Fatigue and depressive symptoms in older people

Fatigue is considered an important indicator of aging-related declines in health and functional abilities. Previous studies have indicated strong associations between fatigue and depressive symptoms among younger populations and in patient groups with specific diseases. However, it is not known how different measures of fatigue are associated with depressive symptoms among general older populations. The purpose of this study is to describe the prevalence of depressive symptoms among community-dwelling older adults reporting mobility-related or general feelings fatigue. The study population consisted of 75-year-old community-living individuals (n = 561). Both, mobility-related and general fatigue, were associated in a stepwise relationship with depressive symptoms: a higher level of fatigue was related to higher level of depressive symptoms. Especially major general fatigue was strongly associated with high level of depressive symptoms. It is important for professionals of the field to be aware of the associations between different measures of fatigue and depressive symptoms.

Lifetime occupational physical activity and musculoskeletal aging in middle-aged men and women in denmark: retrospective cohort study protocol and methods

Background

Physical function is essential for performing most aspects of daily life and musculoskeletal aging leads to a decline in physical function. The onset and rate of this process vary and are influenced by environmental, genetic, and hormonal factors. Although everyone eventually experiences musculoskeletal aging, it is beneficial to study the factors that influence the aging process in order to prevent disability. The role of occupational physical activity in the musculoskeletal aging process is unclear. In the past, hard physical work was thought to strengthen the worker, but current studies in this field fail to find a training effect in jobs with a high level of occupational physical activity.

Objective

The aim of this study is to examine the influence of lifetime occupational physical activity on physical function in midlife. The study follows the “occupational life-course perspective,” emphasizing the importance of occupational exposures accumulated throughout life on the musculoskeletal aging process taking socioeconomic and lifestyle factors into consideration.

Methods

This study is a retrospective cohort study including a cross-sectional measurement of physical function in 5000 middle-aged Danes. Data was obtained from the Copenhagen Aging and Midlife Biobank (CAMB) which is based on three existing Danish cohorts. Using questionnaire information about the five longest-held occupations, the job history was coded from the Danish version of the International Standard Classification of Occupations (D-ISCO 88) and a job exposure matrix containing information about occupational physical activity in Danish jobs was applied to the dataset. The primary outcomes are three tests of physical function: handgrip strength, balance, and chair rise. In the analyses, we will compare physical function in midlife according to accumulated exposure to high levels of occupational physical activity.

Conclusions

We have a unique opportunity to study the influence of work on early musculoskeletal aging taking other factors into account. In this study, the “healthy worker effect” is reduced due to inclusion of people from the working population and people who are already retired or have been excluded from the labor market. However, low participation in the physical tests can lead to selection bias.

Differential associations between white blood cell counts and fatigue in young and older adults

BACKGROUND AND AIMS

The aims of this exploratory study were to study whether fatigue might be related to the cellular immune system by 1) analysing if the number of white blood cell subsets are related to fatigue and 2) if possible relationships vary in younger and older community-dwelling individuals.

METHODS

The participants were recruited from nine general practitioners in Aarhus County, Denmark and included 196 individuals aged 20-35 years and 314 individuals aged 70-85 years. The white blood cell counts included number of total leukocytes, lymphocytes, monocytes, neutrophils, eosinophils, and basophils. General fatigue was measured by a question from the SF-12 Vitality-Scale and mobility-related fatigue by the Avlund Mob-T Scale.

RESULTS

Total number of lymphocytes was associated with fatigue in the old sample, both in the crude and adjusted analyses. Total number of leukocytes and netrophils were associated with fatigue in both age groups in the crude analyses. In the old sample the estimates were attenuated to non-significance when adjusting for physical activity and disability. In the young sample the estimates stayed statistically significant in the fully adjusted analyses regarding number of neutrophils, while the associations between fatigue and number of leukocytes were attenuated to non-significance when adjusting for depressive mood.

CONCLUSION

Total number of leukocytes, lymphocytes and neutrophils were associated with fatigue in both age groups, while the explanatory factors for the associations differed by age group, in that the associations were partly explained by physical activity and disability in the old sample and partly by depressive mood in the young sample. The findings provide initial insight into the potential role of leukocyte, neutrophil and lymphocyte counts in the development of fatigue.

Fatigability in basic indoor mobility in nonagenarians

OBJECTIVES

To evaluate the prevalence and associated health factors of indoor mobility-related fatigability in nonagenarians.

DESIGN

A cross-sectional observational study of all Danes born in 1905 and assessed in 1998.

SETTING

Community, sheltered housing and nursing homes.

PARTICIPANTS

Individuals aged 92 and 93 (N = 1,181) who were independent of help in basic indoor mobility.

MEASUREMENTS

Fatigability in basic indoor mobility was defined as a subjective feeling of fatigue when transferring or walking indoors. Other standardized assessments include self-report measures of medical history and performance-based assessments of walking speed and maximum handgrip strength.

RESULTS

Twenty-six percent of participants reported fatigability when transferring or walking indoors; fatigability was more common in participants living in sheltered housing (32%) than in those living independently (23%, P < .001). Cardiovascular diseases, musculoskeletal pain, medications, walking speed, and depressive symptoms were independently associated with fatigability.

CONCLUSION

Fatigability in basic everyday mobility is common in nondisabled nonagenarians. The results also indicate important associations between fatigability and potentially modifiable health factors.

Are acceptance rates of a national preventive home visit programme for older people socially imbalanced?: a cross sectional study in Denmark

Background

Preventive home visits are offered to community dwelling older people in Denmark aimed at maintaining their functional ability for as long as possible, but only two thirds of older people accept the offer from the municipalities. The purpose of this study is to investigate 1) whether socioeconomic status was associated with acceptance of preventive home visits among older people and 2) whether municipality invitational procedures for the preventive home visits modified the association.

Methods

The study population included 1,023 community dwelling 80-year-old individuals from the Danish intervention study on preventive home visits. Information on preventive home visit acceptance rates was obtained from questionnaires. Socioeconomic status was measured by financial assets obtained from national registry data, and invitational procedures were identified through the municipalities. Logistic regression analyses were used, adjusted by gender.

Results

Older persons with high financial assets accepted preventive home visits more frequently than persons with low assets (adjusted OR = 1.5 (CI95%: 1.1-2.0)). However, the association was attenuated when adjusted by the invitational procedures. The odds ratio for accepting preventive home visits was larger among persons with low financial assets invited by a letter with a proposed date than among persons with high financial assets invited by other procedures, though these estimates had wide confidence intervals.

Conclusion

High socioeconomic status was associated with a higher acceptance rate of preventive home visits, but the association was attenuated by invitational procedures. The results indicate that the social inequality in acceptance of publicly offered preventive services might decrease if municipalities adopt more proactive invitational procedures.

Social inequality in dynamic balance performance in an early old age Spanish population: the role of health and lifestyle associated factors

This study investigates the association between socioeconomic status (SES) and dynamic balance performance and whether lifestyle factors explained any possible associations. A total of 448 nondisabled individuals, age-range 54-75 years and enrolled in the Active Aging Longitudinal Study of Spain in 2006, constituted the study population. Baseline data of this cross-sectional study were obtained by personal interviews and objective measures of balance performance. The present study shows an educational gradient in poor dynamic balance, where individuals with no formal education had higher risk of poor balance, also after adjustment for age, gender, obesity and physical activity. In addition, obesity and sedentary physical activity were related to poor dynamic balance. The findings suggest an independent effect of both SES and behavioral factors on poor balance performance in the older Spanish population.

Measuring aspects of social capital in a gerontological perspective

Within the last 10 years, there has been a growing interest in the importance of social capital and older people. The aims of the study are to advance measurements of aspects of social capital based on bonding, bridging and linking that can be used to study the impact of the local community on community-dwelling older populations and to study the distribution of these three measurements of social capital in 34 municipalities. Data are from a Danish prospective cohort study on preventive home visits among 4,034 old people 75+ in 34 municipalities in Denmark. The measurements of aspects of social capital at community level are based on theory of bonding, bridging and linking social capital. It has been possible to analyse variations in the three measurements of social capital in the 34 municipalities and to characterize different municipalities according to high versus low social capital. There are interesting patterns in distribution of the three measurements. The two extreme groups of municipalities (high and low social capital) differ with regard to demography, social and structural conditions in the municipalities. We believe that the proposed measures of social capital will be relevant in future studies of social capital and health in older populations, since they are theoretically based and cover different aspects of social capital related to older people and their local community.

Mobility-related fatigue, walking speed, and muscle strength in older people

BACKGROUND

Fatigue is an important early marker of functional decline among older people, but the mechanisms underlying this association are not fully understood. The purpose of the present study was to examine the association between mobility-related fatigue and walking speed and to test the degree to which muscle strength accounts for this association.

METHODS

The study is based on baseline (n = 523) and 5-year follow-up data (n = 292) from a cohort of 75-year-old persons. Standardized assessments include self-report measures of mobility-related fatigue (score range 0-6) and medical history, as well as performance-based assessment of walking speed and maximal isometric strength of knee extension, body extension, and handgrip.

RESULTS

In the cross-sectional baseline analysis, one unit increase in fatigue score was associated with 0.03 m/s (β = -.03, p < .001) and 0.05 m/s (β = -.05, p < .001) slower maximum walking speed among women and men, respectively, while adjusting for important covariates. Among women, muscle strength accounted up to 21% and among men up to 24% for the association. In the prospective analysis, fatigue at baseline was predictive of change in walking speed among men (β = -.04, p < .001) but not among women (β = -.005, p = .64). Among men, muscle strength accounted up to 15% for the association between baseline fatigue and change in maximum walking speed.

CONCLUSIONS

Mobility-related fatigue is associated with slower walking speed in older adults. The results suggest that muscle strength is one of the underlying factors explaining this association.

Onset of mobility limitations in old age: the combined effect of socioeconomic position and social relations

PURPOSE

to examine the combined effect of cohabitation status and social participation, respectively, and socioeconomic position on onset of mobility limitations in a prospective study among older Danes.

DESIGN AND METHODS

logistic regression analyses with combined exposure variables were performed in a study population of 2,839 older men and women from the Danish Intervention Study on Preventive Home Visits.

RESULTS

among men low financial assets, living alone or having low social participation significantly increased the odds ratios (OR) for onset of mobility limitations. Among women only low financial assets and low social participation significantly increased the ORs for onset of mobility limitations. Analyses with combined exposure variables showed that simultaneous exposure to low financial assets and poor social relations significantly increased the ORs for onset of mobility limitations among both genders, yet the tendencies appeared stronger for males. In particular, men with simultaneous exposure to low financial assets and low social participation had increased odds ratios for onset of mobility limitations, OR = 5.36 (2.51-11.47), compared with the non-exposed.

CONCLUSION

the study suggests that future interventions to increase social participation might alleviate the negative effects on mobility experienced by older people in low socioeconomic position, perhaps especially among older males.

Amount and type of alcohol consumption and missing teeth among community-dwelling older adults: findings from the Copenhagen Oral Health Senior study

OBJECTIVES

To study if an association between total weekly intake of alcohol, type-specific weekly alcohol intake, alcoholic beverage preference, and the number of teeth among older people exists.

METHODS

A cross-sectional study including a total of 783 community-dwelling men and women aged 65-95 years who were interviewed about alcohol drinking habits and underwent a clinical oral and dental examination. Multiple regression analyses were applied for studying the association between total weekly alcohol consumption, beverage-specific alcohol consumption, beverage preference (defined as the highest intake of one beverage type compared with two other types), and the number of remaining teeth (≤ 20 versus >20 remaining teeth).

RESULTS

The odds ratio (OR) of having a low number of teeth decreased with the total intake of alcohol in women, with ORs for a low number of teeth of 0.40 [95 percent confidence interval (CI) 0.22-0.76] in women drinking 1-14 drinks per week and 0.34 (95 percent CI 0.16-0.74) in women with an intake of more than 14 drinks per week compared with abstainers. Similar relations could also be obtained for type-specific alcohol intake of wine and for wine and spirits preference among women. Men who preferred beer showed a decreased risk for a low number of teeth compared with men with other alcohol preferences.

CONCLUSION

In this study, alcohol consumption, wine drinking, and wine and spirits preference among women were associated with a higher number of teeth compared with abstainers. Among men, those who preferred beer also had a higher number of teeth.

Number of teeth and fatigue in older adults

OBJECTIVES

To examine whether tooth loss at age 70 is associated with fatigue in a nondisabled community-dwelling population cross-sectionally at age 70 and with onset of fatigue longitudinally at 5-, 10-, and 15-year follow-ups.

SETTING

Community-based population in Copenhagen.

PARTICIPANTS

Five hundred seventy-three nondisabled 70-year-old individuals in 1984.

MEASUREMENTS

Data from interviews and a medical and oral examination. Oral health was measured according to number of teeth (0, 1-9, 10-19, ≥ 20). Fatigue was measured using the Avlund Mobility-Tiredness Scale on six mobility activities. Covariates, all measured at baseline, were sex, education, income, comorbidity, and smoking.

RESULTS

Bivariate logistic regression analyses showed significant cross-sectional and longitudinal associations between number of teeth at age 70 and onset of fatigue at 5- and 10- but not 15-year follow-up. The associations between having no teeth and fatigue were attenuated when adjusted for socioeconomic position and smoking.

CONCLUSION

Tooth loss is associated with onset of fatigue in old age, but the estimates are attenuated when adjusting for socioeconomic position and smoking. Tooth loss may be an early indicator of frailty.

Childhood social circumstances and body mass index in adult life: The Metropolit 1953 Danish male birth cohort

Aims: To examine whether father’s social class was associated with body mass index (BMI) at age 20 and 50 years in a cohort of men born in 1953 and to explore the role of birth weight, cognitive function (IQ), and educational status in these relationships. Methods: We used data from the Metropolit cohort which includes 11,532 Danish men born in 1953 with information on father’s socioeconomic position (SEP) at participant’s birth and assessments of height, weight, cognitive performance, and education at age 20. In 2004, 6292 of these men participated in a follow-up survey on health and behaviour. Linear and logistic regression were used to investigate the association of father’s social class with BMI among the 5117 men with complete information on all variables. Results: Between age 20 and 50, mean BMI increased from 21.4 to 26.1 kg/m2, while the prevalence of overweight (BMI ≥25 kg/m2) increased from 8.1 to 57.8%. Men of fathers who were skilled or unskilled workers had higher odds of being overweight (OR = 1.32, 95% CI 1.13—1.53) or often obese (OR = 1.28, 95% CI 1.03—1.60) at age 50 years compared to those with fathers being self-employed, employee, or civil servants when adjusted for the other socially correlated indicators of impaired childhood development. In the linear regression analyses, mean BMI at both age 20 and 50 were around 0.3 kg/m2 higher in men with fathers from working class compared to those self-employed, employee, or civil servants. Conclusions: This study supports that among men, father’s SEP influences the development of obesity later in adult life.

The Copenhagen Oral Health Senior Cohort: design, population and dental health

BACKGROUND

  In order to study the way old age influence oral health, the Copenhagen Oral Health Senior Cohort (COHS) has been established.

OBJECTIVES

  To describe the design, measurement procedures, and baseline values for COHS including spatial distribution of restorations and dental caries as well as reasons for non-participation.

MATERIALS AND METHODS

  Seven hundred and eighty-three individuals aged 65 years or older, from a total of 1918 invited elderly people, underwent an interview regarding oral health-related behaviour and a clinical oral examination including measurement of unstimulated whole saliva flow rate.

RESULTS

  Twelve percent of the COHS was edentulous. The number of dental restorations was higher for women compared to men; however, men had more caries than women. Coronal caries was most frequent on mesial and distal surfaces and on the maxillary incisors and canines; root caries was most frequent on labial surfaces and evenly distributed within the dentition. Only 41% of all invited elderly people accepted the invitation, with old age and poor health being the primary reasons for non-participation.

CONCLUSION

  The baseline values for COHS show that a substantial proportion of the participants had retained a natural dentition and that dental caries was prevalent with the anterior maxillary teeth being most affected.

Preventive home visits to older home-dwelling people in Denmark: are invitational procedures of importance?

Since 1998 all municipalities in Denmark have been required by law to offer two annual preventive home visits to all home-dwelling citizens aged 75 or over. The influence of invitational procedures on acceptance rates has not been investigated. The aim of this study was to describe and investigate whether different invitational procedures were associated with first preventive home visit acceptance rates. The study was based on secondary analyses of data from the Danish Intervention Study on Preventive Home Visits. Data were collected from 1998 to 2002. Of the 4060 participants in the main study, 3245 reported receiving an offer for an identifiable preventive home visit, of whom 2399 (73.9%) provided complete data for the main analyses in the present study. Invitational procedures were categorised as: (1) a letter with a proposed date and time for the visit, (2) a visitor telephone call, and (3) a letter with encouragement to phone the visitor for appointment (letter without a proposed date). Covariates included sex, age, experience with preventive interventions, functional ability, self rated health, social relations and psychosocial characteristics. Statistical analyses included chi-square tests, and bi- and multivariable logistic regression analyses. Different invitational procedures were associated with first preventive home visit acceptance rates. Significantly more men (75.1%) than women (62.8%) declined the first preventive home visit regardless of the invitational procedure. Compared to 'letter with a proposed date', men had an odds ratio of 1.78 (95% CI: 1.16-2.74) for declining visits when 'telephone call' was used and an odds ratio 2.81 (95% CI: 1.79-4.40) when 'letter without a proposed date' was used as the invitational procedure. In women the odds ratios were 1.23 (95% CI: 0.91-1.68) and 1.87 (95% CI: 1.37-2.55), respectively.

Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women

PURPOSE

to investigate if the increased risk of disability onset among older people who live alone could possibly be moderated by either high social participation or by being satisfied with the social relations.

DESIGN AND METHODS

logistic regression models were tested using two waves in a study population of 2,697 non-disabled older men and women from The Danish Longitudinal Study on Preventive Home Visits.

RESULTS

living alone and low social participation were significant risk factors for later male disability onset. Not being satisfied with the social relations was significantly associated with onset of disability for both genders. Among men who lived alone low social participation was a significant predictor of disability onset [odds ratio, OR = 2.30 (1.00-5.29)]; for cohabiting men social participation was not associated with disability onset, [adjusted OR = 0.91 (0.49-1.71)]. Similar results were present concerning satisfaction with the social relations among men. There was no significant interaction for women.

CONCLUSIONS

the study suggests that men who live alone can possibly alleviate their risk of disability onset by being socially active and by having access to satisfactory social relations. Women do not seem to benefit as much from cohabitation as men, although women who live alone and who are not satisfied with their social relations also constitute a significant risk category.

Social Inequality in Onset of Mobility Disability Among Older Danes: The Mediation Effect of Social Relations

Objective: This article investigates social inequality in onset of mobility disability and in measures of social relations and whether social relations mediated the effect of socioeconomic status on mobility. Method: A total of 2,825 nondisabled older men and women, enrolled in the Danish Intervention Study on Preventive Home Visits, constituted the study population. Data were obtained by mailed questionnaires in 1998-1999 and 2001-2002 and by merging analyses to registers at Statistics Denmark. Results: There was a social gradient in onset of mobility disability, with odds ratio of 1.11 (1.07-1.15) per step down the deciles of financial assets and in cohabitation status, social participation, and network diversity. Social relations did not mediate the effect of financial assets on onset of mobility disability. Discussion: The negative effects of low financial assets and poor social relations on mobility appear to be independent. More longitudinal studies on possible mediators of the social gradient in mobility among older people are needed.

[Early signs of ageing and the importance of lifecourse factors for the aging process]

The first professorship in gerontology at the University of Copenhagen has recently been established at the Department of Social Medicine, Institute of Public Health. The research in relation to this professorship will focus on studies of early signs of ageing, on the way different biological, social, mental and health factors in childhood, adolescence and early adulthood influence early signs of ageing in midlife, and on rehabilitation and prevention of disability in late life.

Do childhood and adult socioeconomic circumstances influence health and physical function in middle-age?

This study examines the joint and separate contribution of social class in early and adult life to differences in health and physical function in middle-aged men. We use data from the Metropolit project which includes men born in 1953 in Copenhagen and a study of middle-aged Danish twins (MADT). In total 6292 Metropolit participants in a follow-up survey on health in 2004 were included in the study together with 2198 male twins of which 1294 were part of a male twin pair (N=647 pairs). Logistic regression was used to investigate the association between social class in early and adult life, respectively and health in midlife, measured as limitations in running 100 m, poor dental status, poor self-rated health, and fatigue. In both datasets, men with low childhood or adult social class had a higher risk of being unable to run 100 m, having poor dental status, having poor self-rated health and fatigue than men from the highest social classes. When childhood and adult social class were mutually adjusted, the estimates for both measures were attenuated. Adjustment for living without a partner, body mass index (BMI) and smoking in midlife, which were also related to the four outcomes, had marginal effects on the estimates for childhood social class, but attenuated the effect of adult social class somewhat. Among male twin pairs discordant on adult social class, the twin in the lowest class seemed to be unable to run 100 m, rate own health poorer and being fatigued more often than the high class co-twin, while there seemed to be no twin pair difference in dental status. This suggests that the associations of adult social class with functional limitations, poor self-rated health and fatigue may partly be due to causal effects related to adult social class exposures, while social class differences in dental status might be consistent with an effect of factors mainly operating early in life.

A feasible model for prevention of functional decline in older home-dwelling people--the GP role. A municipality-randomized intervention trial

BACKGROUND

Danish municipalities are required by state law to offer two annual home visits to all non-disabled citizens > or =75 years. Visits are primarily carried out by district nurses. GPs are rarely directly involved.

OBJECTIVE

To evaluate the effects of offering an educational programme to home visitors and GPs on mortality, functional ability and nursing home admissions among home-dwelling older people.

DESIGN

Municipality pair-matched randomized trial.

SETTING

Danish primary care.

SUBJECT

2863 home-dwelling 75-year-olds and 1171 home-dwelling 80-year-olds living in 34 municipalities.

INTERVENTION

Home visitors received regular education for a period of 3 years. In nine of 17 intervention municipalities, GPs participated in one small group training session during the first year.

MAIN OUTCOME MEASURES

Mortality, functional ability and nursing home admission during 4(1/2) years of follow-up.

RESULTS

INTERVENTION was not associated with mortality. Home visitor education was associated with reduction in functional decline among home-dwelling 80-year-olds after the three intervention years in municipalities where GPs accepted and participated in small group-based training. Effects did not persist after the intervention ended. When analyses were restricted to baseline non-disabled persons, intervention was associated with beneficial effects on functional ability after three intervention years among 80-year-olds, regardless of education was given to home visitors alone or to visitors and GPs. Nursing home admission rates were lower among the 80-year-olds living in the intervention municipalities.

CONCLUSION

A brief, practicable interdisciplinary educational programme for primary care professionals postponed functional decline in non-disabled 80-year-old home-dwelling persons.

Life-course socio-economic position, area deprivation and Type 2 diabetes: findings from the British Women's Heart and Health Study

OBJECTIVES

We examined whether area deprivation influenced risk of Type 2 diabetes, fasting blood glucose and insulin resistance over and above the effect of individual socio-economic position (SEP) measured across the life course.

METHODS

A cross-sectional analysis of 4286 women aged 60 to 79 years from 457 British electoral wards in 23 towns.

RESULTS

Area deprivation was positively associated with diagnosed [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.13, 1.53, per quintile of area deprivation, n = 2895], but not undiagnosed Type 2 diabetes after adjustment for individual life-course SEP. This association was robust to adjustment for adult health behaviours and physiological risk factors. Insulin resistance [homeostasis model assessment (HOMA) score] increased by 1.90% (95% CI 0.01, 3.82, n = 2526) per quintile of area deprivation after adjustment for individual SEP, while fasting blood glucose increased by 0.69% (95% CI 0.16, 1.22, n = 2875) after adjustment for individual SEP.

CONCLUSIONS

Area level deprivation independently influences diagnosed Type 2 diabetes, insulin resistance and fasting blood glucose. Examination of more specific characteristics of places is needed to understand the mechanisms by which these effects arise.

Aging-from molecules to populations

The mean age of the human population is steadily increasing in many areas around the globe, a phenomenon with large social, political, economic and biological/medical implications. Inevitably, this phenomenon is stimulating great interest in understanding and potentially modulating the process of human aging. To foster interactions and collaboration between diverse scientists interested in the biochemical, physiological, epidemiological and psychosocial aspects of aging, The University of Copenhagen Faculty of Health Sciences recently organized and co-sponsored a workshop entitled Aging-From Molecules to Populations. The following questions about human aging were discussed at the workshop: What is the limit of human life expectancy? What are the key indicators of human aging? What are the key drivers of human aging? Which genes have the greatest impact on human aging? How similar is aging-related cognitive decline to pathological cognitive decline associated with neurological disease? Are human progeriod diseases, characterized by premature aging, good models for "normal" human aging? Is delayed or "elite" aging informative about "normal" human aging? To what extent and by what mechanisms do early life environmental factors influence aging-associated physical and cognitive decline? To what extent and by what mechanism does the social environment influence life course outcomes? What physiological factors underlie the timing and extent of aging-associated physical and cognitive decline? How do cultural stereotypes and perceptions of aging influence the process and experience of aging? One of the primary outcomes of the workshop was a recognition that cross-disciplinary studies and "out-of-the-box" approaches, especially those that adopt an integrated life course perspective on human health status, are needed to expedite advances in aging research. This and other outcomes of the workshop are summarized and discussed in this report.

Physical functioning and use of health services in a young and old sample. The influence of fatigue

INTRODUCTION

The purpose was to analyse 1) whether fatigue is related to physical functioning and utilization of health services at one-year follow-up in a young and old sample and 2) to compare the results of two different measures of fatigue.

METHODOLOGY

The study is a longitudinal cohort study based on 182 young (age 20-35) and 199 older (age 70-85) community-dwelling individuals recruited from nine general practitioners in Aarhus, Denmark. Physical functioning was measured by the physical health scale from the SF-12-questionnaire. Data on health care utilization were extracted from the county's central register during one year. Fatigue was measured as Vitality-Tiredness by a question from the SF-12 questionnaire and Mobility-Tiredness by the Avlund Mobility-Tiredness Scale on fatigue in six daily activities.

RESULTS

The predictive value of the two measures varied by the age of the participants. The Vitality-Tiredness Scale was related to the outcome measures in both samples, while the Mobility-Tiredness Scale was only predictive in the old population. In the young sample the associations were attenuated by the covariates, while the estimates in the old sample remained strong and significant in the adjusted analyses.

CONCLUSION

Fatigue is related to subsequent physical functioning and use of health services at one year follow-up, both in young and old individuals.

Cognitive impairment as assessed by a short form of MMSE was predictive of mortality

OBJECTIVE

This study explores the association between cognitive impairment and mortality in late senescence. A specific purpose was to validate the ability of a short form of the Mini-Mental State Examination (MMSE) in predicting mortality.

STUDY DESIGN AND SETTING

The cognition-mortality link, as assessed by the original MMSE and D-MMSE (a subscale associated to dementia) was estimated on a community sample of 1,111 older people using Cox proportional hazards models.

RESULTS

Impaired cognitive function as assessed by both the original MMSE and D-MMSE predicted mortality in older men and women over long intervals. The association persisted after controlling for sociodemographic variables, Body Mass Index, mobility, and comorbidity and was unaffected by self-reported specific chronic diseases in both men and women. In addition, disease related risk of mortality was substantially reduced by sociodemographic and health variables including cognitive functioning. Only in women, stroke and diabetes remained statistically significant associated with mortality.

CONCLUSION

The association between cognitive impairment and mortality reflects processes different from those underlying a simple relation between chronic diseases and mortality. A short, valid MMSE subscale, which was a powerful predictor of mortality especially among men, is attractive for research and clinical practice.

Preventive home visits to older people in Denmark--why, how, by whom, and when?

In Denmark, political decisions improved the implementation of 'preventative thinking' into every-day clinical work. The potential benefits of preventive efforts have been supported by legislative and administrative incentives, and an ongoing effort to remain focused on the benefits of these initiatives towards older people is politically formulated and underlined as part of the new structured municipality reform. Evidence of beneficial effects of health promotion and prevention of disease in old age is well documented. In-home visits with individualised assessments make it possible to reach older persons not normally seen in the health care system. In-home assessment is not just a health check, but also an opportunity to meet individual needs that may be of importance for older people to stay independent. Preventive home visits may be part of an overall culture and strategy to avoid or prevent functional decline. There is an urgent need of an interdisciplinary teamwork and management for such programmes, incorporating flexible cooperation between the primary and secondary health care sector. The value and importance of geriatric and gerontological education is evidence based.

[Type 2 diabetes. Social relations and health behaviour]

INTRODUCTION

Type 2 diabetes is a chronic disease that challenges the Danish health care system and health behaviour is important in connection with rehabilitation. Foreign research shows that social relations are associated with a healthy lifestyle, but this effect has not yet been examined thoroughly based on Danish data. The purpose of this study was to examine the association between social relations and health behaviour among adult Danes with type 2 diabetes.

MATERIALS AND METHODS

The study design was cross-sectional and based on data from the report ''Sundheds- og Sygelighedsundersøgelsen 2000'', published by The National Institute of Public Health; 264 respondents with type 2 diabetes were included in the final study population. Social relations were measured in terms of civil status, social contact and functional network. Health behaviour reflects whether the respondents comply with the official Danish recommendations for physical activity, diet, alcohol and smoking. Adjustments were made for sex, age, income, self-rated health, functional ability, stress and Body Mass Index.

RESULTS

Social relations measured as civil status and functional network are positively associated with adherence to the recommendations for physical activity and diet. Only the association between functional network and diet remains significant when adjusted for the effects of co-variates.

CONCLUSION

The study shows a need for the promotion of health behaviour among adult Danes with type 2 diabetes, and indicates that social relations ought to be part of rehabilitation.

Tooth loss and subsequent disability and mortality in old age

OBJECTIVES

To examine whether tooth loss at age 70 is associated with onset of disability at 5-, 10-, 15-, and 20-year follow-up and to mortality at 21-year follow-up.

SETTING

Community-based population in Copenhagen.

DESIGN

A baseline study of a random sample of 70-year-old people born in 1914 and follow-up 5, 10, 15, and 20 years later.

PARTICIPANTS

A total of 573 nondisabled individuals participated in the study of 70-year-olds in 1984, 460 participated in the 5-year follow-up, 292 in the 10-year follow-up, 150 in the 15-year follow-up, and 78 in the 20-year follow-up.

MEASUREMENTS

Data from interviews and a medical and oral examination. Oral health was measured according to number of teeth (0, 1-9, 10-19, > or = 20). Disability was measured using the Avlund Mob-H scale at age 75, 80, 85, and 90. Mortality data were obtained from the National Death Register.

RESULTS

Being edentulous or having one to nine teeth was associated with onset of disability at age 75 and 80. Health-related variables and education attenuated the associations between edentulism and onset of disability, although they remained marginally significant, whereas the association between having one to nine teeth and onset of disability remained unchanged and statistically significant at 10-year follow-up (odds ratio=3.02, 95% confidence interval (CI)=1.26-7.24). Persons who were edentulous at age 70 were at significantly higher risk of mortality 21 years later, also in the adjusted analysis (hazard ratio=1.26, 95% CI=1.03-1.55).

CONCLUSION

Tooth loss is independently associated with onset of disability and mortality in old age. The findings indicate that tooth loss may be an early indicator of accelerated aging.

Preventive home visits to home-dwelling older people and hospital admissions: a municipality-randomised intervention trial

Preventive home visits to older home-dwelling people have been part of national policy in Denmark since 1996. The aim was to evaluate whether education of home visitors and GPs was associated with hospital admission rates. In a population-based prospective controlled intervention trial in 34 municipalities, intervention municipality visitors received regular education during 3 years and GPs were introduced to a short assessment programme. Participation totalled 4,034 75- and 80-year-old home-dwelling persons, of which 3,132 (78%) had no mobility disability at baseline. Complete data on hospital services were obtained for all participants. No difference was observed in time to first admission between older people living in the intervention municipalities compared with people living in the control municipalities, HR 0.93 (95%CI: 0.85, 1.02, P = 0.17). Duration of first hospital stay was the same in the two groups (7.3 days). The mean number of admissions was not associated with intervention. Accepting and receiving home visits was associated with a reduced risk of hospital admission, HR 0.84 (95%CI: 0.76, 0.92), especially among the initially disabled. Hospital admission rates were associated with functional decline patterns. Persons experiencing catastrophic and progressive decline had the highest risk. Persons experiencing reversible functional decline were more often hospitalised in the intervention municipalities, and fewer persons living in the intervention municipalities experienced progressive decline. Education of primary care professionals was not associated with risk for first hospital admission among all older people living in the community, but may be associated with older people's different functional decline patterns.

Cohabitation Status and Onset of Disability Among Older Danes

Objectives: To investigate the effect of cohabitation status in older men and women on (a) onset of disability at 3- and 4.5-year follow-up and (b) changes in functional ability between 3- and 4.5-year follow-up, and to analyze whether this effect was mediated by social participation. Method: A total of 2,533 nondisabled older men and women enrolled in the Danish Intervention Study on Preventive Home Visits constituted the study population. Data were collected by mailed questionnaires in 1998-1999, 2000, 2001-2002, and 2003. Results: Living alone significantly increased the risk of onset of disability (T3 OR = 1.60[1.06-2.43], T4 OR = 1.74[1.22-2.47]) and the risk of sustained poor functional ability (OR = 2.35[1.44-3.84]) among men, but not among single-living women. Social participation mediated only a small part of the effect of cohabitation status on functional ability. Discussion: Our results underline the importance of cohabitation/marriage for maintaining a high functional ability among older men.

Genetic priming of a proinflammatory profile predicts low IQ in octogenarians

The purpose of the study was to test the hypothesis that single nucleotide polymorphisms (SNPs) within interleukin (IL)-18, TNF-alpha, IL-6 and IL-10 gene promoter regions are risk factors for cognitive decline in healthy octogenarians, and to isolate the strongest inflammatory biomarkers of cognitive function in the peripheral blood. The Wechsler Adult Intelligence Scale was administered to 112 individuals at ages 80 and 85. An IL-18 haplotype was an independent risk factor of poor Performance IQ. The TNF-308GA genotype was related to individual declines in Verbal IQ, and the IL-10-592 CC genotype was related to better Verbal IQ at the age of 80. Circulating levels of TNF-alpha, sTNFRs, and IL-6 were negatively correlated with IQ at age 85 and less strongly to IQ at age 80 with activation of the TNF system as the strongest biomarker. In conclusion, SNPs related to high proinflammatory or low anti-inflammatory activity are independent risk factors of reduced cognitive function in octogenarians. Only the IL-18 haplotype was associated with inflammation in the peripheral blood and only with regard to circulating TNF-alpha.

Education of preventive home visitors: the effects on change in tiredness in daily activities

The objective was to investigate whether a 3-year educational intervention towards primary health care professionals had effect on change in tiredness in daily activities during a 3-year intervention period in non-disabled older adults. The design was a controlled 3-year intervention study in 34 Danish municipalities with randomization and intervention at municipality level. The 17 intervention municipality visitors received regular education and general practitioners were introduced to a short assessment program. The effect was measured among old non-disabled individuals living in the municipalities by a validated scale on tiredness in daily activities at baseline and at the end of the intervention period. In total 2,515, 75- and 80-year-old men and women participated in all parts of the present study. Eighty-year-old non-disabled men and women who lived in the control municipalities had larger odds ratios of sustained tiredness during the 3-year intervention period compared with 80-year-olds living in intervention municipalities where both GPs and home visitors participated in the educational programme (OR = 3.48; 95% CI 1.51-8.00) and in intervention municipalities where only the home visitors (OR = 2.63; 95% CI 0.97-7.12) were educated. The intervention had no effect on stability and change in tiredness among the 75-year-old men and women. A brief, feasible educational intervention for primary care professionals has beneficial effect on changes in feelings of tiredness in non-disabled 80-year-old men and women.

Preventive home visits to older home-dwelling people and different functional decline patterns

A preventive home visitation scheme has been part of Danish legislation since 1996. The aim of this study was to describe functional trajectories of older home-dwelling people, and to identify whether education of the preventive home visitation staff and individual risk factors were related to specific functional decline patterns. The study is a secondary analysis of a population-based prospective controlled cohort study. Participation totalled 3,129 non-disabled 75- and 80-year-old men and women without mobility disability at baseline living in 34 municipalities. Self-reported functional ability was measured at baseline and after 1½, 3 and 4½ years follow-up. No functional decline was seen in 58% of the participants. A total of 17% developed catastrophic decline, 6% progressive and 7% showed a reversible decline pattern. The remaining 12% showed mixed patterns. Education of the preventive home visitation staff was associated with a reduced risk of progressive decline, RR = 0.66 (CI 95% 0.50-0.86, p = 0.002). Not receiving home visits and living alone were associated with increased risk of catastrophic decline. Younger age (75 at baseline) was less associated with all decline patterns compared with older age (80 at baseline). Men had less risk of developing progressive, reversible and mixed decline patterns than women, but an increased risk of developing catastrophic decline. A feasible educational preventive staff intervention was associated with a reduced risk of progressive functional decline but not with other functional decline patterns. Early signs of functional decline may serve as an important trigger for when to intensify the search for and actively seek to ameliorate preventable conditions.

Promoting physical activity in older adults by education of home visitors

The objectives were to investigate in older adults (1) whether regular preventive home visits are associated with change or stability in physical activity and (2) whether education of home visitors influences stability and change in physical activity. The design was a prospective controlled randomised follow-up study with randomization at municipality level (17 intervention and 17 control municipalities) and outcomes measured at individual level. Visitors in the intervention-municipalities received regular education during 3 years. The effect of the intervention was measured by a questionnaire survey among 1,913 old persons living in the 34 municipalities at baseline and 4½-year follow-up. Changes in physical activity were measured through self-reported frequencies of vigorous physical activity. All logistic regression analyses were stratified by sex and age group (75 and 80 years old). There was no effect of receiving preventive home visits on change in physical activity among the men and among the 75-year-old women. Among the physically active 80-year-old women those who accepted and received more than four preventive home visits were more likely to go on being physically active compared to women who did not receive preventive home visits. Among the sedentary 80-year-old women those living in the intervention municipalities tended to increase their physical activity compared to the control women. These results were not seen in the old men. Preventive home visits as part of daily routine in primary care and education of home visitors and general practitioners may promote physical activity in older women.

Eight-year change in functional ability among 70- to 95-year-olds

AIM

To describe stability and change in functional ability among non-institutionalized old people in relation to sex, age, and household composition during two subsequent four-year observation periods. The study describes stability and change in total functional ability as well as in specific daily activities.

METHODS

The study population included a random sample of non-institutionalized 70+-year-olds studied in 1986 with follow-up in 1990 and 1995. The number of participants in the three surveys were 1,231 (participation rate 67%), 911 (90% of 1,008 survivors), and 542 (77% of 706 survivors). Functional ability was measured at all three surveys. There is a considerable health selection from survey 1 to 2 to 3 because of a high mortality among participants with poor health.

RESULTS

The proportions with unchanged, improved, and deteriorated functional ability were 51%, 13%, and 37% during the first four years and 50%, 9%, and 42% during the following four years. These changes were not related to age and sex. Major variations were seen with regard to change in individual daily activities with most deterioration in mobility and the more outgoing IADL activities (Instrumental Activities of Daily Living). Relatively large proportions of elderly people demonstrated at the same time improvements in some functions and deterioration in others.

CONCLUSIONS

A notable minority of the population improved in functional ability and a large proportion was stable over time. These observations suggest a potential for health promotion among elderly persons, which up to now has been more or less neglected in health policy.

Educational intervention toward preventive home visitors reduced functional decline in community-living older women

OBJECTIVE

To investigate whether immediate effects of a 3-year educational intervention in primary health care were confirmed 18 months after the end of the intervention.

STUDY DESIGN AND SETTING

A controlled 3-year intervention study in 34 Danish municipalities with randomization and intervention at municipality level. The 17 intervention municipality visitors received regular education, and GPs were introduced to a short assessment program. The effect was measured at the individual level by questions about functional ability at the end of the intervention period and 1(1/2) years later; 4,060 older adults living in the municipalities participated. We adopt the approach introduced by Dufouil et al. (2004) and treat dropouts due to death differently from dropouts from other reasons.

RESULTS

Educational intervention to primary care professionals was associated with better functional ability in surviving women at the end of the intervention (odds ratio [OR]: 1.24, 95% confidence interval [CI]=1.07-1.45), from the end of the intervention until 1(1/2) years later (OR: 1.21, 95% CI=1.03-1.44) and during the total study period (OR: 1.22, 95% CI=1.06-1.42). No effects were seen in men.

CONCLUSION

The effect of a brief, feasible educational intervention for primary care professionals is sustained in women 1(1/2) years after the end of the intervention.

Dental status and dental caries in 85-year-old Danes

OBJECTIVES

This study reports findings on the dental status and the prevalence of dental caries among a group of 85-year-old Danes from the Glostrup 1914 Cohort, Denmark. The purpose of the study was to analyse whether caries experience was related to number of teeth and to indicators of functional ability and cognitive function.

METHODS

A total of 191 individuals (78 men and 113 women) participated in a cross-sectional population study conducted in 2000. Using mobile dental equipment, a clinical oral examination and an interview were administered to all participants in their homes. Functional ability was measured by the Mob-H scale and cognitive function was assessed by the Mini-Mental State Examination.

RESULTS

Fifty-nine per cent of the participants had their own natural teeth and for the dentate participants, the mean number of teeth was 13 (range 1-27). A high prevalence of active caries on coronal and root surfaces was observed. Older adults with few natural teeth had a higher prevalence of active coronal and root caries and a higher unmet treatment need than older adults with many teeth. Further, the study showed that 85-year-old persons with reduced functional ability and cognitive impairment tended to have more active caries than 85-year-olds with no impairment.

CONCLUSIONS

A substantial proportion of 85-year-old individuals had retained a natural dentition; however, active dental caries is a problem of concern among the most elderly.

Factors underlying tiredness in older adults

BACKGROUND AND AIMS

The purpose of the present study was to examine for factors related to tiredness, cross-sectionally at the age of 75 years, and factors related to subsequent onset of tiredness, from age 75 to 80 in a non-disabled community-living population.

METHODS

The study is part of the prospective Nordic Research on Aging Study (NORA) on the 1914 cohort in Jyväskylä, Finland and Glostrup, Denmark. In total, 546 non-disabled older men and women participated in the cross-sectional study at age 75, and 299 persons without tiredness and disability at baseline took part in the follow-up study, from age 75 to 80. Tiredness was measured by a validated scale based on the following items: using the toilet, washing and dressing lower body, and cutting toenails. Independent variables were: social position measured by housing tenure and income, chronic diseases, use of medicine, pain, muscle strength, lung function, cognitive performance, depressive symptoms, life satisfaction and insomnia.

RESULTS

Analyses of cross-sectional data showed that social position, number of comorbidities, muscle impairment, pain and depressive mood were independently associated with tiredness. Longitudinal analyses showed that onset of tiredness was significantly or marginally significantly influenced by use of more than three drugs, muscle impairment, pain and cognitive impairment.

CONCLUSIONS

The present study showed that tiredness in non-disabled older adults is a result of multiple potentially modifiable factors, which may be fully treated or at least alleviated, thus increasing the well-being of the individual, as well as potentially slowing the progression of disability.