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Lopes Vieira MM, Borges VS, Oliveira EJP, Bof de Andrade F. Functional limitation in the older Brazilian adults: Association with multimorbidity and socioeconomic conditions. PLoS One 2023; 18:e0294935. [PMID: 38032910 PMCID: PMC10688755 DOI: 10.1371/journal.pone.0294935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023] Open
Abstract
The aim of this study was to assess the association between multimorbidity and the presence of functional limitation in basic (BADL) and instrumental activities of daily living (IADL) among Brazilian older adults and to verify whether this association is moderated by socioeconomic conditions. Cross-sectional study with data from the Brazilian National Health Survey (PNS) (2019) for the Brazilian population aged 60 years and over. The dependent variables were functional limitation, based on self-reported difficulty in performing one or more activities of daily living, including six BADL (feeding, bathing, using the toilet, dressing, crossing a room on the same floor and getting out of bed) and four IADL (shopping, managing money, taking medication and using transportation). The independent variables were multimorbidity (presence of two or more self-reported chronic diseases) and socioeconomic measures (per capita household income, asset score, and education level). The association between multimorbidity and outcomes was assessed using adjusted logistic regression models. The moderating effect of socioeconomic conditions on the association between multimorbidity and functional limitations was assessed by including an interaction term. The final sample consisted of 22,725 individuals. The prevalence of functional limitation was 8.5% (95%CI: 7.9-9.2) and 18.6% (95%CI: 17.8-19.5) in BADL and IADL, respectively. Multimorbidity was associated with BADL [OR: 2.30 (95%CI: 1.93-2.74)] and IADL [OR: 2.26 (95%CI: 1.98-2.57)]. The odds of functional limitation were higher among individuals with lower levels of education and income, but there was no interaction between multimorbidity and socioeconomic position measures. Multimorbidity was associated with functional limitation (BADL and IADL) and socioeconomic conditions, and this association was constant across socioeconomic position levels.
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Affiliation(s)
| | | | | | - Fabíola Bof de Andrade
- René Rachou Institute, Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Minas Gerais, Brasil
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Midlife improvements in financial situation are associated with a reduced dementia risk later in life: the CAIDE 30-year study. Int Psychogeriatr 2020; 32:1317-1324. [PMID: 31762430 DOI: 10.1017/s104161021900173x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Perceived financial strain is associated with various health conditions, but it is unknown whether it is associated with an increased risk for dementia. The goal is to examine the associations between midlife perceptions of financial situation and dementia risk later in life. METHODS Participants were derived from the Cardiovascular Risk Factors, Aging, and Dementia population-based cohort study (n = 2000) (between 1972 and 1987, baseline mean age 50 years) in Finland. Participants returned for two re-examinations in late life (in 1998 and 2005-2008, mean age 71 and 78 years). In this study, 1442 subjects that participated in at least one re-examination (mean total follow-up 25 years) were included in analyses. Financial strain was measured using two questions in midlife on perceptions of financial situation and perceptions of changes in financial situation. For each question, participants were categorized into three groups reporting improvement, worsening, or stability, with the latter set as the reference group. Analyses were adjusted for potential confounding factors. RESULTS The group reporting better financial situation had a reduced risk for dementia (fully adjusted model: odds ratio (OR): 0.53, 95% confidence interval (CI): 0.33-0.86). In contrast, the group reporting worse financial situation did not have an increased risk for dementia (OR: 1.04, 95% CI: 0.53-2.02). Analyses on perceptions of current financial situation showed that the groups reporting satisfaction or dissatisfaction with financial situation did not differ in risk for dementia. CONCLUSION This study is the first to show that midlife improvements in financial situation are associated with a reduced dementia risk later in life. Potential pathways related to stress reduction, improved lifestyle, and potential biological mechanisms are discussed.
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Galenkamp H, van Oers HAM, Kunst AE, Stronks K. Is quality of life impairment associated with chronic diseases dependent on educational level? Eur J Public Health 2020; 29:634-639. [PMID: 30668855 DOI: 10.1093/eurpub/cky276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Previous research indicates that quality of life impairment as a result of chronic diseases differs between socioeconomic groups, but the pattern seems to vary between health-related quality of life (HRQOL) outcomes. We tested for a one-item and a multi-item outcome whether associations between diseases and HRQOL varied between educational levels. METHODS Data come from Dutch participants of HELIUS (N =4615, aged 18-70). Education was defined as low, middle or high. Myocardial infarction, angina pectoris, hypertension, diabetes, obesity and depressed mood were measured using physical examination and/or self-report. Outcomes were fair/poor self-rated health (SRH) and physical (PCS) and mental (MCS) SF-12 scores. Interaction terms and relative excess risk due to interaction (RERI) were used as measures of additive interaction. RESULTS SRH and PCS were worst in lower educated participants, whereas MCS was worst in middle educated participants. Out of thirty-six interactions tested, four were statistically significant, with risks of poor HRQOL being both larger and smaller in low vs. high education groups. Obesity was associated with smaller risk of fair/poor SRH in low vs. high educated [RERI=-2.49 (-4.66; -0.33)]. Depressed mood was associated with more [b=-3.34 (-6.14; -0.54)] and hypertension with less reduction in PCS [b=1.23 (0.18; 2.27)] in middle vs. high educated. Depressed mood was highly associated with MCS, but less so in middle vs. high educated [b=4.09 (0.72; 7.47)]. CONCLUSION Despite a higher prevalence of diseases in low education groups, if measured in absolute terms, most diseases were not associated with larger impairment of HRQOL in lower vs. higher educated groups, regardless of the outcome measure used.
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Affiliation(s)
- Henrike Galenkamp
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans A M van Oers
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Amsterdam Public Health (APH) Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Wang Q, Tapia Granados JA. Household heating associated with disability in activities of daily living among Chinese middle-aged and elderly: a longitudinal study. Environ Health Prev Med 2020; 25:49. [PMID: 32892744 PMCID: PMC7487906 DOI: 10.1186/s12199-020-00882-5] [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: 05/19/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background The health hazards of indoor air pollution are well-established but studies of the health effects due to pollution from heating are rare. This study investigated the association of heating and disability for activities of daily living among Chinese middle-aged and elderly. Methods We used two consecutive surveys in a cohort of over 17,000 adults aged 45 or older, who were interviewed first in 2011–2012 and then in 2013. In these surveys, taking advantage of random survey time, we applied a random effects logit regression model that included an interaction between pollution-producing heating fuel and a dummy variable, which measured interview time based on whether or not it was heating season. Results Exposure to pollution-producing heating fuel was associated with a 39.9% (OR 1.399; 95%CI 1.227–1.594) and 71.0% (OR 1.710; 95%CI 1.523–1.920) increase in the likelihood of disability in activities of daily living (DADL) and disability in instrumental activities of daily living (DIADL), respectively. In heating season between year 2011 and 2013, moving from clean heating energy for heating to pollution-producing fuel was linked with an increase in the likelihoods having DADL and DIADL, with the OR of 2.014 (95%CI 1.126–3.600) and 1.956 (95%CI 1.186–3.226), respectively. However, disability increases due to change from clean energy to pollution-producing heating energy did not appear in advantaged education respondents. Conclusions We found that exposure to heating by burning of coal, wood, or crop residue was associated with disability in performing daily living activities. Health policymakers should take indoor pollution due to heating into consideration as it is a major determinant of activities of daily living in elderly people; especially, such policy should focus on elderly people who have disadvantaged education.
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Affiliation(s)
- Qing Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250100, Shandong, China. .,Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250002, Shandong, China. .,Pudong Institute for Health Development, Shanghai, 200122, China.
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Strozza C, Pasqualetti P, Egidi V, Loreti C, Vannetti F, Macchi C, Padua L. Health profiles and socioeconomic characteristics of nonagenarians residing in Mugello, a rural area in Tuscany (Italy). BMC Geriatr 2020; 20:289. [PMID: 32799807 PMCID: PMC7429096 DOI: 10.1186/s12877-020-01689-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background Health, as defined by the WHO, is a multidimensional concept that includes different aspects. Interest in the health conditions of the oldest-old has increased as a consequence of the phenomenon of population aging. This study investigates whether (1) it is possible to identify health profiles among the oldest-old, taking into account physical, emotional and psychological information about health, and (2) there are demographic and socioeconomic differences among the health profiles. Methods Latent Class Analysis with covariates was applied to the Mugello Study data to identify health profiles among the 504 nonagenarians residing in the Mugello district (Tuscany, Italy) and to evaluate the association between socioeconomic characteristics and the health profiles resulting from the analysis. Results This study highlights four groups labeled according to the posterior probability of determining a certain health characteristic: “healthy”, “physically healthy with cognitive impairment”, “unhealthy”, and “severely unhealthy”. Some demographic and socioeconomic characteristics were found to be associated with the final groups: older nonagenarians are more likely to be in worse health conditions; men are in general healthier than women; more educated individuals are less likely to be in extremely poor health conditions, while the lowest-educated are more likely to be cognitively impaired; and office or intellectual workers are less likely to be in poor health conditions than are farmers. Conclusions Considering multiple dimensions of health to determine health profiles among the oldest-old could help to better evaluate their care needs according to their health status.
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Affiliation(s)
- Cosmo Strozza
- Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, J.B. Winsløws Vej 9B, 2nd floor, 5000, Odense C, Denmark. .,Department of Statistical Sciences, Sapienza University of Rome, Viale Regina Elena 295, 00161, Rome, Italy.
| | - Patrizio Pasqualetti
- Fatebenefratelli Foundation for Health Research and Education, Via della Lungaretta 177, 00153, Rome, Italy
| | - Viviana Egidi
- Department of Statistical Sciences, Sapienza University of Rome, Viale Regina Elena 295, 00161, Rome, Italy
| | - Claudia Loreti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00136, Rome, Italy
| | - Federica Vannetti
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy
| | | | - Luca Padua
- Department of Geriatrics, Neurosciences and Orthopaedics, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.,UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00136, Rome, Italy
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Gu T, Yuan J, Li L, Shao Q, Zheng C. Demand for community-based care services and its influencing factors among the elderly in affordable housing communities: a case study in Nanjing City. BMC Health Serv Res 2020; 20:241. [PMID: 32293427 PMCID: PMC7092588 DOI: 10.1186/s12913-020-5067-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 03/03/2020] [Indexed: 11/26/2022] Open
Abstract
Background Community-based care services refers to the professional services provided at home to the elderly with formally assessed demands. The growth of the elderly population has increased the demand for these services, and this issue is even worse in the affordable housing community (AHC) of China. Understanding of elderly’s demands for different types of community-based care services and its determinations would enable the implementation of appropriate incentive schemes to promote utilization of community-based care services in the AHCs of China. Methods Guided by previous studies, a conceptual framework was developed. Then, a questionnaire was designed and a community based survey was conducted from May 10–20, 2018 in Daishan AHC of Nanjing City, China. Four hundred eight participants from 25,650 elderly people were selected by systematic random sampling technique. Binary logistic regression was applied to the data about the elderly’ primary demands for community-based care services in the AHC, to quantify the elderly’s demands and explore related individual-level factors. Results The finding indicates that more than 50% of respondents had the demand for an elderly care hotline, building health archives, on-call nursing and doctor visits, medical lectures, regular medical examinations and sporting fitness. The binary logistic regression models revealed that the primary demands of the elderly for community-based care services were influenced by distinct factors. Conclusions Our findings help clarify different types of community-based care services and provide fresh information about the demand for community-based care among the elderly in AHCs. Several policy implications are discussed to enhance the efficiency of community-based care service provision.
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Affiliation(s)
- Tiantian Gu
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China
| | - Jingfeng Yuan
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China.
| | - Lingzhi Li
- School of Civil Engineering, Nanjing Tech University, Nanjing, 211816, China
| | - Qiuhu Shao
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China
| | - Chuanjun Zheng
- School of Civil Engineering, Southeast University, Jiangning District, Nanjing, 211189, China
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Individual and population level impact of chronic conditions on functional disability in older adults. PLoS One 2020; 15:e0229160. [PMID: 32078637 PMCID: PMC7032687 DOI: 10.1371/journal.pone.0229160] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/30/2020] [Indexed: 11/30/2022] Open
Abstract
Background It is unknown if the relationship between multimorbidity and disability differs by combinations of chronic conditions. The objective of our study was to elucidate how joint effect of different combinations of chronic conditions impact the five year risk of functional disability at the population level. Methods Participants ≥65 years from the Canadian Study of Health and Aging were assessed for functional disability measured using activities of daily living (ADL) and instrumental ADL (IADL), and the presence of conditions in five disease domains; cardiometabolic, neurological, sensory, musculoskeletal, and respiratory. Logistic regression was used to assess the relationship between each disease domain and incident ADL and IADL measured at five years of follow up and population attributable risk (PAR) was modeled for diseases domains that were significantly associated with disability. Results were stratified by sex and age (65–74 years, ≥75 years). Results There were 6272 participants free of ADL disability and 4571 participants free from IADL disability at baseline. For incident ADL, the greatest PAR values were 21.3 (9.8–32.8) for the cardiometabolic domain in males 65–74 years, 22.7 (4.7–40.8) for the musculoskeletal domain for females aged 65–74 years, and 11.2 (2.8–19.7) for the musculoskeletal domain in males ≥75 years. The PAR for the musculoskeletal, sensory, and neurological domains were similar in females ≥75 years(9.3–9.9). PAR values were lower but followed similar patterns for IADL disability. Conclusion The chronic disease domains which most strongly predicted incident ADLs and IADLs did not account for the greatest amount of disability at the population level.
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Kelfve S. Underestimated Health Inequalities Among Older People-A Consequence of Excluding the Most Disabled and Disadvantaged. J Gerontol B Psychol Sci Soc Sci 2019; 74:e125-e134. [PMID: 28369563 DOI: 10.1093/geronb/gbx032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 03/09/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The present study analyzed whether estimates of health inequalities in old age are sensitive to the exclusion of people living in institutions and nonuse of proxy interviews. METHOD Pooled data from the 2004 wave (n = 1,180, aged 69-100, primarily interviewed over the phone) and the 2011 wave (n = 931, aged 76-101, primarily interviewed face-to-face) of the Swedish Panel Study of Living Conditions of the Oldest Old were used to compare absolute and relative differences in disability and mortality between people with compulsory education and people with more than compulsory education. RESULTS Both absolute and relative health inequalities would have been underestimated in a survey that excluded institutionalized people and proxy-interviewed community dwellers. The same patterns were found in men and women and regardless of the mode of data collection (telephone or face-to-face interview). The degree of underestimation was lower in those 85 years and older than in those 69 to 84 years. DISCUSSION A survey that only includes people who live in the community and can participate without the help of a proxy might give the impression that those with low levels of education have less extensive health disadvantages than they actually have.
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Affiliation(s)
- Susanne Kelfve
- Aging Research Center (ARC), Karolinska Institutet & Stockholm University, Sweden.,National Institute for the Study of Ageing and Later Life (NISAL), Linköping University, Norrköping, Sweden
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Enroth L, Veenstra M, Aartsen M, Kjær AA, Nilsson CJ, Fors S. Are there educational disparities in health and functioning among the oldest old? Evidence from the Nordic countries. Eur J Ageing 2019; 16:415-424. [PMID: 31798367 PMCID: PMC6857104 DOI: 10.1007/s10433-019-00517-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
With the ageing of the population and recent pressures on important welfare state arrangements, updated knowledge on the linkage between socioeconomic status and health in old age is pertinent for shedding light on emerging patterns of health inequalities in the Nordic countries. This study examined self-rated health (SRH), mobility and activities of daily living (ADL) according to level of education in the three oldest old age groups 75–84, 85–94, and 95+, in four Nordic countries. Altogether, 6132 individuals from Danish Longitudinal Study of Ageing, Norwegian Life Course, Ageing and Generation study, Swedish Panel Study of Living Conditions of the Oldest Old, the 5-Country Oldest Old (Sweden) and Vitality 90 + Study were analysed. First, associations of education level with SRH, mobility, and ADL were estimated for each individual study by means of age- and gender-adjusted logistic regression. Second, results from individual studies were synthesized in a meta-analysis. Older adults with higher education level were more likely to report good SRH, and they were more often independent in mobility and ADL than those with basic education when all age groups were combined. In mobility and ADL, differences between education groups remained stable across the age groups but for SRH, differences seemed to be weaker in older ages. With only a few exceptions, in all age groups, individuals with higher education had more favourable health and functioning than those with basic education. This study shows remarkable persistence of health and functioning inequalities in the Nordic countries throughout later life.
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Affiliation(s)
- Linda Enroth
- 1Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
| | - Marijke Veenstra
- 2Norwegian Social Research, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Marja Aartsen
- 2Norwegian Social Research, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Agnete Aslaug Kjær
- 3The Danish Center for Social Science Research (VIVE), Department of Political Science, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Juul Nilsson
- 4Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stefan Fors
- 5Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Impact of physical and mental health on life satisfaction in old age: a population based observational study. BMC Geriatr 2016; 16:194. [PMID: 27887583 PMCID: PMC5124278 DOI: 10.1186/s12877-016-0365-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022] Open
Abstract
Background It is widely assumed that poor health lowers life satisfaction when ageing. Yet, research suggests this relationship is not straightforward. This study investigated how older people evaluate their life when facing disease and disabilities. Methods The Leiden 85-plus Study, a prospectively followed cohort of a cohort of a middle-sized city in the Netherlands, all aged 85 years, that was age-representative of the general population, was used. Those with severe cognitive dysfunction were excluded (n = 501). Comorbidities, physical performance, cognitive function, functional status, residual lifespan, depressive symptoms and experienced loneliness were measured during home visits. Life satisfaction was self-reported with Cantril’s ladder. All analyses were performed using regression analysis. Results Participants reported high life satisfaction (median 8 out of 10 points) despite having representative levels of disease and disability. Comorbidity, low cognitive function, and residual lifespan as markers of health were not associated with life satisfaction. Poor physical performance and low functional status were weakly but significantly associated with lower life satisfaction (p < 0.05 respectively p < 0.001), but significance was lost after adjustment for depressive symptoms and perceived loneliness. Depressive symptoms and perceived loneliness were strongly related to lower life satisfaction (both p < 0.001), even after adjustment for physical health characteristics. Conclusion Poor physical health was hardly related to lower life satisfaction, whereas poor mental health was strongly related to lower life satisfaction. This indicates that mental health has a greater impact on life satisfaction at old age than physical health, and that physical health is less relevant for a satisfactory old age.
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Puvill T, Lindenberg J, Slaets JPJ, de Craen AJM, Westendorp RGJ. How is Change in Physical Health Status Reflected by Reports of Nurses and Older People Themselves? J Gerontol A Biol Sci Med Sci 2016; 72:579-585. [DOI: 10.1093/gerona/glw103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/19/2016] [Indexed: 11/12/2022] Open
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Strand BH, Skirbekk V, Rosness TA, Engedal K, Bjertness E. Income in midlife and dementia related mortality over three decades: A Norwegian prospective study. eNeurologicalSci 2015; 1:24-29. [PMID: 29479571 PMCID: PMC5822046 DOI: 10.1016/j.ensci.2015.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 12/01/2022] Open
Abstract
Studies on midlife income and dementia are scarce, and our main aim was to investigate midlife with later risk of dementia related mortality, adjusting for education and dementia related risk factors. The study population consisted of Norwegian men, aged 40–59 years in 1980 at income assessment, which participated in Norwegian health examination studies in the period 1980–2002 where risk factors such as cholesterol level, hypertension, smoking, cardiovascular disease, and diabetes were assessed. Dementia related mortality was defined as a dementia diagnosis on the death certificate until 2012. Cox regression was used. The study included 45,944 participants and 1062 dementia related deaths. There was no association between midlife income and dementia mortality risk (HR = 1.04, 95% confidence interval (CI) 0.85, 1.28 for the lowest fifth of income compared to those in the highest fifth). For total mortality, there was a strong inverse association with income (HR = 1.61, 95% CI 1.53, 1.69), which was attenuated when adjusting for education and risk factors, but still significant (HR = 1.27, 95% CI 1.20, 1.34). Lower educational attainment was significantly associated with increased dementia mortality risk, also after adjustment for income and other known risk factors (HR = 1.30, 95% CI 1.03, 1.64 comparing low versus high education). Midlife income was not associated with dementia related mortality, but low education was independently linked to increased risk of dementia related mortality. Our results support the cognitive reserve hypothesis suggesting that mental activity and not material resources are related to dementia related mortality.
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Affiliation(s)
- Bjørn Heine Strand
- Institute of Health and Society, University of Oslo, P.O. box 1130 Blindern, 0318 Oslo, Norway.,Norwegian Institute of Public Health, Norway.,Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Norway
| | | | - Tor A Rosness
- Institute of Health and Society, University of Oslo, P.O. box 1130 Blindern, 0318 Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health (Ageing and Health), Norway
| | - Espen Bjertness
- Institute of Health and Society, University of Oslo, P.O. box 1130 Blindern, 0318 Oslo, Norway
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Birkenhäger-Gillesse EG, den Elzen WPJ, Achterberg WP, Mooijaart SP, Gussekloo J, de Craen AJM. Association Between Glycosylated Hemoglobin and Cardiovascular Events and Mortality in Older Adults without Diabetes Mellitus in the General Population: The Leiden 85-Plus Study. J Am Geriatr Soc 2015; 63:1059-66. [PMID: 26032644 DOI: 10.1111/jgs.13457] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the association between glycosylated hemoglobin (HbA1c) and incident cardiovascular disease and mortality in 85-year-old individuals without diabetes mellitus from the general population. DESIGN Population-based prospective follow-up study. SETTING General population. PARTICIPANTS Individuals without known diabetes mellitus (N = 445, n = 291 female). MEASUREMENTS HbA1c levels were categorized into three groups (<5.0% (31 mmol/mol), 5.0-5.7% (31-39 mmol/mol; reference), 5.7-6.5% (39-48 mmol/mol)). RESULTS At baseline, a history of myocardial infarction (MI) was more prevalent in subjects in the highest HbA1c group (18%) than in the reference group (7%) (P = .001). Prospectively, those with the highest level of HbA1c at baseline had a risk of incident MI during the 5-year follow-up that was 3.6 (95% confidence interval = 1.5-8.3) times as great as that of the reference group. No association was found between HbA1c level and incident stroke, cardiovascular mortality, or all-cause mortality. CONCLUSION In individuals aged 85 and older without diabetes mellitus, higher HbA1c is associated with greater risk of MI but not with stroke and mortality.
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Affiliation(s)
- Elizabeth G Birkenhäger-Gillesse
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Laurens Care Centers, Rotterdam, The Netherlands
| | - Wendy P J den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.,Institute for Evidence-Based Medicine in Old Age, Leiden, the Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
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Predictive value of a profile of routine blood measurements on mortality in older persons in the general population: the Leiden 85-plus Study. PLoS One 2013; 8:e58050. [PMID: 23483967 PMCID: PMC3587570 DOI: 10.1371/journal.pone.0058050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/30/2013] [Indexed: 11/19/2022] Open
Abstract
Background Various questionnaires and performance tests predict mortality in older people. However, most are heterogeneous, laborious and a validated consensus index is not available yet. Since most older people are regularly monitored by laboratory tests, we compared the predictive value of a profile of seven routine laboratory measurements on mortality in older persons in the general population with other predictors of mortality; gait speed and disability in instrumental activities of daily living (IADL). Methodology/Principal Findings Within the Leiden 85-plus Study, a prospective population-based study, we followed 562 participants aged 85 years for mortality over five years. At baseline (age 85 years) high-density lipoprotein cholesterol, albumin, alanine transaminase, hemoglobin, creatinin clearance, C-reactive protein and homocysteine were measured. Participants were stratified based on their number of laboratory abnormalities (0, 1, 2–4 and 5–7). The predictive capacity was compared with gait speed (6-meter walking test) and disability in IADL (Groningen Activity Restriction Scale) by C-statistics. At baseline, 418 (74%) 85-year old participants had at least one laboratory abnormality. All cause mortality risk increased with increasing number of laboratory abnormalities to a hazard ratio of 5.64 [95% CI 3.49–9.12] for those with 5–7 laboratory abnormalities (p<0.001) compared to those without abnormalities. The c-statistic was 0.66 [95% CI 0.59–0.69], similar to that of gait speed and disability in IADL. Conclusions/Significance In the general population of oldest old, the number of abnormalities in seven routine laboratory measurements predicts five-year mortality as accurately as gait speed and IADL disability.
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den Elzen WPJ, de Craen AJM, Wiegerinck ET, Westendorp RGJ, Swinkels DW, Gussekloo J. Plasma hepcidin levels and anemia in old age. The Leiden 85-Plus Study. Haematologica 2012; 98:448-54. [PMID: 23065507 DOI: 10.3324/haematol.2012.068825] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hepcidin, an important regulator of iron homeostasis, is suggested to be causally related to anemia of inflammation. The aim of this study was to explore the role of plasma hepcidin in anemia among older persons from the general population. The Leiden 85-Plus Study is a population-based study of 85-year olds in Leiden, the Netherlands. Eighty-five-year old inhabitants of Leiden were enrolled between September 1997 and September 1999. At the age of 86, plasma hepcidin was determined with time of flight mass spectrometry in 490 participants [160 (32.7%) male, 114 (23.3%) with anemia]. Anemia was defined according to criteria of the World Health Organization (hemoglobin level <13 g/dL for men and hemoglobin <12 g/dL for women). The median plasma hepcidin level was 3.0 nM [interquartile range (IQR) 1.8-4.9]. We found strong correlations between plasma hepcidin and body iron status, C-reactive protein and erythropoietin levels. Significantly higher hepcidin levels were found in participants with anemia of inflammation (P<0.01), in participants with anemia of kidney disease (P=0.01), and in participants with unexplained anemia (P=0.01) than in participants without anemia. Participants with iron-deficiency anemia had significantly lower plasma hepcidin levels than participants without anemia (P<0.01). In conclusion, older persons with anemia of inflammation have higher hepcidin levels than their counterparts without anemia. The potential clinical value of hepcidin in future diagnostic algorithms for anemia has to be explored.
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Affiliation(s)
- Wendy P J den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
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Wu H, Flaherty J, Dong B, Liu G, Deng J, Zhang Y, Wu J, Zeng G, Ren X, Hu J, Wu W, Malmstrom TK. Impact of Geriatric Conditions Versus Medical Diagnoses on ADL Disability Among Nonagenarians and Centenarians. J Aging Health 2012; 24:1298-319. [PMID: 23006424 DOI: 10.1177/0898264312457411] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: The authors investigated the relationship of activities of daily living (ADL) disability with medical diseases and geriatric conditions among nonagenarians and centenarians. Method: Cross-sectional, n = 870 Chinese (age range: 90-108 years). Self-reported medical diseases and geriatric-specific conditions were obtained by face-to-face interviews. Biomedical measurements included systolic/diastolic blood pressure, BMI (body mass index), albumin, fasting glucose, creatinine clearance, hemoglobin, and lipid panel. Results: In bivariate analyses, 4 of 7 geriatric conditions (hearing problems, falls, cognitive impairment, fracture), and 6 of 11 biomedical measurements (fasting glucose, cholesterol, LDL, creatinine clearance, hemoglobin, albumin), but none of 10 medical diseases and no degree of comorbidities, were associated with ADL disability. In four different multivariate logistic regression models, two geriatric conditions (impaired cognition, fracture) were significant in three models, respiratory disease in one model, and fasting glucose in two models. Discussion: This study emphasizes the importance of geriatric conditions and their association with ADL disability among the oldest-old adult population.
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Affiliation(s)
- Hongmei Wu
- West China Hospital, Sichuan University, Chengdu, China
| | | | - Birong Dong
- West China Hospital, Sichuan University, Chengdu, China
| | - Guanjian Liu
- West China Hospital, Sichuan University, Chengdu, China
| | - Juelin Deng
- West China Hospital, Sichuan University, Chengdu, China
| | - Yanling Zhang
- West China Hospital, Sichuan University, Chengdu, China
| | - Jinhui Wu
- West China Hospital, Sichuan University, Chengdu, China
| | - Guo Zeng
- Sichuan University, Chengdu, China
| | | | - Junmei Hu
- School of Basic Science & Forensic Medicine, Sichuan University, Chengdu, China
| | - Weili Wu
- West China Hospital, Sichuan University, Chengdu, China
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Willems JM, den Elzen WPJ, Vlasveld LT, Westendorp RGJ, Gussekloo J, de Craen AJM, Blauw GJ. No increased mortality risk in older persons with unexplained anaemia. Age Ageing 2012; 41:501-6. [PMID: 22417980 DOI: 10.1093/ageing/afs031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND in older persons, anaemia is associated with a number of unfavourable outcomes. In approximately 30% of older persons with anaemia, the cause of the anaemia is unexplained. We assessed the clinical differences between subjects with explained and unexplained anaemia and investigated whether these subjects have different mortality patterns compared with subjects without anaemia. DESIGN observational prospective follow-up study. SETTING the Leiden 85-plus study. PARTICIPANTS four hundred and ninety-one persons aged 86 years. METHODS the study population was divided in three groups: (i) no anaemia (reference group, n=377), (ii) explained anaemia (iron deficiency, folate deficiency, vitamin B12 deficiency, signs of myelodysplastic syndrome or renal failure, n=74) and (iii) unexplained anaemia, (n=40). Mortality risks were estimated with Cox-proportional hazard models. RESULTS haemoglobin levels were significantly lower in subjects with explained anaemia than in subjects with unexplained anaemia (P<0.01). An increased risk for mortality was observed in subjects with explained anaemia [HR: 1.93 (95% CI: 1.47-2.52), P<0.001], but not in subjects with unexplained anaemia [HR: 1.19 (95% CI: 0.85-1.69), P=0.31]. Adjusted analyses (sex, co-morbidity, MMSE, institutionalised and smoking) did not change the observed associations for both explained and unexplained anaemic subjects. CONCLUSION older subjects with unexplained anaemia had similar survival compared with non-anaemic subjects. Increased mortality risks were observed in subjects with explained anaemia compared with non-anaemic subjects.
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Ferrer A, Badía T, Formiga F, Almeda J, Fernández C, Pujol R. [Gender differences in health status in a population of over 85 year-olds: the Octabaix study]. Aten Primaria 2011; 43:577-84. [PMID: 21377767 DOI: 10.1016/j.aprim.2010.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 09/17/2010] [Accepted: 09/17/2010] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine gender differences according to health status in the oldest old people of the community. DESIGN Cross-sectional multicentre study, within the framework of a clinical trial on falls and malnutrition. SETTING 7 primary health centres. PARTICIPANTS Non-institutionalised patients of 85 years or over. METHODS The data collected included, socioeconomic data, cardiovascular risk factors, Barthel Index (BI), cognitive status with the Mini-Mental State Examination (MMSE), Charlson Index to measure comorbidity, nutritional risk evaluated by Nutritional Assessment questionnaire (MNA), mean visual analogue self-rating scale in Euroqol- 5D (EQ-VAS) to assess health related quality life and, Gijón social risk test, and prescribed drugs. RESULTS A total of 312 subjects were included, of which 61.6% were women, 53% widows and a third of them lived alone. High blood pressure was observed in 76%, dyslipidemia in 51.2%, diabetes in 17.4%, median BI 95 (rank 0-100), MMSE 28 (0-35), Charlson index 1 (0-7), MNA 25 (10-30), Gijón test 10 (5-21), EQ-VAS 60 (0-100) and the mean prescription drugs 6.1±3.3. Women most frequently lived alone (P<.001), fell more (P<.006), had a greater nutritional (P<.016) and social risk (P<.001). Men were more likely to be married (P<.001), had better cognition (P<.003), better functional status (P<.018), and higher comorbidity (P<.001). CONCLUSION Being a 85 years old man is associated with being married, having better functionality and cognition, and a higher comorbidity. While being a woman is associated with living alone, a higher rate of falls, and nutritional and social risk. These results are important to help this group of elderly to maintain their position in the community.
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Affiliation(s)
- Assumpta Ferrer
- Centro de Atención Primaria El Plà CAP-I, Sant Feliu de Llobregat, Barcelona, España
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den Elzen WPJ, Willems JM, Westendorp RGJ, de Craen AJM, Blauw GJ, Ferrucci L, Assendelft WJJ, Gussekloo J. Effect of erythropoietin levels on mortality in old age: the Leiden 85-plus Study. CMAJ 2011; 182:1953-8. [PMID: 21149533 DOI: 10.1503/cmaj.100374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The production of erythropoietin is triggered by impaired oxygen delivery to the kidney, either because of anemia or hypoxemia. High erythropoietin levels have been shown to predict the risk of death among patients with chronic heart failure. We investigated the prognostic value of elevated erythropoietin levels on mortality among very elderly people in the general population. METHODS The Leiden 85-plus Study is a population-based prospective follow-up study involving 599 people aged 85 years in Leiden, the Netherlands, enrolled between September 1997 and September 1999. Erythropoietin levels were determined at age 86. For this analysis, we included 428 participants with a creatinine clearance of at least 30 mL/min. Mortality data, recorded until Feb. 1, 2008, were obtained from the municipal registry. RESULTS During follow-up, 324 (75.7%) participants died. Compared with participants whose erythropoietin levels were in the lowest tertile (reference group), those whose levels were in the middle tertile had a 25% increased risk of death (hazard ratio [HR] 1.25, 95% confidence interval [CI] 0.95-1.64), and those whose levels were in the highest tertile had a 73% increased risk (HR 1.73, 95% CI 1.32-2.26) (p value for trend < 0.01). The association between erythropoietin levels and mortality remained largely unchanged after we adjusted for sex, creatinine clearance, hemoglobin level, comorbidity, smoking status and C-reactive protein level, and was similar for deaths from cardiovascular and noncardiovascular causes. INTERPRETATION Among people aged 85 years and older, elevated erythropoietin levels were associated with an increased risk of death, independent of hemoglobin levels.
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Affiliation(s)
- Wendy P J den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands.
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Abstract
This article focuses on social and psychological risk factors for Alzheimer’s
disease, dementia, and cognitive impairment and presents some key points for
prevention in developing countries based on previous studies, a social science
theory, and our preliminary survey. Previous population-based studies found that
educational and occupational attainment, income, participation in social and
mental activities, and psychological distress were associated with dementia
risk. According to the theory of path dependence, earlier factors largely
determine successive ones, where education is one of these early experiences in
life. Our preliminary survey suggested that education sets a path that several
psychosocial risk factors are dependent on. The expansion of basic education is
indispensable. Resources for prevention should be concentrated on individuals
with a low level of education. In order to break from a path creating
self-reinforcement of risk factors, it is necessary to implement early and
active interventions.
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Affiliation(s)
- Hiroko Matsuoka
- MA, School of Nursing & Health, Aichi Prefectural University, Nagoya, Japan
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Schram MT, Frijters D, van de Lisdonk EH, Ploemacher J, de Craen AJM, de Waal MWM, van Rooij FJ, Heeringa J, Hofman A, Deeg DJH, Schellevis FG. Setting and registry characteristics affect the prevalence and nature of multimorbidity in the elderly. J Clin Epidemiol 2008; 61:1104-12. [PMID: 18538993 DOI: 10.1016/j.jclinepi.2007.11.021] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 11/16/2007] [Accepted: 11/30/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to investigate how settings and registry characteristics affect the prevalence and nature of multimorbidity in elderly individuals. STUDY DESIGN AND SETTING We used data from three population-based studies, two general practitioner registries, one hospital discharge register, and one nursing home registry to estimate the prevalence of multimorbidity. Individuals aged 55 years and over were included. RESULTS Multimorbidity was most prevalent in nursing homes (82%), followed by the general population and general practitioner registries (56%-72%) and the hospital setting (22%). There were large differences in the nature of multimorbidity between settings. Combinations of hypertension, heart disease, and osteoarthritis were dominant in the population-based setting, whereas hypertension in combination with osteoarthritis, obesity, disorders of lipid metabolism, and diabetes dominated in the general practitioner setting. In the hospital setting, combinations of heart diseases had the highest prevalence. Combinations of dementia, hypertension, and stroke were dominant within the nursing home setting. CONCLUSION This study shows that setting and registry characteristics have an important influence on the outcome of multimorbidity studies. We recommend provision of at least information about the setting, the (list of) conditions included, the data collection method, and the time frame used, when reporting about the size and nature of multimorbidity.
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Affiliation(s)
- Miranda T Schram
- Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, The Netherlands
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de Craen AJM, Gussekloo J, Blauw GJ, Willems CG, Westendorp RGJ. Randomised controlled trial of unsolicited occupational therapy in community-dwelling elderly people: the LOTIS trial. PLOS CLINICAL TRIALS 2006; 1:e2. [PMID: 16871324 PMCID: PMC1488896 DOI: 10.1371/journal.pctr.0010002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 03/08/2006] [Indexed: 11/18/2022]
Abstract
Objective: The objective of this trial, the Leiden 85-Plus Occupational Therapy Intervention Study (LOTIS), was to assess whether unsolicited occupational therapy, as compared to no therapy, can decelerate the increase in disability in high-risk elderly people. Design: This was a randomised controlled trial with 2-y follow-up. Setting: The study took place in the municipality of Leiden in the Netherlands. Participants: The participants were 402 community-dwelling 85-y-old people, with a Mini-Mental State Examination score of >18 points at baseline. Interventions: Participants in the intervention group were visited by an occupational therapist who provided training and education about assistive devices that were already present and who gave recommendations and information about procedures, possibilities, and costs of assistive devices and community-based services. Control participants were not visited by an occupational therapist. Outcome Measures: The primary outcome measure was the score achieved on the Groningen Activity Restriction Scale. Secondary outcome measures included self-evaluations of well-being and feelings of loneliness. Results: The participants were evenly divided between the two groups: 202 participants were allocated to the intervention group and 200 participants to the control group. Of the 202 participants randomised to occupational therapy, 55 participants declined the proposed intervention. An occupational therapist indicated that of the remaining 147 participants, 66 (45%) needed an occupational therapy intervention. A total of 44 new assistive devices and five community-based services were implemented. During follow-up there was a progressive increase in disability in the intervention group (mean annual increase, 2.0 points; SE 0.2; p < 0.001) and control group (mean annual increase, 2.1 points; SE 0.2; p < 0.001). The increase in disability was not significantly different between study groups (0.08 points; 95% CI, −1.1–1.2; p = 0.75). There was also no difference between study groups for any of the secondary outcome measures. Conclusion: Unsolicited occupational therapy in high-risk elderly participants does not decelerate the increase in disability over time. Background: Community-based services, such as occupational therapy, are widely used for elderly people to help them maintain independence. However, few studies have examined whether unsolicited offering of such services are effective in reducing disability, especially in the “oldest old”, that is, people 85 y or older. What this trial shows: In this population of 85-y-olds, the effect of unsolicited occupational therapy was studied. The study consisted of therapists proactively making visits to elderly people in the trial, in order to provide additional services in addition to routine care. The researchers found no change in the reduction in disability over time in participants receiving unsolicited occupational therapy. Strengths and limitations: The study is notable in that it provides good evidence, previously lacking, on the effects of unsolicited occupational therapy. The design was appropriate and randomisation was done correctly. Limitations include the fact that take-up of occupational therapy in the trial was not uniformly high. Contribution to the evidence: Other evidence has shown that occupational therapy has beneficial effects in elderly people living at home. However, there has been little evidence about the effects of unsolicited occupational therapy in very elderly people, who are at particularly high risk of disability. This trial adds information from such a population and also indicates that making unsolicited visits, with the aim of finding people who have not already been provided with the services they need, is not likely to be of overall benefit.
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Affiliation(s)
- Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands.
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