Using subjective oral health status indicators to screen for dental care needs in older adults

A study was undertaken to assess the ability of a number of subjective oral health status indicators to identify community-dwelling older adults who need dental treatment. The indicators consisted of a single-item self-rating of treatment need, a 15-item psychosocial impact index and the 49-item Oral Health Impact Profile (OHIP). Data for the study were collected as part of an oral health survey of Canadians aged 50 years and over. The associations between these subjective indicators and clinically defined dental treatment needs were assessed using statistics for determining the predictive power of a diagnostic test. Although there were statistically significant associations between the subjective and clinical measures, values for statistics such as sensitivity, positive predictive values and positive likelihood ratios were low. Although the measures did not perform well as screening tests, they did identify a sub-group of individuals whose clinical conditions impacted significantly on daily life and who would probably benefit the most from dental treatment. In this respect, the subjective measures assessed here can themselves be interpreted as indicators of need which complement conventional clinical measures of needs for dental care.     

Legal abortion in Denmark during the past 25 years: aspects of public health and ethics

The present study was designed to investigate the relationship between self-reported oral handicap as measured by socio-dental indicators and both dental state and felt need for dental treatment in a group of frail and functionally dependent older adults. A total of 263 housebound adults over the age of 60 years were investigated with regard to their self-reported dental handicap using the socio-dental indices derived by Locker (Community Dent Health 1992;9:109-24). Of these, 117 were in long-stay residential facilities, 67 in sheltered housing and 79 in private housing. The majority were female (76%) and the largest age group comprised 81-90-year-olds (44%), while only 8% were in the youngest group of 60-70-year-olds. A high level of handicap was recorded. In the previous 4 weeks, 74% of the group experienced difficulty in chewing, 54% some other functional handicap, 22% oral pain, 72% some incident of discomfort and 30% some social problem related to their oral condition. The socio-dental indices related more to the number of teeth than to age or gender. Ability to chew five index foods was related directly to the number of teeth present (P<0.001) but unless there were more than 20 teeth present, subjects with natural teeth were more dissatisfied with their appearance than those with complete dentures (P=0.002). The 57 subjects (29%) who expressed a desire for treatment had significantly higher handicap scores (P<0.001). Thus the results indicate that there are high levels of oral handicap in frail and functionally dependent older adults that are related to both the number of natural teeth retained and desire for treatment.     

Are East Asian versus American differences in arithmetical ability a recent phenomenon?

Younger and older American and Chinese adults were administered arithmetic, perceptual speed, and spatial orientation tests. For the perceptual speed and spatial orientation tests, the younger adults showed substantial performance advantages over the older adults in both the United States and China. For the arithmetic tests, the younger Chinese adults outperformed the older Chinese adults, but the groups of younger and older American adults had comparable arithmetical abilities. Cross-national comparisons indicated that the younger Chinese adults outperformed the younger American adults on the arithmetic tests, but not on the perceptual speed and spatial orientation tests. The performance of the older American and older Chinese adults was comparable for all of the ability measures. The overall pattern suggests that the advantage of Chinese adults over American adults in complex arithmetic might be a relatively recent phenomenon. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns and predictors of mental health service use and mental illness among older and younger adults in the United States.

The present study examined patterns of serious mental illness (SMI), specific mental health syndromes, and service use among older (65+) and younger (18-64) adults throughout the United States, and the extent to which various factors predict SMI and the use and magnitude of mental health treatment. Despite recent developments designed to improve mental healthcare access and treatment for older adults, older individuals were found to receive outpatient mental healthcare at very low rates. Compared to younger adults, older adults were three times less likely to report receiving treatment. Although prevalence estimates for SMI and specific syndromes were markedly lower among older than younger adults, older individuals most in need of care were highly unlikely to report receiving treatment. Findings point to the importance of perceived need in mental healthcare use. Significantly, however, those older adults that made it into services typically reported benefiting considerably from treatment, at least as much as all other age groups. Several predisposing, enabling, and need factors related to mental illness and service use were identified that have important implications for how we plan for, design, and deliver mental health services to older and younger Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gambling, health and age: Data from the National Epidemiologic Survey on Alcohol and Related Conditions.

The health effects of recreational gambling are presently unclear, particularly across age groups. Theories of healthy aging suggest that social activities, including gambling, may be beneficial to the health of older adults. Using cross-sectional data from the National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093), the authors examined associations between gambling (categorized as nongambling, recreational gambling, or problem/pathological gambling) and health and functioning measures stratified by age (40-64 years and ≥65). Problem/pathological gambling was uniformly associated with poorer health measures among both younger and older adults. Among younger respondents, poorer health measures were also found among recreational gamblers. However, among older respondents, recreational gambling was associated not only with some negative measures (e.g., obesity) but also with some positive measures (e.g., better physical and mental functioning). Longitudinal studies are needed to clarify the relationship between gambling and health in older adults in the context of healthy aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive monitoring and strategy choice in younger and older adults.

Younger (24- to 39-year-old) and older (60- to 88-year-old) adults learned a list of vocabulary words; one half of the words were studied using a generally more powerful strategy (mnemonic keyword method), and one half mediated with a less powerful approach (generating semantic contexts). Before using these strategies as part of the experiment, neither younger nor older adults judged that the keyword method was more effective and neither group preferred one strategy over the other. After using the strategies and taking a test of strategically studied unfamiliar vocabulary words, the younger subjects reported accurately the relative effectiveness of the two strategies and selected the one that had worked better for them to apply to a subsequent list of vocabulary items. The older participants were not as aware of the differential potency of the strategies and did not rely as much as did the younger subjects on knowledge of strategy utility in making strategy choices. In short, metacognitive awareness of strategy effects produced by monitoring and use of metacognitive awareness in regulating strategy choice were more pronounced in the younger compared with the older sample in this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of the length-tension relationship in elderly human plantarflexor muscles

The purpose of this study was to determine the effect of aging on the muscle length-tension relationship in the plantarflexor muscles of 10 subjects aged 20-30 yr (Mean = 23; 5 males, 5 females), 10 subjects aged 60-80 yr (Mean = 72.3; 5 males, 5 females), and 10 subjects over 80 yr (Mean = 84.1, 5 males, 5 females). Isometric twitch properties, maximum voluntary strength, passive tension, and range of motion were measured at five different joint angles [20 degrees dorsiflexion (DF), 10 degrees DF, 0 degree, 10 degrees plantarflexion (PF), and 20 degrees PF]. Active (evoked and voluntary) and passive torque production were maximal when the ankle was rotated into the DF positions for all three age groups, whereas the lowest values were recorded when the ankle was rotated into 20 degrees PF. Males were stronger than females at all joint angles (p < .01). Also, young adults were stronger than both elderly adult groups (p < .01). These results illustrate that despite the considerable age-associated loss in both voluntary and evoked strength in the plantarflexors, the optimal angle for torque production remains the same for younger and older adults.     

Influence of adult age on primary and secondary memory search.

Conducted 2 experiments with 25 19–29 yr olds, 26 62–85 yr olds, 30 18–32 yr olds, and 30 61–81 yr olds to compare young and elderly adults on the ability to search lists of words stored in primary memory (PM) and in secondary memory (SM). Exp I indicated that age differences in search performance were greatest under SM conditions. Older Ss, unlike the younger ones, appeared biased toward responding that probe items were not members of the memory sets stored in SM. As a result of this apparent bias, older Ss committed a large number of errors on trials in which the probe was a member of the memorized list (i.e., positive probe trials) yet few errors on the trials in which the probe was not a member of the list ( i.e., negative probe trials). The responses of older Ss to negative probe trials were more rapid than were those to positive probe trials. In Exp II, this pattern of responding was examined. It is concluded that age differences were involved in the ability to encode memory sets and transfer them from PM to SM as well as in the ability to retrieve information from SM prior to conducting a memory search. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multidimensionality of oral health in dentate adults

OBJECTIVES: An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein. METHODS: The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. RESULTS: The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health. CONCLUSIONS: The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.     

The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults

BACKGROUND: The study tested the effect of strength and endurance training on gait, balance, physical health status, fall risk, and health services use in older adults. METHODS: The study was a single-blinded, randomized controlled trial with intention-to-treat analysis. Adults (n = 105) age 68-85 with at least mild deficits in strength and balance were selected from a random sample of enrollees in a health maintenance organization. The intervention was supervised exercise (1-h sessions, three per week, for 24-26 weeks), followed by self-supervised exercise. Exercise groups included strength training using weight machines (n = 25), endurance training using bicycles (n = 25), and strength and endurance training (n = 25). Study outcomes included gait tests, balance tests, physical health status measures, self-reported falls (up to 25 months of follow-up), and inpatient and outpatient use and costs. RESULTS: There were no effects of exercise on gait, balance, or physical health status. Exercise had a protective effect on risk of falling (relative hazard = .53, 95% CI = .30-.91). Between 7 and 18 months after randomization, control subjects had more outpatient clinic visits (p < .06) and were more likely to sustain hospital costs over $5000 (p < .05). CONCLUSIONS: Exercise may have beneficial effects on fall rates and health care use in some subgroups of older adults. In community-living adults with mainly mild impairments in gait, balance, and physical health status, short-term exercise may not have a restorative effect on these impairments.     

Reflecting on self-relevant experiences: Adult age differences.

A broad array of research findings suggest that older adults, as compared with younger adults, have a more positive sense of self and possibly a clearer and more consistent sense of self. Further, older adults report lower motivation to construct or maintain a sense of self. In the present study, we examined whether such differences in self-views were reflected in features of older and younger adults’ narratives and narrating practices around recent, self-relevant events. Narratives about self-discrepant and self-confirming events were elicited from a sample of younger (18–37 years of age; n = 115) and older (58–90 years of age; n = 62) adults and were compared for indicators of engagement in self-construction, meanings, and emotionality. Older adults’ narratives contained significantly fewer self-focused pronouns, less present tense, and less emotional language, and they were significantly less likely to articulate and resolve challenges to their self-concepts. These findings, as well as others, are consistent with the idea that older adults are less engaged in self-construction in narrating everyday events, perhaps especially for self-discrepant events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age differences in anxious responding: Older and calmer, unless the trigger is physical.

The current study examines how the aging relevance of anxiety triggers, particularly those tied to physical threat, influences the expression of anxiety in older and younger adults. It was expected that older adults would exhibit less anxiety than younger adults in response to nonphysical triggers but that this age-related difference would diminish when faced with physical triggers. Anxiety responses were measured in older (N = 49, ages 60–85) and younger (N = 49, ages 17–34) adults in response to (a) physical and social anxiety provocations, and (b) a threat interpretation measure. Consistent with hypotheses, results for the anxiety provocations indicated less anxiety among older (vs. younger) adults on a range of anxiety measures (affective, cognitive, physiological) when triggers did not concern physical health, but this age difference diminished when physical health was threatened. Older adults actually reported more threat interpretations than younger adults to physical threat scenarios. Findings are discussed in terms of the aging relevance of anxiety triggers and theoretical accounts of age-related changes in emotional processing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential memory changes with age: Exact retrieval versus plausible inference.

Conducted 2 experiments on the use of direct retrieval and plausibility memory strategies in elderly and college-age adults. In Exp I, which used an episodic memory task, data were obtained from 49 65–80 yr old college alumni and from 58 college students who had served in a previous study by the 1st author (see record 1983-02731-001). Findings indicate that older Ss effectively used the plausibility strategy but performed more poorly than younger Ss when the direct retrieval strategy was required. Results of Exp II, using 18 college alumni (8 Ss aged 20–31 yrs, 10 Ss aged 64–75 yrs) with a semantic memory task, show that older Ss' accuracy was essentially undistinguishable from that of younger Ss as long as a plausibility judgment process produced the correct response. It is argued that careful inspection is a much more costly process for older adults than it is for young adults but that plausibility judgments and feature overlap processes are equally easy for both age groups. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age, time of testing, and proactive interference.

A four-list version of a release from proactive interference paradigm was used to assess the degree to which older (aged 58-78 yrs) and younger adults (aged 18-32 yrs) tested at optimal and nonoptimal times of day are vulnerable to interference effects in memory, effects that may increase at nonoptimal times. Morning type older adults and Evening type younger adults were tested either early in the morning or late in the afternoon. Standard buildup and release effects were shown for all age groups except for older adults tested in the afternoon; they failed to show release. Recall and intrusion data suggested that older adults are more vulnerable to proactive interference than younger adults and that for older adults at least, interference effects are heightened at nonoptimal times of day. The data are discussed in terms of an inhibitory model of control over the contents of working memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High prevalence of thymic tissue in adults with human immunodeficiency virus-1 infection

The thymus in adults infected with the HIV-1 is generally thought to be inactive, both because of age-related involution and viral destruction. We have revisited the question of thymic function in adults, using chest-computed tomography (CT) to measure thymic tissue in HIV-1-seropositive (n = 99) or HIV-1-seronegative (n = 32) subjects, and correlating these results with the level of circulating CD4(+) and CD8(+) T cells that are phenotypically described as naive thymic emigrants. Abundant thymic tissue was detectable in many (47/99) HIV-1-seropositive adults, aged 20-59. Independent of age, radiographic demonstration of thymic tissue was significantly associated with both a higher CD4(+) T cell count (P = 0.02) and a higher percentage and absolute number of circulating naive (CD45RA+CD62L+) CD4(+) T cells (P < 0.04). The prevalence of an abundant thymus was especially high in younger HIV-1-seropositive adults ( 40 yr) regardless of CD4 count (P = 0.03). These studies suggest that the thymus is functional in some but not all adults with HIV-1 disease.     

Effect of aging on the sensitivity of growth hormone secretion to insulin-like growth factor-I negative feedback

To determine the effect of aging on the suppression of GH secretion by insulin-like growth factor (IGF)-I, we studied 11 healthy young adults (6 men, 5 women, mean +/- SD: 25.2 +/- 4.6 yr old; body mass index 23.7 +/- 1.8 kg/m2) and 11 older adults (6 men, 5 women, 69.5 +/- 5.8 yr old; body mass index 24.2 +/- 2.5 kg/m2). Saline (control) or recombinant human IGF-I (rhIGF-I) (2 h baseline then, in sequence, 2.5 h each of 1, 3, and 10 micrograms/kg.h) was infused iv during the last 9.5 h of a 40.5-h fast; serum glucose was clamped within 15% of baseline. Baseline serum GH concentrations (mean +/- SE: 3.3 +/- 0.7 vs. 1.9 +/- 0.5 micrograms/L, P = 0.02) and total IGF-I concentrations (219 +/- 15 vs. 103 +/- 19 micrograms/L, P < 0.01) were higher in the younger subjects. In both age groups, GH concentrations were significantly decreased by 3 and 10 micrograms/kg.h, but not by 1 microgram/kg.h rhIGF-I. The absolute decrease in GH concentrations was greater in young than in older subjects during the 3 and 10 micrograms/kg.h rhIGF-I infusion periods, but both young and older subjects suppressed to a similar GH level during the last hour of the rhIGF-I infusion (0.78 +/- 0.24 microgram/L and 0.61 +/- 0.16 microgram/L, respectively). The older subjects had a greater increase above baseline in serum concentrations of both total (306 +/- 24 vs. 244 +/- 14 micrograms/L, P = 0.04) and free IGF-I (8.5 +/- 1.4 vs. 4.2 +/- 0.6 micrograms/L, P = 0.01) than the young subjects during rhIGF-I infusion, and their GH suppression expressed in relation to increases in both total and free serum IGF-I concentrations was significantly less than in the young subjects. We conclude that the ability of exogenous rhIGF-I to suppress serum GH concentrations declines with increasing age. This suggests that increased sensitivity to endogenous IGF-I negative feedback is not a cause of the decline in GH secretion that occurs with aging.     

Adult development, self-contexting, and psychotherapy with older adults.

Measured the effect of "self-contexting" on brief dynamic therapy with 15 50–81 yr olds, and 10 20–40 yr olds. Self-contexting is defined as the individual's explicit self-awareness within a larger context, relative to other individuals; it is hypothesized to occur in mid-life. The major presenting problems of Ss were anxiety or depression, the majority of which were situational, although most cases had significant contributing characterological dimensions. Evaluators other than the therapist rated psychotherapeutic outcomes, and a psycholinguistic measure of self-contexting was used to score the 1st 1,000 words of patient discourse. Correlations were calculated for the older and younger groups separately. Results show that a change in self-contexting phrases correlated positively and significantly with psychotherapy outcome in the older but not the younger Ss. Findings confirm an age-specific correlation between a hypothesized development of middle and later life and psychotherapy outcome in older adults. (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathology in younger versus older persons with very mild and mild dementia of the Alzheimer type

OBJECTIVE: The psychopathology associated with early-onset dementia of the Alzheimer type was investigated by comparing the prevalence of psychiatric symptoms in younger subjects (mean age = 59 years) who had very mild or mild dementia with that in older adults (mean age = 72) whose dementia was of equivalent severity. METHOD: Nondemented comparison subjects and persons with very mild or mild dementia of the Alzheimer type were recruited to participate in longitudinal studies. All subjects met strict inclusion and exclusion criteria. Information pertaining to personality changes, affective symptoms, and psychotic symptoms was included in the 90-minute semistructured, physician-administered interview, which was used to assign a clinical dementia rating according to published guidelines. The younger group were age 64 or younger and consisted of 20 nondemented subjects, 11 subjects with very mild dementia, and 18 subjects with mild dementia. The older group, described previously, were 64-83 years old and consisted of 83 nondemented subjects, 41 persons with very mild dementia, and 68 subjects with mild dementia. RESULTS: The psychopathology in the younger subjects was similar to that in the older group. Personality changes occurred in over 80% of the younger persons with very mild illness. Psychotic symptoms were present in over 40% of the younger persons with mild illness but were rare in the group with very mild dementia. CONCLUSIONS: Similar patterns of psychopathology in younger and more elderly persons with dementia of the Alzheimer type support the suggestion that these changes are direct effects of the illness on the CNS. Increased attention to documenting these noncognitive symptoms and studying various treatments is urgently needed.     

The moderating influence of physical fitness on age gradients in vigilance and serial choice responding tasks.

The moderating influence of physical fitness on age gradients in measures obtained from vigilance and serial choice responding tasks is examined in a sample of 90 postal workers. Physiological data relating to aerobic fitness determined fitness level within 2 age groups: younger participants ages 18 to 30 years (M ?=?25.19; 24 men, 24 women) and older participants ages 43 to 62 years (M ?=?49.19; 20 men, 22 women). A performance decrement across time was found in several measures, and some variation as a function of age was apparent. However, post hoc statistical analyses did not indicate this was due to older adults underperforming younger adults. According to predictions, significant Age?×?Fitness interactions showed older less fit workers to consistently underperform other participants. The findings suggest that older less fit individuals have lower signal sensitivity and processing speed than older fitter people and younger individuals. Results are discussed in relation to underlying physiological mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)