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Mehdipour A, Malouka S, Beauchamp M, Richardson J, Kuspinar A. Measurement properties of the usual and fast gait speed tests in community-dwelling older adults: a COSMIN-based systematic review. Age Ageing 2024; 53:afae055. [PMID: 38517125 PMCID: PMC10958613 DOI: 10.1093/ageing/afae055] [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: 08/31/2023] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE The gait speed test is one of the most widely used mobility assessments for older adults. We conducted a systematic review to evaluate and compare the measurement properties of the usual and fast gait speed tests in community-dwelling older adults. METHODS Three databases were searched: MEDLINE, EMBASE and CINAHL. Peer-reviewed articles evaluating the gait speed test's measurement properties or interpretability in community-dwelling older adults were included. The Consensus-based Standards for the selection of health Measurement Instruments guidelines were followed for data synthesis and quality assessment. RESULTS Ninety-five articles met our inclusion criteria, with 79 evaluating a measurement property and 16 reporting on interpretability. There was sufficient reliability for both tests, with intraclass correlation coefficients (ICC) generally ranging from 0.72 to 0.98, but overall quality of evidence was low. For convergent/discriminant validity, an overall sufficient rating with moderate quality of evidence was found for both tests. Concurrent validity of the usual gait speed test was sufficient (ICCs = 0.79-0.93 with longer distances) with moderate quality of evidence; however, there were insufficient results for the fast gait speed test (e.g. low agreement with longer distances) supported by high-quality studies. Responsiveness was only evaluated in three articles, with low quality of evidence. CONCLUSION Findings from this review demonstrated evidence in support of the reliability and validity of the usual and fast gait speed tests in community-dwelling older adults. However, future validation studies should employ rigorous methodology and evaluate the tests' responsiveness.
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Affiliation(s)
- Ava Mehdipour
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Selina Malouka
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Vargese SS, Jylhä M, Raitanen J, Enroth L, Halonen P, Aaltonen M. Dementia-related disability in the population aged 90 years and over: differences over time and the role of comorbidity in the vitality 90 + study. BMC Geriatr 2023; 23:276. [PMID: 37149593 PMCID: PMC10163713 DOI: 10.1186/s12877-023-03980-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/18/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The burden of dementia, multimorbidity, and disability is high in the oldest old. However, the contribution of dementia and comorbidities to functional ability in this age group remains unclear. We examined the combined effects of dementia and comorbidities on ADL and mobility disability and differences between dementia-related disability between 2001, 2010, and 2018. METHODS Our data came from three repeated cross-sectional surveys in the population aged 90 + in the Finnish Vitality 90 + Study. The associations of dementia with disability and the combined effects of dementia and comorbidity on disability adjusted for age, gender, occupational class, number of chronic conditions, and study year were determined by generalized estimating equations. An interaction term was calculated to assess differences in the effects of dementia on disability over time. RESULTS In people with dementia, the odds of ADL disability were almost five-fold compared to people with three other diseases but no dementia. Among those with dementia, comorbidities did not increase ADL disability but did increase mobility disability. Differences in disability between people with and without dementia were greater in 2010 and 2018 than in 2001. CONCLUSION We found a widening gap in disability between people with and without dementia over time as functional ability improved mainly in people without dementia. Dementia was the main driver of disability and among those with dementia, comorbidities were associated with mobility disability but not with ADL disability. These results imply the need for strategies to maintain functioning and for clinical updates, rehabilitative services, care planning, and capacity building among care providers.
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Affiliation(s)
- Saritha Susan Vargese
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland.
- Believers Church Medical College Hospital, Thiruvalla, India.
| | - Marja Jylhä
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Linda Enroth
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
| | - Pauliina Halonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University Hospital, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Wennberg AM, Ebeling M, Ek S, Meyer A, Ding M, Talbäck M, Modig K. Trends in Frailty Between 1990 and 2020 in Sweden Among 75-, 85-, and 95-Year-Old Women and Men: A Nationwide Study from Sweden. J Gerontol A Biol Sci Med Sci 2022; 78:342-348. [PMID: 36190806 PMCID: PMC9951059 DOI: 10.1093/gerona/glac210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aging is the primary risk factor for frailty, which is defined as an inability to respond to acute or chronic stressors. Individuals are living longer with greater multimorbidity, but there is a paucity of evidence examining frailty across birth cohorts and ages. METHODS We investigated frailty prevalence and its association with mortality at ages 75, 85, and 95 in the 1895-1945 birth cohorts in Sweden with data from population registries. Frailty was assessed with the Hospital Frailty Risk Score (HFRS). RESULTS We observed that frailty increased with increasing age and that it has become more common in more recent birth cohorts. At age 75, the percent frail in the Total Population Register increased from 1.1% to 4.6% from birth cohorts 1915-1945, corresponding to calendar years 1990-2020. At age 85, the percentage of frail increased from 3.5% to 11.5% from birth cohorts 1905-1935, and at age 95 from birth cohorts 1895-1925, from 4.7% to 18.7%. Our results show that the increase was primarily driven by an increase in the distribution of individuals with scores in the highest quartile of HFRS, while the bottom 3 quartiles remained relatively stable across birth cohorts. Women accounted for a greater distribution of the overall population and frail population, though these disparities decreased over time. Despite increasing levels of frailty, the relationship between frailty and mortality did not change over time, nor did it differ by sex. CONCLUSION Increased frailty with improved survival points to a chronic condition that could be intervened upon.
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Affiliation(s)
- Alexandra M Wennberg
- Address correspondence to: Alexandra M. Wennberg, PhD, Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77 Stockholm, Sweden. E-mail:
| | - Marcus Ebeling
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mozhu Ding
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Matsumoto K, Gondo Y, Masui Y, Yasumoto S, Yoshida Y, Ikebe K, Arai Y, Kabayama M, Kamide K, Akasaka H, Ishizaki T. Physical performance reference values for Japanese oldest old: a SONIC study. BMC Geriatr 2022; 22:748. [PMID: 36100911 PMCID: PMC9470232 DOI: 10.1186/s12877-022-03299-7] [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: 03/10/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background The oldest old, defined as those aged 90 or over, is now the fastest-growing population sector. This study aimed to determine reference values for several physical performance measures (PPMs) among 90-year-olds using internationally standardized measurements and to clarify the characteristics of these indices by comparing their results for 90-year-olds with those for older people 70 and 80. Methods We used the Septuagenarians, Octogenarians, and Nonagenarians Investigation with Centenarians (SONIC) study data from 2010 to 2018. The study subjects were 70, 80, and 90-year-olds in the target area eligible to participate in the venue. Excluding those certified for long-term care, the final number of eligible persons is 70s cohort 1000 (2010), 80s cohort 973 (2011), and 90s cohort 690. 90s cohort only consisted of three survey waves: 2012, 2015, and 2018. We used hand grip strength and score on the Short Physical Performance Battery (SPPB) for our physical performance measurements. In addition, we statistically analyzed sex and age differences. Result The simple mean ± standard deviation (SD) for the 90-year-old respondents were in men, 24.1 ± 5.4 kg in hand grip strength, 0.80 ± 0.22 m/s in usual gait speed, 17.2 ± 6.73 s in 5times chair stand, 5.89 ± 4.42 s in tandem balance, and 8.3 ± 2.2 in SPPB respectively and in women, 14.4 ± 4.0 kg in hand grip strength, 0.72 ± 0.20 m/s in usual gait speed, 17.8 ± 7.89 s in 5times chair stand, 4.72 ± 4.35 s in tandem balance, and 7.5 ± 2.4 in SPPB, respectively. For all PPMs, the age 90 cohort was statistically significantly different from the age 70 and 80 cohorts (all trends P < 0.001). Hand grip strength decreased with a similar gradient with age cohort increase of 10 years for both sexes. In contrast, SPPB lower limb score showed a larger drop between the age 80 and 90 cohorts than between the age 70 and 80 cohorts. We also constructed sex-specific appraisal standards according to quintiles. Conclusions Our study yielded inclusive sex-specific reference values and appraisal standards for major physical performance measures not certified as requiring long-term care, community-dwelling, oldest old Japanese. The characteristics of age-related decline in physical performance differed between the upper and lower extremity assessments.
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Affiliation(s)
| | - Yasuyuki Gondo
- Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Yukie Masui
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Saori Yasumoto
- Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Yuko Yoshida
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kazunori Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Mai Kabayama
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Kei Kamide
- Division of Health Sciences, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Akasaka
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Zadworna M. Pathways to healthy aging - Exploring the determinants of self-rated health in older adults. Acta Psychol (Amst) 2022; 228:103651. [PMID: 35785683 DOI: 10.1016/j.actpsy.2022.103651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/28/2022] [Accepted: 06/13/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The decade 2021-2030 has been declared the Decade of Healthy Aging by the United Nations General Assembly, underlining that health is central to the experience of older age and the opportunities that aging brings. Self-rated health (SRH) appears consistent with the state of objective health, and therefore can serve as a simple core indicator of healthy aging. SRH can be affected by psychological and lifestyle factors, and by the developmental and sociodemographic context, which can directly and indirectly influence subjective health status. The aim of the present study was to establish the structure of the relationships between SRH, health-related behavior, subjective wellbeing, developmental tasks attainment and sociodemographic factors in the late-life period. METHODS The study group consisted of 340 Polish retired seniors, aged 61 to 94 (M = 70.75, SD = 6.48): 88 men (25.9 %) and 252 women (74.1 %). The respondents completed the following measures: 10-point numerical scale for SRH, Health-Related Questionnaire for Seniors, Satisfaction with Life Scale, Developmental Tasks Questionnaire for Seniors and a sociodemographic survey. RESULTS The group demonstrated a medium level of SRH and other variables. SHR was positively correlated with health-related behavior, wellbeing, developmental tasks attainment and perceived economic status, and negatively with age. Structural equation model revealed that health-related behavior, wellbeing, age and economic status have a direct influence on SRH. Developmental tasks attainment was found to predict health behavior, although no direct relationship with SRH was found. CONCLUSIONS A broader understanding of healthy aging is achieved by considering the context of its factors. Psychological interventions should promote a healthy lifestyle and adapt it to the late life period to promote health among seniors.
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Affiliation(s)
- Magdalena Zadworna
- Department of Health Psychology, Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Poland.
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Ando T, Nishimoto Y, Hirata T, Abe Y, Takayama M, Maeno T, Fujishima S, Takebayashi T, Arai Y. Association between multimorbidity, self-rated health and life satisfaction among independent, community-dwelling very old persons in Japan: longitudinal cohort analysis from the Kawasaki Ageing and Well-being Project. BMJ Open 2022; 12:e049262. [PMID: 35210335 PMCID: PMC8883229 DOI: 10.1136/bmjopen-2021-049262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 12/01/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This study aimed to identify associations between multimorbidity and subjective health outcomes among the very old persons, after adjusting for coexisting conditions such as frailty and depression. STUDY SETTING AND PARTICIPANTS This was an observational cross-sectional study involving 1012 independent, community-dwelling very old persons (507 men, 505 women; aged 85-89 years) in Kawasaki city, Japan. OUTCOME MEASURES The primary outcome was the cross-sectional associations between multimorbidity and poor self-rated health (SRH) and life satisfaction using binary logistic regression. The secondary outcome was the association of subjective health with each chronic condition. RESULTS The prevalence of multimorbidity (≥2 conditions) was 94.7%, and the average number of chronic conditions was 4.47±1.9. Multimorbidity was significantly associated with poor SRH in the adjusted model only when six or more chronic conditions were present (OR 4.80; 95% CI 1.34 to 17.11; p=0.016). Cerebrovascular disease, heart disease, respiratory disease, connective tissue disease and arthritis showed significant associations with poor SRH after multivariate adjustment. Sex-specific analysis replicated associations between multimorbidity with six or more conditions and SRH in both men and women, while the diseases with the greatest impact on SRH differed between men and women. Most conditions were not associated with low satisfaction with life scale, with the exception of arthritis (OR 1.92, 95% CI 1.32 to 2.78, p=0.001). CONCLUSIONS Multimorbidity is prevalent in the independent, community-dwelling very old persons and is associated with poor SRH when six or more conditions are present; conditions causing mobility limitations, such as cerebrovascular disease, connective tissue disease and arthritis, have a negative impact on SRH. TRIAL REGISTRATION NUMBER UMIN000026053.
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Affiliation(s)
- Takayuki Ando
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yoshinori Nishimoto
- Department of Neurology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takumi Hirata
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yukiko Abe
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Midori Takayama
- Faculty of Science and Technology, Keio University, Yokohama, Kanagawa, Japan
| | - Takashi Maeno
- Graduate School of System Design and Management, Keio University, Yokohama, Kanagawa, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Wettstein M, Schilling OK, Wahl HW. Trajectories of Pain in Very Old Age: The Role of Eudaimonic Wellbeing and Personality. FRONTIERS IN PAIN RESEARCH 2022; 3:807179. [PMID: 35295803 PMCID: PMC8915612 DOI: 10.3389/fpain.2022.807179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/26/2022] [Indexed: 11/27/2022] Open
Abstract
Pain is common in very old age and in the last years prior to death. However, little is known regarding longitudinal trajectories of pain in very old age and at the end of life. Moreover, whereas medical and morbidity-related factors contributing to pain are established, the role of psychosocial factors, such as eudaimonic wellbeing or personality as potential determinants of late-life pain trajectories has so far not been sufficiently investigated. We used data from the LateLine project. The sample consisted of n = 118 very old adults (M = 90.5 years, SD = 2.8 years) who were living alone at baseline and who had died between 2009 and 2021. They took part in up to 16 measurement occasions (M = 5.2, SD = 4.7, range 1–16) within an observational interval of 7 years. Assessment of pain was based on the SF-36 bodily pain subscale. Key indicators of eudaimonic wellbeing (autonomy, environmental mastery, and purpose in life) as well two of the Big Five personality traits (neuroticism and extraversion) were included as predictors. We controlled in all analyses for gender, education, subjective health, and depressive symptoms. Contrasting pain trajectories over chronological age (time since birth) vs. time to death, a time-to-death-related model resulted in a better model fit and accounted for a larger amount of pain variability than the age-related model. Mean-level change in pain, both over age and time to death, was not significant, but there was substantial interindividual variability in intraindividual trajectories. Age-related change in pain was significantly predicted by autonomy and neuroticism, with increasing pain among those who had lower initial autonomy scores and higher initial neuroticism scores. With regard to time-to-death-related trajectories of pain, higher purpose in life as well as lower extraversion at baseline predicted less increase or even steeper decrease in pain with approaching death. Our findings suggest that, despite overall mean-level stability in pain both over age and time to death, there is a substantial proportion of individuals who reveal deterioration in pain over time. Regarding the role of psychosocial predictors, personality traits and eudaimonic wellbeing are related with late-life pain trajectories both over age and time-to-death.
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Affiliation(s)
- Markus Wettstein
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
- Network Aging Research, Heidelberg University, Heidelberg, Germany
- *Correspondence: Markus Wettstein
| | - Oliver Karl Schilling
- Department of Psychological Aging Research, Psychological Institute, Heidelberg University, Heidelberg, Germany
| | - Hans-Werner Wahl
- Network Aging Research, Heidelberg University, Heidelberg, Germany
- Department of Psychological Aging Research, Psychological Institute, Heidelberg University, Heidelberg, Germany
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Mental health and motor efficiency of older adults living in the Sardinia's Blue Zone: a follow-up study. Int Psychogeriatr 2021; 33:1277-1288. [PMID: 32867876 DOI: 10.1017/s1041610220001659] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The main aim of this study was to examine the impact of age-related changes on mental health, metacognitive, and motor functioning in late adulthood, while controlling for the effect of gender. Additionally, this investigation intended to study the association between motor efficiency indexes and self-reported psychological well-being, depression and cognitive failures over a period of 24 months. DESIGN Prospective longitudinal study: post hoc analysis. PARTICIPANTS Ninety-one community-dwelling older participants (mean age = 78.7 years, SD = 5.6) were recruited in a rural village of the Sardinian Blue Zone - an area of exceptional longevity located in the central-eastern region of Sardinia, an Italian island in the Mediterranean Sea. MEASUREMENTS All respondents completed a battery of tests and questionnaires assessing motor and general cognitive efficiency, self-reported psychological well-being, negative affect, and cognitive failures. RESULTS The adoption of a multilevel modeling approach highlighted the significative impact of time on psychological well-being, as well as on mobility parameters like gait speed and cadence, while controlling for the gender effect. Overall, psychological well-being and motor swing significantly increase at follow-up, whereas the further above-mentioned measures decreased after 24 months. Moreover, compared to the national cut-off, at baseline and follow-up, participants reported higher perceived emotional well-being. Finally, significant relationships between motor scores and self-reported mental health and metacognitive measures were found both at baseline and follow-up. CONCLUSIONS The maintenance of motor efficiency and preserved mental health seems to contribute to the successful aging of older people living in the Sardinian Blue Zone.
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Mutz J, Roscoe CJ, Lewis CM. Exploring health in the UK Biobank: associations with sociodemographic characteristics, psychosocial factors, lifestyle and environmental exposures. BMC Med 2021; 19:240. [PMID: 34629060 PMCID: PMC8504077 DOI: 10.1186/s12916-021-02097-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/16/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND A greater understanding of the factors that are associated with favourable health may help increase longevity and healthy life expectancy. We examined sociodemographic, psychosocial, lifestyle and environmental exposures associated with multiple health indicators. METHODS UK Biobank recruited > 500,000 participants, aged 37-73, between 2006 and 2010. Health indicators examined were 81 cancer and 443 non-cancer illnesses used to classify participants' health status; long-standing illness; and self-rated health. Exposures were sociodemographic (age, sex, ethnicity, education, income and deprivation), psychosocial (loneliness and social isolation), lifestyle (smoking, alcohol intake, sleep duration, BMI, physical activity and stair climbing) and environmental (air pollution, noise and residential greenspace) factors. Associations were estimated using logistic and ordinal logistic regression. RESULTS In total, 307,378 participants (mean age = 56.1 years [SD = 8.07], 51.9% female) were selected for cross-sectional analyses. Low income, being male, neighbourhood deprivation, loneliness, social isolation, short or long sleep duration, low or high BMI and smoking were associated with poor health. Walking, vigorous-intensity physical activity and more frequent alcohol intake were associated with good health. There was some evidence that airborne pollutants (PM2.5, PM10 and NO2) and noise (Lden) were associated with poor health, though findings were not consistent across all models. CONCLUSIONS Our findings highlight the multifactorial nature of health, the importance of non-medical factors, such as loneliness, healthy lifestyle behaviours and weight management, and the need to examine efforts to improve the health outcomes of individuals on low incomes.
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Affiliation(s)
- Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK.
| | - Charlotte J Roscoe
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Harvard T.H. Chan School of Public Health, Harvard University, Landmark Center, 401 Park Drive, Boston, MA, 02215, USA
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK
- Department of Medical & Molecular Genetics, Faculty of Life Sciences & Medicine, King's College London, Great Maze Pond, London, SE1 9RT, UK
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Strozza C, Pasqualetti P, Egidi V, Loreti C, Vannetti F, Macchi C, Padua L. Health profiles and socioeconomic characteristics of nonagenarians residing in Mugello, a rural area in Tuscany (Italy). BMC Geriatr 2020; 20:289. [PMID: 32799807 PMCID: PMC7429096 DOI: 10.1186/s12877-020-01689-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background Health, as defined by the WHO, is a multidimensional concept that includes different aspects. Interest in the health conditions of the oldest-old has increased as a consequence of the phenomenon of population aging. This study investigates whether (1) it is possible to identify health profiles among the oldest-old, taking into account physical, emotional and psychological information about health, and (2) there are demographic and socioeconomic differences among the health profiles. Methods Latent Class Analysis with covariates was applied to the Mugello Study data to identify health profiles among the 504 nonagenarians residing in the Mugello district (Tuscany, Italy) and to evaluate the association between socioeconomic characteristics and the health profiles resulting from the analysis. Results This study highlights four groups labeled according to the posterior probability of determining a certain health characteristic: “healthy”, “physically healthy with cognitive impairment”, “unhealthy”, and “severely unhealthy”. Some demographic and socioeconomic characteristics were found to be associated with the final groups: older nonagenarians are more likely to be in worse health conditions; men are in general healthier than women; more educated individuals are less likely to be in extremely poor health conditions, while the lowest-educated are more likely to be cognitively impaired; and office or intellectual workers are less likely to be in poor health conditions than are farmers. Conclusions Considering multiple dimensions of health to determine health profiles among the oldest-old could help to better evaluate their care needs according to their health status.
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Affiliation(s)
- Cosmo Strozza
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, J.B. Winsløws Vej 9B, 2nd floor, 5000, Odense C, Denmark. .,Department of Statistical Sciences, Sapienza University of Rome, Viale Regina Elena 295, 00161, Rome, Italy.
| | - Patrizio Pasqualetti
- Fatebenefratelli Foundation for Health Research and Education, Via della Lungaretta 177, 00153, Rome, Italy
| | - Viviana Egidi
- Department of Statistical Sciences, Sapienza University of Rome, Viale Regina Elena 295, 00161, Rome, Italy
| | - Claudia Loreti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00136, Rome, Italy
| | - Federica Vannetti
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy
| | | | - Luca Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.,UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00136, Rome, Italy
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Understanding Health Deterioration and the Dynamic Relationship between Physical Ability and Cognition among a Cohort of Danish Nonagenarians. J Aging Res 2020; 2020:4704305. [PMID: 32655951 PMCID: PMC7323846 DOI: 10.1155/2020/4704305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
This study aims to determine how demographics, socioeconomic characteristics, and lifestyle affect physical and cognitive health transitions among nonagenarians, whether these transitions follow the same patterns, and how each dimension affects the transitions of the other. We applied a multistate model for panel data to 2262 individuals over a 2-year follow-up period from the 1905 Danish Cohort survey. Within two years from baseline, the transition probability from good to bad physical health-ability to stand up from a chair-was higher than dying directly (29% vs. 25%), while this was not observed for cognition (24% vs. 27%) evaluated with Mini-Mental State Examination-a score lower than 24 indicates poor cognitive health. Probability of dying either from bad physical or cognitive health condition was 50%. Health transitions were associated with sex, education, living alone, body mass index, and physical activity. Physical and cognitive indicators were associated with deterioration of cognitive and physical status, respectively, and with survivorship from a bad health condition. We conclude that physical and cognitive health deteriorated differently among nonagenarians, even if they were related to similar sociodemographic and lifestyle characteristics and resulted dynamically related with each other.
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Lisko I, Törmäkangas T, Jylhä M. Structure of self-rated health among the oldest old: Analyses in the total population and those living with dementia. SSM Popul Health 2020; 11:100567. [PMID: 32258355 PMCID: PMC7110410 DOI: 10.1016/j.ssmph.2020.100567] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/08/2020] [Accepted: 03/12/2020] [Indexed: 01/04/2023] Open
Abstract
No previous study has explored the structure of self-rated health (SRH), a measure holding strong predictive value for future health events, in the oldest old or in individuals with dementia. The aim was to construct a structural equation model of SRH for oldest old in general and for oldest old with dementia, and to explore direct and indirect associations between health-related factors and SRH. Cross-sectional data from the Vitality 90+, a population-based study in the city of Tampere, Finland, was used. Data were gathered by a mailed questionnaire in 2014. Altogether 1299 nonagenarians, of which 408 had self-reported dementia or cognitive decline, were included. Structural equation models were constructed for all participants and separately for participants with dementia. Diseases (heart disease, stroke, diabetes, arthritis, hip fracture, cancer and dementia for the model for all), dizziness, hearing, vision, mobility, activities of daily living, fatigue, depression and SRH were included in the models. Among all participants, fatigue, depression, problems in mobility, dizziness, deficits in vision and heart disease were directly associated with poor SRH. Among participants with dementia, only fatigue, dizziness and deficits in vision were directly associated with poor SRH. Among all participants, dementia and arthritis were indirectly associated with poor SRH through problems in mobility, depression and fatigue. Among the oldest old, the effects of diseases on SRH were mainly manifested through the consequences of diseases, namely fatigue, dizziness, deficits in vision and problems in mobility. Depression has an important direct and indirect role, and dementia and arthritis an important indirect role in the structure of SRH. Dementia weakens many of the direct and indirect associations for SRH. First study to explore structure of self-rated health in oldest old and persons with dementia. Fatigue, depression, mobility, dizziness, vision and heart disease directly affect health-rating in oldest old. Dementia, depression and arthritis affect health rating indirectly through various routes in oldest old. Dementia weakens many of the associations between objective indicators of health with self-rated health.
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Affiliation(s)
- Inna Lisko
- Tampere University, Faculty of Social Sciences (Health Sciences), P.O. Box 100, FI-33014, Finland.,Gerontology Research Center, Tampere University and University of Jyväskylä, Finland.,University of Jyväskylä, Faculty of Sport and Health Sciences, P.O. Box 35, FI-40014, Finland.,Karolinska Institutet, Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Stockholm, Karolinska Vägen 37 A, QA32, SE-171 64, Solna, Sweden
| | - Timo Törmäkangas
- Gerontology Research Center, Tampere University and University of Jyväskylä, Finland.,University of Jyväskylä, Faculty of Sport and Health Sciences, P.O. Box 35, FI-40014, Finland
| | - Marja Jylhä
- Tampere University, Faculty of Social Sciences (Health Sciences), P.O. Box 100, FI-33014, Finland.,Gerontology Research Center, Tampere University and University of Jyväskylä, Finland.,Science Center, Tampere University Hospital, Finland
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Simonsson B, Molarius A. Self-rated health and associated factors among the oldest-old: results from a cross-sectional study in Sweden. Arch Public Health 2020; 78:6. [PMID: 32025299 PMCID: PMC6996178 DOI: 10.1186/s13690-020-0389-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very few population-based studies have investigated self-rated health and related factors in the increasing age group 85 years or older. The aim of this study was to examine self-rated health and its association with living conditions, lifestyle factors, physical and mental health problems and functional ability among the oldest-old in the general population in Sweden. METHODS The study is cross-sectional and based on 1360 persons, 85 years of age or older, who answered a survey questionnaire sent to a random population sample in 2012 (participation rate 47%). Multivariate logistic regression was used as the statistical method. RESULTS The prevalence of good self-rated health was 39% in men and 30% in women. Physical inactivity, impaired physical mobility, pain, anxiety/depression and longstanding illness were independently associated with poorer than good self-rated health, while factors such as gender, age, educational level, cash margin, living alone, social support, smoking, alcohol use, obesity, accidents and impaired vision/hearing were not. CONCLUSIONS While a considerable part of the oldest-old assess their health as good, not being physically active and having common health problems such as pain and depression as well as impaired physical mobility are associated with poorer than good self-rated health. This should be considered when planning how to improve and maintain health in the growing population of persons 85 years and older.
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Affiliation(s)
- Bo Simonsson
- Competence Centre for Health, Region Västmanland, Västerås, Sweden
| | - Anu Molarius
- Centre for Clinical Research, Region Värmland, Karlstad, Sweden
- Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
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Rasmussen SH, Thinggaard M, Højgaard MB, Jeune B, Christensen K, Andersen-Ranberg K. Improvement in Activities of Daily Living Among Danish Centenarians?-A Comparative Study of Two Centenarian Cohorts Born 20 Years Apart. J Gerontol A Biol Sci Med Sci 2019; 73:1125-1131. [PMID: 28595320 DOI: 10.1093/gerona/glx113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background With the continued rise in the proportion of the oldest-old in high-income countries, it is of interest to know whether the functional health of today's oldest-olds is better or worse than in previous cohorts. Using two Danish centenarian birth cohorts born 20 years apart we aimed at investigating if the later born cohort had better functioning in terms of activities of daily living (ADL). Methods Identification, methodology, and assessment instruments were identical in the 1895-West and 1915-West Birth Cohort Studies: All persons living in the western part of Denmark and turning 100 years old in 1995 and 2015, respectively. Data were collected through structured in-home interviews. Participation rates were 74% (n = 106) and 79% (n = 238), respectively. Results The proportion of nondisabled women of the 1915-West cohort was more than twice as high compared to the 1895-West cohort and with corresponding lower proportions of moderately and severely disabled persons (17% vs 7%, 33% vs 40% and 50% vs 53% in the 1915-West and 1895-West cohorts, respectively, p = .047). Only nonsignificant improvements were seen among men in the 1915-West cohort. In both sexes, considerably higher proportions of the latest cohort used assistive devices than the former (statistically significant for the majority of assistive devices). Conclusion This comparative study shows improvements in reported ADL in the later born cohort of centenarians, even though only significant among women. As women constitute the majority of the oldest-olds, our findings are encouraging from a public health care view.
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Affiliation(s)
- Signe Høi Rasmussen
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Geriatrics, Odense University Hospital, Denmark
| | - Mikael Thinggaard
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark
| | | | - Bernard Jeune
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - Karen Andersen-Ranberg
- Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Geriatrics, Odense University Hospital, Denmark
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Teixeira L, Araújo L, Duarte N, Ribeiro O. Falls and fear of falling in a sample of centenarians: the role of multimorbidity, pain and anxiety. Psychogeriatrics 2019; 19:457-464. [PMID: 30784146 DOI: 10.1111/psyg.12423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 01/01/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND To explore the recent history of falls and the existence of fear of falling in a sample of centenarians, and to identify factors associated with both conditions. METHODS The sample included 109 centenarians from two Portuguese studies. The two main outcomes of this study are fear of falling and history of fall(s). RESULTS Results revealed that more than a half (51.4%) of the participants had fallen in the last 5 years and that the percentage of fear of falling was 78.9%. No association was found between the two conditions. The factors associated with each one were found to be different: number of health conditions for history of falls, and pain frequency and anxiety for fear of falling. CONCLUSIONS The relationship between anxiety and fear of falling reinforces the importance of screening both conditions as it can improve their detection and treatment. The established relationship between a high number of health conditions (common at very advanced ages) and falls demands greater attention in fall prevention initiatives specifically targeted to the extremely elderly.
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Affiliation(s)
- Laetitia Teixeira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.,CINTESIS, University of Porto, Porto, Portugal
| | - Lia Araújo
- CINTESIS, University of Porto, Porto, Portugal.,School of Education of Viseu, Polytechnic Institute of Viseu, Viseu, Portugal
| | | | - Oscar Ribeiro
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.,CINTESIS, University of Porto, Porto, Portugal.,Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
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Ahrenfeldt LJ, Möller S, Thinggaard M, Christensen K, Lindahl-Jacobsen R. Sex Differences in Comorbidity and Frailty in Europe. Int J Public Health 2019; 64:1025-1036. [PMID: 31236603 PMCID: PMC7237816 DOI: 10.1007/s00038-019-01270-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To examine sex differences in prevalent comorbidity and frailty across age and European regions. METHODS This is a cross-sectional study based on 113,299 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe from 2004-2005 to 2015. Sex differences in the Comorbidity Index and the Frailty Phenotype were investigated using ordinal logistic regressions. RESULTS European women had generally higher odds of prevalent comorbidity (OR 1.11, 95% CI 1.07-1.15) and frailty (OR 1.56, 95% CI 1.51-1.62). Sex differences increased with advancing age. No overall sex difference in comorbidity was found in Western Europe, but women had more comorbidity than men in Eastern (OR 1.30, 95% CI 1.18-1.44), Southern (OR 1.23, 95% CI 1.15-1.30), and Northern (OR 1.08, 95% CI 1.01-1.16) Europe. Women were frailer than men in all regions, with the largest sex difference in Southern Europe (OR 1.84, 95% CI 1.72-1.96). CONCLUSIONS European women are frailer and have slightly more comorbidity than European men lending support for the male-female health survival paradox.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark.
| | - Sören Möller
- OPEN - Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mikael Thinggaard
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Kaare Christensen
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Rune Lindahl-Jacobsen
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense C, Denmark
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The Role of Genetic Profile in Functional Performance Adaptations to Exercise Training or Physical Activity: A Systematic Review of the Literature. J Aging Phys Act 2019; 27:594-616. [PMID: 30676214 DOI: 10.1123/japa.2018-0155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Variations in genotype may contribute to heterogeneity in functional adaptations to exercise. Methods: A systematic search of eight databases was conducted, and 9,696 citations were screened. Results: Eight citations from seven studies measuring 10 single-nucleotide polymorphisms and nine different functional performance test outcomes were included in the review. There was one observational study of physical activity and six experimental studies of aerobic or resistance training. The ACE (D) allele, ACTN3 (RR) genotype, UCP2 (GG) genotype, IL-6-174 (GG) genotype, TNF-α-308 (GG) genotype, and IL-10-1082 (GG) genotype all predicted significantly superior adaptations in at least one functional outcome in older men and women after prescribed exercise or in those with higher levels of physical activity. Conclusion: There is a small amount of evidence that older adults may have better functional outcomes after exercise/physical activity if they have specific alleles related to musculoskeletal function or inflammation. However, more robust trials are needed.
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Association of Body Fat With Health-Related Quality of Life and Depression in Nonagenarians: The Mugello Study. J Am Med Dir Assoc 2019; 20:564-568. [PMID: 30852165 DOI: 10.1016/j.jamda.2019.01.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/07/2019] [Accepted: 01/13/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The association of body fat with health status and depression in the oldest old is still debated. The aim of this cross-sectional study is to investigate the association of body fat with health-related quality of life and depression in a sample of nonagenarians. DESIGN Data are from the Mugello study, a community-based project conducted in Italian older adults aged 90 years. SETTING AND PARTICIPANTS Total body fat was assessed by body impedance assessment. Participants were divided into 3 groups according to gender-specific tertiles of body fat percentage (BF%). Self-perceived mental and physical health status were assessed by the Mental Component Summary (MCS) and the Physical Component Summary (PCS) subscales derived from the 12-item Short Form Health Survey. Lower scores of MCS and PCS indicated poorer mental health and physical health status, respectively. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale, and a score ≥5 was used to identify participants with depression. RESULTS The mean age of 251 study participants was 92.5 years, and 173 (68.9%) were women. Participants were included in the low (n = 83), medium (n = 83), and high (n = 85) BF% groups. In the whole sample, mean scores at PCS progressively declined with the increasing BF% group (P = .004). This association was stronger in women, although no significant interaction was observed between the gender and BF% group (P = .63). No significant association between BF% and MCS was documented. Medium and high BF% were associated with a significantly higher probability of depression as compared with low BF% [odds ratio (OR) 2.15, 95% confidence interval (CI) 1.04-4.44, and OR 2.15, 95% CI 1.06-4.34, respectively]. This association was stronger in women, although no significant interaction was observed between gender and BF% group (P = .70). CONCLUSIONS AND IMPLICATIONS High BF% is significantly positively associated with poor health-related quality of life and depression, underpinning the clinical relevance to test BF% in older adults. These associations appear to be stronger in women than in men, highlighting the need to investigate deep inside this gender discrepancy.
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Sex differences in healthy life expectancy among nonagenarians: A multistate survival model using data from the Vitality 90+ study. Exp Gerontol 2018; 116:80-85. [PMID: 30590122 DOI: 10.1016/j.exger.2018.12.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Little is known about sex differences in healthy life expectancy among the oldest old, the fastest growing segment of the older population. This study examines sex differences in total, healthy and unhealthy life expectancy among nonagenarians. METHODS Longitudinal data of 884 older adults aged 90 and over participating in the Vitality 90+ study (Tampere, Finland) were used, including 2501 observations (health or death states) from 5 measurement waves between 2001 and 2014. Using the MSM and ELECT packages in R, multistate survival models were performed to estimate the transition probabilities of older adults through the different health states and to calculate life expectancies. The analyses were done separately for two health indicators (disability and multimorbidity) to see whether patterns were consistent. RESULTS Women had higher total life expectancies than men (about 8 months), but also higher unhealthy life expectancies. Men had a higher disability-free life expectancy between the age of 90 and 95 compared to women. For multimorbidity, no sex differences in healthy life expectancy were found. CONCLUSIONS This study showed that the male-female health-survival paradox remains at very old age. Women aged 90+ live longer than men, and spend more time in poor health.
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20
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Wearing J, Konings P, Stokes M, de Bruin ED. Handgrip strength in old and oldest old Swiss adults - a cross-sectional study. BMC Geriatr 2018; 18:266. [PMID: 30400825 PMCID: PMC6219188 DOI: 10.1186/s12877-018-0959-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/22/2018] [Indexed: 11/12/2022] Open
Abstract
Background Handgrip strength is indicative of overall physical health and mobility in the elderly. A reduction in strength below a certain threshold severely increases the risk of mobility limitations and is predictive for adverse outcomes such as dependence in daily activities and mortality. An overview of age- and geography- specific handgrip strength values in older adults provide a reference for further investigations and measures in clinical practice to identify people at risk for clinically meaningful weakness. The aim of this study was to evaluate handgrip strength in the Swiss-German population aged 75 and over. Methods In a cross-sectional study, maximal isometric handgrip strength of the dominant hand was evaluated in 244 Swiss people aged 75 years and over (62.7% women), with mean age (SD) of 84.5 (5.6) years in men and 83.1 (5.9) years in women. Demographic data and information about comorbidities, medication, fall history, global cognitive function, self-reported physical activity and dependence in activities of daily living were collected, and correlated with grip strength measures. Age- and gender specific grip strength values are reported as means, standard deviations and standard error of mean. Results Sex-stratified handgrip strength was significantly lower with advancing age in men (p < .01), from 37.7 (6.5) kg to 25.6 (7.6) kg and in women (p < .01) from 22.2 (4.0) kg to 16.5 (4.7) kg. Handgrip strength in our sample was significantly higher than in Southern European countries. Handgrip strength was independently associated with age, height and ADL dependence in men and women. Overall, 44% of men and 53% of women had handgrip strength measures that were below the clinically relevant threshold for mobility limitations. Conclusion This study reports the age- and sex-stratified reference values for handgrip strength in a representative sample of the Swiss population, aged 75–99 years. Although grip strength decreased with advancing age in both sexes; the relative decline was greater in men than women. Nonetheless men had significantly higher grip strength in all age groups. While the Swiss population sampled had greater grip strength than that reported in other European countries, about 50% were still classified as at risk of mobility limitations.
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Affiliation(s)
- Julia Wearing
- Faculty of Health, Medicine and Sciences, School for Public Health and Primary Care, University Maastricht, Minderbroedersberg 4-6, Maastricht, LK, 6211, The Netherlands.,Adullam Stiftung, Mittlere Strasse 15, 4056, Basel, Switzerland
| | - Peter Konings
- Geriatrische Klinik St. Gallen, Rorschacher Strasse 94, 9000, St. Gallen, Switzerland
| | - Maria Stokes
- Faculty of Health Sciences, University of Southampton, Building 45, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Eling D de Bruin
- Insitute of Human Movement Sciences and Sport (IBWS) ETH, Department of Health Sciences and Technology, HCP H 25.1, Leopold-Ruzicka-Weg 4, 8093 Zürich, ETH, Zurich, Switzerland. .,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Rasmussen SH, Andersen-Ranberg K, Thinggaard M, Jeune B, Skytthe A, Christiansen L, Vaupel JW, McGue M, Christensen K. Cohort Profile: The 1895, 1905, 1910 and 1915 Danish Birth Cohort Studies - secular trends in the health and functioning of the very old. Int J Epidemiol 2018; 46:1746-1746j. [PMID: 28449061 DOI: 10.1093/ije/dyx053] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2017] [Indexed: 01/31/2023] Open
Affiliation(s)
- Signe Høi Rasmussen
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Department of Geriatrics, Odense University Hospital, Odense, Denmark
| | - Karen Andersen-Ranberg
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Department of Geriatrics, Odense University Hospital, Odense, Denmark
| | - Mikael Thinggaard
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark
| | - Bernard Jeune
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Axel Skytthe
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Lene Christiansen
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - James W Vaupel
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Max-Planck Institute for Demographic Research, Rostock, Germany.,Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark
| | - Matt McGue
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Storeng SH, Sund ER, Krokstad S. Factors associated with basic and instrumental activities of daily living in elderly participants of a population-based survey: the Nord-Trøndelag Health Study, Norway. BMJ Open 2018; 8:e018942. [PMID: 29530908 PMCID: PMC5857703 DOI: 10.1136/bmjopen-2017-018942] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate factors associated with the need for assistance in basic and instrumental activities of daily living in Norwegian elderly. DESIGN Prospective cohort study. SETTING The Nord-Trøndelag Health Study (HUNT), a large population-based health survey in Norway. PARTICIPANTS 5050 individuals aged 60-69 years old at baseline in HUNT2 (1995-1997) who also participated in HUNT3 (2006-2008) were included in the study. 676/693 individuals were excluded in the analyses due to missing outcomes. OUTCOMES Needing assistance in one or more basic or instrumental activities of daily living reported in HUNT3. RESULTS In adjusted multinomial logistic regression analyses, poor self-rated health and depression were the strongest risk factors for needing assistance in one or more basic activities of daily living in HUNT3, with ORs of 2.13 (1.35 to 3.38) and 1.58 (0.91 to 2.73). Poor self-rated health and poor life satisfaction were the strongest risk factors for needing assistance in one or more instrumental activities of daily living in HUNT3, with ORs of 2.30 (1.93 to 2.74) and 2.29 (1.86 to 2.81), respectively. Excessive sitting time, short or prolonged sleeping time, and physical inactivity seemed to be the most important lifestyle risk factors for basic/instrumental activities of daily living (ADL/IADL) disability. The studied factors were, in general, greater risk factors for mortality during follow-up than for ADL/IADL disability. Smoking was the strongest risk factor for mortality during follow-up and non-participation in HUNT3. Smoking and low social participation were the strongest risk factors for non-participation in HUNT3. CONCLUSIONS Subjective health perception, life satisfaction and depression were the strongest risk factors for needing assistance in one or more basic/instrumental activities of daily living later in life. These factors could be possible targets for prevention purposes.
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Affiliation(s)
- Siri Høivik Storeng
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik R Sund
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Steinar Krokstad
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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The Demography of Mental Health Among Mature Adults in a Low-Income, High-HIV-Prevalence Context. Demography 2018; 54:1529-1558. [PMID: 28752487 DOI: 10.1007/s13524-017-0596-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Very few studies have investigated mental health in sub-Saharan Africa (SSA). Using data from Malawi, this article provides a first picture of the demography of depression and anxiety (DA) among mature adults (aged 45 or older) in a low-income country with high HIV prevalence. DA are more frequent among women than men, and individuals affected by one are often affected by the other. DA are associated with adverse outcomes, such as poorer nutrition intake and reduced work efforts. DA also increase substantially with age, and mature adults can expect to spend a substantial fraction of their remaining lifetime-for instance, 52 % for a 55-year-old woman-affected by DA. The positive age gradients of DA are not due to cohort effects, and they are in sharp contrast to the age pattern of mental health that has been shown in high-income contexts, where older individuals often experience lower levels of DA. Although socioeconomic and risk- or uncertainty-related stressors are strongly associated with DA, they do not explain the positive age gradients and gender gap in DA. Stressors related to physical health, however, do. Hence, our analyses suggest that the general decline of physical health with age is the key driver of the rise of DA with age in this low-income SSA context.
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Abstract
BACKGROUND Physical frailty and depression are common comorbid conditions that have important impact on older adults. Few studies however have examined their co-occurrence in centenarians. This paper explores the relationship between the two conditions and the most characteristic depressive symptoms associated with the frailty syndrome. METHODS Data come from two Portuguese Centenarian Studies. Frailty was measured using Fried's phenotype, which includes at least three clinical signs: exhaustion, weight loss, weakness, slowness, and low physical activity level; the Geriatric Depression Scale was used to assess depression. Descriptive comparison and binary logistic regression models were used for data analysis. RESULTS The final sample comprised 91 centenarians (mean age = 101.0, SD = 1.3; 85.7% female). From these, 5.5% were classified as robust, 42.9% as pre-frail, and 51.6% as frail. The prevalence of depression in the whole sample was 35.2% (51.1% in frail centenarians; 21.1% in pre-frail centenarians; 0% in robust centenarians). Frail centenarians presented higher risk of depression (OR = 3.92; 95% CI 1.48-10.4) when compared to pre-frail centenarians. Findings from the multivariable model (gender, living arrangements, education, cognition, subjective health, current illness, and functionality) revealed that only subjective health remained significant. CONCLUSION It seems that depression is a comorbid clinical independent condition that is frequent in frail and pre-frail centenarians.
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Leibowitz D, Jacobs JM, Lande-Stessman I, Gilon D, Stessman J. Cardiac structure and function predicts functional decline in the oldest old. Eur J Prev Cardiol 2017; 25:263-269. [PMID: 29164920 DOI: 10.1177/2047487317744365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- David Leibowitz
- 1 Heart Institute, Hebrew University Hadassah Medical School, Israel
| | - Jeremy M Jacobs
- 2 Department of Geriatrics and Rehabilitation, Hebrew University Hadassah Medical School, Israel
| | - Irit Lande-Stessman
- 2 Department of Geriatrics and Rehabilitation, Hebrew University Hadassah Medical School, Israel
| | - Dan Gilon
- 1 Heart Institute, Hebrew University Hadassah Medical School, Israel
| | - Jochanan Stessman
- 2 Department of Geriatrics and Rehabilitation, Hebrew University Hadassah Medical School, Israel
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Fleming J, Calloway R, Perrels A, Farquhar M, Barclay S, Brayne C. Dying comfortably in very old age with or without dementia in different care settings - a representative "older old" population study. BMC Geriatr 2017; 17:222. [PMID: 28978301 PMCID: PMC5628473 DOI: 10.1186/s12877-017-0605-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 09/01/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Comfort is frequently ranked important for a good death. Although rising numbers of people are dying in very old age, many with dementia, little is known about symptom control for "older old" people or whether care in different settings enables them to die comfortably. This study aims to examine, in a population-representative sample, associations between factors potentially related to reported comfort during very old people's final illness: physical and cognitive disability, place of care and transitions in their final illness, and place of death. METHODS Retrospective analyses linked three data sources for n = 180 deceased study participants (68% women) aged 79-107 in a representative population-based UK study, the Cambridge City over-75s Cohort (CC75C): i) prospective in-vivo dementia diagnoses and cognitive assessments, ii) certified place of death records, iii) data from interviews with relatives/close carers including symptoms and "How comfortable was he/she in his/her final illness?" RESULTS In the last year of life 83% were disabled in basic activities, 37% had moderate/severe dementia and 45% minimal/mild dementia or cognitive impairment. Regardless of dementia/cognitive status, three-quarters died following a final illness lasting a week or longer. 37%, 44%, 13% and 7% of the deceased were described as having been "very comfortable", "comfortable", "fairly comfortable" or "uncomfortable" respectively during their final illness, but reported symptoms were common: distress, pain, depression and delirium or confusion each affected 40-50%. For only 10% were no symptoms reported. There were ≥4-fold increased odds of dying comfortably associated with being in a care home during the final illness, dying in a care home, and with staying in place (dying at what death certificates record as "usual address"), whether home or care home, compared with hospital, but no significant association with disability or dementia/cognitive status, regardless of adjustment. CONCLUSIONS These findings are consistent with reports that care homes can provide care akin to hospice for the very old and support an approach of supporting residents to stay in their care home or own home if possible. Findings on reported high prevalence of multiple symptoms can inform policy and training to improve older old people's end-of-life care in all settings.
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Affiliation(s)
- Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Rowan Calloway
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- North East Thames Foundation School, London, UK
| | - Anouk Perrels
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Faculty of Medicine, Vrije Universiteit, Amsterdam, Netherlands
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Barclay
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
- Primary Care Unit, Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
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Gordon EH, Peel NM, Samanta M, Theou O, Howlett SE, Hubbard RE. Sex differences in frailty: A systematic review and meta-analysis. Exp Gerontol 2016; 89:30-40. [PMID: 28043934 DOI: 10.1016/j.exger.2016.12.021] [Citation(s) in RCA: 398] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/06/2016] [Accepted: 12/12/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is a well-described clinical phenomenon that females live longer than males, yet tend to experience greater levels of co-morbidity and disability. Females can therefore be considered both more frail (because they have poorer health status) and less frail (because they have a lower risk of mortality). This systematic review aimed to determine whether this ageing paradox is demonstrated when the Frailty Index (FI) is used to measure frailty. METHODS Medline, EMBASE and CINAHL databases were searched for observational studies that measured FI and mortality in community-dwellers over 65years of age. In five-year age groups, meta-analysis determined the sex differences in mean FI (MD=mean FIfemale-mean FImale) and mortality rate. RESULTS Of 6482 articles screened, seven articles were included. Meta-analysis of data from five studies (37,426 participants) found that MD values were positive (p<0.001; MD range=0.02-0.06) in all age groups, indicating that females had higher FI scores than males at all ages. This finding was consistent across individual studies. Heterogeneity was high (I2=72.7%), reflecting methodological differences. Meta-analysis of mortality data (13,127 participants) showed that male mortality rates exceeded female mortality rates up until the 90 to 94-years age group. Individual studies reported higher mortality for males at each level of FI, and higher risk of death for males when controlling for age and FI. CONCLUSIONS The pattern of sex differences in the FI and mortality of older adults was consistent across populations and confirmed a 'male-female health-survival paradox'.
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Affiliation(s)
- E H Gordon
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - N M Peel
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - M Samanta
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - O Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S E Howlett
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R E Hubbard
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia
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Wastesson JW, Oksuzyan A, von Bornemann Hjelmborg J, Christensen K. Changes in Drug Use and Polypharmacy After the Age of 90: A Longitudinal Study of the Danish 1905 Cohort. J Am Geriatr Soc 2016; 65:160-164. [PMID: 27891576 DOI: 10.1111/jgs.14416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the longitudinal development of drug use in very old adults. DESIGN Longitudinal cohort study with waves in 1998, 2000, 2002, and 2005. SETTING Nationwide study in Denmark. PARTICIPANTS All living Danes born in 1905 were approached in 1998; 2,262 responded at baseline. MEASUREMENTS Self-reported use of regularly taken drugs. Mean and median number of drugs and growth curve models were used to identify the change in number of drugs as the cohort aged from 92 to 100. RESULTS The within-person use of drugs increased with age for women (0.19 per year; 95% confidence interval (CI) = 0.15-0.24) and men (0.15 per year; 95% CI = 0.06-0.24). Persons leaving the study prematurely had higher baseline values and a steeper increase in their annual use of drugs. The population-level mean number of drugs increased from baseline (3.6 drugs) to the first follow-up (4.1 drugs) but thereafter remained stable at approximately 4 drugs. Women used more drugs than men at all waves. CONCLUSION In this first longitudinal study of drug use in nonagenarians, individuals used an increasing number of drugs as they aged. This increase is difficult to detect in cross-sectional analyses of the population-level mean. More efforts to understand what is reasonable prescribing at these older ages are needed.
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Affiliation(s)
- Jonas W Wastesson
- Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark
| | - Anna Oksuzyan
- Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Kaare Christensen
- Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark.,Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.,Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology and Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
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Impact of physical and mental health on life satisfaction in old age: a population based observational study. BMC Geriatr 2016; 16:194. [PMID: 27887583 PMCID: PMC5124278 DOI: 10.1186/s12877-016-0365-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022] Open
Abstract
Background It is widely assumed that poor health lowers life satisfaction when ageing. Yet, research suggests this relationship is not straightforward. This study investigated how older people evaluate their life when facing disease and disabilities. Methods The Leiden 85-plus Study, a prospectively followed cohort of a cohort of a middle-sized city in the Netherlands, all aged 85 years, that was age-representative of the general population, was used. Those with severe cognitive dysfunction were excluded (n = 501). Comorbidities, physical performance, cognitive function, functional status, residual lifespan, depressive symptoms and experienced loneliness were measured during home visits. Life satisfaction was self-reported with Cantril’s ladder. All analyses were performed using regression analysis. Results Participants reported high life satisfaction (median 8 out of 10 points) despite having representative levels of disease and disability. Comorbidity, low cognitive function, and residual lifespan as markers of health were not associated with life satisfaction. Poor physical performance and low functional status were weakly but significantly associated with lower life satisfaction (p < 0.05 respectively p < 0.001), but significance was lost after adjustment for depressive symptoms and perceived loneliness. Depressive symptoms and perceived loneliness were strongly related to lower life satisfaction (both p < 0.001), even after adjustment for physical health characteristics. Conclusion Poor physical health was hardly related to lower life satisfaction, whereas poor mental health was strongly related to lower life satisfaction. This indicates that mental health has a greater impact on life satisfaction at old age than physical health, and that physical health is less relevant for a satisfactory old age.
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Franz CE, Finkel D, Panizzon MS, Spoon K, Christensen K, Gatz M, Kremen WS, Krueger R, Neiderhiser J, Reynolds C, Pedersen NL. Facets of Subjective Health From Early Adulthood to Old Age. J Aging Health 2016; 29:149-171. [PMID: 26832851 DOI: 10.1177/0898264315625488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Subjective health is a complex indicator predicting longevity independent of objective health. Few studies examine genetic and environmental mechanisms underlying different facets of subjective health across the life course. METHOD Three subjective health measures were examined in 12,900 twins ( Mage = 63.38, range = 25-102) from nine studies in the Interplay of Genes and Environment across Multiple Studies Consortium: self-rated health (SRH), health compared with others (COMP), and health interfering with activities (ACT). RESULTS Analyses indicated age and sex differences in mean scores depending on the measure. SRH and ACT showed significant linear and non-linear moderation by age for individual differences in both genetic and environmental variance. Significant sex differences in components of variance were found for SRH and ACT, but not COMP. DISCUSSION Subjective health appears to be dependent on frame of reference and reflect different aspects of health. Results suggest different genetic and environmental mechanisms underlie each facet.
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Affiliation(s)
- Carol E Franz
- 1 University of California, San Diego, La Jolla, USA
| | | | | | - Kelly Spoon
- 1 University of California, San Diego, La Jolla, USA
| | | | - Margaret Gatz
- 4 University of Southern California, Los Angeles, USA
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Kröger H, Fritzell J, Hoffmann R. The Association of Levels of and Decline in Grip Strength in Old Age with Trajectories of Life Course Occupational Position. PLoS One 2016; 11:e0155954. [PMID: 27232696 PMCID: PMC4883757 DOI: 10.1371/journal.pone.0155954] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/06/2016] [Indexed: 12/03/2022] Open
Abstract
Background The study of the influence of life course occupational position (OP) on health in old age demands analysis of time patterns in both OP and health. We study associations between life course time patterns of OP and decline in grip strength in old age. Methods We analyze 5 waves from the Survey of Health Ageing and Retirement in Europe (n = 5108, ages 65–90). We use a pattern-mixture latent growth model to predict the level and decline in grip strength in old age by trajectory of life course OP. We extend and generalize the structured regression approach to establish the explanatory power of different life course models for both the level and decline of grip strength. Results Grip strength declined linearly by 0.70 kg (95% CI -0.74;-0.66) for men and 0.42 kg (95% CI -0.45;-0.39) for women per year. The level of men’s grip strength can best be explained by a critical period during midlife, with those exposed to low OP during this period having 1.67 kg (95% CI -2.33;-1.00) less grip strength. These differences remain constant over age. For women, no association between OP and levels of or decline in grip strength was found. Conclusions Men’s OP in midlife seems to be a critical period for the level of grip strength in old age. Inequalities remain constant over age. The integration of the structured regression approach and latent growth modelling offers new possibilities for life course epidemiology.
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Affiliation(s)
- Hannes Kröger
- European University Institute, Florence, Italy
- * E-mail:
| | - Johan Fritzell
- Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden
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Thinggaard M, McGue M, Jeune B, Osler M, Vaupel JW, Christensen K. Survival Prognosis in Very Old Adults. J Am Geriatr Soc 2016; 64:81-8. [PMID: 26782855 DOI: 10.1111/jgs.13838] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine whether simple functional indicators are predictors of survival prognosis in very old adults. DESIGN In-person survey conducted over a 3-month period in 1998; assessment of survival over a 15-year follow-up period. SETTING Denmark. PARTICIPANTS All 3,600 Danes born in 1905 and living in Denmark in 1998, were invited to participate regardless of residence and health; 2,262 (63%) participated in the survey: 1,814 (80.2%) in person and 448 (19.8%) through a proxy. MEASUREMENTS Socioeconomic factors, medications and diseases, activities of daily living, physical performance, cognition, depression symptomatology, self-rated health, and all-cause mortality, evaluated as average remaining lifespan and chance of surviving to 100 years. RESULTS Men aged 92 to 93 had an overall 6.0% chance of surviving to 100 years, whereas the chance for women was 11.4%. Being able to rise without use of hands increased the chance for men to 11.2% (95% confidence interval (CI)=7.7-14.7) and for women to 22.0% (95% CI=18.9-25.1). When combining this with a Mini-Mental State Examination (MMSE) scores from 28 to 30, the chances were 21.7% (95% CI=11.5-31.9) for men and 34.2% (95% CI=24.8-43.5) for women. CONCLUSION Chair stand score combined with MMSE score is a quick and easy way to estimate overall chance of survival in very old adults, which is particularly relevant when treatment with potential side effects for nonacute diseases is considered.
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Affiliation(s)
- Mikael Thinggaard
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Matt McGue
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.,Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Bernard Jeune
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Merete Osler
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - James W Vaupel
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.,Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.,Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.,Max-Planck Odense Center on the Biodemography of Aging, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Scherbov S, Sanderson WC, Gietel-Basten S. Better way to measure ageing in East Asia that takes life expectancy into account. Australas J Ageing 2016; 35:139-42. [PMID: 26970092 DOI: 10.1111/ajag.12267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to improve the measurement of ageing taking into account characteristics of populations and in particular changes in life expectancy. METHOD Using projected life tables, we calculated prospective old age dependency ratios (POADRs) to 2060, placing the boundary to old age at a moving point with a fixed remaining life expectancy (RLE) for all countries of East Asia. RESULTS POADRs grow less rapidly than old age dependency ratios (OADRs). For example, in the Republic of Korea, the OADR is forecast to increase from around 0.1 in 1980 to around 0.8 in 2060, while the POADR is forecast to increase from around 0.1 to 0.4 over the same period. CONCLUSION Policy makers may wish to take into account the fact that the increases in measures of ageing will be slower when those measures are adjusted for changes in life expectancy.
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Affiliation(s)
- Sergei Scherbov
- World Population Program, International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Warren C Sanderson
- World Population Program, International Institute for Applied Systems Analysis, Laxenburg, Austria.,Department of Economics, Stony Brook University, Stony Brook, New York, USA
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Naseer M, Fagerström C. Prevalence and Association of Undernutrition with Quality of Life among Swedish People Aged 60 Years and Above: Results of the SNAC-B Study. J Nutr Health Aging 2015; 19:970-9. [PMID: 26624207 DOI: 10.1007/s12603-015-0656-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to assess the prevalence of undernutrition among elderly and to investigate the association of risk of undernutrition with health-related quality of life and life satisfaction controlling for age, gender, marital status, economic status, housing arrangement, education level, functional ability, and diseases. DESIGN A cross-sectional study design was used for this study. The baseline data (2001-2003) of "The Swedish National Study of Aging and Care-Blekinge (SNAC-B)" was used. SETTING This population-based study focused on both home-living and special-housing residents. PARTICIPANTS The participants (n=1402) were randomly selected and included both males and females 60-96 years of age residing in a municipality of south-east Sweden. MEASUREMENTS The risk of undernutrition was estimated by the occurrence of at least one anthropometric measure (body mass index, mid-arm circumference, and calf circumference) below cut-off, in addition to the presence of at least one subjective measure (declined food intake, weight loss, and eating difficulty). The dependent variables, health-related quality of life and life satisfaction, were measured by the validated short form health survey (SF-12) and Liang's life satisfactions index A (LSIA), respectively. RESULTS According to the criterion, 8.5% of the participants were at risk of undernutrition, and subjects at nutritional risk were significantly older, female, unmarried/widowed/divorced, residing in special housing, and functionally impaired. The risk of undernutrition was significantly associated with poor health-related quality of life, both in the physical (OR 2.31, 95% CI 1.18-4.52) and mental (OR 2.34, 95% CI 1.22-4.47) dimensions. However, no significant association was observed between nutritional status and life satisfaction (OR 1.30, 95% CI 0.70-2.40). CONCLUSION The risk of undernutrition significantly increases the risk of poor physical and mental health-related quality of life but has negligible impact on life satisfaction. This study also highlights the importance of functional ability both for the prevention of undernutrition and promotion of quality of life. However, more studies are needed to validate the tool used here for undernutrition risk assessment before it can be used in clinical or population settings.
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Affiliation(s)
- M Naseer
- Dr Cecilia Fagerström, Department of health, Blekinge Institute of Technology, SE-371 39 Karlskrona, Sweden, Phone: 00 46 (0) 455 385445, Fax: 00 46 (0) 455 385407,
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Predictors of 49-month mortality in Chinese nonagenarians and centenarians in PLAD study. Aging Clin Exp Res 2015; 27:821-7. [PMID: 25847189 DOI: 10.1007/s40520-015-0355-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 03/20/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine whether a set of well-known predictors of mortality in younger elderly also maintain their importance in Chinese oldest old group. DESIGN A cross-sectional study of 1401 inhabitants aged 90 and older were conducted in the area of Dujiangyan, China. 825 subjects participated and were followed up for vital status after 49 months. Professional interviewers collected baseline data concerning socio-demographic characteristics, lifestyle habits, physical factors and geriatric assessment. Bivariate analysis was conducted between survivors and deceased. Cox regression models were used to evaluate predictors of mortality. RESULTS Four hundred and thirty-six (52.8%) of 825 participants eligible for the analysis died during the 49 months of follow-up period. Older age, comorbidity, lower MMSE score, lower ADL and IADL scores increased the risk of mortality in the study group. Multivariate analyses showed older age (HR = 1.03, 95% CI 1.01-1.07) and comorbidity (HR = 1.09, 95% CI 1.02-1.17) were associated with mortality while female gender (HR = 0.61, 95% CI 0.43-0.86), taking exercise (HR = 0.80, 95% CI 0.64-1.01) and higher MMSE scores (HR = 0.96, 95% CI 0.94-0.99) showed a positive effect on survival. CONCLUSION In Chinese nonagenarians and centenarians, age, gender, taking exercise, cognitive impairment and comorbidity at baseline show predictive power of oldest old mortality.
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Mänty M, Kuh D, Cooper R. Associations of Midlife to Late Life Fatigue With Physical Performance and Strength in Early Old Age: Results From a British Prospective Cohort Study. Psychosom Med 2015; 77:823-32. [PMID: 26176776 PMCID: PMC4568292 DOI: 10.1097/psy.0000000000000214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine associations of fatigue in midlife and later life with physical performance and strength in early old age. METHODS Data on approximately 1800 men and women from the UK Medical Research Council National Survey of Health and Development with data on fatigue at ages 43 and 60 to 64 years were used. Fatigue was defined as perceived tiredness and was assessed prospectively at ages 43 and 60 to 64 years. At both ages, participants were categorized as having no, occasional, or frequent fatigue. Physical performance and strength were measured at age 60 to 64 years using four objective measures: grip strength, standing balance, chair rising, and timed get-up-and-go (TUG) tests. RESULTS There were associations between reports of frequent fatigue at both ages and poorer grip strength, chair rise, and TUG performance at 60 to 64 years. Furthermore, individuals reporting frequent fatigue at both ages had weaker grip strength (β = -4.09 kg, 95% confidence interval [CI] = -6.71 to -1.48) and slower chair rise (β = -4.65 repetitions/min, 95% CI = -6.65 to -2.64) and TUG (β = -4.22 cm/s, 95% CI = -12.16 to -2.28) speeds when compared with those who reported no fatigue at both time points. These associations were robust and were maintained after adjustment for a range of covariates including physical activity and health status. CONCLUSIONS Reports of frequent fatigue were associated with poorer physical performance in early old age, especially if sustained from midlife to later life. These findings indicate that it is not just fatigue but fatigue sustained across adulthood that has implications for later life functioning.
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Affiliation(s)
- Minna Mänty
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, University of Helsinki, Finland
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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Buchman AS, Wilson RS, Bienias JL, Bennett DA. Gender differences in upper extremity motor performance of older persons. Geriatr Gerontol Int 2015; 5:59-65. [PMID: 25782068 DOI: 10.1111/j.1447-0594.2005.00266.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Motor performance declines with age. Although gender differences in motor strength and speed have been widely reported, the extent to which these differences are maintained in old age has not been well established. METHODS Upper extremity motor performance was assessed in 234 men and 530 women Catholic clergy members aged 65 years or older with no clinical evidence of dementia who were participants in the Religious Orders Study. As part of a uniform clinical evaluation, upper extremity motor performance including strength (grip and pinch dynamometry), movement speed including finger tapping and Purdue pegboard and muscle bulk of the arm were collected. RESULTS Men were stronger than women at all ages but this difference became less prominent at older ages. Women scored higher on the Purdue Pegboard than men whereas men had faster maximal finger tapping rates than women. Gender differences in speed were not modified by age. Men had greater muscle bulk than women at all ages and these differences were not modified by age. These relationships were not modified by participants with a clinical diagnosis of Parkinson's disease or stroke or by hormone replacement therapy in women. CONCLUSIONS Gender differences in upper extremity speed and muscle bulk appear to be relatively stable with increasing age, whereas gender differences in strength were reduced in the oldest old. Longitudinal studies are needed to determine if men and women differ in the rate of decline of strength in old age.
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Affiliation(s)
- Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center,Department of Neurological Sciences, Rush University Medical Center,Department of Psychology, Rush University Medical Center andRush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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Yang M, Jiang J, Li H, Wu H, Dong B. Association between waist circumference and self-reported disability among Chinese adults aged 90 years and older. Geriatr Gerontol Int 2014; 15:1249-57. [PMID: 25496442 DOI: 10.1111/ggi.12424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 02/05/2023]
Abstract
AIM To investigate the relationship between waist circumference (WC) and activities of daily living (ADL)/instrumental activities of daily living (IADL) disability among nonagenarians and centenarians. METHODS We analyzed data obtained from a cross-sectional study carried out in 870 older Chinese adults aged 90 years and older in Dujiangyan, a town in West China. The participants were divided into four groups according to their sex and WC quartile. The ADL and IADL disabilities were measured using the physical self-maintenance scale and Lawton and Brody's IADL scale, respectively. RESULTS We included 233 men and 505 women in this statistical analysis. The prevalence of ADL or IADL disability was 53.6% in men and 71.3% in women. Participants in the highest WC quartile group (WC ≥83.0 cm for men or WC ≥82.0 cm for women) had higher prevalence of ADL or IADL disability compared with those in the lowest WC quartile group (WC <73.0 cm for men or WC <70.5 cm for women). Adjusting for relevant confounders, the highest quartile group showed significantly increased odds ratios for either ADL (1.7 for men and 2.1 for women) or IADL disability (odds ratios 3.3 for men and 2.0 for women) compared with the lowest quartile group. CONCLUSION Among Chinese older adults aged 90 years and older, both men and women in the highest quartile of WC were at higher risk of ADL or IADL disability compared with those in the lowest quartile of WC. Geriatr Gerontol Int 2015; 15: 1249-1257.
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Affiliation(s)
- Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaojiao Jiang
- Department of Rehabilitation, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Li
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Hongmei Wu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Konerding U, Elkhuizen SG, Faubel R, Forte P, Malmström T, Pavi E, Janssen MFB. The validity of the EQ-5D-3L items: an investigation with type 2 diabetes patients from six European countries. Health Qual Life Outcomes 2014; 12:181. [PMID: 25479769 PMCID: PMC4263046 DOI: 10.1186/s12955-014-0181-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 11/26/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Most previous studies concerning the validity of the EQ-5D-3L items refer to applications of only a single language version of the EQ-5D-3L in only one country. Therefore, there is little information concerning the extent to which the results can be generalised across different language versions and/or different countries. Here the validity of the EQ-5D-3L items is investigated for six different language versions in six different countries. METHODS Data came from 1341 type 2 diabetes patients (England: 289; Finland: 177; Germany: 255; Greece: 165; the Netherlands: 354; Spain: 101). The relationships of the five EQ-5D-3L items with seven different test variables (age, gender, education, previous stroke, problems with heart, problems with lower extremities, problems with eyes), were analysed for each combination of item and test variable. For each combination two logistic regression models with the dichotomised EQ-5D-3L item as dependent variable were computed. The first model contained the test variable and dummy coded countries as independent variables, the second model additionally the terms for the interaction between country and test variable. Statistically significant better fit of the second model was taken as evidence for country specific differences regarding the relationship. When such differences could be attributed mainly to one country the analyses were repeated without the data from this country. Validity was investigated with the remaining data using results of the first models. RESULTS Due to lack of variation in the Spanish data only 31 of the originally intended 35 interaction tests could be performed. Only three of these yielded a significant result. In all three cases the Spanish data deviated most. Without the Spanish data only 1 of the 35 interaction tests yielded a significant result. With 3 exceptions, the tendency of reporting problems increased with age, female gender, lower education, previous stroke, heart problems, problems with lower extremities and problems with eyes for all EQ-5D-3L items. CONCLUSION The results concerning the European Spanish version are ambiguous. However, the items of the English, Finnish, German, Greek and Dutch versions of the EQ-5D-3L relate in substantially the same way to the test variables. Mostly, these relationships indicate the items' validity.
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Affiliation(s)
- Uwe Konerding
- Trimberg Research Academy, University of Bamberg, Bamberg, D-96045, Germany.
| | - Sylvia G Elkhuizen
- Institute of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam, DR, 3000, The Netherlands.
| | - Raquel Faubel
- Joint Research Unit in Biomedical Engineering, IIS La Fe- Universitat Politècnica de València, Bulevar sur s/n, 46026, Valencia, Spain.
| | - Paul Forte
- The Balance of Care Group, 39a Cleveland Road, London, N1 3ES, UK.
| | - Tomi Malmström
- Department of Industrial Engineering and Management, Aalto University, PO Box 15500, Espoo, Aalto, 00076, Finland.
| | - Elpida Pavi
- Department of Health Economics, National School of Public Health, 196 Alexandras Ave, 115 21, Athens, Greece.
| | - M F Bas Janssen
- Department of Psychiatry, Section Medical Psychology & Psychotherapy, Erasmus MC, PO Box 2040, CA, 3000, Rotterdam, The Netherlands.
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Duarte N, Teixeira L, Ribeiro O, Paúl C. Frailty phenotype criteria in centenarians: Findings from the Oporto Centenarian Study. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2014.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Idland G, Småstuen MC, Engedal K, Bergland A. Functioning and Self-Rated Health in the Oldest Old Community-Dwelling Women: A Four-Year Longitudinal Study. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2014. [DOI: 10.3109/02703181.2014.895794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cevenini E, Cotichini R, Stazi MA, Toccaceli V, Palmas MG, Capri M, De Rango F, Dato S, Passarino G, Jeune B, Franceschi C. Health status and 6 years survival of 552 90+ Italian sib-ships recruited within the EU Project GEHA (GEnetics of Healthy Ageing). AGE (DORDRECHT, NETHERLANDS) 2014; 36:949-66. [PMID: 24323371 PMCID: PMC4039258 DOI: 10.1007/s11357-013-9604-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 11/26/2013] [Indexed: 05/02/2023]
Abstract
In a scenario of increasing life expectancy worldwide, it is mandatory to identify the characteristics of a healthy aging phenotype, including survival predictors, and to disentangle those related to environment/lifestyle versus those related to familiarity/genetics. To this aim we comprehensively characterised a cohort of 1,160 Italian subjects of 90 years and over (90+, mean age 93 years; age range 90-106 years) followed for 6 years survival, belonging to 552 sib-ships (familiar longevity) recruited (2005-2008) within the EU-funded GEHA project in three Italian geographic areas (Northern, Central and Southern Italy) different for urban/rural and socio-economical characteristics. On the whole, the following factors emerged as significant predictors of survival after 90 years of age: absence of cognitive impairment and physical disability, high hand grip strength scores and body mass index (BMI) values, "excellent/good" self-reported health, high haemoglobin and total cholesterol levels and low creatinine levels. These parameters, excluding BMI values, were also significantly associated within sib-ships, suggesting a strong familial/genetic component. Geographical micro-heterogeneity of survival predictors emerged, such as functional and physical status being more important in Southern than in Central and Northern Italy. In conclusion, we identified modifiable survival predictors related to specific domains, whose role and importance vary according to the geographic area considered and which can help in interpreting the genetic results obtained by the GEHA project, whose major aim is the comprehensive evaluation of phenotypic and genetic data.
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Affiliation(s)
- E. Cevenini
- />C.I.G.—Interdepartmental Centre “L. Galvani”, University of Bologna, Piazza di Porta San Donato 1, 40126 Bologna, Italy
- />DIMES—Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 12, 40138 Bologna, Italy
| | - R. Cotichini
- />National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
- />IFC—Institute of Clinical Physiology, CNR, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - M. A. Stazi
- />National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - V. Toccaceli
- />National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - M. G. Palmas
- />C.I.G.—Interdepartmental Centre “L. Galvani”, University of Bologna, Piazza di Porta San Donato 1, 40126 Bologna, Italy
- />DIMES—Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 12, 40138 Bologna, Italy
| | - M. Capri
- />C.I.G.—Interdepartmental Centre “L. Galvani”, University of Bologna, Piazza di Porta San Donato 1, 40126 Bologna, Italy
- />DIMES—Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 12, 40138 Bologna, Italy
| | - F. De Rango
- />Department of Biology, Ecology and Earth Science, University of Calabria, 87036 Rende, Italy
| | - S. Dato
- />Department of Biology, Ecology and Earth Science, University of Calabria, 87036 Rende, Italy
| | - G. Passarino
- />Department of Biology, Ecology and Earth Science, University of Calabria, 87036 Rende, Italy
| | - B. Jeune
- />Epidemiology, Danish Ageing Research Center, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - C. Franceschi
- />C.I.G.—Interdepartmental Centre “L. Galvani”, University of Bologna, Piazza di Porta San Donato 1, 40126 Bologna, Italy
- />DIMES—Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via San Giacomo 12, 40138 Bologna, Italy
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Mänty M, Ekmann A, Thinggaard M, Christensen K, Avlund K. Indoor mobility-related fatigue and muscle strength in nonagenarians: a prospective longitudinal study. Aging Clin Exp Res 2014; 26:39-46. [PMID: 24297217 DOI: 10.1007/s40520-013-0178-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 08/09/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Mobility-related fatigue is an important indicator of functional decline in old age, however, very little is known about fatigue in the oldest old population segment. The aim of this study was to examine the association between indoor mobility-related fatigue and muscle strength decline in nonagenarians. METHODS The study is based on a prospective longitudinal study of all Danes born in 1905 and assessed in 1998, 2000 and 2003, and includes 92- to 93-year-old persons who were independent of help in basic indoor mobility at baseline (n = 1,353). Fatigue was assessed at baseline and defined as a subjective feeling of fatigue when transferring or walking indoors. The outcome measure, maximum grip strength, was measured at each measurement point. RESULTS Grip strength declined throughout the study in participants with and without fatigue, but those reporting fatigue had significantly (P < .001) lower muscle strength during the entire study period. Longitudinal analyses indicated slightly slower decline in muscle strength among participants with fatigue compared to those without; however, observed selective dropout of participants with fatigue and poor performance at baseline needs to be considered when interpreting the results. Accordingly, participants without fatigue had significantly higher chances of being alive and having muscle strength above gender-specific median at first (RR 1.32, 95 % CI 1.07-1.58), second (RR 1.51, 1.06-1.96) and third (RR 1.39, 1.01-1.97) measurement points. CONCLUSIONS Indoor mobility-related fatigue in advanced later life should not merely be considered as an unpleasant symptom, but rather an indicator of physical impairment, and consequently declined physiological reserve.
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Affiliation(s)
- Minna Mänty
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014, Copenhagen K, Denmark,
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Dato S, Soerensen M, Lagani V, Montesanto A, Passarino G, Christensen K, Tan Q, Christiansen L. Contribution of genetic polymorphisms on functional status at very old age: a gene-based analysis of 38 genes (311 SNPs) in the oxidative stress pathway. Exp Gerontol 2014; 52:23-9. [PMID: 24462499 DOI: 10.1016/j.exger.2014.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/03/2014] [Accepted: 01/11/2014] [Indexed: 01/08/2023]
Abstract
Preservation of functional ability is a well-recognized marker of longevity. At a molecular level, a major determinant of the physiological decline occurring with aging is the imbalance between production and accumulation of oxidative damage to macromolecules, together with a decreased efficiency of stress response to avoid or repair such damage. In this paper we investigated the association of 38 genes (311 SNPs) belonging to the pro-antioxidant pathways with physical and cognitive performances, by analyzing single SNP and gene-based associations with Hand Grip strength (HG), Activities of Daily Living (ADL), Walking Speed (WS), Mini Mental State Examination (MMSE) and Composite Cognitive Score (CCS) in a Cohort of 1089 Danish nonagenarians. Moreover, for each gene analyzed in the pro-antioxidant pathway, we tested the influence on longitudinal survival. In the whole sample, nominal associations were found for TXNRD1 variability with ADL and WS, NDUFS1 and UCP3 with HG and WS, GCLC and UCP2 with WS (p<0.05). Stronger associations although not holding the multiple comparison correction, were observed between MMSE and NDUFV1, MT1A and GSTP1 variability (p<0.009). Moreover, we found that association between genetic variability in the pro-antioxidant pathway and functional status at old age is influenced by sex. In particular, most significant associations were observed in nonagenarian females, between HG scores and GLRX and UCP3 variability, between ADL levels and TXNRD1, MMSE and MT1A genetic variability. In males, a borderline statistically significant association with ADL level was found for UQCRFS1 gene. Nominally significant associations in relation to survival were found in the female sample only with SOD2, NDUFS1, UCP3 and TXNRD1 variability, the latter two confirming previous observations reported in the same cohort. Overall, our work supports the evidence that genes belonging to the pro-anti-oxidant pathway are able to modulate physical and cognitive performance after the ninth decade of life, finally influencing extreme survival.
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Affiliation(s)
- S Dato
- Department of Biology, Ecology and Heart Sciences, University of Calabria, Ponte Pietro Bucci cubo 4C, 87036 Rende, CS, Italy; The Danish Aging Research Center, Epidemiology, Institute of Public Health, University of Southern Denmark, J.B. Winslows Vej 9B, 5000 Odense C, Denmark.
| | - M Soerensen
- The Danish Aging Research Center, Epidemiology, Institute of Public Health, University of Southern Denmark, J.B. Winslows Vej 9B, 5000 Odense C, Denmark; Department of Clinical Genetics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - V Lagani
- Bio Informatics Laboratory, Institute of Computer Science, Foundation for Research and Technology (Hellas), Heraklion, Greece.
| | - A Montesanto
- Department of Biology, Ecology and Heart Sciences, University of Calabria, Ponte Pietro Bucci cubo 4C, 87036 Rende, CS, Italy.
| | - G Passarino
- Department of Biology, Ecology and Heart Sciences, University of Calabria, Ponte Pietro Bucci cubo 4C, 87036 Rende, CS, Italy.
| | - K Christensen
- The Danish Aging Research Center, Epidemiology, Institute of Public Health, University of Southern Denmark, J.B. Winslows Vej 9B, 5000 Odense C, Denmark; Department of Clinical Genetics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - Q Tan
- The Danish Aging Research Center, Epidemiology, Institute of Public Health, University of Southern Denmark, J.B. Winslows Vej 9B, 5000 Odense C, Denmark; Department of Clinical Genetics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
| | - L Christiansen
- The Danish Aging Research Center, Epidemiology, Institute of Public Health, University of Southern Denmark, J.B. Winslows Vej 9B, 5000 Odense C, Denmark; Department of Clinical Genetics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
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Ghorbani Saeedian R, Nagyova I, Klein D, Skorvanek M, Rosenberger J, Gdovinova Z, Groothoff JW, van Dijk JP. Self-rated health mediates the association between functional status and health-related quality of life in Parkinson's disease. J Clin Nurs 2013; 23:1970-7. [PMID: 24354845 DOI: 10.1111/jocn.12442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore whether self-rated health acts as a potential mediator in the association between functional status and health-related quality of life in Parkinson's disease. BACKGROUND Older persons (as most patients with Parkinson's disease are) who reported poor self-rated health compared with those with excellent self-rated health were two-and-a-half times more likely to have experienced a decline in functional ability. DESIGN Cross-sectional. METHODS Socio-demographic and clinical data of the patients (n = 176) were obtained during a structured interview and from medical records. Functional status was measured with the Unified Parkinson's Disease Rating Scale (total score), self-rated health with the first item of the Short-Form 36-item Health Survey Questionnaire and health-related quality of life with the disease-specific questionnaire called the Parkinson's Disease Quality of Life Questionnaire-39. Multiple linear regression analyses and the Sobel test were employed to assess mediation. RESULTS Self-rated health seems to have a mediating effect on the association between functional status and health-related quality of life. The Sobel test confirmed an indirect effect of functional status via self-rated health on health-related quality of life and showed a statistically significant indirect effect of functional status on health-related quality of life via self-rated health against the direct route without the mediator. CONCLUSIONS Self-rated health partially mediates the deteriorating effect of functional status on health-related quality of life. RELEVANCE TO CLINICAL PRACTICE Supportive and adaptation psychosocial intervention programmes leading to restored self-rated health may enhance the quality of life regardless of disability in Parkinson's disease.
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Affiliation(s)
- Radka Ghorbani Saeedian
- Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Safarik University, Kosice, Slovak Republic; Institute of Public Health, Department of Social Medicine, Faculty of Medicine, Safarik University, Kosice, Slovak Republic
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Molino-Lova R, Sofi F, Pasquini G, Gori A, Vannetti F, Abbate R, Gensini GF, Macchi C. The Mugello study, a survey of nonagenarians living in Tuscany: design, methods and participants' general characteristics. Eur J Intern Med 2013; 24:745-9. [PMID: 24125724 DOI: 10.1016/j.ejim.2013.09.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/31/2013] [Accepted: 09/13/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous studies on nonagenarians have widely investigated functional and cognitive decline, falls, predictors of mortality, inflammation and aging genetics. However, some intriguing domains, such as body composition, daily energy expenditure, sleep quality and physical activity, as well as endothelial progenitor cells and "omics" fields, such as proteomics or metabolomics, have been poorly explored. In this preliminary paper we report design, methods and characteristics of participants in the Mugello Study, a survey of nonagenarians aimed at filling these gaps. METHODS 475 non selected nonagenarians, 130 men and 345 women, mean age 92.6 years ± SD 2.6, received a visit by a trained physician at their residence. Along with the assessment of social, functional and cognitive status, reported in this paper, participants also underwent instrumental examinations, including body impedance assessment and continuous direct calorimetry, and were administered a series of validated questionnaires. Further, 385 participants accepted to undergo blood withdrawal. RESULTS In 52 cases the visit was conducted in nursing homes. Among the 423 home-living participants, 91 lived alone and 77 were not looked after by any caregiver. Altogether, 154 participants over 475 were free from disabilities and 266 showed Mini Mental State Examination raw scores ≥ 21. Men showed less disability and cognitive impairment (p<0.001, for both). CONCLUSIONS As a whole, our findings are comparable to those reported in other surveys. Future studies, by using the Mugello Study database and biologic bank, that will be available to all researchers, will shed some more light on the aging process in nonagenarians.
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Christensen K, Thinggaard M, Oksuzyan A, Steenstrup T, Andersen-Ranberg K, Jeune B, McGue M, Vaupel JW. Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart. Lancet 2013; 382:1507-13. [PMID: 23849796 PMCID: PMC3818336 DOI: 10.1016/s0140-6736(13)60777-1] [Citation(s) in RCA: 265] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND A rapidly increasing proportion of people in high-income countries are surviving into their tenth decade. Concern is widespread that the basis for this development is the survival of frail and disabled elderly people into very old age. To investigate this issue, we compared the cognitive and physical functioning of two cohorts of Danish nonagenarians, born 10 years apart. METHODS People in the first cohort were born in 1905 and assessed at age 93 years (n=2262); those in the second cohort were born in 1915 and assessed at age 95 years (n=1584). All cohort members were eligible irrespective of type of residence. Both cohorts were assessed by surveys that used the same design and assessment instrument, and had almost identical response rates (63%). Cognitive functioning was assessed by mini-mental state examination and a composite of five cognitive tests that are sensitive to age-related changes. Physical functioning was assessed by an activities of daily living score and by physical performance tests (grip strength, chair stand, and gait speed). FINDINGS The chance of surviving from birth to age 93 years was 28% higher in the 1915 cohort than in the 1905 cohort (6·50% vs 5·06%), and the chance of reaching 95 years was 32% higher in 1915 cohort (3·93% vs 2·98%). The 1915 cohort scored significantly better on the mini-mental state examination than did the 1905 cohort (22·8 [SD 5·6] vs 21·4 [6·0]; p<0·0001), with a substantially higher proportion of participants obtaining maximum scores (28-30 points; 277 [23%] vs 235 [13%]; p<0·0001). Similarly, the cognitive composite score was significantly better in the 1915 than in the 1905 cohort (0·49 [SD 3·6] vs 0·01 [SD 3·6]; p=0·0003). The cohorts did not differ consistently in the physical performance tests, but the 1915 cohort had significantly better activities of daily living scores than did the 1905 cohort (2·0 [SD 0·8] vs 1·8 [0·7]; p<0·0001). INTERPRETATION Despite being 2 years older at assessment, the 1915 cohort scored significantly better than the 1905 cohort on both the cognitive tests and the activities of daily living score, which suggests that more people are living to older ages with better overall functioning. FUNDING Danish National Research Foundation; US National Institutes of Health-National Institute on Aging; Danish Agency for Science, Technology and Innovation; VELUX Foundation.
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Affiliation(s)
- Kaare Christensen
- Danish Aging Research Center, Institute of Public Health, University of Southern Denmark, Odense, Denmark; Max Planck Odense Center, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
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Engberg H, Jeune B, Andersen-Ranberg K, Martinussen T, Vaupel JW, Christensen K. Optimism and survival: does an optimistic outlook predict better survival at advanced ages? A twelve-year follow-up of Danish nonagenarians. Aging Clin Exp Res 2013; 25:517-25. [PMID: 24014276 DOI: 10.1007/s40520-013-0122-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/12/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Studies examining predictors of survival among the oldest-old have primarily focused on objective measures, such as physical function and health status. Only a few studies have examined the effect of personality traits on survival, such as optimism. The aim of this study was to examine whether an optimistic outlook predicts survival among the oldest-old. METHODS The Danish 1905 Cohort Survey is a nationwide, longitudinal survey comprising all individuals born in Denmark in 1905. At baseline in 1998, a total of 2,262 persons aged 92 or 93 agreed to participate in the intake survey. The baseline in-person interview consisted of a comprehensive questionnaire including physical functioning and health, and a question about whether the respondent had an optimistic, neutral or pessimistic outlook on his or her own future. RESULTS During the follow-up period of 12 years (1998-2010) there were 2,239 deaths (99 %) in the 1905 Cohort Survey. Univariable analyses revealed that optimistic women and men were at lower risk of death compared to their neutral counterparts [HR 0.82, 95 % CI (0.73-0.93) and 0.81, 95 % CI (0.66-0.99), respectively]. When confounding factors such as baseline physical and cognitive functioning and disease were taken into account the association between optimism and survival weakened in both sexes, but the general pattern persisted. Optimistic women were still at lower risk of death compared to neutral women [HR 0.85, 95 % CI (0.74-0.97)]. The risk of death was also decreased for optimistic men compared to their neutral counterparts, but the effect was non-significant [HR 0.91, 95 % CI (0.73-1.13)]. CONCLUSION An optimistic outlook appears to be a significant predictor of survival among the oldest-old women. It may also be a significant predictor for men but the sample size is small.
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Affiliation(s)
- Henriette Engberg
- Department of Epidemiology, The Danish Aging Research Center, Institute of Public Health, University of Southern Denmark, Odense, Denmark,
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49
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Galenkamp H, Deeg DJH, Huisman M, Hervonen A, Braam AW, Jylhä M. Is self-rated health still sensitive for changes in disease and functioning among nonagenarians? J Gerontol B Psychol Sci Soc Sci 2013; 68:848-58. [PMID: 23921719 DOI: 10.1093/geronb/gbt066] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES With age, there is an increasing gap between relatively stable levels of self-rated health (SRH) and actual health status. This study investigates longitudinal changes in SRH and examines its sensitivity to changes in chronic conditions and functioning among people aged 90 and older. METHODS In the Vitality 90+ Study, questionnaires were sent to all people aged 90 years and older living in Tampere, Finland. Included were respondents who provided data on the 2001 measurement and at least one follow-up measurement in 2003, 2007, or 2010 (N = 334). Generalized Estimating Equations analyses examined longitudinal change in SRH and the predictive value of number of chronic conditions and a functioning score based on 5 activities. RESULTS Within 2 years, most people (56.3%) had unchanged SRH, but declined SRH (22.3%) was associated with worse baseline functioning and declined functioning. Clear declines in SRH after 6 and 9 years were associated with increased chronic conditions (odds ratio [OR] = 1.23) and decreased functioning (OR = 1.28). The impact of chronic conditions and functioning was smaller among institutionalized people (chronic conditions OR = 0.90; functioning OR = 1.18) than among people living independently (chronic conditions OR = 1.30; functioning OR = 1.44). DISCUSSION SRH among nonagenarians was sensitive to changes in the number of chronic conditions and functioning although more pronounced on the longer than on the shorter term.
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Affiliation(s)
- Henrike Galenkamp
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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50
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Cayuelas Redondo L, Navarro González M, Kostov B, Sisó Almirall A. Baja comorbilidad en longevos. Aten Primaria 2013; 45:330-2. [PMID: 23411162 PMCID: PMC6983558 DOI: 10.1016/j.aprim.2012.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 11/17/2022] Open
Affiliation(s)
- Laia Cayuelas Redondo
- Medicina de Familia y Comunitaria, Centro de Salud Casanova, Unidad Docente Multiprofesional Clínic-Maternitat, Universidad de Barcelona, Barcelona, España
- Autor para correspondencia.
| | - Marta Navarro González
- Medicina de Familia y Comunitaria, Centro de Salud Comte Borrell, Unidad Docente Multiprofesional Clínic-Maternitat, Universidad de Barcelona, Barcelona, España
- Grupo transversal de investigación en Atención Primaria, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Belchin Kostov
- Grupo transversal de investigación en Atención Primaria, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
- Medicina de Familia y Comunitaria, Centro de Salud Les Corts, Unidad Docente Multiprofesional Clínic-Maternitat, Universidad de Barcelona, Barcelona, España
| | - Antoni Sisó Almirall
- Grupo transversal de investigación en Atención Primaria, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
- Medicina de Familia y Comunitaria, Centro de Salud Les Corts, Unidad Docente Multiprofesional Clínic-Maternitat, Universidad de Barcelona, Barcelona, España
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