Weak Grip Strength and Cognition Predict Functional Limitation in Older Europeans

Household Environments and Functional Decline Among Middle-Aged and Older Adults in China: Variations by Gender, Age, and Residence

This study examined the associations between household social, economic, and physical environments and the trajectory of functional limitations over time among middle-aged and older adults in China, and how this relationship differs by gender, age, and residence. Linear growth curve models were applied to a sample of 13,564 respondents aged 45 years and older from four waves of the China Health and Retirement Longitudinal Study (CHARLS 2011-2018). Living alone, particularly for rural, female, and older respondents, was associated with a faster functional decline when compared to living with a spouse and without children. Improved housing quality was associated with a slower functional decline. Living with young descendants and without adult children for urban residents and a lower expenditure per capita for younger respondents were associated with a faster functional decline. These findings suggest that policies aimed at enhancing living conditions have the potential to improve physical functioning of older adults.

Association Between Typologies of Sedentary Behavior and Muscle Strength, Gait Speed, and Balance in Community-Dwelling Older Adults

Knowledge of how the different types of sedentary behaviors (SB) are associated with functional limitations can guide professionals who work with older adults on better recommendations about the amount of daily time that should be encouraged in each type of SB. The objective was to estimate the associations between two SB typologies (SB television [TV] and SB computer/internet) and the presence of handgrip strength, lower limb strength, gait speed, and balance limitations in Brazilian community-dwelling older adults. This is a cross-sectional study with 1,298 community-dwelling older adults (≥60 years). SB was assessed by self-reporting daily time spent watching TV or using computer/internet (categorized into <2, 3-4, and ≥5 hr/day). Outcomes were handgrip strength, lower limb strength, gait speed, and balance limitations considering referenced cutoff points. Older adults in SB TV ≥5 hr/day had 1.75 (95% confidence interval [CI] [1.07, 2.86]) and 1.88 (95% CI [1.02, 3.46]) times more chances of handgrip strength and gait speed limitations, respectively. On the other hand, those who spent 3-4 and ≥5 hr/day in SB computer/internet had 0.45 (95% CI [0.20, 0.99]) and 0.37 (95% CI [0.15, 0.93]) had less chances of lower limb strength and balance limitations, respectively. In conclusion, functional limitations would be associated differently depending on the type of SB in the older adults sampled.

The impact of critical illness on patients' physical function and recovery: An explanatory mixed-methods analysis

OBJECTIVES

To determine how the perception of physical function 6-months following critical illness compares to objectively measured function, and to identify key concerns for patients during recovery from critical illness.

RESEARCH METHODOLOGY AND DESIGN

A nested convergent parallel mixed methods study assessed physical function during a home visit 6-months following critical illness, with semi-structured interviews conducted at the same time.

SETTING

Participants were recruited from two hospitals at one healthcare network in Melbourne, Australia from September 2017 to October 2018 with follow-up data completed in April 2019.

MAIN OUTCOME MEASURES

Physical function was assessed through four objective outcomes: the functional independence measure, six-minute walk test, functional reach test, and grip strength. Semi structured interviews focused on participants function, memories of the intensive care and hospital stay, assistance required on discharge, ongoing limitations, and the recovery process.

FINDINGS

Although many participants (12/20, 60%) stated they had recovered from their critical illness, 14 (70%) had function below expected population norms. Decreased function on returning home was commonly reported, although eleven participants were described as independent and safe for discharge from hospital-based staff. The importance of family and social networks to facilitate discharge was highlighted, however participants often described wanting more support and issues accessing services. The effect of critical illness on the financial well-being of the family network was confirmed, with difficulties accessing financial support identified.

CONCLUSION

Survivors of critical illness perceived a better functional state than measured, but many report new limitations 6-months after critical illness. Family and friends play a crucial role in facilitating transition home and providing financial support.

IMPLICATIONS FOR CLINICAL PRACTICE

Implementation of specific discharge liaison personnel to provide education, support and assist the transition from hospital-based care to home, particularly in those without stable social supports, may improve the recovery process for survivors of critical illness.

The relationship between handgrip strength and cognitive function among older adults in China: Functional limitation plays a mediating role

BACKGROUND

The deterioration of cognitive function with age has become a major public health issue. To date, the underlying mechanisms of the association between handgrip strength and cognitive function were poorly understood. This study aimed to examine the mediating effect of functional limitation in the longitudinal relationship between handgrip strength and subsequent cognitive function.

METHODS

This research recruited 4416 participants aged 60 and above from wave 2015 and 2018 of the China Longitudinal Study of Health and Retirement (CHARLS). We conducted the linear regression model and bootstrap analyses to test the mediating role of functional limitation in the relationship between handgrip strength and cognitive function.

RESULTS

After adjusting the confounders, handgrip strength was positively associated with subsequent cognitive function (β = 0.12, P < 0.001) and was negatively associated with functional limitation (β = -0.14, P < 0.001). The mediation effect of functional limitation accounted for 23.33 % of the total effect regarding the handgrip strength with cognitive function, and the magnitude of mediation effect was a*b = 0.021 (95%CI: 0.017-0.027).

LIMITATIONS

The variable of functional limitations was self-reported. And this study did not analyse the severity and duration of handgrip strength loss and functional limitations, which may lose some information.

CONCLUSIONS

Our findings revealed that handgrip strength not only directly influenced cognitive function among older individuals but also indirectly via functional limitation over 3-year follow-up. Physical exercise targeting handgrip strength and functional limitation may be an effective approach to prevent and delay cognitive decline.

Trajectories and contributing factors of neural compensation in healthy and pathological aging

Neural degeneration is a hallmark of healthy aging and can be associated with specific cognitive impairments. However, neural degeneration per se is not matched by unremitting declines in cognitive abilities. Instead, middle-aged and older adults typically maintain surprisingly high levels of cognitive functioning, suggesting that the human brain can adapt to structural degeneration by neural compensation. Here, we summarize prevailing theories and recent empirical studies on neural compensation with a focus on often neglected contributing factors, such as lifestyle, metabolism and neural plasticity. We suggest that these factors moderate the relationship between structural integrity and neural compensation, maintaining psychological well-being and behavioral functioning. Finally, we discuss that a breakdown in neural compensation may pose a tipping point that distinguishes the trajectories of healthy vs pathological aging, but conjoint support from psychology and cognitive neuroscience for this alluring view is still scarce. Therefore, future experiments that target the concomitant processes of neural compensation and associated behavior will foster a comprehensive understanding of both healthy and pathological aging.

Relationship between functional limitations due to subjective cognitive decline and falling focusing exercise intensity: Results from the Korean Community Health Survey

Background

To explore the association between functional limitation due to subjective cognitive decline (SCD) and falling by focusing on exercise intensity in the Korean population aged 45 years and older.

Study Design

The 2019 Korean Community Health Survey (KCHS) was used to analyze 35,387 people by applying individual weights imposed from the raw data.

Methods

To analyze the association between functional limitation due to SCD and falling in the Korean population aged 45 years and older, weighted logistic regression analysis and weighted zero-inflated Poisson regression analysis were used.

Results

In both the middle-aged group and the older adult group, the functional limitation due to SCD had a higher fall experience rate and more falls than the non-functional limitation due to SCD group. Additionally, the middle-aged group and the moderate or vigorous physical exercise (MVPE) group had a higher fall experience rate and number of falls than the non-MVPE group; however, the older adult group walking regularly and performing MVPE had a lower fall experience rate and number of falls than the non-exercise group.

Conclusions

Active participation in exercise is encouraged and should lead to fewer falls in older adults. Furthermore, a group with functional limitations due to SCD should be provided with exercise guidelines and a community program and facilities that enable regular participation should be developed.

Thigh and Calf Myosteatosis are Strongly Associated with Muscle and Physical Function in African Caribbean Men

BACKGROUND

African Caribbeans have higher levels of myosteatosis than other populations; however, little is known about the impact of myosteatosis on physical function in African Caribbeans. Herein, we examined the association between regional myosteatosis of the calf, thigh, and abdomen versus physical function in 850 African-Ancestry men aged 64.2 ± 8.9 (range 50-95) living on the Caribbean Island of Tobago.

METHODS

Myosteatosis was measured using computed tomography and included intermuscular adipose tissue (IMAT) and muscle density levels of the thigh, calf, psoas, and paraspinous muscles. Outcomes included grip strength, time to complete 5 chair-rises, and 4-meter gait speed. Associations were quantified using separate linear models for each myosteatosis depot and were adjusted for age, height, demographics, physical activity, and chronic diseases. Beta coefficients were presented per standard deviation of each myosteatosis depot.

RESULTS

Higher thigh IMAT was the only IMAT depot significantly associated with weaker grip strength (β = -1.3 ± 0.43 kg, p = .003). However, lower muscle density of all 4 muscle groups was associated with weaker grip strength (all p < .05). Calf and thigh myosteatosis (IMAT and muscle density) were significantly associated with both worse chair rise time and gait speed (all p < .05), whereas psoas IMAT and paraspinous muscle density were associated with gait speed.

CONCLUSION

Myosteatosis of the calf and thigh-but not the abdomen-were strongly associated with grip strength and performance measures of physical function in African Caribbean men. However, posterior abdominal myosteatosis may have some utility when abdominal images are all that are available.

Combination of gait speed and grip strength to predict cognitive decline and dementia

Introduction

To determine whether slowed gait and weakened grip strength independently, or together, better identify risk of cognitive decline or dementia.

Methods

Time to walk 3 meters and grip strength were measured in a randomized placebo-controlled clinical trial involving community-dwelling, initially cognitively healthy older adults (N = 19,114).

Results

Over a median 4.7 years follow-up, slow gait and weak grip strength at baseline were independently associated with risk of incident dementia (hazard ratio [HR] = 1.44, 95% confidence interval [CI]: 1.19-1.73; and 1.24, 95% CI: 1.04-1.50, respectively) and cognitive decline (HR = 1.38, 95% CI: 1.26-1.51; and 1.04, 95% CI: 0.95-1.14, respectively) and when combined, were associated with 79% and 43% increase in risk of dementia and cognitive decline, respectively. Annual declines in gait and in grip over time showed similar results.

Discussion

Gait speed and grip strength are low-cost markers that may be useful in the clinical setting to help identify and manage individuals at greater risk, or with early signs, of dementia, particularly when measured together.

Highlights

Grip strength and gait speed are effective predictors and markers of dementia.Dementia risk is greater than cognitive decline risk with declines in gait or grip.Decline in gait speed, more so than in grip strength, predicts greater dementia risk.Greater risk prediction results from combining grip strength and gait speed.

Lower grip strength and insufficient physical activity can increase depressive symptoms among middle-aged and older European adults: a longitudinal study

Objectives

The present study aimed to identify the gender-specific trajectories of grip strength using group-based trajectories, explore the interaction between grip strength and physical activity on depression, and investigate the association of physical activity with the change in depression by different grip strength groups among middle-aged and older European adults.

Methods

A total of 14,098 participants aged 50 years or older from the Survey of Health, Ageing and Retirement in Europe 2007–2019 were included in this study. Group-based trajectory modeling was used to identify the low, middle and high group of grip strength by gender. Generalized estimated equations were fitted to analyze the interaction effect. The data of wave 2-wave 5 and wave 2-wave 7 were chosen to conduct sensitivity analyses.

Results

Significant interactions between grip strength group and physical inactivity were found (x²_interaction = 11.16, P = 0.004). Significant interactions between physical inactivity and time on depression were identified in low (x²_interaction = 27.83, P < 0.001) and moderate (x²_interaction = 23.67, P < 0.001) grip strength, but a similar result was not found in high grip strength (x²_interaction = 4.39, P = 0.495). Participants in the physical inactivity group had higher depression scores in the low and moderate grip strength groups. Sensitivity analyses yield almost similar results.

Conclusions

Grip strength and physical inactivity interact with depression. Lower grip strength and insufficient physical activity can increase depressive symptoms. People with lower grip strength and physical inactivity should pay special attention to the prevention of depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03392-x.

Association Between Grip Strength and Cognitive Function in US Older Adults of NHANES 2011–2014

Background: The relationship between grip strength and cognitive function remains no consensus in the older adults. Objective: To investigate the association of grip strength with cognitive function and cognitive performance in different domains. Methods: Participants of the present cross-sectional study were from the National Health and Nutrition Examination Survey 2011-2014. Grip strength was measured by grip dynamometer, and combined handgrip strength was the sum of the largest reading from each hand. Four cognitive domains (immediate and delayed memory, language, and attention) were assessed by a set of neuropsychological tests. The subjective cognitive decline was determined via self-report. Results: Among 2,618 participants, combined grip strength was positively associated with scores on global cognitive function and each cognitive domain after controlling for demographic characteristics, lifestyle factors, and history of disease. In addition, compared to those with grip strength <  46.7 kg, participants with grip strength≥75.3 kg had odds ratios of 0.36 (95% CI: 0.21 to 0.63) for poor global cognitive function, 0.66 (95% CI: 0.38 to 1.13) for poor immediate memory, 0.53 (95% CI: 0.30 to 0.93) for poor delayed memory, 0.48 (95% CI: 0.27 to 0.86) for poor language function, 0.20 (95% CI: 0.11 to 0.35) for poor attention, and 0.36 (95% CI: 0.18 to 0.73) for subjective cognitive decline in fully adjusted model. Conclusion: Older adults with higher grip strength were significantly associated with better performance on cognition function included global and various domains such as memory, language, attention, and subjective cognitive decline.

The Influence of Interpersonal Behaviors and Population Density on Grip Strength of Elderly People: An Analysis of the Direct vs. Indirect Effects via Social Participation

The impact of social participation (SP) on the health of the elderly has been widely recognized, and urban-rural differences in social participation have attracted attention. However, few studies discussed the impact of social participation on specific health indicators and the further subdivision of urban-rural differences. This research aims to use the dimensions of interpersonal behaviors and population density rather than simple urban-rural distinctions to justify community differences and compare these differences' direct and indirect effects on grip strength. This study used 15,871 respondents aged over 50 years from the China Health and Retirement Longitudinal Study (CHARLS). An SEM (Structural Equation Modeling) analysis was used to explore the joint effect of interpersonal behavior and population density on social participation and the consequent impact on changes in grip strength and compare the differences among different genders, ages, wealth levels, and family relationships. The results indicated that community differences characterized by interpersonal behavior and population density have direct effects on grip strength and indirect effects on it through social participation. The conclusion is that the frequency of social activities, such as mah-jong and dancing in the Metropolitan Fringe and county-level cities is higher than that in Metropolitan centers. The high frequency of these activities has a positive and indirect impact on grip strength, and community differences have a more significant impact on women's social participation than men. However, the direct effect of community differences as defined by interpersonal communication and population density on grip strength is greater than the indirect effect of other factors through social participation.

Predicting cognitive function based on physical performance: findings from the China Health and Retirement Longitudinal Study

BACKGROUND

Physical performance tests are simple means of predicting an individual's risk of cognitive decline.

AIMS

This study aimed to assess the predictive value of physical performance tests and develop predictive models for cognitive function.

METHODS

Cognitive function was tested biennially and calculated for mental intactness, episodic memory, and global cognition. Using a generalized estimating equation (GEE), we examined each baseline physical performance test as a predictor of cognitive decline. Using a multivariate linear regression model (MLRM), we developed predictive models for cognitive function. Bland-Altman analysis was performed to analyze the agreement between estimated and measured cognition. We validated the predictive model internally with 1000 bootstrap resamples.

RESULTS

Better physical performance test results, except for standing balance, were associated with a slower cognitive decline over time and better cognitive function at follow-up. Regarding the predictive models, all physical performance tests were included in men; only five chair stands test was included in women. Bland-Altman analysis showed that measured cognition was equivalent to estimated cognition in men (mean bias, 0; 95% limits of agreement, - 8.56 to 8.56) and women (mean bias, 0; 95% limits of agreement - 8.79 to 8.7). Bootstrap analysis showed that predictors were selected in 78.4-100% for men and 64.5-100% for women.

DISCUSSION

Bland-Altman and bootstrap analysis demonstrated good agreement and stability of the predictive models.

CONCLUSIONS

Physical performance tests are simple, easily obtainable, and clinically relevant markers for cognitive function with aging; predictive models based on physical performance can be used to predict cognitive function.

Spousal Concordance in the Development of Functional Limitations Among Married Adults in China

IMPORTANCE

Functional limitation is increasingly common as people age and is often associated with negative consequences. Evidence of the dynamics of functional limitation within couples in China is still inadequate.

OBJECTIVES

To examine whether functional limitation was associated within middle-aged and older couples and to explore sex differences in spousal associations.

DESIGN, SETTING, AND PARTICIPANTS

In this nationwide, population-based cohort study performed from January 1, 2011, to December 31, 2018, participants were selected using multistage probability sampling, and 5207 community-dwelling couples (10 414 individuals) 45 years or older were included in the nationally representative China Health and Retirement Longitudinal Study. Data analysis was performed from January 1 to February 28, 2021.

EXPOSURES

The exposure variable was the presence of functional limitation in spouses. Functional limitation was measured by the activities of daily living (ADLs) and instrumental activities‎ of daily ‎living (IADLs) scales and was defined as having difficulty in independently performing at least 1 ADL or IADL item.

MAIN OUTCOMES AND MEASURES

The main outcome was functional limitation in index participants. Multivariable logistic regression with generalized estimating equations was used to estimate the reciprocal association of functional limitation within couples over time.

RESULTS

A total of 5207 married, different-sex couples (mean [SD] age, 59.1 [8.8] years for husbands and 57.0 [8.2] years for wives) were included in the study. For husbands, the number (percentage) of participants classified with baseline functional limitation was 1140 (21.9%), the number (percentage) with ADL limitation was 684 (13.1%), and the number (percentage) with IADL limitation was 834 (16.0%). For wives, the number (percentage) of participants classified with baseline functional limitation was 1502 (28.8%), the number (percentage) with ADL limitation was 887 (17.0%), and the number (percentage) with IADL limitation was 1183 (22.7%). Longitudinal results demonstrated an association in spouses developing functional limitation (adjusted odds ratio [OR], 2.55; 95% CI, 2.41-2.69; P < .001), ADL limitation (adjusted OR, 2.26; 95% CI, 2.11-2.41; P < .001), and IADL limitation (adjusted OR, 2.58; 95% CI, 2.43-2.73; P < .001). Subgroup analyses by sex revealed similar patterns of spousal health concordance in terms of all studied outcomes, indicating no sex specificity.

CONCLUSIONS AND RELEVANCE

This population-based cohort study suggests that among Chinese middle-aged and older couples there is significant concordance in the development of functional limitation. This study of spousal functional ability from a dyadic perspective may help in the understanding of health risks within a wider familial context and offers novel insights for prioritizing policy focus from individual centered to couple based.

Association of lung function with functional limitation in older adults: A cross-sectional study

INTRODUCTION

Impaired lung function is independently associated with higher rates of disability, however, few studies have examined the association between lung function and functional limitation. This study aimed to assess this association and dose-response relationship in older adults.

METHODS

Data from the National Health and Nutrition Examination Survey (2007-2012) was used as a cross-sectional study. Lung function was determined by Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Functional limitation in older adults was identified by six self-reported questions on physical function. 3070 adults aged 60 and over were enrolled in our study. Logistic regression models and restricted cubic spline models were applied to examine the association between lung function and the risk of functional limitation.

RESULTS

FEV1 and FVC were inversely associated with the risk of functional limitation. In the full adjusted model, compared with the lowest tertile of FEV1, the odds ratios (95% confidence intervals) of functional limitation for tertile 2 and tertile 3 were 0.5422 (0.3848-0.7639) and 0.4403 (0.2685-0.7220), and the odds ratios (95% confidence intervals) of functional limitation for tertile 2 and tertile 3 of FVC were 0.5243 (0.3503-0.7848) and 0.3726 (0.2072-0.6698). Furthermore, an inverse association persisted after stratified analysis by gender and sensitivity analysis. Dose-response analyses showed that the odds of functional limitation declined with increase in FEV1 and FVC in a nonlinear manner.

CONCLUSIONS

Lung function was inversely associated with functional limitation among older adults.

Association between coffee consumption and functional disability in older US adults

The effect of coffee consumption on functional disability has been scarcely investigated. Thus, this study aimed to examine the association between coffee consumption and functional disability in older American adults. Participants (≥60 years old, n 7704) were from the National Health and Nutrition Examination Survey 2007-2016. Coffee consumption was assessed through two 24-h dietary recall interviews. Five domains of functional disability including lower extremity mobility (LEM), general physical activity (GPA), leisure and social activities (LSA), activities of daily living (ADL) and instrumental activities of daily living (IADL) were self-reported. Age- and multivariate-adjusted logistic regression models and restricted cubic spline analyses were used. Total coffee consumption was inversely associated with LEM, GPA, LSA and IADL disability. Compared with non-drinkers of total coffee, those who consumed ≥2 cups/d reported lower odds of LEM (OR 0·67, 95 % CI 0·50, 0·91), GPA (OR 0·65, 95 % CI 0·47, 0·88), LSA (OR 0·61, 95 % CI 0·45, 0·83) and IADL (OR 0·59, 95 % CI 0·44, 0·78) disability. The dose-response analyses confirmed these relationships. Intake of ≥2 cups/d caffeinated coffee was also inversely linked to GPA (OR 0·67, 95 % CI 0·48, 0·92), LSA (OR 0·66, 95 % CI 0·46, 0·93) and IADL (OR 0·57, 95 % CI 0·43, 0·75) disability, whereas the inverse association of 2+ cups/d decaffeinated coffee was only on LEM (OR 0·43, 95 % CI 0·23, 0·81) and LSA (OR 0·39, 95 % CI 0·16, 0·94) disability. The present study suggested that coffee consumption was inversely associated with functional disability in older American adults. Those associations of diverse coffee types differed across domains of functional disability.

Pain management and cognitive function among older adults: an exploratory study of the China Health and Retirement Longitudinal Study

BACKGROUND

Chronic pain and cognitive decline are common age-related conditions affecting a large segment of older populations. Little is known about the pathway of cognitive functioning during the course of pain management in older adults.

AIMS

The study aimed to examine the association between chronic body pain management and cognitive function over time among Chinese older adults.

METHODS

A total of 792 respondents aged 60 and above from urban and rural households in 28 provinces, 150 counties/districts, and 450 communities were selected from the China Health and Retirement Longitudinal Study (2013-2015). Cognitive function was measured in three domains: episodic memory, mental status, and global cognitive function. Difference-in-differences approach and mixed-effects linear regression models were employed to assess the association between chronic body pain management and cognitive function over time.

RESULTS

Scores of mental status were found to decline slower by 0.49 unit (SE = 0.22, p < 0.05) in respondents who received pain management using analgesics, complementary and alternative medicine, or both from 2013 to 2015 after controlling for basic demographic and health confounders.

CONCLUSION

Chronic pain management was associated with slower decline in domain-specific cognitive function, mental status over time. Findings of the study may contribute to understanding the mechanism of change in diverse cognitive abilities attributable to pain symptoms. More research is needed to elucidate the mediating effect of pain on cognitive decline, which could lead to testing of the impact of pain management on cognitive function among older population in both clinical and community settings.

Effects of Handgrip Strength on 10-Year Cardiovascular Risk among the Korean Middle-Aged Population: The Korea National Health and Nutrition Examination Survey 2014

Handgrip strength is a simple, inexpensive health status indicator and can be used to assess mortality rate and cardiovascular disease (CVD) risk. This study used data from the Sixth Korea National Health and Nutrition Examination Survey (2014) to determine the effective use of handgrip strength to predict CVD risk. We analyzed data from 2427 adults aged from 40 to 64 years without CVD at baseline. Relative handgrip strength was calculated as the sum of the maximal absolute handgrip strength of both hands divided by body mass index, and the 10-year risk of CVD was calculated using the Framingham risk score. We performed logistic regression analysis to assess the association between handgrip strength and 10-year CVD risk. Results showed that CVD risk increased with age (95% CI: 1.19–1.33, p < 0.001). Men were 38.05 times more likely to develop CVD than women (95% CI: 15.80–91.58, p < 0.001). Every increase by 1 in handgrip strength reduced the 10-year CVD risk by 1.76 times (95% CI: 1.58–3.71, p < 0.001), and when waist-to-height ratio was <0.50, the CVD risk decreased by 3.3 times (95% CI: 0.16–0.56, p < 0.001). Developing specific modifications and improving lifestyle habits that could lead to increased handgrip strength and reduced obesity, which could prevent CVD, is recommended.

The association between Dietary Inflammatory Index and disability in older adults

BACKGROUND & AIMS

The impact of the potential inflammatory effect of diet on disability has not been adequately investigated. We examined the association of Dietary Inflammatory Index (DII) on disability in older American adults and detected if these associations differed by stratification across sex and body mass index (BMI) level.

METHODS

Data were from the National Health and Nutrition Examination Survey (2007-2016). DII scores were calculated through two 24-h dietary recall interviews. Disability including functional limitations and activities of daily living (ADL) limitations were self-reported. The associations of DII scores on functional limitations and ADL limitations were evaluated by age-sex and multivariable adjusted logistic regression models and further stratification of these associations by sex and BMI level. Restricted cubic splines analyses were used to assess the shapes of these associations.

RESULTS

A total of 6893 participants aged 60 years and above were eligible for this study. DII was related to higher odds of functional limitations. Compared to the lowest quintile of DII scores, the odds ratio (OR) for participants in the second, third, fourth, and highest quintile were 1.61 (95%CI:1.20-2.15), 1.42(95%CI:1.09-1.85), 1.51 (95%CI:1.09-2.09) and 1.97 (95%CI:1.37-2.82) for functional limitations (P-trend = 0.003). The positive associations between DII scores and functional limitations were observed both in men and women. The corresponding ORs (95%CI) across all quintiles were 1.68(1.07-2.66), 1.54(1.06-2.25), 2.03(1.18-3.47), 2.11(1.19-3.74) in men (P-trend = 0.008) and 1.52(1.03-2.27), 1.32(0.86-2.02), 1.24(0.81-1.90), 1.74(1.11-2.73) in women (P-trend = 0.089). In the stratified analyses by BMI level, comparing the lowest quintiles, the corresponding ORs of functional limitations in second, third, fourth, and fifth quintiles were 2.71 (95% CI: 1.57-4.68), 2.39(95% CI: 1.38-4.11), 2.34(95% CI: 1.31-4.19), 2.54(95% CI: 1.25-5.13) in overweight (P-trend = 0.019) and 1.32(95% CI: 0.81-2.15), 1.17(95% CI: 0.71-1.92), 1.33(95% CI: 0.77-2.30), 2.15(95% CI: 1.19-3.87) in obesity (P-trend = 0.032).

CONCLUSIONS

The results provide evidence of a positive association between DII score and functional limitations in American older adults, especially participants with overweight and obesity.

Associations between Multimorbidity and Physical Performance in Older Chinese Adults

Background: Evidence on the association between physical performance and multimorbidity is scarce in Asia. This study aimed to identify multimorbidity patterns and their association with physical performance among older Chinese adults. Methods: Individuals aged ≥60 years from the China Health and Retirement Longitudinal Study 2011-2015 (N = 10,112) were included. Physical performance was measured by maximum grip strength (kg) and average gait speed (m/s) categorized as fast (>0.8 m/s), median (>0.6-0.8 m/s), and slow (≤0.6 m/s). Multimorbidity patterns were explored using exploratory factor analysis. Generalized estimating equation was conducted. Results: Four multimorbidity patterns were identified: cardio-metabolic, respiratory, mental-sensory, and visceral-arthritic. An increased number of chronic conditions was associated with decreased normalized grip strength (NGS). Additionally, the highest quartile of factor scores for cardio-metabolic (β = -0.06; 95% Confidence interval (CI) = -0.07, -0.05), respiratory (β = -0.03; 95% CI = -0.05, -0.02), mental-sensory (β = -0.04; 95% CI = -0.05, -0.03), and visceral-arthritic (β = -0.04; 95% CI = -0.05, -0.02) patterns were associated with lower NGS compared with the lowest quartile. Participants with ≥4 chronic conditions were 2.06 times more likely to have a slow gait speed. Furthermore, the odds ratios for the highest quartile of factor scores of four patterns with slow gait speed compared with the lowest quartile ranged from 1.26-2.01. Conclusion: Multimorbidity was related to worse physical performance, and multimorbidity patterns were differentially associated with physical performance. A shift of focus from single conditions to the requirements of a complex multimorbid population was needed for research, clinical guidelines, and health-care services. Grip strength and gait speed could be targeted to routinely measure clinical performance among older adults with multimorbidity, especially mental-sensory disorders, in clinical settings.

A Prospective Study on the Association Between Grip Strength and Cognitive Function Among Middle-Aged and Elderly Chinese Participants

Objective

To study the efficacy of grip strength (GS) as a predictor of cognitive function in a large, nationwide sample of Chinese participants aged 45 years and above.

Methods

We used data from three waves (W1, W2, and W3) fielded by the China Health and Retirement Longitudinal Study (CHARLS). Cognitive function was tested biennially and calculated using two categories: episodic memory and mental intactness. Demographics, health behaviors, and medical conditions were considered potential confounders. Using multivariate linear regression models (MLRMs), we examined the association between baseline GS (measure in W1) and cognitive function in W3. Using a generalized estimating equation (GEE), we examined baseline GS as a predictor of cognitive function change.

Results

Total 9,333 individuals (53.2% women), with a mean baseline episodic memory score of 6.5, mean baseline mental intactness score of 7.2, and aged over 45 years (mean age = 58.6), were selected. The mean follow-up time was 4.0 years (range: 3.3–5.0 years). Using MLRMs and comparing the lowest GS score with the highest baseline GS score, we observed a significant correlation with a higher global cognitive function in both women (β = 1.061, p < 0.001) and men (β = 1.233, p < 0.001). After adjusting baseline global cognition, the highest GS level was still statistically significant in both women (β = 0.543, p < 0.05) and men (β = 0.742, p < 0.001). GEE suggested that the participants in the highest GS quartile had better cognitive performance over time in both women (β = 0.116, p = 0.030) and men (β = 0.143, p = 0.008) than those in the lowest quartile.

Conclusion

Higher baseline level of GS was significantly related to better cognitive function and slowed the rate of its decline. Thus, it is an independent predictor of better cognitive status in middle-aged and elderly Chinese.

Alcohol Consumption and Functional Limitations in Older Men: Does Muscle Strength Mediate Them?

OBJECTIVES

To evaluate the dose-response relationships between alcohol consumption and functional limitations in older European men, and explore the role of muscle strength as a mediator of these relationships.

DESIGN

Cross-sectional study of older men participating in the Survey of Health, Aging and Retirement in Europe (SHARE).

SETTING

Urban and rural households in 17 European countries and Israel.

PARTICIPANTS

A total of 17 870 men aged 65 years and older from the SHARE (Wave 6, 2015) were included in this study.

MEASUREMENTS

Outcome variables were functional limitations: mobility limitation, arm function limitation, and fine motor limitation. Main exposure variable was alcohol consumption. Mediating factor was grip strength. Basic demographics, life habits, and health status were considered as potential confounders. Dose-response analyses with restricted cubic splines and the Karlson/Holm/Breen method were conducted.

RESULTS

A total of 17 870 participants were included in this study. Dose-response analyses revealed that moderate alcohol consumption was related to the lower odds of reporting mobility limitation (≤35 units/wk) and arm function limitation (≤41 units/wk), with a minimum odds ratio (OR) occurring at 10 units/week drinks for mobility limitation (OR = .71; 95% confidence interval [CI] = .62-.81) and arm function limitation (OR = .66; 95% CI = .59-.75). The odds of reporting the fine motor limitation monotonically increased with alcohol consumption when alcohol consumption was beyond 15 units/week. No significant mediating effect of grip strength on the relationships between alcohol consumption and mobility limitation and arm function limitation was found.

CONCLUSION

Moderate alcohol consumption has a protective role in mobility and arm function limitation in older European men. Grip strength is not the main mediator of these associations, suggesting that the protective effect is independent of muscle strength. Alcohol consumption is associated with higher odds of reporting fine motor limitation in older European men. J Am Geriatr Soc 67:2331-2337, 2019.

Age modify the associations of obesity, physical activity, vision and grip strength with functional mobility in Irish aged 50 and older

OBJECTIVE

To estimate whether the associations of obesity, physical activity, vision and grip strength with functional mobility were modified by age.

METHODS

Data from The Irish Longitudinal Study on Ageing (2009-2012) were analyzed and 5001 individuals were included in this study. Mobility was assessed by the timed up and go test (TUG-test). Main exposure variables were obesity, physical activity, visual acuity and grip strength at baseline. Multiple linear regression models were fitted to assess the associations of baseline main exposure variables with 2-year follow-up functional mobility and potential confounders were adjusted. Stratified analyses by age were used to assess the interaction between main exposures and age on functional mobility.

RESULTS

Multiple linear regression models identified significant interactions of obesity (P < 0.001), vigorous physical activity (P = 0.001), vision (P < 0.001) and grip strength (P < 0.001) with age on functional mobility. Stratified analyses suggested that the risk effect of obesity on functional mobility was greater in middle-aged group (β = 0.025, P < 0.001) than in older group (β = 0.016, P = 0.017). The protective effects of high level of physical activity and grip strength on functional mobility were stronger in older group (β = -0.023, P = 0.004 for physical activity; β = -0.002, P < 0.001 for grip strength) than in middle-aged group (β = -0.012, P = 0.008 for physical activity; β = -0.0015, P < 0.001 for grip strength). The benefit of better vision on functional mobility was observed in middle-aged group only (β = -0.032, P = 0.002).

CONCLUSION

Non-obesity, higher level of physical activity, vision and grip strength at baseline were associated with better mobility performance among middle-aged and older Irish. And these associations were modified by age.