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Kuper H, Rotenberg S, Azizatunnisa' L, Banks LM, Smythe T. The association between disability and mortality: a mixed-methods study. Lancet Public Health 2024; 9:e306-e315. [PMID: 38702095 DOI: 10.1016/s2468-2667(24)00054-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities. METHODS We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374. FINDINGS Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ2=0·28, I2=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types. INTERPRETATION Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health. FUNDING National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.
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Affiliation(s)
- Hannah Kuper
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Missing Billion Initiative, Seattle, WA, USA.
| | - Sara Rotenberg
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Luthfi Azizatunnisa'
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Lena Morgon Banks
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Tracey Smythe
- Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK; Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
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2
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Enroth L, Halonen P, Tiainen K, Raitanen J, Jylhä M. Cohort profile: The Vitality 90+ Study-a cohort study on health and living conditions of the oldest old in Tampere, Finland. BMJ Open 2023; 13:e068509. [PMID: 36750290 PMCID: PMC9906174 DOI: 10.1136/bmjopen-2022-068509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
PURPOSE Vitality 90+ is an ongoing population-based study with repeated cross-sectional data collections. The study was designed to examine trends in health, functioning, living conditions, quality of life and care needs among the oldest old in Finland. PARTICIPANTS Nine mailed surveys have been conducted in the city of Tampere between 1995 and 2018. The first three surveys in 1995, 1996 and 1998 included all community-dwelling individuals aged 90 years or older; and the following six surveys in 2001, 2003, 2007, 2010, 2014 and 2018 covered all individuals in Tampere regardless of their living arrangements. In total, the surveys have included 5935 participants (8840 observations). Around 80% of the participants have been women. The participants' age range has been between 90 and 107 years. FINDINGS TO DATE The surveys have consistently asked the same questions over time, covering basic sociodemographic factors, morbidity, functioning, self-rated health (SRH), living arrangements, social relations, quality of life, care needs and providers of care. Survey data have been linked with national register data on health and social service use, mortality and medication. The main findings regarding the time trends show an increase in the proportion of people independent in activities of daily living and mobility. Along with improved functioning, the number of chronic conditions has increased, and SRH has shown a tendency to decline. In addition, we have found increasing occupational class inequalities in functioning and SRH over time. FUTURE PLANS The next round of data collection will be completed by the end of 2022. The Vitality 90+ Study welcomes research collaborations that fall within the general aims of the project. The research data 1995-2014 are archived at the Finnish Social Science Data Archive and the data for years 2018 and 2022 will be archived in 2023.
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Affiliation(s)
- Linda Enroth
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, Tampere University, Tampere, Finland
| | - Pauliina Halonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, Tampere University, Tampere, Finland
| | - Kristina Tiainen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, Tampere University, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, Tampere University, Tampere, Finland
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Marja Jylhä
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center, Tampere University, Tampere, Finland
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3
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Kashtanova DA, Erema VV, Gusakova MS, Sutulova ER, Yakovchik AY, Ivanov MV, Taraskina AN, Terekhov MV, Matkava LR, Rumyantseva AM, Yudin VS, Akopyan AA, Strazhesko ID, Kordiukova IS, Akinshina AI, Makarov VV, Tkacheva ON, Kraevoy SA, Yudin SM. Mortality and survival in nonagenarians during the COVID-19 pandemic: Unstable equilibrium of aging. Front Med (Lausanne) 2023; 10:1132476. [PMID: 36936206 PMCID: PMC10018166 DOI: 10.3389/fmed.2023.1132476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Aging puts the human body under an immense stress and makes it extremely susceptible to many diseases, often leading to poor outcomes and even death. Long-living individuals represent a unique group of people who withstood the stress of time and offer an abundance of information on the body's ability to endure the pressure of aging. In this study, we sought to identify predictors of overall one-year mortality in 1641 long-living individuals. Additionally, we analyzed risk factors for COVID-19-related morality, since statistics demonstrated an extreme vulnerability of older adults. Methods We conducted a two-stage evaluation, including a comprehensive geriatric assessment for major aging-associated: frailty, cognitive impairment, frontal lobe dysfunction, chronic pain, anxiety, risk of falls, sensory deficit, depression, sarcopenia, risk of malnutrition, fecal and urinary incontinence, dependence in Activities of Daily Living, dependence in Instrumental Activities of Daily Living, polypragmasia, and orthostatic hypotension; extensive blood testing, a survey, and a one-year follow-up interview. Results The most reliable predictors of overall mortality were cognitive impairment, malnutrition, frailty, aging-associated diseases and blood markers indicating malnutrition-induced metabolic dysfunctions (decreased levels of protein fractions, iron, 25-hydroxyvitamin D, and HDL), and aging biomarkers, such as IGF-1 and N-terminal pro b-type natriuretic peptide. In post-COVID 19 participants, the most significant mortality predictors among geriatric syndromes were depression, frontal lobe dysfunction and frailty, and similar to overall mortality blood biomarkers - 25-hydroxyvitamin D, IGF-1, HDL as well as high white blood cell, neutrophils counts and proinflammatory markers. Based on the results, we built a predictive model of overall mortality in the long-living individuals with f-score=0.76. Conclusion The most sensitive and reliable predictors of mortality were modifiable. This is another evidence of the critical importance of proper geriatric care and support for individuals in their "golden years". These results could facilitate geriatric institutions in their pursuit for providing improved care and could aid physicians in detecting early signs of potentially deadly outcomes. Additionally, our findings could be used in developing day-to-day care guidelines, which would greatly improve prevention statistics.
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Affiliation(s)
- Daria A. Kashtanova
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
- *Correspondence: Daria A. Kashtanova,
| | - Veronika V. Erema
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Maria S. Gusakova
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Ekaterina R. Sutulova
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Anna Yu. Yakovchik
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Mikhail V. Ivanov
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Anastasiia N. Taraskina
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Mikhail V. Terekhov
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Lorena R. Matkava
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Antonina M. Rumyantseva
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Vladimir S. Yudin
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Anna A. Akopyan
- Russian Clinical Research Center for Gerontology, Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Irina D. Strazhesko
- Russian Clinical Research Center for Gerontology, Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Irina S. Kordiukova
- Russian Clinical Research Center for Gerontology, Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Alexandra I. Akinshina
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Valentin V. Makarov
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Olga N. Tkacheva
- Russian Clinical Research Center for Gerontology, Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Sergey A. Kraevoy
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
| | - Sergey M. Yudin
- Federal State Budgetary Institution “Centre for Strategic Planning and Management of Biomedical Health Risks” of the Federal Medical Biological Agency, Moscow, Russia
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Pancani S, Lombardi G, Sofi F, Gori AM, Boni R, Castagnoli C, Paperini A, Pasquini G, Vannetti F, Molino Lova R, Macchi C, Cecchi F. Predictors of Mortality in 433 Nonagenarians Inside the Mugello Study: A 10 Years Follow-Up Study. J Aging Health 2022; 34:1071-1080. [PMID: 35499248 DOI: 10.1177/08982643221091653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to identify the predictors of mortality in a cohort of nonagenarians inside the "Mugello study" after 10 years follow-up. METHODS Information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 non-selected participants aged 90-99 years, living in the Mugello area (Italy). Participants were followed over 10 years and their dates of death were retrieved from the municipal registers. Cox regression analysis was used to determine significant potential prognostic factors. RESULTS The mortality rate was 96.5%. Cox proportional hazards analysis showed that a lower cognitive status was significantly associated with higher mortality as well as a poorer functional status, a higher comorbidity, and a higher number of drugs consumption. DISCUSSION Impaired cognitive function, loss of functional independence, higher comorbidity, and higher drugs intake were the stronger predictors of mortality.
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Affiliation(s)
| | | | - Francesco Sofi
- 9360IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, 9300University of Florence, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, 9300University of Florence, Florence, Italy.,Atherothrombotic Unit, Careggi University Hospital, Florence, Italy
| | - Roberta Boni
- 9360IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | - Claudio Macchi
- 9360IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, 9300University of Florence, Florence, Italy
| | - Francesca Cecchi
- 9360IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, 9300University of Florence, Florence, Italy
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5
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Pancani S, Lombardi G, Sofi F, Gori AM, Boni R, Castagnoli C, Paperini A, Pasquini G, Vannetti F, Lova RM, Macchi C, Cecchi F. 12-month survival in nonagenarians inside the Mugello study: on the way to live a century. BMC Geriatr 2022; 22:194. [PMID: 35279074 PMCID: PMC8918304 DOI: 10.1186/s12877-022-02908-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Life expectancy has increased over the last century and a growing number of people is reaching age 90 years and over. However, data on nonagenarians’ health trends are scarce due to difficulties in investigating this specific population. This study aims to identify risk factors for one-year mortality in nonagenarians using data collected within the “Mugello Study”. Methods Complete information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 nonagenarians, as well as information about survival after 1 year from the interview. Results The sample included 314 women (72.5%) and 119 men (27.5%) with a median age of 92 years (range 90-99 years). The mortality rate was 20.3% (88 deaths). After adjustment for age and sex, a significantly higher risk of dying within 12 months was observed in individuals with more severe cognitive impairment (HR = 5.011, p < 0.001), more severe disability in basic activities of daily living (HR = 4.193, p < 0.001), sedentary lifestyle (HR = 3.367, p < 0.001), higher number of drugs assumed (HR = 1.118, p = 0.031), and kidney dysfunction (HR = 2.609, p = 0.004). When all the variables were included in the analysis, only older age (HR = 1.079, p = 0.048), lower cognitive function (HR = 2.859, p = 0.015), sedentary lifestyle (HR = 2.030, p = 0.026), and kidney dysfunction (HR = 2.322, p = 0.018) remained significantly associated with reduced survival. Conclusions Data from the Mugello study support the hypothesis that survival at 12 months in nonagenarians is not a stochastic process and that older age, reduced cognitive function, sedentary lifestyle, and the presence of kidney dysfunction are associated with mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02908-9.
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6
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Schilling OK, Wettstein M, Wahl HW. Associations of Wellbeing Levels, Changes, and Within-Person Variability With Late-Life All-Cause Mortality Across 12 Years: Contrasting Hedonic vs. Eudaimonic Wellbeing Among Very Old Adults. Front Psychol 2022; 12:750891. [PMID: 35087446 PMCID: PMC8787264 DOI: 10.3389/fpsyg.2021.750891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
Advanced old age has been characterized as a biologically highly vulnerable life phase. Biological, morbidity-, and cognitive impairment-related factors play an important role as mortality predictors among very old adults. However, it is largely unknown whether previous findings confirming the role of different wellbeing domains for mortality translate to survival among the oldest-old individuals. Moreover, the distinction established in the wellbeing literature between hedonic and eudaimonic wellbeing as well as the consideration of within-person variability of potentially relevant mortality predictors has not sufficiently been addressed in prior mortality research. In this study, we examined a broad set of hedonic and eudaimonic wellbeing indicators, including their levels, their changes, as well as their within-person variability, as predictors of all-cause mortality in a sample of very old individuals. We used data from the LateLine study, a 7-year longitudinal study based on a sample of n = 124 individuals who were living alone and who were aged 87–97 years (M = 90.6, SD = 2.9) at baseline. Study participants provided up to 16 measurement occasions (mean number of measurement occasions per individual = 5.50, SD = 4.79) between 2009 and 2016. Dates of death were available for 118 individuals (95.2%) who had deceased between 2009 and 2021. We ran longitudinal multilevel structural equation models and specified between-person level differences, within-person long-term linear change trends, as well as the “detrended” within-person variability in three indicators of hedonic (i.e., life satisfaction and positive and negative affect) and four indicators of eudaimonic wellbeing (i.e., purpose in life, autonomy, environmental mastery, and self-acceptance) as all-cause mortality predictors. Controlling for age, gender, education, and physical condition and testing our sets of hedonic and eudaimonic indictors separately in terms of their mortality impact, solely one eudaimonic wellbeing indicator, namely, autonomy, showed significant effects on survival. Surprisingly, autonomy appeared “paradoxically” related with mortality, with high individual levels and intraindividual highly stable perceptions of autonomy being associated with a shorter residual lifetime. Thus, it seems plausible that accepting dependency and changing perceptions of autonomy over time in accordance with objectively remaining capabilities might become adaptive for survival in very old age.
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Affiliation(s)
- Oliver Karl Schilling
- Department of Psychological Aging Research, Psychological Institute, Heidelberg University, Heidelberg, Germany
| | - Markus Wettstein
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Hans-Werner Wahl
- Department of Psychological Aging Research, Psychological Institute, Heidelberg University, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
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7
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Davies LE, Kingston A, Todd A, Hanratty B. Is polypharmacy associated with mortality in the very old: findings from the Newcastle 85+ Study. Br J Clin Pharmacol 2022; 88:2988-2995. [PMID: 34981552 PMCID: PMC9302636 DOI: 10.1111/bcp.15211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022] Open
Abstract
Polypharmacy is common in the very old (≥85 years), where little is known about its association with mortality. We aimed to investigate the association between polypharmacy and all-cause mortality in the very old, over an 11-year time period. Data were drawn from the Newcastle 85+ Study (741), a cohort of people who were born in 1921 and turned 85 in 2006. Survival analysis was performed using Cox proportional hazards models with time-varying covariates, wherein polypharmacy was operationalised continuously. Each additional medication prescribed was associated with a 3% increased risk of mortality (HR: 1.03, 95% CI: 1.00-1.06). Amongst the very old, the risks and benefits of each additional medication prescribed should be carefully considered.
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Affiliation(s)
- Laurie E Davies
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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8
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Viljanen A, Salminen M, Irjala K, Heikkilä E, Isoaho R, Kivelä SL, Korhonen P, Vahlberg T, Viitanen M, Wuorela M, Löppönen M, Viikari L. Subjective and objective health predicting mortality and institutionalization: an 18-year population-based follow-up study among community-dwelling Finnish older adults. BMC Geriatr 2021; 21:358. [PMID: 34112108 PMCID: PMC8193868 DOI: 10.1186/s12877-021-02311-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Objective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults. Also, self-reported assessment of health by simple self-rated health (SRH) has been shown to predict mortality and institutionalization. The aim of this study was to assess the association of objective and subjective health with mortality and institutionalization in Finnish community-dwelling older adults. METHODS In this prospective study with 10- and 18-year follow-ups, objective health was measured by registered illnesses and subjective health was evaluated by simple SRH, self-reported walking ability (400 m) and self-reported satisfaction in life. The participants were categorized into four groups according to their objective and subjective health: 1. subjectively and objectively healthy, 2. subjectively healthy and objectively unhealthy, 3. subjectively unhealthy and objectively healthy and 4. subjectively and objectively unhealthy. Cox regression model was used in the analyses. Death was used as a competing factor in the institutionalization analyses. RESULTS The mean age of the participants (n = 1259) was 73.5 years (range 64.0-100.0). During the 10- and 18-year follow-ups, 466 (37%) and 877 (70%) died, respectively. In the institutionalization analyses (n = 1106), 162 (15%) and 328 (30%) participants were institutionalized during the 10- and 18-year follow-ups, respectively. In both follow-ups, being subjectively and objectively unhealthy, compared to being subjectively and objectively healthy, was significantly associated with a higher risk of institutionalization in unadjusted models and with death both in unadjusted and adjusted models. CONCLUSIONS The categorization of objective and subjective health into four health groups was good at predicting the risk of death during 10- and 18-year follow-ups, and seemed to also predict the risk of institutionalization in the unadjusted models during both follow-ups. Poor subjective health had an additive effect on poor objective health in predicting mortality and could therefore be used as part of an older individual's health evaluation when screening for future adverse outcomes.
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Affiliation(s)
- Anna Viljanen
- Municipality of Lieto, Health Care Center, Hyvättyläntie 7, 21420, Lieto, Finland. .,Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, FI-20014 University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland.
| | - Marika Salminen
- City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland.,Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland
| | - Kerttu Irjala
- Faculty of Medicine, Department of Clinical Medicine, Unit of Clinical Chemistry, TYKSLAB, 20521, Turku, Finland
| | - Elisa Heikkilä
- Faculty of Medicine, Department of Clinical Medicine, Unit of Clinical Chemistry, TYKSLAB, 20521, Turku, Finland
| | - Raimo Isoaho
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,City of Vaasa, Social and Health Care, Ruutikellarintie 4, 65101, Vaasa, Finland
| | - Sirkka-Liisa Kivelä
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland.,Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, 00014, Helsinki, Finland
| | - Päivi Korhonen
- Faculty of Medicine, Department of Clinical Medicine, Unit of Family Medicine, University of Turku and Turku University Hospital, 20014, Turku, Finland
| | - Tero Vahlberg
- Faculty of Medicine, Department of Clinical Medicine, Unit of Biostatistics, University of Turku, Turku, Finland
| | - Matti Viitanen
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, FI-20014 University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Maarit Wuorela
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, FI-20014 University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland.,City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland
| | - Minna Löppönen
- City of Raisio, Social and Health Care for Elderly, Sairaalakatu 5, 21200, Raisio, Finland
| | - Laura Viikari
- Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, FI-20014 University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland.,City of Turku, Welfare Division, Yliopistonkatu 30, 20101, Turku, Finland
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9
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García-Gollarte JF, García-Andrade MM, Santaeugenia-González SJ, Solá Hermida JC, Baixauli-Alacreu S, Santabalbina FJT. Risk Factors for Mortality in Nursing Home Residents: An Observational Study. Geriatrics (Basel) 2020; 5:geriatrics5040071. [PMID: 33050016 PMCID: PMC7709674 DOI: 10.3390/geriatrics5040071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose: Identifying mortality risk factors in people living in nursing homes could help healthcare professionals to individualize or develop specific plans for predicting future care demands and plan end-of-life care in this population. This study aims to identify mortality risk factors in elderly nursing home (NH) residents, based on variables adapted to this environment, routinely collected and easily accessible to their healthcare professionals. Methods: A prospective, longitudinal, observational study of NH residents aged 65 years and older was carried out collecting sociodemographic, functional and cognitive status, nutritional variables, comorbidities, and other health variables. These variables were analyzed as mortality risk factors by Cox proportional hazard models. Results: A total of 531 residents (75.3% female; average age 86.7 years (SD: 6.6)) were included: 25.6% had total dependence, 53.4% had moderate to severe cognitive impairment, 84.5% were malnourished or at risk of malnutrition, and 79.9% were polymedicated. Risk of mortality (hazard ratio, HR) increased in totally dependent residents (HR = 1.52; p = 0.02) and in those with moderate or severe cognitive impairment ((HR = 1.59; p = 0.031) and (HR = 1.93; p = 0.002), respectively). Male gender (HR = 1.88; p < 0.001), age ≥80 years (HR = 1.73; p = 0.034), hypertension (HR = 1.53; p = 0.012), atrial fibrillation/arrhythmia (HR = 1.43; p = 0.048), and previous record of pneumonia (HR = 1.65; p = 0.029) were also found to be mortality drivers. Conclusion: Age and male gender (due to the higher prevalence of associated comorbidity in these two variables), certain comorbidities (hypertension, atrial fibrillation/arrhythmia, and pneumonia), higher functional and cognitive impairment, and frequency of medical emergency service care increased the risk of mortality in our study. Given their importance and their easy identification by healthcare professionals in nursing homes, these clinical variables should be used for planning care in institutionalized older adults.
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Affiliation(s)
- José Fermín García-Gollarte
- Medical Department Grupo Ballesol, Universidad Católica de Valencia, La Eliana, 46183 Valencia, Spain;
- Correspondence:
| | | | - Sebastiá J. Santaeugenia-González
- Chronic Care Program, Ministry of Health, Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care, 08500 Barcelona, Spain;
| | - José Carlos Solá Hermida
- Medical Department Grupo Ballesol, Universidad Católica de Valencia, La Eliana, 46183 Valencia, Spain;
| | - Susana Baixauli-Alacreu
- Department of Nursing, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Francisco José Tarazona Santabalbina
- Geriatric Service, Hospital Universitario de la Ribera, 46600 Alzira, Spain;
- Division of Geriatric Medicine, 7GPR+3M Doha, Qatar
- CIBERFES, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, 0 28029 Madrid, Spain
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10
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Predictors of Mortality in the Older Population: The Role of Polypharmacy and Other Medication and Chronic Disease-Related Factors. Drugs Aging 2020; 37:767-776. [PMID: 32885396 DOI: 10.1007/s40266-020-00794-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Polypharmacy has been associated with increased mortality but the contribution of different medication-related factors to this is unknown. AIMS The aim of this study was to identify demographic and medication-related predictors of mortality in the older population. Given the intrinsic link between polypharmacy and multimorbidity, the secondary aim was to examine if the medicines or underlying diseases predicted mortality. METHODS Patients aged ≥ 65 years from an outpatient multimorbidity clinic were included. Medication-related factors included the medicines count, high-risk medicines, inappropriate medicines duplication, and potential drug-drug and drug-disease interactions. Logistic regression was used to identify mortality predictors within a year of clinic discharge from the outpatient clinic. Patients attend the clinic until medications and comorbidity management have been optimised, at which point they are discharged from the clinic, and their General Practitioner provides ongoing care. RESULTS A total of 584 patients were included (median age 80.0 years) and 9.9% (n = 58) died within a year of discharge. Demographics, namely age (adjusted odds ratio [aOR] 1.05; 95% CI 1.01-1.09; p = 0.018) and being male (aOR 5.10; 95% CI 2.63-9.88; p < 0.001); chronic disease, namely heart failure (aOR 3.36; 95% CI 1.78-6.35; p < 0.001); and medication-related factors, namely the number of sedative and anticholinergic medicines (aOR 1.66; 95% CI 1.19-2.33; p = 0.003) predicted mortality in the study population. CONCLUSION Whilst polypharmacy has been defined using the number of medicines in the literature, a combination of demographics, chronic disease and medications predicted mortality in our study. This provides guidance for the development of future tools and guidelines regarding the inclusion of key factors for identifying high-risk patients at risk of adverse health outcomes such as mortality.
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11
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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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12
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Brandão D, Ribeiro O, Teixeira L, Paúl C. Perceived risk of institutionalization, hospitalization, and death in oldest old primary care patients. Arch Gerontol Geriatr 2019; 87:103974. [PMID: 31786410 DOI: 10.1016/j.archger.2019.103974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/05/2019] [Accepted: 11/06/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aims to analyze the accuracy and predictive ability of the Risk Instrument for Screening in the Community (RISC) scored by general practitioners (GPs) in a sample of primary care patients aged 80+ with perceived mental health concerns. METHOD GPs ranked the perceived risk of the three adverse outcomes (hospitalization, institutionalization and death) at 1 year in a five Likert scale (RISC score), where 1 is the lowest risk and 5 is the highest. Follow up contacts were conducted after 1 year of assessment in order to collect data on the three outcomes. RESULTS The 1-year proportion of institutionalization, hospitalization and death were 12.1 %, 25.2 % and 19.0 % respectively. Based upon the sensitivity and specificity from the Receiver Operating Characteristic (ROC) curves, we found an optimal cut-off point of ≥4 for the RISC. The RISC had fair accuracy for 1-year risk of institutionalization (Area Under the ROC curve (AUC) = 0.75, 95% CI 0.43-0.68) and hospitalization (AUC = 0.65, 95% CI 0.52-0.78), but not for death (AUC = 0.55, 95% CI 0.43-0.68). CONCLUSIONS The RISC as a short global subjective assessment is to be considered a reliable tool for use by GPs. Our results showed that RISC seems to be a good instrument to triage very old people at risk for institutionalization but with poor accuracy at predicting hospitalization and limited predictive ability for death, suggesting further research and caution on this instrument's use.
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Affiliation(s)
- Daniela Brandão
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Department of Education and Psychology, University of Aveiro (DEP.UA), Aveiro, Portugal
| | - Laetitia Teixeira
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
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13
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Zabielska P, Wieder-Huszla S, Gutowska I, Lubkowska A, Knyszyńska A, Jurczak A. Gender-Specific Differences in Concentrations of Biochemical Parameters in Persons over the Age of 90. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111915. [PMID: 31151190 PMCID: PMC6603764 DOI: 10.3390/ijerph16111915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 01/01/2023]
Abstract
The ageing process is a phenomenon leading to an emergence of a web of interrelated biological processes producing significant changes in the human body. The aim of the paper was to analyse gender-specific differences with regard to selected biochemical parameters in longevity. The study was conducted in Poland in 2017. The study population comprised of long-lived individuals, both living at home and staying at residential care homes. There were 90 people of both genders (69 women and 21 men) aged between 90 and 103 years (mean = 92.36; SD = 2.98). The biochemical markers of longevity in the studied patients were identified by assessing their pro-inflammatory and anti-inflammatory status in various metabolic aspects. The analysis of biochemical variables revealed numerous statistically significant differences, both in the study group as a whole and between the genders. The ageing process is extremely complex, but understanding it will allow for a real intervention in life extension. Research into the processes involved in ageing and longevity will enable a better understanding of the mechanisms responsible for them, and to enjoy those processes in good health.
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Affiliation(s)
- Paulina Zabielska
- Department of Social Medicine and Public Health, Chair of Social Medicine, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland.
| | - Sylwia Wieder-Huszla
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland.
| | - Izabela Gutowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Broniewskiego Str. 24, 71-460 Szczecin, Poland.
| | - Anna Lubkowska
- Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University in Szczecin, Żołnierska Str. 54, 71-210 Szczecin, Poland.
| | - Anna Knyszyńska
- Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University in Szczecin, Żołnierska Str. 54, 71-210 Szczecin, Poland.
| | - Anna Jurczak
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, Żołnierska Str. 48, 71-210 Szczecin, Poland.
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14
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Eekhoff EMW, van Schoor NM, Biedermann JS, Oosterwerff MM, de Jongh R, Bravenboer N, van Poppel MNM, Deeg DJH. Relative importance of four functional measures as predictors of 15-year mortality in the older Dutch population. BMC Geriatr 2019; 19:92. [PMID: 30909878 PMCID: PMC6434808 DOI: 10.1186/s12877-019-1092-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decreased physical function is known to raise mortality risk. Little is known about how different physical function measures compare in predicting mortality risk in older men and women. The objective of this study was to compare four, objective and self-reported, physical function measures in predicting 15-year mortality risk in older men and women. METHODS Data were used from the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of the older Dutch population, sampled from municipal records. The 1995-96 cycle, including 727 men and 778 women aged 65-88 years, was considered as the baseline. Mortality was followed up through September 1, 2011. Physical function measures were: lower-body performance (chair stands test, walk test and tandem stand); handgrip strength (grip strength dynamometer); lung function (peak expiratory flow rate); functional limitations (self-report of difficulties in performing six activities of daily living). Cox proportional hazard models were used to determine the predictive value of each physical function measure for 15-year mortality risk, adjusted for demographic, lifestyle and health variables as potential confounders. RESULTS 1031 participants (68.5%) had died. After adjustments for confounders, in models assessing single functional measures, peak flow was the strongest predictor of all-cause mortality in men (HR 1.76, CI 1.38-2.26, CI) and lower-body performance in women (HR 1.97,CI 1.40-2.76, CI). In a model including all four functional measures only peak flow was statistically significant in predicting mortality in both genders (men HR 1.54,CI 1.18-2.01 and women HR 1.45,CI 1.08-1.94). In women, lower-body performance (HR 1.66, CI 1.15-2.41) followed by grip strength (HR 1.38, CI 1.02-1.89), and in men, functional limitations (HR 1.43, CI 1.14-1.8) were the other significant predictors of all-cause mortality. CONCLUSION Both objective and self-reported measures of physical functioning predicted all-cause mortality in a representative sample of the older Dutch population to different extents in men and women. Peak flow contributed important unique predictive value for mortality in both men and women. In women, however, lower-body performance tests had better predictive ability. A second-best predictor in men was self-reported functional limitations. Peak flow, and possibly one of the other measures, may be used in clinical practice for assessment in the context of time constraints.
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Affiliation(s)
- Elisabeth M W Eekhoff
- Department of Internal Medicine, Section Endocrinology, Amsterdam University Medical Centers location VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics/LASA, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers location VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
| | - Joseph S Biedermann
- Department of Internal Medicine, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - Mirjam M Oosterwerff
- Department of Internal Medicine, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Renate de Jongh
- Department of Internal Medicine, Section Endocrinology, Amsterdam University Medical Centers location VU University Medical Center, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Nathalie Bravenboer
- Department of Clinical Chemistry, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers location VU University Medical Center, Amsterdam, The Netherlands.,Institute of Sport Science, University of Graz, Graz, Austria
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics/LASA, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers location VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands
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15
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Zasadzka E, Trzmiel T, Roszak M, Pawlaczyk M. Is the outcome of frailty syndrome gender dependent? J Women Aging 2019; 32:349-360. [DOI: 10.1080/08952841.2019.1593797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ewa Zasadzka
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznán, Poland
| | - Tomasz Trzmiel
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznán, Poland
| | - Magdalena Roszak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznań, Poland
| | - Mariola Pawlaczyk
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznán, Poland
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16
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Wang H, Hai S, Liu Y, Liu Y, Dong B. Skeletal Muscle Mass as a Mortality Predictor among Nonagenarians and Centenarians: A Prospective Cohort Study. Sci Rep 2019; 9:2420. [PMID: 30787413 PMCID: PMC6382937 DOI: 10.1038/s41598-019-38893-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/04/2018] [Indexed: 02/05/2023] Open
Abstract
This study aimed to evaluate the association between skeletal muscle mass and long-term all-cause mortality among nonagenarians and centenarians in China. We used data from the Project of Longevity and Aging in Dujiangyan (PLAD). A total of 738 community-dwelling people aged ≥ 90 years (mean age of 93.5 ± 3.2 years) were analyzed in this study. The appendicular skeletal muscle mass (ASM) was estimated using a previously validated anthropometric equation. The information on the survival status was requested from the local government registries during the 4 year follow-up period following the baseline investigation. The mean muscle mass index (SMI) was 6.11 ± 0.53 kg/m2 in men and 4.00 ± 0.63 kg/m2 in women, respectively. Low muscle mass was associated with a higher risk of death (hazard ratio [HR] 1.54; (95% confidence interval [CI]:1.10–2.16) in women; however, no significant association was found in men. Disability in activities of daily living (ADL) (HR = 1.73; 95% CI: 1.13–2.63) in men and women and cognitive impairment (HR = 1.49; 95% CI: 1.05–2.13) in men were also associated with increased all-cause mortality. In conclusion, low muscle mass were predictors of long-term mortality in nonagenarian and centenarian women.
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Affiliation(s)
- Hui Wang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.,Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Shan Hai
- Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Yixin Liu
- Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Ying Liu
- Center of Gerontology and Geriatrics, West China Hospital of Sichuan University, Chengdu, China
| | - Birong Dong
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
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17
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Odden MC, Koh WJH, Arnold AM, Rawlings AM, Psaty BM, Newman AB. Trajectories of Nonagenarian Health: Sex, Age, and Period Effects. Am J Epidemiol 2019; 188:382-388. [PMID: 30407481 PMCID: PMC6357807 DOI: 10.1093/aje/kwy241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 12/14/2022] Open
Abstract
The US population aged 90 years or more is growing rapidly, and there are limited data on their health. The Cardiovascular Health Study is a prospective study of black and white adults aged ≥65 years recruited in 2 waves (1989-1990 and 1992-1993) from Medicare eligibility lists in Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania. We created a synthetic cohort of the 1,889 participants who had reached age 90 years at baseline or during follow-up through July 16, 2015. Participants entered the cohort at 90 years of age, and we evaluated their changes in health after age 90 years (median duration of follow-up, 3 years (interquartile range, 1.3-5)). Measures of health included cardiovascular events, cognitive function, depressive symptoms, prescription medications, self-rated health, and functional status. The mortality rate was high: 19.0 per 100 person-years (95% confidence interval : 17.8, 20.3) in women and 20.9 per 100 person-years (95% confidence interval: 19.2, 22.8) in men. Cognitive function and all measures of functional status declined with age; these changes were similar by sex. When we isolated period effects, we found that medication use increased over time. These estimates can help inform future research and can help health-care systems meet the needs of this growing population.
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Affiliation(s)
- Michelle C Odden
- Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - William Jen Hoe Koh
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Alice M Arnold
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Andreea M Rawlings
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Bruce M Psaty
- Cardiovascular Health Research Unit and Department of Medicine, School of Medicine, University of Washington, Seattle, Washington
- Departments of Epidemiology and Health Services, School of Public Health, University of Washington, Seattle, Washington
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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18
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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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19
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Kauppi M, Raitanen J, Stenholm S, Aaltonen M, Enroth L, Jylhä M. Predictors of long-term care among nonagenarians: the Vitality 90 + Study with linked data of the care registers. Aging Clin Exp Res 2018; 30:913-919. [PMID: 29222731 DOI: 10.1007/s40520-017-0869-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The need for long-term care services increases with age. However, little is known about the predictors of long-term care (LTC) entry among the oldest old. AIMS Aim of this study was to assess predictors of LTC entry in a sample of men and women aged 90 years and older. METHODS This study was based on the Vitality 90 + Study, a population-based study of nonagenarians in the city of Tampere, Finland. Baseline information about health, functioning and living conditions were collected by mailed questionnaires. Information about LTC was drawn from care registers during the follow-up period extending up to 11 years. Cox regression models were used for the analyses, taking into account the competing risk of mortality. RESULTS During the mean follow-up period of 2.3 years, 844 (43%) subjects entered first time into LTC. Female gender (HR 1.39, 95% CI 1.14-1.69), having at least two chronic conditions (HR 1.24, 95% CI 1.07-1.44), living alone (HR 1.37, 95% CI 1.15-1.63) and help received sometimes (HR 1.23, 95% CI 1.02-1.49) or daily (HR 1.68, 95% CI 1.38-2.04) were independent predictors of LTC entry. CONCLUSION Risk of entering into LTC was increased among women, subjects with at least two chronic conditions, those living alone and with higher level of received help. Since number of nonagenarians will increase and the need of care thereby, it is essential to understand predictors of LTC entry to offer appropriate care for the oldest old in future.
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Affiliation(s)
- Maarit Kauppi
- Finnish Institute of Occupational Health, Turku, Finland.
- Gerontology Research Center, University of Tampere, Tampere, Finland.
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland.
| | - Jani Raitanen
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Sari Stenholm
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | - Mari Aaltonen
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
| | - Linda Enroth
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
| | - Marja Jylhä
- Gerontology Research Center, University of Tampere, Tampere, Finland
- Faculty of Social Sciences (Health Sciences), University of Tampere, Tampere, Finland
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Ibarra-Castillo C, Guisado-Clavero M, Violan-Fors C, Pons-Vigués M, López-Jiménez T, Roso-Llorach A. Survival in relation to multimorbidity patterns in older adults in primary care in Barcelona, Spain (2010-2014): a longitudinal study based on electronic health records. J Epidemiol Community Health 2018; 72:185-192. [PMID: 29330165 DOI: 10.1136/jech-2017-209984] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Several studies have analysed the characteristics of multimorbidity patterns but none have evaluated the relationship with survival. The purpose of this study was to compare survival across older adults with different chronic multimorbidity patterns (CMPs). METHODS Prospective longitudinal observational study using electronic health records for 190 108 people aged ≥65 years in Barcelona, Spain (2009-2014). CMPs were identified by cluster analysis. Mortality rates were estimated using the Catalan population structure and individual time at risk. Survival according to CMP (Cox regression) was analysed using hazard ratios (HRs) and 95% confidence intervals (CIs) with stratification by sex and age group (65-79, 80-94) and adjustment for age at onset, deprivation index, number of chronic conditions and invoiced drugs. RESULTS The highest mortality rates were observed in men, adults aged 80-94 years, socially disadvantaged quintiles and people prescribed more drugs and with fewer conditions. Using the musculoskeletal pattern as the reference category, men with the digestive-respiratory pattern had a higher risk of death, with adjusted HRs of 6.16 (95% CI 5.37 to 7.06) in the 65-79 age group and 2.62 (95% CI 2.31 to 2.97) in the 80-94 age group. In women, the cardiovascular pattern was associated with the highest risk, with adjusted HRs of 6.34 (95% CI 5.28 to 7.61) in the 65-79 age group and 3.05 (95% CI 2.73 to 3.41) in the 80-94 age group. These patterns were also associated with the highest mortality rates. CONCLUSIONS Mortality and survival vary according to CMPs in older adults stratified by sex and age. Our findings are useful for guiding the design and implementation of clinical management strategies.
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Affiliation(s)
- Carolina Ibarra-Castillo
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Marina Guisado-Clavero
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institut Català de la Salut, Barcelona, Spain
| | - Concepció Violan-Fors
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Universitat de Girona, Girona, Spain
| | - Tomàs López-Jiménez
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Albert Roso-Llorach
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
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Nascimento CDM, Oliveira CD, Firmo JO, Lima-Costa MF, Peixoto SV. Prognostic value of disability on mortality: 15-year follow-up of the Bambuí cohort study of aging. Arch Gerontol Geriatr 2018; 74:112-117. [DOI: 10.1016/j.archger.2017.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/04/2017] [Accepted: 10/13/2017] [Indexed: 11/30/2022]
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Brandão D, Freitas A, Ribeiro O, Paúl C. Pathways after inpatient admission in very advanced age: A Portuguese nationwide study. Arch Gerontol Geriatr 2017; 73:89-94. [PMID: 28797945 DOI: 10.1016/j.archger.2017.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/21/2017] [Accepted: 07/21/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Oldest old patients often have complex and multiple medical conditions, which are associated with higher rates of use of healthcare services, and a higher risk of experiencing adverse outcomes, such as mortality. This study investigated (a) the in-hospital mortality rate and predictors in patients aged 80+; (b) the destination patients have after hospital discharge. METHODS Nationwide study. All inpatient admissions by individuals aged 80 years and older between 2011 and 2014 in Portugal were considered. Exploratory descriptive analyses of data regarding in-hospital mortality and destination after discharge were performed; multivariate logistic regression analyses were conducted to identify predictors of in-hospital mortality. RESULTS A total of 614,807 episodes of hospital admissions were analysed. A mortality rate of 15.4% was observed. In the majority of episodes, patients returned home (78.6%). Increased age, male gender, increased length of stay, unplanned attendance, medical DRG type, increased severity of illness and mortality risk, and comorbidities were significant predictors of in-hospital mortality. DISCUSSION This study strengthens the importance of implementing health policies specifically to the oldest old, namely with the promotion of the use of primary care services. That would expectably concur to a better management of the most common medical conditions in this population, and a decrease in hospital unplanned attendances.
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Affiliation(s)
- Daniela Brandão
- Research and Education Unit on Ageing (UNIFAI/ICBAS-UP), University of Porto, Porto, Portugal; Faculty of Medicine, University of Porto (FMUP-UP), Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.
| | - Alberto Freitas
- Faculty of Medicine, University of Porto (FMUP-UP), Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Oscar Ribeiro
- Research and Education Unit on Ageing (UNIFAI/ICBAS-UP), University of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Constança Paúl
- Research and Education Unit on Ageing (UNIFAI/ICBAS-UP), University of Porto, Porto, Portugal; Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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23
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Nosraty L, Pulkki J, Raitanen J, Enroth L, Jylhä M. Successful Aging as a Predictor of Long-Term Care Among Oldest Old: The Vitality 90+ Study. J Appl Gerontol 2017; 38:553-571. [PMID: 28671023 DOI: 10.1177/0733464817716968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIM The aim of the study was to investigate whether successful aging (SA) predicts entering long-term care (LTC) among nonagenarians. METHODS Data originated from the linkage of the Vitality 90+ Study surveys with register data from Finnish Population Register and Care Registers. Altogether 1,966 community-dwelling individuals were followed for 2 years and 1,354 individuals for 5 years. Four models of SA were constructed by varying combinations of physical, psychological, and social components. Competing risk regression analysis was used. FINDINGS The incidence rate for entering LTC was lower for successful agers. Three models of SA presented a significantly decreased risk for entering LTC in the whole group and in women. The impact of SA was attenuated when living alone, needing help, and the year of participation were adjusted for, but was still significant for Model 3. CONCLUSION Nonagenarians who meet the multidimensional criteria of SA are less likely to enter LTC than those aging less successfully.
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Affiliation(s)
| | | | - Jani Raitanen
- 1 University of Tampere, Finland.,2 UKK Institute, Tampere, Finland
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24
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Motor functioning differentially predicts mortality in men and women. Arch Gerontol Geriatr 2017; 72:6-11. [PMID: 28500880 DOI: 10.1016/j.archger.2017.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/24/2017] [Accepted: 05/01/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Research indicates gender differences in functional performance at advanced ages, but little is known about their impact on longevity for men and women. OBJECTIVE To derive a set of motor function factors from a battery of functional performance measures and examine their associations with mortality, incorporating possible gender interactions. METHOD Analyses were performed on the longitudinal Swedish Adoption/Twin Study of Aging (SATSA) including twenty-four assessments of motor function up to six times over a 19-year period. Three motor factors were derived from several factor analyses; fine motor, balance/upper strength, and flexibility. A latent growth curve model was used to capture longitudinal age changes in the motor factors and generated estimates of intercept at age 70 (I), rates of change before (S1) and after age 70 (S2) for each factor. Cox regression models were used to determine how gender in interaction with the motor factors was related to mortality. RESULTS Females demonstrated lower functional performance in all motor functions relative to men. Cox regression survival analyses demonstrated that both balance/upper strength, and fine motor function were significantly related to mortality. Gender specific analyses revealed that this was true for women only. For men, none of the motor factors were related to mortality. CONCLUSION Women demonstrated more difficulties in all functioning facets, and only among women were motor functioning (balance/upper strength and fine motor function) associated with mortality. These results provide evidence for the importance of considering motor functioning, and foremost observed gender differences when planning for individualized treatment and rehabilitation.
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25
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Lisko I, Tiainen K, Raitanen J, Jylhävä J, Hurme M, Hervonen A, Jylhä M, Stenholm S. Body Mass Index and Waist Circumference as Predictors of Disability in Nonagenarians: The Vitality 90+ Study. J Gerontol A Biol Sci Med Sci 2017; 72:1569-1574. [DOI: 10.1093/gerona/glx032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 02/22/2017] [Indexed: 12/11/2022] Open
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Abstract
This analysis brings “aging with disability” into middle and older ages. We study U.S. adults ages 51+ and ages 65+ with persistent disability (physical, household management, personal care; physical limitations, instrumental activities of daily living [IADLs], activities of daily living [ADLs]), using Health and Retirement Study data. Two complementary approaches are used to identify persons with persistent disability, one based directly on observed data and the other on latent classes. Both approaches show that persistent disability is more common for persons ages 65+ than ages 51+ and more common for physical limitations than IADLs and ADLs. People with persistent disability have social and health disadvantages compared to people with other longitudinal experiences. The analysis integrates two research avenues, aging with disability and disability trajectories. It gives empirical heft to government efforts to make aging with disability an age-free (all ages) rather than age-targeted (children and youths) perspective.
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Bergland A, Jørgensen L, Emaus N, Strand BH. Mobility as a predictor of all-cause mortality in older men and women: 11.8 year follow-up in the Tromsø study. BMC Health Serv Res 2017; 17:22. [PMID: 28068995 PMCID: PMC5223479 DOI: 10.1186/s12913-016-1950-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/15/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Disability in older adults is associated with loss of independence, institutionalization, and death. The aim of this study was to study the association between the Timed Up and Go (TUG) test and all-cause mortality in a population-based sample of older men and women. METHODS Our study population was home dwellers aged 65 and above, who participated in the fifth wave of the Tromsø study. This study included the TUG test and a range of lifestyle and mortality predictors. Participants were linked to the Cause of Death Registry and followed up for mortality for a maximum of 11.8 years. Cox regression was used to investigate the association between TUG and total mortality. RESULTS Mean TUG score was 12.6 s, and men performed better than women. The oldest participants had poorer TUG score compared to younger participants, increasing 0.25 s per year. There was a significant association between TUG and all-cause mortality, and the association was equally strong in men and women. Across the TUG-score categories, from quickest fifth to slowest fifth, the mortality increased in a step-wise fashion. Compared to the quickest fifth, the slowest fifth had hazard ratio (HR) of 1.79 (95% confidence interval (CI) 1.33, 2.42) in a model adjusted for age and gender. For each standard deviation TUG-score the increase in HR was 1.23 (95% CI 1.14, 1.33). The association between the TUG score and mortality remained significant after adjusting for self-reported health, body mass index, smoking and education. CONCLUSIONS A significant association between the TUG score and mortality was observed in both men and women. Identifying older people with poor TUG may aid in identifying those at risk and thus targeted interventions may be applied.
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Affiliation(s)
- Astrid Bergland
- Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Pilestredet, P.O. Box 4 St. Olavs plass, 0130, Oslo, Norway.
| | - Lone Jørgensen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway.,Department of Clinical Therapeutic Services, University Hospital of North Norway, Tromsø, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - Bjørn Heine Strand
- Department on ageing, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.,Norwegian National Advisory Unit on Ageing and Health, Tønsberg, Norway
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28
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Verbrugge LM, Brown DC, Zajacova A. Disability Rises Gradually for a Cohort of Older Americans. J Gerontol B Psychol Sci Soc Sci 2017; 72:151-161. [PMID: 26968638 PMCID: PMC5156489 DOI: 10.1093/geronb/gbw002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 01/06/2016] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES We study changes in average disability over nearly two decades for a large epidemiological cohort of older Americans. As some people exit by mortality, do average disability levels for the living cohort rise rapidly, rise gradually, stay steady, or decline? METHOD Data are from the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD) cohort for 1993-2010. Cohort members are aged 70+ in 1993 (mean = 77.5 years), and the survivors are aged 87+ in 2010 (mean = 90.2 years). Personal care disability (activities of daily living), household management disability (instrumental activities of daily living), and physical limitations are studied. We study average disability for the living cohort over time and the disability histories for decedent and survivor groups. RESULTS Average disability rises gradually over time for the living cohort. Earlier decedent groups have higher average disability than later ones. Near death, disability rises sharply for all decedent groups. Longer surviving groups have less average disability, and slower disability increases, than shorter surviving groups. All results are repeated for younger cohort members (baseline age = 70-79 years), older ones (baseline age = 80+ years), women, and men. DISCUSSION As a cohort ages, average disability among living members increases gradually, signaling behavioral, psychological, and biological fitness in very old persons.
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Affiliation(s)
| | - Dustin C Brown
- Department of Sociology and Social Science Research Center, Mississippi State University
| | - Anna Zajacova
- Department of Sociology, University of Wyoming, Laramie
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Cavanaugh A, LaCroix AZ, Kritz-Silverstein D, Rillamas-Sun E, Rifkin DE. Kidney Function and Disability-Free Survival in Older Women. J Am Geriatr Soc 2017; 65:98-106. [PMID: 27650533 PMCID: PMC5258685 DOI: 10.1111/jgs.14433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the prospective association between kidney function and three outcomes: survival to age 85 with functional independence, survival to age 85 with disability, and death before age 85. DESIGN Prospective study. SETTING Women's Health Initiative, conducted at 40 U.S. clinical centers. PARTICIPANTS Postmenopausal women enrolled between 1993 and 1998 with baseline biomarker assessments who had the potential to reach age 85 before September 2013 (N = 7,178). MEASUREMENTS Kidney function was measured according to estimated glomerular filtration rate (eGFR) calculated from serum creatinine collected at baseline. Outcomes were survival to age 85 with functional independence, survival with disability, or death before age 85. Disability was defined as mobility or activity of daily living limitations measured by questionnaire. RESULTS eGFR was greater than 90 mL/min per 1.73 m2 in 22.7% of women, 60 to 89 mL/min per 1.73 m2 in 66.5%, 45 to 59 mL/min per 1.73 m2 in 8.7%, and less than 45 mL/min per 1.73 m2 in 2.0%. Median follow-up was 15 years. Of 4,953 survivors, 3,155 reported no physical disability at age 85. Two thousand two hundred twenty-five participants died before age 85. Women with an eGFR of 90 mL/min per 1.73 m2 or greater had 2.71 times greater odds of survival to age 85 with functional independence than of dying before 85 (95% confidence interval (CI) = 1.62-4.51) than those with an eGFR less than 45 mL/min per 1.73 m2 , women with an eGFR of 60 to 89 mL/min per 1.73 m2 had 3.04 times (95% CI = 1.85-5.00) greater odds, and women with an eGFR of 45 to 59 mL/min per 1.73 m2 had 2.22 times (95% CI = 1.31-3.76) greater odds. Similar, but slightly weaker odds were seen for survival to age 85 with disability. Better kidney function was not significantly associated with greater likelihood of survival to age 85 with independent function than of surviving with disability. CONCLUSION Better kidney function was associated with greater likelihood of survival to age 85 with and without disability.
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Affiliation(s)
- Alyson Cavanaugh
- San Diego State University/University of California, San Diego, Joint Doctoral Program in Public Health (Epidemiology)
| | - Andrea Z. LaCroix
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Donna Kritz-Silverstein
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, CA
| | | | - Dena E. Rifkin
- Division of Nephrology, Department of Preventative Medicine and Public Health, University of California, San Diego, CA
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Muscari A, Bianchi G, Forti P, Giovagnoli M, Magalotti D, Pandolfi P, Zoli M. Physical Activity and Other Determinants of Survival in the Oldest Adults. J Am Geriatr Soc 2016; 65:402-406. [DOI: 10.1111/jgs.14569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Muscari
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
| | - Paola Forti
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
| | - Marco Giovagnoli
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
| | - Donatella Magalotti
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
| | - Paolo Pandolfi
- Epidemiological and Health Promotion Unit; Department of Public Health; AUSL Bologna; Bologna Italy
| | - Marco Zoli
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
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Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA. Multimorbidity and mortality in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2016; 67:130-8. [PMID: 27500661 DOI: 10.1016/j.archger.2016.07.008] [Citation(s) in RCA: 399] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To review literature and provide a pooled effect for the association between multimorbidity and mortality in older adults. METHODS A systematic review was performed of articles held on the PUBMED database published up until January 2015. Studies which used different diseases and other conditions to define frailty, evaluated multimorbidity related only to mental health or which presented disease homogeneity were not included. A meta-analysis using random effect to obtain a pooled effect of multimorbidity on mortality in older adults was conducted only with studies which reported hazard ratio (HR). Stratified analysis and univariate meta-regression were performed to evaluate sources of heterogeneity. RESULTS Out of 5806 identified articles, 26 were included in meta-analysis. Overall, positive association between multimorbidity and mortality [HR: 1.44 (95%CI: 1.34; 1.55)] was detected. The number of morbidities was positively related to risk of death [HR: 1.20 (95%CI: 1.10; 1.30)]. Compared to individuals without multimorbidity, the risk of death was 1.73 (95%CI: 1.41; 2.13) and 2.72 (95%CI: 1.81; 4.08) for people with 2 or more and 3 or more morbidities, respectively. Heterogeneity between studies was high (96.5%). The sample, adjustment and follow-up modified the associations. Only nine estimates performed adjustment which included demographic, socioeconomic and behaviour variables. Disabilities appear to mediate the effect of multimorbidity on mortality. CONCLUSIONS Multimorbidity was associated with an increase in risk of death. Multimorbidity measurement standardization is needed to produce more comparable estimates. Adjusted analysis which includes potential confounders might contribute to better understanding of causal relationships between multimorbidity and mortality.
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Affiliation(s)
- Bruno Pereira Nunes
- Department of Nursing, Federal University of Pelotas, Pelotas, RS, Brazil; Postgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Thaynã Ramos Flores
- Postgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Grégore Iven Mielke
- Postgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Elaine Thumé
- Department of Nursing, Federal University of Pelotas, Pelotas, RS, Brazil; Postgraduate Program of Nursing, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Luiz Augusto Facchini
- Postgraduate Program of Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program of Nursing, Federal University of Pelotas, Pelotas, RS, Brazil
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Karppinen H, Laakkonen ML, Strandberg TE, Huohvanainen EA, Pitkala KH. Do you want to live to be 100? Answers from older people. Age Ageing 2016; 45:543-9. [PMID: 27076523 DOI: 10.1093/ageing/afw059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 01/20/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND little is known about the oldest-olds' views on ageing. OBJECTIVE to investigate older people's desire and the reasons they give for wanting to live to 100. DESIGN a postal questionnaire, analysed both quantitatively and qualitatively. SETTING population based in Helsinki, Finland. SUBJECTS a random sample (response rate 64%; N = 1,405) of community-dwelling older people (aged 75-96). METHODS a structured self-completed questionnaire with an open-ended question on the reasons why/why not participants wished/did not wish to live to 100. RESULTS one-third (32.9%) of home-dwelling older people wanted to live to be 100. Those who did were older, more often male and self-rated their health better than those who did not. Often the desire for long life was conditional: 'Yes, if I stay healthy'. Among the reasons is that many were curious to see what would happen. Many stated that they loved life, they had twinkle in their eye or significant life roles. Those who did not want to live extremely long lives gave various rationales: they would become disabled, life would be meaningless, they were reluctant to become a burden to others or they feared loss of autonomy or suffering pain or loneliness. Some people also shared the view that they should not intervene in destiny or they felt that they had accomplished what they wanted in life. CONCLUSIONS one-third of the oldest-old participants wanted to live to 100. Identifying what motivated them to desire long life could be a resource in their care plans.
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Affiliation(s)
- Helena Karppinen
- General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland Helsinki University Hospital, Helsinki, Finland
| | - Marja-Liisa Laakkonen
- General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland Helsinki University Hospital, Helsinki, Finland Department of Social Services and Health Care, Laakso Hospital, City of Helsinki, Helsinki, Finland
| | - Timo E Strandberg
- Helsinki University Hospital, Helsinki, Finland Geriatrics, University of Helsinki, Helsinki, Finland Institute of Health Sciences/Geriatrics, University of Oulu, Oulu, Finland Oulu University Hospital, Oulu, Finland
| | - Emmi A Huohvanainen
- Institute of Health Sciences/Geriatrics, University of Oulu, Oulu, Finland Oulu University Hospital, Oulu, Finland
| | - Kaisu H Pitkala
- General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland Helsinki University Hospital, Helsinki, Finland
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Herr M, Arvieu JJ, Robine JM, Ankri J. Health, frailty and disability after ninety: Results of an observational study in France. Arch Gerontol Geriatr 2016; 66:166-75. [PMID: 27341649 DOI: 10.1016/j.archger.2016.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/09/2016] [Accepted: 06/04/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND In spite of their increasing demographic weight, health characteristics of the oldest old remain poorly described in epidemiological studies. OBJECTIVE To describe the health of people aged 70 years and over included in the SIPAF study, and to compare the prevalence of health indicators including successful aging, frailty, and disability between three age groups including the oldest old. METHODS The study population is composed of 2350 retired people recruited between 2008 and 2010, of whom 512 are aged 90 and over (21.8%). A comprehensive geriatric assessment was performed at home by trained nurses. The prevalence of health and functional indicators, as well as the distribution of people among successful ageing, frailty, and disability, were described by age group (70-79, 80-89, 90+) and sex. RESULTS Compared to their younger counterparts, people aged 90 years and over were more likely to experience functional limitations, sensory impairment, cognitive impairment, poor mood, and frailty. One third of the nonagenarians needed help in at least one basic activity of daily living and 25% met the frailty criteria. In contrast, the prevalence of most chronic diseases did not increase after ninety. Successful ageing concerned 9% of the oldest old. Women were less likely to experience successful ageing and more likely to be frail or dependent. CONCLUSION This study shows the diversity of health states in very old age and points out that one quarter of the people aged 90 and over said frail are likely to take advantage of preventive actions of disability.
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Affiliation(s)
- M Herr
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France; AP-HP, Hôpital Sainte Périne, Département de Santé Publique, Paris, France.
| | - J J Arvieu
- AG2R La Mondiale, Direction des Etudes, Prévoyance Individuelle et IARD, Paris, France
| | - J M Robine
- INSERM U988 et U1198, EPHE, Paris & Montpellier, France
| | - J Ankri
- INSERM, U1168, VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches, F-94807, Villejuif, France; Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, F-78180, Montigny le Bretonneux, France; AP-HP, Hôpital Sainte Périne, Département de Santé Publique, Paris, France
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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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Hamirudin AH, Ghosh A, Charlton K, Bonney A, Walton K. Trends in uptake of the 75+ health assessment in Australia: a decade of evaluation. Aust J Prim Health 2016; 21:423-8. [PMID: 25200596 DOI: 10.1071/py14074] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/03/2014] [Indexed: 11/23/2022]
Abstract
In Australia, older adults aged 75+ years are encouraged to avail themselves of the comprehensive 75+ health assessment (75+ HA) to identify medical conditions and highlight potential risk factors for poor health. However, uptake of this item has been reported to be low. This study aimed to identify the uptake of the 75+ HA within regional areas of New South Wales and compare this against state and national trends over an 11-year period. Data on uptake of the 75+ HA for item numbers 700 and 702, from 1999 until 2010, were obtained from the Medicare Australia portal and Department of Health and Ageing databases. Trends over time were collated and compared at the regional, state and national level. The study found that an increasing number of the 75+ HAs were performed from 1999 to 2009. Overall, the uptake of the 75+ HA is generally low across Australia, at -20% of the eligible population, but varied across states and even regions within states. The study also revealed that despite low uptake encouraging trends were evident over a decade of 75+ HA implementation. It is argued that strategies in improving the uptake should be targeted for early identification of health risk and overall improved quality of health in older adults.
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Godard-Sebillotte C, Dramé M, Basileu T, Fanon JL, Godaert L. Is self-rated health an independent prognostic factor of six-week mortality in older patients hospitalized for an acute condition? Qual Life Res 2016; 25:2335-40. [PMID: 26919847 DOI: 10.1007/s11136-016-1252-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether self-rated health is a prognostic factor of six-week mortality, independently of other known objective prognostic factors. METHODS The SAFMA study was a prospective cohort, which recruited patients from the University Hospital of Martinique Acute Care for Elders unit (French West Indies) from January to June 2012. Patients aged 75 or older and hospitalized for an acute condition were eligible. The outcome was time to death within the six-week follow-up. The main explanatory variable was self-rated health. Sociodemographic and clinical characteristics were considered as covariates. Cox's proportional hazards model was used. RESULTS The mean age of the 223 patients included was 85.1 ± 5.5 years. Six-week mortality rate was 14.8 %; none were lost to follow-up. In total, 123 claimed "very good to good" health, and 100 "medium to very poor" health. Self-rated health was the only independent prognostic factor associated with 6-week mortality (hazard ratio 2.61; 95 % confidence interval 1.18-5.77; p = .02), when adjusting for known prognostic factors such as age, dimensions of the comprehensive geriatric assessment and comorbidity burden. CONCLUSION The association between self-rated health and short-term mortality could have implications for clinical practice, particularly in helping in the estimation of prognosis in acute care setting.
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Affiliation(s)
- Claire Godard-Sebillotte
- Department of Family Medicine, McGill University, 5858, Chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Moustapha Dramé
- Faculty of Medicine, University of Reims Champagne-Ardenne, EA 3797, Reims, France
- Department of Research and Innovation, University Hospitals of Reims, Robert Debré Hospitals, 51092, Reims, France
| | - Tatiana Basileu
- Department of Geriatrics, Martinique General Hospital, Fort-De-France, France
| | - Jean-Luc Fanon
- Department of Geriatrics, Martinique General Hospital, Fort-De-France, France
| | - Lidvine Godaert
- Department of Geriatrics, Martinique General Hospital, Fort-De-France, France
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Wu YT, Prina AM, Jones A, Barnes LE, Matthews FE, Brayne C. Land use mix and five-year mortality in later life: Results from the Cognitive Function and Ageing Study. Health Place 2016; 38:54-60. [PMID: 26798962 PMCID: PMC4797107 DOI: 10.1016/j.healthplace.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 10/28/2022]
Abstract
This study explores the potential modifying effect of age and mediation effect of co-morbidity on the association between land use mix, a measure of neighbourhood walkability, and five-year mortality among the 2424 individuals participating in the year-10 follow-up of the Cognitive Function and Ageing Study in England. Postcodes of participants were mapped onto Lower-layer Super Output Areas, a small area level geographical unit in the UK, and linked to Generalised Land Use data. Cox regression models were fitted to investigate the association. For the younger older age group (75-79 years), the effect of high land use mix on an elevated risk of mortality was mediated by co-morbidity. For older old age groups (80-84, 85+ years), a higher land use mix was directly associated with a 10% lower risk of five-year mortality. The findings suggest differential impacts of land use mix on the health of the younger and older old.
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Affiliation(s)
- Yu-Tzu Wu
- Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
| | - A Matthew Prina
- Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, Health Service and Population Research Department, De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom
| | - Andy Jones
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, United Kingdom
| | - Linda E Barnes
- Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom
| | - Fiona E Matthews
- MRC Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, United Kingdom
| | - Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom
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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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Tiainen K, Raitanen J, Vaara E, Hervonen A, Jylhä M. Longitudinal changes in mobility among nonagenarians: the Vitality 90+ Study. BMC Geriatr 2015; 15:124. [PMID: 26472649 PMCID: PMC4608212 DOI: 10.1186/s12877-015-0116-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 10/05/2015] [Indexed: 11/26/2022] Open
Abstract
Background Several studies have focused on predictors of mobility limitations and disabilities. Yet little is known about the pace and patterns of mobility changes among very old people. This study examined changes in functional mobility among individuals aged 90 years and older during a 2-9-year follow-up. In addition, we were interested in the patterns of mobility changes. Methods Data were collected through a mailed questionnaire in the years 2001, 2003, 2007 and 2010. The study population (n = 948) consisted of individuals from three cohorts (2001, 2003, 2007) who participated in at least two survey rounds and answered the mobility questions. The length of the follow-up varied from 2–9 years between individuals as well as according to how many times an individual took part in the survey. Multilevel ordinal logistic regression analysis was used to evaluate the effects of time, age, gender, cohort and chronic conditions on changes in mobility. Results At the baseline, “younger” old people, men and individuals in the cohorts for 2003 and 2007 had significantly better mobility compared with women, older individuals and individuals in the 2001 cohort. In addition, individuals with fewer chronic conditions had better mobility than those with more diseases. Mobility declined for most of the participants during the follow-up. The difference in the change in mobility over time for gender, age or chronic conditions was not statistically significant. The analyses were performed with a subgroup of participants aged 90–91 years at the baseline, and results did not differ substantially from the results for the entire study sample. However, the effect of chronic conditions on the change in mobility was statistically significant among participants aged 90-91years. Conclusions No differences were observed in the rate of mobility decline over time between age or gender. The effect of chronic conditions on the change in mobility was significant only among individuals aged 90–91 years. The prevention efforts are important and should focus even more, also among the oldest-old, on additional modifiable risk factors such as maintaining muscle strength.
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Affiliation(s)
- Kristina Tiainen
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland.
| | - Jani Raitanen
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland. .,UKK-Institute for Health Promotion Research, P.O. Box 30, 33501, Tampere, Finland.
| | - Elina Vaara
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland. .,Department of Social Research, University of Helsinki, P.O. Box 54, 00014, Helsinki, Finland.
| | - Antti Hervonen
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland.
| | - Marja Jylhä
- School of Health Sciences and Gerontology Research Center, University of Tampere, 33014, Tampere, Finland. .,Institute for Advanced Social Research, University of Tampere, 33014, Tampere, Finland.
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Liu LF, Yao HP. Examining the need assessment process by identifying the need profiles of elderly care recipients in the Ten-year Long-Term Care Project (TLTCP) of Taiwan. J Am Med Dir Assoc 2014; 15:946-54. [PMID: 25244959 DOI: 10.1016/j.jamda.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 06/29/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To deal with the increasing long-term care (LTC) needs of elderly people in Taiwan, the government launched the Ten-year Long-term Care Project (TLTCP) in 2007, and through the care management system, care plans for those in need were distributed and implemented by care managers according to the single assessment process. Based on the emphasis of linking the right need assessment to the care plan, this study aimed to explore the need profiles of LTC recipients with regard to their health indicators to serve as a validity check on the identified dependency levels and care plans in the current care management system. DESIGN A model based on latent class analysis (LCA) was used for dealing with the issue of health heterogeneity. LCA provides an empirical method that examines the interrelationships among health indicators and characterizes the underlying set of mutually exclusive latent classes that account for the observed indicators. The analysis included a total of 2901 elderly care recipients in the LTC dataset from a southern city, 1 of the 5 major metropolitan areas in Taiwan. The identified dependency levels of the samples and their care plans in need assessment were compared and discussed. RESULTS Four need profiles were explored in the LTC dataset. Apart from the low (LD) (32.95%) and moderate dependent groups (MD) (17.48%), there were 2 groups identified among the high-dependency levels, including the severe physical and psychological dependency (SPP) (26.37%) and the comorbidities and severe dependency (CSD) groups (23.20%), which in sum were approximately identified as high dependency (HD) by care managers in the LTC dataset. In addition, the CSD group currently costs more for their care plans on average in LTC services (NT. 277,081.15, approximately 9200 USD) than the SPP group (NT. 244,084.21) and the other groups. CONCLUSION Need assessment is a key to success in care management in LTC. The results of this study showed the importance of focusing on multifacet indicators, especially the mental and social health indicators in need assessments by improving the unified assessment process to sensitively detect those with various needs and then link them to the right care plan.
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Affiliation(s)
- Li-Fan Liu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Hui-Ping Yao
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Nosraty L, Enroth L, Raitanen J, Hervonen A, Jylhä M. Do successful agers live longer? The Vitality 90+ study. J Aging Health 2014; 27:35-53. [PMID: 24907039 DOI: 10.1177/0898264314535804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To discover whether successful aging, understood as a multidimensional concept, predicts further survival in very old people. METHOD The population sample consisted of 1,370 persons aged 90 or over in the Vitality 90+ study. Four alternative models of successful aging were constructed, each of them consisting of physical, psychological, and social dimensions. Mortality was followed up after 4 and 7 years. RESULTS Three out of four models significantly predicted survival at both follow-ups for the whole group. Separately, "success" in the physical, psychological, and social components was also associated with higher survival. The associations were stronger in women than in men. DISCUSSION Successful aging, measured using physical, psychological, and social dimensions, predicts the length of future life in nonagenarians.
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Affiliation(s)
- Lily Nosraty
- Gerontology Research Center and School of Health Sciences, University of Tampere, Finland
| | - Linda Enroth
- Gerontology Research Center and School of Health Sciences, University of Tampere, Finland
| | - Jani Raitanen
- Gerontology Research Center and School of Health Sciences, University of Tampere, Finland UKK Institute for Health Promotion Research, Tampere, Finland
| | - Antti Hervonen
- Gerontology Research Center and School of Health Sciences, University of Tampere, Finland
| | - Marja Jylhä
- Gerontology Research Center and School of Health Sciences, University of Tampere, Finland
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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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Medina-Solís CE, Pontigo-Loyola AP, Pérez-Campos E, Hernández-Cruz P, Avila-Burgos L, Mendoza-Rodríguez M, Maupomé G. Edentulism and other variables associated with self-reported health status in Mexican adults. Med Sci Monit 2014; 20:843-52. [PMID: 24852266 PMCID: PMC4043565 DOI: 10.12659/msm.890100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 12/27/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To determine if edentulism, controlling for other known factors, is associated with subjective self-report health status (SRH) in Mexican adults. MATERIAL AND METHODS We examined the SRH of 13 966 individuals 35 years and older, using data from the National Survey of Performance Assessment, a cross-sectional study that is part of the technical collaboration between the Ministry of Health of Mexico and the World Health Organization, which used the survey instrument and sampling strategies developed by WHO for the World Health Survey. Sociodemographic, socioeconomic, medical, and behavioral variables were collected using questionnaires. Self-reported health was our dependent variable. Data on edentulism were available from 20 of the 32 Mexican states. A polynomial logistic regression model adjusted for complex sampling was generated. RESULTS In the SRH, 58.2% reported their health status as very good/good, 33.8% said they had a moderate health status, and 8.0% reported that their health was bad/very bad. The association between edentulism and SRH was modified by age and was significant only for bad/very bad SRH. Higher odds of reporting moderate health or poor/very poor health were found in women, people with lower socio-economic status and with physical disabilities, those who were not physically active, or those who were underweight or obese, those who had any chronic disease, and those who used alcohol. CONCLUSIONS The association of edentulism with a self-report of a poor health status (poor/very poor) was higher in young people than in adults. The results suggest socioeconomic inequalities in SRH. Inequality was further confirmed among people who had a general health condition or a disability. Dentists and health care professionals need to recognize the effect of edentulism on quality of life among elders people.
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Affiliation(s)
- Carlo Eduardo Medina-Solís
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Hidalgo, Mexico
- Research Centre in Medical and Biological Sciences, School of Medicine and Surgery, Autonomous University “Benito Juarez” of Oaxaca, Oaxaca, Mexico
| | | | - Eduardo Pérez-Campos
- Research Centre in Medical and Biological Sciences, School of Medicine and Surgery, Autonomous University “Benito Juarez” of Oaxaca, Oaxaca, Mexico
- Biochemistry Unit ITO-UNAM, Oaxaca, Mexico
| | - Pedro Hernández-Cruz
- Research Centre in Medical and Biological Sciences, School of Medicine and Surgery, Autonomous University “Benito Juarez” of Oaxaca, Oaxaca, Mexico
- Biochemistry Unit ITO-UNAM, Oaxaca, Mexico
| | - Leticia Avila-Burgos
- Health Systems Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Martha Mendoza-Rodríguez
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Hidalgo, Mexico
| | - Gerardo Maupomé
- Indiana University/Purdue University at Indianapolis, School of Dentistry, Indianapolis, IN, U.S.A
- The Regenstrief Institute, Inc. Indianapolis, Indiana, IN, U.S.A
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Ul-Haq Z, Mackay DF, Pell JP. Association between self-reported general and mental health and adverse outcomes: a retrospective cohort study of 19,625 Scottish adults. PLoS One 2014; 9:e93857. [PMID: 24705574 PMCID: PMC3976324 DOI: 10.1371/journal.pone.0093857] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/06/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Self-reported general health and mental health are independent predictors of all-cause mortality. This study examines whether they are also independent predictors of incident cancer, coronary heart disease and psychiatric hospitalisation. METHODS We conducted a retrospective, population cohort study by linking the 19 625 Scottish adults who participated in the Scottish Health Surveys 1995-2003, to hospital admissions, cancer registration and death certificate records. We conducted Cox proportional hazard models adjusting for potential confounders including age, sex, socioeconomic status, alcohol, smoking status, body mass index, hypertension and diabetes. RESULTS Poor general health was reported by 1215 (6.2%) participants and was associated with cancer registrations (adjusted Hazard Ratio [HR] 1.30, 95% CI 1.10, 1.55), coronary heart disease events (adjusted HR 2.30, 95% CI 1.86, 2.84) and psychiatric hospitalisations (adjusted HR 2.42, 95% CI 1.65, 3.56). There was evidence of dose relationships and the associations remained significant after adjustment for mental health. 3172 (16%) participants had poor mental health (GHQ ≥ 4). After adjustment for general health, the associations between poor mental health and coronary heart disease events (adjusted HR 1.36, 95% CI 1.13, 1.63) and all-cause death (adjusted HR 1.38, 95% CI 1.23, 1.55) became non-significant, but mental health remained associated with psychiatric hospitalisations (fully adjusted HR 2.02, 95% CI 1.48, 2.75). CONCLUSION Self-reported general health is a significant predictor of a range of clinical outcomes independent of mental health. The association between mental health and non-psychiatric outcomes is mediated by general health but it is an independent predictor of psychiatric outcome. Individuals with poor general health or mental health warrant close attention.
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Affiliation(s)
- Zia Ul-Haq
- Institute of Health & Wellbeing, Public Health, University of Glasgow, Glasgow, United Kingdom
- Institute of Public Health & Social Sciences, Khyber Medical University, KPK, Peshawar, Pakistan
| | - Daniel F. Mackay
- Institute of Health & Wellbeing, Public Health, University of Glasgow, Glasgow, United Kingdom
| | - Jill P. Pell
- Institute of Health & Wellbeing, Public Health, University of Glasgow, Glasgow, United Kingdom
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Kulmala J, Nykänen I, Hartikainen S. Frailty as a predictor of all-cause mortality in older men and women. Geriatr Gerontol Int 2014; 14:899-905. [DOI: 10.1111/ggi.12190] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Jenni Kulmala
- Gerontology Research Center and Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - Irma Nykänen
- Kuopio Research Center of Geriatric Care; University of Eastern Finland; Kuopio Finland
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
| | - Sirpa Hartikainen
- Kuopio Research Center of Geriatric Care; University of Eastern Finland; Kuopio Finland
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
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The contribution of diseases to the male-female disability-survival paradox in the very old: results from the Newcastle 85+ study. PLoS One 2014; 9:e88016. [PMID: 24516578 PMCID: PMC3917849 DOI: 10.1371/journal.pone.0088016] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/02/2014] [Indexed: 11/29/2022] Open
Abstract
Background Explanations for the male-female disability-survival paradox - that woman live longer than men but with more disability - include sex differences in diseases and their impact on disability and death. Less is known about the paradox in the very old. We examine sex differences in the presence and impact of disabling and fatal diseases accounting for the male-female disability-survival paradox in very late life. Methods We use data from the Newcastle 85+ Study, a cohort of people born in 1921 and all recruited at age 85 in 2006. Participants underwent a health assessment (HA) at baseline, 18 months, 36 months, 60 months, and a review of their GP records (GPRR) at baseline and 36 months. We used multi-state modelling to assess the impact of specific diseases on disability and death. Disability (measured via ADLs/IADLs) was categorised as no disability (difficulty with 0 activities), or disabled (difficulty with one or more activities). Diseases were ascertained from review of general practice records and cognitive impairment which was defined as an sMMSE of 21 or less (from health assessment). Results In participants who had complete HA and GPRR, women had more arthritis (RR = 1.2, 95% CI: 1.1–1.3) and hypertension (RR = 1.2, 95%CI 1.0–1.3), more disability, and were more likely disabled at all follow-ups. From multistate models, women with cerebrovascular disease (HR: 2.6, 95% CI: 2.1–3.4) or respiratory disease (HR: 2.0, 95% CI: 1.4–3.0) were more likely to become disabled than those without but this did not hold for men (sex difference p<0.01). Men were more likely to die from respiratory disease (HR: 2.2, 95% CI: 1.8–2.8) but this did not hold for women (p = 0.002). Conclusion The disability-survival paradox was still evident at age 85 and appears due to sex differences in the types of diseases and their impact on the disability pathway.
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Sjölund BM, Wimo A, Qiu C, Engström M, von Strauss E. Time trends in prevalence of activities of daily living (ADL) disability and survival: comparing two populations (aged 78+ years) living in a rural area in Sweden. Arch Gerontol Geriatr 2013; 58:370-5. [PMID: 24439722 DOI: 10.1016/j.archger.2013.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 11/17/2013] [Accepted: 12/17/2013] [Indexed: 11/15/2022]
Abstract
The aim was to study time trends in prevalence of disability in ADL and survival among men and women 78 years and older comparing two cohorts. The study was a time trend study based on two population-based community cohorts, the Nordanstig Project (NP), collected 1995-1998 and the Swedish National Study on Aging and Care in Nordanstig (SNAC-N), collected 2001-2003. The participants were people aged 78 years and older from the NP cohort (N=303) and from the SNAC-N cohort (N=406). All were clinically examined by physicians and nurses using standardized protocols. Disability was defined as a need for assistance in one or more ADL activities. The prevalence of disability and survival were compared using logistic and Cox models. The prevalence of ADL disability was stable for men, while women became more disabled in ADL during the time period, OR 2.36 (1.12-4.94). There was no significant difference in survival time between the cohorts in either ADL disabled persons or non-disabled persons. There was a tendency for increased survival for non-disabled persons in SNAC-N compared with NP, although not significant; this was particularly true for women. In general, women survived longer than men did regardless of whether they were ADL disabled or not. The time trends for ADL disability found in the study show that ADL disability had increased in women but not in men. More studies are needed to identify risk factors for ADL disability with a view to preventing it in time.
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Affiliation(s)
- Britt-Marie Sjölund
- Aging Research Center (ARC), Karolinska Institutet-Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden; University of Gävle, 801 76 Gävle, Sweden.
| | - Anders Wimo
- Aging Research Center (ARC), Karolinska Institutet-Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden; KI-Alzheimer's Disease Research Center, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Chengxuan Qiu
- Aging Research Center (ARC), Karolinska Institutet-Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden
| | | | - Eva von Strauss
- Aging Research Center (ARC), Karolinska Institutet-Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden; The Non-profit Foundation for the Red Cross Hospital and Red Cross University College in Sweden
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