Socioeconomic differences in the benefits of structured physical activity compared with health education on the prevention of major mobility disability in older adults: the LIFE study

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

OBJECTIVE

To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.

DATA SOURCES

PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.

STUDY SECTION

Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.

DATA EXTRACTION

The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.

DATA SYNTHESIS

Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.

CONCLUSIONS

Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.

Low paraspinal lean muscle mass is an independent predictor of adjacent vertebral compression fractures after percutaneous kyphoplasty: A propensity score–matched case-control study

Background

To investigate the relationship between paraspinal lean muscle mass and adjacent vertebral compression fracture (AVCF) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF).

Methods

The data of 272 patients who underwent two consecutive single-level PKP in our hospital from January 2017 to December 2019 were collected. 42 patients who met the inclusion and exclusion criteria were selected as AVCF group, and 42 propensity score-matched patients were selected as control group. There were 10 males and 32 females in each group; the ages were 75.55 ± 5.76 years and 75.60 ± 5.87 years, respectively. All patients underwent preoperative lumbar MRI. The total cross-sectional area (CSA), functional cross-sectional area (FCSA), cross-sectional area of vertebra index (CSA-VI), functional cross-sectional area of vertebra index (FCSA-VI) of the multifidus (MF), erector spinae (ES), psoas (PS), and paravertebral muscles (PVM) were measured. Other related parameters included preoperative bone mineral density (BMD), kyphotic angle (KA), anterior-to-posterior body height ratio (AP ratio), vertebral height restoration, and cement leakage into the disc. Logistic regression analysis was performed to find independent risk factors for AVCF using the parameters that were statistically significant in univariate analysis.

Results

At L3 and L4 levels, the mean CSA, FCSA, and FCSA-VI of MF, ES, PVM and PS were significantly lower in the AVCF group. DeLong test indicated that the AUC of ES (0.806 vs. 0.900) and PVM (0.861 vs. 0.941) of FCSA-VI at L4 level were significantly greater than L3 level. In the AVCF group, patients had a significantly lower BMD (93.55 ± 14.99 HU vs. 106.31 ± 10.95 HU), a greater preoperative KA (16.02° ± 17.36° vs. 12.87° ± 6.58°), and a greater vertebral height restoration rate (20.4% ± 8.1% vs. 16.4% ± 10.0%, p = 0.026). Logistic regression analysis showed that PVM with lower FCSA-VI at L4 level (OR 0.830; 95% CI 0.760–0.906) and lower BMD (OR 0.928; 95% CI 0.891–0.966) were independent risk factors for AVCF after PKP.

Conclusions

Low paraspinal lean muscle mass is an independent risk factor for AVCF after PKP. Surgeons should pay attention to evaluate the status of paraspinal muscle preoperatively. Postoperative reasonable nutrition, standardized anti-osteoporosis treatment, and back muscle exercise could reduce the incidence of AVCF.

Skeletal muscle atrophy: From mechanisms to treatments

Skeletal muscle is a crucial tissue for movement, gestural assistance, metabolic homeostasis, and thermogenesis. It makes up approximately 40% of the total body weight and 50% of total protein. However, several pathological abnormalities (e.g., chronic diseases, cancer, long-term infection, aging) can induce an imbalance in skeletal muscle protein synthesis and degradation, which triggers muscle wasting and even leads to atrophy. Skeletal muscle atrophy is characterized by weakening, shrinking, and decreasing muscle mass and fiber cross-sectional area at the histological level. It manifests as a reduction in force production, easy fatigue and decreased exercise capability, along with a lower quality of life. Mechanistically, there are several pathophysiological processes involved in skeletal muscle atrophy, including oxidative stress and inflammation, which then activate signal transduction, such as the ubiquitin proteasome system, autophagy lysosome system, and mTOR. Considering the great economic and social burden that muscle atrophy can inflict, effective prevention and treatment strategies are essential but still limited. Exercise is widely acknowledged as the most effective therapy for skeletal muscle atrophy; unfortunately, it is not applicable for all patients. Several active substances for skeletal muscle atrophy have been discovered and evaluated in clinical trials, however, they have not been marketed to date. Knowledge is being gained on the underlying mechanisms, highlighting more promising treatment strategies in the future. In this paper, the mechanisms and treatment strategies for skeletal muscle atrophy are briefly reviewed.

A retrospective on fundamental cause theory: State of the literature, and goals for the future

Fundamental Cause Theory (FCT) was originally proposed to explain how socioeconomic inequalities in health emerged and persisted over time. The concept was that higher socioeconomic status helped some people to avoid risks and adopt protective strategies using flexible resources - knowledge, money, power, prestige and beneficial social connections. As a sociological theory, FCT addressed this issue by calling on social stratification, stigma, and racism as they affected medical treatments and health outcomes. The last comprehensive review was completed a decade ago. Since then, FCT has been tested, and new applications have extended central features. The current review consolidates key foci in the literature in order to guide future research in the field. Notable themes emerged around types of resources and their usage, approaches used to test the theory, and novel extensions. We conclude that after 25 years of use, there remain crucial questions to be addressed.

Socioeconomic disparities in health: Changes in sleep quality and inflammation during bereavement

Widow(er)s experience significant sleep disruption that may dysregulate immune functioning. This longitudinal study aimed to determine 1) whether changes in sleep quality were associated with changes in pro-inflammatory cytokine production during the first six months of bereavement and 2) whether these relationships depended on objective socioeconomic status (SES) and/or subjective social status. One hundred and six bereaved spouses (M ​= ​68.49 years, SD ​= ​9.35, 69 females) completed the following assessments at approximately three months post-death and six-month post-death: a venous blood draw and self-report questionnaires on sleep quality (Pittsburgh Sleep Quality Index), SES (MacArthur Sociodemographic Questionnaire), health, and demographic information. T-cell stimulated pro-inflammatory cytokines were assessed, including IL-6, TNF-α, IFN-γ, IL-17A, and IL-2. Worsening sleep quality was associated with increased levels of pro-inflammatory activity even after adjusting for confounding variables. The present study also identified SES as an important factor for understanding health following spousal bereavement: individuals with low SES were more susceptible to sleep-related changes in immune function. Compared to more educated widow(er)s, less educated widow(er)s showed greater increases and decreases in inflammation when sleep quality worsened or improved, respectively, over time. Findings provide evidence for a biobehavioral pathway linking bereavement to disease risk, highlight SES disparities in late adulthood, and identify individuals who may require tailored interventions to offset SES-related burden that impedes adaptive grief recovery.

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Changes in sleep quality are associated with changes in inflammation in widow(er)s.

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Proinflammatory cytokine levels increase as sleep quality worsens in widow(er)s.

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Low SES widow(er)s are susceptible to sleep-related changes in inflammation.

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Socioeconomic disparities in biobehavioral health are evident in older adulthood.

Level of physical activity among middle-aged and older Chinese people: evidence from the China health and retirement longitudinal study

Background

With data from different regions accumulated, physical inactivity (PI) was found to be pandemic worldwide. Using China Health and Retirement Longitudinal Study (CHARLS), a nationwide longitudinal survey data, we aimed to delineate the prevalence, incidence and risk factors of physical inactivity (PI) among Chinese people aged 45 years and older.

Methods

The CHARLS covered nearly all provinces, autonomous regions, municipalities of mainland China. With data from CHARLS, three cross-sectional analyses and a cohort analysis were conducted. In cross-sectional studies, we used surveys at 2011, 2013 and 2015 to examine the prevalence and its trend of PI. Multivariate generalized linear model was conducted in survey at 2011 to examine the risk factors for prevalent PI. Multiple imputation of missing values was used and results before and after imputation were compared. In cohort analysis, we identified people free of PI at 2011 and followed them up until 2015 to estimate the incidence of PI. Generalized estimating equation was used to examine the risk factors associated with incidence PI. In all analyses, PI was defined as insufficient physical activity according to the International Physical Activity Questionnaire (IPAQ) criterion.

Results

6650, 5946 and 9389 participants were eligible for cross-sectional analyses, and 4525 participants were included for cohort analysis. The weighted prevalence of PI was 22.25% (95% CI: 20.63–23.95%) in 2011, 20.64% (95% CI: 19.22–22.14%) in 2013 and 19.31% (95% CI: 18.28–20.38%) in 2015. In multivariate analysis, PI was associated with older age, higher education, overweight, obesity and difficulties in daily living, and was negatively associated with working and higher level of expenditure. No material change was detected in results after multiple imputation. In cohort analysis, older age, abundant public facilities, difficulties in daily living were identified as risk factors of incidence PI, while urban areas, college and above education, and working were protective factors.

Conclusions

PI is pandemic in 45 years and older people in China. People with older age, difficulties in daily living and people who are not working are at higher risk. More efforts should be paid in estimating and promoting leisure-time physical activities.

Improvement in muscular strength and aerobic capacities in elderly people occurs independently of physical training type or exercise model

OBJECTIVES

Progressive decline of physiological processes with aging is normal. Aging is also associated with decreased functional capacity and onset of many diseases. This study evaluated the changes in physical fitness (PF), body composition (BC), and lipid profile (LP) in elderly men completing different training protocols.

METHODS

Fifty-five men (age 60-80 years) were randomized into the following groups: without training, aerobic training on dry land, combined training on dry land, and combined training in water. Training was conducted for 8 weeks, and PF, LP, and BC were assessed at the beginning and end of the intervention.

RESULTS

Significant improvements were observed in all parameters; however, combined programs on land or in water were more effective at improving strength and aerobic fitness. Combined exercise produced greater effects on BC and LP and some muscle fitness parameters; however, improvements in muscular and aerobic capacities occurred independently of exercise type or model.

CONCLUSION

These results indicate that the effects of training occur regardless of training type or model, and are directly associated with training periodization, adherence, and regularity.

The Molecular Mechanisms and Prevention Principles of Muscle Atrophy in Aging

Muscle atrophy in aging is characterized by progressive loss of muscle mass and function. Muscle mass is determined by the balance of synthesis and degradation of protein, which are regulated by several signaling pathways such as ubiquitin-proteasome system, autophagy-lysosome systems, oxidative stress, proinflammatory cytokines, hormones, and so on. Sufficient nutrition can enhance protein synthesis, while exercise can improve the quality of life in the elderly. This chapter will discuss the epidemiology, pathogenesis, as well as the current treatment for aging-induced muscular atrophy.

Salivary Cortisol and Regional Brain Volumes Among Veterans With and Without Posttraumatic Stress Disorder

BACKGROUND

Human studies have often found that brain regions rich in glucocorticoid receptors exhibit smaller volume in samples with past trauma and ongoing stress; however, relatively little research has addressed the hypothesis that such smaller volumes can be traced to elevated circulating glucocorticoid hormones (GCs). This issue takes on renewed interest in light of recent proposals to treat symptoms of stress disorders such as posttraumatic stress disorder (PTSD) with exogenous synthetic GCs. We sought to examine the relation of circulating GCs to brain macrostructure among veterans with and without PTSD.

METHODS

Participants (n = 90) included combat veterans with and without PTSD. Veterans completed self-report surveys, home-based cortisol samples, reactive cortisol samples over the course of two serial Trier Social Stress Tests, a low-dose dexamethasone suppression test, and structural magnetic resonance brain imaging over the course of 3 to 5 days.

RESULTS

No associations were observed between any salivary cortisol index and the volumes of the hippocampus or amygdala. A negative association was observed between evening basal cortisol and both FreeSurfer global volume and BrainImage supratentorial tissue volume. This effect was moderated by PTSD. Also observed was a positive association between reactive cortisol and these same brain volumes.

CONCLUSIONS

Estimates of cortical but not hippocampal or amygdala volume were moderately associated with evening basal salivary cortisol and cortisol reactivity to a social stressor. Existing models relating GC receptor density, circulating cortisol levels, and regional brain volumes received little support.

Socioeconomic inequities and cardiovascular disease-related disability in China: A population-based study

The prevalence of disability has changed along with aggressive economic development in China. However, socioeconomic inequalities associated with cardiovascular disease (CVD)-related disability have not been explored. This is the first study to explore CVD-related disability among persons aged 45 years and older in China.Data were taken from the 2006 Second China National Sample Survey on Disability, which was a nationally representative, population-based survey. To derive a nationally representative sample, the survey used multistage, stratified, and cluster random sampling with probability proportional to size. We used standard weighting procedures to construct sample weights that considered the multistage, stratified, and cluster sampling survey scheme. Associations between CVD-related disability risk and socioeconomic inequality were examined using logistic regression.In this study, the weighted prevalence of CVD-related disability was 1.84 per 100 persons (95% confidence interval [CI]: 1.80-1.89), and 73% of CVD-related disability consisted of a single disability, including speech, physical, and intellectual disabilities, whereas 23% of CVD-related disability consisted of multiple disabilities, that is, any combination of speech, physical, and intellectual disabilities. A higher risk of CVD-related disability was observed among rural residents than urban residents as well as among males than females. Age presented consistent increased associations with CVD-related disability. Education inequality was strongly associated with the risk of multiple disabilities.To address the challenge of CVD-related disability in China, the government should adjust its strategies for health care systems to prevent disability. The widening discrepancy between urban and rural areas indicates that the most important priorities for disability prevention in China are to reinforce health promotion in the working age population and to improve health services in rural communities.

Comparison of 2-year clinical outcomes between diabetic versus nondiabetic patients with acute myocardial infarction after 1-month stabilization: Analysis of the prospective registry of DIAMOND (DIabetic acute myocardial infarctiON Disease) in Korea: an observational registry study

This study assessed the 2-year clinical outcomes of patients with diabetes mellitus (DM) after acute myocardial infarction (AMI) in a cohort of the DIAMOND (DIabetic Acute Myocardial infarctiON Disease) registry. Clinical outcomes were compared between 1088 diabetic AMI patients in the DIAMOND registry after stabilization of MI and 1088 nondiabetic AMI patients from the KORMI (Korean AMI) registry after 1 : 1 propensity score matching using traditional cardiovascular risk factors. Stabilized patients were defined as patients who did not have any clinical events within 1 month after AMI. Primary outcomes were the 2-year rate of major adverse cardiac events (MACEs), a composite of all-cause death, recurrent MI (re-MI), and target vessel revascularization (TVR). Matched comparisons revealed that diabetic patients exhibited significantly lower left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate and smaller stent size. Diabetic patients exhibited significantly higher 2-year rates of MACE (8.0% vs 3.7%), all-cause death (3.9% vs 1.4%), re-MI (2.8% vs 1.2%), and TVR (3.5% vs 1.3%) than nondiabetic patients (all P < 0.01), and higher cumulative rates in Kaplan-Meier analyses of MACE, all-cause death, and TVR (all P < 0.05). A multivariate Cox regression analysis revealed that chronic kidney disease, LVEF < 35%, and long stent were independent predictors of MACE, and large stent diameter and the use of drug-eluting stents were protective factors against MACE. The 2-year MACE rate beyond 1 month after AMI was significantly higher in DM patients than non-DM patients, and this rate was associated with higher comorbidities, coronary lesions, and procedural characteristics in DM.

Social support and the self-rated health of older people: A comparative study in Tainan Taiwan and Fuzhou Fujian province

The lack of social support in elderly populations incurs real societal costs and can lead to their poor health. The aim of this study is to investigate the self-rated health (SRH) and social support among older people as well as its associated factors.We conducted a cross-sectional study among 312 urban community-dwelling elderly aged 65 to 90 years in Tainan Taiwan and Fuzhou Fujian Province from March 2012 to October 2012. A Spearson correlation test, independent t test, a Pearson χ test, a linear regression analysis, and a multiple-level model were performed to analyze the results.The participants identified children as the most important source of objective and subjective support, followed by spouse and relatives. Tainan's elderly received more daily life assistance and emotional support, showed stronger awareness of the need to seek help, and maintained a higher frequency of social interactions compared with the elderly in Fuzhou. The mean objective support, subjective support, and support utilization scores as well as the overall social support among Tainan's elderly were significantly high compared with the scores among Fuzhou's elderly. Further, Tainan's elderly rated better SRH than Fuzhou's elderly. Correlation analysis showed that social support was significantly correlated with city, age, living conditions, marital status, and SRH. Multiple linear regression analysis, with social support as a dependent variable, retained the following independent predictors in the final regression model: city (4.792, 95% confidence interval [CI]: 3.068-6.516, P = 0.000), age (-0.805, 95% CI: -1.394 to -0.135, P = 0.013), marital status (-1.260, 95% CI: -1.891 to -0.629, P = 0.000), living conditions (4.069, 95% CI: 3.022-5.116, P = 0.000), and SRH -1.941, 95% CI: -3.194 to -0.688, P = 0.003). The multiple-level model showed that city would impact older people's social support (χ = 5.103, P < 0.001). Marital status (-2.133, 95% CI: -2.768 to -1.499, P = 0.000), education (1.697, 95% CI: 0.589-2.805 P = 0.003), living conditions (4.20, 95% CI: 1.762-6.638, P = 0.000), and SRH (-3.144, 95% CI: -4.502 to -1.727, P = 0.000) were the associated factors. Thus, city, age, marital status, education, living conditions, and SRH might be the associated factors for social support among older people.This study presents some feasible implications for social support improvement in China and in other nations worldwide.