. We linked HCS with Hospital Episode Statistics and mortality data to 31/03/2010 and analysed associations between the score and risk of different types of hospital admission: any; elective; emergency; long stay (>7?days); 30-day readmission (any, or emergency).RESULTS: 32%, 40%, 20% and 7% of men engaged in 0, 1, 2 and 3/4 poor health behaviours; corresponding percentages for women 51%, 38%, 9%, 2%. 75% of men (69% women) experienced at least one hospital admission. Among men and women, increased number of poor health behaviours was strongly associated (p<0.01) with greater risk of long stay and emergency admissions, and 30-day emergency readmissions. Hazard ratios (HRs) for emergency admission for 3/4 poor health behaviours in comparison with none were: men, 1.37 (95% CI 1.11 to 1.69); women, 1.84 (95% CI 1.22 to 2.77). Associations were unaltered by adjustment for age, body mass index and comorbidity.CONCLUSIONS: Clustered poor health behaviours are associated with increased risk of hospital admission among older people in the UK. Lifecourse interventions to reduce number of poor health behaviours could have substantial beneficial impact on health and use of healthcare in later life
Activation of the hypothalamic-pituitary-adrenal axis in adults of low birthweight: similar increased activity in women and men
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