The Jerusalem seventy-year-old longitudinal study. I: Description of the initial cross-sectional survey

Holocaust survivors: Health and longevity 70 years later

BACKGROUND

Holocaust survivors (HS) alive today form a unique and disappearing population, whose exposure to systematic genocide occurred over 70 years ago. Negative health outcomes were widely documented prior to age 70. We examine the hypothesis that the experience of remote trauma continues to negatively affect health, functional status, and survival between the ages of 85-95.

METHODS

The Jerusalem Longitudinal Study (1990-2022) followed a representative sample of Jerusalem residents born 1920-1921, at ages 85, 90 and 95. Home assessment included medical, social, functional, and cognitive status, and mortality data. Subjects were classified: (1) HS-Camp (HS-C): survived slave-labor, concentration, or death camps; (2) HS-Exposed (HS-E): survived Nazi occupation of Europe; (3) Controls: European descent, outside Europe during WWII. We determined Hazards Ratios (HR), adjusting for gender, loneliness, financial difficulty, physical activity, ADL dependence, chronic ischemic heart disease, cancer, cognitive deficits, chronic joint pain, self-rated health.

RESULTS

At ages 85 (n = 496), 90 (n = 524), and 95 (n = 383) the frequency of HS-C versus HS-E versus Controls was 28%/22%/50%, 19%/19%/62%, and 20%/22%/58%, respectively. No consistent significant morbidity differences were observed. Mortality between ages 85-90 and 90-95 years was 34.9% versus 38% versus 32.0%, and 43.4% versus 47.3% versus 43.7%, respectively, with no significant differences in survival rates (log rank p = 0.63, p = 0.81). Five-year mortality adjusted HRs were insignificant for HS-C and HS-E between ages 85-90 (HR 0.87, 95% CI 0.54-1.39; HR 1.14, 95% CI 0.73-1.78) and ages 90-95 (HR 0.72, 95% CI 0.39-1.32; HR 1.38, 95% CI 0.85-2.23).

CONCLUSIONS

Seventy years following their trauma and suffering during the Holocaust, the significant impairments of health, function, morbidity, and mortality which have accompanied survivors throughout their entire adult life, were no longer observed. Indeed, it is likely that survivors living >85 years old represent a uniquely resilient population of people, whose adaptation to adversity has accompanied them throughout their lives.

Optimism and longevity beyond age 85

BACKGROUND

Optimism is associated with health benefits and improved survival among adults aged >65. Whether or not optimism beyond age 85 continues to confer survival benefits is poorly documented. We examine the hypothesis that being optimistic at ages 85 and 90 is associated with improved survival.

METHODS

The Jerusalem Longitudinal Study (1990-2020) assessed comorbidity, depression, cognition, social and functional status, and 5-year mortality among a representative community sample, born 1920-1921, at age 85 (n=1096) and age 90 (n=533). Overall optimism (Op-Total) was measured using a validated 7-item score from the Scale of Subjective Wellbeing for Older Persons. The four questions concerning positive future expectations (Op-Future) and three questions concerning positive experiences (Op-Happy) were also analyzed separately. We determined unadjusted mortality Hazards Ratios, and also adjusted for gender, financial difficulty, marital status, educational status, ADL dependence, physical activity, diabetes mellitus, hypertension, ischemic heart disease, cognitive impairment and depression.

RESULTS

Between ages 85-90 and 90-95 years, 33.2% (364/1096) and 44.3% (236/533) people died respectively. All mean optimism scores declined from age 85 to 90, with males significantly more optimistic than females throughout. All measures of optimism (Op-Total, Op-Future, Op-Happy) at age 85 and 90 were significantly associated with improved 5-year survival from age 85-90 and 90-95 respectively, in both unadjusted and adjusted models. Findings remained unchanged after separately excluding depressed subjects, cognitively impaired subjects, and subjects dying within 6 months from baseline.

CONCLUSIONS

These finding support the hypothesis that being optimistic continues to confer a survival benefit irrespective of advancing age.

Longitudinal changes in cardiac function in the very elderly: the Jerusalem longitudinal cohort study

Background

People over the age of 85 are a rapidly growing age group with a high incidence of congestive heart failure (CHF), in particular heart failure with preserved ejection fraction (HFpEF). The diagnosis of CHF is challenging and longitudinal data assessing cardiac structure and function are necessary to distinguish physiologic from pathologic cardiac aging. The objective of the study was to determine longitudinal changes in cardiac struture and function from ages 85 to 94 years using home echocardiography.

Methods

Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Sixty three members of the initial cohort (32F, 31M) who underwent home echocardiography at age 85 were the subjects of the current study and underwent repeat home 2-D and Doppler echocardiographic assessment at age 94.

Results

There were no significant longitudinal changes in left ventricular mass index (LVMI), however LV end-diastolic volume significantly decreased from 113.4 ± 30 to 103.6 ± 35.5 mL (P < 0.02). Ejection fraction (EF) remained stable, however longitudinal systolic function significantly decreased with age from 7.9 ± 1.8 to 6.6 ± 1.4 cm/s² (P < 0.0001). Diastolic function as assessed by increased E: e' (11.2 ± 3.4 to 16 ± 7.5, P < 0.0001) and increased left atrial volume index (34.1 ± 11.3 to 42.4 ± 13.7 mL/m², P < 0.0001) was reduced with aging.

Conclusions

This study demonstrated preserved EF with decreased longitudinal systolic function and diastolic function without significant change in LV mass. Changes in LV function in the very elderly may be independent of changes in LV geometry.

The Pharmacological Treatment of Arterial Hypertension in Frail, Older Patients—a Systematic Review

BACKGROUND

It is debated whether the treatment goals and decision-making algorithms for elderly patients with hypertension should be the same as those for younger patients. The American and European guidelines leave decisions about antihypertensive treatment in frail, institutionalized patients up to the treating physician. We therefore systematically searched the literature for publications on the phamacotherapy of arterial hypertension in frail patients.

METHODS

The MEDLINE, Embase, and Central databases were systematically searched for randomized, controlled trials (RCTs) and non-randomized studies, including observational studies, on the pharmacotherapy of arterial hypertension in elderly patients since the introduction of the concept of frailty, published over the period 1992-2017.

RESULTS

Out of 19 282 citations for randomized, controlled trials and 5659 for non-randomized trials and observational studies, four RCTs and three observational studies were included in the further analysis. The included RCTs showed a trend to- wards a benefit from pharmacotherapy of hypertension in frail patients with respect to mortality, cardiovascular disease, functional status, and quality of life. On the other hand, some of the observational studies indicated a lower rate of falls and lower mortality among patients who received no antihypertensive treatment.

CONCLUSION

In view of the conflicting findings of RCTs and non-randomized studies, the lower representation of frail subjects in RCTs, and the high risk of bias in non- randomized studies, the findings of the studies included in this review do not enable the formulation of any strictly evidence-based treatment recommendations. As a rule of thumb, the authors propose that a target systolic blood pressure of <150 mmHg should be aimed at in patients whose gait speed is less than 0.8 m/s, while a target range of 130-139 mmHg can be set for patients over age 80 who are no more than mildly frail.

Left atrial function and mortality in the oldest old

BACKGROUND

Previous studies demonstrated that left atrium (LA) size is associated with mortality in an elderly population. It remains unclear whether indices of LA function including reservoir, conduit, or booster elements of LA function provide incremental prognostic information.

HYPOTHESIS

Echocardiographic measures of the various parameters of LA function would predict 5-year mortality in a community-dwelling population of 85 to 86 year olds independently of LA volume.

METHODS

Subjects ages 85 to 86 years old underwent home echocardiography. LA volumes were assessed by the biplane Simpson's method from apical views using measurements of phasic volumes and functions of the LA, including LA expansion index. LA passive and active emptying fractions were assessed. Survival status at 5-year follow-up was assessed.

RESULTS

Two hundred eighty-two subjects were included, of whom 87 (31%) had died at follow-up. Survival of the subjects in the lowest quartile of the LA expansion index as well as LA active filling index was significantly lower. When measurements of LA volume index were added to the model, the relationship between survival and indices of LA function remained significant.

CONCLUSIONS

This study demonstrated that elderly subjects aged 85 to 86 years with significantly impaired LA function had increased 5-year mortality independently of indices of LA volume.

Cardiac structure and function predicts functional decline in the oldest old

Background This study examined the association between cardiac structure and function and the deterioration in activities of daily living (ADLs) in an age-homogenous, community-dwelling population of patients born in 1920-1921 over a five-year follow-up period. Design Longitudinal cohort study. Methods Patients were recruited from the Jerusalem Longitudinal Cohort Study, which has followed an age-homogenous cohort of Jerusalem residents born in 1920-1921. Patients underwent home echocardiography and were followed up for five years. Dependence was defined as needing assistance with one or more basic ADL. Standard echocardiographic assessment of cardiac structure and function, including systolic and diastolic function, was performed. Reassessment of ADLs was performed at the five-year follow-up. Results A total of 459 patients were included in the study. Of these, 362 (79%) showed a deterioration in at least one ADL at follow-up. Patients with functional deterioration had a significantly higher left ventricular mass index and left atrial volume with a lower ejection fraction. There was no significant difference between the diastolic parameters the groups in examined. When the data were examined categorically, a significantly larger percentage of patients with functional decline had an abnormal left ventricular ejection fraction and left ventricular hypertrophy. The association between left ventricular mass index and functional decline remained significant in all multivariate models. Conclusions In this cohort of the oldest old, an elevated left ventricular mass index, higher left atrial volumes and systolic, but not diastolic dysfunction, were predictive of functional disability.

Frequency of Leaving the House and Mortality from Age 70 to 95

OBJECTIVES

To determine the association between frequency of leaving the house and mortality.

DESIGN

Prospective follow-up of an age-homogenous, representative, community-dwelling birth cohort (born 1920-21) from the Jerusalem Longitudinal Study (1990-2015).

SETTING

Home.

PARTICIPANTS

Individuals aged 70 (n = 593), 78 (n = 973), 85 (n = 1164), and 90 (n = 645), examined in 1990, 1998, 2005, and 2010, respectively.

MEASUREMENTS

Frequency of leaving the house, defined as daily (6-7/week), often (2-5/week), and rarely (≤1/week); geriatric assessment; all-cause mortality (2010-15). Kaplan-Meier survival charts and proportional hazards models adjusted for social (sex, marital status, financial status, loneliness), functional (sex, self-rated health, fatigue, depression, physical activity, activity of daily living difficulty), and medical (sex, chronic pain, visual impairment, hearing impairment, diabetes mellitus, hypertension, ischemic heart disease, chronic kidney disease) covariates.

RESULTS

At ages 70, 78, 85, and 90, frequency of going out daily was 87.0%, 80.6%, 65.6%, and 48.4%; often was 6.4%, 9.5%, 17.4%, and 11.3%; and rarely was 6.6%, 10.0%, 17.0%, and 40.3% respectively. Decreasing frequency of going out was associated with negative social, functional, and medical characteristics. Survival rates were lowest among those leaving rarely and highest among those going out daily throughout follow-up. Similarly, compared with rarely leaving the house, unadjusted mortality hazard ratios (HRs) were lowest among subjects leaving daily and remained significant after adjustment for social, functional and medical covariates. Among subjects leaving often, unadjusted HRs showed a similar effect of smaller magnitude, with attenuation of significance after adjustment in certain models. Findings were unchanged after excluding subjects dying within 6 months of follow-up.

CONCLUSION

In community-dwelling elderly adults aged 70 to 90, leaving the house daily was associated with lower mortality risk, independent of social, functional, or medical status.

Handgrip Strength in Old and Very Old Adults: Mood, Cognition, Function, and Mortality

OBJECTIVES

To determine the trajectory of handgrip strength (HGS) from age 70 to 90 and its association with mood, cognition, functional status, and mortality.

DESIGN

Prospective follow-up of an age-homogenous representative community-dwelling cohort (born 1920-21) in the Jerusalem Longitudinal Cohort Study (1990-2015).

SETTING

Home-based assessment.

PARTICIPANTS

Subjects aged 70 (n = 327), 78 (n = 384), 85 (n = 1187), and 90 (n = 406), examined in 1990, 1998, 2005, and 2010, respectively.

MEASUREMENTS

Handgrip strength (kg) (dynamometer), low HGS defined as sex-specific lowest quartile grip; geriatric assessment; all-cause mortality (1990-2015).

RESULTS

Mean HGS declined between age 70 and 90 from 21.3 ± 7.2 to 11.5 ± 5.6 kg in women and from 35.3 ± 8.4 to 19.5 ± 8.2 kg in men. Cross-sectional associations were observed between low HGS and poor functional measures (age 70-90), lower educational and financial status, smoking, and diabetes mellitus (ages 78-90). After adjustment for baseline education, self-rated health, physical activity, diabetes mellitus, depression, and cognition, low HGS predicted subsequent activity of daily living dependence from age 78 to 85 (odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.04-6.89) and 85 to 90 (OR = 2.31, 95% CI = 1.01-5.30), whereas the adjusted ORs for activities of daily living difficulty and depression failed to achieve significance. HGS did not predict subsequent cognitive decline. Survival rates were significantly lower in participants with low HGS (Quartile 1) than in those with normal HGS (Quartiles 2, 3, 4) throughout follow-up from ages 78 to 85, 85 to 90, and 90 to 95. Similarly, after adjusting for sex, education, self-rated health, body mass index, hypertension, diabetes mellitus, ischemic heart disease, and smoking, a low HGS was associated with significantly higher mortality.

CONCLUSIONS

Mean HGS declined progressively with age, and participants in the lowest age-specific quartile of HGS had a higher risk of subsequent functional decline and mortality.

Climbing Stairs, Handrail Use, and Survival

BACKGROUND

Negotiating stairs is identified as a challenging task by older people, and using a handrail to climb stairs is a compensatory gait strategy to overcome mobility difficulties. We examine the association between handrail use to climb stairs at increasing ages, and long term survival.

METHODS

Data were collected by the Jerusalem Longitudinal Study, which is a prospective study of a representative sample from the 1920-1921 birth-cohort living in West Jerusalem. Comprehensive assessment at home in 1990, 1998, and 2005, at ages 70 (n=446), 78 (n=897), and 85 (n=1041) included direct questioning concerning handrail use for climbing stairs. Mortality data were collected from age 70-90.

RESULTS

The frequency of handrail use to climb stairs at ages 70, 78, 85 years was 23.1% (n=103/446), 41.0% (n=368/897), and 86.7% (n=903/1041) respectively. Handrail use was associated throughout follow-up with a consistent pattern of negative demographic, functional and medical parameters. Between ages 70-78, 70-90, 78-85, 78-90, and 85-90, survival was significantly lower among subjects using a handrail, with unadjusted mortality Hazard Ratios of HR 1.57 (95%CI, 1.01-2.42), HR 1.65 (95%CI, 1.27-2.14), HR 1.78 (95%CI, 1.41-2.25), HR 1.71 (95%CI, 1.41-2.06), and HR 1.53 (95%CI, 1.01-2.33) respectively. HR's remained significant at all ages after adjusting for sociodemographic factors (gender, education, marital, and financial status), and common medical conditions (ischemic heart disease, hypertension, diabetes, chronic pain), as well as between ages 78-85 and 78-90 after adjusting for functional covariables (self-rated health, physical activity, depression, BMI and ADL difficulties).

CONCLUSION

Using a handrail to climb stairs is increasingly common with rising age, was associated with a negative profile of health parameters and is associated with subsequent mortality.

Cardiac Structure and Function and Frailty in Subjects Aged 85 and 86 Years

Frailty is a biologic syndrome reflecting a state of decreased physiological reserve of increasing importance in cardiovascular disease given the aging of the population. The relation between frailty and indexes of cardiac structure and function remains unclear, particularly in the "oldest old." The objective of this study was to examine the association between cardiac function and frailty in an age-homogenous, community-dwelling population of subjects aged 85 and 86 years. Subjects were recruited at ages 85 to 86 from the Jerusalem Longitudinal Cohort Study that has followed an age-homogenous cohort of Jerusalem residents. Subjects underwent echocardiography at their place of residence with standard assessment of cardiac structure and function. Frailty was defined according to the "phenotype of frailty" including at least 3 of the following: weakness, slowness, low physical activity level, exhaustion, and weight loss; 405 subjects (193 men and 212 women) were enrolled in the study. Subjects defined as frail had significantly lower ejection fraction compared with the non-frail group (53.7 ± 0.09% vs 56.4 ± 0.09%; p <0.04). In addition, frail subjects had increased LV mass index (130.6 ± 36.2 g/m(2) vs 119.2 ± 31.1 g/m(2); p <0.03) and LA volume index (41.9 ± 14.7 cm(3)/m(2) vs 36.7 ± 13.1 cm(3)/m(2); p <0.001). Indexes of diastolic function (E/e)' were not significantly different in the 2 groups (11.5 vs 11.8; p = NS). In this age-homogenous cohort of the oldest old, structural changes and indexes of systolic but not diastolic function were associated with frailty.

Left Ventricular Mass as a Risk Factor in the Oldest Old

In middle-aged and "young elderly" cohorts, higher left ventricular mass (LVM) is associated with worse outcomes. The authors examined LVM and 5-year mortality among community-dwelling 85-year-old patients. A representative sample (n=526, born 1920-1921) from the Jerusalem Longitudinal Cohort Study underwent echocardiography at age 85. LVM was indexed by body surface area (LVM-BSA) or height (LVM-Ht). Patients with higher LVM were less educated and sedentary and had poorer self-rated health, functional limitations, and increased comorbidity. Five-year mortality was 21.7% (n=114). Adjusted 5-year mortality rates were increased for the two upper quintiles of LVM-BSA (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.05-3.06) and LVM-Ht (HR, 2.2; 95% CI, 1.2-3.5). A step up in mortality occurred around the third quintile corresponding with LVM-BSA 110 g/m(2) or LVM-Ht 51 g/m(2.7). Among the oldest old, elevated LVM is significantly associated with mortality.

Prevalence of pain with advancing age brief report

BACKGROUND

The epidemiology of chronic pain with advancing age remains poorly established. Although most studies have examined somatic (musculoskeletal and joint) pain, visceral pain (such as headache and abdominal pain) has warranted less attention. We present longitudinal data from age 70 to 90 years concerning chronic musculoskeletal/joint pain, abdominal pain, and headache.

METHODS

Data was collected by the Jerusalem Longitudinal Study, which is a prospective study of a representative sample from the 1920-1921 birth-cohort living in West Jerusalem. Participants underwent comprehensive assessment at home in 1990, 1998, 2005, and 2010, at ages 70 (n = 460), 78 (n = 763), 85 (n = 1149), and 90 years (n = 394), respectively, and were directly questioned concerning the presence and location of pain.

RESULTS

The overall prevalence of pain of any kind at ages 70, 78, 85, and 90 years was 73% (n = 336/460), 81.1% (n = 619/763), 56.3% (n = 647/1149), and 31.2% (n = 123/394), respectively. Pain at younger ages only was associated with female gender, lower educational status, functional dependence, physical inactivity, increased body mass index, loneliness, depression, and poor self-rated health. At ages 70, 78, 85, and 90 years, chronic neck/back pain was present among 41.5%, 58.9%, 30.1%, and 14.6% of participants, respectively; chronic joint pain was present among 43.0%, 60.6%, 45.2%, and 25.2%, respectively. In contrast abdominal pain was less common and disappeared among the oldest old: 14.7%, 13.9%, 1.7%, and 1.5%, respectively, with a similar pattern for headache: 43.3%, 33.5%, 2.1%, and 1.3%. While pain was reported at ≥2 sites by 42.3% and 54.6% at ages 70 and 78 years, respectively, by ages 85 and 90 years, pain was most frequently reported at only 1 site.

CONCLUSIONS

Visceral pain (headache and abdominal pain) completely disappeared among the oldest old, in contrast to a far smaller decline in somatic (musculoskeletal and joint) pain.

Diabetes Mellitus, Physical Activity, and Longevity Between the Ages of 70 and 90

OBJECTIVES

To determine the effect of physical activity (PA) on survival in older adults (70-90) with diabetes mellitus (DM).

DESIGN

The Jerusalem Longitudinal Cohort Study (1990-2010) prospectively follows up a representative cohort born in 1920-1921.

SETTING

Home-based assessment.

PARTICIPANTS

Individuals aged 70 in 1990 (n = 463), 78 in 1998 (n = 972), and 85 in 2005 (n = 1,181).

MEASUREMENTS

Comprehensive geriatric assessment; self-reported PA dichotomized to active (≥4 hours of activity/wk) or inactive (<4 hours of activity/wk); mortality data (1990-2010).

RESULTS

Prevalence of DM was 15.7% at age 70, 18.4% at age 78, and 21.3% at age 85. DM was associated with greater morbidity. Survival was higher in active than inactive with DM (aged 70-77: 78.8% vs 48.7%, P = .008; aged 78-84: 60.0% vs 40%, P = .01; aged 85-90: 70.2% vs 49.6%, P < .001) and without DM (aged 70-77: 85.9% vs 74.1%, P = .002; aged 78-84: 75.0% vs 64.0%, P = .004; aged 85-90: 82.3% vs 60.3%, P < .001). Cox proportional hazards ratios (HRs) according to PA status compared active subjects without DM (reference) with inactive subjects without DM, active subjects with DM, and inactive subjects with DM after adjusting for sex, self-rated health, ischemic heart disease, hypertension, smoking, and body mass index. Adjusted HRs were 1.39 for inactive subjects without DM, 1.34 for active subjects with DM, and 3.54 for inactive subjects with DM for age 70 to 77 (P < .001); 1.43 for inactive subjects without DM, 1.55 for active subjects with DM, and 3.74 for inactive subjects with DM for age 78 to 84 (P < .001); and 1.98 for inactive subjects without DM, 1.56 for active subjects with DM, and 2.18 for inactive with DM for age 85 to 90 (P < .001).

CONCLUSION

In adults with DM, greater survival continues to be associated with PA up to and including very old adults (70-90). These findings support the encouragement of regular PA in people with DM regardless of advancing age.

Cholesterol, statins, and longevity from age 70 to 90 years

BACKGROUND

The importance of cholesterol as a risk factor among older people, particularly among the very old, is controversial. Whether or not hypercholesterolemia warrants medical concern, and whether statins are beneficial among very old people, remain unresolved common clinical dilemmas. This study examines whether increased total cholesterol (TC) was associated with higher mortality from age 70 to 90, and if statins had a protective effect.

METHODS

A representative sample (born 1920-1921) from the Jerusalem Longitudinal Cohort Study (1990-2010) was assessed at ages 70, 78, and 85 for fasting serum TC, low-density (LDL), and high-density lipoprotein (LDL); triglycerides; statin usage; social, functional, and medical domains; and all-cause mortality data (1990-2010). TC was analyzed as either continuous (10 mg/dL increments) or dichotomous variable (high TC >200 mg/dL). Cox proportional hazards models determined mortality hazard ratios (HRs), adjusting for TC, statin treatment, gender, self-rated health, smoking, hypertension, diabetes, ischemic heart disease, neoplasm, body mass index, albumin, and triglycerides.

RESULTS

Prevalence of high TC at ages 70, 78, and 85 was 75% (n = 344), 65% (n = 332), and 34% (n = 237), and statin use was 0%, 17.9%, and 45.4%, respectively. Survival was increased (not significantly) among subjects with high TC >200 mg/dL versus ≤200 mg/dL from ages 70 to 78, 78 to 85, and 85 to 90: 79.1% versus 73.3% (log rank P = .16), 68.7% versus 61.5% (P = .10), and 73.4% versus 70.3% (P = .45), respectively. Survival was significantly increased among subjects treated with statins versus no statins at ages 78 to 85 (74.7% vs 64.3%, log rank P = .07) and 85 to 90 (76.2% vs 67.4%, P = .01). After adjustment, TC (continuous or dichotomous) was not associated with mortality from 70 to 78, 78 to 85, or 85 to 90. In contrast, statins at age 85 were associated with decreased mortality from age 85 to 90 (adjusted HR 0.61, 95% confidence interval 0.42-0.89).

CONCLUSIONS

Among older people, cholesterol levels were unrelated to mortality between the ages of 70 and 90. The protective effect of statins observed among the very old appears to be independent of TC.

Prevalence and prognosis of aortic valve disease in subjects older than 85 years of age

Although degenerative aortic valve disease is common with increasing age, limited data exist regarding prevalence and prognosis of aortic valve disease among the oldest old. Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at home in 498 randomly selected subjects. Subjects were divided into 3 groups; normal subjects, subjects with valve calcium but without stenosis (AVC), and subjects with aortic stenosis (AS). Survival status at 5-year follow-up was assessed via the centralized population registry. AVC was noted in 55% of the study subjects and AS was seen in 8.2%. There were no significant differences between the 3 groups in any of the clinical parameters examined including risk factors for atherosclerotic heart disease. Of the 498 subjects, 107 (21%) had died at the time of 5-year follow-up. Five-year mortality was similar among the normal (17%) and AVC (20%) subjects but was significantly higher among the subjects with AS (46%; p <0.0001). AS was associated with a nearly fourfold increased likelihood of mortality (hazard ratio 3.7, 95% confidence interval 1.4 to 9.3). In conclusion, among subjects ≥85 years of age, the prevalence of AS is higher than previously reported and not associated with traditional vascular risk factors. AS but not AVC alone was independently predictive of 5-year mortality.

Cardiac structure and function and renal insufficiency in the oldest old

BACKGROUND

People over the age of 85 years have a high incidence of cardiovascular disease and chronic kidney disease.

HYPOTHESIS

There is an association between renal function and cardiac structure and function in subjects 85 years of age.

METHODS

Subjects born in the years 1920 and 1921 were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at the subject's home with assessment of cardiac structure and function. Glomerular filtration rate (GFR) was assessed by the Cockroft-Gault formula, with abnormal GFR defined as ≤60 mL/min/1.73 m(2).

RESULTS

There were 310 subjects who were enrolled. When GFR was examined as a continuous variable, linear regression showed a small although statistically significant relationship between GFR and left atrial volume (r = 0.15, P < 0.014), left ventricular mass index (r = 0.12, P < 0.04), and ejection fraction (r = 0.19, P < 0.03) but not with indices of diastolic function (r = 0.02, P < 0.72). However, using the accepted clinical cutoff of 60 mL/min/1.73 m(2), there were no significant differences between subjects with normal and abnormal GFR in indices of cardiac structure. Ejection fraction (57.0 ± 10.4% vs 54.4 ± 10.3%; P = 0.08) and indices of diastolic function (E/e' 12.4 ± 5.0 vs 12.3 ± 4.6; P = 0.89) were not significantly different between the 2 groups.

CONCLUSIONS

A weak and clinically insignificant association was found between GFR as a continuous variable and indices of cardiac function. However, using the clinically accepted cutoff, no association between abnormal GFR and cardiac structure or function was observed.

Cardiac structure and function as predictors of mortality in persons 85 years of age

Individuals aged > 85 years are the world's most rapidly growing age group and have a high incidence of cardiovascular mortality. The objective of this study was to prospectively determine the prognosis of abnormal cardiac structure and function in an age-homogenous, community-dwelling population of subjects born in 1920 and 1921. Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed with a portable echocardiograph at the subjects' places of residence. Standard echocardiographic assessment of cardiac structure and function was performed. Five-year mortality was assessed through a centralized government database. Five hundred two subjects (235 men, 267 women) were enrolled in the study, of whom 107 (21%) had died at the time of 5-year follow-up. Subjects who died had significantly higher left atrial volume indexes (42.3 ± 16.5 vs 36.6 ± 12.5 ml/m2, p < 0.01) and left ventricular mass indexes (133.1 ± 47.6 vs 119.8 ± 30.6 g/m2, p < 0.05). Ejection fractions were significantly lower in subjects who died (52.5 ± 11.5% vs 56.4 ± 9.4%, p < 0.003), but indexes of left ventricular diastolic function were not significantly different between the 2 groups (E/e' ratio 13.0 ± 5.3 vs 12.2 ± 4.9, p = 0.18). In conclusion, elevated left atrial volume index and left ventricular mass index and decreased LV systolic function predicted 5-year mortality in a community-dwelling population of subjects aged 85 years, even after correction for possible confounders. Left ventricular diastolic dysfunction did not predict 5-year mortality in this cohort.

Loneliness, social networks, and mortality: 18 years of follow-up

We examined the influence of changes in loneliness and social support networks upon mortality during 18 years of follow-up among an elderly cohort and determined the gender-specific nature of this relationship. The study is based on data collected from the Jerusalem Longitudinal Study (1990-2008), which has followed a representative sample of 605 community-dwelling elderly people. Subjects were randomly selected from an age homogenous cohort born 1920-1921 and were aged 70, 78, and 85 when data were collected at baseline in 1990 and at follow-up in 1998 and 2005. All-cause mortality from age 70-88 was determined according to the National Death Registry. Sense of loneliness was found to be stable among the majority of the respondents. Loneliness among men was found in bivariate analyses to be a risk factor for mortality. Although multivariate analyses found that loneliness was not a significant predictor of mortality, nonetheless several social network factors (marital status at the baseline and living arrangements) were found to predict mortality among men. Loneliness and solitude among elderly men can be a risk factor of mortality. The findings imply that attention should be given to this high risk group.

Cardiac structure and function in persons 85 years of age

Individuals aged >85 years constitute the world's most rapidly growing age group. Despite the rapid growth of this population and its high incidence of cardiovascular morbidity, normative data concerning cardiac structure and function are limited. The objective of this study was to define cardiac structure and function in an age-homogenous, community-dwelling population of subjects born in 1920 and 1921. Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed using a portable echocardiograph at the subject's place of residence. Standard echocardiographic assessment of cardiac structure and function was performed. Four hundred fifty subjects (219 men, 231 women) were enrolled in the study. The cohort exhibited large left atrial volumes (64.6 ± 26 ml) and high left ventricular (LV) mass indexes (122 ± 36 g/m(2)) with normal LV volumes. Ejection fractions were preserved (55.3 ± 10.2%), but tissue Doppler s-wave velocities (lateral 7.8 ± 2.1 cm/s, septal 6.7 ± 1.9 cm/s) were reduced. Reduced tissue Doppler e waves (lateral 7.3 ± 2.2 cm/s, septal 6.2 ± 2 cm/s) and elevated E/e' ratios (12.2 ± 4.9) indicated significantly impaired diastolic function. In conclusion, the findings of this study demonstrate a high prevalence of left atrial enlargement, elevated LV mass, evidence of LV systolic dysfunction with preserved ejection fractions, and significant LV diastolic dysfunction in a community-dwelling cohort of 85-year-olds. The finding of elevated E/e' ratios in a subset free of known cardiovascular disease should be considered when clinical assessment of LV diastolic dysfunction in this age group is performed.

Frailty, cognitive impairment and mortality among the oldest old

INTRODUCTION

Both frailty and cognitive impairment are increasingly prevalent with advancing age. Nonetheless among the oldest old their relationship is poorly described. This study examines the association between frailty status and cognitive impairment at age 85 and their impact on 5-year mortality.

METHODS

A representative sample of 840 community dwelling people from the Jerusalem Longitudinal Cohort Study was comprehensively assessed at age 85. Frailty was defined according to the "phenotype of frailty", as including at least three of the following: weight loss, slowness, weakness, exhaustion and low physical activity levels. Pre frailty was defined as 1-2/5 criteria. Cognitive impairment was assessed according to the Mini Mental State Examination (MMSE). Mortality data was collected from age 85-90.

RESULTS

A total of 164 (19.5%) were frail, 470 (56%) were pre frail and 206 (24.5%) were not frail, with prevalence of MMSE≤24 being 53.3%, 15%, and 7.4% respectively. A uniform pattern of increased adverse health, affective, disease and functional measures were associated with frailty status. Frailty status was significantly associated with cognitive impairment, with an Odds Ratios of 3.77 (95%CI 1.42-9.99) for MMSE≤24 after adjustment for socio demographic, medical mood and functional covariates. Among frail, pre frail and non frail subjects, 5-year mortality was 44.5%, 20.4%, 13.6% respectively. Mortality among frail subjects with or without cognitive impairment was 54.2% vs. 54.9%, p=0.9). Adjusting together for frailty, MMSE, education and gender, the Hazards ratio for 5-year mortality for frailty was 3.861 (95%CI 2.4-6.2), and for MMSE≤24 was 1.25 (95%CI 0.87-1.78).

CONCLUSIONS

Among the oldest old, frailty status was significantly associated with cognitive impairment; after adjustment, frailty alone was predictive of subsequent mortality.

Fatigue, function, and mortality in older adults

BACKGROUND

Although fatigue is common among the elderly people, little is known concerning its relationship with mortality and function over extended periods of time among the very old. This study evaluates the association of fatigue with health, functional status, and mortality from ages 70-88 years.

METHODS

Mortality data from ages 70-88 years and both health and functional status at age 70, 78, and 85 years were assessed among a representative community-dwelling cohort born 1920-1921 from the Jerusalem Longitudinal Study (1990-2008).

RESULTS

At age 70, 78, and 85, fatigue prevalence was 29%, 53%, and 68%, respectively, with increased prevalence among women. Fatigue was associated with poorer health, function, and psychosocial parameters at all ages and greater likelihood to deteriorate in subsequent self-rated health (SRH), functional status, loneliness, depression, and physical activity level. After adjustment, fatigue at age 70 predicted poor subsequent SRH, difficulty in activities of daily living, reduced levels of physical activity, and poor sleep satisfaction, and at age 78, fatigue predicted subsequent depression. Hazard ratios for mortality among fatigued participants were significant after adjustment for numerous risk factors. The addition of physical activity level and/or depression reduced the significance of the relationship between fatigue and mortality.

CONCLUSIONS

Fatigue among the elderly people, up to and including the oldest old, has a significant negative impact on health status, function, and mortality. Pathways of action may be related to the complex relationship of fatigue with depression and levels of physical activity.

High prevalence of left ventricular hypertrophy in octogenarian women: The Jerusalem Longitudinal Cohort Study

BACKGROUND

Left ventricular hypertrophy (LVH) is more frequent in women and increases with age; however, it is unclear whether this finding is true in the very elderly. The objective of this study was to examine gender differences in the prevalence of LVH in a very elderly cohort.

METHODS

Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Three hundred and thirty-nine of the subjects from the most recent set of data collection in 2005-2006 underwent echocardiography in addition to structured interviews and physical examination.

RESULTS

The overall prevalence of LVH was high and significantly higher among women (60% vs 43%, p=0.0023). Systolic blood pressure (SBP) was significantly higher in women with LVH compared with women without LVH (p<0.01) and both groups of men (p<0.005). Women with LVH were three times more likely than women without LVH and 6.5 times more likely than men with LVH to believe that a BP of 160/100 mmHg represents their BP goal (p<0.05).

CONCLUSIONS

This study demonstrates a high prevalence of LVH in a very elderly population, a finding significantly more pronounced in women and related to SBP.

Reading daily predicts reduced mortality among men from a cohort of community-dwelling 70-year-olds

OBJECTIVES

Although social and physical components of leisure activity have proven beneficial to successful aging, the influence of solitary and nonstrenuous activity on subsequent aging is unclear. This study examined reading activity to investigate the relationship of a solitary, nonstrenuous activity on aging and mortality.

METHODS

A cohort of visually and cognitively intact community-dwelling participants born in 1920-1921, taken from the Jerusalem Longitudinal Study, underwent comprehensive assessment at ages 70 and 78. We collected mortality data spanning 8 years. We dichotomized reading frequency to daily or less and performed data analyses separately by gender.

RESULTS

Reading daily was common at both ages 70 (62% of the sample) and 78 (68%) and was associated at baseline with female gender, Western origin, higher socioeconomic and educational statuses, employment, and reduced medications. The hazard ratio for mortality over the 8-year follow-up among men was significantly reduced (hazard ratio = 0.44, 95% confidence interval = 0.23-0.84) after we adjusted for numerous social, medical, and health parameters.

DISCUSSION

The findings suggest that leisure activities devoid of social or physical benefits may nonetheless contribute to improved aging, predicting reduced mortality among men. A broader definition of leisure activities may be useful when considering the impact of these activities among older people.

Going Outdoors Daily Predicts Long-Term Functional and Health Benefits Among Ambulatory Older People

Objective: This article examines the association between frequency of going out of the house and health and functional status among older people. Method: A randomly chosen cohort of ambulatory participants born in 1920 or 1921 from the Jerusalem Longitudinal Study underwent assessments for health, functional, and psychosocial variables at ages 70 and 77. Twelve-year mortality data were collected. Results: Women went out daily less than did men. Participants going out daily at age 70 reported significantly fewer new complaints at age 77 of musculoskeletal pain, sleep problems, urinary incontinence, and decline in activities of daily living (ADLs). Logistic regression analysis indicated that not going out daily at age 70 was predictive of subsequent dependence in ADL, poor self-rated health, and urinary incontinence at age 77. Discussion: Going out daily is beneficial among independent older people, correlating with reduced functional decline and improved health measures.

Evolution of Medication Use in Jerusalem Elders

BACKGROUND

While overall rates of medication use have been increasing over time, less is known about how medication use changes within individuals as they age.

OBJECTIVE

The aim of this study was to evaluate changes in medication use and predictors of medication accrual among community-dwelling elders followed for a 7-year period, from age 70 +/- 1 years to age 77 +/- 1 years.

METHODS

The study was a community-based, longitudinal, cohort study. The study group consisted of 280 patients from the Jerusalem Longitudinal Study, a population-based sample of Jerusalem residents born in 1920-1 who underwent extensive evaluation in 1990-1 and again in 1997-8. The main outcome measure of the study was the change in the total number of medications taken between baseline and follow-up. Medication use was assessed by home interviews.

RESULTS

Half of the sample were men. Medication use more than doubled over the 7-year study period, from a mean of 2.0 to 5.3 medications per patient (p < 0.001), and 57 patients (20%) increased their total drug use by six or more medications. Vitamins, minerals and cardiovascular medications were the most commonly prescribed medications at follow-up, and accounted for approximately half of the total increase in medication use. On multivariable logistic regression analyses, decline in self-rated health was the strongest predictor of above-median increases in medication use (odds ratio [OR] 3.2; 95% CI 1.8, 6.2). The only nonclinical predictor of above-median increases in medication use was good social engagement at baseline (OR 1.8; 95% CI 1.1, 3.1).

CONCLUSION

Medication use in Jerusalem elders grew rapidly over the 1990s, more than doubling in volume over a 7-year period. While health status was the factor most strongly predictive of the degree of change, the magnitude of increase for elders as a whole suggests major changes in prescribing practices over this interval.

Usefulness of nocturia as a mortality risk factor for coronary heart disease among persons born in 1920 or 1921

Cardiovascular events are clustered in the morning hours, after increases in blood pressure and heart rate that accompany awakening and arising. Similar hemodynamic changes occur during the night after nocturnal awakening and getting up. Such changes are common among older patients who have nocturia frequently and rise to urinate. We tested the hypothesis that nocturia may be associated with increased mortality in a population sample of 456 subjects born from 1920 to 1921, examined in 1990, and followed for total mortality until 2002. At baseline, they were questioned about nocturia (> or =2 times at night) as part of a detailed questionnaire and examination. Twelve-year survival was significantly lower (61% vs 72%, p = 0.0206) among subjects reporting nocturia (n = 160, 64% men) compared with those without nocturia (n = 296, 50% men). After accounting for numerous confounders, a proportional hazard model determined the mortality hazard ratio (HR) for nocturia alone to be 0.89 (95% confidence interval [CI] 0.55 to 1.43). The interaction between nocturia and previous coronary heart disease (CHD) was highly significant (p <0.0001), with an interaction variable HR of 2.16 (95% CI 1.01 to 4.61). Survival of patients who had CHD with nocturia (n = 54) versus those without nocturia (n = 65) was 44% versus 66% (p = 0.0201). Among patients with CHD, the mortality HR for nocturia was 2.11 (95% CI 1.16 to 4.00). In conclusion, nocturia is a significant independent predictor of mortality among 70-year-old patients with known CHD and thus warrants special attention.

Chronic back pain among the elderly: prevalence, associations, and predictors

STUDY DESIGN

A longitudinal age homogeneous cohort study.

OBJECTIVE

To describe the prevalence, nature, and predictors of chronic back pain (CBP) in older people.

SUMMARY OF BACKGROUND DATA

CBP is a growing source of morbidity among the elderly. Few longitudinal studies exist, and its time course and predictors are largely undefined.

METHODS

The Jerusalem Longitudinal Study assessed 277 subjects aged 70 years at baseline and 77 years at follow-up. Data collection included back pain symptoms, psychosocial, functional, and physical domains.

RESULTS

The prevalence of CBP increased from 44% to 58% at ages 70 and 77 years, respectively, while frequency and severity decreased. CBP was associated with female gender, economic difficulties, loneliness, fatigue, poor self-rated health, dependence in activities of daily living, joint pain, and obesity. Depression was associated at age 70 years, and unemployment, not leaving the house for leisure, poor sleep satisfaction, hypertension, and osteoporosis were at age 77 years. Predictors of CBP at age 77 years were female gender, loneliness, joint pain, hypertension, and preexisting CBP. Unemployment and not leaving the house for leisure showed a trend toward significance.

CONCLUSION

CBP is increasingly common in the elderly. Psychosocial factors, female gender, hypertension, and existing joint pain identify individuals most at risk.

Global sleep satisfaction of older people: the Jerusalem Cohort Study

OBJECTIVES

To describe the nature of global sleep satisfaction (GSS) of older people and the factors associated with it.

DESIGN

A 7-year follow-up of an age-homogenous cohort.

SETTING

Community based.

PARTICIPANTS

Two hundred ninety subjects aged 70 at baseline and 77 at follow-up.

MEASUREMENTS

Self-reported sleep domains and a comprehensive assessment of health variables, including psychosocial, physical, and functional factors, at ages 70 and 77.

RESULTS

GSS was found to be poor in 25% of subjects at ages 70 and 77, with an estimated average annual remission rate of 7% and an annual incidence of 2.4%. Poor GSS at ages 70 and 77 was significantly associated with difficulty falling asleep, awakening feeling tired, two or more nocturnal awakenings, and taking sleeping tablets. Significant cross-sectional associations were found at age 70 and 77 between poor GSS and poor self-rated health, general fatigue, depression, dependence in one or more activities of daily living, and low level of physical activity. In a regression analysis, risk factors at age 70 for subsequent poor GSS were loneliness, depression, poor self-rated health, economic difficulties, back pain, obesity, and prior poor GSS. The only significant long-term association was between poor GSS and poor self-rated health. GSS did not influence mortality data.

CONCLUSION

Poor GSS in older people is common and chronic. Its chief determinants are loneliness, depression, poor self-rated health, economic difficulties, back pain, and obesity. It predicts poor self-rated health but not increased mortality.

Moderate renal insufficiency at 70 years predicts mortality

BACKGROUND

Glomerular filtration rate (GFR) diminishes with age. Kidney function in the elderly is often assessed by serum creatinine alone, although it is insensitive in this age group. Formulae for predicting GFR are not widely used.

AIM

To study the effect of low predicted GFR on mortality.

DESIGN

Longitudinal cohort study.

SETTING

The community-based Jerusalem Seventy Year Olds Longitudinal Study.

METHODS

We studied 445 subjects, all aged 70 years, using questionnaires, a medical examination with history-taking, and standard laboratory tests. Moderate renal insufficiency was defined as a predicted GFR of <60 ml/min, based on the Cockcroft-Gault (CG) and the Modification of Diet in Renal Disease (MDRD) equations.

RESULTS

Predicted GFR was normally distributed, with a mean +/- SD of 62.4 +/- 15.27 ml/min. Predicted GFR was <60 ml/min in 221 (46%), most of whom had normal serum creatinine. Twelve-year mortality was 38.7% in these 221 vs. 27% in the other 204. The survival advantage was already evident after 3 years. Under Cox proportional hazard analysis using numerous common risk factors as independent variables, lower predicted GFR had a significant mortality risk (hazard ratio 2.108, 95%CI 1.43-3.12, p = 0.0002).

DISCUSSION

In community-dwelling elderly people, moderate renal insufficiency as assessed using the CG equation is a strong and independent predictor of mortality. Most of these at-risk patients have 'normal' serum creatinine.

Strategies to enhance longevity and independent function: the Jerusalem Longitudinal Study

PURPOSE

To analyze the impact of medical and social factors on survival and function from age 70 to 82 and point to possible genetic basis for differences.

MATERIALS AND METHODS

Longitudinal, cohort study of a representative sample of Jerusalem residents, born 1920-1921. At age 70, 463 subjects underwent a thorough interview eliciting social determinants as well as a medical history and examination and laboratory investigation. At age 77,265 of the survivors, 71%, were re-examined. In 2002, all death certificates in Israel were reviewed. End points were performance of basic and advanced tasks with ease at age 77 and survival to age 82 or life span in subjects who had succumbed. The independent influence of each factor was tested using logistic regression.

RESULTS

89.6% of women were alive after 6 years and 77.4% after 12. Survival for men was 79.9% and 59.8%, respectively. Social factors predominated in the correlation with longer life: financial security, p=.0004; volunteer activity, p=.0002; regular exercise, p=.0002; positive self-assessed health, p<.0001; and activities of daily living (ADL) independence, p<.0001. Less striking but significant correlation for longevity was noted for avoiding naps, p=.04 and instrumental activities of daily living (IADL) independence, p=.048. Medical conditions associated with increased mortality included diabetes, p<.0001; coronary artery disease, p=.0002; impaired vision, p=.0007; and renal insufficiency, p=.008. Anemia and disturbed sleep did not independently correlate with mortality while the association with hypertension did not reach statistical significance, p=.056. In a regression to determine the independent impact of medical and social factors on mortality, unimpaired renal function, good vision, avoiding afternoon naps, volunteer or compensated work, physical activity and IADL independence all correlated with improved survival. Moreover, good vision, volunteer work or work for pay and physical activity were independently associated with continued ADL independence after 7 years.

CONCLUSIONS

These findings highlight the ability of social, economic and functional factors to modify genetic influence on survival and function. Increased physical and social activity is an important tool to lengthen the span of robust function. The role of heredity in determining function and mortality may be expressed through diverse pathways.

Candidate genes associated with ageing and life expectancy in the Jerusalem longitudinal study

In an exploratory study, 11 common polymorphisms were examined for contributing to longevity including: apolipoprotein E (apoE), methylenetetrahydrofolate reductase (MTHFR), cathepsin D (CAD), superoxide dismutase 2 (SOD2), angiotensinogen (AGT) and insulin-like growth factor 2 (IGF2), Leiden factor 7, p53 oncogene, dopamine D4 receptor (DRD4) and the serotonin transporter (SERT). Genotype and allele frequencies of these genes were compared in 224 older (75 years) Jewish Jerusalem residents of Ashkenazi ethnicity to a group of 441 younger subjects (22 years). Nominally significant results provide suggestive evidence in the Ashkenazi group that apoE, MHTFR, SOD2, IGF2 ApaI, and factor VII are risk factors for a single outcome, survival to 75. Overall, the more genetically homogenous Ashkenazi ethnic group showed evidence for association in five genes examined suggesting that future studies in this population would gainfully focus on this ethnic group.

Sex differences in the effect of heart rate on mortality in the elderly

OBJECTIVES

To examine the association between heart rate and mortality risk in the elderly.

DESIGN

Longitudinal cohort.

SETTING

Outpatient.

PARTICIPANTS

Four hundred twenty-two people, aged 70 upon entry, were surveyed and followed for 6 years.

MEASUREMENTS

Pulse rate was measured manually, while sitting and standing, and heart rate was measured from electrocardiogram recordings. The population was divided into quartiles of heart rate, with the top quartile comprising those with heart rate greater than 77 beats per minute (bpm) and the bottom quartile those with heart rate less than 60 bpm.

RESULTS

After controlling for possible confounders, there was a clear correlation (r) between heart rate and all-cause mortality in elderly women (r=0.25, P=.0003). The correlation in women was observed using the three different methods for measuring heart rate. Heart rate was associated with all-cause and cardiovascular mortality. There was no relationship between heart rate and level of exercise or smoking status. In multiple regression analysis, the increased risk of death in the women was independent of previous cardiovascular or cerebrovascular disease, hypertension, anemia, congestive heart failure, smoking, and level of exercise or activities of daily living (relative odds ratio (ROR)=3.37, 95% confidence interval (CI)=0.96-11.8). When women using beta-blockers were excluded, this relationship became even stronger (ROR=8.5, 95% CI=1.19-60.1).

CONCLUSION

Elevated heart rate is related to increased mortality in elderly women, thus representing a simple index of general health status in this population. Elevated heart rate did not predict mortality in elderly men.

Effect of exercise on ease in performing activities of daily living and instrumental activities of daily living from age 70 to 77: the Jerusalem longitudinal study

OBJECTIVES

To determine the prevalence of independence and ease of performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) at ages 70 and 77 in a well-characterized cohort and to measure the effect of regular exercise at age 70 on independence and ease of performance 7 years later.

DESIGN

Two stages of a longitudinal study of an age-homogeneous cohort employing extensive interview data, physical examination, and clinical laboratory investigation.

SETTING

Home-based interviews and examinations in Jerusalem.

PARTICIPANTS

Two hundred eighty-seven west Jerusalem residents, born between June 1920 and May 1921, who participated fully in two phases of an ongoing longitudinal cohort study. Subjects were culled from a larger study population of 605 in the first phase and 1,021 in the second phase.

MEASUREMENTS

Two-stage comprehensive demographic, social, and economic profile; medical history and examination; cognitive and affective assessment; and clinical laboratory studies performed in 1990-91 and 1997-98. The investigation questionnaire included details of ADL and IADLs and voluntary exercise.

RESULTS

Most aspects of personal and social life did not change from age 70 to 77. Independence in ADLs remained high, as did self-reliance in IADLs for women. A more-sensitive marker of diminished function was reported ease in performance, which declined for use of the toilet, dressing, and all spheres of IADLs. For nearly every task, subjects who reported exercising 4 days a week at age 70 were more likely to report ease in performance at age 77. In a logistic regression accounting for the presence of diabetes mellitus, hypertension, obesity, chronic back pain, loneliness, and performance with ease at age 70 and deterioration in self-assessed health from age 70 to 77, ease of performance in at least three of four ADL tasks was independently related to exercise at age 70 for women (odds ratio (OR) = 8.5, 95% confidence interval (CI) = 2.0-36.2) and for men (OR = 4.3, 95% CI = 1.1-17.1). Ease of independent function in at least four of five IADL tasks also correlated to exercise for men in this regression (OR = 3.7, 95% CI = 1.1-12.2) but not for women (OR = 2.0, 95% CI = 0.6-6.3). Ease in shopping, alternatively, correlated with physical activity for men (OR = 4.3, 95% CI = 1.5-12.0) and women (OR = 2.6, 95% CI = 1.1-6.1).

CONCLUSIONS

Subjects remained active and independent at age 77. Reported ease of performance declined and revealed changes in function. Exercise at least four times a week at age 70 preserved ease of performance at age 77 independent of the influence of specific disease or general self-assessed health.

The effects of physical activity on mortality in the Jerusalem 70-Year-Olds Longitudinal Study

OBJECTIVE

To study the association between physical activity and mortality in older men and women.

DESIGN

A community-based cohort study: the Jerusalem 70-Year-Olds Longitudinal Study.

PARTICIPANTS

A systematically selected and representative sample of all residents of the western part of Jerusalem born in 1920-1921: 456 subjects, 25% of the total population.

MEASUREMENTS

An extensive social and medical profile was developed by extensive interview and physical and ancillary examination. Medical diagnoses were established and subjects reported their level of regular physical activity.

RESULTS

Unadjusted mortality at 6-year follow-up was significantly greater for subjects reporting no regular exercise than for those walking as little as 4 hours weekly (23.4% vs 9.9%, odds ratio (OR) = 2.77; 95% confidence interval (CI), 1.64-4.69). The significance of these benefits was demonstrated for males as well as for females (30.28% vs 12.14%, P < .001, 16.19% vs 6.86%, P = .036, respectively). Logistic regression analysis demonstrated the survival advantage to be independent of gender, smoking, subjective economic hardship, or preexisting medical conditions (hypertension; diabetes; coronary artery, cerebrovascular, renal, and respiratory diseases; anemia; and malignancy). Increased regularity of activity correlated with declining mortality. The odds ratios for mortality compared to the sedentary group were 0.73 (CI, 0.33-1.62) for those doing sports activity at least twice weekly, 0.41 (CI, 0.19-0.91) for those walking at least 4 hours weekly, 0.14 (CI, 0.04-0.50) for those exercising daily, and 0.40 (CI, 0.22-0.72) for all levels of physical activity combined.

CONCLUSIONS

These results suggest that regular physical activity confers increased survival in the aged. It is proposed that older people be encouraged to engage in regular, moderate physical activity.