The Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences

Hughes M. Helm, Judith C. Hays, Elizabeth P. Flint, Harold G. Koenig, Dan G. Blazer

doi: 10.1093/gerona/55.7.M400pmid: 10898257

Background. Previous studies have linked higher religious attendance and longer survival. In this study, we examine the relationship between survival and private religious activity. Methods. A probability sample of elderly community-dwelling adults in North Carolina was assembled in 1986 and followed for 6 years. Level of participation in private religious activities such as prayer, meditation, or Bible study was assessed by self-report at baseline, along with a wide variety of sociodemographic and health variables. The main outcome was time (days) to death or censoring. Results. During a median 6.3-year follow-up period, 1,137 subjects (29.5%) died. Those reporting rarely to never participating in private religious activity had an increased relative hazard of dying over more frequent participants, but this hazard did not remain significant for the sample as a whole after adjustment for demographic and health variables. When the sample was divided into activity of daily living (ADL) impaired and unimpaired, the effect did not remain significant for the ADL impaired group after controlling for demographic variables (hazard ratio (RH) 1.11, 95% confidence interval (CI) 0.91–1.35). However, the increased hazard remained significant for the ADL unimpaired group even after controlling for demographic and health variables (RH 1.63, 95% CI 1.20–2.21), and this effect persisted despite controlling for numerous explanatory variables including health practices, social support, and other religious practices (RH 1.47, 95% CI 1.07–2.03). Conclusions. Older adults who participate in private religious activity before the onset of ADL impairment appear to have a survival advantage over those who do not. The Gerontological Society of America « Previous | Next Article » Table of Contents This Article J Gerontol A Biol Sci Med Sci (2000) 55 (7): M400-M405. doi: 10.1093/gerona/55.7.M400 » Abstract Free Full Text (HTML) Free Full Text (PDF) Free Classifications Journal of Gerontology: Medical Sciences Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Helm, H. M. Articles by Blazer, D. G. Search for related content PubMed PubMed citation Articles by Helm, H. M. Articles by Hays, J. C. Articles by Flint, E. P. Articles by Koenig, H. G. Articles by Blazer, D. G. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 2015 70 (11) Alert me to new issues The Journal About the journal Translational Articles Free Editors’ Choice Articles Impact Factor Articles The Journals of Gerontology, Series A Supplements Special Issues Rights & permissions We are mobile – find out more Journal Career Network Published on behalf of The Gerontological Society of America Impact Factor: 5.416 5-Yr impact factor: 5.406 Editorial Boards The Journals of Gerontology, Series A: Biological Sciences Rafael de Cabo, PhD, Editor View full editorial board The Journals of Gerontology, Series A: Medical Sciences Stephen B. Kritchevsky, PhD View full editorial board For the Media GSA Press Room For Authors Instructions to authors Services for authors Submit Now: Biological Sciences Submit Now: Medical Sciences Self-Archiving Policy Online Submission Open access options for authors - visit Oxford Open WhsSvhnOkaAwYG81FJCYgwG7z1LnIP2F true Looking for your next opportunity? Looking for jobs... jQuery_1_11 = jQuery.noConflict(true); Corporate Services What we offer Advertising sales Reprints Supplements Classified Advertising Sales Alerting Services Email table of contents CiteTrack XML RSS feed

Robert D. Lindeman, Linda J. Romero, Hwa Chi Liang, Richard N. Baumgartner, Kathleen M. Koehler, Philip J. Garry

doi: 10.1093/gerona/55.7.M361pmid: 10898251

Background. A recently published and widely quoted modified food guide pyramid encourages persons over the age of 70 years to ingest eight glasses (2 liters) of fluids per day. We challenge the need for this much fluid intake and even question whether it may do more harm than good. Methods. Equal numbers of Hispanic and non-Hispanic white men and women were selected randomly from the Health Care Financing Administration (Medicare) rolls and recruited for a home interview followed by a 4-hour interview/examination in a senior health clinic. Questionnaires and examinations were used to determine usual daily self-reported intake of fluids, lying and standing blood pressures, history of falls over the past year, and the presence of chronic constipation and chronic fatigue or tiredness. Serum samples were obtained for determination of sodium, urea nitrogen (SUN) and creatinine concentrations, and calculation of SUN/creatinine ratios. Results. Interviews/examinations were conducted on 883 volunteers (mean age of 74.1 years). Most participants (71%) estimated that their usual fluid intake was equal to or exceeded six glasses per day. Evidence of hypernatremia (serum sodium concentration > 146 mEq/l) was not observed in the 227 individuals ingesting less than this. Hyponatremia also was rare in this population. Fluid intake showed no significant associations with lying and standing blood pressures, a history of falling, or the frequency of chronic constipation or fatigue/tiredness. Conclusion. Until we have more evidence-based documentation that fluid intake of eight glasses (2 liters) per day improves some aspect of an elderly person's health, encouraging a fluid intake above a level that is comfortable for the individual seems to serve little useful purpose. The Gerontological Society of America « Previous | Next Article » Table of Contents This Article J Gerontol A Biol Sci Med Sci (2000) 55 (7): M361-M365. doi: 10.1093/gerona/55.7.M361 » Abstract Free Full Text (HTML) Free Full Text (PDF) Free Classifications Journal of Gerontology: Medical Sciences Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Lindeman, R. D. Articles by Garry, P. J. Search for related content PubMed PubMed citation Articles by Lindeman, R. D. Articles by Romero, L. J. Articles by Liang, H. C. Articles by Baumgartner, R. N. Articles by Koehler, K. M. Articles by Garry, P. J. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 2015 70 (11) Alert me to new issues The Journal About the journal Translational Articles Free Editors’ Choice Articles Impact Factor Articles The Journals of Gerontology, Series A Supplements Special Issues Rights & permissions We are mobile – find out more Journal Career Network Published on behalf of The Gerontological Society of America Impact Factor: 5.416 5-Yr impact factor: 5.406 Editorial Boards The Journals of Gerontology, Series A: Biological Sciences Rafael de Cabo, PhD, Editor View full editorial board The Journals of Gerontology, Series A: Medical Sciences Stephen B. Kritchevsky, PhD View full editorial board For the Media GSA Press Room For Authors Instructions to authors Services for authors Submit Now: Biological Sciences Submit Now: Medical Sciences Self-Archiving Policy Online Submission Open access options for authors - visit Oxford Open WhsSvhnOkaAwYG81FJCYgwG7z1LnIP2F true Looking for your next opportunity? Looking for jobs... jQuery_1_11 = jQuery.noConflict(true); Corporate Services What we offer Advertising sales Reprints Supplements Classified Advertising Sales Alerting Services Email table of contents CiteTrack XML RSS feed

Wyrwich, Kathleen W.; Wolinsky, Fredric D.

doi: N/Apmid: N/A

Background. A recent investigation of physical activity, disability, and the risk of breast cancer among older women in the Iowa 65+ Rural Health Study reported a decreased risk of breast cancer among women with any disability compared with physically capable but inactive women (relative risk [RR] = 0.4, 95% confidence interval [CI] 0.2–0.9). Because of the intriguing nature of that association, those investigators urged replication before drawing any conclusions.Methods. We replicated the Iowa approach using the Longitudinal Study on Aging (LSOA), a nationally representative, prospective cohort study. The 3131 community-dwelling women for whom we had complete data for these analyses ranged in age from 70 to 98 years old at baseline in 1984. Using ICD9-CM 174 codes, linked Medicare hospital claims identified 77 women with hospitalizations for breast cancer between 1984 and 1991. Multivariable proportional hazards regression was used to model the risk for this event among disabled, inactive, moderately active, and highly active women.Results. No significant association between disability in older women and the risk of hospitalization for breast cancer relative to inactive older women was detected (adjusted hazard ratio [AHR]-0.78, 95% CI 0.41–1.5). Highly active older women had a significantly reduced risk of hospitalization for breast cancer (AHR-0.42, 95% CI 0.19–0.95).Conclusion. The intriguing finding from the Iowa 65+ Rural Health Study that disabled older women's risk for breast cancer was reduced could not be replicated in the LSOA, although power was limited. Highly active older women, however, had a significantly lower risk for breast cancer in both studies.

A.I. Yashin, G. De Benedictis, J.W. Vaupel, Q. Tan, K.F. Andreev, I.A. Iachine, M. Bonafe, S. Valensin, M. De Luca, L. Carotenuto, C. Franceschi

doi: 10.1093/gerona/55.7.B319pmid: 10898245

In population studies of aging, the data on genetic markers are often collected for individuals from different age groups. The idea of such studies is to identify “longevity” or “frailty” genes by comparing the frequencies of genotypes in the oldest and in the younger groups of individuals. In this paper we discuss a new approach to the analysis of such data. This approach, based on the maximum likelihood method, combines data on genetic markers with survival information obtained from standard demographic life tables. This method allows us to evaluate survival characteristics for individuals carrying respective candidate genes. It can also be used in the estimation of the effects of allele–area and allele–allele interaction, either in the presence or absence of hidden heterogeneity. We apply this method to the analysis of Italian data on genetic markers for five autosomal loci and mitochondrial genomes. Then we discuss basic assumptions used in this analysis and directions of further research. The Gerontological Society of America « Previous | Next Article » Table of Contents This Article J Gerontol A Biol Sci Med Sci (2000) 55 (7): B319-B328. doi: 10.1093/gerona/55.7.B319 » Abstract Free Full Text (HTML) Free Full Text (PDF) Free Classifications Journal of Gerontology: Biological Sciences Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Yashin, A. Articles by Franceschi, C. Search for related content PubMed PubMed citation Articles by Yashin, A. Articles by De Benedictis, G. Articles by Vaupel, J. Articles by Tan, Q. Articles by Andreev, K. Articles by Iachine, I. Articles by Bonafe, M. Articles by Valensin, S. Articles by De Luca, M. Articles by Carotenuto, L. Articles by Franceschi, C. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 2015 70 (11) Alert me to new issues The Journal About the journal Translational Articles Free Editors’ Choice Articles Impact Factor Articles The Journals of Gerontology, Series A Supplements Special Issues Rights & permissions We are mobile – find out more Journal Career Network Published on behalf of The Gerontological Society of America Impact Factor: 5.416 5-Yr impact factor: 5.406 Editorial Boards The Journals of Gerontology, Series A: Biological Sciences Rafael de Cabo, PhD, Editor View full editorial board The Journals of Gerontology, Series A: Medical Sciences Stephen B. Kritchevsky, PhD View full editorial board For the Media GSA Press Room For Authors Instructions to authors Services for authors Submit Now: Biological Sciences Submit Now: Medical Sciences Self-Archiving Policy Online Submission Open access options for authors - visit Oxford Open WhsSvhnOkaAwYG81FJCYgwG7z1LnIP2F true Looking for your next opportunity? Looking for jobs... jQuery_1_11 = jQuery.noConflict(true); Corporate Services What we offer Advertising sales Reprints Supplements Classified Advertising Sales Alerting Services Email table of contents CiteTrack XML RSS feed

Shirley S. Travis, Lisa Sparks Bethea, Peter Winn

doi: 10.1093/gerona/55.7.M412pmid: 10898259

Background . Even under the new long-term care mantra for increased home- and community-based care options, attention to and an understanding of the ways that family caregivers are managing complex care for dependent elderly persons, for example, with medication administration, have been slow to materialize. Methods. Twenty-three family caregivers completed semistructured, face-to-face interviews to capture the shared and idiosyncratic experiences of individuals responsible for all aspects of medication administration regimens for elderly, dependent family members. Data analysis consisted of content analysis of the verbatim interview transcripts. This article reports an emerging typology of caregiver medication administration hassles derived from the interviews. Results. Based on 122 separate accounts, three categories of medication administration hassles were identified. The categories (with the percentage of all accounts represented by the category) include (i) scheduling logistics (29.5%), (ii) administration procedures (31.9%), and (iii) safety issues (38.6%). Conclusions . Primary care providers must continually reevaluate and simplify medication regimens for dependent elderly persons in the care of family members, and the family caregivers must be given adequate training and access to ongoing information support systems to help them perform safe and effective medication administration responsibilities. The Gerontological Society of America « Previous | Next Article » Table of Contents This Article J Gerontol A Biol Sci Med Sci (2000) 55 (7): M412-M417. doi: 10.1093/gerona/55.7.M412 » Abstract Free Full Text (HTML) Free Full Text (PDF) Free Classifications Journal of Gerontology: Medical Sciences Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Travis, S. S. Articles by Winn, P. Search for related content PubMed PubMed citation Articles by Travis, S. S. Articles by Bethea, L. S. Articles by Winn, P. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 2015 70 (11) Alert me to new issues The Journal About the journal Translational Articles Free Editors’ Choice Articles Impact Factor Articles The Journals of Gerontology, Series A Supplements Special Issues Rights & permissions We are mobile – find out more Journal Career Network Published on behalf of The Gerontological Society of America Impact Factor: 5.416 5-Yr impact factor: 5.406 Editorial Boards The Journals of Gerontology, Series A: Biological Sciences Rafael de Cabo, PhD, Editor View full editorial board The Journals of Gerontology, Series A: Medical Sciences Stephen B. Kritchevsky, PhD View full editorial board For the Media GSA Press Room For Authors Instructions to authors Services for authors Submit Now: Biological Sciences Submit Now: Medical Sciences Self-Archiving Policy Online Submission Open access options for authors - visit Oxford Open WhsSvhnOkaAwYG81FJCYgwG7z1LnIP2F true Looking for your next opportunity? Looking for jobs... jQuery_1_11 = jQuery.noConflict(true); Corporate Services What we offer Advertising sales Reprints Supplements Classified Advertising Sales Alerting Services Email table of contents CiteTrack XML RSS feed

Caruso, Lisa B.; Silliman, Rebecca A.; Demissie, Serkalem; Greenfield, Sheldon; Wagner, Edward H.

doi: N/Apmid: N/A

Background. Older persons with type 2 diabetes are at higher risk for functional impairment than are their age-matched counterparts without diabetes. We therefore sought to identify factors associated with impaired physical function in older persons with type 2 diabetes by using a cross-sectional study design.Methods. We studied 1238 persons with type 2 diabetes who were 55 years of age or older and enrolled in the Type II Diabetes Patient Outcomes Research Team (PORT) project. Subjects were primary care patients at a large staff model health maintenance organization who had completed a mailed survey that collected information about demographics (age, race, marital status, income, education, gender, and body mass index [BMI]), health behaviors (exercise, smoking, and alcohol), care and control of diabetes (therapy, self-reported glucose control, home glucose monitoring, and disease duration), mood (Center for Epidemiologic Studies—Depression Scale [CES-D]), comorbidity, and the Short-Form-36 health survey (SF-36).We evaluated the bivariate relationships between the PFI-10, a 10-item measure of physical function from the SF-36, and candidate independent variables from the domains described previously. Variables that were significant at an α level of .10 were entered into a multiple linear regression model.Results. There were eight independent predictors of impaired physical function (all p < .05, R2 = .40). Factors associated with impaired function in order of their relative importance were as follows: a higher comorbidity score, older age, obesity, lack of regular exercise, CES-D score higher than 20, taking insulin, lower formal education, and abstinence from alcohol.Conclusions. Increased comorbidity and older age are associated with poorer function, as is the severity of diabetes and less formal education. Exercise, lower BMI, and better mood are associated with better function. Therefore, promoting regular exercise and weight loss, in addition to treating depression, are likely to preserve or even improve the functional status of older persons with type 2 diabetes. Moderate alcohol use may be beneficial as well. The extent to which these relationships persist in prospective studies or clinical trials remains to be evaluated.

Morley, John

doi: N/Apmid: N/A

William T. Cefalu, James G. Terry, Michael J. Thomas, Timothy M. Morgan, Iris J. Edwards, Lawrence L. Rudel, Joseph W. Kemnitz, Richard Weindruch

doi: 10.1093/gerona/55.7.B355pmid: 10898249

Caloric restriction (CR), which increases longevity and retards age-associated diseases in laboratory rodents, is being evaluated in nonhuman primate trials. CR reduces oxidative stress in rodents and appears to improve risk factors for cardiovascular disease in nonhuman primates. We tested the hypothesis that low-density lipoprotein (LDL) oxidizability is reduced in two monkey species (rhesus and cynomolgus) subjected to chronic CR. In both species, no significant differences occurred between CR and control animals on total, LDL, or high-density lipoprotein (HDL) cholesterol. In rhesus monkeys, triglycerides were higher in controls than CR (139 ± 23 vs 66 ± 8 mg/dl, p < .01, respectively). LDL from CR rhesus monkeys was reduced in triglyceride content and molecular weight compared to controls, whereas LDL composition in cynomolgus monkeys was similar in CR and control animals. In keeping with minor deviations in lipids, antioxidants, and LDL composition, no consistent differences in in vitro LDL oxidizability were apparent between CR and controls in either species. The Gerontological Society of America « Previous | Next Article » Table of Contents This Article J Gerontol A Biol Sci Med Sci (2000) 55 (7): B355-B361. doi: 10.1093/gerona/55.7.B355 » Abstract Free Full Text (HTML) Free Full Text (PDF) Free Classifications Journal of Gerontology: Biological Sciences Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Cefalu, W. T. Articles by Weindruch, R. Search for related content PubMed PubMed citation Articles by Cefalu, W. T. Articles by Terry, J. G. Articles by Thomas, M. J. Articles by Morgan, T. M. Articles by Edwards, I. J. Articles by Rudel, L. L. Articles by Kemnitz, J. W. Articles by Weindruch, R. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue November 2015 70 (11) Alert me to new issues The Journal About the journal Translational Articles Free Editors’ Choice Articles Impact Factor Articles The Journals of Gerontology, Series A Supplements Special Issues Rights & permissions We are mobile – find out more Journal Career Network Published on behalf of The Gerontological Society of America Impact Factor: 5.416 5-Yr impact factor: 5.406 Editorial Boards The Journals of Gerontology, Series A: Biological Sciences Rafael de Cabo, PhD, Editor View full editorial board The Journals of Gerontology, Series A: Medical Sciences Stephen B. Kritchevsky, PhD View full editorial board For the Media GSA Press Room For Authors Instructions to authors Services for authors Submit Now: Biological Sciences Submit Now: Medical Sciences Self-Archiving Policy Online Submission Open access options for authors - visit Oxford Open WhsSvhnOkaAwYG81FJCYgwG7z1LnIP2F true Looking for your next opportunity? Looking for jobs... jQuery_1_11 = jQuery.noConflict(true); Corporate Services What we offer Advertising sales Reprints Supplements Classified Advertising Sales Alerting Services Email table of contents CiteTrack XML RSS feed

Ritchie, Christine S.; Joshipura, Kaumudi; Silliman, Rebecca A.; Miller, Barbara; Douglas, Chester W.

doi: N/Apmid: N/A

Background. Studies of hospitalized and institutionalized older adults suggest a relationship between poor oral health and subsequent weight loss. Given the association between weight loss and subsequent mortality and morbidity, we evaluated how oral health problems contributed to significant weight loss over a 1-year period among a representative sample of community-dwelling older adults.Methods. The study population consisted of 563 adults aged 70 years and older living at home in rural and urban areas in six New England states. Baseline data included information regarding health status, functional status, physical activity, disease diagnoses, lifestyle behaviors, and cognitive and affective status. Dentists performed oral health assessments. One year later, participants were called and asked questions regarding their health and dietary practices and their current weight.Results. Over the 1-year period of follow-up, approximately one third of the sample had lost 4% or more of their previous total body weight; 6% of men and 11% of women lost 10% or more of their previous body weight. Of the subjects, 37% were edentulous; most of these individuals wore full dentures. With gender, income, advanced age, and baseline weight controlled for, edentulousness remained an independent risk factor for significant weight loss (odds ratio 1.63 for 4% weight loss and 2.03 for 10% weight loss). Individuals with increasing numbers of posterior teeth and functional units were at slightly lower risk for weight loss; however, these associations did not reach statistical significance.Conclusions. Dentate status is an important risk factor for clinically significant weight loss among community-dwelling older adults.

Scudds, Rhonda J.; Robertson, James M.

doi: N/Apmid: N/A

Background. Little is known about the specific aspects of pain that may contribute to the association between pain and disability. This study investigated whether the presence of a physical disability is associated with specific aspects of musculoskeletal pain.Methods. Questionnaires sent to a sample of community-dwelling seniors included detailed questions about pain; the topics covered pain intensity, frequency, duration and location, use of pain medication, cause of pain, physical disability, depressive symptoms, chronic conditions, and demographic information.Results. Of the 885 respondents, 644 reported musculoskeletal pain \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((\mathrm{mean\ age}\ =\ 75.85\ \mathrm{years},\ SD\ =\ 5.83{;}\ 63.2\%\ \mathrm{men\ vs}\ 36.8\%\ \mathrm{women})\) \end{document}. Multiple logistic regression analysis revealed that pain of severe or greater intensity was shown to be significantly associated with disability \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((\mathrm{odds\ ratio}\ [\mathrm{OR}]\ =\ 4.32,\ 95\%\ \mathrm{confidence\ interval}\ [\mathrm{CI}]\ 2.01\ \mathrm{and}\ 9.01,\ \mathrm{respectively})\) \end{document}. Pain experienced all or nearly all of the time \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((\mathrm{OR}\ =\ 2.00,\ 95\%\ \mathrm{CI}\ 1.07\ \mathrm{and}\ 3.72)\) \end{document} and taking pain medication \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((\mathrm{OR}\ =\ 1.64,\ 95\%\ \mathrm{CI}\ 1.08\ \mathrm{and}\ 2.51)\) \end{document} were also shown to be associated with disability. The number of pain locations reported by the respondents was also shown to be significantly associated with disability. The OR for the mean number of pain locations (5.8 locations out of a possible 45) was calculated to be 2.12 (95% CI 1.43 and 3.16).Conclusion. A thorough pain evaluation and appropriate management of certain aspects of pain may aid in the independent functioning of elderly persons.