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Schumacher BT, LaMonte MJ, Di C, Parada H, Hooker SP, Bellettiere J, Simonsick EM, Liles S, LaCroix AZ. Associations of Relative Intensity of Physical Activity With Incident Cardiovascular Events and All-Cause Mortality. J Gerontol A Biol Sci Med Sci 2024; 79:glae113. [PMID: 38699999 PMCID: PMC11212487 DOI: 10.1093/gerona/glae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The relative intensity of physical activity (PA) can be estimated as the percent of one's maximal effort required. METHODS We compared associations of relative and absolute intensity PA with incident major cardiovascular disease (CVD) and all-cause mortality in 5 633 women from the Objective Physical Activity and Cardiovascular Health Study (mean age 78.5 ± 6.7). Absolute intensity was measured by accelerometry. Relative intensity was estimated by dividing accelerometer-estimated metabolic equivalents (METs) by maximal MET capacity. Both were aggregated into mean daily hours of light intensity PA (LPA) and moderate-to-vigorous PA (MVPA). Cox proportional hazard models estimated hazard ratios (HRs) for 1-hour higher amounts of PA on outcomes. RESULTS During follow-up (median = 7.4 years), there were 748 incident CVD events and 1 312 deaths. Greater LPA and MVPA, on either scale, were associated with reduced risk of both outcomes. HRs for a 1-hour increment of absolute LPA were 0.88 (95% CI: 0.83-0.93) and 0.88 (95% CI: 0.84-0.92) for incident CVD and mortality, respectively. HRs for a 1-hour increment of absolute MPVA were 0.73 (95% CI: 0.61-0.87) and 0.55 (95% CI: 0.48-0.64) for the same outcomes. HRs for a 1-hour increment of relative LPA were 0.70 (95% CI: 0.59-0.84) and 0.78 (95% CI: 0.68-0.89) for incident CVD and mortality, respectively. HRs for a 1-hour increment of relative MPVA were 0.89 (95% CI: 0.83-0.96) and 0.82 (95% CI: 0.77-0.87) for the same outcomes. On the relative scale, LPA was more strongly, and inversely associated with both outcomes than relative MVPA. Absolute MVPA was more strongly inversely associated with the outcomes than relative MVPA. CONCLUSIONS Findings support the continued shift in the PA intensity paradigm toward recommendation of more movement, regardless of intensity. Relative LPA--a modifiable, more easily achieved behavioral target, particularly among ambulatory older adults--was associated with reduced risk of incident major CVD and death.
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Affiliation(s)
- Benjamin T Schumacher
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo–SUNY, Buffalo, New York, USA
| | - Chongzhi Di
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- UCSD Moores Cancer Center, La Jolla, California, USA
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California, USA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Eleanor M Simonsick
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Sandy Liles
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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LaMonte MJ, LaCroix AZ, Nguyen S, Evenson KR, Di C, Stefanick ML, Hyde ET, Anuskiewicz B, Eaton CB. Accelerometer-Measured Physical Activity, Sedentary Time, and Heart Failure Risk in Women Aged 63 to 99 Years. JAMA Cardiol 2024; 9:336-345. [PMID: 38381446 PMCID: PMC10882503 DOI: 10.1001/jamacardio.2023.5692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/27/2023] [Indexed: 02/22/2024]
Abstract
Importance Heart failure (HF) prevention is paramount to public health in the 21st century. Objective To examine incident HF and its subtypes with preserved ejection fraction (HFpEF) and reduced EF (HFrEF) according to accelerometer-measured physical activity (PA) and sedentary time. Design, Setting, and Participants This was a prospective cohort study, the Objective Physical Activity and Cardiovascular Health (OPACH) in Older Women study, conducted from March 2012 to April 2014. Included in the analysis were women aged 63 to 99 years without known HF, who completed hip-worn triaxial accelerometry for 7 consecutive days. Follow-up for incident HF occurred through February 2022. Data were analyzed from March to December 2023. Exposure Daily PA (total, light, moderate to vigorous PA [MVPA], steps) and sedentary (total, mean bout duration) behavior. Main Outcomes and Measures Adjudicated incident HF, HFpEF, and HFrEF. Results A total of 5951 women (mean [SD] age, 78.6 [6.8] years) without known HF were included in this analysis. Women self-identified with the following race and ethnicity categories: 2004 non-Hispanic Black (33.7%), 1022 Hispanic (17.2%), and 2925 non-Hispanic White (49.2%). There were 407 HF cases (257 HFpEF; 110 HFrEF) identified through a mean (SD) of 7.5 (2.6) years (range, 0.01-9.9 years) of follow-up. Fully adjusted hazard ratios (HRs) for overall HF, HFpEF, and HFrEF associated with a 1-SD increment were 0.85 (95% CI, 0.75-0.95), 0.78 (95% CI, 0.67-0.91), and 1.02 (95% CI, 0.81-1.28) for minutes per day total PA; 0.74 (95% CI, 0.63-0.88), 0.71 (95% CI, 0.57-0.88), and 0.83 (95% CI, 0.62-1.12) for steps per day; and 1.17 (95% CI, 1.04-1.33), 1.29 (95% CI, 1.10-1.51), and 0.94 (95% CI, 0.75-1.18) for minutes per day total sedentary. Cubic spline curves for overall HF and HFpEF were significant inverse for total PA and steps per day and positive for total sedentary. Light PA and MVPA were inversely associated with overall HF (HR per 1 SD: 0.88; 95% CI, 0.78-0.98 and 0.84; 95% CI, 0.73-0.97) and HFpEF (0.80; 95% CI, 0.70-0.93 and 0.85; 95% CI, 0.72-1.01) but not HFrEF. Associations did not meaningfully differ when stratified by age, race and ethnicity, body mass index, physical function, or comorbidity score. Results for sedentary bout duration were inconsistent. Conclusions and Relevance Higher accelerometer-measured PA (MVPA, light PA, steps per day) was associated with lower risk (and greater total sedentary time with higher risk) of overall HF and HFpEF in a racially and ethnically diverse cohort of older women. Increasing PA and reducing sedentary time for primary HFpEF prevention may have relevant implications for cardiovascular resilience and healthy aging in later life.
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Affiliation(s)
| | | | | | | | - Chongzhi Di
- Fred Hutchinson Cancer Center, Seattle, Washington
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Beydoun HA, Beydoun MA, Kwon E, Alemu BT, Zonderman AB, Brunner R. Relationship of psychotropic medication use with physical function among postmenopausal women. GeroScience 2024:10.1007/s11357-024-01141-z. [PMID: 38517642 DOI: 10.1007/s11357-024-01141-z] [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: 01/03/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024] Open
Abstract
To examine cross-sectional and longitudinal relationships of psychotropic medications with physical function after menopause. Analyses involved 4557 Women's Health Initiative Long Life Study (WHI-LLS) participants (mean age at WHI enrollment (1993-1998): 62.8 years). Antidepressant, anxiolytic, and sedative/hypnotic medications were evaluated at WHI enrollment and 3-year follow-up visits. Performance-based physical function [Short Physical Performance Battery (SPPB)] was assessed at the 2012-2013 WHI-LLS visit. Self-reported physical function [RAND-36] was examined at WHI enrollment and the last available follow-up visit-an average of 22 [±2.8] (range: 12-27) years post-enrollment. Multivariable regression models controlled for socio-demographic, lifestyle, and health characteristics. Anxiolytics were not related to physical function. At WHI enrollment, antidepressant use was cross-sectionally related to worse self-reported physical function defined as a continuous (β = -6.27, 95% confidence interval [CI]: -8.48, -4.07) or as a categorical (< 78 vs. ≥ 78) (odds ratio [OR] = 2.10, 95% CI: 1.48, 2.98) outcome. Antidepressant use at WHI enrollment was also associated with worse performance-based physical function (SPPB) [< 10 vs. ≥ 10] (OR = 1.53, 95% CI: 1.05, 2.21) at the 2012-2013 WHI-LLS visit. Compared to non-users, those using sedative/hypnotics at WHI enrollment but not at the 3-year follow-up visit reported a faster decline in physical function between WHI enrollment and follow-up visits. Among postmenopausal women, antidepressant use was cross-sectionally related to worse self-reported physical function, and with worse performance-based physical function after > 20 years of follow-up. Complex relationships found for hypnotic/sedatives were unexpected and necessitate further investigation.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, A.T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA, 22060, USA.
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA.
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Edward Kwon
- Department of Family Medicine, A.T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA, 22060, USA
| | - Brook T Alemu
- Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, NC, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Robert Brunner
- Department of Family and Community Medicine (Emeritus), School of Medicine, University of Nevada Reno, Reno, NV, USA
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Nguyen S, Bellettiere J, Anuskiewicz B, Di C, Carlson J, Natarajan L, LaMonte MJ, LaCroix AZ. Prospective Associations of Accelerometer-Measured Machine-Learned Sedentary Behavior With Death Among Older Women: The OPACH Study. J Am Heart Assoc 2024; 13:e031156. [PMID: 38410939 PMCID: PMC10944026 DOI: 10.1161/jaha.123.031156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/14/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Sedentary behavior is a recognized mortality risk factor. The novel and validated convolutional neural network hip accelerometer posture algorithm highly accurately classifies sitting and postural changes compared with accelerometer count cut points. We examined the prospective associations of convolutional neural network hip accelerometer posture-classified total sitting time and mean sitting bout duration with all-cause and cardiovascular disease (CVD) death. METHODS AND RESULTS Women (n=5856; mean±SD age, 79±7 years; 33% Black women, 17% Hispanic or Latina women, 50% White women) in the Women's Health Initiative Objective Physical Activity and Cardiovascular Health (OPACH) Study wore the ActiGraph GT3X+ for ~7 days from May 2012 to April 2014 and were followed through February 19, 2022 for all-cause and CVD death. The convolutional neural network hip accelerometer posture algorithm classified total sitting time and mean sitting bout duration from GT3X+ output. Over follow-up (median, 8.4 years; range, 0.1-9.9), there were 1733 deaths (632 from CVD). Adjusted Cox regression hazard ratios (HRs) comparing women in the highest total sitting time quartile (>696 min/d) to those in the lowest (<556.0 min/d) were 1.57 (95% CI; 1.35-1.83; P-trend<0.001) for all-cause death and 1.78 (95% CI; 1.36-2.31; P-trend<0.001) for CVD death. HRs comparing women in the longest mean sitting bout duration quartile (>15 minutes) to the shortest (<9.3 minutes) were 1.43 (95% CI; 1.23-1.66; P-trend<0.001) for all-cause death and 1.52 (95% CI; 1.18-1.96; P-trend<0.001) for CVD death. Apparent nonlinear associations for total sitting time suggested higher all-cause death (P nonlinear=0.009) and CVD death (P nonlinear=0.008) risk after ~660 to 700 min/d. CONCLUSIONS Higher total sitting time and longer mean sitting bout duration are associated with higher all-cause and CVD mortality risk among older women. These data support interventions aimed at reducing both total sitting time and interrupting prolonged sitting.
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Affiliation(s)
- Steve Nguyen
- Division of EpidemiologyHerbert Wertheim School of Public Health, University of California San DiegoLa JollaCAUSA
| | - John Bellettiere
- Division of EpidemiologyHerbert Wertheim School of Public Health, University of California San DiegoLa JollaCAUSA
| | - Blake Anuskiewicz
- Division of EpidemiologyHerbert Wertheim School of Public Health, University of California San DiegoLa JollaCAUSA
| | - Chongzhi Di
- Division of Public Health SciencesFred Hutchinson Cancer CenterSeattleWAUSA
| | - Jordan Carlson
- Center for Children’s Healthy Lifestyles and Nutrition, Children’s Mercy Kansas CityKansas CityMOUSA
| | - Loki Natarajan
- Division of EpidemiologyHerbert Wertheim School of Public Health, University of California San DiegoLa JollaCAUSA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health ProfessionsUniversity at Buffalo – SUNYBuffaloNYUSA
| | - Andrea Z. LaCroix
- Division of EpidemiologyHerbert Wertheim School of Public Health, University of California San DiegoLa JollaCAUSA
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Chavan PP, Weitlauf JC, LaMonte MJ, Sisto SA, Tomita M, Gallagher-Thompson D, Shadyab AH, Bidwell JT, Manson JE, Kroenke CH, Hayden KM, Hirsch CH, Mouton CP, Cannell MB, Hovey KM, Wactawski-Wende J. Caregiving and all-cause mortality in postmenopausal women: Findings from the Women's Health Initiative. J Am Geriatr Soc 2024; 72:24-36. [PMID: 37936486 PMCID: PMC10841917 DOI: 10.1111/jgs.18620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Caregiving is commonly undertaken by older women. Research is mixed, however, about the impact of prolonged caregiving on their health, well-being, and mortality risk. Using a prospective study design, we examined the association of caregiving with mortality in a cohort of older women. METHODS Participants were 158,987 postmenopausal women aged 50-79 years at enrollment into the Women's Health Initiative (WHI) who provided information on current caregiving status and caregiving frequency at baseline (1993-1998) and follow-up (2004-2005). Mortality was ascertained from baseline through March of 2019. Cox regression with caregiving status defined as a time-varying exposure was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality, adjusting for sociodemographic factors, smoking, and history of diabetes, hypertension, cardiovascular disease (CVD), and cancer. Stratified analyses explored whether age, race-ethnicity, depressive symptoms, frequency of caregiving, optimism, and living status modified the association between caregiver status and mortality. RESULTS At baseline, 40.7% of women (mean age 63.3 years) self-identified as caregivers. During a mean 17.5-year follow-up, all-cause mortality (50,526 deaths) was 9% lower (multivariable-adjusted HR = 0.91, 95% CI: 0.89-0.93) in caregivers compared to non-caregivers. The inverse association between caregiving and all-cause mortality did not differ according to caregiving frequency or when stratified by age, race-ethnicity, depressive symptoms, optimism, or living status (interaction p > 0.05, all). Caregiving was inversely associated with CVD and cancer mortality. CONCLUSION Among postmenopausal women residing across the United States, caregiving was associated with lower mortality. Studies detailing the type and amount of caregiving are needed to further determine its impact on older women.
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Affiliation(s)
- Prachi P. Chavan
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
- Master of Public Health Program, School of Health Professions, Eastern Virginia Medical School, Norfolk, VA
| | - Julie C. Weitlauf
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
| | - Sue Ann Sisto
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo-SUNY, NY
| | - Machiko Tomita
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo-SUNY, NY
| | | | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human, University of California San Diego, Longevity Science, La Jolla, CA
| | - Julie T. Bidwell
- Betty Irene Moore School of Nursing, Family Caregiving Institute, University of California Davis, Sacramento, CA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, MA
| | | | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Calvin H. Hirsch
- Division of General Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Charles P. Mouton
- Office of Provost, University of Texas Medical Branch, Galveston, TX
| | - Michael Brad Cannell
- Department of Epidemiology, Human Genetics, and Environmental Science, School of Public Health, University of Texas Health Science Center, Dallas, TX
| | - Kathleen M Hovey
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, NY
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Peila R, Xue X, Shadyab AH, Wactawski-Wende J, Espeland MA, Snetselaar LG, Saquib N, Ikramuddin F, Manson JE, Wallace RB, Rohan TE. Association Between the Healthy Lifestyle Index and Risk of Multimorbidity in the Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2023; 78:2282-2293. [PMID: 37463321 DOI: 10.1093/gerona/glad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Multimorbidity, defined as the presence of 2 or more chronic health conditions, is increasingly common among older adults. The combination of lifestyle characteristics such as diet quality, smoking status, alcohol intake, physical activity (PA), sleep duration, and body fat as assessed by body mass index (BMI) or waist circumference, and risk of multimorbidity are not well understood. OBJECTIVES We investigated the association between the healthy lifestyle index (HLI), generated by combining indicators of diet quality, smoking, alcohol, PA, sleep amount, and BMI, and risk of multimorbidity, a composite outcome that included cardiovascular disease (CVD), diabetes, cancer, and fracture. METHODS We studied 62 037 postmenopausal women aged 50-79 years at enrollment in the Women's Health Initiative, with no reported history of CVD, diabetes, cancer, or fracture at baseline. Lifestyle characteristics measured at baseline were categorized and a score (0-4) was assigned to each category. The combined HLI (0-24) was grouped into quintiles, with higher quintiles indicating a healthier lifestyle. Multivariable adjusted estimates of hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the risk of developing multimorbidity were obtained using Cox proportional hazard models. RESULTS Over an average follow-up period of 16.3 years, 5 656 women developed multimorbidity. There was an inverse association between the HLI levels and risk of multimorbidity (compared to the HLI_1st quintile: HR_2nd quintile = 0.81 95% CI 0.74-0.83, HR_3rd quintile = 0.77 95% CI 0.71-0.83, HR_4th quintile = 0.70 95% CI 0.64-0.76, and HR_5th quintile = 0.60 95% CI 0.54-0.66; p trend < .001). Similar associations were observed after stratification by age or BMI categories. CONCLUSIONS Among postmenopausal women, higher levels of the HLI were associated with a reduced risk of developing multimorbidity.
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Affiliation(s)
- Rita Peila
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Mark A Espeland
- Department of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Linda G Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Nazmus Saquib
- College of Medicine at Sulaiman, Al Rajhi University, Al Bukayriyah, Saudi Arabia
| | - Farha Ikramuddin
- Department of Rehabilitation Medicine, University of Minnesota, Medical School, Minneapolis, Minnesota, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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Fisher SR, Halder GE, Lee MJ, Allen L, Kilic GS. Cumulative Effects of Comorbid Burden and Overactive Bladder Symptoms on Fall Risk Among Older Women Seeking Treatment for Urogynecologic Conditions. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:763-769. [PMID: 36946883 DOI: 10.1097/spv.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
IMPORTANCE Overactive bladder (OAB) syndrome and urinary incontinence, age, and comorbid burden are strong risk factors for falls in women. Less is known about their cumulative effects on fall risk in a urogynecologic population. OBJECTIVE The purpose of this study was to investigate the effects of coexisting OAB, older age, and comorbidities on risk of falling among treatment seeking women with pelvic floor disorders. STUDY DESIGN We conducted a retrospective medical records review of 348 consecutive women presenting to a urogynecology clinic over 6 months. Fall risk was determined by the Centers for Disease Control and Prevention's, Stopping Elderly Accidents, Deaths, and Injuries screening tool. Clinical and sociodemographic measures were abstracted from the electronic medical record. Odds of screening positive for high fall risk based on different patient profiles were calculated. We then used a classification and regression tree analysis to determine the relative importance of the different variables on fall risk within the homogeneous subgroups. RESULTS Of the 348 women (mean age, 58.7 ± 15.8 years) who completed the fall risk screen, 124 (36%) screened positive for increased fall risk. Overactive bladder symptoms increased the likelihood of a positive fall risk screen across all combinations of age and comorbid burden. The patient profile of ≥3 OAB symptoms, ≥4 comorbid conditions, and age 65 years or older increased the odds of screening positive for high fall risk more than 6-fold (odds ratio, 6.4; 95% confidence interval, 3.1-12.9). In the following order of importance, the combination of high comorbid burden, OAB, and older age identified approximately 3 in 4 patients (73.3%) at high risk of falling. CONCLUSION The presence of 3 easily identifiable patient characteristics is strongly associated with a risk of falls in women seeking care for pelvic floor disorders.
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Affiliation(s)
- Steve R Fisher
- From the Department of Physical Therapy, School of Health Professions
| | - Gabriela E Halder
- Female Pelvic Medicine and Reconstructive Surgery, Urogynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Mi Jung Lee
- From the Department of Physical Therapy, School of Health Professions
| | - Lindsay Allen
- From the Department of Physical Therapy, School of Health Professions
| | - Gokhan S Kilic
- Female Pelvic Medicine and Reconstructive Surgery, Urogynecology, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX
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Zalah MA, Alsobayel HI, Algarni FS, Vennu V, Ajeebi ZH, Maeshi HM, Bindawas SM. The Severity of Pain and Comorbidities Significantly Impact the Dependency on Activities of Daily Living among Musculoskeletal Patients in Jizan, Saudi Arabia. Healthcare (Basel) 2023; 11:2313. [PMID: 37628510 PMCID: PMC10454086 DOI: 10.3390/healthcare11162313] [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: 06/22/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Limited research has been carried out on the effects of pain, comorbidity, and impaired function in musculoskeletal patients in Jizan, Saudi Arabia. A cross-sectional study was conducted on 115 patients (aged ≥ 55 years) with physician-diagnosed musculoskeletal conditions in Jizan to investigate the association between pain severity, comorbidities, and dependence on activities of daily living (ADLs). Self-reported questionnaires were used to collect data on pain, comorbidities, and physical function measured by ADLs. In ADLs, participants were categorized as dependent (n = 36) or independent (n = 79). Logistic regression analysis was employed to determine the predictors of dependence. The results showed that higher pain severity (adjusted odds ratio (OR): 1.69, 95% confidence interval (CI): 1.21-2.38, p = 0.002) and a greater number of comorbidities (adjusted OR: 1.52, 95% CI: 1.06-2.17, p = 0.021) were independently associated with dependence in ADLs. These associations remained significant even after controlling for covariates. This study concluded that patients with musculoskeletal conditions in Jizan who experience high levels of pain and comorbidities are at risk of dependence on basic daily activities. Therefore, addressing pain and comorbidities is crucial for maintaining independence and improving quality of life. Personalized rehabilitation programs are needed to manage these conditions in this region.
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Affiliation(s)
- Mohammed A. Zalah
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
- Medical Rehabilitation Center, King Fahad Central Hospital, Jazan 82666, Saudi Arabia
| | - Hana I. Alsobayel
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Fahad S. Algarni
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Zohoor H. Ajeebi
- Department of Physical Therapy, Ahad Al Mosaraha Hospital, Jazan 86289, Saudi Arabia
| | - Hatem M. Maeshi
- Medical Rehabilitation Center, King Fahad Central Hospital, Jazan 82666, Saudi Arabia
| | - Saad M. Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
- King Salman Center for Disability Research, Riyadh 11614, Saudi Arabia
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Posis AIB, Bellettiere J, Salem RM, LaMonte MJ, Manson JE, Casanova R, LaCroix AZ, Shadyab AH. Associations of Accelerometer-Measured Physical Activity and Sedentary Time With All-Cause Mortality by Genetic Predisposition for Longevity. J Aging Phys Act 2023; 31:265-275. [PMID: 36002033 PMCID: PMC9950283 DOI: 10.1123/japa.2022-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022]
Abstract
The goal of this study was to examine associations between accelerometer-measured physical activity (PA) and sedentary time (ST) with mortality by a genetic risk score (GRS) for longevity. Among 5,446 women, (mean [SD]: age, 78.2 [6.6] years), 1,022 deaths were observed during 33,350 person-years of follow-up. Using multivariable Cox proportional hazards models, higher light PA and moderate to vigorous PA were associated with lower mortality across all GRS for longevity categories (low/medium/high; all ptrend < .001). Higher ST was associated with higher mortality (ptrend across all GRS categories < .001). Interaction tests for PA and ST with the GRS were not statistically significant. Findings support the importance of higher PA and lower ST for reducing mortality risk in older women, regardless of genetic predisposition for longevity.
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Affiliation(s)
- Alexander Ivan B. Posis
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Rany M. Salem
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - JoAnn E. Manson
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, MA, USA
| | - Ramon Casanova
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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10
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Sharma SK, Nambiar D, Ghosh A. Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India. BMJ Open 2023; 13:e067994. [PMID: 36972971 PMCID: PMC10069553 DOI: 10.1136/bmjopen-2022-067994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Older male and female adults differ in key characteristics such as disease-specific life expectancy, health behaviours and clinical presentations and non-communicable disease multimorbidity (NCD-MM). Therefore, examining the sex differences in NCD-MM among older adults is vital, as this issue is understudied in low-income and middle-income country (LMIC) contexts such as India, and has been growing in the past few decades. DESIGN Large scale nationally representative cross-sectional study. SETTINGS AND PARTICIPANTS Longitudinal Ageing Study in India (LASI 2017-2018) had data on 27 343 men and 31 730 women aged 45+, drawn from a sample of 59 073 individuals across India. PRIMARY AND SECONDARY OUTCOMES MEASURES We operationalised NCD-MM based on prevalence of the presence of two or more long-term chronic NCD morbidities. Descriptive statistics and bivariate analysis along with multivariate statistics were used. RESULTS Women aged 75+ had a higher prevalence of multimorbidity as compared with men (52.1% vs 45.17%). NCD-MM was more common among widows (48.5%) than widowers (44.8%). The female-to-male ratios of ORs (RORs) for NCD-MM associated with overweight/obesity and prior history of chewing tobacco were 1.10 (95% CI: 1.01 to 1.20) and 1.42 (95% CI: 1.12 to 1.80), respectively. The female-to-male RORs show that the odds of NCD-MM were greater in formerly working women (1.24 (95% CI: 1.06 to 1.44)) relative to formerly working men. The effect of increasing NCD-MM on limitations in activities of daily living and instrumental ADL was greater in men than women but reversed for the hospitalisation. CONCLUSIONS We found significant sex differences in NCD-MM prevalence among older Indian adults, with various associated risk factors. The patterns underlying these differences warrant greater study, given existing evidence on differential longevity, health burdens and health-seeking patterns all of which operate in a larger structural context of patriarchy. Health systems in turn must respond to NCD-MM mindful of these patterns and aim to redress some of the larger inequities they reflect.
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Affiliation(s)
| | - Devaki Nambiar
- The George Institute for Global Health India, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Arpita Ghosh
- The George Institute for Global Health India, New Delhi, India
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11
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Seguin-Fowler RA, LaCroix AZ, LaMonte MJ, Liu J, Maddock JE, Rethorst CD, Bird CE, Stefanick ML, Manson JE. Association of Neighborhood Walk Score with Accelerometer-Measured Physical Activity Varies by Neighborhood Socioeconomic Status in Older Women. Prev Med Rep 2022; 29:101931. [PMID: 36161128 PMCID: PMC9502671 DOI: 10.1016/j.pmedr.2022.101931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 10/27/2022] Open
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12
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Jain P, Binder AM, Chen B, Parada H, Gallo LC, Alcaraz J, Horvath S, Bhatti P, Whitsel EA, Jordahl K, Baccarelli AA, Hou L, Stewart JD, Li Y, Justice JN, LaCroix AZ. Analysis of Epigenetic Age Acceleration and Healthy Longevity Among Older US Women. JAMA Netw Open 2022; 5:e2223285. [PMID: 35895062 PMCID: PMC9331104 DOI: 10.1001/jamanetworkopen.2022.23285] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Accelerated biological aging is associated with decreased physical capability and cognitive functioning, which are associated with increased risk of morbidity and mortality. OBJECTIVE We investigated associations between epigenetic age acceleration (EAA), a biomarker associated with aging, and healthy longevity among older women. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a secondary analysis of participants in the Women's Health Initiative (WHI) who were eligible to survive to age 90 years by September 30, 2020. Participants were located in multiple centers. This study was restricted to women with genome-wide DNA methylation data, generated from baseline blood samples within 3 WHI ancillary studies. Median (IQR) follow-up times from baseline were 21.6 (19.6-22.9) years and 21.4 (19.8-22.7) years for women who survived to age 90 years with and without intact mobility, respectively, and 13.2 (8.8-16.7) for women who did not survive to age 90 years. Data were analyzed from December 2020 to July 2021. EXPOSURES EAA was estimated using 4 established "clocks": Horvath pantissue, Hannum, Pheno, and Grim. MAIN OUTCOMES AND MEASURES Using multinomial logistic regression, odds ratios (ORs) and 95% CIs were estimated for 3 healthy longevity outcomes for each clock: survival to age 90 years with intact mobility, survival to age 90 years without intact mobility, and no survival to age 90 years. RESULTS Among 1813 women, there were 464 women (mean [SD] age at baseline, 71.6 [3.5] years) who survived to age 90 years with intact mobility and cognitive functioning, 420 women (mean [SD] age at baseline, 71.3 [3.2] years) who survived to age 90 years without intact mobility and cognitive functioning, and 929 women (mean [SD] age at baseline, 70.2 [3.4] years) who did not survive to age 90 years. Women who survived to age 90 years with intact mobility and cognitive function were healthier at baseline compared with women who survived without those outcomes or who did not survive to age 90 years (eg, 143 women [30.8%] vs 101 women [24.0%] and 202 women [21.7%] with 0 chronic conditions). The odds of surviving to age 90 years with intact mobility were lower for every 1 SD increase in EAA compared with those who did not survive to age 90 years as measured by AgeAccelHorvath (OR, 0.82; 95% CI, 0.69-0.96; P = .01), AgeAccelHannum (OR, 0.67; 95% CI, 0.56-0.80; P < .001), AgeAccelPheno (OR, 0.60; 95% CI, 0.51-0.72; P < .001), and AgeAccelGrim (OR, 0.68; 95% CI, 0.55-0.84; P < .001). ORs were similar for women who survived to age 90 years with intact mobility and cognitive function (eg, AgeAccelHorvath: OR per 1 SD increase in EAA, 0.83; 95% CI, 0.71-0.98; P = .03) compared with women who did not survive to age 90 years. CONCLUSIONS AND RELEVANCE These findings suggest that EAA may be a valid biomarker associated with healthy longevity among older women and may be used for risk stratification and risk estimation of future functional and cognitive aging. Outcomes suggest that future studies may focus on the potential for public health interventions to counteract EAA and its association with poor health outcomes to lower disease burden while increasing longevity.
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Affiliation(s)
- Purva Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - Alexandra M. Binder
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Brian Chen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Linda C. Gallo
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University
| | - John Alcaraz
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles
- Department of Biostatistics, School of Public Health, University of California, Los Angeles
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Eric A. Whitsel
- Department of Epidemiology, Gillings School of Public Health, Chapel Hill, North Carolina
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Kristina Jordahl
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Andrea A. Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Lifang Hou
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois
| | - James D. Stewart
- Department of Epidemiology, Gillings School of Public Health, Chapel Hill, North Carolina
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Yun Li
- Department of Genetics, University of North Carolina at Chapel Hill
- Department of Biostatistics, University of North Carolina at Chapel Hill
- Department of Computer Science, University of North Carolina at Chapel Hill
| | - Jamie N. Justice
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
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13
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Boursiquot BC, Bellettiere J, LaMonte MJ, LaCroix AZ, Perez MV. Sedentary Behavior and Atrial Fibrillation in Older Women: The OPACH Study. J Am Heart Assoc 2022; 11:e023833. [PMID: 35253465 PMCID: PMC9075327 DOI: 10.1161/jaha.121.023833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/18/2022] [Indexed: 12/18/2022]
Abstract
Background Sedentary behavior is associated with cardiovascular disease, but its association with incident atrial fibrillation is not well studied. Our aim was to measure the association between objectively measured sedentary behavior and incident atrial fibrillation. Methods and Results Sedentary behavior was measured by a triaxial accelerometer worn on a belt for 1 week. Incident atrial fibrillation was ascertained from Medicare claims. The associations between total sedentary time (or patterns of sedentary behavior) and incident atrial fibrillation were assessed using Cox proportional hazards models adjusted for demographic and clinical covariates. Among 2675 participants (mean age, 78.2 years), there were 268 (10.0%) cases of incident atrial fibrillation at a rate of 31 cases per 1000 person-years. Greater total sedentary time was associated with a higher risk of incident atrial fibrillation after adjustment for age, race and ethnicity, body mass index, education, smoking history, hypertension, diabetes, stroke, heart disease, and other chronic conditions (quartile 4 versus quartile 1: hazard ratio, 1.20, [95% CI, 0.81-1.78]; P for trend=0.05). After adjusting for physical function and self-rated health, this was no longer statistically significant. Both longer mean sedentary bout duration and more continuous sedentary periods (versus frequent breaks in sedentary time) were also associated with higher risks of incident atrial fibrillation, but these associations were also attenuated with serial adjustment. Conclusions Total sedentary time and prolonged patterns of sedentary accumulation were associated with a higher risk of atrial fibrillation in this prospective study of community-dwelling older women, but these associations were attenuated by adjustment for physical function and self-reported health. This suggests that associations between sedentary behavior and atrial fibrillation may be attributable to global measures of overall function and health.
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Affiliation(s)
| | - John Bellettiere
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental HealthSchool of Public Health and Health ProfessionsUniversity at Buffalo–SUNYBuffaloNY
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCA
| | - Marco V. Perez
- Division of Cardiovascular MedicineDepartment of MedicineStanford UniversityStanfordCA
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14
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Sands LP, Do Q, Du P, Xu Y, Pruchno R. Long term impact of Hurricane Sandy on hospital admissions of older adults. Soc Sci Med 2022; 293:114659. [PMID: 34954672 PMCID: PMC8810733 DOI: 10.1016/j.socscimed.2021.114659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/05/2021] [Accepted: 12/14/2021] [Indexed: 01/03/2023]
Abstract
RATIONALE In the weeks and months following a disaster, acute illness and injuries requiring hospital admission increase. It is not known whether disaster exposure is associated with increased risk for hospitalization in the years after a disaster. OBJECTIVE We examined the extent to which disaster exposure is associated with hospitalization two years after Hurricane Sandy. The analyses fill a clinical gap in our understanding of long-term physical health consequences of disaster exposure by identifying older adults at greatest risk for hospitalization two years after disaster exposure. METHOD Survey data from a longitudinal panel study collectedbefore and after Hurricane Sandy were linked with Medicare inpatient files in order to assess the impact of Hurricane Sandy on hospital admissions two years following the hurricane. RESULTS We found that people who reported experiencing a lot of fear and distress in the midst of Hurricane Sandy were at an increased risk of being hospitalized two years after the hurricane [Hazard Ratio = 1.75; 95% CI (1.12-2.73)]. Findings held after controlling for pre-disaster demographics, social risks, chronic conditions, hospitalizations during the year before the hurricane, and decline in physical functioning. CONCLUSIONS These findings are the first to show that disaster exposure increases the risk for hospital admissions two years after a disaster. Controlling for known risk factors for hospitalization, older adults who experience high levels of fear and distress during a disaster are more likely to be hospitalized two years following the disaster than older adults who do not have this experience.
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Affiliation(s)
| | - Quyen Do
- Department of Statistics, Virginia Tech, USA
| | - Pang Du
- Department of Statistics, Virginia Tech, USA
| | - Yunnan Xu
- Novartis International AG, East Hanover, NJ, USA
| | - Rachel Pruchno
- New Jersey Institute for Successful Aging, Rowan University, USA
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15
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Liu H, Zhang X, Chen B, Fang B, Lou VWQ, Hu J. The Differential Impact of Multimorbidity Patterns and Subsequent Accumulation on Longitudinal Trajectories of Physical Function Decline in a Population-based Cohort of Older People. J Gerontol A Biol Sci Med Sci 2021; 77:1629-1636. [PMID: 34951651 DOI: 10.1093/gerona/glab384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although both the patterns and accumulation of multimorbidity are important for predicting physical function, studies have not simultaneously examined their impact on functional decline. This study aimed to associate multimorbidity patterns and subsequently developed conditions with longitudinal trajectories of functional decline, and it tested whether the effects of newly developed conditions on functional decline varied across distinct multimorbidity patterns. METHODS We included 6,634 participants aged at least 60 years from the China Health and Retirement Longitudinal Survey. Latent class analysis identified multimorbidity patterns from 14 chronic conditions. Mixed negative binomial models estimated the changes in physical function measured across four waves as a function of multimorbidity patterns, subsequently developed conditions and their interactions. RESULTS Five distinct patterns were identified three years before wave 1: stomach/arthritis (15.7%), cardiometabolic (6.7%), arthritis/hypertension (47.9%), hepatorenal/multi-system (18.3%), and lung/asthma (11.4%). The hepatorenal/multi-system and the lung/asthma pattern were associated with worse baseline physical function, and the hypertension/arthritis pattern was associated with greater decline of physical function. The effect of developing new conditions on decline of physical function over time was most evident for individuals from the cardiometabolic pattern. DISCUSSION Considering both the combinations and progressive nature of multimorbidity is important for identifying individuals at greater risk of disability. Future studies are warranted to differentiate the factors responsible for the progression of chronic conditions in distinct multimorbidity patterns and investigate the potential implications for improved prediction of functional decline.
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Affiliation(s)
- Huiying Liu
- Department of Sociology, Central South University, Changsha, Hunan province, China.,Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China
| | - Xinyan Zhang
- Department of Sociology, Central South University, Changsha, Hunan province, China
| | - Beizhuo Chen
- Department of Sociology, Central South University, Changsha, Hunan province, China
| | - Boye Fang
- Sun Yat-Sen University, School of Sociology & Anthropology, Guangzhou, Guangdong province, CN
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China.,Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Jian Hu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan province, China
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16
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Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study. J Aging Phys Act 2021; 30:635-645. [PMID: 34627127 DOI: 10.1123/japa.2021-0159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/26/2021] [Accepted: 09/04/2021] [Indexed: 11/18/2022]
Abstract
Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63-97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.
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17
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Zhou Y, Zhu XP, Shi JJ, Yuan GZ, Yao ZA, Chu YG, Shi S, Jia QL, Chen T, Hu YH. Coronary Heart Disease and Depression or Anxiety: A Bibliometric Analysis. Front Psychol 2021; 12:669000. [PMID: 34149564 PMCID: PMC8211422 DOI: 10.3389/fpsyg.2021.669000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022] Open
Abstract
This study aimed to conduct a bibliometric analysis of published studies on the association between coronary heart disease (CHD) and depression or anxiety. The study also aimed to identify leading authors, institutions, and countries to determine research hotspots and obtain some hints from the speculated future frontiers. Publications about CHD and depression or anxiety between 2004 and 2020 were collected from the Web of Science Core Collection (WOSCC) database. Bibliographic information, such as authorship, country, citation frequency, and interactive visualization, was generated using VOSviewer1.6.16 and CiteSpace5.6.R5. In total, 8,073 articles were identified in the WOSCC database. The United States (2,953 publications), Duke University and Harvard University (214 publications), Psychosomatic Medicine (297 publications), and Denollet Johan. (99 publications) were the most productive country, institutions, journal, and author, respectively. The three hotspots of the research were “The relationship between depression and CHD,” “depression and myocardial infarction,” and “The characteristic of women suffering depression after MI.” The four future research frontiers are predicted to be “treating depression in CHD patients with multimorbidity,” “psychometric properties of instruments for assessing depression and anxiety in CHD patients,” “depression or anxiety in post-PCI patients,” and “other mental diseases in CHD patients.” Bibliometric analysis of the association between CHD and depressive disorders might identify new directions for future research.
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Affiliation(s)
- Yan Zhou
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China.,Clinical Medical School, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-Ping Zhu
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Jing-Jing Shi
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Guo-Zhen Yuan
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Zi-Ang Yao
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Yu-Guang Chu
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Shuai Shi
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Qiu-Lei Jia
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Ting Chen
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Yuan-Hui Hu
- Department of Cardiology, Guanganmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
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18
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Rosenberg DE, Rillamas-Sun E, Bellettiere J, LaMonte M, Buchner DM, Di C, Hunt J, Marshall S, Stefanick M, Zhang Y, LaCroix AZ. Accelerometer-Measured Sedentary Patterns are Associated with Incident Falls in Older Women. J Am Geriatr Soc 2021; 69:718-725. [PMID: 33252141 PMCID: PMC8020891 DOI: 10.1111/jgs.16923] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/25/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE Falls cause significant problems for older adults. Sedentary time is associated with lower physical function and could increase the risk for falls. DESIGN Prospective study. SETTING Sites across the United States. PARTICIPANTS Older women (N = 5,545, mean age 79 years) from the Women's Health Initiative Objective Physical Activity and Cardiovascular Health study. MEASUREMENTS Accelerometers worn at the hip for up to 1 week collected measures of daily sedentary time and the mean sedentary bout duration, a commonly used metric for sedentary accumulation patterns. For up to 13 months after accelerometer wear, women reported daily whether they had fallen on monthly calendars. RESULTS In fully adjusted models, the incident rate ratios (95% confidence interval) for quartiles 1 (lowest), 2, 3, and 4 of sedentary time respectively were 1.0 (ref.), 1.07 (0.93-1.24), 1.07 (0.91-1.25), and 1.14 (0.96-1.35; P-trend = .65) and for mean sedentary bout duration was 1.0 (ref.), 1.05 (0.92-1.21), 1.02 (0.88-1.17), and 1.17 (1.01-1.37; P-trend = .01), respectively. Women with a history of two or more falls had stronger associations between sedentary time and falls incidence compared with women with a history of no or one fall (P for interaction = .046). CONCLUSIONS Older women in the highest quartile of mean sedentary bout duration had a significantly increased risk of falling. Women with a history of frequent falling may be at higher risk for falling if they have high sedentary time. Interventions testing whether shortening total sedentary time and/or sedentary bouts lowers fall risk are needed to confirm these observational findings.
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Affiliation(s)
- Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | | | - John Bellettiere
- Family Medicine and Public Health, University of California, San Diego, California, USA
| | - Michael LaMonte
- Department of Epidemiology and Environmental health, State University of New York, Buffalo, New York, USA
| | - David M Buchner
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Chongzhi Di
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Julie Hunt
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Stephen Marshall
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marcia Stefanick
- Medicine - Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Yuzheng Zhang
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrea Z LaCroix
- Family Medicine and Public Health, University of California, San Diego, California, USA
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19
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Lange-Maia BS, Karvonen-Gutierrez CA, Kazlauskaite R, Strotmeyer ES, Karavolos K, Appelhans BM, Janssen I, Avery EF, Dugan SA, Kravitz HM. Impact of Chronic Medical Condition Development on Longitudinal Physical Function from Mid- to Early Late-Life: The Study of Women's Health Across the Nation. J Gerontol A Biol Sci Med Sci 2021; 75:1411-1417. [PMID: 31732730 DOI: 10.1093/gerona/glz243] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic medical conditions (CMCs) often emerge and accumulate during the transition from mid- to late-life, and the resulting multimorbidity can greatly impact physical function. We assessed the association of CMC presence and incidence on trajectories of physical function from mid- to early late-life in the Study of Women's Health Across the Nation. METHODS Physical function was assessed at eight clinic visits (average 14 years follow-up) using the physical function subscale of the Short Form-36. CMCs included osteoarthritis, diabetes, stroke, hypertension, heart disease, cancer, osteoporosis, and depressive symptomatology, and were considered cumulatively. Repeated-measures Poisson models estimated longitudinal change (expressed as percent difference) in physical function by chronic CMCs. Change-points assessed physical function change coincident with the development of a new condition. RESULTS Women (N = 2,283) followed from age 50.0 ± 2.7 to 64.0 ± 3.7 years; 7.3% had zero CMCs through follow-up, 22.5% (N = 513) had no baseline CMCs but developed ≥1, 22.7% women had ≥1 baseline CMC but never developed another, and 47.6% had ≥1 baseline CMC and developed ≥1 more. Each additional baseline CMC was associated with 4.0% worse baseline physical function and annual decline of 0.20%/year. Women with more baseline CMCs had greater decline in physical function with a new CMC (-1.90% per condition); and annual decline when developing a new condition accelerated by -0.33%/year per condition. CONCLUSIONS Self-reported physical function changes are evident from mid- to early late-life with the development of CMCs. Preventing or delaying CMCs may delay declines in physical function, and these potential pathways to disability warrant further research.
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Affiliation(s)
- Brittney S Lange-Maia
- Department of Preventive Medicine, Chicago, Illinois.,Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | | | - Rasa Kazlauskaite
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh
| | | | | | - Imke Janssen
- Department of Preventive Medicine, Chicago, Illinois
| | - Elizabeth F Avery
- Department of Preventive Medicine, Chicago, Illinois.,Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | - Sheila A Dugan
- Department of Physical Medicine and Rehabilitation, Chicago, Illinois
| | - Howard M Kravitz
- Department of Preventive Medicine, Chicago, Illinois.,Department of Psychiatry, Rush University Medical Center, Chicago, Illinois
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Sousa RCRD, Araújo GKND, Souto RQ, Santos RCD, Santos RDC, Almeida LRD. Factors associated with the risk of violence against older adult women: a cross-sectional study. Rev Lat Am Enfermagem 2021; 29:e3394. [PMID: 33439947 PMCID: PMC7798391 DOI: 10.1590/1518-8345.4039.3394] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/15/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: to identify the factors associated with the risk of violence against older adult women. Method: this is a quantitative, analytical, and cross-sectional research conducted with 122 older adult females in the city of Recife, state of Pernambuco, Brazil. Data collection was carried out using validated instruments adapted to Brazil. The analysis was performed using descriptive statistics (absolute and relative frequency) and inferential statistics (Pearson’s chi- square, Spearman’s correlation test, and Multiple Logistic Regression). Results: there was prevalence of a risk of abuse against older adult women under 70 years of age, literate, without a stable relationship, living alone, without any work activity, and who had an income higher than the minimum wage. There is a significant association between the risk of violence among older women with a higher number of chronic health conditions (24; 77.4%), and who are less active in advanced activities (42; 70.0%). A reduction in quality of life and satisfaction with life, and the onset of depressive symptoms, increase the risk of violence. Conclusion: multimorbidity, low functional capacity, depressive symptoms, low quality of life and low satisfaction with life, a high number of chronic conditions, depressive symptoms, and functional dependence to perform daily activities can be conditioning factors for the emergence of abuse against older adults.
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Affiliation(s)
| | | | - Rafaella Queiroga Souto
- Universidade Federal da Paraíba, Departamento de Enfermagem em Saúde Coletiva, João Pessoa, PB, Brazil
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Neuhouser ML, Hunt RP, Van Horn L, Shikany JM, Stefanick ML, Johnson KC, Brunner R, Cannell B, Hatsu IE, Tinker LF. Barriers to eating are associated with poor physical function in older women. Prev Med 2020; 139:106234. [PMID: 32795644 PMCID: PMC7494579 DOI: 10.1016/j.ypmed.2020.106234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/20/2020] [Accepted: 08/06/2020] [Indexed: 01/06/2023]
Abstract
Older adults have physical and social barriers to eating but whether this affects functional status is unknown. We examined associations between eating barriers and physical function in the Women's Health Initiative (WHI). In 2012-14, a subset of alive and participating women (n = 5910) completed an in-home examination including the Short Physical Performance Battery (SPPB) (grip strength, balance, timed walking speed, chair stand). WHI participants complete annual mailed questionnaires; the 2013-14 questionnaire included items on eating alone, eating < two meals/day, dentition problems affecting eating, physical difficulties with cooking/shopping and monetary resources for food. Linear regression tested associations of these eating barriers with SPPB, adjusting for BMI, age, race/ethnicity, and medical multimorbidities. Over half (56.8%) of participants were ≥ 75 years, 98.8% had a BMI ≥ 25.0 kg/m2 and 66% had multimorbidities. Eating barriers, excluding eating alone, were associated with significantly lower total (all p < .001) and component-specific, multivariate-adjusted SPPB scores (all p < .05). Compared to no barriers, eating < two meals/day (7.83 vs. 8.38, p < .0002), dentition problems (7.69 vs. 8.38, p < .0001), inability to shop/prepare meals (7.74 vs. 8.38, p < .0001) and insufficient resources (7.84 vs. 8.37 p < .001) were significantly associated with multivariate-adjusted mean SPPB score < 8. Models additionally adjusting for Healthy Eating Index-2010 had little influence on scores. As barriers increased, scores declined further for grip strength (16.10 kg for 4-5 barriers, p = .001), timed walk (0.58 m/s for 4-5 barriers, p = .001) and total SPPB (7.27 for 4-5 barriers, p < .0001). In conclusion, in this WHI subset, eating barriers were associated with poor SPPB scores.
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Affiliation(s)
- Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4B402, Seattle, WA 98109-1024, USA.
| | - Rebecca P Hunt
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4B402, Seattle, WA 98109-1024, USA.
| | - Linda Van Horn
- Departrment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive #1400, Chicago, IL 60611, USA.
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave. S., MT 619, Birmingham, AL 35294-4410, USA.
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Rd, Room X308, Stanford, CA 94305, USA.
| | - Karen C Johnson
- University of Tennessee Health Science Center, Department of Preventive Medicine, 66 N Pauline, suite 633, Memphis, TN 38163, USA.
| | - Robert Brunner
- School of Medicine, University of Nevada, Reno, 1664 N Virginia St, Reno, NV 89557, USA.
| | - Brad Cannell
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, Dallas Campus, University of Texas Health Science Center, 6011 Harry Hines Blvd, Suite V8, Dallas, TX 75390, USA.
| | - Irene E Hatsu
- Human Nutrition, 341 Campbell Hall, 1787 Neil Ave, The Ohio State University, Columbus, OH, 43210, USA.
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M4B402, Seattle, WA 98109-1024, USA.
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22
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Full KM, Malhotra A, Gallo LC, Kerr J, Arredondo EM, Natarajan L, LaMonte MJ, Stefanick ML, Stone KL, LaCroix AZ. Accelerometer-Measured Sleep Duration and Clinical Cardiovascular Risk Factor Scores in Older Women. J Gerontol A Biol Sci Med Sci 2020; 75:1771-1778. [PMID: 31504216 PMCID: PMC7494034 DOI: 10.1093/gerona/glz201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evidence suggests that short and long sleep durations are potential lifestyle factors associated with cardiovascular disease (CVD). Research on sleep duration and CVD risk is limited by use of self-report sleep measures, homogeneous populations, and studies on individual CVD risk factors. For women, risk of CVD and inadequate sleep duration increases with age. We hypothesized that accelerometer-measured sleep duration was associated with 10-year predicted probability of future CVD risk in a cohort of aging women. METHODS This cross-sectional analysis included 3,367 older women (mean age 78.9 years; 53.3% White), from the Objective Physical Activity and Cardiovascular Health Study, ancillary study to the Women's Health Initiative. Women wore ActiGraph GT3X+ accelerometers on the hip for 24 hours/7 days. A 10-year predicted probability of future CVD risk, the Reynolds Risk Score (RRS), was computed using age, systolic blood pressure, high-sensitivity C-reactive protein (CRP), total and HDL cholesterol, diabetes mellitus status, smoking status, and family history of CVD. Average nightly sleep duration was derived from accelerometer data. Adjusted linear regression models investigated the association between sleep duration and RRS. RESULTS Results suggested a U-shaped relationship between sleep duration and RRS, with both short and long sleep associated with higher RRS (p < .001). The association remained significant after adjustments for race/ethnicity, education, lifestyle factors, and health status indicators. CONCLUSION In older women, actigraphy-ascertained sleep duration was associated with a 10-year predicted probability of future CVD risk. This study supports sleep duration as a modifiable risk factor for CVD in older women.
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Affiliation(s)
- Kelsie M Full
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Atul Malhotra
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla
| | - Linda C Gallo
- Department of Psychology, San Diego State University, California
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Elva M Arredondo
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, California
| | - Loki Natarajan
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, New York
| | | | - Katie L Stone
- California Pacific Medical Center Research Institute, University of California San Francisco
| | - Andrea Z LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
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Reuter C, Bellettiere J, Liles S, Di C, Sears DD, LaMonte MJ, Stefanick ML, LaCroix AZ, Natarajan L. Diurnal patterns of sedentary behavior and changes in physical function over time among older women: a prospective cohort study. Int J Behav Nutr Phys Act 2020; 17:88. [PMID: 32646435 PMCID: PMC7346671 DOI: 10.1186/s12966-020-00992-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/29/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Sedentary behavior (SB) is linked to negative health outcomes in older adults. Most studies use summary values, e.g., total sedentary minutes/day. Diurnal timing of SB accumulation may further elucidate SB-health associations. METHODS Six thousand two hundred four US women (mean age = 79 ± 7; 50% White, 34% African-American) wore accelerometers for 7-days at baseline, yielding 41,356 person-days with > 600 min/day of data. Annual follow-up assessments of health, including physical functioning, were collected from participants for 6 years. A novel two-phase clustering procedure discriminated participants' diurnal SB patterns: phase I grouped day-level SB trajectories using longitudinal k-means; phase II determined diurnal SB patterns based on proportion of phase I trajectories using hierarchical clustering. Mixed models tested associations between SB patterns and longitudinal physical functioning, adjusted for covariates including total sedentary time. Effect modification by moderate-vigorous-physical activity (MVPA) was tested. RESULTS Four diurnal SB patterns were identified: p1 = high-SB-throughout-the-day; p2 = moderate-SB-with-lower-morning-SB; p3 = moderate-SB-with-higher-morning-SB; p4 = low-SB-throughout-the-day. High MVPA mitigated physical functioning decline and correlated with better baseline and 6-year trajectory of physical functioning across patterns. In low MVPA, p2 had worse 6-year physical functioning decline compared to p1 and p4. In high MVPA, p2 had similar 6-year physical functioning decline compared to p1, p3, and p4. CONCLUSIONS In a large cohort of older women, diurnal SB patterns were associated with rates of physical functioning decline, independent of total sedentary time. In particular, we identified a specific diurnal SB subtype defined by less SB earlier and more SB later in the day, which had the steepest decline in physical functioning among participants with low baseline MVPA. Thus, diurnal timing of SB, complementary to total sedentary time and MVPA, may offer additional insights into associations between SB and physical health, and provide physicians with early warning of patients at high-risk of physical function decline.
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Affiliation(s)
- Chase Reuter
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California 92093 USA
| | - John Bellettiere
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California 92093 USA
- Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University, San Diego, CA 92123 USA
| | - Sandy Liles
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California 92093 USA
- Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University, San Diego, CA 92123 USA
| | - Chongzhi Di
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109 USA
| | - Dorothy D. Sears
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California 92093 USA
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004 USA
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr, La Jolla, CA 92037 USA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo–SUNY, New York, NY 14214 USA
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, CA 94305 USA
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California 92093 USA
| | - Loki Natarajan
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California 92093 USA
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr, La Jolla, CA 92037 USA
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Peng X, Bao X, Xie Y, Zhang X, Huang J, Liu Y, Cheng M, Liu N, Wang P. The mediating effect of pain on the association between multimorbidity and disability and impaired physical performance among community-dwelling older adults in southern China. Aging Clin Exp Res 2020; 32:1327-1334. [PMID: 31522389 DOI: 10.1007/s40520-019-01324-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/14/2019] [Indexed: 11/26/2022]
Abstract
AIM To investigate the association between multimorbidity and disability and impaired physical performance, and to further evaluate the mediating effect of physical pain in this association. METHODS 1321 community-dwelling older adults, who were over 60 years old in southern China, were regarded as participants in this cross-sectional study. Subjects completed a multi-instrument questionnaire including essential characteristics and physical function assessments. Physical function was assessed by activities of daily living (ADL), instrumental activities of daily living (IADL), index of mobility scale (NAGI), index of basic physical activities scale (RB), and short physical performance battery (SPPB). Multimorbidity was defined as the simultaneous presence of two or more chronic conditions. Multivariable regression and mediation analyses were conducted and gender differences were explored. RESULTS The prevalence of multimorbidity was 44.6% in our study. In gender stratification analysis, multimorbidity was significantly associated with ADL disability (OR = 2.16), IADL disability (OR = 1.97), NAGI disability (OR = 2.84), RB disability (OR = 2.65) and lower SPPB score (β = - 0.83) in women. The rate of pain increased with the number of chronic diseases and the multimorbidity patients with higher pain prevalence. Moreover, the presence of pain was also significantly associated with disability and impaired physical performance. Mediation analysis illustrated that pain was accounted for 16.5% to 22.1% of the adverse effects of multimorbidity on disability and impaired physical performance in women. CONCLUSIONS Multimorbidity was significantly associated with disability and impaired physical performance, and pain might be a mediating factor for adverse effects of multimorbidity on disability and impaired physical performance in women.
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Affiliation(s)
- Xin Peng
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China
| | - XinYu Bao
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China
| | - YiXian Xie
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China
| | - XiaoXia Zhang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China
| | - JunXuan Huang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China
| | - Yan Liu
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China
| | - MengJiao Cheng
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China
| | - Nan Liu
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, People's Republic of China.
| | - PeiXi Wang
- General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, 528244, People's Republic of China.
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Associations of social, physical, and financial factors with diet quality among older, community-dwelling women. ACTA ACUST UNITED AC 2020; 27:756-762. [PMID: 32132442 DOI: 10.1097/gme.0000000000001528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This analysis examined whether specific social, physical, and financial factors were associated with diet quality among older, community-dwelling women. METHODS This cross-sectional analysis was conducted in a subset of 6,094 community-dwelling Women's Health Initiative participants who completed a food frequency questionnaire, administered from 2012 to 2013, and a self-administered supplemental questionnaire, administered approximately 1 year later. The supplemental questionnaire included five questions assessing social, physical, and financial factors related to eating. Diet quality was assessed with the Healthy Eating Index-2010 (HEI-2010; range of 0-100; higher score indicates a higher quality diet). The total HEI-2010 score was calculated by summing individual scores representing the intake of nine adequacy components (beneficial food groups) and three moderation components (food groups to limit). Associations of responses to the five questions on the supplemental questionnaire with HEI-2010 scores were examined with multiple linear regression, adjusting for relevant covariates. RESULTS Mean ± standard deviation age of participants was 78.8 ± 6.7 years. Reporting eating fewer than two meals per day, having dental or other mouth problems causing problems with eating, and not always being able to shop, cook, or feed oneself were associated with statistically significantly lower HEI-2010 scores, compared with those not reporting these issues, after multivariable adjustment: 5.37, 2.98, and 2.39 lower scores, respectively (all P values <0.0001). Reporting eating alone most of the time and not always having enough money to buy food were not associated with HEI-2010 scores. CONCLUSIONS Among older, community-dwelling women, eating fewer than two meals per day, dental and other mouth problems, and diminished ability to shop for food, prepare meals, and feed oneself were associated with lower diet quality. These are potential targets for interventions to improve diet quality in older women. : Video Summary:http://links.lww.com/MENO/A561.
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Langsetmo L, Burghardt AJ, Schousboe JT, Cawthon PM, Cauley JA, Lane NE, Orwoll ES, Ensrud KE. Objective measures of moderate to vigorous physical activity are associated with higher distal limb bone strength among elderly men. Bone 2020; 132:115198. [PMID: 31866494 PMCID: PMC6993955 DOI: 10.1016/j.bone.2019.115198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022]
Abstract
Our aim was to determine the association between objectively measured physical activity (PA) and bone strength of the distal limbs among older men. We studied 994 men from the MrOS cohort study (mean age 83.9) who had repeat (Year 7 and 14) 5-day activity assessment with at least 90% wear time (SenseWearPro3 Armband) and Year 14 measures using high resolution peripheral quantitative tomography (HR-pQCT) (Scanco). Total energy expenditure (TEE), total steps per day, peak cadence (mean of top 30 steps/min over 24 h) and time spent in a given level of activity: sedentary (reference, <1.5 metabolic equivalents of task [METs]), light (1.5 to <3 METs), or moderate to vigorous physical activity(MVPA: ≥3 METs) were calculated as mean over the two time points. Estimated failure load was determined from HR-pQCT data using finite element analysis. We used standardized variables and adjusted for potential confounders using linear regression. The means ±SDs for daily activity were: 2338 ± 356 kcal/d [TEE]; 5739 ± 2696 steps/day [step count], 60 ± 20 cpm [peak cadence], 67 ± 28 min/d [light activity], and 85 ± 52 min/d [MVPA]. Higher TEE, step count, and peak cadence were each associated with higher failure load of the distal radius (effect sizes respectively: 0.13 [95% CI: 0.05, 0.20], 0.11 [95% CI: 0.04, 0.18], and 0.08 [95% CI: 0.01, 0.15]) and higher failure load of the distal tibia (effect sizes respectively 0.21 [95% CI: 0.13, 0.28], 0.19 [95% CI: 0.13, 0.26], 0.19 [95% CI, 0.13, 0.25]). Time spent in MVPA vs. time sedentary was related to bone strength at both sites after adjustment, whereas time spent in light activity vs. time sedentary was not. TEE was associated with compartmental area and BMD parameters at distal tibia, but only area parameters at the distal radius. In summary, MVPA over a 7-year period of time may have a modest association with bone strength and geometry among older men.
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Affiliation(s)
- Lisa Langsetmo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, United States of America.
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States of America
| | - John T Schousboe
- HealthPartners Institute, Bloomington, MN, United States of America; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, United States of America
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Nancy E Lane
- Department of Internal Medicine, University of California, Davis, CA, United States of America
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, United States of America
| | - Kristine E Ensrud
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, United States of America; Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America; Center for Care Delivery & Outcomes Research, VA Health Care System, Minneapolis, MN, United States of America
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Full KM, Gallo LC, Malhotra A, Bellettiere J, Kerr J, Arredondo E, Stone KL, Zaslavsky O, Lewis CE, Lin X, Lacroix AZ. Modeling the cardiometabolic benefits of sleep in older women: exploring the 24-hour day. Sleep 2020; 43:zsz205. [PMID: 31553045 PMCID: PMC6955642 DOI: 10.1093/sleep/zsz205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/15/2019] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Activities throughout the day, including sleep, sedentary behavior (SB), light-intensity physical activity (LIPA), and moderate to vigorous physical activity (MVPA) are independently associated with cardiometabolic health. Few studies have examined interrelationships between sleep and 24-hour activity and associations with cardiometabolic risk. The objective of this study is to understand how replacing time in SB, LIPA, or MVPA with sleep impacts cardiometabolic risk. METHODS Women's Health Initiative OPACH Study participants (N = 3329; mean age = 78.5 ± 6) wore ActiGraph GT3X+ accelerometers 24 hours/7 days. Adjusted linear regression estimated the relationship between sleep duration and cardiometabolic markers. Separately for shorter (<8 hours) and longer (≥8 hours) sleepers, isotemporal substitution models estimated the cross-sectional associations with cardiometabolic markers with reallocating time in daytime activities to or from sleep. RESULTS Longer sleep duration was associated with higher insulin, HOMA-IR, glucose, total cholesterol, and triglycerides (all p < 0.05). The associations between sleep duration and C-reactive protein, waist circumference, and body mass index (BMI) were U-shaped (both p < 0.05). For shorter sleepers, reallocating 33 minutes of MVPA to sleep was associated with higher values of insulin, HOMA-IR, glucose, triglycerides, waist circumference, and BMI (0.7%-11.5%). Replacing 91 minutes of SB time with sleep was associated with lower waist circumference and BMI (-1.3%, -1.8%). For long sleepers, shifting 91 minutes of sleep to SB was associated with higher waist circumference and BMI (1.3%, 1.4%). CONCLUSIONS This is one of the first isotemporal analyses to include objectively measured sleep duration. Results illuminate possible cardiometabolic risks and benefits of reallocating time to or from sleep.
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Affiliation(s)
- Kelsie M Full
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA
| | - Atul Malhotra
- Division of Pulmonary & Critical Care Medicine, University of California, San Diego School of Medicine, La Jolla, CA
| | - John Bellettiere
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA
| | - Jacqueline Kerr
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA
| | - Elva Arredondo
- Division of Health Promotion and Behavioral Science, San Diego State University, San Diego, CA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, University of California San Francisco, San Francisco, CA
| | - Oleg Zaslavsky
- School of Nursing, University of Washington, Seattle, WA
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Xiaochen Lin
- Department of Epidemiology, Brown University, Providence, RI
| | - Andrea Z Lacroix
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA
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Bellettiere J, Healy GN, LaMonte MJ, Kerr J, Evenson KR, Rillamas-Sun E, Di C, Buchner DM, Hovell MF, LaCroix AZ. Sedentary Behavior and Prevalent Diabetes in 6,166 Older Women: The Objective Physical Activity and Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2019; 74:387-395. [PMID: 29726906 DOI: 10.1093/gerona/gly101] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We examined associations of sedentary time and sedentary accumulation patterns (ie, how sedentary time is accumulated) with prevalent diabetes in an ethnically diverse cohort of older women. METHODS Community-dwelling women aged 63-99 (n = 6,116; median age = 79) wore ActiGraph GT3X+ accelerometers 24 h/day for up to 7 days from which we derived average daily sedentary time and three measures of sedentary accumulation patterns: breaks in sedentary time, usual sedentary bout duration, and alpha. Odds ratios (ORs) and 95% confidence intervals (CIs) for prevalent diabetes were estimated using multivariable logistic regression. RESULTS Twenty-one percent (n = 1,282) of participants had diabetes. Women in the highest quartile of sedentary time (≥10.3 h/day) had higher odds of diabetes (OR = 2.18; 95% CI = 1.77-2.70) than women in the lowest quartile (≤8.3 h/day). Prolonged accumulation patterns (ie, accumulating sedentary time in longer sedentary bouts) was associated with higher odds of diabetes than regularly interrupted patterns (comparing quartiles with the most vs least prolonged patterns: usual bout duration OR = 1.57, 95% CI = 1.28-1.92; alpha OR = 1.61, 95% CI = 1.32-1.97); however, there was no significant association for breaks in sedentary time (OR = 1.00, 95% CI = 0.82-1.20). CONCLUSIONS High levels of sedentary time and accumulating it in prolonged patterns were associated with increased odds of diabetes among older women.
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Affiliation(s)
- John Bellettiere
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla.,Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, California
| | - Genevieve N Healy
- The University of Queensland, School of Public Health, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,School of Physiotherapy, Curtin University, Perth, Western Australia, Australia
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo SUNY
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Seattle, WA
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chongzhi Di
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, California.,Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, California
| | - Andrea Z LaCroix
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla
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29
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Cavanaugh AM, Rauh MJ, Thompson CA, Alcaraz J, Mihalko WM, Bird CE, Eaton CB, Rosal MC, Li W, Shadyab AH, Gilmer T, LaCroix AZ. Racial and ethnic disparities in utilization of total knee arthroplasty among older women. Osteoarthritis Cartilage 2019; 27:1746-1754. [PMID: 31404657 PMCID: PMC6875623 DOI: 10.1016/j.joca.2019.07.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 07/14/2019] [Accepted: 07/31/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate racial and ethnic disparities in utilization of total knee arthroplasty (TKA) in relation to demographic, health, and socioeconomic status variables. DESIGN Prospective study of 102,767 Women's Health Initiative postmenopausal women initially aged 50-79, examining utilization rates of primary TKA between non-Hispanic Black/African American, non-Hispanic White, and Hispanic/Latina women (hereafter referred to as Black, White, and Hispanic). A total of 8,942 Black, 3,405 Hispanic, and 90,420 White women with linked Medicare claims data were followed until time of TKA, death, or transition from fee-for-service coverage. Absolute disparities were determined using utilization rates by racial/ethnic group and relative disparities quantified using multivariable hazards models in adjusting for age, arthritis, joint pain, mobility disability, body mass index, number of comorbidities, income, education, neighborhood socioeconomic status (SES), and geographic region. RESULTS TKA utilization was higher among White women (10.7/1,000 person-years) compared to Black (8.5/1,000 person-years) and Hispanic women (7.6/1,000 person-years). Among women with health indicators for TKA including diagnosis of arthritis, moderate to severe joint pain, and mobility disability, Black and Hispanic women were significantly less likely to undergo TKA after adjusting for age [Black: HR (95% confidence interval) = 0.70 (0.63-0.79); Hispanic: HR = 0.58 (0.44-0.77)]. Adjustment for SES modestly attenuated the measured disparity, but significant differences remained [Black: HR = 0.75 (0.67-0.89); Hispanic: HR = 0.65 (0.47-0.89)]. CONCLUSIONS Compared to White women, Black and Hispanic women were significantly less likely to undergo TKA after considering need and appropriateness for TKA and SES. Further investigation into personal-level and provider-level factors that may explain these disparities is warranted.
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Affiliation(s)
- A M Cavanaugh
- San Diego State University/University of California San Diego, Joint Doctoral Program in Public Health, USA.
| | - M J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, USA; Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
| | - C A Thompson
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
| | - J Alcaraz
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
| | - W M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee, Memphis, TN, USA.
| | - C E Bird
- Health Care Division, RAND, Santa Monica, CA, USA.
| | - C B Eaton
- Department of Family Medicine at Warren Alpert Medical School and Department of Epidemiology at School of Public Health at Brown University, Providence, RI, USA.
| | - M C Rosal
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, USA.
| | - W Li
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
| | - A H Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
| | - T Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
| | - A Z LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
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30
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Wei MY, Kabeto MU, Galecki AT, Langa KM. Physical Functioning Decline and Mortality in Older Adults With Multimorbidity: Joint Modeling of Longitudinal and Survival Data. J Gerontol A Biol Sci Med Sci 2019. [PMID: 29529179 DOI: 10.1093/gerona/gly038] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Multimorbidity is common among older adults and strongly associated with physical functioning decline and increased mortality. However, the full spectrum of direct and indirect effects of multimorbidity on physical functioning and survival has not been quantified. We aimed to determine the longitudinal relationship of multimorbidity on physical functioning and quantify the impact of multimorbidity and multimorbidity-attributed changes in physical functioning on mortality risk. Methods The Health and Retirement Study (HRS) is a nationally representative population-based prospective cohort of adults aged 51 or older. In 2000, participants were interviewed about physician-diagnosed chronic conditions, from which their multimorbidity-weighted index (MWI) was computed. Between 2000 and 2011, participants reported their current physical functioning using a modified Short Form-36. With MWI as a time-varying exposure, we jointly modeled its associations with physical functioning and survival. Results The final sample included 74,037 observations from 18,174 participants. At baseline, participants had a weighted mean MWI of 4.6 ± 4.2 (range 0-36.8). During follow-up, physical functioning declined: -1.72 (95% confidence interval [CI] -1.77, -1.67, p < .001) HRS physical functioning units per point MWI in adjusted models. Over follow-up, 6,362 (34%) participants died. Mortality risk increased 8% (hazard ratio 1.08, 95% CI 1.07-1.08, p < .001) per point MWI in adjusted models. Across all population subgroups, MWI was associated with greater physical functioning decline and mortality risk. Conclusions Multimorbidity and its associated decline in physical functioning were significantly associated with increased mortality. These associations can be predicted with an easily interpreted and applied multimorbidity index that can better identify and target adults at increased risk for disability and death.
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Affiliation(s)
- Melissa Y Wei
- Division of General Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Mohammed U Kabeto
- Division of General Medicine, University of Michigan, Ann Arbor.,Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, Michigan
| | - Andrzej T Galecki
- Division of Geriatric Medicine, Department of Internal Medicine, and Institute of Gerontology, University of Michigan Medical School, Ann Arbor.,Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor
| | - Kenneth M Langa
- Division of General Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, Michigan.,Institute for Social Research, University of Michigan, Ann Arbor
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31
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Rillamas-Sun E, LaMonte MJ, Evenson KR, Thomson CA, Beresford SA, Coday MC, Manini TM, Li W, LaCroix AZ. The Influence of Physical Activity and Sedentary Behavior on Living to Age 85 Years Without Disease and Disability in Older Women. J Gerontol A Biol Sci Med Sci 2019; 73:1525-1531. [PMID: 29165626 DOI: 10.1093/gerona/glx222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Indexed: 12/17/2022] Open
Abstract
Background Whether physical activity (PA) and sedentary behavior influence the odds of women living to age 85 years without chronic disease or disability is not well described. Methods Participants of the Women's Health Initiative (n = 49,612) were categorized based on health status by age 85 years: (i) lived without developing major chronic disease or mobility disability ("healthy"); (ii) lived and developed mobility disability with or without disease; (iii) lived and developed major chronic disease, but not mobility disability; and (iv) died before their 85th birth year. Multinomial logistic regression models that adjusted for covariates such as age, race/ethnicity, and body size estimated associations of self-reported PA and sitting time on developing major disease or mobility disability or dying before age 85 relative to being healthy. Results Mean ± SD baseline age was 70.2 ± 3.6 years. Distributions were: 22% healthy, 23% had mobility disability, 26% had major disease, and 29% died. Relative to those with high total PA, the adjusted odds ratios (OR) (confidence intervals [CI]) for mobility disability was 1.6 (1.4-1.7), 1.2 (1.1-1.3), and 1.1 (1.0-1.2) for women with no, low, and moderate total PA, respectively (p-trend < .001). The corresponding covariate-adjusted OR (CI) for mortality was 1.7 (1.5-1.8), 1.2 (1.1-1.3), and 1.0 (1.0-1.1) (p-trend < .001). Total PA was not associated with developing chronic disease before age 85 years. Sitting ≥10 relative to <5 hours per day increased the odds of mobility disability (1.1, CI: 1.0-1.3) and mortality (1.2, CI: 1.0-1.3) prior to age 85 years (p < .001). Conclusions Increasing PA to recommended levels and reducing sitting time are modifiable behaviors that may improve healthy aging in older women.
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Affiliation(s)
- Eileen Rillamas-Sun
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo - SUNY, Buffalo, New York
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | - Shirley A Beresford
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Mathilda C Coday
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Wenjun Li
- Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Andrea Z LaCroix
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla
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32
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Grieshober L, Wactawski-Wende J, Hageman Blair R, Mu L, Liu J, Nie J, Carty CL, Hale L, Kroenke CH, LaCroix AZ, Reiner AP, Ochs-Balcom HM. A Cross-Sectional Analysis of Telomere Length and Sleep in the Women's Health Initiative. Am J Epidemiol 2019; 188:1616-1626. [PMID: 31145433 PMCID: PMC6736371 DOI: 10.1093/aje/kwz134] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 12/20/2022] Open
Abstract
Telomere length is a heritable marker of cellular age that is associated with morbidity and mortality. Poor sleep behaviors, which are also associated with adverse health events, may be related to leukocyte telomere length (LTL). We studied a subpopulation of 3,145 postmenopausal women (1,796 European-American (EA) and 1,349 African-American (AA)) enrolled in the Women's Health Initiative in 1993-1998 with data on Southern blot-measured LTL and self-reported usual sleep duration and sleep disturbance. LTL-sleep associations were analyzed separately for duration and disturbance using weighted and confounder-adjusted linear regression models in the entire sample (AAs + EAs; adjusted for race/ethnicity) and in racial/ethnic strata, since LTL differs by ancestry. After adjustment for covariates, each additional daily hour of sleep beyond 5 hours, approximately, was associated with a 27-base-pair (95% confidence interval (CI): 6, 48) longer LTL in the entire sample. Associations between sleep duration and LTL were strongest among AAs (adjusted β = 37, 95% CI: 4, 70); a similar, nonsignificant association was observed for EAs (adjusted β = 20, 95% CI: -7, 48). Sleep disturbance was not associated with LTL in our study. Our models did not show departure from linearity (quadratic sleep terms: P ≥ 0.55). Our results suggest that longer sleep duration is associated with longer LTL in postmenopausal women.
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Affiliation(s)
- Laurie Grieshober
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York
| | - Rachael Hageman Blair
- Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York
| | - Lina Mu
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York
| | - Jingmin Liu
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jing Nie
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York
| | - Cara L Carty
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lauren Hale
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Candyce H Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Andrea Z LaCroix
- Division of Epidemiology, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Alex P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York
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33
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Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev 2019; 53:100903. [PMID: 31048032 DOI: 10.1016/j.arr.2019.04.005] [Citation(s) in RCA: 282] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/14/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023]
Abstract
Multimorbidity is typically defined as the co-existence of two or more chronic diseases within an individual. Its prevalence is highest among the elderly, with poor quality of life (QoL) being one of the major consequences. This study aims to: (1) understand the relationship between multimorbidity and QoL or health-related quality of life (HRQoL) through systematic literature review; (2) explore the strength of this association by conducting the first meta-analysis on the subject. Following PRISMA, Medline/PubMed, Embase, CINAHL and PsycINFO were searched for studies published through September 1st, 2018. Original studies with clear operationalization of multimorbidity and validated QoL (or HRQoL) measurement were retained. For random-effect meta-analysis, a minimum of three studies with the same multimorbidity tool (e.g. number of diseases or equal comorbidity index) and the same QoL tool were required. Number of diseases was most common and the only measure on which meta-analysis was carried out. The outcome of interest was the linear regression slope between increasing number of diseases and QoL. Heterogeneity was explored with meta-regression. Out of 25,890 studies initially identified, 74 studies were retained for systematic review (total of 2,500,772 participants), of which 39 were included in the meta-analysis. The mean decrease in HRQoL per each added disease, depending on the scale, ranged from: -1.55% (95%CI: -2.97%, -0.13%) for the mental component summary score of pooled SF-36, -12 and -8 scales to -4.37% (95%CI: -7.13%, -1.61%) for WHOQoL-BREF physical health domain. Additional studies considering severity, duration and patterns of diseases are required to further clarify this association.
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Affiliation(s)
- Tatjana T Makovski
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Department of Family medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Chairgroup of Complex Genetics and Epidemiology, Nutrition and Metabolism in Translational Research (NUTRIM), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Susanne Schmitz
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Maurice P Zeegers
- Chairgroup of Complex Genetics and Epidemiology, Nutrition and Metabolism in Translational Research (NUTRIM), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Saverio Stranges
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada; Department of Family Medicine, Western University, London, Ontario, Canada
| | - Marjan van den Akker
- Department of Family medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands; Academic Centre for General Practice/Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium; Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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34
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Everson-Rose SA, Mendes de Leon CF, Roetker NS, Lutsey PL, Alonso A. Subclinical Cardiovascular Disease and Changes in Self-Reported Mobility: Multi-Ethnic Study of Atherosclerosis. J Gerontol A Biol Sci Med Sci 2019; 73:218-224. [PMID: 28582505 DOI: 10.1093/gerona/glx103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 01/06/2023] Open
Abstract
Background We examined associations of three markers of subclinical cardiovascular disease (intimal-medial thickening, coronary artery calcification , and ankle-brachial index) with changes in self-reported walking over time. Methods Data were from 6,490 Multi-Ethnic Study of Atherosclerosis participants (aged 45-84 years), free of clinical cardiovascular disease at baseline. Outcomes, assessed four times over 11 years, included self-reported walking pace (none to striding pace; score, 0-4) and total walking time (minutes/week). Linear generalized estimating equation models estimated associations of baseline intimal-medial thickening (z-scored), coronary artery calcification (Agatston units), and ankle-brachial index (ratio of ankle-to-arm systolic blood pressure) with walking pace and walking time modeled continuously in separate analyses. Results Median follow-up was 9.2 years (maximum, 11.4). Walking pace (estimate, -0.042 points [95% CI; -0.048, -0.036], p < 0.0001) and walking time (estimate, -4.71 minutes [95% CI: -8.54, -0.88], p = 0.016) decreased yearly. Greater baseline intimal-medial thickening related to faster decline in walking pace in multivariable analyses: walking pace score decreased 0.004 points (95% CI: -0.008, -0.001) more per year for each 1-SD higher intimal-medial thickening z-score, equivalent to an additional 10% slower yearly walking. Greater coronary artery calcification was associated with slower walking but inconsistently related to decline in walking pace. Higher ankle-brachial index was associated with faster baseline walking pace (estimate, 0.043 points [95% CI: 0.027, 0.059] per 1-SD) but unrelated to changes in walking pace. Cardiovascular disease measures were unrelated to total walking time. Conclusions Greater subclinical cardiovascular disease is associated with prevalent slower self-reported walking pace in middle-aged and older adults but has limited impact on changes in walking over time.
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Affiliation(s)
| | | | - Nicholas S Roetker
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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35
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Margolis KL, Buchner DM, LaMonte MJ, Zhang Y, Di C, Rillamas-Sun E, Hunt J, Ikramuddin F, Li W, Marshall S, Rosenberg D, Stefanick ML, Wallace R, LaCroix AZ. Hypertension Treatment and Control and Risk of Falls in Older Women. J Am Geriatr Soc 2019; 67:726-733. [PMID: 30614525 PMCID: PMC6458056 DOI: 10.1111/jgs.15732] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES A lower risk of falls is commonly cited as a reason to treat hypertension conservatively in older individuals. We examined the effect of hypertension treatment and control status and measured blood pressure (BP) level on the risk of falls in older women. DESIGN/SETTING Prospective cohort study. PARTICIPANTS A total of 5971 women (mean age 79 years; 50.4% white, 33.1% black, 16.5% Hispanic/Latina) enrolled in the Women's Health Initiative and Objective Physical Activity and Cardiovascular Health study. MEASUREMENTS BP was measured by trained nurses, and hypertension treatment was assessed by medication inventory. Participants mailed in monthly calendars to self-report falls for 1 year. RESULTS Overall, 70% of women had hypertension at baseline (53% treated and controlled, 12% treated and uncontrolled, 5% untreated). There were 2582 women (43%) who reported falls in the 1 year of surveillance. Compared with nonhypertensive women, when adjusted for fall risk factors and lower limb physical function, the incidence rate ratio (IRR) for falls was 0.82 (confidence interval [CI] = 0.74-0.92) in women with treated controlled hypertension (p = .0008) and 0.73 (CI = 0.62-0.87) in women with treated uncontrolled hypertension (p = .0004). Neither measured systolic nor diastolic BP was associated with falls in the overall cohort. In women treated with antihypertensive medication, higher diastolic BP was associated with a lower risk of falls in a model adjusted for fall risk factors (IRR = 0.993 per mm Hg; 95% CI = 0.987-1.000; p = .04). The only class of antihypertensive medication associated with an increased risk of falls compared with all other types of antihypertensive drugs was β-blockers. CONCLUSION Women in this long-term research study with treated hypertension had a lower risk of falls compared with nonhypertensive women. Diastolic BP (but not systolic BP) is weakly associated with fall risk in women on antihypertensive treatment (<1% decrease in risk per mm Hg increase). J Am Geriatr Soc, 2019. J Am Geriatr Soc 67:726-733, 2019.
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Affiliation(s)
| | - David M Buchner
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, Illinois
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, School of Public Health and Health Professions, Buffalo, New York
| | - Yuzheng Zhang
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Chongzhi Di
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Julie Hunt
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Farha Ikramuddin
- Department of Rehabilitation Medicine, University of Minnesota, Medical School, Minneapolis, Minnesota
| | - Wenjun Li
- Department of Medicine, University of Massachusetts, Medical School, Worcester, Massachusetts
| | - Steve Marshall
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Dori Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
| | - Robert Wallace
- Department of Epidemiology, Gillings School of Global Public Health, University of Iowa, College of Public Health, Iowa City, Iowa
| | - Andrea Z LaCroix
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California
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36
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Warner CB, Roberts AR, Jeanblanc AB, Adams KB. Coping Resources, Loneliness, and Depressive Symptoms of Older Women With Chronic Illness. J Appl Gerontol 2019; 38:295-322. [PMID: 28380713 DOI: 10.1177/0733464816687218] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women (N = 138) with at least one chronic illness (M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to depressive symptoms: one through physical symptoms, pain, and disability, and another through the experience of loneliness. Findings support intervention approaches that address disability-related issues and loneliness, and assist older women with chronic illness in identifying and marshaling social support.
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37
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Bellettiere J, LaMonte MJ, Evenson KR, Rillamas-Sun E, Kerr J, Lee IM, Di C, Rosenberg DE, Stefanick M, Buchner DM, Hovell MF, LaCroix AZ. Sedentary behavior and cardiovascular disease in older women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study. Circulation 2019; 139:1036-1046. [PMID: 31031411 PMCID: PMC6481298 DOI: 10.1161/circulationaha.118.035312] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Evidence that higher sedentary time is associated with higher risk for cardiovascular disease (CVD) is based mainly on self-reported measures. Few studies have examined whether patterns of sedentary time are associated with higher risk for CVD. Methods Women from the Objective Physical Activity and Cardiovascular Health (OPACH) Study (n=5638, aged 63-97, mean age=79±7) with no history of myocardial infarction (MI) or stroke wore accelerometers for 4-to-7 days and were followed for up to 4.9 years for CVD events. Average daily sedentary time and mean sedentary bout duration were the exposures of interest. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) for CVD using models adjusted for covariates and subsequently adjusted for potential mediators (body mass index (BMI), diabetes, hypertension, and CVD-risk biomarkers [fasting glucose, high-density lipoprotein, triglycerides, and systolic blood pressure]). Restricted cubic spline regression characterized dose-response relationships. Results There were 545 CVD events during 19,350 person-years. Adjusting for covariates, women in the highest (≥ ~11 hr/day) vs. the lowest (≤ ~9 hr/day) quartile of sedentary time had higher risk for CVD (HR=1.62; CI=1.21-2.17; p-trend <0.001). Further adjustment for potential mediators attenuated but did not eliminate significance of these associations (p-trend<.05, each). Longer vs. shorter mean bout duration was associated with higher risks for CVD (HR=1.54; CI=1.27-2.02; p-trend=0.003) after adjustment for covariates. Additional adjustment for CVD-risk biomarkers attenuated associations resulting in a quartile 4 vs. quartile 1 HR=1.36; CI=1.01-1.83; p-trend=0.10). Dose-response associations of sedentary time and bout duration with CVD were linear (P-nonlinear >0.05, each). Women jointly classified as having high sedentary time and long bout durations had significantly higher risk for CVD (HR=1.34; CI=1.08-1.65) than women with both low sedentary time and short bout duration. All analyses were repeated for incident coronary heart disease (MI or CVD death) and associations were similar with notably stronger hazard ratios. Conclusions Both high sedentary time and long mean bout durations were associated in a dose-response manner with increased CVD risk in older women, suggesting that efforts to reduce CVD burden may benefit from addressing either or both component(s) of sedentary behavior.
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Affiliation(s)
- John Bellettiere
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, California
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo -SUNY, Buffalo, NY
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Chongzhi Di
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Dori E. Rosenberg
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Marcia Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Stanford, CA
| | | | - Melbourne F. Hovell
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, San Diego, California
- Division of Health Promotion & Behavioral Science, School of Public Health, San Diego State University, San Diego, California
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
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Bouscaren N, Yildiz H, Dartois L, Vercambre MN, Boutron-Ruault MC. Decline in Instrumental Activities of Daily Living over 4-Year: The Association with Hearing, Visual and Dual Sensory Impairments among Non-Institutionalized Women. J Nutr Health Aging 2019; 23:687-693. [PMID: 31560024 DOI: 10.1007/s12603-019-1231-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Most older adults express the wish to live at home as long as possible, thus autonomy promoting measures are essential. Hearing and visual impairments are common among older people, and they have been consistently associated with functional disability. However, longitudinal data are scarce, notably regarding dual sensory impairments (both in hearing and vision). We aimed at assessing the relationship between hearing, visual, and dual sensory impairments, and subsequent decline in instrumental activities of daily living (IADL). DESIGN Longitudinal. SETTING the French E3N-elderly sub-cohort. PARTICIPANTS 4,010 community-dwelling older women born between 1925 and 1930, and free of IADL limitations in 2006. MEASUREMENTS Hearing and visual impairments were self-reported in 2006. IADLs were evaluated in 2006 and 2010. RESULTS After 4 years of follow-up, 588 women became limited in their IADLs. In logistic regression models adjusted for potential confounders, odds ratios [95% confidence interval] for developing IADL limitations were 1.18 [0.98; 1.41], 1.98 [1.26; 3.11], and 2.61 [1.50; 4.54] for hearing, visual, or both sensory impairments respectively, compared with no sensory impairment at baseline. CONCLUSION Results suggest that among autonomous older women, visual, and to a lesser extent, hearing impairment, have a short-term negative impact on their ability to perform daily activities, with some evidence of a multiplicative effect between sensory impairments. Appropriate evaluation and management of sensory impaired elderly, and more particularly those with dual impairments, may contribute to prevent disability in aging.
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Affiliation(s)
- N Bouscaren
- Marie-Christine Boutron-Ruault, Inserm U1018, Gustave Roussy, 114 rue Edouard Vaillant, Villejuif Cedex 94 805, France, +33 [142116466],
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Langsetmo L, Johnson A, Demmer RT, Fino N, Orwoll ES, Ensrud KE, Hoffman AR, Cauley JA, Shmagel A, Meyer K, Shikany JM. The Association between Objectively Measured Physical Activity and the Gut Microbiome among Older Community Dwelling Men. J Nutr Health Aging 2019; 23:538-546. [PMID: 31233075 PMCID: PMC6618308 DOI: 10.1007/s12603-019-1194-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To determine the relationship between objectively measured physical activity (PA) and the gut microbiome among community-dwelling older men. DESIGN Cross-sectional study. SETTING Osteoporotic Fractures in Men (MrOS) cohort participants at Visit 4 (2014-16). PARTICIPANTS Eligible men (n=373, mean age 84 y) included participants with 5-day activity assessment with at least 90% wear time and analyzed stool samples. MEASUREMENTS PA was measured with the SenseWear Pro3 Armband and stool samples analyzed for 16S v4 rRNA marker genes using Illumina MiSeq technology. Armband data together with sex, height, and weight were used to estimate total steps, total energy expenditure, and level of activity. 16S data was analyzed using standard UPARSE workflow. Shannon and Inverse Simpson indices were measures of (within-participant) α-diversity. Weighted and unweighted Unifrac were measures of (between-participant) β-diversity. We used linear regression analysis, principal coordinate analysis, zero-inflated Gaussian models to assess association between PA and α-diversity, β-diversity, and specific taxa, respectively, with adjustments for age, race, BMI, clinical center, library size, and number of chronic conditions. RESULTS PA was not associated with α-diversity. There was a slight association between PA and β-diversity (in particular the second principal coordinate). Compared to those who were less active, those who had higher step counts had higher relative abundance of Cetobacterium and lower relative abundance of taxa from the genera Coprobacillus, Adlercreutzia, Erysipelotrichaceae CC-115 after multivariable adjustment including age, BMI, and chronic conditions. There was no consistent pattern by phylum. CONCLUSION There was a modest association between levels of PA and specific gut microbes among community-dwelling older men. The observed associations are consistent with the hypothesis that underlying health status and composition of the host microbiome are related.
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Affiliation(s)
- L Langsetmo
- Lisa Langsetmo, University of Minnesota, Epidemiology and Community Health, 1300 S. 2nd St., Suite 300, Minneapolis, MN 55454, Phone: 612-467-1649; Fax: 612-467-2118,
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Espinoza SE, Quiben M, Hazuda HP. Distinguishing Comorbidity, Disability, and Frailty. CURRENT GERIATRICS REPORTS 2018; 7:201-209. [PMID: 30984516 PMCID: PMC6457658 DOI: 10.1007/s13670-018-0254-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Over half of the older adults in U.S. have multimorbidity, defined broadly as the presence of 2 or more chronic diseases in an individual. Multimorbidity has significant overlap with disability and frailty. In this review, we broadly review the concepts of multimorbidity, disability, and frailty, as well as their interrelationships, and ability to predict future adverse health outcomes in older adults. RECENT FINDINGS Depending on the study, the prevalence of individuals with all three of multimorbidity, disability, and frailty ranges from 2-20%. Multimorbidity and patterns of multimorbidity are predictive of functional limitations, disability, health care usage, and mortality. The degree to which multimorbidity predicts these outcomes depends on many factors but partly upon the population examined and the presence of frailty and disability. SUMMARY Multimorbidity is an emerging public health concern that is observed with and predictive of disability and frailty.
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Affiliation(s)
- Sara E. Espinoza
- The Department of Medicine, Divisions of Geriatrics, Gerontology & Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- The Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- The Sam & Ann Barshop Institute for Longevity & Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Myla Quiben
- Geriatrics Research, Education & Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Helen P. Hazuda
- The Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Physical Therapy, University of North Texas Health Science Center
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Bea JW, Going SB, Wertheim BC, Bassford TL, LaCroix AZ, Wright NC, Nicholas JS, Heymsfield SB, Chen Z. Body composition and physical function in the Women's Health Initiative Observational Study. Prev Med Rep 2018; 11:15-22. [PMID: 30065910 PMCID: PMC6066466 DOI: 10.1016/j.pmedr.2018.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/26/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022] Open
Abstract
Physical function is critical for mobility and quality of life. We hypothesized that higher total lean mass is associated with higher physical function, and body fat inversely associated, among postmenopausal women. Women's Health Initiative Observational Study participants at Pittsburgh, PA; Birmingham, AL; and Tucson-Phoenix, AZ (1993–1998) completed dual-energy X-ray absorptiometry scans and the Rand SF-36 questionnaire at baseline and 3 y (N = 4526). Associations between quartiles (Q1–4) of lean or fat mass and physical function were tested using linear regression, adjusted for demographics, lifestyle factors, medical history, and scanner serial number. At baseline, participants had a mean ± SD age of 63.4 ± 7.4 y and BMI of 27.4 ± 5.8 kg/m2. Higher percent lean mass was positively associated with physical function at baseline (Q4, 83.6 ± 0.6 versus Q1, 74.6 ± 0.7; p < 0.001), while fat mass (kg and %) was inversely associated (e.g., Q4, 73.7 ± 0.7 versus Q1, 84.2 ± 0.7 kg; ptrend < 0.001). Physical function had declined across the cohort at 3 y; the highest relative lean mass quartile at baseline conferred a lesser decline in physical function than the lowest (Q4, −3.3 ± 0.6 versus Q1–7.0 ± 0.6; ptrend < 0.001), while the highest fat mass quartile (% and kg) conferred greater decline (ex. Kg Q4, −6.7 ± 0.7 versus Q1–2.8 ± 0.6; ptrend < 0.001). Increased fat mass (≥5%), but not lean mass, was associated with lower physical function at 3 y (p < 0.001). Adiposity, as well as lean mass, requires consideration in the prediction of physical function among postmenopausal women over time. Lean mass (%) is positively associated with physical function in menopause. Body fat is negatively associated with physical function in menopause. Decline in physical function is more rapid with gains in fat during menopause. Body composition influence on functional decline is more evident among women <65 y.
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Affiliation(s)
- Jennifer W. Bea
- Department of Nutritional Sciences, University of Arizona, 3950 S Country Club Rd., Ste 330, Tucson, AZ 85714, USA
- Department of Medicine, University of Arizona, 1515 N. Campbell Ave., Tucson, AZ 85724, USA
- University of Arizona Cancer Center, 1515 N. Campbell Ave., Tucson, AZ 85724, USA
- Corresponding author at: 1515 N. Campbell Ave., Tucson, AZ 85724, USA.
| | - Scott B. Going
- Department of Nutritional Sciences, University of Arizona, 3950 S Country Club Rd., Ste 330, Tucson, AZ 85714, USA
| | - Betsy C. Wertheim
- University of Arizona Cancer Center, 1515 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Tamsen L. Bassford
- Department of Medicine, University of Arizona, 1515 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive #0725, La Jolla, CA 92093, USA
| | - Nicole C. Wright
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd., Ryals Public Health Building, Birmingham, AL 35294, USA
| | - Jennifer S. Nicholas
- Department of Epidemiology and Biostatistics, University of Arizona, 1295 N. Martin Ave., P.O. Box 245210, Tucson, AZ 85724, USA
| | - Steven B. Heymsfield
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Zhao Chen
- Department of Epidemiology and Biostatistics, University of Arizona, 1295 N. Martin Ave., P.O. Box 245210, Tucson, AZ 85724, USA
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Bouscaren N, Dartois L, Boutron-Ruault MC, Vercambre MN. How do self and proxy dependency evaluations agree? Results from a large cohort of older women. Age Ageing 2018; 47:619-624. [PMID: 29733342 DOI: 10.1093/ageing/afy071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/20/2018] [Accepted: 04/12/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND epidemiological studies based on questionnaires can face difficulties when collecting data on functional ability of older people, and may thus use a proxy to obtain or confirm data. It is therefore of importance to compare data from older people and from their proxies, to establish to what extent proxies' answers can be used as a substitute or a complement in epidemiological studies on dependency. OBJECTIVE we evaluated agreement in dependency assessment, and identified factors associated with discrepancy between older people and proxy reports, in a large postal epidemiological survey. METHODOLOGY autonomy of 5,164 community-dwelling women from the French E3N cohort study aged 75-83 was self- and proxy-evaluated with the instrumental activities of daily living (IADL) scales. Agreement was assessed using Cohen's Kappa coefficients, and factors associated with discrepancy were determined using logistic regression models. RESULTS there was agreement between self and proxy dependency assessment in 90.8% of the women, with satisfactory Cohen's kappa. Discrepancy was associated with older age, poor self-reported health, prior low level of physical activity and the proxy being the partner. DISCUSSION we found that a proxy could be a reliable source of dependency assessment in large epidemiological surveys, and that some characteristics of the older person and of the proxy could modulate the agreement between proxy- and self-dependency assessments.
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Affiliation(s)
- Nathalie Bouscaren
- INSERM U1018, Center for Research in Epidemiology and Population Health, Villejuif, France
- University Paris-Sud, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Laureen Dartois
- INSERM U1018, Center for Research in Epidemiology and Population Health, Villejuif, France
- University Paris-Sud, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- INSERM U1018, Center for Research in Epidemiology and Population Health, Villejuif, France
- University Paris-Sud, Villejuif, France
- Gustave Roussy, Villejuif, France
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LaMonte MJ, Buchner DM, Rillamas-Sun E, Di C, Evenson KR, Bellettiere J, Lewis CE, Lee IM, Tinker LF, Seguin R, Zaslovsky O, Eaton CB, Stefanick ML, LaCroix AZ. Accelerometer-Measured Physical Activity and Mortality in Women Aged 63 to 99. J Am Geriatr Soc 2018; 66:886-894. [PMID: 29143320 PMCID: PMC5955801 DOI: 10.1111/jgs.15201] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To prospectively examine associations between accelerometer-measured physical activity (PA) and mortality in older women, with an emphasis on light-intensity PA. DESIGN Prospective cohort study with baseline data collection between March 2012 and April 2014. SETTING Women's Health Initiative cohort in the United States. PARTICIPANTS Community-dwelling women aged 63 to 99 (N = 6,382). MEASUREMENTS Minutes per day of usual PA measured using hip-worn triaxial accelerometers, physical functioning measured using the Short Physical Performance Battery, mortality follow-up for a mean 3.1 years through September 2016 (450 deaths). RESULTS When adjusted for accelerometer wear time, age, race-ethnicity, education, smoking, alcohol, self-rated health, and comorbidities, relative risks (95% confidence intervals) for all-cause mortality across PA tertiles were 1.00 (referent), 0.86 (0.69, 1.08), 0.80 (0.62, 1.03) trend P = .07, for low light; 1.00, 0.57 (0.45, 0.71), 0.47 (0.35, 0.61) trend P < .001, for high light; and, 1.00, 0.63 (0.50, 0.79), 0.42 (0.30, 0.57) trend P < .001, for moderate-to-vigorous PA (MVPA). Associations remained significant for high light-intensity PA and MVPA (P < .001) after further adjustment for physical function. Each 30-min/d increment in light-intensity (low and high combined) PA and MVPA was associated, on average, with multivariable relative risk reductions of 12% and 39%, respectively (P < .01). After further simultaneous adjusting for light intensity and MVPA, the inverse associations remained significant (light-intensity PA: RR = 0.93, 95% CI = 0.89-0.97; MVPA: RR = 0.67, 95% CI = 0.58-0.78). These relative risks did not differ between subgroups for age or race and ethnicity (interaction, P ≥ .14, all). CONCLUSION When measured using accelerometers, light-intensity and MVPA are associated with lower mortality in older women. These findings suggest that replacing sedentary time with light-intensity PA is a public health strategy that could benefit an aging society and warrants further investigation.
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Affiliation(s)
- Michael J. LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | - David M. Buchner
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL, USA
| | | | - Chongzhi Di
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kelley R. Evenson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - John Bellettiere
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Cora E. Lewis
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - I-Min Lee
- Department of Epidemiology, Harvard University, Boston, MA, USA
| | - Lesly F. Tinker
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL, USA
| | - Rebecca Seguin
- Department of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Oleg Zaslovsky
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Charles B. Eaton
- Department of Family Medicine and Epidemiology, Brown University, Providence, RI, USA
| | | | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
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Buchner DM, Rillamas-Sun E, Di C, LaMonte MJ, Marshall S, Hunt J, Zhang Y, Rosenberg D, Lee IM, Evenson KR, Herring AH, Lewis CE, Stefanick ML, LaCroix AZ. Accelerometer-Measured Moderate to Vigorous Physical Activity and Incidence Rates of Falls in Older Women. J Am Geriatr Soc 2017; 65:2480-2487. [PMID: 28755415 PMCID: PMC5681400 DOI: 10.1111/jgs.14960] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine whether moderate to vigorous physical activity (MVPA) measured using accelerometry is associated with incident falls and whether associations differ according to physical function or history of falls. DESIGN Prospective study with baseline data collection from 2012 to 2014 and 1 year of follow-up. SETTING Women's Health Initiative participants living in the United States. PARTICIPANTS Ambulatory women aged 63 to 99 (N = 5,545). MEASUREMENTS Minutes of MVPA per day measured using an accelerometer, functional status measured using the Short Physical Performance Battery (SPPB), fall risk factors assessed using a questionnaire, fall injuries assessed in a telephone interview, incident falls ascertained from fall calendars. RESULTS Incident rate ratios (IRRs) revealed greater fall risk in women in the lowest quartile of MVPA compared to those in the highest (IRR = 1.18, 95% confidence interval = 1.01-1.38), adjusted for age, race and ethnicity, and fall risk factors. Fall rates were not significantly associated with MVPA in women with high SPPB scores (9-12) or one or fewer falls in the previous year, but in women with low SPPB scores (≤ 8) or a history of frequent falls, fall rates were higher in women with lower MVPA levels than in those with higher levels (interaction P < .03 and < .001, respectively). Falls in women with MVPA above the median were less likely to involve injuries requiring medical treatment (9.9%) than falls in women with lower MVPA levels (13.0%) (P < .001). CONCLUSION These findings indicate that falls are not more common or injurious in older women who engage in higher levels of MVPA. These findings support encouraging women to engage in the amounts and types of MVPA that they prefer. Older women with low physical function or frequent falls with low levels of MVPA are a high-risk group for whom vigilance about falls prevention is warranted.
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Affiliation(s)
- David M. Buchner
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Eileen Rillamas-Sun
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chongzhi Di
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo of The State University New York, Buffalo, NY
| | - Stephen Marshall
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Julie Hunt
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yuzheng Zhang
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Dori Rosenberg
- Group Health Research Institute, Group Health Cooperative, Seattle, WA
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kelly R. Evenson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Amy H. Herring
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cora E. Lewis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Marcia L. Stefanick
- Departments of Medicine, and Obstetrics and Gynecology, Stanford University, Palo Alto, CA
| | - Andrea Z. LaCroix
- Department of Preventive and Family Medicine, University of California San Diego, San Diego, CA
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Gray KE, Katon JG, Rillamas-Sun E, Bastian LA, Nelson KM, LaCroix AZ, Reiber GE. Association Between Chronic Conditions and Physical Function Among Veteran and Non-Veteran Women With Diabetes. THE GERONTOLOGIST 2016; 56 Suppl 1:S112-25. [PMID: 26768385 PMCID: PMC5881620 DOI: 10.1093/geront/gnv675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/27/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY To compare the number of chronic conditions among a list of 12 and their association with physical function among postmenopausal non-Veteran and Veteran women with diabetes. DESIGN AND METHODS Among women with diabetes from the Women's Health Initiative, we compared the average number of chronic conditions between non-Veterans and Veterans and the association between total number of chronic conditions on subsequent RAND-36 physical function. To examine associations between each condition and subsequent physical function, we compared women with diabetes plus one chronic condition to women with diabetes alone using linear regression in separate models for each condition and for non-Veterans and Veterans. RESULTS Both non-Veterans (N = 23,542) and Veterans (N = 618) with diabetes had a median of 3 chronic conditions. Decreases in physical function for each additional condition were larger among Veterans than non-Veterans (-6.3 vs. -4.1 points). Decreases in physical function among women with diabetes plus one chronic condition were greater than that reported for diabetes alone for all combinations and were more pronounced among Veterans (non-Veterans: -11.1 to -24.2, Veterans: -16.6 to -40.4 points). Hip fracture, peripheral artery disease, cerebrovascular disease, and coronary disease in combination with diabetes were associated with the greatest decreases in physical function. IMPLICATIONS Chronic conditions were common among postmenopausal women with diabetes and were associated with large declines in physical function, particularly among Veterans. Interventions to prevent and reduce the impact of these conditions and facilitate coordination of care among women with diabetes may help them maintain physical function.
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Affiliation(s)
- Kristen E Gray
- VA Puget Sound Health Care System, Health Services Research & Development, Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle.
| | | | - Eileen Rillamas-Sun
- VA Puget Sound Health Care System, Health Services Research & Development, Seattle, Washington. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven. Division of General Internal Medicine, University of Connecticut Health Center, Farmington
| | - Karin M Nelson
- VA Puget Sound Health Care System, Health Services Research & Development, Seattle, Washington. VA Puget Sound Health Care System, General Internal Medicine Service, Seattle, Washington. Department of Medicine, University of Washington, Seattle
| | - Andrea Z LaCroix
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego
| | - Gayle E Reiber
- VA Puget Sound Health Care System, Health Services Research & Development, Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle. Department of Epidemiology, University of Washington School of Public Health, Seattle
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Washington DL, Bird CE, LaMonte MJ, Goldstein KM, Rillamas-Sun E, Stefanick ML, Woods NF, Bastian LA, Gass M, Weitlauf JC. Military Generation and Its Relationship to Mortality in Women Veterans in the Women's Health Initiative. THE GERONTOLOGIST 2016; 56 Suppl 1:S126-37. [PMID: 26768386 PMCID: PMC5881617 DOI: 10.1093/geront/gnv669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/05/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY Women's military roles, exposures, and associated health outcomes have changed over time. However, mortality risk-within military generations or compared with non-Veteran women-has not been assessed. Using data from the Women's Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women. DESIGN AND METHODS WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation. RESULTS After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09-1.23) for pre-Vietnam and 1.16 (95% CI: 0.99-1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64-5.23). IMPLICATIONS Veterans' higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed.
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Affiliation(s)
- Donna L Washington
- VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, California. University of California Los Angeles, Geffen School of Medicine.
| | - Chloe E Bird
- RAND Corporation, Pardee Rand Graduate School, Santa Monica, California
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo
| | | | | | - Marcia L Stefanick
- Stanford University School of Medicine, Stanford Center for Health Research on Women & Sex Differences in Medicine, California
| | - Nancy F Woods
- Division of Biobehavioral Nursing & Health Systems, University of Washington School of Nursing, Seattle
| | - Lori A Bastian
- VA Connecticut, and University of Connecticut Health Center, West Haven
| | - Margery Gass
- The North American Menopause Society, Mayfield Heights, Ohio
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Innovation to Implementation, California. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California
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Rapp SR, LaCroix AZ, Shumaker SA. Living Long and Living Well: Results from the Women’s Health Initiative. J Gerontol A Biol Sci Med Sci 2015; 71 Suppl 1:S100-2. [DOI: 10.1093/gerona/glv215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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