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Montero-Sandiego E, Ruiz-Robledillo N, Ferrer-Cascales R, Clement-Carbonell V, Alcocer-Bruno C, Albaladejo-Blázquez N. Spanish validation of the simple lifestyle indicator questionnaire: validity and reliability analysis. Front Public Health 2024; 11:1146010. [PMID: 38264245 PMCID: PMC10803412 DOI: 10.3389/fpubh.2023.1146010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction It has been shown that lifestyle is a highly modifiable determinant having a direct effect on the health status. Therefore, short and simple questionnaires assessing the lifestyle of the general and clinical population are needed to create interventions on behavioral aspects that can improve the health status. The Simple Lifestyle Indicator Questionnaire (SLIQ) is a validated health scale in English that combines five lifestyle factors: diet, exercise, alcohol consumption, tobacco use, and stress level. The objective of this study was to validate the SLIQ questionnaire in Spanish by analyzing the scale's validity and reliability. Its discriminatory power of the scale was also examined by evaluating the differences in health outcomes according to the levels of adherence to a healthy lifestyle. Methods The sample consisted of 745 participants with an average age of 39.94 (SD: 16.99). A transcultural adaptation process was carried out to validate the SLIQ questionnaire in the Spanish context, to determinate the structural equivalence of the Spanish version as compared to the English version, and to assess the psychometric properties of the scale. PREDIMED and IPAQ scales were used to analyze the convergent validity of the Spanish version of the SLIQ regarding to diet and exercise, and the questionnaires SF-12 and DASS-21 questionnaires were used to assess the capacity of the Spanish version of the SLIQ to discriminate health status related to different levels of reported lifestyles. Results Regarding validity, the results indicate significant correlations between the different dimensions of the SLIQ questionnaire and those used as a reference. As for reliability, the test-retest analyses reveal a high temporal consistency for the scores obtained on the questionnaire. Finally, the differences found in anxiety, depression, and quality of life, with regard to the different levels of adherence in the SLIQ questionnaire, suggest that the questionnaire's Spanish version has adequate discriminatory power. Discussion The obtained correlation coefficients between the SLIQ and the other standardized measures pointed out the adequate convergent validity of the instrument. Moreover, the test-retest results demonstrated the stability of the results obtained through this questionnaire. Finally, the lifestyle categories derived from the SLIQ showed a high ability to discriminate between participants' health profiles. Hence, it can be concluded that the Spanish version of the SLIQ questionnaire is a valid and reliable tool for the quick and effective assessment of lifestyle.
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Affiliation(s)
| | - Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
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Nilaweera D, Gurvich C, Freak-Poli R, Woods RL, Owen A, McNeil J, Nelson M, Stocks N, Ryan J. The association between adverse events in later life and mortality in older individuals. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 16:100210. [PMID: 37753199 PMCID: PMC10518669 DOI: 10.1016/j.cpnec.2023.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Background Stress can have adverse impacts on health, particularly when it is chronic or resulting from major adverse events. Our study investigated whether relatively common adverse events in older individuals were associated with an increased risk of death, as well as cause-specific death and potential gender differences. Methods Participants were 12896 community-dwelling Australians aged ≥70 years at enrolment into the ASPREE (ASPirin in Reducing Events in the Elderly) study and without known life-limiting disease. A questionnaire administered in the year after enrolment, collected information on ten adverse events experienced in the past year. Mortality status was verified by multiple sources including health records and the National Death Index across a maximum of 10 years. Underlying causes of death were determined using clinical information by two adjudicators. Cox-proportional hazards regression models were used to estimate mortality risk. Results Two of the ten adverse events were associated with an increased risk of mortality in fully adjusted models. A 69% increased risk of mortality was observed in participants who reported their spouse/partner had recently died (95% CI: 1.19-2.39, P < 0.01). Cancer-related but not cardiovascular deaths also increased. Participants with a seriously ill spouse/partner also had a 23% increased risk of mortality (HR: 1.23, 95% CI: 1.02-1.48, P = 0.03). There was a tendency for these associations to be stronger among men than women. Limitations Perceived stress and cortisol were not measured, thus limiting our understanding of the psychological and physiological impacts of adverse events. Conclusions Experiencing adverse events in later-life, especially the death of a spouse/partner, may be a risk factor for earlier mortality. These findings may increase public health awareness and better inform initiatives for particular groups, including bereaved men.
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Affiliation(s)
- Dinuli Nilaweera
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline Gurvich
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ferreira LK, Filgueiras Meireles JF, de Oliveira Gomes GA, Caputo Ferreira ME. Development and Psychometric Evaluation of a Lifestyle Evaluation Instrument for Older Adults. Percept Mot Skills 2023; 130:1901-1923. [PMID: 37286477 DOI: 10.1177/00315125231182173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Brazil is experiencing an accelerated period of population aging, with important implications for individuals, families, and the society at large. Lifestyles for the elderly can have both positive and negative health effects and are characterized by behaviors that individuals constantly reproduce in day-to-day life. However, few assessment instruments are aimed at evaluating lifestyles, and this has hampered research development. Thus, our aim in this study was to develop and evaluate the psychometric qualities of a new instrument to assess older adults' lifestyles. We developed this single scale to assess the lifestyles of older men and women using the sequential mixed method. Individuals over 60 years old of both sexes participated in this study of several phases. In Phase 1, we produced a 96-item single scale instrument, based on a literature review, previous scales, and qualitative research. In Phase 2, we verified the scale's content validity with help from 12 experts and 20 members of a target audience, aged between 60-84 years, deleting some items and reworking others. In Phase 3, we analyzed the psychometric qualities of the new scale in a sample of 700 older adults, aged 60 and above, from the five regions of Brazil, using both exploratory and confirmatory factor analysis. Our completed "Older Adult Lifestyle Scale" (OALS) is composed of 19 items divided into four subscales. The OALS has shown good psychometric qualities for Brazilian older adults over 60 years of age, and we can now recommend its use in this population.
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Lockery JE, Collyer TA, Woods RL, Orchard SG, Murray A, Nelson MR, Stocks NP, Wolfe R, Moran C, Ernst ME. Potentially inappropriate medication use is associated with increased risk of incident disability in healthy older adults. J Am Geriatr Soc 2023; 71:2495-2505. [PMID: 37039393 PMCID: PMC10524300 DOI: 10.1111/jgs.18353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/12/2023] [Accepted: 03/05/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications (PIMs). However, most PIMs research has focused on older people in aged or inpatient care, creating an evidence gap for community-dwelling older adults. To address this gap, we investigated the impact of PIMs use in the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial cohort. METHODS Analysis included 19,114 community-dwelling ASPREE participants aged 70+ years (65+ if US minorities) without major cardiovascular disease, cognitive impairment, or significant physical disability. PIMs were defined according to a modified 2019 AGS Beers Criteria. Cox proportional-hazards regression models were used to estimate the association between baseline PIMs exposure and disability-free survival, death, incident dementia, disability, and hospitalization, with adjustment for sex, age, country, years of education, frailty, average gait speed, and comorbidities. RESULTS At baseline, 7396 (39% of the total) participants were prescribed at least one PIM. Compared with those unexposed, participants on a PIM at baseline were at an increased risk of persistent physical disability (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.21, 1.80) and hospitalization (adjusted HR 1.26, 95% CI 1.20, 1.32), but had similar rates of disability-free survival (adjusted HR 1.02; 95% CI 0.93, 1.13) and death (adjusted HR 0.92, 95% CI 0.81, 1.05). These effects did not vary by polypharmacy status in interaction analyses. PIMs exposure was associated with higher risk of disability followed by hospitalization (adjusted HR 1.92, 95% CI 1.25, 2.96) as well as vice versa (adjusted HR 1.54, 95% CI 1.15, 2.05). PPIs, anti-psychotics and benzodiazepines, were associated with increased risk of disability. CONCLUSIONS PIMs exposure is associated with subsequent increased risk of both incident disability and hospitalization. Increased risk of disability prior to hospitalization suggests that PIMs use may start the disability cascade in healthy older adults. Our findings emphasize the importance of caution when prescribing PIMs to older adults in otherwise good health.
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Affiliation(s)
- Jessica E Lockery
- Cancer, Ageing and Vaccines Research Group, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Taya A Collyer
- Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Suzanne G Orchard
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Anne Murray
- Hennepin Healthcare Research Institute, Hennepin Healthcare, Minnesota, U.S
- Division of Geriatrics, Department of Medicine, University of Minnesota, Minnesota, U.S
| | - Mark R Nelson
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Nigel P Stocks
- Discipline of General Practice, University of Adelaide, South Australia, Australia
| | - Rory Wolfe
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Chris Moran
- School of Public Health & Preventive Medicine, Monash University, Melbourne VIC, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, U.S
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López-Herreros J, Martínez-González MA, Gea A, Sánchez-Villegas A, Dierssen-Sotos T, Jiménez-Moleón JJ, Ruiz-Canela M, Toledo E. Health-related quality of life and mortality in the 'Seguimiento Universidad de Navarra' prospective cohort study. Exp Gerontol 2023; 178:112224. [PMID: 37244372 DOI: 10.1016/j.exger.2023.112224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To study the association between health-related quality of life (HRQoL) and all-cause mortality in a healthy middle-aged Mediterranean cohort. METHODS We included 15,390 participants -mean age 42.8 years at first HRQoL ascertainment, all university graduates-. HRQoL was assessed with the self-administered Medical Outcomes Study Short Form-36 (SF-36) twice, with a 4-year gap. We used multivariable-adjusted Cox regression models to address the relation between self-reported health and Physical or Mental Component Summary (PCS-36 or MCS-36) and mortality, and their interaction with prior comorbidities or adherence to the Mediterranean diet (MedDiet). RESULTS Over 8.7 years of median follow-up time, 266 deaths were identified. Hazard ratio (HR) for the excellent vs. poor/fair category in self-reported health was 0.30 (95 % confidence interval (CI), 0.16-0.57) in the model with repeated measurements of HRQoL. Both the PCS-36 (HRquartile4(Q4)vs.Q1 0.57 [95%CI, 0.36-0.90], ptrend < 0.001; HRper+10points: 0.64 [95%CI, 0.54-0.75]) and the MCS-36 (HRQ4vs.Q1 0.67 [95%CI, 0.46-0.97], ptrend = 0.025; HRper+10points: 0.86 [95%CI, 0.74-0.99]) were inversely associated with mortality in the model with repeated measurements of HRQoL. Previous comorbidities or adherence to the MedDiet did not modify these associations. CONCLUSIONS Self-reported HRQoL -assessed as self-reported health, PCS-36 and MCS-36- obtained with the Spanish version of the SF-36 were inversely associated with mortality risk, regardless of the presence of previous comorbidities or adherence to the MedDiet.
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Affiliation(s)
- J López-Herreros
- Universidad de Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain
| | - M A Martínez-González
- Universidad de Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; Department of Nutrition, Harvard T. H Chan School, Boston, MA 02115, USA
| | - A Gea
- Universidad de Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - A Sánchez-Villegas
- Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain; ISFOOD - Institute for Innovation & Sustainable Development in Food Chain, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - T Dierssen-Sotos
- Biomedical Research Network Centre for Pathophysiology of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain; IDIVAL Santander, 39011 Santander, Spain; Faculty of Medicine, University of Cantabria, 39011 Santander, Spain
| | - J J Jiménez-Moleón
- Biomedical Research Network Centre for Pathophysiology of Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain; Universidad de Granada, Department of Preventive Medicine and Public Health, Granada, Spain; Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - M Ruiz-Canela
- Universidad de Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - E Toledo
- Universidad de Navarra, Department of Preventive Medicine and Public Health, Pamplona, Spain; Biomedical Research Network Centre for Pathophysiology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, Madrid, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
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6
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Ribeiro-Gonçalves JA, Costa PA, Leal I. Double Stigma in Portuguese Lesbian, Gay, and Bisexual Older Adults: A Study of Health Status. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:886-901. [PMID: 37222608 DOI: 10.1080/0092623x.2023.2215258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The double stigma-sexual stigma and ageism-can affect the health status of lesbian, gay, and bisexual (LGB) older adults, but little is known about this topic in Portugal and internationally. The aim of this study was to assess the health status and the prevalence of chronic diseases of Portuguese LGB older adults, as well as to assess the relationship between double stigma and health status. A sample of 280 Portuguese LGB older adults completed a chronic disease questionnaire, the Homosexuality-Related Stigma Scale, the Ambivalent Ageism Scale, and the SF-12 Short Form Health Survey. A structural equation model was performed using the double stigma variables as independent variables and health status as outcome. The mental health status of Portuguese LGB older adults was lower when compared to people from studies from more than 10 countries. Higher sexual self-stigma, sexual enacted stigma related to health care, and benevolent ageism significantly explained the worse general health status. The double stigma significantly affects the health status of these older adults in a profile of internalization of sexual stigma and benevolent age discrimination, and not necessarily by a hostile/aggressive profile. More research is needed on the double stigma.
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Affiliation(s)
| | | | - Isabel Leal
- William James Center for Research, ISPA - University Institute, Lisbon, Portugal
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Wang Y, Owen A, Franks A, Ackerman I, Fitzgerald SM, Liew S, Woods RL, Wluka AE, McNeil JJ, Cicuttini FM. Functional outcomes following knee replacement in community-dwelling older adults. BMC Geriatr 2023; 23:261. [PMID: 37131170 PMCID: PMC10152584 DOI: 10.1186/s12877-023-03925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/24/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Knee replacements are increasingly performed in older adults but uncertainty remains regarding their benefits in the context of age-related decline in physical function and other comorbidities. This study aimed to examine (1) the effect of knee replacement on functional outcomes in the context of age-related decline in physical function and (2) the factors associated with minimal important improvement in physical function after knee replacement in community-dwelling older adults aged ≥ 70 years. METHODS This cohort study was performed within the ASPREE trial, with 889 participants undergoing knee replacement during the trial and 858 age- and sex-matched controls without knee or hip replacement identified from 16,703 Australian participants aged ≥ 70 years. Health-related quality of life was assessed annually using the SF-12, including its physical and mental component summary (PCS and MCS). Gait speed was measured biennially. Multiple linear regression and analysis of covariance were used to adjust for potential confounders. RESULTS Participants with knee replacement had significantly lower pre- and post-replacement PCS scores and gait speed compared with age- and sex-matched controls. Participants with knee replacement had significant improvement in PCS score following knee replacement (mean change 3.6, 95% CI 2.9-4.3) while PCS score remaining unchanged in age- and sex-matched controls (-0.02, 95% CI -0.6 to 0.6) during follow-up period. The greatest improvements were observed for bodily pain and physical function. Following knee replacement, 53% of participants experienced minimal important improvement in PCS score (increased by ≥ 2.7), while 24% experienced worsened PCS score (reduced by > 2.7). Participants experiencing improved PCS score postoperatively had significantly lower PCS and higher MCS scores pre-surgery. CONCLUSIONS Although community-based older adults experienced a significant improvement in PCS scores after knee replacement, their postoperative physical functional status remained significantly lower than age- and sex-matched controls. The degree of preoperative physical function impairment was a strong predictor of functional improvement, suggesting that this could be an important consideration when identifying older people most likely to benefit from knee replacement surgery.
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Affiliation(s)
- Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Angus Franks
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ilana Ackerman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sharyn M Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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Phyo AZZ, Ryan J, Freak-Poli R. The role of health-related quality of life in risk prediction for developing cardiovascular disease, dementia and all-cause death among general older adults. Front Public Health 2022; 10:1014019. [PMID: 36466450 PMCID: PMC9713931 DOI: 10.3389/fpubh.2022.1014019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
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Wang Y, Owen A, Franks A, Ackerman I, Fitzgerald SM, Liew S, Woods RL, Wluka AE, McNeil JJ, Cicuttini FM. Functional Outcomes Following Hip Replacement in Community-Dwelling Older Adults. J Clin Med 2022; 11:jcm11175117. [PMID: 36079051 PMCID: PMC9457152 DOI: 10.3390/jcm11175117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
Uncertainty remains regarding the benefit of hip replacement in older adults in the context of age-related decline in physical function. This study aimed to examine the effect of hip replacement on functional outcomes and identify factors associated with clinically important improvement in physical function postoperatively in community-dwelling older adults. This cohort study was performed within the ASPREE trial, with 698 participants receiving hip replacement and 677 age- and sex-matched controls without knee or hip replacement during the trial drawn from 16,703 Australian participants aged ≥70 years. Health status (physical and mental component summary [PCS and MCS]) was assessed annually using the SF-12. Participants receiving hip replacement had significantly lower pre- and post-replacement PCS scores compared with controls (p < 0.0001). There was significant improvement in PCS score following hip replacement (mean change 4.9, 95%CI 4.0−5.7) but no change in controls (0.01, 95%CI −0.7−0.7). Following hip replacement, 46.7% of participants experienced clinically important improvement in PCS score, while 15.5% experienced worsened PCS score. Participants experiencing improved postoperative PCS score had significantly lower PCS and higher MCS scores preoperatively. The degree of preoperative physical function impairment was a significant indicator of older people most likely to benefit from hip replacement surgery.
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Affiliation(s)
- Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Angus Franks
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Ilana Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Sharyn M. Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Susan Liew
- Alfred Hospital, Melbourne 3004, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Anita E. Wluka
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Flavia M. Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Correspondence: ; Tel.: +61-39-9030158
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10
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Ward SA, Storey E, Gasevic D, Naughton MT, Hamilton GS, Trevaks RE, Wolfe R, O'Donoghue FJ, Stocks N, Abhayaratna WP, Fitzgerald S, Orchard SG, Ryan J, McNeil JJ, Reid CM, Woods RL. Sleep-disordered breathing was associated with lower health-related quality of life and cognitive function in a cross-sectional study of older adults. Respirology 2022; 27:767-775. [PMID: 35580042 PMCID: PMC9540665 DOI: 10.1111/resp.14279] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/14/2022] [Indexed: 12/14/2022]
Abstract
Background and objective The clinical significance of sleep‐disordered breathing (SDB) in older age is uncertain. This study determined the prevalence and associations of SDB with mood, daytime sleepiness, quality of life (QOL) and cognition in a relatively healthy older Australian cohort. Methods A cross‐sectional analysis was conducted from the Study of Neurocognitive Outcomes, Radiological and retinal Effects of Aspirin in Sleep Apnoea. Participants completed an unattended limited channel sleep study to measure the oxygen desaturation index (ODI) to define mild (ODI 5–15) and moderate/severe (ODI ≥ 15) SDB, the Centre for Epidemiological Studies Scale, the Epworth Sleepiness Scale, the 12‐item Short‐Form for QOL and neuropsychological tests. Results Of the 1399 participants (mean age 74.0 years), 36% (273 of 753) of men and 25% (164 of 646) of women had moderate/severe SDB. SDB was associated with lower physical health‐related QOL (mild SDB: beta coefficient [β] −2.5, 95% CI −3.6 to −1.3, p < 0.001; moderate/severe SDB: β −1.8, 95% CI −3.0 to −0.6, p = 0.005) and with lower global composite cognition (mild SDB: β −0.1, 95% CI −0.2 to 0.0, p = 0.022; moderate/severe SDB: β −0.1, 95% CI −0.2 to 0.0, p = 0.032) compared to no SDB. SDB was not associated with daytime sleepiness nor depression. Conclusion SDB was associated with lower physical health‐related quality of life and cognitive function. Given the high prevalence of SDB in older age, assessing QOL and cognition may better delineate subgroups requiring further management, and provide useful treatment target measures for this age group. The clinical implications for sleep‐disordered breathing (SDB) in older age remain uncertain. This study of healthy community‐dwelling older Australians reports significant associations between SDB and a lower physical health‐related quality of life, in contrast to other studies of SDB in older age, and between SDB and lower cognitive function. See relatededitorial
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Affiliation(s)
- Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Kensington, New South Wales.,Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, New South Wales
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria.,Centre for Global Health Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Matthew T Naughton
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,The Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Garun S Hamilton
- Department of Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Ruth E Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Walter P Abhayaratna
- College of Health and Medicine, Australian National University, Acton, Australian Capital Territory, Australia.,Academic Unit of Internal Medicine, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Sharyn Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria
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11
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Phyo AZZ, Gonzalez-Chica DA, Stocks NP, Woods RL, Fisher J, Tran T, Owen AJ, Ward SA, Britt CJ, Ryan J, Freak-Poli R. Impact of economic factors, social health and stressful life events on physical health-related quality of life trajectories in older Australians. Qual Life Res 2022; 31:1321-1333. [PMID: 34677781 PMCID: PMC8532095 DOI: 10.1007/s11136-021-03021-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE Physical health-related quality of life (HRQoL) is associated with adverse health outcomes, including hospitalizations and all-cause mortality. However, little is known about how physical HRQoL changes over time in older people and the predictors of this trajectory. This study (a) identified trajectories of physical HRQoL among older people and (b) explored whether economic factors, social health or stressful life events impact physical HRQoL trajectories. METHOD A cohort of 12,506 relatively 'healthy' community-dwelling Australians aged ≥ 70 years (54.4% females), enrolled in the ASPREE Longitudinal Study of Older Persons (ALSOP) study and was followed for six years. Economic factors, social health and life events in the last 12 months were assessed through a questionnaire at baseline. Physical HRQoL was measured by using the 12-item short form at baseline and annual follow-ups. Growth mixture and structural equation modelling were used to identify physical HRQoL trajectories and their predictors. RESULTS Four physical HRQoL trajectories were identified-stable low (7.1%), declining (9.0%), stable intermediate (17.9%) and stable high (66.0%). Living in more disadvantaged areas, having a lower household income, no paid work, no voluntary work, loneliness and stressful life events (i.e. spousal illness, friend/family illness, financial problem) were associated with a 10%-152% higher likelihood of being in the stable low or declining physical HRQoL trajectory than the stable high group. CONCLUSION Specific stressful life events had a greater impact on adverse physical HRQoL trajectories in older people than other factors. Volunteering may prevent physical HRQoL decline and requires further investigation.
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Affiliation(s)
- Aung Zaw Zaw Phyo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - David A Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Nigel P Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jane Fisher
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Thach Tran
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alice J Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Carlene J Britt
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Department of Epidemiology, Erasmus Medical Centre, 3015 GD, Rotterdam, The Netherlands.
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12
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Agustini B, Lotfaliany M, Mohebbi M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Reid CM, Tonkin A, Ryan J, Williams LJ, Forbes MP, Berk M. Trajectories of depressive symptoms in older adults and associated health outcomes. NATURE AGING 2022; 2:295-302. [PMID: 37117752 DOI: 10.1038/s43587-022-00203-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/10/2022] [Indexed: 04/30/2023]
Abstract
With the progressive aging of the world's population, prolongation of a healthy lifespan in old age has become a medical research priority. The presence of depressive symptoms in later life is associated with poor health prognosis and increased mortality1,2. Here we explore distinct trajectories of depressive symptoms in later life and their association with several health-related outcomes in 19,110 older individuals followed for a median of 4.7 years. Using a latent class, mixed-modeling approach we identified four distinct trajectories of depressive symptoms with scoring patterns of consistently low, moderate, emerging and persistently high. Compared to those with minimal depressive symptoms, membership of any other class was associated with specific patterns of baseline sociodemographic and medical factors. Membership of any group with depressive symptoms was associated with a higher likelihood of health events, including physical disability, cancer and major bleeding episodes. Membership of the persistently depressed class was associated with increased mortality, while a diagnosis of dementia was generally limited to the class with initially low and progressively rising symptoms. The course of depressive symptoms in older individuals can vary widely and depend on several factors. The presence of depressive symptoms, including those that do not meet criteria for major depression, can flag a poor prognosis and risk for specific health conditions. Systematic assessment of depressive symptoms may facilitate early identification of at-risk populations.
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Affiliation(s)
- Bruno Agustini
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.
| | - Mojtaba Lotfaliany
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lana J Williams
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Malcolm P Forbes
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Psychiatry, Orygen, the National Centre of Excellence in Youth Health, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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13
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Phyo AZZ, Gonzalez-Chica DA, Stocks NP, Woods RL, Tran T, Reid CM, Tonkin AM, Nelson MR, McNeil JJ, Murray AM, Gasevic D, Freak-Poli R, Ryan J. Trajectories of physical health-related quality of life and the risk of incident cardiovascular disease events and all-cause mortality in older people. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100117. [PMID: 36959831 PMCID: PMC10031654 DOI: 10.1016/j.ahjo.2022.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Study objective The aim of this study was to identify whether physical component score (PCS) of health-related quality of life trajectories over 4.7-years predicted subsequent risk of incident fatal and non-fatal CVD events, and all-cause mortality. Methods This study included 16,871 community-dwelling people aged ≥65 years enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) trial. PCS was assessed annually using the SF-12 (version-2) over a median 4.7-years (i.e. from baseline (2010-2014) till June 2017). Incident CVD events and all-cause mortality occurring after June 2017 until the second-year after the end of the trial were considered. Growth mixture and logistic regression modelling were used. Results Four PCS trajectories were identified: high (66.5%), intermediate (13.3%), decline (13.8%), and low (6.5%), and there was subsequently a total of 406 (2.50%) incident CVD events, 197 (1.17%) fatal CVD, and 751 (4.45%) deaths. The declining PCS trajectory group had the highest risk of incident CVD (adjusted OR, 1.51; 95% CI 1.14, 1.99), while the low PCS trajectory group had the greatest risk of fatal CVD (adjusted OR, 1.74; 95%CI 1.06, 2.85) and all-cause mortality (adjusted OR, 1.83; 95%CI 1.40, 2.40). After further adjustment for the baseline PCS score, only the association between declining PCS trajectory and incident CVD (adjusted OR, 1.51; 95%CI 1.11, 2.07) remained. Conclusion Our study strengthens the importance of PCS as a predictive measure of CVD and all-cause mortality in older people and also highlights that a declining PCS trajectory could be considered an early predictor of future CVD events.
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Affiliation(s)
- Aung Zaw Zaw Phyo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - David A. Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Nigel P. Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Public Health, Curtin University, Perth, WA 6102, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Mark R. Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Hennepin HealthCare Research Institute, Hennepin HealthCare, Minneapolis, MN 55415, United States
- Division of Geriatrics, Department of Medicine, Hennepin HealthCare and University of Minnesota, Minneapolis, MN 55415, United States
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Corresponding author at: School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC 3004, Australia., (J. Ryan)
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14
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Raparelli V, Zuliani G. Re-appraisal of cardiovascular risk prediction in healthy older people: Have you ever considered the added value of patient-perception of health status? Int J Cardiol 2021; 343:162-163. [PMID: 34474095 DOI: 10.1016/j.ijcard.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Valeria Raparelli
- University Internal Medicine Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy; University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy; Faculty of Nursing, University of Alberta, Edmonton, Canada.
| | - Giovanni Zuliani
- University Internal Medicine Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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15
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Health-related quality of life and incident cardiovascular disease events in community-dwelling older people: A prospective cohort study. Int J Cardiol 2021; 339:170-178. [PMID: 34245793 PMCID: PMC9993351 DOI: 10.1016/j.ijcard.2021.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/17/2021] [Accepted: 07/02/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Lower health-related quality of life (HRQoL) has been shown to predict a higher risk of hospital readmission and mortality in patients with cardiovascular disease (CVD). Few studies have explored the associations between HRQoL and incident CVD. We explored the associations between baseline HRQoL and incident and fatal CVD in community-dwelling older people in Australia and the United States. METHODS Longitudinal study using ASPirin in Reducing Events in the Elderly (ASPREE) trial data. This includes 19,106 individuals aged 65-98 years, initially free of CVD, dementia, or disability, and followed between March 2010 and June 2017. The physical (PCS) and mental component scores (MCS) of HRQoL were assessed using the SF-12 questionnaire. Incident major adverse CVD events included fatal CVD (death due to atherothrombotic CVD), hospitalizations for heart failure, myocardial infarction or stroke. Analyses were performed using Cox proportional-hazard regression. RESULTS Over a median 4.7 follow-up years, there were 922 incident CVD events, 203 fatal CVD events, 171 hospitalizations for heart failure, 355 fatal or nonfatal myocardial infarction and 403 fatal or nonfatal strokes. After adjustment for sociodemographic, health-related behaviours and clinical measures, a 10-unit higher PCS, but not MCS, was associated with a 14% lower risk of incident CVD, 28% lower risk of hospitalization for heart failure and 15% lower risk of myocardial infarction. Neither PCS nor MCS was associated with fatal CVD events or stroke. CONCLUSION Physical HRQoL can be used in combination with clinical data to identify the incident CVD risk among older individuals.
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16
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Effects of aspirin on the long-term management of depression in older people: a double-blind randomised placebo-controlled trial. Mol Psychiatry 2021; 26:5161-5170. [PMID: 33504953 PMCID: PMC8313623 DOI: 10.1038/s41380-021-01020-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/14/2020] [Accepted: 01/07/2021] [Indexed: 01/30/2023]
Abstract
Late-life depression is common and often inadequately managed using existing therapies. Depression is also associated with increased markers of inflammation, suggesting a potential role for anti-inflammatory agents. ASPREE-D is a sub-study of ASPREE, a large multi-centre, population-based, double-blind, placebo-controlled trial of aspirin vs placebo in older Australian and American adults (median follow-up: 4.7 years) of whom 1879 were depressed at baseline. Participants were given 100 mg daily dose of aspirin or placebo. Depressive symptoms were assessed annually using the validated, self-rated short version of the Center for Epidemiological Studies Depression scale. There was a significant increase in depressive scores (0.6; 95% CI 0.2 to 0.9; χ2 (1) = 10.37; p = 0.001) and a decreased score in the mental health component of a quality of life scale (-0.7; 95% CI -1.4 to -0.1; χ2 (1) = 4.74; p = 0.029) in the aspirin group compared to the placebo group. These effects were greater in the first year of follow-up and persisted throughout the study, albeit with small to very small effect sizes. This study failed to demonstrate any benefit of aspirin in the long-term course of depression in this community-dwelling sample of older adults over a 5-year period, and identified an adverse effect of aspirin in the course of depression in those with pre-existing depressive symptoms.
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17
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Phyo AZZ, Ryan J, Gonzalez-Chica DA, Woods RL, Reid CM, Nelson MR, Murray AM, Gasevic D, Stocks NP, Freak-Poli R. Health-related quality of life and all-cause mortality among older healthy individuals in Australia and the United States: a prospective cohort study. Qual Life Res 2021; 30:1037-1048. [PMID: 33389487 PMCID: PMC8005489 DOI: 10.1007/s11136-020-02723-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Previous research has demonstrated that lower health-related quality of life (HRQoL) is associated with higher morbidity and mortality, especially in-patient groups. The association of HRQoL with all-cause mortality in community samples requires further investigation. This study aimed to examine whether HRQoL predicts all-cause mortality in older healthy community-dwelling people from Australia and the United States (U.S.) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. We also explored whether this association varies by gender or country. METHOD A prospective cohort of 19,106 individuals aged 65-98 years, who were without a dementia diagnosis or a known major life-limiting disease, and completed the 12-item short-form-HRQoL at recruitment (2010-2014). They were followed until June 2017. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours and clinical measures. Hazards ratios were estimated for every 10-unit increase in PCS or MCS. RESULTS There were 1052 deaths over a median 4.7-years (interquartile range 3.6-5.7) of follow-up, with 11.9 events per 1000 person-years. Higher PCS was associated with lower all-cause mortality (HR 0.83, 95% CI 0.77, 0.89) in the entire sample, while higher MCS was associated with lower mortality among U.S. participants only (HR 0.78, 95% CI 0.63, 0.95). Gender differences in the association of either PCS or MCS with mortality were not observed. CONCLUSION Our large study provides evidence that HRQoL is inversely associated with all-cause mortality among initially healthy older people.
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Affiliation(s)
- Aung Zaw Zaw Phyo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- PSNREC, Univ Montpellier, INSERM, 34000, Montpellier, France
| | - David A Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- School of Public Health, Curtin University, Perth, WA, 6102, Australia
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin HealthCare Research Institute, Hennepin HealthCare, Minneapolis, MN, 55415, USA
- Division of Geriatrics, Department of Medicine, Hennepin HealthCare and University of Minnesota, Minneapolis, MN, 55415, USA
| | - Danijela Gasevic
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Nigel P Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, 5005, Australia
| | - Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Department of Epidemiology, Erasmus Medical Centre, 3015 GD, Rotterdam, The Netherlands.
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18
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Berk M, Woods RL, Nelson MR, Shah RC, Reid CM, Storey E, Fitzgerald S, Lockery JE, Wolfe R, Mohebbi M, Dodd S, Murray AM, Stocks N, Fitzgerald PB, Mazza C, Agustini B, McNeil JJ. Effect of Aspirin vs Placebo on the Prevention of Depression in Older People: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:1012-1020. [PMID: 32492080 PMCID: PMC7271558 DOI: 10.1001/jamapsychiatry.2020.1214] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Depression is associated with increased inflammation, which may precede its onset, especially in older people. Some preclinical data suggest potential antidepressant effects of aspirin, supported by limited observational data suggesting lower rates of depression in individuals treated with aspirin. There currently appears to be no evidence-based pharmacotherapies for the primary prevention of depression. OBJECTIVE To determine whether low-dose aspirin (100 mg) reduces the risk of depression in healthy older adults. DESIGN, SETTING, AND PARTICIPANTS This double-blinded, placebo-controlled randomized clinical trial was a substudy of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, which examined if aspirin increased healthy life span, defined as survival free of dementia and disability. The prespecified secondary outcome was depression. Individuals of all races/ethnicities older than 70 years in Australia, as well as white individuals older than 70 years and black and Hispanic individuals older than 65 years in the United States, were included. INTERVENTIONS Participants were randomized to aspirin (100 mg daily) or placebo, with a median (interquartile range) follow-up of 4.7 (3.5-5.6) years. MAIN OUTCOMES AND MEASURES The primary outcome was a proxy measure of major depressive disorder defined as a score of 8 or more on the Center for Epidemiologic Studies Depression 10-item (CES-D-10) scale. RESULTS Of the 19 114 participants enrolled in the trial, 9525 received aspirin and 9589 received a placebo. The mean (SD) age was 75.2 (4.0) years in the aspirin group and 75.1 (4.5) years in the placebo group; 9531 (56.4%) were women. Participants' demographics and clinical characteristics at baseline were similar between groups. A total of 79 886 annual CES-D-10 measurements were taken, with a mean of 4.2 measurements per participant. There were no significant differences at annual visits in the proportions of CES-D-10 scores of 8 or more between the aspirin and placebo groups. The incidence rate of new CES-D-10 scores of 8 or more was 70.4 events per 1000 person-years in the aspirin group and 69.1 in the placebo group (hazard ratio, 1.02 [95% CI, 0.96-1.08]; P = .54). CONCLUSIONS AND RELEVANCE Low-dose aspirin did not prevent depression in this large-scale study of otherwise healthy older adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01038583.
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Affiliation(s)
- Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation Strategy Research Centre, Deakin University School of Medicine, Geelong, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia,Department of Psychiatry, University of Melbourne, Parkville, Australia,Orygen Youth Health Research Centre, Parkville, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Raj C. Shah
- Rush Alzheimer’s Disease Center, Department of Family Medicine, Rush University Medical Center, Chicago, Illinois
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia,School of Public Health, Curtin University, Perth, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sharyn Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jessica E. Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mohammadreza Mohebbi
- The Institute for Mental and Physical Health and Clinical Translation Strategy Research Centre, Deakin University School of Medicine, Geelong, Australia,Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Seetal Dodd
- The Institute for Mental and Physical Health and Clinical Translation Strategy Research Centre, Deakin University School of Medicine, Geelong, Australia
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Australia
| | - Paul B. Fitzgerald
- Epworth Centre for Innovation in Mental Health, the Epworth Clinic, Epworth Healthcare, Camberwell, Australia,Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Melbourne, Australia
| | - Catherine Mazza
- The Institute for Mental and Physical Health and Clinical Translation Strategy Research Centre, Deakin University School of Medicine, Geelong, Australia
| | - Bruno Agustini
- The Institute for Mental and Physical Health and Clinical Translation Strategy Research Centre, Deakin University School of Medicine, Geelong, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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19
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Orchard SG, Lockery JE, Gibbs P, Polekhina G, Wolfe R, Zalcberg J, Haydon A, McNeil JJ, Nelson MR, Reid CM, Kirpach B, Murray AM, Woods RL. Cancer history and risk factors in healthy older people enrolling in the ASPREE clinical trial. Contemp Clin Trials 2020; 96:106095. [PMID: 32739494 DOI: 10.1016/j.cct.2020.106095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/09/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cancer is a leading cause of death globally. Given the elevated risk of cancer with age and an ageing population, it is important to understand the changing burden of cancer in older populations. The ASPirin in Reducing Events in the Elderly (ASPREE) study randomised healthy older individuals to 100 mg aspirin or placebo, with clinical outcomes and disability-free survival endpoints. Detailed baseline data provides a rare opportunity to explore cancer burden in a uniquely healthy older population. METHODS At study enrolment (2010-2014), self-reported personal cancer history, cancer type and cancer risk factor data were sought from 19,114 participants (Australia, n = 16,703; U.S., n = 2411). Eligible participants were healthy, free of major diseases and expected to survive 5 years. RESULTS Nearly 20% of enrolling ASPREE participants reported a prior cancer diagnosis; 18% of women and 22% of men, with women diagnosed younger (16% vs 6% of diagnoses <50 years). Cancer prevalence increased with age. Prevalence of prostate and breast cancer history were higher in U.S. participants; melanoma and colorectal cancer were higher in Australian participants. Cancer history prevalence was not associated with contemporary common risk factors nor previous aspirin use, but was associated with poor health ratings in men. Blood and breast cancer history were more common with past aspirin use. CONCLUSIONS Personal cancer history in healthy older ASPREE participants was as expected for the most common cancer types in the respective populations, but was not necessarily aligned with known risk factors. We attribute this to survivor bias, likely driven by entry criteria. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register (ISRCTN83772183) and clinicaltrials.gov (NCT01038583).
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Affiliation(s)
- Suzanne G Orchard
- Department of Epidemiology & Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Jessica E Lockery
- Department of Epidemiology & Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Peter Gibbs
- The Walter & Eliza Hall Institute of Medical Research, University of Melbourne,1G Royal Parade, Parkville, Victoria 3052, Australia.
| | - Galina Polekhina
- Department of Epidemiology & Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Rory Wolfe
- Department of Epidemiology & Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - John Zalcberg
- Department of Epidemiology & Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Andrew Haydon
- Department of Epidemiology & Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - John J McNeil
- Department of Epidemiology & Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St (Private Bag 23), Hobart 7000, Tasmania, Australia.
| | - Christopher M Reid
- School of Public Health, Curtin University, Kent Street, Bentley, Perth 6102, Western Australia, Australia.
| | - Brenda Kirpach
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute (HHRI), 701 Park Avenue, Suite PP7.700, Minneapolis 55415, Minnesota, USA.
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute (HHRI), 701 Park Avenue, Suite PP7.700, Minneapolis 55415, Minnesota, USA; Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, East River Parkway, Minneapolis 55455, Minnesota, USA.
| | - Robyn L Woods
- Department of Epidemiology & Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
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Agustini B, Lotfaliany M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Ernst ME, Reid CM, Tonkin A, Lockery JE, Williams LJ, Berk M, Mohebbi M. Patterns of Association between Depressive Symptoms and Chronic Medical Morbidities in Older Adults. J Am Geriatr Soc 2020; 68:1834-1841. [PMID: 32402115 DOI: 10.1111/jgs.16468] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the association between depressive symptoms and several medical morbidities, and their combination, in a large older population. DESIGN Cross-sectional study of baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. SETTING Multicentric study conducted in Australia and the United States. PARTICIPANTS A total of 19,110 older adults (mean age = 75 years [standard deviation = ±4.5]). MEASUREMENTS Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D 10) scale. Medical morbidities were defined according to condition-specific methods. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to test associations before and after accounting for possible confounders. RESULTS Depressive symptoms were significantly associated with obesity (OR = 1.19; 95% CI = 1.07-1.32), diabetes (OR = 1.22; 95% CI = 1.05-1.42), gastroesophageal reflux disease (GERD) (OR = 1.41; 95% CI = 1.28-1.57), metabolic syndrome (OR = 1.16; 95% CI = 1.03-1.29), osteoarthritis (OR = 1.41; 95% CI = 1.27-1.57), respiratory conditions (OR = 1.25; 95% CI = 1.10-1.42), history of cancer (OR = 1.19; 95% CI = 1.05-1.34), Parkinson's disease (OR = 2.56; 95% CI = 1.83-3.56), polypharmacy (OR = 1.60; 95% CI = 1.44-1.79), and multimorbidity (OR = 1.29; 95% CI = 1.12-1.49). No significant association was observed between depressive symptoms and hypertension, chronic kidney disease, dyslipidemia, and gout (P > .05). A significant dose-response relationship was evident between the number of medical comorbidities and the prevalence of depression (OR = 1.18; 95% CI = 1.13-1.22). CONCLUSION Late-life depressive symptoms are significantly associated with several medical morbidities, and there appears to be a cumulative effect of the number of somatic diseases on the prevalence of depression. These findings augment the evidence for a complex relationship between mental and physical health in an otherwise healthy older population and might guide clinicians toward early recognition of high-risk individuals. J Am Geriatr Soc 68:1834-1841, 2020.
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Affiliation(s)
- Bruno Agustini
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, Iowa, USA
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lana J Williams
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Psychiatry, Orygen, the National Centre of Excellence in Youth Health, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammadreza Mohebbi
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia.,Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
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21
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Chowdhury EK, Nelson MR, Ernst ME, Margolis KL, Beilin LJ, Johnston CI, Woods RL, Murray AM, Wolfe R, Storey E, Shah RC, Lockery JE, Tonkin AM, Newman AB, Williamson JD, Abhayaratna WP, Stocks NP, Fitzgerald SM, Orchard SG, Trevaks RE, Donnan GA, Grimm R, McNeil JJ, Reid CM. Factors Associated With Treatment and Control of Hypertension in a Healthy Elderly Population Free of Cardiovascular Disease: A Cross-sectional Study. Am J Hypertens 2020; 33:350-361. [PMID: 31807750 DOI: 10.1093/ajh/hpz192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/01/2019] [Accepted: 12/04/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Despite readily available treatments, control of blood pressure (BP) with population aging remains suboptimal. Further, there are gaps in the understanding of the management of high BP in the aged. We explored antihypertensive treatment and control among elderly hypertensive participants free from overt cardiovascular disease (CVD), and identified factors related to both "untreated" and "treated but uncontrolled" high BP. METHODS We analyzed baseline data from 19,114 individuals aged ≥65 years enrolled from Australia and United States (US) in the ASPirin in Reducing Events in the Elderly study. Hypertension was defined as an average systolic/diastolic BP ≥140/90 mm Hg and/or the use of any BP lowering medication. "Controlled hypertension" was defined if participants were receiving antihypertensive medication and BP <140 and 90 mm Hg. Descriptive analyses were used to summarize hypertension control rates; logistic regression was used to investigate relationships with treatment and BP control. RESULTS Overall, 74% (14,213/19,114) of participants were hypertensive; and of these 29% (4,151/14,213) were untreated. Among those treated participants, 53% (5,330/10,062) had BP ≥140/90 mm Hg. Participants who were untreated were more likely to be men, have higher educational status, and be in good physical health, and less likely to have significant comorbidities. The factors related to "treated but uncontrolled" BP included older age, male, Black race (vs. White), using antihypertensive monotherapy (vs. multiple) and residing in Australia (vs. US). CONCLUSIONS High levels of "untreated" and "treated but uncontrolled" BP occur in healthy elderly people without CVD, suggesting there are opportunities for better BP control in the primary prevention of CVD in this population. CLINICAL TRIALS REGISTRATION NCT01038583.
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Affiliation(s)
- Enayet K Chowdhury
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Mark R Nelson
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City , IA, USA
| | | | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, WA, Australia
| | | | - Robyn L Woods
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute (HHRI), Hennepin Healthcare, Minneapolis, MN, USA
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| | - Rory Wolfe
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elsdon Storey
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Jessica E Lockery
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew M Tonkin
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeff D Williamson
- Sticht Center on Healthy Aging and Alzheimer’s Prevention, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Walter P Abhayaratna
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Nigel P Stocks
- Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia
| | - Sharyn M Fitzgerald
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Suzanne G Orchard
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ruth E Trevaks
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
| | - Richard Grimm
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| | - John J McNeil
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher M Reid
- Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
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