RESUMEN
AIMS: To document the prevalence of current depressive symptoms and history of depression across the glycaemic spectrum in older adults, and examine if measures of health status and healthcare satisfaction, access and utilization explain differences in the prevalence of current depressive symptoms by diabetes status. METHODS: We conducted a cross-sectional study of 6226 participants aged 67-90 years who attended the 2011-2013 visit of the Atherosclerosis Risk in Communities (ARIC) study. Diabetes was based on self-report, medication use and HbA1c . Current depressive symptoms were defined using the Center for Epidemiologic Studies Depression 11-item questionnaire, and history of depression was assessed via self-report. We examined obesity, history of cardiovascular disease, hypertension, kidney disease, cognitive function, and self-reported health compared with others. Prevalence and prevalence ratios were estimated using age-, race-, and sex-adjusted Poisson regression. RESULTS: The prevalence of current depressive symptoms was 5.4% in people without diabetes and 11.0% in people with diabetes (prevalence ratio 2.04, 95% CI 1.60, 2.48); the prevalence of history of depression was 11% in people without diabetes and 17.7% in people with diabetes (prevalence ratio 1.61, 95% CI 1.28,1.95). Strong correlates of current depressive symptoms were history of depression (prevalence ratio 3.86, 95% CI 3.05, 4.90) and reporting poor health compared with others (prevalence ratio 3.88, 95% CI 2.93, 5.15). No variables had significantly different associations with depressive symptoms across glycaemic categories (P for interaction >0.10). CONCLUSIONS: In older adults, current depressive symptoms were twice as prevalent in people with diabetes compared with those without. Measures of health status and healthcare did not explain differences in depressive symptoms between people with and without diabetes.
Asunto(s)
Depresión/epidemiología , Diabetes Mellitus/epidemiología , Estado de Salud , Estado Prediabético/epidemiología , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Comorbilidad , Estudios Transversales , Depresión/psicología , Diabetes Mellitus/metabolismo , Diabetes Mellitus/psicología , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Estado Prediabético/metabolismo , Estado Prediabético/psicología , Prevalencia , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: To investigate the association of different measures of central (abdominal) and overall adiposity with autonomic nervous system (ANS) function, indexed by heart rate variability (HRV), in apparently healthy human adults. DESIGN AND MEASUREMENTS: Cross-sectional data of 8,538 participants (20% female, age: 41 ± 11 years, body mass index (BMI): 24 ± 4 kg/m2, waist circumference (WC): 91 ± 12 cm, waist-to-height ratio (WHtR): 0.45 ± 0.08) were available for analysis. RESULTS: All measures of adiposity were inversely correlated with vagally-mediated HRV indexed by RMSSD (all p<0.001). Strongest associations were found with WC and RMSSD (r = -0.29). Associations were stronger in males (WC r = -0.32) than in females (WC r = -0.23). Partial correlations revealed the same pattern for RMSSD (WC all pcc = -0.12 p<0.001; WC male pcc = -0.14 p<0.001; WC female pcc = -0.06 p<0.05). Correlation strength of BMI and WHtR with RMSSD were similar and significantly weaker compared to WC (p < .001) in unadjusted analysis. Overall, nonparametric Kendall's τb led to the same conclusions. CONCLUSION: The present data supports previous findings, that HRV is related to measures of adiposity in healthy individuals. In line with previous research, we found that WC is more strongly related to measures of HRV, indicating that WC best captures adiposity related risk.
Asunto(s)
Adiposidad , Sistema Nervioso Autónomo/fisiología , Índice de Masa Corporal , Frecuencia Cardíaca , Obesidad/fisiopatología , Circunferencia de la Cintura , Relación Cintura-Estatura , Adulto , Estudios Transversales , Empleo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Obesidad Abdominal/complicaciones , Obesidad Abdominal/fisiopatología , Valores de Referencia , Factores SexualesRESUMEN
Previous studies reported that a device-guided slow-breathing (DGB) exercise decreases resting blood pressure (BP) in hypertensive patients. This study investigated the effects of daily practice of DGB on (a) 24-h BP and breathing patterns in the natural environment, as well as (b) BP and breathing pattern during clinic rest. Altogether, 40 participants with pre-hypertension or stage 1 hypertension were trained to decrease breathing rate through DGB or to passively attend to breathing (control, CTL) during daily 15-min sessions. The participants practiced their breathing exercise at home for 4 weeks. The DGB (but not the CTL) intervention decreased clinic resting BP, mid-day ambulatory systolic BP (in women only) and resting breathing rate, and increased resting tidal volume. However, 24-h BP level was not changed by DGB or CTL interventions, nor was overnight breathing pattern. These findings are consistent with the conclusion that a short-term, autonomic mechanism mediated the observed changes in resting BP, but provided no evidence that regular DGB affected factors involved in long-term BP regulation. Additional research will be needed to determine whether 24-h BP can be lowered by a more prolonged intervention.
Asunto(s)
Presión Sanguínea , Ejercicios Respiratorios , Hipertensión/terapia , Prehipertensión/terapia , Frecuencia Respiratoria , Descanso , Monitoreo Ambulatorio de la Presión Arterial , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Prehipertensión/fisiopatología , Volumen de Ventilación Pulmonar , Factores de Tiempo , Resultado del TratamientoRESUMEN
Previous studies have reported that regular practice of a device-guided slow-breathing (DGB) exercise decreases resting blood pressure (BP) in hypertensive patients. The performance of DGB is associated with acute decreases in sympathetic vascular tone, and it has been suggested that the decreases in resting BP produced by regular practice of DGB over periods of weeks are due to chronic decreases in sympathetic nervous system activity. However, the kidneys respond to sympathetically mediated changes in BP by readjusting blood volume levels within a few days. Thus, the mechanism by which DGB could produce long-term BP changes remains to be clarified. Previous research with laboratory animals and human subjects has shown that slow, shallow breathing that increases pCO(2) potentiates BP sensitivity to high sodium intake. These findings raise the possibility that deeper breathing during DGB that decreases BP might involve opposite changes in pCO(2). The present study tested the hypothesis that performance of DGB acutely decreases a marker of pCO(2), end-tidal CO(2) (PetCO(2)). Breathing rate, tidal volume, and PetCO(2) were monitored before, during, and after a 15-min session of DGB by patients with elevated BP. BP, heart rate, and heart-rate variability (HRV) were also measured under these conditions. A control group was also studied before, during, and after a 15-min session of spontaneous breathing (SB). The DGB group, but not the SB group, showed progressive and substantial increases in tidal volume and low-frequency HRV and decreases in PetCO(2) and systolic BP. The PetCO(2) effects persisted into the posttask, rest period. The findings are consistent with the hypothesis that habitual changes in breathing patterns of the kind observed during DGB could potentiate an antihypertensive adaptation via effects on pCO(2) and its role in cardiovascular homeostasis.
Asunto(s)
Dióxido de Carbono/metabolismo , Electrofisiología/instrumentación , Frecuencia Cardíaca/fisiología , Respiración , Volumen de Ventilación Pulmonar/fisiología , Adulto , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana EdadRESUMEN
Polypharmacy, common in older people, confers both risk of adverse outcomes and benefits. We assessed the relationship of commonly prescribed medications with anticholinergic and sedative effects to physical and cognitive performance in older individuals. The study population comprised 932 moderately to severely disabled community-resident women aged 65 years or older who were participants in the Women's Health and Aging Study I. A scale based on pharmacodynamic principles was developed and utilized as a measure of drug burden. This was related to measures of physical and cognitive function. After adjusting for demographics and comorbidities, anticholinergic drug burden was independently associated with greater difficulty in four physical function domains with adjusted odds ratios (95% confidence interval (CI)) of 4.9 (2.0-12.0) for balance difficulty; 3.2 (1.5-6.9) for mobility difficulty; 3.6 (1.6-8.0) for slow gait; 4.2 (2.0-8.7) for chair stands difficulty; 2.4 (1.1-5.3) for weak grip strength; 2.7 (1.3-5.4) for upper extremity limitations; 3.4 (1.7-6.9) for difficulty in activities of daily living; and 2.4 (95% CI, 1.1-5.1) for poor performance on the Mini-Mental State Examination. Sedative burden was associated only with impaired grip strength (3.3 (1.5-7.3)) and mobility difficulty (2.4 (1.1-5.3)). The burden of multiple drugs can be quantified by incorporating the recommended dose regimen and the actual dose and frequency of drug taken. Anticholinergic drug burden is strongly associated with limitations in physical and cognitive function. Sedative burden is associated with impaired functioning in more limited domains. The risk associated with exposure of vulnerable older women to drugs with anticholinergic properties, and to a lesser extent those with sedative properties, implies that such drugs should not be used in this patient group without compelling clinical indication.