Annals of Long Term Care

Serum Parathyroid Hormone Levels Predict Falls in Older Adults with Diabetes Mellitus

Denise K. Houston, PhD, Ann V. Schwartz, PhD, Jane A. Cauley, DrPH, Frances A. Tylavsky, DrPH, Eleanor M. Simonsick, PhD, Tamara B. Harris, MD, Nathalie de Rekeneire MD, Gary G. Schwartz, PhD, and Stephen B. Kritchevsky, PhD, for the Health, Aging and Body Composition Study

OBJECTIVES: To examine the association between serum parathyroid hormone (PTH) levels and incident falls in older adults with diabetes mellitus.

DESIGN: Longitudinal analysis of incident falls over 1 year in a substudy of participants with diabetes mellitus in the Health, Aging and Body Composition Study.

SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee.

PARTICIPANTS: Well-functioning, community-dwelling black and white adults aged 70 to 79 with diabetes mellitus (N=472).

MEASUREMENTS: Measured baseline serum PTH. Self-report of falls over the subsequent 12 months. Baseline physical performance and self-reported demographic, behavioral, and health status measures including kidney function, chronic conditions, and medication use.

RESULTS: One-third (30.3%) of participants reported falling over 1 year of follow-up. Mean baseline serum PTH was 53.5±30.0 pg/mL in nonfallers and 62.6±46.2 pg/mL in fallers (P=.01). For every 1 standard deviation (36 pg/mL) increment in baseline serum PTH, there was approximately a 30% greater likelihood of reporting a fall in the subsequent year, after adjusting for age, sex, race, field center, alcohol consumption, body mass index, physical activity, and winter or spring season (adjusted odds ratio (aOR)=1.30, 95% confidence interval (CI)=1.06–1.59). Further adjustment for kidney function, chronic conditions, medication and supplement use, and physical performance attenuated the association slightly (aOR=1.26, 95% CI=1.01–1.58). A trend remained after additional adjustment for reported falls in the previous year.

CONCLUSION: Higher serum PTH was associated with incident falls in older, well-functioning men and women with diabetes mellitus. Further investigation aimed at understanding the underlying mechanism for the association between serum PTH and falls is needed. J Am Geriatr Soc 2008;56(11):2027-2032.

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Views of Older Persons with Multiple Morbidities on Competing Outcomes and Clinical Decision-Making

Terri R. Fried, MD, Sarah McGraw, PhD, Joseph V. Agostini, MD, and Mary E. Tinetti, MD

OBJECTIVES: To examine the ways in which older persons with multiple conditions think about potentially competing outcomes in order to gain insight into how processes to elicit values regarding these outcomes can be grounded in the patient's perspective.

DESIGN: Qualitative study consisting of purposefully sampled focus groups.

SETTING: Community.

PARTICIPANTS: Persons aged 65 and older taking five or more medications.

MEASUREMENTS: Participants were asked their perceptions about whether their illnesses or treatment interacted with each other, goals of their treatment, and decisions to change or stop treatment.

RESULTS: Although participants were largely unaware that treatment of one condition could worsen another, many had experience with adverse medication effects as a competing outcome. Participants initially discussed their conditions in terms of disease-specific outcomes, such as achieving a target blood pressure or lipid level. In the context of decision-making, participants shifted their discussion from disease-specific to global, cross-disease health outcomes, such as survival, preservation of physical function, and relief of symptoms. Despite having some misconceptions regarding the likelihood of these outcomes, they weighed the outcomes against one another to consider what was most important to them.