Annals of Long Term Care

Effects of Ultra-Low-Dose Estrogen Therapy on Muscle and Physical Function in Older Women
Anne M. Kenny, MD, Alison Kleppinger, MS, Yahzen Wang, PhD, and Karen M. Prestwood, MD

Objectives: To determine the effects of ultra-low-dose hormone therapy on muscle mass and physical function in community-dwelling women.

Design: Double-blind, placebo-controlled trial.

Setting: Clinical research center in Connecticut.

Participants: Healthy, community-dwelling women aged 65 and older (n=167).

Intervention: Eligible women were randomly assigned to treatment with 0.25 mg 17-beta estradiol or placebo for 36 months. All women (estradiol or placebo) with an intact uterus received micronized progesterone 100 mg/d for 2 weeks every 6 months. All participants received 1,300 mg elemental calcium with 1,000 IU vitamin D per day.

Measurements: Appendicular skeletal muscle mass (ASM), lean body mass (LBM), and percentage body fat were measured using dual x-ray absorptiometry. Sarcopenia was defined as skeletal muscle mass (ASM/height2) 2 standard deviations or less than young, healthy reference population mean. Physical activity (Physical Activity Scale in the Elderly (PASE)) and performance were measured. Serum estrone, estradiol, and sex hormone–binding globulin were measured.

Results: The prevalence of sarcopenia at baseline was 13%. There were no baseline differences between groups except for PASE score and chair rise time, in which the estrogen group had better performance. No changes in ASM, LBM, percentage of body fat, or physical performance were found after 3 years of estrogen therapy.

Conclusion: Sarcopenia was present in 13% of this group of community-dwelling, postmenopausal older women. Ultra-low-dose estrogen therapy neither improves nor harms ASM. Similarly, no changes in body fat or physical performance were detected. J Am Geriatr Soc 2005;53(11):1973-1977.

Effect of Cataract Surgery on Cognitive Function in Older Adults
Tyler Andrew Hall, MD, Gerald McGwin, Jr, MS, PhD, and Cynthia Owsley, MSPH, PhD
nObjectives: To assess whether cataract surgery has an effect on cognitive function in older adults.

Design: Longitudinal.

Setting: Assessment of patients seen in eye clinics.

Participants: Patients with no cataract (n= 92), patients with cataract who elected surgery (n=122), and patients with cataract who declined surgery (n=87).

Measurements: At baseline and 1-year follow-up visits, the following information was obtained: demographic, health behavior, general health status, medication use, depressive symptoms, cognitive function, and visual function information. This information was compared within and between groups at baseline and follow-up visits.

Results: Mattis Organic Mental Syndrome Screening Examination scores at baseline and follow-up varied across the three groups, with the cataract/no surgery group having the highest scores (more cognitive impairment) and the no-cataract group having the lowest scores (less cognitive impairment). For the within-group analysis, at follow-up, the cataract/no surgery group and the cataract/surgery group had significantly less cognitive impairment (P<.001), whereas the no-cataract group experienced no change. For those with cataract, there were no associations between changes in visual function and cognitive function.

Conclusion: Improvement in cognitive function may occur after cataract surgery but cannot be attributed to the cataract surgery per se or to improved visual function. Clinicians may find this information useful when discussing the nonvisual outcomes of cataract surgery with patients. J Am Geriatr Soc 2005;53(12):2140-2144.

Increased Use of Hip Protectors in Nursing Homes: Economic Analysis of a Cluster Randomized, Controlled Trial
Gabriele Meyer, PhD, Karl Wegscheider, PhD, Jan F.