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Groos SS, de Wildt KK, van de Loo B, Linn AJ, Medlock S, Shaw KM, Herman EK, Seppala LJ, Ploegmakers KJ, van Schoor NM, van Weert JCM, van der Velde N. Development of the ADFICE_IT clinical decision support system to assist deprescribing of fall-risk increasing drugs: A user-centered design approach. PLoS One 2024; 19:e0297703. [PMID: 39236057 PMCID: PMC11376580 DOI: 10.1371/journal.pone.0297703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION Deprescribing fall-risk increasing drugs (FRIDs) is promising for reducing the risk of falling in older adults. Applying appropriate deprescribing in practice can be difficult due to the outcome uncertainties associated with stopping FRIDs. The ADFICE_IT intervention addresses this complexity with a clinical decision support system (CDSS) that facilitates optimum deprescribing of FRIDs by using a fall-risk prediction model, aggregation of deprescribing guidelines, and joint medication management. METHODS The development process of the CDSS is described in this paper. Development followed a user-centered design approach in which users and experts were involved throughout each phase. In phase I, a prototype of the CDSS was developed which involved a literature and systematic review, European survey (n = 581), and semi-structured interviews with clinicians (n = 19), as well as the aggregation and testing of deprescribing guidelines and the development of the fall-risk prediction model. In phase II, the feasibility of the CDSS was tested by means of two usability testing rounds with users (n = 11). RESULTS The final CDSS consists of five web pages. A connection between the Electronic Health Record allows for the retrieval of patient data into the CDSS. Key design requirements for the CDSS include easy-to-use features for fast-paced clinical environments, actionable deprescribing recommendations, information transparency, and visualization of the patient's fall-risk estimation. Key elements for the software include a modular architecture, open source, and good security. CONCLUSION The ADFICE_IT CDSS supports physicians in deprescribing FRIDs optimally to prevent falls in older patients. Due to continuous user and expert involvement, each new feedback round led to an improved version of the system. Currently, a cluster-randomized controlled trial with process evaluation at hospitals in the Netherlands is being conducted to test the effect of the CDSS on falls. The trial is registered with ClinicalTrials.gov (date; 7-7-2022, identifier: NCT05449470).
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Affiliation(s)
- Sara S Groos
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Kelly K de Wildt
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Bob van de Loo
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annemiek J Linn
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephanie Medlock
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Stichting Open Electronics Lab, Maarssen, The Netherlands
| | - Kendrick M Shaw
- Stichting Open Electronics Lab, Maarssen, The Netherlands
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | | | - Lotta J Seppala
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Kim J Ploegmakers
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Natasja M van Schoor
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Nathalie van der Velde
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Just KS, Pott LM, Sommer J, Scholl C, Steffens M, Denkinger MD, Rothenbacher D, Dallmeier D, Stingl JC. Association of Polymorphic Cytochrome P450 Enzyme Pathways with Falls in Multimedicated Older Adults. J Am Med Dir Assoc 2024; 25:105235. [PMID: 39236770 DOI: 10.1016/j.jamda.2024.105235] [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: 11/14/2023] [Revised: 06/27/2024] [Accepted: 07/29/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVES Dose exposure is considered relevant for drug-associated falls in older adults, pointing to an importance of drug metabolism. Aim was to analyze individual factors altering drug metabolism such as enzyme saturation by drug exposure and pharmacogenetics in the context of drug-associated falls. DESIGN Prospective population-based study (ActiFE-Ulm study). SETTING AND PARTICIPANTS Community-dwelling older adults. METHODS Focus was laid on the metabolism by polymorphic cytochrome P450 (CYP) enzymes CYP2C19, 2C9, and 2D6. Relevant variants of pharmacogenes were analyzed. Logistic binary regression analysis was used to calculate odds ratios (ORs) and 95% CIs for falls observed prospectively over a 1-year period with drug metabolism characteristics. RESULTS In total, 1377 participants were included in the analysis. Although the phenotype predicted by the genotype was not, the use of drugs metabolized by CYP2C19 was associated with falls. Drugs not known as fall risk-increasing drugs (FRIDs; ie, non-FRIDs), but metabolized by CYP2C19, showed an OR of 1.46 (1.11-1.93) in adjusted analysis. Significant effect modification was observed for a reduced CYP2C19 activity phenotype with non-FRIDs metabolized by CYP2C19. CONCLUSIONS AND IMPLICATIONS This study suggests an association between the occurrence of falls in older adults and the metabolic capacity of CYP2C19. Thus, an important step toward prevention of falls might be to personalize dosage and treatment length of the main drug classes known to be CYP2C19 substrates, such as many antidepressants, opioids, and sedatives, but also proton pump inhibitors in particular in poor and intermediate metabolizers.
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Affiliation(s)
- Katja S Just
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Germany.
| | - Laura M Pott
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jakob Sommer
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Germany
| | - Catharina Scholl
- Research Department, Federal Institute of Drugs and Medical Devices, Bonn, Germany
| | - Michael Steffens
- Research Department, Federal Institute of Drugs and Medical Devices, Bonn, Germany
| | - Michael D Denkinger
- AGAPLESION Bethesda Clinic, Ulm, Germany; Geriatric Centre Ulm, Ulm, Germany; Institute for Geriatric Research, Ulm University Medical Center, Ulm Germany
| | | | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic, Ulm, Germany; Geriatric Centre Ulm, Ulm, Germany; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Julia C Stingl
- Institute of Clinical Pharmacology, University Hospital RWTH Aachen, Aachen, Germany
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van Beek SW, Wijnhoven HA, Visser M. The association between the 'at risk of developing undernutrition' category of the Short Nutritional Assessment Questionnaire 65+ and incident undernutrition in community-dwelling older adults. Clin Nutr ESPEN 2024; 62:137-143. [PMID: 38901935 DOI: 10.1016/j.clnesp.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/03/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND & AIMS Screening tools like the Short Nutritional Assessment Questionnaire 65+ (SNAQ65+) have been developed for the early recognition of undernutrition in older adults. The SNAQ65+ screens for being undernourished (red), being 'at risk of developing undernutrition' (i.e. 'at risk', orange), or 'not at risk' (green). This study investigated whether community-dwelling older adults 'at risk' (orange) are more likely to develop undernutrition during a 3-year follow-up compared to those 'not at risk' (green). METHODS Prospective data from a Longitudinal Aging Study were used. A total of 5461 observations, using multiple 3-year waves of participants aged ≥65 years with an orange or green baseline score were included. Logistic mixed models were used to assess the association with four indicators of incident undernutrition at 3-year follow-up: (1) red SNAQ65+ score (mid upper arm circumference (MUAC) < 25 cm and/or ≥4 kg self-reported unintended weight loss in 6 months); (2) MUAC <25 cm; (3) ≥4 kg self-reported unintended weight loss in 6 months; and (4) ≥10% objectively measured weight loss in 3 years. RESULTS There were 53.1% female participants across waves, with a mean age of 74.2 (SD 6.1) years. Overall, 6.2% were 'at risk of developing undernutrition' (orange) at baseline. The incidence rates of undernutrition based on a red SNAQ65+ score, MUAC <25 cm, ≥4 kg self-reported unintended weight loss, and ≥10% measured weight loss were 10.4%, 2.9%, 6.4%, and 5.4%, respectively. Those 'at risk' (orange) had a higher odds ratio of incident undernutrition based on these four indicators than those 'not at risk' (green) (respective odds ratio's: 2.51 (95%CI 1.74-3.62); 2.16 (95%CI 1.11-4.20); 2.43 (95%CI 1.61-3.65); and 2.08 (95%CI 1.28-3.37)). CONCLUSION Community-dwelling older adults screened to be 'at risk of developing undernutrition' (orange) with the SNAQ65+ have a more than two-fold higher odds ratio of developing undernutrition during a 3-year follow-up compared to those 'not at risk' (green).
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Affiliation(s)
- S W van Beek
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands.
| | - H A Wijnhoven
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands.
| | - M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands.
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Hammer T, Braisch U, Rothenbacher D, Denkinger M, Dallmeier D. Relationship between hemoglobin and grip strength in older adults: the ActiFE study. Aging Clin Exp Res 2024; 36:59. [PMID: 38451343 PMCID: PMC10920471 DOI: 10.1007/s40520-024-02698-7] [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: 07/21/2023] [Accepted: 01/05/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Although anemia is associated with low muscle strength, hemoglobin has been rarely studied considering ferritin. AIM To analyze the association between hemoglobin and grip strength in community-dwelling older adults. METHODS We used data from a German cohort of adults ≥ 65 years, excluding those with CRP > 10 mg/L or taking iron supplements. Grip strength (kg) was measured using a Jamar dynamometer. Analysis was performed using multiple linear regression, adjusted for established confounders. Due to interaction, age-stratified (< 80, 80 +), further sex-stratified analysis in those < 80 years old and ferritin-stratified in men < 80 years were performed. RESULTS In total, 1294 participants were included in this analysis (mean age 75.5 years, 549 (42.3%) women, 910 (70.3%) < 80 years). On average, hemoglobin and grip strength were 14.9 g/dL and 41.3 kg for men, 13.9 g/dL and 25.1 kg for women. Hemoglobin was significantly positively associated with grip strength only among women < 80 years (β 0.923 [95% CI 0.196, 1.650]). For men < 80 years, the association was significant when ferritin was ≥ 300 µg/L (β 2.028 [95% CI 0.910, 3.146]). No association was detected among those participants 80 + . DISCUSSION AND CONCLUSIONS Our data show an association between hemoglobin and grip strength only in women < 80 years old. For men < 80 years, the association was only significant with ferritin levels ≥ 300 µg/L. Considering the decreasing levels of hemoglobin and grip strength and the high prevalence of iron deficiency in older adults further analyses investigating this relationship with more iron specific parameters such as transferrin saturation are warranted.
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Affiliation(s)
- Theresa Hammer
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Institute for Geriatric Research, Ulm University, Ulm, Germany
| | - Ulrike Braisch
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Michael Denkinger
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Institute for Geriatric Research, Ulm University, Ulm, Germany
- Medical Faculty, Ulm University, Ulm, Germany
| | - Dhayana Dallmeier
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany.
- Medical Faculty, Ulm University, Ulm, Germany.
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.
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van de Loo B, Seppala LJ, van der Velde N, Medlock S, Denkinger M, de Groot LCPGM, Kenny RA, Moriarty F, Rothenbacher D, Stricker B, Uitterlinden A, Abu-Hanna A, Heymans MW, van Schoor N. Development of the AD FICE_IT models for predicting falls and recurrent falls in community-dwelling older adults: pooled analyses of European cohorts with special attention to medication. J Gerontol A Biol Sci Med Sci 2022; 77:1446-1454. [PMID: 35380638 PMCID: PMC9255686 DOI: 10.1093/gerona/glac080] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Use of fall prevention strategies requires detection of high-risk patients. Our goal was to develop prediction models for falls and recurrent falls in community-dwelling older adults and to improve upon previous models by using a large, pooled sample and by considering a wide range of candidate predictors, including medications. Methods Harmonized data from 2 Dutch (LASA, B-PROOF) and 1 German cohort (ActiFE Ulm) of adults aged ≥65 years were used to fit 2 logistic regression models: one for predicting any fall and another for predicting recurrent falls over 1 year. Model generalizability was assessed using internal–external cross-validation. Results Data of 5 722 participants were included in the analyses, of whom 1 868 (34.7%) endured at least 1 fall and 702 (13.8%) endured a recurrent fall. Positive predictors for any fall were: educational status, depression, verbal fluency, functional limitations, falls history, and use of antiepileptics and drugs for urinary frequency and incontinence; negative predictors were: body mass index (BMI), grip strength, systolic blood pressure, and smoking. Positive predictors for recurrent falls were: educational status, visual impairment, functional limitations, urinary incontinence, falls history, and use of anti-Parkinson drugs, antihistamines, and drugs for urinary frequency and incontinence; BMI was a negative predictor. The average C-statistic value was 0.65 for the model for any fall and 0.70 for the model for recurrent falls. Conclusion Compared with previous models, the model for recurrent falls performed favorably while the model for any fall performed similarly. Validation and optimization of the models in other populations are warranted.
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Affiliation(s)
- Bob van de Loo
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lotta J Seppala
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephanie Medlock
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Michael Denkinger
- Institute for Geriatric Research, Ulm University at Agaplesion Bethesda Clinic, and Geriatric Center Ulm, Ulm, Germany
| | | | - Rose-Anne Kenny
- TILDA, Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - Frank Moriarty
- TILDA, Department of Medical Gerontology, Trinity College, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Bruno Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - André Uitterlinden
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Natasja van Schoor
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Braisch U, Koenig W, Rothenbacher D, Denkinger M, Friedrich N, Felix SB, Ittermann T, Dörr M, Dallmeier D. N-terminal pro brain natriuretic peptide reference values in community-dwelling older adults. ESC Heart Fail 2022; 9:1703-1712. [PMID: 35199488 PMCID: PMC9065825 DOI: 10.1002/ehf2.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Available upper reference levels (URLs) in older adults for N-terminal pro brain natriuretic peptide (NT-proBNP), an established biomarker for heart failure, are mainly based on small samples. We aimed to identify NT-proBNP URL in a population-based reference sample of individuals aged ≥65 years. METHODS AND RESULTS We analysed established NT-proBNP predictors using quantile regression among 2459 participants of two-independent population-based cohorts located in Germany, the Activity and Function in the Elderly Study (ActiFE, n = 1450) and the Study of Health in Pomerania (SHIP-TREND-0, n = 1009). Based on predictors a reference population of 441 subjects (ActiFE, n = 227; SHIP-TREND-0, n = 214) without history of diabetes, cardiovascular, or pulmonary diseases and with systolic blood pressure (BP) <140 mmHg, diastolic BP ≥60 and ≤90 mmHg, haemoglobin in men ≥14 and ≤18 g/dL and in women ≥12 and ≤16 g/dL, GFR ≥60 mL/min/1.73 m2 , CRP <5 mg/L, BMI ≥18 and ≤33 kg/m2 , and hs-cTnI <40 ng/L were built with NT-proBNP median levels and 97.5% quantiles reported stratified by sex and age. In a secondary analysis the URL among 97 SHIP-TREND-0 participants with a left ventricular ejection fraction (LVEF) ≥50 and no diastolic dysfunction were estimated. The median age in the identified reference sample was 70 years, with 41.9% and 40.2% male participants in ActiFE and SHIP-TREND-0, respectively. We observed an age-dependent increment of NT-proBNP levels with higher values in women compared to men. Notably, NT-proBNP levels were >125 ng/L in 165 participants (37.4%), with NT-proBNP URL (97.5% quantiles) equal to 663, 824, 592, and 697 ng/L in men, and 343, 463, 2641, 1276 ng/L in women for ages 65-69, 70-74, 75-79, and 80+ years, respectively. In the secondary analysis with a LVEF ≥50 and no diastolic dysfunction (35 men and 62 women) NT-proBNP levels >125 ng/L were still observed in 38 (39.2%) participants. CONCLUSIONS This reference sample of apparently healthy asymptomatic older adults showed an age-related increment of NT-proBNP levels with URL markedly higher than the European Society of Cardiology recommended cut-off of 125 ng/L for the diagnosis of heart failure in ambulatory settings. Identifying URL in those ≥80 years remains complex. Our results attempt to provide a frame for the further investigation of age-specific NT-proBNP cut-offs in older adults. Considering the demographic changes, further evaluation of NT-proBNP URL in larger samples of older adults followed by the validation of age-specific cut-off values for the identification of heart failure in those 65 years or older are urgently needed.
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Affiliation(s)
- Ulrike Braisch
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,German Heart Center Munich, Technical University of Munich, Munich, Germany.,German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | | | - Michael Denkinger
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany
| | - Nele Friedrich
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Dhayana Dallmeier
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Klimek M, Peter RS, Denkinger M, Dallmeier D, Rapp K, Rothenbacher D, Klenk J, Böhm B, Geiger H, Lukas A, Stingl J, Riepe M, Rapp K, Scharffetter-Kochanek K, Koenig W, Steinacker JM, Ludolph A, Nagel G, Peter R. The relationship of weather with daily physical activity and the time spent out of home in older adults from Germany – the ActiFE study. Eur Rev Aging Phys Act 2022; 19:6. [PMID: 35151273 PMCID: PMC8903592 DOI: 10.1186/s11556-022-00286-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background There is a need for a comprehensive evaluation of the associations between varieties of weather conditions on the time spent out-of-home (TOH) and on walking duration (WD) among older adults. We aim to investigate the extent to which various weather parameters (temperature, solar radiation, sunshine duration, humidity, windspeed, and rain) determine daily WD the TOH in older adults. Methods The ActiFE (Activity and Function in Older People in Ulm) study is a prospective study of participants aged 65 years or older who wore an accelerometer and kept a movement diary in up to three temporally separated waves from 2009 to 2018 for a duration up to seven days per wave (up to three weeks in summary). We used weather data from a weather station near the participants‘ homes. Age-adjusted and gender-stratified generalized mixed models were used to predict WD and TOH (with 95% confidence interval (CI)) within and between weather categories. Generalized additive models were computed for the single predictions at the weather quartile boundaries. Cubic splines (with 95% pointwise confidence bands (CB)) visualized the continuous course of the weather values. Results Higher temperatures, solar radiation and more hours of sunshine, led to an increase in WD and TOH, while higher precipitation, humidities and windspeeds led to a decrease. Women had in general higher WD and TOH times than men. Conclusions Our data suggest that weather parameters have a considerable influence on PA and TOH. Future analyses and interpretation of PA data should therefore account for weather parameters. Supplementary Information The online version contains supplementary material available at 10.1186/s11556-022-00286-0.
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Kremer KM, Braisch U, Rothenbacher D, Denkinger M, Dallmeier D. Systolic Blood Pressure and Mortality in Community-Dwelling Older Adults: Frailty as an Effect Modifier. Hypertension 2021; 79:24-32. [PMID: 34689594 DOI: 10.1161/hypertensionaha.121.17530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Current evidence is insufficient to support different hypertension treatment targets in older adults. We evaluated whether frailty modifies the association between systolic blood pressure (SBP) and 8-year all-cause mortality in community-dwelling older adults. Longitudinal data from the ActiFE Ulm study (Activity and Function in the Elderly in Ulm; Germany) was collected. The association between SBP and mortality was analyzed using Cox proportional hazards models adjusted for age, sex, education, smoking, alcohol consumption, sleep disturbance, diastolic blood pressure, and antihypertensive medications, evaluating the presence of effect modification by frailty according to a frailty index based on the accumulation of deficits. Among 1170 participants (median age 73.9 years, 41.6% women), the prevalence of history of hypertension was 53.8% (median SBP, 144.0 mm Hg [interquartile range, 135.0-149.5], median diastolic blood pressure 78.0 mm Hg [interquartile range, 71.0-86.5]). The median follow-up time was 8.1 years, detecting 268 deaths. We identified 251 (21.5%, 114 deaths) frail participants (frailty index ≥0.2). Effect modification by frailty was detected. Among non-frail a J-shaped association was found with hazard ratio, 4.01 (95% CI, 1.13-14.28) for SBP<110 mm Hg, hazard ratio, 0.92 (95% CI, 0.53-1.59) for SBP 140-150 mm Hg, and hazard ratio, 1.98 (95% CI, 0.75-5.27) for SBP≥160 mm Hg. For frail older adults, a tendency toward lower risk among those with SBP≥130 mm Hg was observed. Our results suggest the presence of effect modification by frailty indicating a possible protective effect for elevated SBP in frail older adults with respect to all-cause mortality even after adjusting for diastolic blood pressure and antihypertensive treatment.
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Affiliation(s)
- Kaj-Marko Kremer
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Institute of Geriatric Research, Ulm University, Germany. (K.-M.K., M.D.)
| | - Ulrike Braisch
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Institute of Epidemiology and Medical Biometry, Ulm University, Germany. (U.B., D.R.)
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany. (U.B., D.R.)
| | - Michael Denkinger
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Institute of Geriatric Research, Ulm University, Germany. (K.-M.K., M.D.)
| | - Dhayana Dallmeier
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Department of Epidemiology, Boston University School of Public Health, Boston, MA (D.D.)
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Häckl D, Kossack N, Schoenfelder T. [Prevalence, Costs of Medical Treatment and Modalities of Dialysis-dependent Chronic Renal Failure in Germany: Comparison of Dialysis Care of Nursing Home Residents and in Outpatient Units]. DAS GESUNDHEITSWESEN 2021; 83:818-828. [PMID: 33450773 PMCID: PMC8497075 DOI: 10.1055/a-1330-7152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY OBJECTIVES Current estimates on the prevalence of chronic renal failure and the costs of dialysis in Germany's population are not available. The aim of this study was to assess the prevalence of dialysis-dependent chronic renal failure and treatment costs of dialysis-dependent patients in Germany as well as differences between those residing in nursing homes and those treated in outpatient units. METHODS Health insurance claims from 4.5 million anonymized patients in the WIG2 research database were analyzed. Patients of all ages who had received outpatient dialysis treatment for chronic renal failure in 2017 (using uniform value scale code 13602) were included. These insurance claims were extrapolated to the German statutory health insurance population and, using official statistics, further to the entire population of Germany. Data on comorbidities, use of health resources, and costs were compared among patients residing in nursing homes and those treated in outpatient units. RESULTS In 2017, there were 87,255 dialysis-dependent statutory health insurance patients (≙1,054 person/1 million population, pmp), and 100,202 in Germany's whole population (≙1,210 pmp). About 8% of dialysis-dependent patients (n=7,676) were living in nursing homes. Our analyses predict an increase in dialysis-dependent patients of about 20-23% (up to 120,000-123,000), with an increase of dialysis-dependent nursing home residents of 37-44% (up to 10,500-11,000) by 2040. Almost all dialysis-dependent patients were treated with hemodialysis; peritoneal dialysis was rarely observed. The average annual treatment costs for dialysis-dependent patients residing in nursing homes amounted to 57,205 Euro and 53,996 Euro per patient respectively, with total annual statutory health insurance treatment costs amounting to about 4.73 billion Euro in 2017. CONCLUSION This study presents current estimates for dialysis-dependent chronic renal failure in Germany. Our findings on prevalence are comparable to data from other European countries and suggest a considerable increase in dialysis dependency by 2040, particularly for nursing home residents, resulting in a further increase in dialysis care costs. Hemodialysis was the most commonly used dialysis modality in patients living both in and out of nursing care facilities, with peritoneal dialysis rarely being used.
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Affiliation(s)
- Dennis Häckl
- Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung, (WIG2), Leipzig, Deutschland
| | - Nils Kossack
- Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung, (WIG2), Leipzig, Deutschland
| | - Tonio Schoenfelder
- Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung, (WIG2), Leipzig, Deutschland
- Technische Universität Dresden, Lehrstuhl für Gesundheitswissenschaften/Public Health, Dresden, Deutschland
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10
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Schönstein A, Dallmeier D, Denkinger M, Rothenbacher D, Klenk J, Bahrmann A, Wahl HW. Health and Subjective Views on Aging: Longitudinal Findings From the ActiFE Ulm Study. J Gerontol B Psychol Sci Soc Sci 2021; 76:1349-1359. [PMID: 33528511 PMCID: PMC8363042 DOI: 10.1093/geronb/gbab023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives Previous research supports that subjective views on aging (VoA), such as older subjective age (SA) and negative attitudes toward own aging (ATOA), go along with negative outcomes. A differentiated treatment of health and disease as antecedents of VoA is largely lacking. Therefore, our objective was to estimate the relationship between generally framed physical, affective, and cognitive health as well as specific diseases and VoA, operationalized both as SA and ATOA. Methods Data were drawn from the ActiFE Ulm study for which a representative sample of community-dwelling older people (65–90 years) was recruited at baseline. Follow-ups were conducted 7.7 years (median) after recruitment (N = 526). Health- and disease-related data at baseline, based on established assessment procedures for epidemiological studies, were regressed on VoA (1-item SA indicator, 5-item ATOA scale) measures at follow-up. Results Reported severity of affective health problems such as depression was the strongest general risk factor for both older SA and negative ATOA. Also, some but not all major diseases considered were associated with VoA. Notably, back pain predicted negative ATOA, while cancer was associated with older SA. Rheumatism was linked with more negative ATOA along with higher SA. Throughout analyses, explained variance in ATOA was considerably higher than in SA. Discussion Affective health problems, such as depression, should be regarded as a major correlate of subjective aging views. Interestingly, diseases do not have to be life-threatening to be associated with older SA or negative ATOA.
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Affiliation(s)
| | - Dhayana Dallmeier
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Germany.,Department of Epidemiology, Boston University School of Public Health, Massachusetts, USA
| | - Michael Denkinger
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Germany
| | | | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Anke Bahrmann
- Network Aging Research (NAR), Heidelberg University, Germany.,Heidelberg University Hospital, Germany
| | - Hans-Werner Wahl
- Network Aging Research (NAR), Heidelberg University, Germany.,Institute of Psychology, Heidelberg University, Germany
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11
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A Propensity Score Matched Approach to Assess the Associations of Commonly Prescribed Medications with Fall Risk in a Large Harmonized Cohort of Older Ambulatory Persons. Drugs Aging 2021; 38:797-805. [PMID: 34224104 PMCID: PMC8419131 DOI: 10.1007/s40266-021-00876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 11/16/2022]
Abstract
Introduction Several medication classes are considered to present risk factors for falls. However, the evidence is mainly based on observational studies that often lack adequate adjustment for confounders. Therefore, we aimed to assess the associations of medication classes with fall risk by carefully selecting confounders and by applying propensity score matching (PSM). Methods Data from several European cohorts, harmonized into the ADFICE_IT cohort, was used. Our primary outcome was time until the first fall within 1-year follow-up. The secondary outcome was a fall in the past year. Our exposure variables were commonly prescribed medications. We used 1:1 PSM to match the participants with reported intake of specific medication classes with participants without. We constructed Cox regression models stratified by the pairs matched on the propensity score for our primary outcome and conditional logistic regression models for our secondary outcome. Results In total, 32.6% of participants fell in the 1-year follow-up and 24.4% reported falling in the past year. ACE inhibitor users (prevalence of use 15.3%) had a lower fall risk during follow-up when matched to non-users, with a hazard ratio (HR) of 0.82 (95% CI 0.68–0.98). Also, statin users (prevalence of use 20.1%) had a lower risk, with an HR of 0.76 (95% CI 0.65–0.90). Other medication classes showed no association with risk of first fall. Also, in our secondary outcome analyses, statin users had a significantly lower risk. Furthermore, β-blocker users had a lower fall risk and proton pump inhibitor use was associated with a higher risk in our secondary outcome analysis. Conclusion Many commonly prescribed medication classes showed no associations with fall risk in a relatively healthy population of community-dwelling older persons. However, the treatment effects and risks can be heterogeneous between individuals. Therefore, focusing on identification of individuals at risk is warranted to optimize personalized falls prevention. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00876-0.
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12
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Hatami O, Aghabagheri M, Kahdouei S, Nasiriani K. Psychometric properties of the Persian version of the Physical Activity Scale for the Elderly (PASE). BMC Geriatr 2021; 21:383. [PMID: 34162345 PMCID: PMC8220717 DOI: 10.1186/s12877-021-02337-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 06/11/2021] [Indexed: 02/08/2023] Open
Abstract
Background Old age is associated with reduced physical ability. It is necessary to measure and evaluate the physical activity of older people. Implementing appropriate requires a valid and reliable tool. Physical Activity Scale for the Elderly (PASE) is the frequently used self-reported physical activity assessment for older adults. Therefore, this study aimed to determine the translation validity and reliability of the Persian version of the Physical Activity Scale for the Elderly. Methods This study is a methodological, descriptive applied research was conducted on 300 older people. The translation process of the English version of PASE into Persian was carried out according to the process of translation and adaptation of scale recommended by the World Health Organization. The reliability of the scale was examined by calculating the Cronbach’s alpha, Pearson, and intraclass correlation coefficient (ICC). The reliability and validity of the scale were evaluated by following the “Consensus-Based Standards for the Selection of Health Status Measurement Instruments” (COSMIN) checklist. To assess the face and content validity, impact score (IS), the content validity ratio (CVR), and the content validity index (CVI) were determined. A confirmatory factor analysis was also performed. Results The experts approved the quality of the Persian version of PASE. The reliability was calculated with a Cronbach’s alpha of 0.94, an ICC of 0.99, and a test-retest correlation coefficient of 0.94. The qualitative and quantitative face validity of all questions by expert judgment and IS of greater than 1.5 was considered. Also, CVR and CVI scores of all questions were higher than 0.6 and 0.79, respectively. Confirmatory factor analysis revealed a good fit for the original three-factor structure. Conclusions The Persian or Farsi version of PASE was shown to have acceptable validity and reliability. This tool is suitable for measuring the physical activity level in the Persian elderly language special in clinical environments and therapeutic interventions.
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Affiliation(s)
- Omid Hatami
- Department of Nursing, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
| | - Mahdi Aghabagheri
- Medicine School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Khadijeh Nasiriani
- Department of Nursing, Mother and Newborn Health Research Center, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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13
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Fall-Associated Drugs in Community-Dwelling Older Adults: Results from the ActiFE Ulm Study. J Am Med Dir Assoc 2021; 22:2177-2183.e10. [PMID: 33516672 DOI: 10.1016/j.jamda.2020.12.032] [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: 09/29/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Many studies describing an association of drugs with falls focus mostly on drugs acting in the central nervous system. We aim to analyze the association of all drugs taken with falls in older adults. DESIGN Prospective population-based study (ActiFE study). SETTING AND PARTICIPANTS A total of 1377 community-dwelling older adults with complete recording of falls and baseline information on drug intake. METHODS Negative binomial regression was used to analyze the association of 34 drug classes with a 12-month incidence rate ratio (IRR) of falls adjusting for age, sex, comorbidities, gait speed, balance, chair rise, kidney function, liver disease, and smoking. RESULTS Participants took a median 3 drugs (interquartile range 1, 5), with 34.5% (n = 469) having ≥5 drugs. The median IRR for a fall per person-year was overall 0.72 [95% confidence interval (CI) 0.60-0.83] and 2.22 (95% CI 1.90-2.53) among those who experienced ≥1 fall. The following drug classes showed significant associations: antiparkinsonian medication [IRR 2.68 (95% CI 1.59-4.51)], thyroid therapy [IRR 1.40 (95% CI 1.08-1.81)], and systemic corticosteroids [IRR 0.33 (95% CI 0.13-0.81)]. Among fall-risk-increasing drugs only antiepileptics [IRR 2.16 (95% CI 1.10-4.24)] and urologicals [IRR 2.47 (95% CI 1.33-4.59)] were associated with falls in those participants without a prior fall history at baseline. CONCLUSION AND IMPLICATIONS Additional drug classes, such as antiparkinsonian medication, thyroid therapy, and systemic corticosteroids, might be associated with falls in older adults, possibly representing pharmacological effects on the musculoskeletal and central nervous systems. Further evaluations in larger study populations are recommended.
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14
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Skeleton avatar technology as a way to measure physical activity in healthy older adults. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Association of lung function with overall mortality is independent of inflammatory, cardiac, and functional biomarkers in older adults: the ActiFE-study. Sci Rep 2020; 10:11862. [PMID: 32681112 PMCID: PMC7367870 DOI: 10.1038/s41598-020-68372-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/18/2020] [Indexed: 11/08/2022] Open
Abstract
Reduced lung function is associated with overall and cardiovascular mortality. Chronic low grade systemic inflammation is linked to impaired lung function and cardiovascular outcomes. We assessed the association of lung function with overall 8-year mortality in 867 individuals of the Activity and Function in the Elderly study using confounder-adjusted Cox proportional hazards models (including gait speed and daily walking time as measures of physical function) without and with adjustment for inflammatory and cardiac markers. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) but not FVC was related to mortality after adjustment for physical function and other confounders. Additional adjustment for inflammatory and cardiac markers did not change the hazard ratios (HR) markedly, e.g. for a FEV1/FVC below 0.7 from 1.55 [95% confidence-interval (CI) 1.14-2.11] to 1.49 (95% CI 1.09-2.03). These independent associations were also observed in the apparently lung healthy subpopulation with even higher HRs up to 2.76 (95% CI 1.52-4.93). A measure of airflow limitation but not vital capacity was associated with overall mortality in this community-dwelling older population and in the subgroup classified as lung healthy. These associations were independent of adjustment for inflammatory and cardiac markers and support the role of airflow limitation as independent predictor of mortality in older adults.
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16
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Villumsen M, Grarup B, Christensen SWMP, Palsson TS, Hirata RP. "Study protocol for the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (the NOCfao study)". BMC Geriatr 2020; 20:198. [PMID: 32513121 PMCID: PMC7278063 DOI: 10.1186/s12877-020-01535-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 03/25/2020] [Indexed: 01/06/2023] Open
Abstract
Background Accidental falls are common among community-dwellers, probably due to the level of physical activity and impaired postural stability. Today, fall risk prediction tools’ discriminative validity are only moderate. In order to increase the accuracy, multiple variables such as highly validated objective field measurements of physical activity and impaired postural stability should be adressed in order to predict falls. The main aim of this paper is to describe the ≥65 years NOrthern jutland Cohort of Fall risk Assessment with Objective measurements (NOCfao) investigating the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults. Methods The study consists of a baseline session where the participants are asked to respond to three questionnaires, perform physical tests (i.e., measuring strength in the upper and lower extremities, balance, and walking speed), participate in an assessment of pain sensitivity, and to wear an ankle mounted pedometer for measuring physical activity for 5 days. Subsequently, the fall incidences and the circumstances surrounding the falls during the previous 1 to 2 months will be recorded throughout a one-year follow-up period. Discussion This study will add to the present-day understanding of the association between physical activity and impaired postural stability and the risk of fall episodes among community-dwelling older adults. These data will provide valid and reliable information on the relationship between these variables and their significance for community-dwelling older adults. Trial registration ClinicalTrials.gov identifier: NCT2995317. Registered December 13th, 2016.
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Affiliation(s)
- Morten Villumsen
- Department of Elderly and Health, Section of Training and Activity, Aalborg Municipality, Aalborg, Denmark.,Department of Health Science and Technology, Aalborg University (AAU), Aalborg, Denmark
| | - Bo Grarup
- Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg East, Denmark.
| | - Steffan Wittrup Mc Phee Christensen
- Department of Health Science and Technology, Aalborg University (AAU), Aalborg, Denmark.,Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg East, Denmark
| | | | - Rogerio Pessoto Hirata
- Performance and Technology, Department of Health Science and Technology Aalborg University, Niels Jernes Vej 12, 9220, Aalborg East, Denmark
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17
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Cattelani L, Chesani F, Palmerini L, Palumbo P, Chiari L, Bandinelli S. A rule-based framework for risk assessment in the health domain. Int J Approx Reason 2020. [DOI: 10.1016/j.ijar.2019.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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18
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Klenk J, Peter RS, Rapp K, Dallmeier D, Rothenbacher D, Denkinger M, Büchele G, Becker T, Böhm B, Scharffetter-Kochanek K, Stingl J, Koenig W, Riepe M, Peter R, Geiger H, Ludolph A, von Arnim C, Nagel G, Weinmayr G, Steinacker JM, Laszlo R. Lazy Sundays: role of day of the week and reactivity on objectively measured physical activity in older people. Eur Rev Aging Phys Act 2019; 16:18. [PMID: 31673299 PMCID: PMC6815398 DOI: 10.1186/s11556-019-0226-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/09/2019] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to assess the effect of day of the week and wearing a device (reactivity) on objectively measured physical activity (PA) in older people. Methods Walking duration as a measure for PA was recorded from 1333 German community-dwelling older people (≥65 years, 43.8% women) over 5 days using accelerometers (activPAL). Least-square means of PA with 95%-confidence intervals (95%-CI) from multi-level analysis were calculated for each day of the week and each measurement day (days after sensor attachment). Results Walking duration on Sundays was significantly lower compared to working days (Sunday vs. Monday-Friday: − 12.8 min (95%-CI: − 14.7; − 10.9)). No statistically significant difference compared to working days was present for Saturdays. The linear slope for measurement day and walking duration was marginal and not statistically significant. Conclusions Studies using PA sensors in older people should assess Sundays and working days to adequately determine the activity level of the participants.
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Affiliation(s)
- Jochen Klenk
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany
| | - Raphael Simon Peter
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany
| | - Kilian Rapp
- 2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany
| | | | - Dietrich Rothenbacher
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany
| | | | - Gisela Büchele
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany
| | | | - T Becker
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - B Böhm
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - K Scharffetter-Kochanek
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - J Stingl
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - W Koenig
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - M Riepe
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - R Peter
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - H Geiger
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - A Ludolph
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - C von Arnim
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - G Nagel
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - G Weinmayr
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - J M Steinacker
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
| | - R Laszlo
- 1Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr 22, 89081 Ulm, Germany.,2Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr 110, 70376 Stuttgart, Germany.,IB University of Applied Sciences Berlin, Study Center Stuttgart, Paulinenstraße 45, 70178 Stuttgart, Germany.,Bethesda Geriatric Clinic, Zollernring 26, 89073 Ulm, Germany
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Abstract
Besides its known function as a transport protein for testosterone and other steroid hormones, sex hormone-binding globulin (SHBG) is a biomarker associated with many adverse health effects. The aim of this study was to investigate the association of physical activity with SHBG serum levels in older adults. The physical activity and SHBG values for 1,259 older adults (43.4% female; 56.6% male) with a mean age of 75.6 ± 6.5 years were included in the analysis. The average daily walking duration was 104.2 ± 40.4 (mean ± SD) min. A positive dose-response relationship of daily walking duration with quartiles of SHBG was seen after adjustment for age, sex, history of cardiovascular diseases, diabetes, smoking, γ-glutamyl transferase, and C-reactive protein (p for trend = .010). However, this relationship disappeared after adjustment for body mass index (p for trend = .977). Body mass index seems to be an important determinant of SHBG and a possible confounding factor in the relationship of physical activity and SHBG.
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20
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Rothenbacher D, Dallmeier D, Christow H, Koenig W, Denkinger M, Klenk J. Association of growth differentiation factor 15 with other key biomarkers, functional parameters and mortality in community-dwelling older adults. Age Ageing 2019; 48:541-546. [PMID: 30855645 DOI: 10.1093/ageing/afz022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/07/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Growth differentiation factor 15 (GDF-15) has been associated with many adverse age-related outcomes and other age-related disorders. The aim of the study was to investigate if baseline levels of GDF-15 are associated with total mortality in community living, older adults during eight years of follow-up after simultaneous consideration of key biomarkers and functional parameters. METHODS prospective cohort study including 1,470 community-dwelling older adults aged 65 years or older. GDF-15 was measured by ElectroChemi-Lumisnescence Immunoassays (Roche, Mannheim, Germany). We used Cox-proportional hazards regression to estimate the association of GDF-15 levels with 8-year all-cause mortality. RESULTS GDF-15 levels were independently of age and sex strongly associated with many biomarkers such as CRP, IL-6, NT-proBNP, hs-troponines as well as with lipids, metabolic and endocrine markers and kidney function (all P-values < 0.001). GDF-15 showed also a statistically significant correlation to gait speed, hand grip strength and walking duration. In addition, we found a consistent association between levels of GDF-15 and risk of subsequent all-cause mortality which persisted after additional adjustment for key markers of inflammation, cardiac function and damage, and physical function. The hazard ratio (HR) per unit increase of log-transformed GDF-15 was 1.72 (95% CI 1.35; 2.18). CONCLUSIONS GDF-15 levels were not only strongly associated with many functional parameters and key biomarkers independently of age and sex, but also with 8-year all-cause mortality even after adjusting for gait speed, NT-proBNP and hs-TnT.
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Affiliation(s)
| | - Dhayana Dallmeier
- Agaplesion Bethesda Hospital, Geriatric Research Unit, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Hannes Christow
- Agaplesion Bethesda Hospital, Geriatric Research Unit, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Technische Universität München, Munich, Germany
| | - Michael Denkinger
- Agaplesion Bethesda Hospital, Geriatric Research Unit, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Geriatrics and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- IB Hochschule Berlin, Studienzentrum Stuttgart, Stuttgart, Germany
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21
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Jonkman NH, Colpo M, Klenk J, Todd C, Hoekstra T, Del Panta V, Rapp K, van Schoor NM, Bandinelli S, Heymans MW, Mauger D, Cattelani L, Denkinger MD, Rothenbacher D, Helbostad JL, Vereijken B, Maier AB, Pijnappels M. Development of a clinical prediction model for the onset of functional decline in people aged 65-75 years: pooled analysis of four European cohort studies. BMC Geriatr 2019; 19:179. [PMID: 31248370 PMCID: PMC6595632 DOI: 10.1186/s12877-019-1192-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 06/18/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Identifying those people at increased risk of early functional decline in activities of daily living (ADL) is essential for initiating preventive interventions. The aim of this study is to develop and validate a clinical prediction model for onset of functional decline in ADL in three years of follow-up in older people of 65-75 years old. METHODS Four population-based cohort studies were pooled for the analysis: ActiFE-ULM (Germany), ELSA (United Kingdom), InCHIANTI (Italy), LASA (Netherlands). Included participants were 65-75 years old at baseline and reported no limitations in functional ability in ADL at baseline. Functional decline was assessed with two items on basic ADL and three items on instrumental ADL. Participants who reported at least some limitations at three-year follow-up on any of the five items were classified as experiencing functional decline. Multiple logistic regression analysis was used to develop a prediction model, with subsequent bootstrapping for optimism-correction. We applied internal-external cross-validation by alternating the data from the four cohort studies to assess the discrimination and calibration across the cohorts. RESULTS Two thousand five hundred sixty community-dwelling people were included in the analyses (mean age 69.7 ± 3.0 years old, 47.4% female) of whom 572 (22.3%) reported functional decline at three-year follow-up. The final prediction model included 10 out of 22 predictors: age, handgrip strength, gait speed, five-repeated chair stands time (non-linear association), body mass index, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, arthritis, and depressive symptoms. The optimism-corrected model showed good discrimination with a C statistic of 0.72. The calibration intercept was 0.06 and the calibration slope was 1.05. Internal-external cross-validation showed consistent performance of the model across the four cohorts. CONCLUSIONS Based on pooled cohort data analyses we were able to show that the onset of functional decline in ADL in three years in older people aged 65-75 years can be predicted by specific physical performance measures, age, body mass index, presence of depressive symptoms, and chronic conditions. The prediction model showed good discrimination and calibration, which remained stable across the four cohorts, supporting external validity of our findings.
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Affiliation(s)
- Nini H. Jonkman
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Marco Colpo
- Laboratory of Clinical Epidemiology, InCHIANTI Study Group, LHTC Local Health Tuscany Center, Firenze, Italy
| | - Jochen Klenk
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre and Manchester University NHS Foundation Trust, Manchester, UK
| | - Trynke Hoekstra
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Vieri Del Panta
- Laboratory of Clinical Epidemiology, InCHIANTI Study Group, LHTC Local Health Tuscany Center, Firenze, Italy
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Natasja M. van Schoor
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Stefania Bandinelli
- Laboratory of Clinical Epidemiology, InCHIANTI Study Group, LHTC Local Health Tuscany Center, Firenze, Italy
| | - Martijn W. Heymans
- Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Dominique Mauger
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Luca Cattelani
- Department of Computer Science and Engineering, University of Bologna, Bologna, Italy
| | - Michael D. Denkinger
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Geriatric Research Unit Ulm University and Geriatric Center, Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | | | - Jorunn L. Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andrea B. Maier
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Faculty of Medicine Dentistry and Health Sciences, Medicine and Aged Care, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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22
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Abstract
Older adults are at risk of protein-energy malnutrition (PEM). PEM detrimentally impacts on health, cognitive and physical functioning and quality of life. Given these negative health outcomes in the context of an ageing global population, the Healthy Diet for a Healthy Life Joint Programming Initiative Malnutrition in the Elderly (MaNuEL) sought to create a knowledge hub on malnutrition in older adults. This review summarises the findings related to the screening and determinants of malnutrition. Based on a scoring system that incorporated validity, parameters used and practicability, recommendations on setting-specific screening tools for use with older adults were made. These are: DETERMINE your health checklist for the community, Nutritional Form for the Elderly for rehabilitation, Short Nutritional Assessment Questionnaire-Residential Care for residential care and Malnutrition Screening Tool or Mini Nutritional Assessment-Short Form for hospitals. A meta-analysis was conducted on six longitudinal studies from MaNuEL partner countries to identify the determinants of malnutrition. Increasing age, unmarried/separated/divorced status (vs. married but not widowed), difficulties walking 100 m or climbing stairs and hospitalisation in the year prior to baseline or during follow-up predicted malnutrition. The sex-specific predictors of malnutrition were explored within The Irish Longitudinal Study of Ageing dataset. For females, cognitive impairment or receiving social support predicted malnutrition. The predictors for males were falling in the previous 2 years, hospitalisation in the past year and self-reported difficulties in climbing stairs. Incorporation of these findings into public health policy and clinical practice would support the early identification and management of malnutrition.
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23
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Wolters M, Volkert D, Streicher M, Kiesswetter E, Torbahn G, O'Connor EM, O'Keeffe M, Kelly M, O'Herlihy E, O'Toole PW, Timmons S, O'Shea E, Kearney P, van Zwienen-Pot J, Visser M, Maitre I, Van Wymelbeke V, Sulmont-Rossé C, Nagel G, Flechtner-Mors M, Goisser S, Teh R, Hebestreit A. Prevalence of malnutrition using harmonized definitions in older adults from different settings - A MaNuEL study. Clin Nutr 2018; 38:2389-2398. [PMID: 30448194 DOI: 10.1016/j.clnu.2018.10.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/12/2018] [Accepted: 10/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions. METHODS Available studies within the Joint Programming Initiative (JPI) Knowledge Hub 'Malnutrition in the Elderly' (MaNuEL) were used to calculate and compare prevalences of malnutrition indicators: low BMI (<20 kg/m2; age-specific BMI <20 if age 65-<70 and <22 kg/m2 if age ≥70 years), previous weight loss (WL), moderate and severe decrease in food intake, and combined BMI <20 kg/m2 and/or WL in participants aged ≥65 years. RESULTS Fifteen samples with in total 5956 participants (59.3% women) were included: 7 consisting of community-dwelling persons, 2 studies in geriatric day hospitals, 3 studies in hospitalized patients and 3 in nursing homes. Mean age of participants ranged between 67 and 87 years. Up to 4.2% of community-dwelling persons had a BMI <20 kg/m2, 1.6 and 9% of geriatric day hospital patients, 4.5-9.4% of hospital patients and 3.8-18.2% of nursing home residents. Using age-specific cut-offs doubled these prevalences. WL was reported in 2.3-10.5% of community-dwelling persons, 6% and 12.6% of geriatric day hospital patients, 5-14% of hospitalized patients and 4.5-7.7% of nursing home residents. Severe decrease in food intake was recorded in up to 9.6% of community-dwelling persons, 1.5% and 12% of geriatric day hospital patients, 3.4-34.2% of hospitalized patients and 1.5-8.2% of nursing home residents. The criteria age-specific BMI and WL showed opposing prevalences across all settings. Compared to women, low BMI and moderate decrease in food intake showed low prevalences in men but similar prevalences were observed for weight loss and severe decrease in food intake. In half of the study samples, participants in a younger age group had a higher prevalence of WL compared to those of an older age group. Prevalence of BMI <20 kg/m2 and WL at the same time did not exceed 2.6% in all samples. The highest prevalences were observed based on combined definitions when only one of the three criteria had to be present. CONCLUSIONS Prevalences for different criteria vary between and within the settings which might be explained by varying functional status. The criteria used strongly affect prevalence and it may be preferable to look at each criterion separately as each may indicate a nutritional problem.
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Affiliation(s)
- Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany
| | - Melanie Streicher
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany
| | - Eibhlís M O'Connor
- Dept Biological Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Mary O'Keeffe
- Dept Biological Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Mary Kelly
- Dept Biological Sciences, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | - Eileen O'Herlihy
- School of Microbiology and APC Microbiome Ireland, University College Cork, Cork, T12 Y337, Ireland
| | - Paul W O'Toole
- School of Microbiology and APC Microbiome Ireland, University College Cork, Cork, T12 Y337, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Emma O'Shea
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Patricia Kearney
- Dept Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Judith van Zwienen-Pot
- Department of Internal Medicine, Nutrition and Dietetics, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Isabelle Maitre
- USC 1422 GRAPPE, Ecole Supérieure d'Agricultures (ESA), SFR 4207 QUASAV, INRA, 55 Rue Rabelais, F-49007 Angers, France
| | - Virginie Van Wymelbeke
- Centre Hospitalier Universitaire Dijon Bourgogne, Centre Champmaillot, Unité de Recherche Pôle Personnes Âgées, 2 Rue Jules Violle, F-21000 Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, 9(E) Boulevard Jeanne d'Arc, F-21000 Dijon, France
| | - Claire Sulmont-Rossé
- Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, 9(E) Boulevard Jeanne d'Arc, F-21000 Dijon, France
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Marion Flechtner-Mors
- Medical Center, Division of Sports and Rehabilitation Medicine, University of Ulm, Leimgrubenweg 14, 89075 Ulm, Germany
| | - Sabine Goisser
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408 Nuremberg, Germany; Network Aging Research, Heidelberg University, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Ruth Teh
- General Practice and Primary Health Care, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
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24
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Soares WJS, Lopes AD, Nogueira E, Candido V, de Moraes SA, Perracini MR. Physical Activity Level and Risk of Falling in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis. J Aging Phys Act 2018; 27:1-10. [PMID: 29543113 DOI: 10.1123/japa.2017-0413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This systematic review examines the association between physical activity (PA) level and risk of falling in community-dwelling older adults. A search of PubMed, Embase, CINAHL, SPORTDiscus, and Web of Science was performed in January 2017. Four prospective cohort studies investigating the incidence of falls in a period of at least 12 months and its association with the level of PA in people aged 60 years and older were reviewed and pooled for meta-analysis. The pooled risk ratio (RR) for being a recurrent faller (2,420 participants) was 39% higher among those who were in the lowest PA level (RR = 1.39; 95% confidence interval [1.17, 1.65]; I2 = 0%, p = .43; p < .0001). The association between being a faller (7,927 participants) and PA level was inconclusive. This review identified that the benefit of general PA for preventing falls is associated with the adopted PA level.
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25
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Why Is Social Isolation Among Older Adults Associated with Depressive Symptoms? The Mediating Role of Out-of-Home Physical Activity. Int J Behav Med 2018; 25:649-657. [DOI: 10.1007/s12529-018-9752-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Streicher M, van Zwienen-Pot J, Bardon L, Nagel G, Teh R, Meisinger C, Colombo M, Torbahn G, Kiesswetter E, Flechtner-Mors M, Denkinger M, Rothenbacher D, Thorand B, Ladwig KH, Corish CA, Clarke M, Kerse N, Muru-Lanning M, Gibney ER, O'Connor EM, Visser M, Volkert D. Determinants of Incident Malnutrition in Community-Dwelling Older Adults: A MaNuEL Multicohort Meta-Analysis. J Am Geriatr Soc 2018; 66:2335-2343. [PMID: 30136728 DOI: 10.1111/jgs.15553] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To identify determinants of incident malnutrition in community-dwelling older adults. DESIGN Meta-analysis of 6 community-based longitudinal datasets with follow-up of 1 to 3 years. SETTING Datasets from MaNuEL (MalNutrition in the Elderly) partners were included: 3 studies from Germany and 1 each from Ireland, the Netherlands, and New Zealand. PARTICIPANTS community-dwelling adults aged 65 and older (N=4,844). MEASUREMENT The same definition of incident malnutrition was used for all cohorts (body mass index < 20.0 kg/m2 at follow-up or weight loss ≥10 % between baseline and follow-up). Twenty-one potential baseline determinants from 7 domains (demographic, nutritional, lifestyle, social, psychological, physical functioning, medical) and 2 follow-up variables (hospitalization, falls) were harmonized for all studies. Binary logistic regression analyses were performed to assess the association between each variable, adjusted for specific confounders, and incident malnutrition. Combined odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects meta-analyses. RESULTS Studies included between 209 and 1,841 participants without malnutrition at baseline; mean age ranged from 71.7 to 84.6. Incidence of malnutrition varied from 5.1% and 17.2%. Meta-analyses identified 6 variables as independent determinants of incident malnutrition; with increasing age, the risk of developing malnutrition increased continuously. Unmarried, separated, or divorced participants were more likely to develop malnutrition than married participants, whereas no association was found for widowed participants. Participants with difficulty walking (OR=1.41, 95% CI=1.06-1.89) or difficulty climbing stairs (OR=1.45, 95% CI=1.14-1.85) and those who were hospitalized before baseline (OR=1.49, 95% CI=1.25-1.76) and during follow-up (OR=2.02, 95% CI=1.41-2.88) had higher odds of incident malnutrition. CONCLUSION In this harmonized meta-analysis based on prospective data of older, community-dwelling adults, age, marital status, limitations with walking and climbing stairs, and hospitalization were identified as determinants of incident malnutrition. J Am Geriatr Soc 66:2335-2343, 2018.
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Affiliation(s)
- Melanie Streicher
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Judith van Zwienen-Pot
- Department of Internal Medicine, Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Laura Bardon
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland.,School of Agricultural and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Ruth Teh
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Neuherberg, Germany
| | - Christine Meisinger
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Department of Epidemiology, University Center for Health Sciences at the Klinikum Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Miriam Colombo
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Marion Flechtner-Mors
- Division of Sports and Rehabilitation Medicine, Medical Center, University of Ulm, Ulm, Germany
| | - Michael Denkinger
- Agaplesion Bethesda Hospital, Ulm, Geriatric Research Unit, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | | | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Clare A Corish
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Michelle Clarke
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland.,School of Agricultural and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Ngaire Kerse
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Marama Muru-Lanning
- James Henare Māori Research Centre, University of Auckland, Auckland, New Zealand
| | - Eileen R Gibney
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland.,School of Agricultural and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Eibhlís M O'Connor
- Department of Biological Sciences, and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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27
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Rapp K, Mikolaizak S, Rothenbacher D, Denkinger MD, Klenk J. Prospective analysis of time out-of-home and objectively measured walking duration during a week in a large cohort of older adults. Eur Rev Aging Phys Act 2018; 15:8. [PMID: 29946372 PMCID: PMC6004085 DOI: 10.1186/s11556-018-0197-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity is considered an effective measure to promote health in older people. There is evidence that the number of outdoor trips increases physical activity by increasing walking duration. The objective of this study was to analyse the relationship between daily time out-of-home and walking duration. Furthermore, predictors for walking duration and time out-of-home were evaluated. METHODS Walking duration was measured prospectively over a 1 week period by a body-fixed sensor and the time out-of-home was assessed by a questionnaire at the same days. Seven thousand, two hundred and forty-three days from 1289 older people (mean age 75.4 years) with both sensor-based measures and completed questionnaires were included in the analyses. To account for several observation days per participant multilevel regression analyses were applied. Analyses were stratified according to the time out-of-home (more or less than 100 min/day). RESULTS In the group with less than 100 min out-of-home, each additional minute out-of-home added 20 s to overall walking duration. If the time exceeded 100 min the additional increase of walking duration was only moderate or weak. Leaving the home once added 40 min of walking, the following trips 15 to 20 min. Increasing age, lower gait speed, comorbidities, low temperature, rain and specific week days (Sunday) decreased both the time out-of-home and walking duration. Other variables like gender (female), isolation or living with a spouse reduced the time out-of-home without affecting walking duration. CONCLUSIONS Being out-of-home increases daily walking duration. The association is strongest if the time out-of-home is 100 min or less.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Stefanie Mikolaizak
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | | | - Jochen Klenk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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28
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Herbolsheimer F, Riepe MW, Peter R. Cognitive function and the agreement between self-reported and accelerometer-accessed physical activity. BMC Geriatr 2018; 18:56. [PMID: 29466954 PMCID: PMC5822490 DOI: 10.1186/s12877-018-0747-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 02/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Numerous studies have reported weak or moderate correlations between self-reported and accelerometer-assessed physical activity. One explanation is that self-reported physical activity might be biased by demographic, cognitive or other factors. Cognitive function is one factor that could be associated with either overreporting or underreporting of daily physical activity. Difficulties in remembering past physical activities might result in recall bias. Thus, the current study examines whether the cognitive function is associated with differences between self-reported and accelerometer-assessed physical activity. Methods Cross-sectional data from the population-based Activity and Function in the Elderly in Ulm study (ActiFE) were used. A total of 1172 community-dwelling older adults (aged 65–90 years) wore a uniaxial accelerometer (activPAL unit) for a week. Additionally, self-reported physical activity was assessed using the LASA Physical Activity Questionnaire (LAPAQ). Cognitive function was measured with four items (immediate memory, delayed memory, recognition memory, and semantic fluency) from the Consortium to Establish a Registry for Alzheimer’s Disease Total Score (CERAD-TS). Results Mean differences of self-reported and accelerometer-assessed physical activity (MPA) were associated with cognitive function in men (rs = −.12, p = .002) but not in women. Sex-stratified multiple linear regression analyses showed that MPA declined with high cognitive function in men (β = −.13; p = .015). Conclusion Results suggest that self-reported physical activity should be interpreted with caution in older populations, as cognitive function was one factor that explained the differences between objective and subjective physical activity measurements. Electronic supplementary material The online version of this article (10.1186/s12877-018-0747-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florian Herbolsheimer
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany.
| | - Matthias W Riepe
- Division of Mental Health & Old Age Psychiatry, Psychiatry II, Ulm University, Günzburg, Germany
| | - Richard Peter
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Parkstraße 11, 89073, Ulm, Germany
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Laszlo R, Konz H, Kunz K, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker For The ActiFE Study Group JM. Evaluation of left and right ventricular systolic and diastolic electromechanical synchrony in older people: a population-based observational study. Physiol Res 2017; 66:933-948. [PMID: 28937256 DOI: 10.33549/physiolres.933453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
It is unknown whether physiological ageing also goes along with electromechanical asynchrony of contraction. Aim of the study was to evaluate synchrony of contraction in older people with ("non-healthy") or without ("healthy") evidence for structural cardiac disease. In 547 persons (age 76.7+/-5.5 years, 306 male, 241 female) recruited from a population-based cohort of the ActiFE-Ulm study including a random sample of people >/=65 years old living in the region of Ulm, Germany, various PW- and TDI-Doppler based markers for asynchrony were obtained by echocardiography. Within a subgroup of 84 healthy subjects, at most minimal systolic and diastolic asynchrony was found. Concerning systolic asynchrony, similar observations were made within the non-healthy subgroup. However, extent of diastolic left ventricular intraventricular asynchrony and also - by tendency - diastolic interventricular asynchrony was increased in comparison to the healthy subgroup. To conclude, no evidence that physiological ageing might go along with relevant left or right ventricular systolic or diastolic electromechanical asynchrony was found in our study. Furthermore, our population-based data support the results from other clinical studies with rather selected cohorts that structural heart diseases might go along with increased diastolic asynchrony.
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Affiliation(s)
- R Laszlo
- Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany.
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Laszlo R, Kunz K, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker JM. Accuracy of ECG indices for diagnosis of left ventricular hypertrophy in people >65 years: results from the ActiFE study. Aging Clin Exp Res 2017; 29:875-884. [PMID: 27830522 DOI: 10.1007/s40520-016-0667-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The detection of left ventricular hypertrophy (LVH) is still a common objective of electrocardiography (ECG) in clinical practice. AIMS The aim of our study was to evaluate the accuracy of LVH ECG indices in people older than 65 recruited from a population-based cohort (ActiFE-Ulm study). METHODS In 432 subjects (mean age 76.2 ± 5.5 years, 51% male), left ventricular mass was echocardiographically determined (Devereux formula) and indexed (LVMI) to body surface area. Several LVH ECG indices (Lewis voltage, Gubner-Ungerleider voltage, Sokolow-Lyon voltage/product, Cornell voltage/product) were calculated with the help of resting ECG data and compared with the echocardiographic assessment. RESULTS Despite echocardiographic signs of LVH [LVMI > 115 (♂) or >95 g/m2 (♀)] in 47.5% of all subjects, diagnostic performance of all ECG indices was generally low. Magnitude of all LVH-indices was mainly predicted by frontal QRS axis in multivariate linear regression analysis. In comparison with the literature data from younger subjects, average frontal QRS axis turned counterclockwise. DISCUSSION AND CONCLUSIONS Most probably, age-related counterclockwise turn of frontal QRS axis is mainly explanatory for the decreased magnitude of LVH ECG indices and consecutive worse diagnostic performance of these indices in the elderly. ECG indices for detection of LVH have insufficient predictive values in geriatric subjects and should therefore not be used clinically for this purpose. Nevertheless, due to its established relevancy in cardiac risk stratification in this age group, usage of some established ECG indices might keep its significance even in the age of modern cardiac imaging.
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Florian MC, Klenk J, Marka G, Soller K, Kiryakos H, Peter R, Herbolsheimer F, Rothenbacher D, Denkinger M, Geiger H. Expression and Activity of the Small RhoGTPase Cdc42 in Blood Cells of Older Adults Are Associated With Age and Cardiovascular Disease. J Gerontol A Biol Sci Med Sci 2017; 72:1196-1200. [PMID: 28498918 DOI: 10.1093/gerona/glx091] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Indexed: 12/11/2022] Open
Abstract
The small RhoGTPase Cdc42 is mechanistically linked to aging of multiple tissues and to rejuvenation of hematopoietic stem cells in mice. However, data validating Cdc42 activity and expression as biomarker for aging in humans are still missing. Here, we hypothesized that Cdc42 might serve as a novel biomarker of aging in older adults and therefore we determined Cdc42 activity and expression levels in peripheral blood cells from a cohort of 196 donors. We investigated the association of these parameters with both chronological and biological aging. We also tested in this cohort of older adults a recently published algorithm determining chronological age based on DNA methylation profiles. A positive correlation with chronological age was found for both the level of Cdc42 mRNA and the level of active Cdc42 protein (the GTP bound form). Notably, the level of Cdc42 mRNA as well as total protein showed a specific strong association to cardiovascular disease and Cdc42 mRNA levels also to a history of myocardial infarction. In summary, these data validate Cdc42 as a blood biomarker of both chronological aging as well as aging-associated diseases like cardiovascular disease and myocardial infarction.
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Affiliation(s)
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany.,Department of Clinical Gerontology, Robert Bosch Hospital Stuttgart, Germany
| | - Gina Marka
- Institute of Molecular Medicine and Stem Cell Aging, Ulm University, Germany
| | - Karin Soller
- Institute of Molecular Medicine and Stem Cell Aging, Ulm University, Germany
| | - Hady Kiryakos
- Institute of Molecular Medicine and Stem Cell Aging, Ulm University, Germany
| | - Richard Peter
- Institute for History, Theory and Ethics in Medicine
| | | | | | - Michael Denkinger
- AGAPLESION Bethesda Clinic, Geriatric Medicine, Ulm University, Germany.,Geriatric Center Ulm/Alb-Donau, Germany
| | - Hartmut Geiger
- Institute of Molecular Medicine and Stem Cell Aging, Ulm University, Germany.,Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Ohio
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Tam ZY, Ng SP, Tan LQ, Lin CH, Rothenbacher D, Klenk J, Boehm BO. Metabolite profiling in identifying metabolic biomarkers in older people with late-onset type 2 diabetes mellitus. Sci Rep 2017; 7:4392. [PMID: 28663594 PMCID: PMC5491522 DOI: 10.1038/s41598-017-01735-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/30/2017] [Indexed: 12/31/2022] Open
Abstract
Regulation of blood glucose requires precise coordination between different endocrine systems and multiple organs. Type 2 diabetes mellitus (T2D) arises from a dysregulated response to elevated glucose levels in the circulation. Globally, the prevalence of T2D has increased dramatically in all age groups. T2D in older adults is associated with higher mortality and reduced functional status, leading to higher rate of institutionalization. Despite the potential healthcare challenges associated with the presence of T2D in the elderly, the pathogenesis and phenotype of late-onset T2D is not well studied. Here we applied untargeted metabolite profiling of urine samples from people with and without late-onset T2D using ultra-performance liquid-chromatography mass-spectrometry (UPLC-MS) to identify urinary biomarkers for late-onset T2D in the elderly. Statistical modeling of measurements and thorough validation of structural assignment using liquid chromatography tandem mass-spectrometry (LC-MS/MS) have led to the identification of metabolite biomarkers associated with late-onset T2D. Lower levels of phenylalanine, acetylhistidine, and cyclic adenosine monophosphate (cAMP) were found in urine samples of T2D subjects validated with commercial standards. Elevated levels of 5′-methylthioadenosine (MTA), which previously has only been implicated in animal model of diabetes, was found in urine of older people with T2D.
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Affiliation(s)
- Zhi Yang Tam
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore
| | - Sean Pin Ng
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore
| | - Ling Qiao Tan
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore
| | - Chih-Hsien Lin
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstrasse 22, 89081, Ulm, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstrasse 22, 89081, Ulm, Germany.,Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Bernhard Otto Boehm
- Singapore Phenome Center, Experimental Medicine Building, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore. .,Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, UK. .,Department of Internal Medicine I, Ulm University Medical Centre, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Laszlo R, Baumann T, Konz H, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker JM. Right ventricular function assessed by tissue Doppler echocardiography in older subjects without evidence for structural cardiac disease. Aging Clin Exp Res 2017; 29:557-562. [PMID: 27245355 DOI: 10.1007/s40520-016-0590-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/18/2016] [Indexed: 12/23/2022]
Abstract
The aim of our study was to obtain right ventricular (RV) tissue Doppler imaging (TDI) data in older subjects (n = 95, mean age: 74.5 ± 4.6 years) without evidence of hemodynamically significant structural heart disease recruited from a large population-based cohort (ActiFE-Ulm study). Our data indicate that aging may be accompanied by decreasing RV diastolic function and at most little alterations of RV systolic function. Mean values of all parameters were still within the guideline-suggested reference range with most of them closer to the abnormality thresholds. On an individual basis, respective thresholds were also exceeded in some subjects (almost all parameters <20 %) despite the absence of evidence for structural cardiac disease. RV-TDI is a feasible method for evaluation of RV systolic and diastolic function also in a geriatric population as sufficient TDI data was obtainable in the majority of our participants. Published reference values also seem to be mostly suitable although among older subjects, presumed pathological measures might still be compatible with physiological age-related alterations. Therefore, they always have to be interpreted across the clinical context and in relation to other parameters of morphology and function obtained by other ultrasound imaging techniques (M-mode, B-mode, etc.) in the context of echocardiographic evaluation of the right heart.
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Affiliation(s)
- Roman Laszlo
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany.
| | - Tobias Baumann
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
| | - Hanna Konz
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
| | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic, Geriatric Medicine, University of Ulm, Zollernring 26, 89073, Ulm, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Clinic, Geriatric Medicine, University of Ulm, Zollernring 26, 89073, Ulm, Germany
| | - Wolfgang Koenig
- Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Juergen Michael Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
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Relationship between Social Isolation and Indoor and Outdoor Physical Activity in Community-Dwelling Older Adults in Germany: Findings from the ActiFE Study. J Aging Phys Act 2016; 25:387-394. [PMID: 26421605 PMCID: PMC4857800 DOI: 10.1123/japa.2016-0060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to establish the feasibility of using an aerobics class to produce potentially bone protective vertical impacts of ≥ 4g in older adults and to determine whether impacts can be predicted by physical function. Participants recruited from older adult exercise classes completed an SF-12 questionnaire, short physical performance battery, and an aerobics class with seven different components, performed at low and high intensity. Maximum g and jerk values were identified for each activity. Forty-one participants (mean 69 years) were included. Mean maximal values approached or exceeded the 4g threshold for four of the seven exercises. In multivariate analyses, age (–0.53; –0.77, –0.28) (standardized beta coefficient; 95% CI) and 4-m walk time (–0.39; –0.63, –0.16) were inversely related to maximum g. Aerobics classes can be used to produce relatively high vertical accelerations in older individuals, although the outcome is strongly dependent on age and physical function.
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Palumbo P, Klenk J, Cattelani L, Bandinelli S, Ferrucci L, Rapp K, Chiari L, Rothenbacher D. Predictive Performance of a Fall Risk Assessment Tool for Community-Dwelling Older People (FRAT-up) in 4 European Cohorts. J Am Med Dir Assoc 2016; 17:1106-1113. [PMID: 27594522 PMCID: PMC6136246 DOI: 10.1016/j.jamda.2016.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVE The fall risk assessment tool (FRAT-up) is a tool for predicting falls in community-dwelling older people based on a meta-analysis of fall risk factors. Based on the fall risk factor profile, this tool calculates the individual risk of falling over the next year. The objective of this study is to evaluate the performance of FRAT-up in predicting future falls in multiple cohorts. METHODS Information about fall risk factors in 4 European cohorts of older people [Activity and Function in the Elderly (ActiFE), Germany; English Longitudinal Study of Aging (ELSA), England; Invecchiare nel Chianti (InCHIANTI), Italy; Irish Longitudinal Study on Aging (TILDA), Ireland] was used to calculate the FRAT-up risk score in individual participants. Information about falls that occurred after the assessment of the risk factors was collected from subsequent longitudinal follow-ups. We compared the performance of FRAT-up against those of other prediction models specifically fitted in each cohort by calculation of the area under the receiver operating characteristic curve (AUC). RESULTS The AUC attained by FRAT-up is 0.562 [95% confidence interval (CI) 0.530-0.594] for ActiFE, 0.699 (95% CI 0.680-0.718) for ELSA, 0.636 (95% CI 0.594-0.681) for InCHIANTI, and 0.685 (95% CI 0.660-0.709) for TILDA. Mean FRAT-up AUC as estimated from meta-analysis is 0.646 (95% CI 0.584-0.708), with substantial heterogeneity between studies. In each cohort, FRAT-up discriminant ability is surpassed, at most, by the cohort-specific risk model fitted on that same cohort. CONCLUSIONS We conclude that FRAT-up is a valid approach to estimate risk of falls in populations of community-dwelling older people. However, further studies should be performed to better understand the reasons for the observed heterogeneity across studies and to refine a tool that performs homogeneously with higher accuracy measures across different populations.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi"-DEI, University of Bologna, Bologna, Italy.
| | - Jochen Klenk
- Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Luca Cattelani
- Department of Computer Science and Engineering-DISI, University of Bologna, Bologna, Italy
| | | | - Luigi Ferrucci
- Clinical Research Branch, National Institute on Aging, Baltimore, MD
| | - Kilian Rapp
- Department of Geriatrics and Clinic of Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi"-DEI, University of Bologna, Bologna, Italy; Health Sciences and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Bologna, Italy
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Laszlo R, Baumann T, Konz H, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker JM. Echocardiographic B-mode evaluation of the right heart in older people: The ActiFE Study. Arch Gerontol Geriatr 2016; 67:145-52. [PMID: 27518473 DOI: 10.1016/j.archger.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Right heart B-mode echocardiography reference values have been predominantly obtained in younger age cohorts (<65years). Aims of the study were to describe and evaluate the feasibility of right heart B-mode echocardiography in a large geriatric cohort and to analyze standard parameters in defined subgroups with or without any evidence for structural cardiac disease. METHODS ActiFE-Ulm study is a population-based cohort study including a sample of people≥65years old living in the region of Ulm, Germany. Echocardiography including right heart parameters was performed within a cardiovascular follow-up of 688 subjects. PRINCIPAL RESULTS Non-obtainability of right heart B-mode data was rather not a consequence of accompanying cardiac diseases or risk factors but of a more obese body composition. Mean values of right heart measurements of our subpopulation of subjects without evidence for structural cardiac disease were continuously higher than those of the guidelines (e.g. mean right ventricular end diastolic area 23.5±5.6cm(2) (males), 20.3±5.0cm(2) (females)). On an individual basis, guideline-suggested abnormality thresholds were also often exceeded, whereas this situation occurred more often in male than in female subjects. MAJOR CONCLUSIONS Methodically, right heart B-mode echocardiography in older subjects is challenging. Our results suggest an ageing-associated right heart enlargement. Utilization of published right heart reference values in older adults seems to be problematic and in clinical practice, they always have to be interpreted within the clinical and functional context and in relation to other right heart echocardiographic parameters.
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Affiliation(s)
- Roman Laszlo
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany.
| | - Tobias Baumann
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany
| | - Hannah Konz
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany
| | - Dhayana Dallmeier
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Zollernring 26, 89073 Ulm, Germany
| | - Jochen Klenk
- University of Ulm, Institute of Epidemiology and Medical Biometry, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Michael Denkinger
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Zollernring 26, 89073 Ulm, Germany
| | - Wolfgang Koenig
- Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Dietrich Rothenbacher
- University of Ulm, Institute of Epidemiology and Medical Biometry, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Juergen Michael Steinacker
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany
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Klenk J, Dallmeier D, Denkinger MD, Rapp K, Koenig W, Rothenbacher D. Objectively Measured Walking Duration and Sedentary Behaviour and Four-Year Mortality in Older People. PLoS One 2016; 11:e0153779. [PMID: 27082963 PMCID: PMC4833405 DOI: 10.1371/journal.pone.0153779] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 04/04/2016] [Indexed: 11/18/2022] Open
Abstract
Background Physical activity is an important component of health. Recommendations based on sensor measurements are sparse in older people. The aim of this study was to analyse the effect of objectively measured walking and sedentary duration on four-year mortality in community-dwelling older people. Methods Between March 2009 and April 2010, physical activity of 1271 participants (≥65 years, 56.4% men) from Southern Germany was measured over one week using a thigh-worn uni-axial accelerometer (activPAL; PAL Technologies, Glasgow, Scotland). Mortality was assessed during a four-year follow-up. Cox-proportional-hazards models were used to estimate the associations between walking (including low to high intensity) and sedentary duration with mortality. Models were adjusted for age and sex, additional epidemiological variables, and selected biomarkers. Results An inverse relationship between walking duration and mortality with a minimum risk for the 3rd quartile (102.2 to128.4 minutes walking daily) was found even after multivariate adjustment with HRs for quartiles 2 to 4 compared to quartile 1 of 0.45 (95%-CI: 0.26; 0.76), 0.18 (95%-CI: 0.08; 0.41), 0.39 (95%-CI: 0.19; 0.78), respectively. For sedentary duration an age- and sex-adjusted increased mortality risk was observed for the 4th quartile (daily sedentary duration ≥1137.2 min.) (HR 2.05, 95%-CI: 1.13; 3.73), which diminished, however, after full adjustment (HR 1.63, 95%-CI: 0.88; 3.02). Furthermore, our results suggest effect modification between walking and sedentary duration, such that in people with low walking duration a high sedentary duration was noted as an independent factor for increased mortality. Conclusions In summary, walking duration was clearly associated with four-year overall mortality in community-dwelling older people.
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Affiliation(s)
- Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Geriatrics and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
| | - Dhayana Dallmeier
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
- Agaplesion Bethesda Hospital, Geriatric Research Unit, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Michael Dieter Denkinger
- Agaplesion Bethesda Hospital, Geriatric Research Unit, Ulm University and Geriatric Center Ulm/Alb-Donau, Ulm, Germany
| | - Kilian Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Geriatrics and Geriatric Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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A prospective assessment of cardiac biomarkers for hemodynamic stress and necrosis and the risk of falls among older people: the ActiFE study. Eur J Epidemiol 2015; 31:427-35. [PMID: 26130126 DOI: 10.1007/s10654-015-0059-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 06/11/2015] [Indexed: 01/21/2023]
Abstract
Falls are related to a complex interaction of risk factors. We examined if cardiac biomarkers for hemodynamic stress (N-terminal pro Brain Natriuretic Peptide-NT-proBNP), and for necrosis [high sensitive (hs) cardiac troponins T (cTnT) and I (cTnI)] are associated with falls in older people. Biomarkers were measured at baseline in a cohort of 1506 community-dwelling adults ≥65 years. Falls were assessed prospectively in a falls calendar (median 370 days). Cox-proportional hazards models evaluated the association of each biomarker with the incidence of the first fall accounting for established confounders. We observed 430 incident falls among 1327 participants and an effect modification by sex for all biomarkers. In multivariable analyses among men a one unit increment of log-transformed hs-cTnI was associated with a hazard ratio (HR) of 1.26 (95 % CI 1.04, 1.53). Men with hs-cTnT ≥ 14 ng/L had a HR of 1.74 (95 % CI 1.15, 2.61) compared to those with undetectable hs-cTnT levels. In women cTn were not associated with falls. We did not detect an association between NT-proBNP and the risk of fall. Our results suggest that cardiac troponins may not only identify subjects at risk for cardiovascular diseases, but also help to understand the underlying complex pathophysiology of falls.
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Klenk J, Kerse N, Rapp K, Nikolaus T, Becker C, Rothenbacher D, Peter R, Denkinger MD. Physical Activity and Different Concepts of Fall Risk Estimation in Older People--Results of the ActiFE-Ulm Study. PLoS One 2015; 10:e0129098. [PMID: 26058056 PMCID: PMC4461251 DOI: 10.1371/journal.pone.0129098] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/05/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate the relationship between physical activity and two measures of fall incidence in an elderly population using person-years as well as hours walked as denominators and to compare these two approaches. DESIGN Prospective cohort study with one-year follow-up of falls using fall calendars. Physical activity was defined as walking duration and recorded at baseline over one week using a thigh-worn uni-axial accelerometer (activPAL; PAL Technologies, Glasgow, Scotland). Average daily physical activity was extracted from these data and categorized in low (0-59 min), medium (60-119 min) and high (120 min and more) activity. SETTING The ActiFE Ulm study located in Ulm and adjacent regions in Southern Germany. PARTICIPANTS 1,214 community-dwelling older people (≥65 years, 56.4% men). MEASUREMENTS Negative-binomial regression models were used to calculate fall rates and incidence rate ratios for each activity category each with using (1) person-years and (2) hours walked as denominators stratified by gender, age group, fall history, and walking speed. All analyses were adjusted either for gender, age, or both. RESULTS No statistically significant association was seen between falls per person-year and average daily physical activity. However, when looking at falls per 100 hours walked, those who were low active sustained more falls per hours walked. The highest incidence rates of falls were seen in low-active persons with slow walking speed (0.57 (95% confidence interval (95% CI): 0.33 to 0.98) falls per 100 hours walked) or history of falls (0.60 (95% CI: 0.36 to 0.99) falls per 100 hours walked). CONCLUSION Falls per hours walked is a relevant and sensitive outcome measure. It complements the concept of incidence per person years, and gives an additional perspective on falls in community-dwelling older people.
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Affiliation(s)
- Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kilian Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Richard Peter
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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Pettigrew S, Jongenelis M, Newton RU, Warburton J, Jackson B. Research protocol for a randomized controlled trial of the health effects of volunteering for seniors. Health Qual Life Outcomes 2015; 13:74. [PMID: 26040633 PMCID: PMC4453438 DOI: 10.1186/s12955-015-0263-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/12/2015] [Indexed: 12/15/2022] Open
Abstract
Abstract Background A growing evidence base demonstrates that interventions that focus on participation in physical and social activities can assist in preventing and treating both physical and mental health problems. In addition, there is some evidence that engaging in volunteering activities can provide beneficial social, physical, psychological, and cognitive outcomes for older people. This study will use a randomized controlled trial approach to investigate the potential for interventions involving volunteer activities to produce positive physical and psychological outcomes for older people, thereby contributing to the limited evidence relating to the potential for volunteering to provide multiple health effects. Methods/Design This randomized controlled trial will involve 400 retired/non-employed individuals in good health aged 60+ years living in the metropolitan area in Perth, Western Australia. Participants will be recruited from the Perth metropolitan area using a variety of recruitment methods to achieve a diverse sample in terms of age, gender, and socioeconomic status. Consenting and eligible participants will be randomly assigned to an intervention (n = 200) or control group (n = 200). Those in the intervention group will be asked to engage in a minimum 60 min of volunteer activities per week for a period of 6 months, while those in the control group will be asked to maintain their existing lifestyle or take on new activities as they see fit. Physical and psychological outcomes will be assessed. Primary physical outcomes will include physical activity and sedentary time (measured using pedometers and Actigraph monitors) and physical health (measured using a battery of physical functioning tests, resting heart rate, blood pressure, BMI, and girth). Primary psychological outcomes will include psychological well-being, depression, self-esteem, and quality of life (measured using the Warwick-Edinburgh Mental Well-Being Scale, Center for Epidemiologic Studies Depression Scale, the Rosenberg Self-Esteem Survey, and the Global Quality of Life Scale, respectively). Secondary outcomes of interest will include attitudes to volunteering (measured via open-ended interviews) and personal growth, purpose in life, social support, and self-efficacy (measured using the Personal Growth and Purpose in Life subscales of Ryff’s Psychological Well-Being Scale, the Social Provisions Scale, and the Generalized Self-Efficacy Scale, respectively). Participants will be re-assessed on these measures after 6 months. Discussion The results of this randomized controlled trial will generate new knowledge relating to the physical and psychological health benefits of different levels and types of volunteering for older people. In addition, insight will be provided into the major factors influencing the recruitment and retention of older volunteers. Understanding the full potential for volunteering to affect physical and mental well-being will provide policy makers with the evidence they require to determine appropriate investment in the volunteering sector, especially in relation to encouraging volunteering among older people who constitute an important resource for the community. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12615000091505. Date registered: 3 February, 2015.
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Affiliation(s)
- Simone Pettigrew
- School of Psychology and Speech Pathology, Curtin University, Kent St Bentley, WA, 6102, Australia.
| | - Michelle Jongenelis
- School of Psychology and Speech Pathology, Curtin University, Kent St Bentley, WA, 6102, Australia.
| | - Robert U Newton
- School of Exercise and Health Sciences, Edith Cowan University, Perth, Australia.
| | - Jeni Warburton
- Faculty of Health Sciences, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Ben Jackson
- School of Sports Science, Exercise, and Health, University of Western Australia, Perth, Australia.
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Dallmeier D, Denkinger M, Peter R, Rapp K, Jaffe AS, Koenig W, Rothenbacher D. Sex-specific associations of established and emerging cardiac biomarkers with all-cause mortality in older adults: the ActiFE study. Clin Chem 2014; 61:389-99. [PMID: 25501933 DOI: 10.1373/clinchem.2014.230839] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND N-terminal pro B-type natriuretic peptide (NT-proBNP) has strong prognostic value for all-cause mortality in the general population. High-sensitivity assays now allow detection of cardiac troponins even in asymptomatic populations. We examined the association between NT-proBNP, high-sensitivity cardiac troponin T (hs-cTnT), and hs-cTnI and all-cause mortality in older adults. METHODS We conducted a longitudinal cohort study [Activity and Function in the Elderly in Ulm (ActiFE Ulm)] including 1506 community-dwelling adults ≥65 years old with NT-proBNP, hs-cTnT, and hs-cTnI measured at baseline. We evaluated the associations between log-transformed biomarker concentrations and 4-year total mortality, accounting for possible confounders, with Cox proportional hazards models. RESULTS We observed 125 deaths among 1422 participants (median follow-up 4 years). We detected effect modification by sex for all biomarkers (all P values <0.05) expressed as hazard ratio (HR) for death per 1-unit increment of ln(biomarker concentration) in women (n = 618, 37 deaths) compared with men (n = 804, 88 deaths): HR 2.97 (95% CI 2.04-4.33) vs 1.73 (1.40-2.13) for NT-proBNP; 3.67 (2.31-5.81) vs 2.15 (1.61-2.87) for hs-cTnT; and 3.32 (2.13-5.18) vs 1.92 (1.55-2.38) for hs-cTnI. Among 777 participants with undetectable hs-cTnT (<5 ng/L), hs-cTnI remained associated with all-cause mortality in age- and sex-adjusted analysis. CONCLUSIONS NT-proBNP, hs-cTnT, and hs-cTnI were independently associated with all-cause mortality in older adults. The strength of these associations varied between men and women, emphasizing the need for additional sex-specific research among older people.
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Affiliation(s)
- Dhayana Dallmeier
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany; Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Michael Denkinger
- Agaplesion Bethesda Clinic Ulm, Geriatric Center Ulm/Alb-Donau, Ulm, Germany; Institute of Molecular Medicine and Stem Cell Research
| | - Richard Peter
- Institute of Epidemiology and Medical Biometry, and Institute of the History, Philosophy, and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Kilian Rapp
- Clinic for Geriatric Rehabilitation, Robert-Bosch Hospital, Stuttgart, Germany
| | - Allan S Jaffe
- Mayo Clinic College of Medicine, Division of Cardiovascular Diseases, Rochester, MN
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany;
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Rapp K, Freiberger E, Todd C, Klenk J, Becker C, Denkinger M, Scheidt-Nave C, Fuchs J. Fall incidence in Germany: results of two population-based studies, and comparison of retrospective and prospective falls data collection methods. BMC Geriatr 2014; 14:105. [PMID: 25241278 PMCID: PMC4179843 DOI: 10.1186/1471-2318-14-105] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Fall incidence differs considerably between studies and countries. Reasons may be differences between study samples or different assessment methods. The aim was to derive estimates of fall incidence from two population-based studies among older community-living people in Germany and compare retrospective and prospective falls data collection methods. Methods Data were derived from the 2008–11 wave of the German health interview and examination survey for adults (DEGS1), and the Activity and Function of the Elderly in Ulm study (ActiFE-Ulm). Data collection took place in community facilities (DEGS1) or participants’ homes (ActiFE-Ulm). Participation rates were 42% (newly recruited) and 64% (panel component) in DEGS1 and 19.8% in ActiFE-Ulm. Self-report retrospective fall data covering the previous 12 month period in DEGS1 and ActiFE-Ulm were collected, but only ActiFE-Ulm used prospective 12 month fall calendars. The incidence of ‘any fall’ and ‘recurrent falls’ were calculated for both methods. Results Fall rates increased with age in men but not women. The ActiFE-Ulm prospectively assessed incidence (95% confidence interval) in women and men aged 65- < 90 years were 38.7 (36.9-40.5) and 29.7 (28.1-31.3) fallers/year and 13.7 (12.5-14.9) and 10.9 (9.9-12.0) recurrent fallers/year, respectively. Retrospective and prospective fall incidence in ActiFE-Ulm did not differ.The retrospectively assessed incidence of ‘any fall’ among persons 65- < 80 years were significantly lower in DEGS1 than ActiFE-Ulm (women: 25.7% (22.4-29.2) versus 37.4% (34.8-39.9); men: 16.3% (13.6-19.3) versus 28.9% (26.6-31.1). Retrospective incidence estimates of recurrent falls were similar in both studies for women (10.4% (8.3-12.9) versus 10.2% (8.5-11.8)) and men (6.1% (4.3-8.5) versus 8.4% (7.1-9.8)). Conclusion Both studies were population-based, but retrospective self-reported fall incidence differed between studies. Study design influences retrospective reported fall incidence considerably. Costly collection of prospective data gives similar rates to the cheaper retrospective report method.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany.
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Denkinger MD, Lukas A, Nikolaus T, Peter R, Franke S. Multisite pain, pain frequency and pain severity are associated with depression in older adults: results from the ActiFE Ulm study. Age Ageing 2014; 43:510-4. [PMID: 24603284 DOI: 10.1093/ageing/afu013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND there is ample literature showing pain and depression are related. However, different dimensions of pain have been used in former studies. OBJECTIVE the objective of the study was to compare the strength of the association of different pain dimensions with depression in older adults. METHODS assessments including evaluation of pain (severity, frequency, chronicity, quality, pain medication, painful body sites) and depression (measured by the Hospital Anxiety and Depression Scale) were performed in an observational study in community dwelling older adults (sample mean age 76, n = 1130) in Germany. The associations of different dimension of pain with depression were assessed using descriptive and multivariate methods. RESULTS the number of painful body areas was most significantly associated with self-reported late life depression (OR 1.20, CI 1.11-1.31). Pain severity and frequency (OR 1.12, CI 1.01-1.23 and OR 1.18, CI 1.01-1.37) were also associated with depression; quality and duration were not. Except for severity (OR 1.12, CI 1.02-1.24) associations of pain dimensions were strongly reduced when controlling for relevant confounders and gender was an effect modifier. CONCLUSIONS multisite pain, pain severity and frequency were the best predictors of late life depression. Clinicians should be especially aware of depressive disorders when older patients are complaining of pain in multiple areas across the body.
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Affiliation(s)
| | - Albert Lukas
- AGAPLESION Bethesda Clinic, Geriatric Center Ulm University; Zollernring 26, Ulm 89073, Germany
| | - Thorsten Nikolaus
- AGAPLESION Bethesda Clinic, Geriatric Center Ulm University; Zollernring 26, Ulm 89073, Germany
| | - Richard Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Sebastian Franke
- Developmental Science and Special Education, University of Siegen, Siegen, Germany
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Rothenbacher D, Klenk J, Denkinger MD, Herbolsheimer F, Nikolaus T, Peter R, Boehm BO, Rapp K, Dallmeier D, Koenig W. Prospective evaluation of renal function, serum vitamin D level, and risk of fall and fracture in community-dwelling elderly subjects. Osteoporos Int 2014; 25:923-32. [PMID: 24221451 DOI: 10.1007/s00198-013-2565-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 10/21/2013] [Indexed: 01/21/2023]
Abstract
SUMMARY This prospective study in elderly showed that kidney function plays a minor role in explaining the high prevalence of vitamin D deficiency seen in noninstitutionalized elderly subjects. However, 25-hydroxyvitamin D levels were clearly inversely associated with risk for first fall, which was especially seen in subjects with calcium levels above median. INTRODUCTION Few prospective studies in elderly exist that have investigated the association of renal dysfunction and vitamin D status on risk of falls. The aim of this study is to evaluate the association of renal function with 25-hydroxyvitamin D (25-OH-D) levels and, secondly, to assess the role of both factors on the risk of falls and subsequent bone fractures. METHODS This is a prospective population-based cohort study among noninstitutionalized elderly subjects during a 1-year follow-up. 25-OH-D levels and renal function were estimated, the latter by cystatin C-based equations. Information on falls was assessed prospectively. RESULTS Overall, 1,385 subjects aged 65 and older were included in the study (mean age 75.6 years), of whom 9.2 % had a 25-OH-D serum level above 75 nmol/L (US units 30 ng/mL); 41.4 %, between 50 and 75 nmol/L (US units 20 to 29 ng/mL, insufficiency); and 49.4 %, <50 nmol/L (US units <20 ng/mL, deficiency). We found no association of chronic kidney disease with risk of first fall. In contrast, 25-OH-D serum categories were clearly associated with risk of first fall and we found evidence of effect modification with calcium levels. In the group with a calcium level above the median (≥ 9.6 mg/dL), subjects with 25-OH-D serum level between 50 and 75 nmol/L and with concentrations <50 nmol/L had a hazard rate ratio (HRR) of 1.75 (1.03-2.87) and 1.93 (1.10-3.37) for risk of first fall. 25-OH-D serum levels were also associated with several markers of inflammation and hemodynamic stress. CONCLUSIONS We demonstrated an association of 25-OH-D serum levels and risk of first fall, which was especially evident in subjects with serum calcium in upper normal, independent of renal function.
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Affiliation(s)
- D Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany,
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Klenk J, Rapp K, Denkinger MD, Nagel G, Nikolaus T, Peter R, Koenig W, Böhm BO, Rothenbacher D. Seasonality of vitamin D status in older people in Southern Germany: implications for assessment. Age Ageing 2013; 42:404-8. [PMID: 23542723 DOI: 10.1093/ageing/aft042] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND from a clinical and public health perspective, it is important to understand the influence of seasonality on the serum vitamin D level to adequately assess and interpret an individual measurement. Therefore, the aim of this study was to analyse the effects of seasonal conditions on 25-hydroxyvitamin D (25(OH)D) serum levels in a population-based cohort of older people. METHODS between March 2009 and April 2010 the 25(OH)D serum level was assessed in 1,418 community-dwelling individuals living in Germany aged ≥65 years (56.7% men) with no subscribed vitamin D supplementation. Least-square means of monthly 25(OH)D serum levels with 95% confidence intervals (CI) were estimated, adjusted for gender, age and body mass index. Additionally, the proportion of vitamin deficiency (<20 ng/ml), insufficiency (20-<30 ng/ml) and sufficiency (30 ng/ml or higher) were estimated for each month. Finally, mean values of daily total global solar radiation and daylight were calculated for each month. RESULTS the minimum 25(OH)D serum level was observed in March with 15.4 ng/ml (SD = 6.56 ng/ml) and the maximum in August with 25.6 ng/ml (SD = 6.59 ng/ml). Compared with daylight and global solar radiation the progression over the year was similar but delayed by ∼2 months. The proportion of vitamin D deficiency, insufficiency and sufficiency were 78.8, 19.2 and 1.9% in March and 16.1, 63.4 and 20.5% in August, respectively. CONCLUSION vitamin D insufficiency was very common in this cohort and showed a strong seasonal effect with lowest values in March.
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Affiliation(s)
- Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
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van der Pas S, Castell MV, Cooper C, Denkinger M, Dennison EM, Edwards MH, Herbolsheimer F, Limongi F, Lips P, Maggi S, Nasell H, Nikolaus T, Otero A, Pedersen NL, Peter R, Sanchez-Martinez M, Schaap LA, Zambon S, van Schoor NM, Deeg DJH. European project on osteoarthritis: design of a six-cohort study on the personal and societal burden of osteoarthritis in an older European population. BMC Musculoskelet Disord 2013; 14:138. [PMID: 23597054 PMCID: PMC3637520 DOI: 10.1186/1471-2474-14-138] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/12/2013] [Indexed: 12/04/2022] Open
Abstract
Background Osteoarthritis (OA), the most common form of arthritis, is a major contributor to functional impairment and loss of independence in older persons. The European Project on OSteoArthritis (EPOSA) is a collaborative study involving six European cohort studies on ageing. This project focuses on the personal and societal burden and its determinants of osteoarthritis. This paper describes the design of the project, and presents some descriptive analyses on selected variables across countries. Methods/design EPOSA is an observational study including pre-harmonized data from European cohort studies (Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom) on older community-dwelling persons aged 65 to 85 years. In total, 2942 persons were included in the baseline study with a mean age of 74.2 years (SD 5.1), just over half were women (51,9%). The baseline assessment was conducted by a face-to-face interview followed by a clinical examination. Measures included physical, cognitive, psychological and social functioning, lifestyle behaviour, physical environment, wellbeing and care utilisation. The clinical examination included anthropometry, muscle strength, physical performance and OA exam. A follow-up assessment was performed 12–18 months after baseline. Discussion The EPOSA study is the first population-based study including a clinical examination of OA, using pre-harmonized data across European countries. The EPOSA study provides a unique opportunity to study the determinants and consequences of OA in general populations of older persons, including both care-seeking and non care-seeking persons.
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Methodological issues when analysing the role of physical activity in gastric cancer prevention: a critical review. Eur Rev Aging Phys Act 2012. [DOI: 10.1007/s11556-012-0113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Abstract
The beneficial effect of physical activity (PA) has been confirmed in several types of cancer (especially colon and breast tumours). However, the role of PA as a risk factor directly related to the incidence of gastric cancer is still open to doubt. This is in part due to the fact that most studies have not considered gastric sub-site or histology of oesophageal cancer, as well as the different approaches used in order to measure PA. Indeed, some studies have tried to link gastric cancer to PA intensity and timing, whereas others have focused on a specific PA type such as recreational, occupational or sporting activity. Furthermore, most of them do not use validated questionnaires, and others create a PA index and employ different unit measures (metabolic equivalents, hours/week, times per week, etc.), which makes it difficult to compare its findings. Under these circumstances, this brief critical review aims to explore and show all the methodological issues that need to be taken into account in order to objectify the link between PA and gastric cancer, as well as provide alternative solutions to these matters.
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Denkinger MD, Lukas A, Herbolsheimer F, Peter R, Nikolaus T. Physical activity and other health-related factors predict health care utilisation in older adults: the ActiFE Ulm study. Z Gerontol Geriatr 2012; 45:290-7. [PMID: 22622677 DOI: 10.1007/s00391-012-0335-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Health care utilisation (HCU) can be a useful outcome for estimating costs and patient needs. It can also be used as a surrogate parameter for healthy ageing. The aim of this study was to analyse the associations of formerly described and potentially new parameters influencing health care utilisation in older adults in Germany. PATIENTS AND METHODS The ActiFE Ulm (Activity and Function in the Elderly in Ulm) study is a population-based study in 1,506 community dwelling older adults aged 65-90 years in Ulm and surrounding areas in southwestern Germany. Between March 2009 and April 2010 a full geriatric assessment was performed including accelerometer-based average daily walking duration, comorbidity, medication, physical and psychological functioning, health care utilisation, sociodemographic factors etc. The association between above named measures and health care utilisation, represented by the number of drugs, the days in hospital and the number of physician contacts over one year was calculated in multiple regression models. Analysis was conducted among subjects with complete information (n = 1,059, mean age 76 years, 55% male). RESULTS The average number of drugs was 4.5 and over 95% of participants visited a physician at least once a year while still more than 65% contacted their physician more than twice a year. Reduced physical activity, BMI, self-rated health and/or comorbidity and male sex were the best predictors of health care utilisation in community dwelling older adults when looking at both the number of drugs and the number of physician contacts over 12 months together. With regard to single diseases entities the best predictors of both the number of drugs and the number of physician contacts were asthma, chronic obstructive pulmonary disease (COPD)/chronic bronchitis and chronic neurological diseases (mostly Parkinson's disease). The number of drugs was most strongly associated with coronary heart disease, diabetes, and high blood pressure. CONCLUSION Reduced walking activity, self-rated health and/or comorbidity and male sex are the best predictors of health care utilisation as measured by the number of drugs and number of physician contacts over 12 months. Walking activity could be regarded as the most promising modifiable predictor of HCU in older adults.
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Affiliation(s)
- M D Denkinger
- Agaplesion Bethesda Clinic, Geriatric Center Ulm University, Zollernring 26, 89073 Ulm, Germany.
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Shah RC, Buchman AS, Leurgans S, Boyle PA, Bennett DA. Association of total daily physical activity with disability in community-dwelling older persons: a prospective cohort study. BMC Geriatr 2012; 12:63. [PMID: 23072476 PMCID: PMC3492176 DOI: 10.1186/1471-2318-12-63] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 10/09/2012] [Indexed: 11/10/2022] Open
Abstract
Background Based on findings primarily using self-report measures, physical activity has been recommended to reduce disability in old age. Collecting objective measures of total daily physical activity in community-dwelling older adults is uncommon, but might enhance the understanding of the relationship of physical activity and disability. We examined whether greater total daily physical activity was associated with less report of disability in the elderly. Methods Data were from the Rush Memory and Aging Project, a longitudinal prospective cohort study of common, age-related, chronic conditions. Total daily physical activity was measured in community-dwelling participants with an average age of 82 using actigraphy for approximately 9 days. Disability was measured via self-reported basic activities of daily living (ADL). The odds ratio and 95% Confidence Interval (CI) were determined for the baseline association of total daily physical activity and ADL disability using a logistic regression model adjusted for age, education level, gender and self-report physical activity. In participants without initial report of ADL disability, the hazard ratio and 95% CI were determined for the relationship of baseline total daily physical activity and the development of ADL disability using a discrete time Cox proportional hazard model adjusted for demographics and self-report physical activity. Results In 870 participants, the mean total daily physical activity was 2. 9 × 105 counts/day (range in 105 counts/day = 0.16, 13. 6) and the mean hours/week of self-reported physical activity was 3.2 (SD = 3.6). At baseline, 718 (82.5%) participants reported being independent in all ADLs. At baseline, total daily physical activity was protective against disability (OR per 105 counts/day difference = 0.55; 95% CI = 0.47, 0.65). Of the participants without baseline disability, 584 were followed for 3.4 years on average. Each 105 counts/day additional total daily physical activity was associated with reduced hazard of developing disability by 25% (HR = 0.75, 95% CI = 0.66, 0.84). The results were unchanged after controlling for important covariates including cognition, depressive symptoms, and chronic health conditions. Conclusions Greater total daily physical activity is independently associated with less disability even after controlling for self-reported physical activity.
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Affiliation(s)
- Raj C Shah
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
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Physical activity for the prevention of cognitive decline: current evidence from observational and controlled studies. Z Gerontol Geriatr 2012; 45:11-6. [PMID: 22278001 DOI: 10.1007/s00391-011-0262-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A sedentary life style has been associated with different types of dementia in several cross sectional, longitudinal, and case-controlled studies. However, randomized controlled trials that support this relationship are rare, have rather few participants, and mainly focus on physical (usually aerobic) exercise. The benefit of an increased physical activity (PA) has been mainly demonstrated for the prevention of Alzheimer's disease and vascular dementia, less so for other dementia types such as Lewy body dementia or frontotemporal dementia. The clinical evidence builds on a significant amount of animal research pointing to potential mechanisms as to how PA relates to cognitive function. While most studies have investigated singular interventions, others have studied the combination of both mental and physical activity to improve cognition or delay decline. However, questions remain such as what type and how much PA is beneficial? This review gives an overview of the current evidence on the clinical and epidemiological level and tries to answer these questions.
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