Attention deficit hyperactivity disorder and personality characteristics in older adults in the general Dutch population

OBJECTIVE

The authors wanted to examine the association between attention deficit hyperactivity disorder (ADHD) and personality characteristics and the potential mediating role of these characteristics in the relationship between ADHD and depression in older adults in the general Dutch population.

METHODS

Data from the Longitudinal Aging Study Amsterdam in 2008/2009 were used in a cross-sectional design on 231 participants with and without ADHD aged 60-94 years. Questionnaires assessing self-esteem, self-efficacy, mastery, neuroticism, and social inadequacy were administered. ADHD was measured by means of ADHD diagnosis and level of ADHD symptoms. Linear regression analyses were performed to assess the association between ADHD (symptoms) and personality characteristics. Single and multivariate mediation analyses were performed to examine the mediating role of personality characteristics in the relationship between ADHD (symptoms) and depressive symptoms.

RESULTS

ADHD was significantly negatively associated with sense of mastery (B = -2.44, t = -3.14, df = 228, p = 0.002), self-esteem (B = -1.16, t = -2.27, df = 228, p = 0.02), and self-efficacy (B = -2.33, t = -2.02, df = 228, p = 0.045) and positively associated with neuroticism (B = 0.99, t = 4.90, df = 228, p <0.001) and social inadequacy (B = 0.65, t = 3.32, df = 229, p = 0.001). In the single mediation analyses, all personality characteristics were mediators in the relationship between ADHD symptoms and depressive symptoms. In the multivariate analysis only mastery and self-esteem were mediators.

CONCLUSION

Older adults with ADHD reported lower self-esteem and sense of mastery and higher levels of neuroticism and social inadequacy than older adults without ADHD. Mastery and self-esteem partly explained the association between ADHD and depressive symptoms in old age. The results implicate that in treatment clinicians should pay attention to the personality characteristics of older adults with ADHD.

Relationships between physical performance and knee and hip osteoarthritis: findings from the European Project on Osteoarthritis (EPOSA)

BACKGROUND

poor physical performance (PP) is known to be associated with disability, lower quality of life and higher mortality rates. Knee and hip osteoarthritis (OA) might be expected to contribute to poor PP, through joint pain and restricted range of movement. Both clinical and self-reported OA are often used for large-scale community and epidemiological studies.

OBJECTIVE

to examine the relationships between hip and knee OA and PP in a large data set comprising cohorts from six European countries.

METHODS

a total of 2,942 men and women aged 65-85 years from the Germany, Italy, Netherlands, Spain, Sweden and the UK were recruited. Assessment included an interview and clinical assessment for OA. PP was determined from walking speed, chair rises and balance (range 0-12); low PP was defined as a score of ≤9.

RESULTS

the mean (SD) age was 74.2 (5.1) years. Rates of self-reported OA were much higher than clinical OA. Advanced age, female gender, lower educational attainment, abstinence from alcohol and higher body mass index were independently associated with low PP. Clinical knee OA, hip OA or both were associated with a higher risk of low PP; OR (95% CI) 2.93 (2.36, 3.64), 3.79 (2.49, 5.76) and 7.22 (3.63, 14.38), respectively, with relationships robust to adjustment for the confounders above as well as pain.

CONCLUSION

lower limb OA at the hip and knee is associated with low PP, and for clinical diagnosis relationships are robust to adjustment for pain. Those at highest risk have clinical OA at both sites.

Perceived control in health care: a conceptual model based on experiences of frail older adults

Frail older adults are increasingly encouraged to be in control of their health care, in Western societies. However, little is known about how they themselves perceive control in health care. Therefore, this study aims to investigate the concept of health care-related perceived control from the viewpoint of frail older adults. A qualitative interview study was conducted following a Grounded Theory approach. Thirty-two Dutch frail older adults, aged 65 and over, participated in 20 in-depth interviews (n=20) and three focus group discussions (n=12). Data were analysed according to techniques of coding and constant comparison. From this analysis constituting factors of perceived control emerged, providing elements of a conceptual model. Perceived control reflects the feeling or belief that health care is under control, which is constituted by five, either internal or external, factors: (I) self-confidence in organising professional and/or informal care, (II) self-confidence in health management in the home setting, (III) perceived support from people in the social network, (IV) perceived support from health care professionals and organisations, and (V) perceived support from (health care) infrastructure and services. Therefore, the concept does not only consist of people's own perceived efforts, but also includes the influence of external sources. Our conceptual model points out what external factors should be taken into consideration by health care professionals and policy makers when enhancing older people's perceived control. Moreover, it can serve as the basis for the development of a measurement instrument, to enable future quantitative research on health care-related perceived control among older adults.

Predictors of having paid work in older workers with and without chronic disease: a 3-year prospective cohort study

BACKGROUND

As the prevalence of chronic disease amongst older workers is high and increasing, it is important to know if the large subgroup of older workers with chronic disease has specific needs when it comes to prolonging participation in paid work.

OBJECTIVES

To investigate differences and similarities in predictors of having paid work in workers aged 55+ with and without chronic disease.

METHODS

Workers aged 55-62 years were selected from the 2002-2003 cohort of the Longitudinal Aging Study Amsterdam (n = 333). Potential predictors were: health, personality, work characteristics, and demographics. Per potential predictor, a logistic regression coefficient for 'having paid work in 2005-2006' was calculated for workers with and without chronic disease. A pooled estimate was computed and differences between the pooled estimate and the coefficients were tested. Results Follow-up data were available for 95 %, of whom 67 % still had paid work. Predictors of having paid work were similar for workers with and without chronic diseases, except for physical workload (χ(2) = 5.37; DF = 1) and psychosocial resources at work (χ(2) = 5.94; DF = 1). Having more psychosocial resources (OR = 3.57; 95 %CI 1.33-10.0) was predictive for having paid work in workers with chronic disease and not in workers without chronic disease. Lower age, more weekly working hours, no functional limitations, fewer depressive symptoms, lower neuroticism scores, and more sense of mastery were significantly associated with having paid work in all workers.

CONCLUSIONS

Differences between predictors of having paid work between workers with and without chronic disease should be taken into account when aiming to prevent exit from the workforce. In particular the vulnerable subgroup of older workers with chronic disease and low psychosocial resources at work is more likely to quit working.

Assistive technology and self-rated health in comparison with age peers: a longitudinal study in 55-64-year-olds

PURPOSE

To determine changes in self-rated health in comparison with age peers (SRH-AP) among 55-64-year-olds, as affected by (1) initiating, (2) ceasing, and (3) prolonging the use of assistive technology (AT).

METHODS

Data included two national cohorts of 55-64-year-olds from the Longitudinal Aging Study Amsterdam (total N = 1968), with baseline cycles in 1992-93 and 2002-03 and 3-year follow-ups. The effect of AT use on SRH-AP was studied in analyses of variance for repeated measurements, adjusting for age and self-reported disability.

RESULTS

Respondents using AT reported poorer SRH-AP than respondents not using AT. Over time disability increased for respondents prolonging and initiating AT use and decreased for respondents ceasing AT use. No major changes were seen in SRH-AP over time, except for a small improvement for respondents prolonging AT use.

CONCLUSIONS

AT use had a negative influence on SRH-AP, but this influence subsided over time for prolonged AT use. Despite longitudinal changes in disability, there was a marked stability of SRH-AP over time which may be attributed to AT use. Implications for Rehabilitation Both the proportion of 55-64-year-olds using AT and the proportion reporting disability was significantly higher in the recent cohort as compared to the early cohort. 55-64-Year-olds not using AT rated their health compared with age peers (SRH-AP) better than those using AT. 55-64-Year-olds who prolonged the use of AT reported the poorest ratings of SRH-AP, but also showed the clearest improvement in SRH-AP, suggesting that the initial negative influence of AT use on SRH-AP may subside over time.

A life-course perspective on physical functioning in women

OBJECTIVE

To validate Kalache & Kickbusch's model: namely, that functional capacity peaks in early adulthood, then declines at a rate dependent on fitness level until a "disability threshold" is reached.

METHODS

Data came from the Australian Longitudinal Study on Women's Health, which followed three cohorts from 1996 to 2011: a young, a mid-aged and an older cohort (born in 1973-78, 1946-51 and 1921-26, respectively). The Short Form (36) Health Survey was used to measure physical functioning (score 1-100). The disability threshold was the mean physical functioning score in older women requiring assistance with daily activities (62.8). The relationship between age and physical functioning was modelled using spline regression for the entire sample, and by baseline physical functioning quintile and physical activity level.

FINDINGS

PHYSICAL DECLINE QUICKENED WITH AGE: 0.05 annual units (95% confidence interval, CI: -0.13 to 0.22) at ages 18-23 years (i.e. no decline); -2.43 (95% CI: -2.64 to -2.23) at ages 82-90 years. Decline was faster in quintiles with lower baseline physical functioning in the younger and mid-age cohorts and in quintiles with higher baseline physical functioning in the older cohort. The disability threshold was reached at a mean age of 79 years, but the range was 45-88 years, depending on baseline physical functioning and physical activity.

CONCLUSION

Age and physical decline are not linearly related, as traditionally believed; decline accelerates with age. However, baseline physical functioning, but not physical activity, influences the rate of decline.

Plasma osteocalcin levels as a predictor of cardiovascular disease in older men and women: a population-based cohort study

OBJECTIVE

The role of osteocalcin (OC) in cardiovascular disease (CVD) is unresolved. We aimed to study the association between plasma OC concentrations and the risk of non-fatal and fatal CVDs. We also aimed to investigate whether such an association, if present, would be mediated by established metabolic risk factors.

DESIGN

A population-based longitudinal cohort study.

METHODS

In 1995/1996, OC was determined in blood samples drawn from 1319 subjects aged 65-88 years participating in the Longitudinal Aging Study Amsterdam in 1995/1996. The self-reported CVD events were collected every 3 years until 2005/2006, and CVD deaths until 1st January 2007. Cox proportional hazards regression was performed, considering potential confounders (smoking, physical activity, and BMI) and mediators (blood pressure, plasma triglycerides, total and HDL cholesterol, fructosamine, and aortic calcification).

RESULTS

During the median 4.1 years follow-up, 709 subjects (53.8%) suffered a CVD event. There was no overall association between OC and CVD: hazard ratio (HR) was 0.97 (95% CI 0.90-1.04) per nmol/l higher plasma OC, adjusted for age and sex. There was a statistical interaction between plasma OC, age, and sex on CVD (P=0.014). In those subjects aged ≥75 years, age-adjusted HRs (95% CI) were 0.86 (0.75-0.99) in men and 1.16 (1.03-1.31) in women per nmol/l higher plasma OC. Adjustment for covariates only slightly attenuated the association in older-old men, but did not affect the association in older-old women.

CONCLUSION

A higher plasma OC concentration was associated with a reduced risk of CVD in older-old men and with an increased risk of CVD in older-old women. We found no evidence that this was mediated by arterial calcification or metabolic risk factors.

Adverse Childhood and Recent Negative Life Events: Contrasting Associations With Cognitive Decline in Older Persons

OBJECTIVE

To examine whether persons who experienced adverse childhood events or recent negative life events have a worse cognitive performance and faster cognitive decline and the role of depression and apolipoprotein E-∊4 in this relationship.

METHODS

The community-based sample consisted of 10-year follow-up data of 1312 persons participating in the Longitudinal Aging Study Amsterdam (age range 65-85 years).

RESULTS

Persons who experienced adverse childhood events showed a faster 10-year decline in processing speed but only when depressive symptoms were experienced. Persons with more recent negative life events showed slower processing speed at baseline but no faster decline.

CONCLUSIONS

Childhood adversity may cause biological or psychological vulnerability, which is associated with both depressive symptoms and cognitive decline in later life. The accumulation of recent negative life events did not affect cognitive functioning over a longer time period.

Longitudinal changes and seasonal variations in serum 25-hydroxyvitamin D levels in different age groups: results of the Longitudinal Aging Study Amsterdam

Vitamin D levels remained fairly stable during ageing with increasing levels in persons aged 55-65 years old and decreasing levels in persons aged 65-88 years old. The seasonal variation was larger than the longitudinal change. Our findings implicate that vitamin D supplementation becomes more important in older age groups and during wintertime.

INTRODUCTION

Longitudinal changes in serum 25-hydroxyvitamin D (25-OHD) levels during aging have not been studied extensively. Two studies showed increasing serum 25-OHD levels. One of these studies suggested that there might be decreasing levels in persons aged 65 years and older. The objectives of the current study are the following: (1) to examine longitudinal changes in serum 25-OHD levels in different age groups and (2) to describe the seasonal variation in different age groups.

METHODS

Data of the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study, were used. Two different cohorts were included: (1) younger cohort: aged 55-65 years old at baseline, n = 738, follow-up of 6 years and (2) older cohort: aged 65-88 years old at baseline, n = 1,320, follow-up of 13 years.

RESULTS

At baseline, average levels were 56.5 nmol/L in the younger cohort and 51.1 nmol/L in the older cohort. In the younger cohort, a longitudinal increase in the mean serum 25-OHD levels of 4 nmol/L in 6 years was observed; in the older cohort, a longitudinal decrease in the mean serum 25-OHD levels of 4 nmol/L in 13 years was observed. The seasonal variation was ±12 nmol/L in the younger cohort and ±7 nmol/L in the older cohort.

CONCLUSIONS

Long-term serum 25-OHD levels remained fairly stable during aging with slightly increasing levels in persons aged 55-65 years old and slightly decreasing levels in persons aged 65-88 years old. On average, the seasonal variation was larger than the longitudinal change. Our findings implicate that vitamin D supplementation becomes more important in older age groups and during wintertime.

[Discussion between informal and formal caregivers of community-dwelling older adults]

Current Dutch policy on long-term care is aimed at a stronger connection between formal home care and informal care. We examined if formal and informal caregivers of community-dwelling older adults discuss the care and whether this is related to characteristics of the older adult, the care network and the individual caregivers. Data are derived from 63 community-dwelling older adults, including their health, their perceived control of the care and their care network. In addition, 79 informal and 90 formal caregivers are interviewed on their motives and vision on caregiving. The 112 dyads between those formal and informal caregivers are the units of analysis in the current study. Bivariate analyses reveal that informal caregivers are more likely to discuss the care with formal caregivers when they are residing with the older adult, when they provide a lot of care and/or when they are strongly motivated to keep the older adult at home. This is particularly the case when the care demands are high. Characteristics of the formal caregivers were not important. In conclusion, discussion of care between non-resident informal caregivers and formal caregivers is not self-evident and requires more effort to be established.

Self-perceived weather sensitivity and joint pain in older people with osteoarthritis in six European countries: results from the European Project on OSteoArthritis (EPOSA)

Background

People with osteoarthritis (OA) frequently report that their joint pain is influenced by weather conditions. This study aimed to examine whether there are differences in perceived joint pain between older people with OA who reported to be weather-sensitive versus those who did not in six European countries with different climates and to identify characteristics of older persons with OA that are most predictive of perceived weather sensitivity.

Methods

Baseline data from the European Project on OSteoArthritis (EPOSA) were used. ACR classification criteria were used to determine OA. Participants with OA were asked about their perception of weather as influencing their pain. Using a two-week follow-up pain calendar, average self-reported joint pain was assessed (range: 0 (no pain)-10 (greatest pain intensity)). Linear regression analyses, logistic regression analyses and an independent t-test were used. Analyses were adjusted for several confounders.

Results

The majority of participants with OA (67.2%) perceived the weather as affecting their pain. Weather-sensitive participants reported more pain than non-weather-sensitive participants (M = 4.1, SD = 2.4 versus M = 3.1, SD = 2.4; p < 0.001). After adjusting for several confounding factors, the association between self-perceived weather sensitivity and joint pain remained present (B = 0.37, p = 0.03). Logistic regression analyses revealed that women and more anxious people were more likely to report weather sensitivity. Older people with OA from Southern Europe were more likely to indicate themselves as weather-sensitive persons than those from Northern Europe.

Conclusions

Weather (in)stability may have a greater impact on joint structures and pain perception in people from Southern Europe. The results emphasize the importance of considering weather sensitivity in daily life of older people with OA and may help to identify weather-sensitive older people with OA.

Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL)

BACKGROUND

Known risk factors for Alzheimer's disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce.

METHODS

We tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort study among 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed (Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT)). Logistic regression analysis was used to examine the association between social isolation and feelings of loneliness and the risk of dementia, controlling for sociodemographic factors, medical conditions, depression, cognitive functioning and functional status.

RESULTS

After adjustment for other risk factors, older persons with feelings of loneliness were more likely to develop dementia (OR 1.64, 95% CI 1.05 to 2.56) than people without such feelings. Social isolation was not associated with a higher dementia risk in multivariate analysis.

CONCLUSIONS

Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.

Circulating uncarboxylated matrix Gla protein, a marker of vitamin K status, as a risk factor of cardiovascular disease

OBJECTIVES

Vitamin K plays a pivotal role in the synthesis of Matrix Gla protein (MGP), a calcification inhibitor in vascular tissue. Vascular calcification has become an important predictor of cardiovascular disease. The aim of the current study was to examine the potential association of circulating desphospho-carboxylated and -uncarboxylated MGP (dp-cMGP and dp-ucMGP), reflecting vitamin K status, with the incidence of cardiovascular events and disease (CVD) in older individuals.

STUDY DESIGN

The study was conducted in 577 community-dwelling older men and women of the Longitudinal Aging Study Amsterdam (LASA), aged >55 year, who were free of cardiovascular disease at baseline. Multivariate Cox proportional hazards models were used to analyze the data.

MAIN OUTCOME MEASURES

Incidence of CVD.

RESULTS

After a mean follow-up of 5.6±1.2 year, we identified 40 incident cases of CVD. After adjustment for classical confounders and vitamin D status, we observed a more than 2-fold significantly higher risk of CVD for the highest tertile of dp-ucMGP with a HR of 2.69 (95% CI, 1.09-6.62) as compared with the lowest tertile. Plasma dp-cMGP was not associated with the risk of CVD.

CONCLUSIONS

Vitamin K insufficiency, as assessed by high plasma dp-ucMGP concentrations is associated with an increased risk for cardiovascular disease independent of classical risk factors and vitamin D status. Larger epidemiological studies on dp-ucMGP and CVD incidence are needed followed by clinical trials to test whether vitamin K-rich diets will lead to a decreased risk for cardiovascular events.

Individual determinants of task division in older adults' mixed care networks

Older adults in need of long-term care often receive help from both informal and formal caregivers. The division of tasks between these different types of caregivers may vary among such mixed care networks. Traditional models of task division suggest that formal and informal caregivers may either supplement each other or specialise in the care activities performed. Our study explores the determinants of various forms of task division in the Netherlands, using data collected in 2007 on 458 mixed care situations. Four types of task divisions of informal and formal care are distinguished: the complementation model [neither Activities of Daily Living (ADL) nor instrumental ADL (IADL) tasks shared, 14%], the supplementation model (both ADL and IADL tasks shared, 39%) and informal and formal specialisation (one type of task shared, one type of task not shared, 27% and 20% respectively). Marginal effects calculated with multinomial regression analyses show that the intensity of care provision, the informal caregivers' motives and the presence of privately paid help - more than care receiver's health - are related to type of task division with formal care. For example, when the informal caregiver provides more hours of help and out of a strong personal bond, the likelihood of informal specialisation increases, whereas the likelihood of formal specialisation decreases. When privately paid help is present, the complementation model is more likely, whereas the supplementation model is less likely to be found. Results are discussed regarding the differential consequences for co-ordination and co-operation in mixed care networks.

[Frailty comprises more than mental health]

In a recent study published in this journal, a frailty index was operationally defined by 14 items from 'The older people and informal caregivers survey - minimum data set' (TOPICS-MDS). These items remained after other items from the TOPICS data set were used separately to define morbidity and disability. These 14 items predominantly pertain to mental health. A frailty index, however, should include all deficits, i.e. symptoms, morbidity and disability. If anything, these 14 items should be more properly labelled as mental health.

Hearing Status in Older Persons: A Significant Determinant of Depression and Loneliness? Results From the Longitudinal Aging Study Amsterdam

Purpose

In this study, the authors' aims were to (a) determine the longitudinal relationships between baseline hearing status and 4-year follow-up depression and loneliness in an older population and (b) investigate possible differences across subgroups in these relationships.

Method

The authors used data from 2 waves of the Longitudinal Aging Study Amsterdam (4-year follow-up, baseline ages 63–93 years). Sample sizes were 996 (self-report analyses) and 830 (speech-in-noise test analyses). The authors used multiple linear regression analyses to assess the associations between baseline hearing status and 4-year follow-up of depression, social loneliness, and emotional loneliness. Hearing was measured by self-report and by a speech-in-noise test. Age, gender, hearing aid use, baseline depression or loneliness, and relevant confounders and effect modifiers were incorporated.

Results

Both hearing measures showed significant associations with loneliness ( p < .05), but these effects were confined to specific subgroups of older persons. For instance, adverse effects were confined to nonusers of hearing aids (self-report, social loneliness model) and men (self-report and speech-in-noise test, emotional-loneliness model). No significant effects appeared for depression.

Conclusion

Significant adverse effects of poor hearing on loneliness were found for specific subgroups of older persons. In future research, investigators should further examine the subgroup effects observed. Eventually, this may contribute to the development of tailored prevention programs.

Longitudinal mediation of processing speed on age-related change in memory and fluid intelligence

Age-related decline in processing speed has long been considered a key driver of cognitive aging. While the majority of empirical evidence for the processing speed hypothesis has been obtained from analyses of between-person age differences, longitudinal studies provide a direct test of within-person change. Using recent developments in longitudinal mediation analysis, we examine the speed-mediation hypothesis at both the within-and between-person levels in two longitudinal studies, Longitudinal Aging Study Amsterdam (LASA) and Origins of Variance in the Oldest-Old (OCTO-Twin). We found significant within-person indirect effects of change in age, such that increasing age was related to lower speed, which in turn relates to lower performance across repeated measures on other cognitive outcomes. Although between-person indirect effects were also significant in LASA, they were not in OCTO-Twin which is not unexpected given the age homogeneous nature of the OCTO-Twin data. A more in-depth examination through measures of effect size suggests that, for the LASA study, the within-person indirect effects were small and between-person indirect effects were consistently larger. These differing magnitudes of direct and indirect effects across levels demonstrate the importance of separating between- and within-person effects in evaluating theoretical models of age-related change.

European ageing research in the social, behavioural and health areas: a multidimensional account

At the 10th anniversary of the European Journal of Ageing in 2013, this article makes an attempt towards a comprehensive overview of European ageing research (EAR) from the three perspectives of this Journal: the social, behavioural and health related domains. First, we provide some general observations on the state of EAR, noting the difficulties of defining this field. Second, we provide a description of EAR and its current trends and characteristics in terms of research themes and theoretical directions. Towards this end, we use the 10 volumes of the European Journal of Ageing as well as other available information. Third, we address the infrastructure of EAR as reflected in major studies, looking at data availability, language, education and training. Given this background, we derive a set of six recommendations to further consolidate and expand EAR.

Development and validation of a physical and psychosocial job-exposure matrix in older and retired workers

OBJECTIVES

A general population job-exposure matrix (GPJEM) including physical and psychosocial demands as well as psychosocial resources applicable to older and retired workers was developed. Its validity was evaluated by examining associations of physical demands and iso-strain (combination of high psychosocial demands and low resources) with health.

METHODS

Physical and psychosocial work exposures reported by 55-64 year olds were derived from the Netherlands Working Conditions Survey and linked to the Netherlands Standard Classification of Occupations 1992. A GPJEM with low, moderate, and high probability of exposure to demands and resources was developed. To examine associations with health, two groups of the Longitudinal Aging Study Amsterdam were selected: current (i.e. at the time of the interview, 55-64 years) and former workers (55-84 years). Linear and logistic regression models were applied.

RESULTS

Use of force and work in uncomfortable positions were significantly associated with functional limitations and self-perceived health (SPH), but not hip or knee osteoarthritis (OA), in current and former workers. A moderate probability of repetitive movements was associated with functional limitations in former workers. A high probability of repetitive movements was associated with functional limitations in current and former workers as well as with SPH and hip and knee OA in former workers. Respondents formerly exposed to iso-strain had significantly higher diastolic blood pressure and more often hypertension. No such associations were found in current workers. No association was found with cardiovascular disease.

CONCLUSIONS

The results suggest that our GPJEM accurately classifies jobs according to physical demands and, although less clearly, iso-strain.

The elimination half-life of benzodiazepines and fall risk: two prospective observational studies

BACKGROUND

the STOPP criteria advise against the use of long-acting benzodiazepines (LBs).

OBJECTIVE

to study whether LBs are associated with a higher fall risk than short-acting benzodiazepines (SBs) (elimination half-life ≤ 10 h).

METHODS

we used base-line data and prospective fall follow-up from the Longitudinal Aging Study Amsterdam, a longitudinal cohort study including 1,509 community-dwelling older persons (Study 1) and from a separate fall prevention study with 564 older persons after a fall (Study 2). Time to the first fall after inclusion and number of falls in the first year after inclusion were the primary endpoints.

RESULTS

both in Study 1 and Study 2 the use of SBs was associated with time to the first fall, hazard ratio (HR) 1.62 (95% CI: 1.03-2.56) and HR 1.64 (95% CI: 1.19-2.26),respectively. LBs were not significantly associated with time to first fall, HR 1.40 (0.85-2.31) and HR 1.08 (0.72-1.62). In both studies, the use of SBs was also associated with number of falls, odds ratio (OR) 1.28 (95% CI: 1.01-1.61) and OR 1.37 (95% CI: 1.10-1.70). LBs were not significantly associated with number of falls, OR 1.23 (0.96-1.57) and 1.10 (0.82-1.48).

CONCLUSIONS

the use of SBs is not associated with a lower fall risk compared with LBs. The use of both SBs and LBs by old persons should be strongly discouraged.

Are IADLs comparable across countries? Sociodemographic associates of harmonized IADL measures

BACKGROUND AND AIMS

Independence in Instrumental Activities of Daily Living (IADLs) is determined not only by physical ability but also by the environmental and cultural surroundings of the individual. The present study describes the harmonization of data on IADL functioning of the Comparison of Longitudinal European Studies on Aging (CLESA) Project. The focus of this report is to examine the comparability of IADLs across countries and to study the association of IADLs with age, gender and socioeconomic status, and the scalability of the measure.

METHODS

The study base includes data from five European countries (Finland, Italy, The Netherlands, Spain, Sweden) and Israel, for older people aged 65-89 living both in the community and in institutions, for a total of 11,557 subjects. In this report, only community-dwelling respondents were included (N=8420). The common IADL items in all six countries were: preparing meals, shopping, and doing housework. The analyses include how these items are distributed by age group and gender, and the associations between independence in these items and socioeconomic status (SES) with logistic regression modeling. The scale properties of these three items are also examined.

RESULTS

Independence in IADLs decreases steadily with age in all countries. Associations with gender and SES follow largely similar patterns across countries. The reliability of the 3-item scale is satisfactory in most countries, and Cronbach's alpha-coefficient for the complete CLESA sample was 0.75.

CONCLUSIONS

The associations between sociodemographic variables and independence in preparing meals, shopping, and doing housework are similar across countries. Results suggest that the predictors of IADLs in different countries are comparable.

Effects of self-reported osteoarthritis on physical performance: a longitudinal study with a 10-year follow-up

BACKGROUND AND AIMS

Osteoarthritis (OA) of the knee or hip is associated with limitations in activities of daily life. There are only a few long-term studies on how knee or hip OA affects the course of physical performance. The aim of this study was to investigate the effects of knee or hip OA on physical performance during a follow-up period of 10 years.

METHODS

Participants in the Longitudinal Aging Study Amsterdam with self-reported hip or knee OA (N = 155) were prospectively followed for 10 years on 4 occasions from the onset of OA and compared to participants without OA (N = 1004). Physical performance was tested with walk, chair stand and balance tests. Scores for each test were summed to a total performance score (range 0-12), higher scores indicating better performance. Generalized estimating equations were used to analyze differences between participants with and without OA, unadjusted as well as adjusted for confounders.

RESULTS

There was a significant interaction between OA and sex (P = 0.068). Both in men and women, total performance was lower for participants with OA, with greater differences in men. Chair stand and walking performance (P < 0.05), but not balance, were lower in participants with OA. After adjustment for confounders, these associations remained significant in men but not in women. Additional analyses correcting for follow-up duration and attrition showed lower performance scores for men and women with OA.

CONCLUSIONS

OA negatively affected physical performance 3-6 years after it was first reported. Performance in men with OA was more affected than in women.