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Weinstein G, Schonmann Y, Yeshua H, Zelber-Sagi S. The association between liver fibrosis score and incident dementia: A nationwide retrospective cohort study. Alzheimers Dement 2024. [PMID: 38946688 DOI: 10.1002/alz.14033] [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: 03/09/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND We assessed the relationship of liver fibrosis score with incident dementia in a large, national sample. METHODS For this retrospective cohort study, data of dementia-free individuals aged 40-69 years were derived from electronic records of the largest healthcare provider in Israel. The association between liver fibrosis score (FIB-4), assessed from routine laboratory measurements, and incident dementia was explored through multivariate cox regression models. RESULTS Of the total sample (N = 826,578, mean age 55 ± 8 years at baseline), 636,967 (77%) had no fibrosis, 180,114 (21.8%) had inconclusive fibrosis status and 9497 (1.2%) had high risk for advanced fibrosis. Over a median follow-up of 17 years, 41,089 dementia cases were recorded. Inconclusive liver fibrosis and advanced fibrosis were associated with increased dementia risk (HR = 1.09, 95%CI: 1.07-1.11 and HR = 1.18, 95%CI: 1.10-1.27, respectively). This association remained robust through seven sensitivity analyses. CONCLUSIONS Liver fibrosis assessed through a serum-based algorithm may serve as a risk factor for dementia in the general population. HIGHLIGHTS Liver fibrosis may predict dementia diagnosis in the general population. Inconclusive liver fibrosis was associated with 9% increased dementia risk. Advanced liver fibrosis was associated with 18% increased dementia risk. Findings remained robust in sensitivity analyses and after adjustments.
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Affiliation(s)
| | - Yochai Schonmann
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Quality Measurements and Research, Clalit Health Services, Tel-Aviv, Israel
- Department of Family Medicine, Tel-Aviv District, Clalit Health Services, Tel-Aviv, Israel
| | - Hanny Yeshua
- Department of Family Medicine, Tel-Aviv District, Clalit Health Services, Tel-Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Ahola J, Kekäläinen T, Kinnunen ML, Tolvanen A, Pitkänen T, Pulkkinen L, Saajanaho M, Kokko K. Stability in health behavior patterns in middle adulthood: a 19-year follow-up study. Psychol Health 2024:1-21. [PMID: 38389311 DOI: 10.1080/08870446.2024.2316676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024]
Abstract
Objective: This study investigated subgroups of adults with particular health behavior patterns, their stability over 19 years, and the role of sociodemographic and personality characteristics in these. Methods and Measures: Data on smoking, alcohol consumption, and physical activity were collected at ages 42, 50, and 61 in the Jyväskylä Longitudinal Study of Personality and Social Development (n = 205-302). Latent class, latent transition, and logistic regression analyses were used. Results: Four similar classes of health behaviors were identified at each age. A class named low alcohol consumption (AC)-high physical activity (PA) included individuals with the lowest levels of alcohol consumption and the highest levels of physical activity, and a class named high AC-low PA vice versa. Classes between these extremes of alcohol consumption and physical activity levels were nonsmokers with the lowest proportion of smokers, and smokers vice versa. Although transitions emerged, class memberships were relatively stable. Women, those who were married, held a degree, had higher occupational status, and certain personality traits at age 42 were more likely to belong continuously to healthier classes compared to a stable membership in high AC-low PA. Conclusion: Health behaviors exist in patterns, are relatively stable across adulthood, and associated with sociodemographic and personality characteristics.
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Affiliation(s)
- Johanna Ahola
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tiia Kekäläinen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Marja-Liisa Kinnunen
- The Wellbeing Services County of Central Finland, Jyväskylä, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Asko Tolvanen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | | | - Lea Pulkkinen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Milla Saajanaho
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Katja Kokko
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Skow LF, Sharrett AR, Gottesman RF, Coresh J, Deal JA, Palta P, Sullivan KJ, Griswold ME, Schrack JA, Windham BG. Mid-Life Vascular Risk and Rate of Physical Function Decline Among Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad210. [PMID: 37659100 PMCID: PMC10809050 DOI: 10.1093/gerona/glad210] [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: 04/03/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Physical function and its decline in older age may be connected to treatable vascular risk factors in mid-life. This study aimed to evaluate whether these factors affect the underlying rate of decline. METHODS This prospective cohort included 5 481 older adults aged 67-91 in the Atherosclerosis Risk in Communities Study (mean [standard deviation {SD}] age = 75.8 [5.0], 58% women, 21% Black race) without a history of stroke. The main outcome was the rate of Short Physical Performance Battery (SPPB) decline over a median late-life follow-up of 4.8 years. Primary mid-life (aged 45-64) exposures were Visit 1 hypertension (>140/90 mm Hg or treatment), diabetes (>126 mg/dL or treatment), high cholesterol (>240 mg/dL or treatment), and smoking, and number of decades of vascular risk exposure across Visits 1-4. RESULTS The average adjusted rate of SPPB decline (points per 5 years) for older adults was -0.79 (confidence interval [CI]: -0.87, 0.71) and was accelerated by mid-life hypertension (+57% decline vs normotension: additional decline of -0.47, 95% CI: -0.64, -0.30), diabetes (+73% decline vs no diabetes: additional decline of -0.67, 95% CI: -1.09, -0.24), elevated systolic blood pressure (+17% decline per SD: -0.16, 95% CI: -0.23, -0.10), and elevated fasting blood glucose (+16% decline per SD: -0.015, 95% CI: -0.24, -0.06). Each decade greater mid-life exposure to hypertension (+32% decline: -0.93, 95% CI: -1.25, -0.61) and diabetes (+35% decline: -1.03, 95% CI: -1.68, -0.38) was associated with faster SPPB decline. CONCLUSIONS Mid-life control of blood pressure and diabetes may offset aging-related functional decline.
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Affiliation(s)
- Laura F Skow
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Priya Palta
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin J Sullivan
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, Department of Medicine, Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael E Griswold
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, Department of Medicine, Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - B Gwen Windham
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, Department of Medicine, Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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4
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Riley E, Turker H, Wang D, Swallow KM, Anderson AK, De Rosa E. Nonlinear changes in pupillary attentional orienting responses across the lifespan. GeroScience 2024; 46:1017-1033. [PMID: 37318717 PMCID: PMC10828243 DOI: 10.1007/s11357-023-00834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023] Open
Abstract
The cognitive aging process is not necessarily linear. Central task-evoked pupillary responses, representing a brainstem-pupil relationship, may vary across the lifespan. Thus we examined, in 75 adults ranging in age from 19 to 86, whether task-evoked pupillary responses to an attention task may serve in as an index of cognitive aging. This is because the locus coeruleus (LC), located in the brainstem, is not only among the earliest sites of degeneration in pathological aging, but also supports both attentional and pupillary behaviors. We assessed brief, task-evoked phasic attentional orienting to behaviorally relevant and irrelevant auditory tones, stimuli known specifically to recruit the LC in the brainstem and evoke pupillary responses. Due to potential nonlinear changes across the lifespan, we used a novel data-driven analysis on 6 dynamic pupillary behaviors on 10% of the data to reveal cut off points that best characterized the three age bands: young (19-41 years old), middle aged (42-68 years old), and older adults (69 + years old). Follow-up analyses on independent data, the remaining 90%, revealed age-related changes such as monotonic decreases in tonic pupillary diameter and dynamic range, along with curvilinear phasic pupillary responses to the behaviorally relevant target events, increasing in the middle-aged group and then decreasing in the older group. Additionally, the older group showed decreased differentiation of pupillary responses between target and distractor events. This pattern is consistent with potential compensatory LC activity in midlife that is diminished in old age, resulting in decreased adaptive gain. Beyond regulating responses to light, pupillary dynamics reveal a nonlinear capacity for neurally mediated gain across the lifespan, thus providing evidence in support of the LC adaptive gain hypothesis.
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Affiliation(s)
- Elizabeth Riley
- Department of Psychology, Cornell University, Ithaca, NY, USA.
| | - Hamid Turker
- Department of Psychology, Cornell University, Ithaca, NY, USA
| | - Dongliang Wang
- Department of Public Health and Preventative Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Khena M Swallow
- Department of Psychology, Cornell University, Ithaca, NY, USA
| | - Adam K Anderson
- Department of Psychology, Cornell University, Ithaca, NY, USA
| | - Eve De Rosa
- Department of Psychology, Cornell University, Ithaca, NY, USA
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Ding H, Liu C, Li Y, Ang TFA, Devine S, Liu Y, Au R, Doraiswamy PM. Sex-specific blood biomarkers linked to memory changes in middle-aged adults: The Framingham Heart Study. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12569. [PMID: 38545543 PMCID: PMC10966919 DOI: 10.1002/dad2.12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 06/06/2024]
Abstract
The relationship between sex-specific blood biomarkers and memory changes in middle-aged adults remains unclear. We aimed to investigate this relationship using the data from the Framingham Heart Study (FHS). We conducted association analysis, partial correlation analysis, and causal dose-response curves using blood biomarkers and other data from 793 middle-aged participants (≤ 60 years) from the FHS Offspring Cohort. The results revealed associations of adiponectin and fasting blood glucose with midlife memory change, along with a U-shaped relationship of high-density lipoprotein cholesterol with memory change. No significant associations were found for the other blood biomarkers (e.g., amyloid beta protein 42) with memory change. To our knowledge, this is the first sex-specific network analysis of blood biomarkers related to midlife memory change in a prospective cohort study. Our findings highlight the importance of targeting cardiometabolic risks and the need to validate midlife-specific biomarkers that can accelerate the development of primary preventive strategies.
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Affiliation(s)
- Huitong Ding
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Chunyu Liu
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Yi Li
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusettsUSA
| | - Ting Fang Alvin Ang
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Sherral Devine
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Yulin Liu
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Rhoda Au
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Slone Epidemiology CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMassachusettsUSA
| | - P. Murali Doraiswamy
- Neurocognitive Disorders ProgramDepartments of Psychiatry and Medicineand the Duke Institute for Brain SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
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Brenn T, Løvsletten O. Mid-life alcohol consumption and survival to age 90 in men: The Tromsø Study 1979-1980 with follow-up to 2019. Scand J Public Health 2023; 51:1069-1076. [PMID: 35876432 PMCID: PMC10599080 DOI: 10.1177/14034948221111264] [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: 11/19/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022]
Abstract
AIMS The Tromsø Study 1979-1980 collected information on alcohol (beer, wine and spirits) consumption frequency and inebriation frequency, and the oldest male participants (aged 50-54 years) were followed for all-cause mortality. This study aimed to identify the impact of habitual alcohol consumption in mid-life on reaching up to 90 years of age. RESULTS Among the study sample of 778, a total of 120 (15.4%) men reached the age of 90. The most common reported alcohol consumption frequency was 'never or a few times a year', and 18.9% of those in this group reached 90 compared with 11.9% of those who reported a more frequent beer consumption. Fifty per cent survival in these groups was 80.5 and 76.9 years, respectively. The pattern was similar for spirits consumption and for inebriation but not for wine consumption. Number of deaths increased gradually with increasing beer and spirits consumption frequency and with inebriation frequency. We observed no J-shape or pattern that revealed a beneficial influence of light alcohol consumption. Daily smoking, physical inactivity, marital status, blood pressure and total cholesterol reduced the contribution of alcohol consumption to a small degree. CONCLUSIONS This study shows that all beer and spirits consumption frequencies in mid-life affect later life and total lifespan. Refraining from alcohol consumption or drinking only a few times a year increases one's chances of living longer, and the chance of reaching 90 years of age is 1.6-fold higher than in those with more frequent alcohol consumption.
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Affiliation(s)
- Tormod Brenn
- Department of Community Medicine, UiT – The Arctic University of Norway, Norway
| | - Ola Løvsletten
- Department of Community Medicine, UiT – The Arctic University of Norway, Norway
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Chua KY, Li H, Lim WS, Koh WP. Consumption of Coffee, Tea, and Caffeine at Midlife, and the Risk of Physical Frailty in Late Life. J Am Med Dir Assoc 2023; 24:1655-1662.e3. [PMID: 37488031 DOI: 10.1016/j.jamda.2023.06.015] [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: 04/14/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES Our study evaluated the prospective association between the consumption of caffeine-containing beverages at midlife and the risk of physical frailty at late life within a population-based cohort of Chinese adults living in Singapore over a follow-up period of 20 years. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS We used data from 12,583 participants from the baseline and third follow-up interviews of the Singapore Chinese Health Study (SCHS). Participants had a mean age of 53 years at baseline (1993-1998), and a mean age of 73 years during the third follow-up (2014-2017). METHODS At baseline, habitual consumption of caffeine-containing beverages was evaluated using a validated semi-quantitative food-frequency questionnaire. During the third follow-up, physical frailty was assessed using the modified Cardiovascular Health Study phenotype. RESULTS Compared with non-daily drinkers, those who drank 4 or more cups of coffee daily had reduced odds of physical frailty [odds ratio (OR), 0.54; 95% CI, 0.38-0.76]. Similarly, compared with those who hardly drank tea, participants who drank tea everyday also had reduced odds (OR, 0.82; 95% CI, 0.71-0.95). Total daily caffeine intake at midlife was associated with reduced likelihood of frailty at late life in a dose-response relationship (Ptrend < .001). Relative to their counterparts in the lowest quartile of daily caffeine intake (0-67.6 mg/d), participants in the highest quartile (223.0-910.4 mg/d) had an OR of 0.77 (95% CI, 0.66-0.91). Higher caffeine consumption was associated with lower likelihood of being in the slowest quintile for timed up-and-go (TUG) and weakest quintile for handgrip strength. CONCLUSIONS AND IMPLICATIONS In this cohort of Chinese adults, higher consumption of caffeine at midlife, via coffee and tea, was associated with a reduced likelihood of physical frailty in late life.
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Affiliation(s)
- Kevin Y Chua
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, Singapore
| | - Huiqi Li
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wee-Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A∗STAR), Singapore.
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Heger I, van Boxtel M, Deckers K, Bosma H, Verhey F, Köhler S. Socioeconomic position, modifiable dementia risk and cognitive decline: results of 12-year Maastricht Aging Study. Int Psychogeriatr 2023:1-13. [PMID: 37905417 DOI: 10.1017/s1041610223000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES This study investigated whether the association between modifiable dementia risk and rate of cognitive decline differs across socioeconomic status (SES) strata. DESIGN, SETTING AND PARTICIPANTS Data were used from Maastricht Aging Study, a prospective cohort study with a 12-year follow-up. The baseline sample consisted of 1023 adults over 40 years old. MEASUREMENTS The "LIfestyle for BRAin health" (LIBRA) index was used to assess modifiable dementia risk. Cognitive performance was assessed at baseline, 6 and 12 years, and measured in the domains of information processing speed, executive functioning and verbal memory function. An SES score was calculated from equivalent income and educational level (tertiles). Linear mixed models were used to study the association between LIBRA, SES and their interaction on the rate of cognitive decline. RESULTS Participants in the lowest SES tertile displayed more decline in information processing speed (vs. middle SES: X2 = 7.08, P = 0.029; vs. high SES: X2 = 9.49, P = 0.009) and verbal memory (vs. middle SES: X2 = 9.28, P < 0.001; vs. high SES: X2 = 16.68, P < 0.001) over 6 years compared to their middle- and high-SES counterparts. Higher (unhealthier) LIBRA scores were associated with more decline in information processing speed (X2 = 12.66, P = 0.002) over 12 years and verbal memory (X2 = 4.63, P = 0.032) over 6 years. No consistent effect modification by SES on the association between LIBRA and cognition was found. CONCLUSIONS Results suggest that lifestyle is an important determinant of cognitive decline across SES groups. Yet, people with low SES had a more unfavorable modifiable risk score suggesting more potential for lifestyle-based interventions.
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Affiliation(s)
- Irene Heger
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Martin van Boxtel
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (CAPHRI), Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Frans Verhey
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Kuczmarski MF, Beydoun MA, Georgescu MF, Noren Hooten N, Mode NA, Evans MK, Zonderman AB. Pro-Inflammatory Diets Are Associated with Frailty in an Urban Middle-Aged African American and White Cohort. Nutrients 2023; 15:4598. [PMID: 37960250 PMCID: PMC10648548 DOI: 10.3390/nu15214598] [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: 10/13/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Diet quality is a modifiable risk factor for frailty, but research on the association of frailty with dietary inflammatory potential is limited. The objective was to determine associations between diet quality assessed by the dietary inflammatory index (DII) with frailty status over time. Participants with both dietary and frailty data from the longitudinal Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used (n = 2901, 43.5% male, 43.8% African American, 48.5 y mean baseline age, with a mean 8.7 y of follow-up). Group-based trajectory modeling identified two frailty (remaining non-frail or being pre-frail/frail over time) and three diet quality trajectory groups (high or medium pro-inflammatory and anti-inflammatory potentials). Multiple logistic regression found both medium pro-inflammatory and anti-inflammatory DII trajectory groups, compared to the high pro-inflammatory group, were positively associated with being non-frail over time for the overall sample, both sexes and races. Kaplan-Meier curves and log-rank test revealed anti-inflammatory DII scores were associated with lower risk for being pre-frail or frail. No longitudinal relationship existed between frailty status at baseline and annualized DII change, a check on reverse causality. This study contributes to our current knowledge providing longitudinal evidence of the link between anti-inflammatory DII score with lower frailty risk.
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Affiliation(s)
- Marie Fanelli Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA; (M.A.B.); (M.F.G.); (N.N.H.); (N.A.M.); (M.K.E.); (A.B.Z.)
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Zaninotto P, Steptoe A. Young older adults at risk of not having a good later life and the implications for mental health and wellbeing: evidence from the English Longitudinal Study of Ageing. RESEARCH SQUARE 2023:rs.3.rs-3404200. [PMID: 37886486 PMCID: PMC10602091 DOI: 10.21203/rs.3.rs-3404200/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
We identified risk categories of not having a good later life among young older people and reported the consequences that being in these groups have on mental health and wellbeing. 3,511 participants aged 50 to 69 from the English Longitudinal Study of Ageing (ELSA) provided data on 10 domains of a good later life. The domains were then entered into a model to identify risk groups using Latent Class Analysis. Regression models were used to assess the association between identified risk groups and depression, life satisfaction, loneliness and wellbeing. We found that 20% of individuals were in the "high" risk group for not having a good later life. These people were more likely to report depression, loneliness, lower life satisfaction and lower wellbeing than those in the low risk group. Being at risk of not having a good later life has important consequences for mental health and wellbeing. Appropriate support and services should be in place to ensure that everyone is able to live longer in good mental health.
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Zhou Y, Ni Y, Jones M, Dai X, Lim CCW, Zhu A, Xu X. Sleep Behaviors and Progression of Multimorbidity in Middle-Aged and Older Adults: A Prospective Cohort Study From China. J Gerontol A Biol Sci Med Sci 2023; 78:1871-1880. [PMID: 36943283 DOI: 10.1093/gerona/glad087] [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: 08/01/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Sleep behavior (eg, sleep duration, sleep quality, and nap) is closely related to many chronic conditions. However, less is known about its association with multiple chronic conditions (multimorbidity), particularly evidence from cohort studies. METHODS Data were collected from a cohort of 8 937 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (2011-2018). Sleep duration, sleep quality, and nap duration were collected in 2011 and 2013. Progression of multimorbidity was defined as the first report of 2 or more chronic conditions for participants without multimorbidity or the new report of 1 or more conditions for those with multimorbidity. Cox regression models were performed to calculate the hazard ratios and 95% confidence intervals (CIs) of the associations between sleep behaviors and the progression of multimorbidity. RESULTS Short sleep duration and poor sleep quality were associated with the progression of multimorbidity independently and jointly, especially in those less than 65 years and females. The U-shaped dose-response relationships were observed between nighttime and total sleep duration and the progression of multimorbidity. Persistent short and unsteadily changed sleep behaviors increased the risk of multimorbidity progression. Individuals sleeping ≤5 h/night with 5-7 restless days/week had 1.53 times higher risk of multimorbidity progression (95% CI: 1.37-1.71), compared to those sleeping 7-8 h/night with <1 restless day/week. CONCLUSIONS Short sleep duration and poor sleep quality were independently and jointly associated with a higher risk of multimorbidity progression in a mid-to-older population. Optimal sleep duration and sleep quality should be emphasized in multimorbidity prevention and control.
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Affiliation(s)
- Yaguan Zhou
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yujie Ni
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Mark Jones
- Institute for Evidence-based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Xiaochen Dai
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Carmen C W Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Anna Zhu
- Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Xiaolin Xu
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
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Hobbs M, McLeod GFH, Mackenbach JD, Marek L, Wiki J, Deng B, Eggleton P, Boden JM, Bhubaneswor D, Campbell M, Horwood LJ. Change in the food environment and measured adiposity in adulthood in the Christchurch Health and development birth cohort, Aotearoa, New Zealand: A birth cohort study. Health Place 2023; 83:103078. [PMID: 37517383 DOI: 10.1016/j.healthplace.2023.103078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/11/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023]
Abstract
This study investigated associations between change in the food environment and change in measured body mass index (BMI) and waist circumference (WC) in the Christchurch Health and Development Study (CHDS) birth cohort. Our findings suggest that cohort members who experienced the greatest proportional change towards better access to fast food outlets had the slightly larger increases in BMI and WC. Contrastingly, cohort members who experienced the greatest proportional change towards shorter distance and better access to supermarkets had slightly smaller increases in BMI and WC. Our findings may help explain the changes in BMI and WC at a population level.
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Affiliation(s)
- Matthew Hobbs
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; The Cluster for Community and Urban Resilience (CURe), University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand.
| | - Geraldine F H McLeod
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije University, Amsterdam, the Netherlands; Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Amsterdam, the Netherlands
| | - Lukas Marek
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - Jesse Wiki
- Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland - Waipapa Taumata Rau, Auckland, New Zealand
| | - Bingyu Deng
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - Phoebe Eggleton
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - Joseph M Boden
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
| | - Dhakal Bhubaneswor
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
| | - Malcolm Campbell
- Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; School of Earth and Environment, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - L John Horwood
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
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Williams GR, Fowler M, Giri S, Dai C, Harmon C, Al‐Obaidi M, Stephenson C, Bona K, Landier W, Bhatia S, Wolfson J. Association of unmet basic resource needs with frailty and quality of life among older adults with cancer-Results from the CARE registry. Cancer Med 2023; 12:13846-13855. [PMID: 37245226 PMCID: PMC10315805 DOI: 10.1002/cam4.6038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Basic resource needs related to transportation, housing, food, and medications are important social determinants of health and modifiable indicators of poverty, but their role in modifying the risk of frailty and health-related quality of life (HRQoL) remains unknown. The goal of our study was to examine the prevalence of unmet basic needs and their association with frailty and HRQoL in a cohort of older adults with cancer. METHODS The CARE registry prospectively enrolls older adults (≥60 years) with cancer. Assessments of transportation, housing, and material hardship were added to the CARE tool in 8/2020. The 44-item CARE Frailty Index was used to define frailty, and subdomains of physical and mental HRQoL were assessed using the PROMIS® 10-global. Multivariable analysis examined the association between unmet needs with frailty and HRQoL subdomains, adjusting for covariates. RESULTS The cohort included 494 participants. Median age of 69 years, 63.6% were male and 20.2% were Non-Hispanic (NH) Black. Unmet basic needs were reported in 17.8% (transportation 11.5%, housing 2.8%, and material hardship 7.5%). Those with unmet needs were more often NH Black (33.0% vs. 17.8%, p = 0.006) and less educated ( CONCLUSIONS Unmet basic needs represent a novel exposure that is independently associated with frailty and low HRQoL and warrants the development of targeted interventions.
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Affiliation(s)
- Grant R. Williams
- Institute for Cancer Outcomes & SurvivorshipUniversity of AlabamaBirminghamAlabamaUSA
- O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Mackenzie Fowler
- Institute for Cancer Outcomes & SurvivorshipUniversity of AlabamaBirminghamAlabamaUSA
| | - Smith Giri
- Institute for Cancer Outcomes & SurvivorshipUniversity of AlabamaBirminghamAlabamaUSA
- O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Chen Dai
- Institute for Cancer Outcomes & SurvivorshipUniversity of AlabamaBirminghamAlabamaUSA
| | - Christian Harmon
- Institute for Cancer Outcomes & SurvivorshipUniversity of AlabamaBirminghamAlabamaUSA
| | - Mustafa Al‐Obaidi
- Institute for Cancer Outcomes & SurvivorshipUniversity of AlabamaBirminghamAlabamaUSA
| | | | - Kira Bona
- Division of Population SciencesDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Wendy Landier
- Institute for Cancer Outcomes & SurvivorshipUniversity of AlabamaBirminghamAlabamaUSA
- O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Smita Bhatia
- Institute for Cancer Outcomes & SurvivorshipUniversity of AlabamaBirminghamAlabamaUSA
- O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
| | - Julie Wolfson
- Institute for Cancer Outcomes & SurvivorshipUniversity of AlabamaBirminghamAlabamaUSA
- O'Neal Comprehensive Cancer CenterUniversity of AlabamaBirminghamAlabamaUSA
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Frailty and all-cause and cause-specific mortality in Japan. Arch Gerontol Geriatr 2023; 107:104906. [PMID: 36563613 DOI: 10.1016/j.archger.2022.104906] [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: 05/23/2022] [Revised: 11/15/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In aging societies, there is an increasing focus on the concept of frailty. However, there is no consistent means to assess this concept. We assessed frailty using the Kihon Checklist (KCL), which is widely used in Japan, and examined the association between frailty and all-cause and cause-specific mortality in Japan, the most aged society in the world. METHODS This was a retrospective cohort study, and we analyzed 43,312 participants aged ≥ 65 years who were enrolled in basic health checkups in Okayama City, Japan. We defined the frailty status of the participants using the KCL. To assess the association of frailty status with all-cause and cause-specific mortality, we used cause-specific Cox proportional hazard models to estimate hazard ratios (HRs), adjusting for individual potential confounders. Mean follow-up time was 9.3 years. RESULTS The fully adjusted HR for all-cause mortality was 1.34 (95% confidence interval [CI]: 1.27-1.41) for the prefrail group and 2.22 (95% CI: 2.11-2.33) for the frail group. A similar pattern was observed for cardiovascular disease, respiratory disease, and cancer mortality. Younger people (65-74 years) and women tended to have higher effect estimates than older people (≥ 75 years) and men. CONCLUSION Prefrailty and frailty can increase the risk of both all-cause and cause-specific mortality. Our study suggests that to support frail patients, it could be effective to focus on the prevention and management of cardiovascular and respiratory disease, and that the KCL may be useful as a method of screening for frailty.
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Byeon G, Kwon SO, Jhoo J, Jang JW, Kim Y. Dementia Incidence Rate Before and After Implementing the National Responsibility Policy for Dementia Care in Patients With Vascular Risk Factors in Korea. Dement Neurocogn Disord 2023; 22:49-60. [PMID: 37179693 PMCID: PMC10166674 DOI: 10.12779/dnd.2023.22.2.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 05/15/2023] Open
Abstract
Background and Purpose The National Responsibility Policy for Dementia Care was implemented in September 2017 in Korea. This study aimed to compare dementia incidence in Seoul and Gangwon-do before and after the implementation of this policy. Methods We extracted insurance claim data from the Korean Health Insurance Review and Assessment Service for people diagnosed with diabetes, hypertension, or dyslipidemia for the first time in Seoul and Gangwon-do, Korea. We defined two enrollment groups based on the policy implementation date: 1) January 1, 2015 to December 31, 2016 (Index 1, pre-implementation), and 2) January 1, 2017 to December 31, 2018 (Index 2, post-implementation). Each group was followed up for 1 year from the time of enrollment. Then, we calculated hazard ratios to compare the incidence of dementia between the two groups, and between Seoul and Gangwon-do. Results In Seoul, the incidence of dementia was significantly lower in Index 2 than in Index 1 (hazard ratio [HR], 0.926; 95% confidence interval [CI], 0.875-0.979). However, the incidence rate did not differ between the 2 groups (HR, 1.113; 95% CI, 0.966-1.281) in Gangwon-do. In Index 1, the incidence of dementia did not differ between Seoul and Gangwon-do (HR, 1.043; 95% CI, 0.941-1.156), but in Index 2, was significantly higher in Gangwon-do than in Seoul (HR, 1.240; 95% CI, 1.109-1.386). Conclusions After implementing the National Responsibility Policy for Dementia Care, the dementia incidence rate decreased significantly in Seoul, consistent with other studies, but not in Gangwon-do.
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Affiliation(s)
- Gihwan Byeon
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, Korea
| | - Sung Ok Kwon
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea
| | - JinHyeong Jhoo
- Department of Psychiatry, Kangwon National University Hospital, Chuncheon, Korea
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University School of Medicine, Chuncheon, Korea
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Abstract
BackgroundWomen in many cohorts have a higher risk for Alzheimer's disease (AD), the most common form of dementia. Sex is a biological construct whereby differences in disease manifestation and prevalence are rooted in genetic differences between XX and XY combinations of chromosomes. This chapter focuses specifically on sex-driven differences in dementia, as opposed to differences driven by gender - a social construct referring to the societal norms that influence people's roles, relationships, and positional power throughout their lifetime.MethodsUsing a narrative review, this chapter explored the characteristics and risk factors for the dementias, alongside a discussion of sex differences including loss of sex steroid hormones in middle-aged women, differences in the prevalence of cardiovascular diseases and engagement in lifestyle protective factors for dementia.ResultsThe sex difference in AD prevalence may exist because of systematic and historic differences in risk and protective factors for dementia, including level of education obtained and socioeconomic status differences, which can impact on health and dementia risk.Levels of sex steroids decline significantly after menopause in women, whereas this is more gradual in men with age. Animal and cell culture studies show strong biological plausibility for sex steroids to protect the ageing brain against dementia. Sex steroid hormone replacement therapy has in some observational studies shown to protect against AD, but treatment studies in humans have mainly shown disappointing results. Cardiovascular disease (CVD) shares midlife medical risk (e.g. hypertension, hyperlipidaemia, obesity etc.) factors with AD and other forms of dementia, but also with related lifestyle risk - and protective factors (e.g. exercise, not smoking etc.). Men tend to die earlier of CVD, so fewer survive to develop AD at an older age. Those who do survive may have healthier lifestyles and fewer risk factors for both CVD and AD. An earlier age at menopause also confers great risk for both without hormone treatment.DiscussionIt could be the case that the decline in sex steroids around the menopause make women more susceptible to lifestyle-related risk factors associated with dementia and CVD, but this remains to be further investigated. Combining hormone treatment with lifestyle changes in midlife (e.g. exercise) could be an important preventative treatment for dementia and CVD in later life, but this also requires further research.
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Kim T, Park SY, Oh IH. Health-related factors leading to disabilities in Korea: Survival analysis. Front Public Health 2022; 10:1048044. [PMID: 36620295 PMCID: PMC9813747 DOI: 10.3389/fpubh.2022.1048044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study is to analyze (a) population and socioeconomic factors affecting disability, excluding the occurrence of disability due to accidents and congenital diseases, and (b) health-related behavioral factors and factors that can prevent and reduce the cause of disability due to disease in Korea. This study was a longitudinal research. Data were obtained from The 2018 Korean Health Panel (KHP) is a survey jointly conducted by the Korea Institute of Health and Social Affairs and the National Health Insurance Service. A total of 7, 372 (Mage = 52.14, SD = 21.39; Male = 47.52%) were analyzed in this study. People with Higher education attainments and more income levels were associated with lower hazard of developing new disabilities (all p < 0.05). In this study, the health factors that could be related to the occurrence of new disabilities were smoking, alcohol consumption, physical activity, and stress (all p < 0.0001). However, physical activity was negatively associated with the risk of developing a disability at all follow-ups (p < 0.05). Higher scores on the number of chronic diseases (valid scores = 0, 1, 2, 3, or more) represented a greater level of newly developing disability present at all follow-ups (all p < 0.0001). This longitudinal study confirmed the relationship between health-related factors and specific chronic diseases. Its findings can be used as a crucial foundation for establishing healthcare policies and services that can lower and prevent disability by preventing and reducing specific negative health behaviors and unhealthy behavioral factors, and alleviating chronic diseases in Korea.
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Affiliation(s)
- TaeEung Kim
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - So-Youn Park
- Department of Medical Education and Humanities, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea,*Correspondence: In-Hwan Oh ✉
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Tsai FJ, Shen SW. Concepts of dementia prevention in the health promotion among older adults: A narrative review. Medicine (Baltimore) 2022; 101:e32172. [PMID: 36550862 PMCID: PMC9771271 DOI: 10.1097/md.0000000000032172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The number of older adults with dementia is predicted to markedly increase in the coming decades. A person suffers from dementia every 3 seconds globally, and one out of every 7 people suffers from dementia in Taiwan. The purpose of this narrative review is to integrate existing concepts of dementia prevention into health promotion and improve older adults' quality of life. This narrative review was performed using the PubMed database by searching for basic research and systematic reviews on dementia prevention and health promotion among older adults. We established a framework for dementia prevention and health promotion with regard to the physical, mental, spiritual, and social health aspects. We identified the following strategies related to older adults towards dementia prevention and health promotion in follows: Physical health promotion: cognitive activities, physical activities, body mass index, balanced diet, rainbow diet, Mediterranean diet, dietary approaches to stop hypertension diet, mind diet, no smoking and drinking, avoiding the "three highs" (i.e., hyperglycemia, hyperlipidemia, and hypertension), and head trauma; Mental health promotion: Positive thinking, Brief Symptom Rating Scale (BSRS-5), depression scale, and ascertained dementia 8 questionnaire (AD8) screening; Spiritual health promotion: religious beliefs, spiritual music, meditative activities, mindfulness, yoga, Qi-gong, Tai-chi, and Baduanjin; and Social health promotion: A supportive family system, socialization, social support, social networks, social interaction, and social participation. The conclusion of this narrative review was to integrate the concepts of dementia prevention and health promotion among older adults.
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Affiliation(s)
- Fu-Ju Tsai
- Department of Nursing, Fooyin University, Taiwan R.O.C
| | - Sheng-Wei Shen
- Department of Neurology, Pingtung Hospital, Ministry of Health and Welfare, Taiwan, R.O.C
- * Correspondence: Sheng-Wei Shen, 270, Ziyou Rd., Pingtung City, Pingtung County 900, Taiwan R.O.C. (e-mail: )
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Tapias-Merino E, De Hoyos-Alonso MDC, Contador-Castillo I, Rodríguez-Sánchez E, Sanz-Cuesta T, Becerro-Muñoz CM, Hernández-Gallego J, Vega-Quiroga S, Bermejo-Pareja F. Cardiovascular risk in subjects over 55 years of age and cognitive performance after five years. NEDICES2-RISK study. Study protocol. PLoS One 2022; 17:e0274589. [PMID: 36441718 PMCID: PMC9704606 DOI: 10.1371/journal.pone.0274589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cognitive impairment and dementia have a high prevalence among the elderly and cause significant socio-economic impact. Any progress in their prevention can benefit millions of people. Current data indicate that cardiovascular risk (CVR) factors increase the risk of developing cognitive impairment and dementia. Using models to calculate CVR specific for the Spanish population can be useful for estimating the risk of cognitive deterioration since research on this topic is limited and predicting this risk is mainly based on outcomes in the Anglo-Saxon population. The aim of this study is to assess the relationship between CVR in the Spanish population, as calculated using the FRESCO (Función de Riesgo Española de acontecimientos Coronarios y Otros) and REGICOR (Registre Gironí del Cor) CVR tables, and the change in cognitive performance at a 5-year follow-up. METHODS Design: Observational, analytic, prospective cohort study, with a 5-year follow-up. Ambit: Population. Population: Subjects 55 to 74 years of age, included in the NEDICES2 (2014-2017) cohort, who did not present dementia and had undergone the neuropsychological evaluation (N = 962). Variables: Exposure factors (CVR factors and estimated risk according to the CVR predictors by REGICOR and FRESCO), dependent variables (change in the score of the brief neuropsychological test in the study NEDICES2 five years after the first evaluation), and clinical and socio-demographic variables. Statistical analysis: Analysis of data quality. Descriptive analysis: socio-demographic and clinical variables of subjects. Bivariate analysis: relationship between basal CVR and change in neuropsychological tests. Multivariate analysis: relationship between basal CVR and change in neuropsychological tests adjusted by co-variables. Analysis and comparison of the reliable change in independent samples. DISCUSSION The Spanish population can benefit from determining if individuals with high CVR, which is commonly detected in usual clinical practice, will present decreased cognitive performance compared to subjects with lower CVR. This study can affect how to address CVR factors and the design of effective prevention strategies for cognitive deterioration. TRIAL REGISTRATION Clinicaltrials.gov, NCT03925844.
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Affiliation(s)
- Ester Tapias-Merino
- Healthcare Centre Comillas, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (REDIAPP), Spain
- Research Institute Hospital 12 de Octubre i+12, Group for Research in Health Services and Results, Madrid, Spain
- Faculty of Medicine, Department of Medicine, Complutense University of Madrid, Madrid, Spain
- * E-mail:
| | | | - Israel Contador-Castillo
- Faculty of Psychology, Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (REDIAPP), Spain
- Research Unit for Primary Health Care, Institute for Biomedical Research of Salamanca (IBSAL), Castilla y León Health Service, Salamanca, Spain
- Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Teresa Sanz-Cuesta
- Research Unit, Gerencia Asistencial de Atención Primaria (GAAP), Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Instituto Salud Carlos III, Madrid, Spain
| | - Concepción María Becerro-Muñoz
- Spanish Research Network for Preventive Activities and Health Promotion in Primary Care (REDIAPP), Spain
- Research Unit for Primary Health Care, Institute for Biomedical Research of Salamanca (IBSAL), Castilla y León Health Service, Salamanca, Spain
| | - Jesús Hernández-Gallego
- Faculty of Medicine, Department of Medicine, Complutense University of Madrid, Madrid, Spain
- Department of Neurology, Hospital Universitario 12 de Octubre (Madrid, Spain)
- Research Institute Hospital 12 de Octubre i+12, Neurosciences Group CIBERNED, Madrid, Spain
| | - Saturio Vega-Quiroga
- Healthcare Centre Arévalo, Gerencia Asistencial Atención Primaria, Sanidad de Castilla y León, Arévalo, Spain
| | - Félix Bermejo-Pareja
- Department of Neurology, Hospital Universitario 12 de Octubre (Madrid, Spain)
- Research Institute Hospital 12 de Octubre i+12, Neurosciences Group CIBERNED, Madrid, Spain
- Consulting Neurologist, Hospital 12 de Octubre, Madrid, Spain
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What Do We Know about Social and Non-Social Factors Influencing the Pathway from Cognitive Health to Dementia? A Systematic Review of Reviews. Brain Sci 2022; 12:brainsci12091214. [PMID: 36138950 PMCID: PMC9497077 DOI: 10.3390/brainsci12091214] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022] Open
Abstract
The heterogeneous and multi-factorial nature of dementia requires the consideration of all health aspects when predicting the risk of its development and planning strategies for its prevention. This systematic review of reviews provides a comprehensive synthesis of those factors associated with cognition in the context of dementia, identifying the role of social aspects and evidencing knowledge gaps in this area of research. Systematic reviews and meta-analyses from 2009–2021 were searched for within Medline, PsycINFO, CINAHL Complete, Cochrane, and Epistemonikos. Reviewers independently screened, reviewed, and assessed the records, following the PRISMA-2020 guidelines. From 314 included studies, 624 cognitive-related factors were identified, most of them risk factors (61.2%), mainly belonging to the group of ‘somatic comorbidities’ (cardiovascular disease and diabetes) and ‘genetic predispositions’. The protective factors (20%) were mainly related to lifestyle, pointing to the Mediterranean diet, regular physical activity, and cognitively stimulating activities. Social factors constituted 9.6% of all identified factors. Research on biological and medical factors dominates the reviewed literature. Greater social support and frequent contact may confer some protection against cognitive decline and dementia by delaying its onset or reducing the overall risk; however, overall, our findings are inconsistent. Further research is needed in the fields of lifestyle, psychology, social health, and the protective factors against cognitive decline and dementia.
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Mavrodaris A, Lafortune L, Brayne CE. The future longevity: designing a synergistic approach for healthy ageing, sustainability, and equity. THE LANCET. HEALTHY LONGEVITY 2022; 3:e584-e586. [PMID: 35935473 PMCID: PMC9345530 DOI: 10.1016/s2666-7568(22)00145-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Angelique Mavrodaris
- Cambridge Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Louise Lafortune
- Cambridge Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Carol E Brayne
- Cambridge Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
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Neumann JT, Thao LTP, Murray AM, Callander E, Carr PR, Nelson MR, Wolfe R, Woods RL, Reid CM, Shah RC, Newman AB, Williamson JD, Tonkin AM, McNeil JJ. Prediction of disability-free survival in healthy older people. GeroScience 2022; 44:1641-1655. [PMID: 35420334 PMCID: PMC9213595 DOI: 10.1007/s11357-022-00547-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/16/2022] [Indexed: 11/04/2022] Open
Abstract
Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and without prior cardiovascular events, dementia or persistent physical disability. Disability-free survival outcome was defined as absence of dementia, persistent disability or death. Selection of potential predictors from amongst 25 biomedical, psychosocial and lifestyle variables including recognized geriatric risk factors, utilizing a machine-learning approach. Separate models were developed for men and women. The selected predictors were evaluated in a multivariable Cox proportional hazards model and validated internally by bootstrapping. We included 19,114 Australian and US participants aged ≥65 years (median 74 years, IQR 71.6-77.7). Common predictors of a worse prognosis in both sexes included higher age, lower Modified Mini-Mental State Examination score, lower gait speed, lower grip strength and abnormal (low or elevated) body mass index. Additional risk factors for men included current smoking, and abnormal eGFR. In women, diabetes and depression were additional predictors. The biased-corrected areas under the receiver operating characteristic curves for the final prognostic models at 5 years were 0.72 for men and 0.75 for women. Final models showed good calibration between the observed and predicted risks. We developed a prediction model in which age, cognitive function and gait speed were the strongest predictors of disability-free survival in healthy older people.Trial registration Clinicaltrials.gov (NCT01038583).
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Affiliation(s)
- Johannes Tobias Neumann
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Cardiology, University Heart & Vascular Centre Hamburg, Hamburg, Germany. .,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
| | - Le T P Thao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Anne M Murray
- Division of Geriatrics, Department of Medicine, Hennepin Healthcare, and Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, USA
| | - Emily Callander
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Prudence R Carr
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia.,Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Centre, Rush University Medical Centre, Chicago, IL, USA
| | - Anne B Newman
- Centre for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA
| | - Jeff D Williamson
- Sticht Centre on Health Aging and Alzheimer's Prevention, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
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Restifo D, Zhao C, Kamel H, Iadecola C, Parikh NS. Impact of Cigarette Smoking and Its Interaction with Hypertension and Diabetes on Cognitive Function in Older Americans. J Alzheimers Dis 2022; 90:1705-1712. [PMID: 36314206 PMCID: PMC9988389 DOI: 10.3233/jad-220647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The detrimental impact of tobacco smoking on brain health is well recognized. OBJECTIVE To evaluate whether smoking acts synergistically with hypertension and diabetes to influence cognitive performance. METHODS We performed a cross-sectional analysis using the US National Health and Nutrition Examination Survey. Participants were tested for serum cotinine, a validated cigarette smoking/exposure biomarker, and had standardized blood pressure and hemoglobin A1c measurements. Participants were administered four cognitive tests: Digit Symbol Substitution (DSST), Animal Fluency, Immediate Recall, and Delayed Recall. Multivariable linear regression models adjusted for demographics and confounders evaluated the association of cotinine with cognition. Interaction testing evaluated effect modification by hypertension, diabetes, and their continuous measures (systolic blood pressure and hemoglobin A1c). RESULTS For 3,007 participants, mean age was 69.4 years; 54% were women. Using cotinine levels, 14.9% of participants were categorized as active smokers. Higher cotinine levels were associated with worse DSST performance when modeling cotinine as a continuous variable (β, -0.70; 95% CI, -1.11, -0.29; p < 0.01) and when categorizing participants as active smokers (β, -5.63; 95% CI, -9.70, -1.56; p < 0.01). Cotinine was not associated with fluency or memory. Effect modification by hypertension and diabetes were absent, except that cotinine was associated with worse Immediate Recall at lower blood pressures. CONCLUSION Higher levels of a smoking and secondhand exposure biomarker were associated with worse cognitive performance on a multidomain test. Overall, the relationship of cotinine with cognition was not contingent on or amplified by hypertension or diabetes; smoking is detrimental for brain health irrespective of these comorbidities.
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Affiliation(s)
- Daniel Restifo
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Chen Zhao
- Department of Neurology, Penn State Milton S. Hershey Medical Center, and Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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24
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Stephen R, Barbera M, Peters R, Ee N, Zheng L, Lehtisalo J, Kulmala J, Håkansson K, Chowdhary N, Dua T, Solomon A, Anstey KJ, Kivipelto M. Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions. Front Neurol 2021; 12:763573. [PMID: 34764935 PMCID: PMC8577650 DOI: 10.3389/fneur.2021.763573] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
The first WHO guidelines for risk reduction of cognitive decline and dementia marked an important milestone in the field of dementia prevention. In this paper, we discuss the evidence reviewed as part of the guidelines development and present the main themes emerged from its synthesis, to inform future research and policies on dementia risk reduction. The role of intervention effect-size; the mismatch between observational and intervention-based evidence; the heterogeneity of evidence among intervention trials; the importance of intervention duration; the role of timing of exposure to a certain risk factor and interventions; the relationship between intervention intensity and response; the link between individual risk factors and specific dementia pathologies; and the need for tailored interventions emerged as the main themes. The interaction and clustering of individual risk factors, including genetics, was identified as the overarching theme. The evidence collected indicates that multidomain approaches targeting simultaneously multiple risk factors and tailored at both individual and population level, are likely to be most effective and feasible in dementia risk reduction. The current status of multidomain intervention trials aimed to cognitive impairment/dementia prevention was also briefly reviewed. Primary results were presented focusing on methodological differences and the potential of design harmonization for improving evidence quality. Since multidomain intervention trials address a condition with slow clinical manifestation—like dementia—in a relatively short time frame, the need for surrogate outcomes was also discussed, with a specific focus on the potential utility of dementia risk scores. Finally, we considered how multidomain intervention could be most effectively implemented in a public health context and the implications world-wide for other non-communicable diseases targeting common risk factors, taking into account the limited evidence in low-middle income countries. In conclusion, the evidence from the first WHO guidelines for risk reduction of cognitive decline and dementia indicated that “one size does not fit all,” and multidomain approaches adaptable to different populations and individuals are likely to be the most effective. Harmonization in trial design, the use of appropriate outcome measures, and sustainability in large at-risk populations in the context of other chronic disorders also emerged as key elements.
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Affiliation(s)
- Ruth Stephen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mariagnese Barbera
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,The Ageing Epidemiology Research Unit, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Ruth Peters
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Nicole Ee
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Lidan Zheng
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Jenni Lehtisalo
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jenni Kulmala
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Krister Håkansson
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alina Solomon
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,The Ageing Epidemiology Research Unit, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Miia Kivipelto
- The Ageing Epidemiology Research Unit, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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25
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Wong PH, Kourtit K, Nijkamp P. The ideal neighbourhoods of successful ageing: A machine learning approach. Health Place 2021; 72:102704. [PMID: 34758442 DOI: 10.1016/j.healthplace.2021.102704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/24/2021] [Accepted: 10/24/2021] [Indexed: 01/30/2023]
Abstract
Ageing outcomes are shaped by not only health conditions, but also their interactions with the external environment. While the effects of some specific neighbourhood characteristics such as rurality on ageing have been evaluated in various studies, we still know little about the relative importance of particular natural and urban environments and how the impact varies at different stages of the ageing process. This article addresses these knowledge gaps by analysing survey data from 33 European countries using a machine learning method called multivariate regression trees (MRT). Multiple wellbeing indicators are combined to form an ageing profile for each individual in the survey. After studying these profiles using MRT, we find that generally the affordability of health facilities is a major determinant of life satisfaction, self-rated health condition and mental wellbeing for individuals in most age groups. Other important but age-specific determinants are neighbourhood safety and accessibility to cultural facilities and to green areas. In contrast, characteristics such as urbanity, transportation and air quality do not significantly influence ageing outcomes. Our findings lend support to the resources theory in explaining ageing outcomes and suggest that more resources may have to be directed to improve the affordability and quality of health care services, the policing services and the accessibility to cultural and green areas in order to achieve more favourable ageing outcomes.
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Affiliation(s)
- Pui-Hang Wong
- Maastricht University and UNU-MERIT, Boschstraat 24, 6211 AX Maastricht, the Netherlands.
| | - Karima Kourtit
- Open University, Heerlen, the Netherlands; Alexandru Ioan Cuza' University of Iași, Iași, Romania; Polytechnic University (UM6P), Ben Guerir, Morocco
| | - Peter Nijkamp
- Open University, Heerlen, the Netherlands; Alexandru Ioan Cuza' University of Iași, Iași, Romania; Polytechnic University (UM6P), Ben Guerir, Morocco; Adam Mickiewicz University, Poznan, Poland
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26
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Hafdi M, Hoevenaar-Blom MP, Richard E. Multi-domain interventions for the prevention of dementia and cognitive decline. Cochrane Database Syst Rev 2021; 11:CD013572. [PMID: 34748207 PMCID: PMC8574768 DOI: 10.1002/14651858.cd013572.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dementia is a worldwide concern. Its global prevalence is increasing. Currently, no effective medical treatment exists to cure or to delay the onset of cognitive decline or dementia. Up to 40% of dementia is attributable to potentially modifiable risk factors, which has led to the notion that targeting these risk factors might reduce the incidence of cognitive decline and dementia. Since sporadic dementia is a multifactorial condition, thought to derive from multiple causes and risk factors, multi-domain interventions may be more effective for the prevention of dementia than those targeting single risk factors. OBJECTIVES To assess the effects of multi-domain interventions for the prevention of cognitive decline and dementia in older adults, including both unselected populations and populations at increased risk of cognitive decline and dementia. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), and ClinicalTrials.gov on 28 April 2021. We also reviewed citations of reference lists of included studies, landmark papers, and review papers to identify additional studies and assessed their suitability for inclusion in the review. SELECTION CRITERIA We defined a multi-domain intervention as an intervention with more than one component, pharmacological or non-pharmacological, but not consisting only of two or more drugs with the same therapeutic target. We included randomised controlled trials (RCTs) evaluating the effect of such an intervention on cognitive functioning and/or incident dementia. We accepted as control conditions any sham intervention or usual care, but not single-domain interventions intended to reduce dementia risk. We required studies to have a minimum of 400 participants and an intervention and follow-up duration of at least 12 months. DATA COLLECTION AND ANALYSIS We initially screened search results using a 'crowdsourcing' method in which members of Cochrane's citizen science platform identify RCTs. We screened the identified citations against inclusion criteria by two review authors working independently. At least two review authors also independently extracted data, assessed the risk of bias and applied the GRADE approach to assess the certainty of evidence. We defined high-certainty reviews as trials with a low risk of bias across all domains other than blinding of participants and personnel involved in administering the intervention (because lifestyle interventions are difficult to blind). Critical outcomes were incident dementia, incident mild cognitive impairment (MCI), cognitive decline measured with any validated measure, and mortality. Important outcomes included adverse events (e.g. cardiovascular events), quality of life, and activities of daily living (ADL). Where appropriate, we synthesised data in random-effects meta-analyses. We expressed treatment effects as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). MAIN RESULTS We included nine RCTs (18.452 participants) in this review. Two studies reported incident dementia as an outcome; all nine studies reported a measure for cognitive functioning. Assessment of cognitive functioning was very heterogeneous across studies, ranging from complete neuropsychological assessments to short screening tests such as the mini-mental state examination (MMSE). The duration of the interventions varied from 12 months to 10 years. We compared multi-domain interventions against usual care or a sham intervention. Positive MDs and RRs <1 favour multi-domain interventions over control interventions. For incident dementia, there was no evidence of a difference between the multi-domain intervention group and the control group (RR 0.94, 95% CI 0.76 to 1.18; 2 studies; 7256 participants; high-certainty evidence). There was a small difference in composite Z-score for cognitive function measured with a neuropsychological test battery (NTB) (MD 0.03, 95% CI 0.01 to 0.06; 3 studies; 4617 participants; high-certainty evidence) and with the Montreal Cognitive Assessment (MoCA) scale (MD 0.76 point, 95% CI 0.05 to 1.46; 2 studies; 1554 participants), but the certainty of evidence for the MoCA was very low (due to serious risk of bias, inconsistency and indirectness) and there was no evidence of an effect on the MMSE (MD 0.02 point, 95% CI -0.06 to 0.09; 6 studies; 8697participants; moderate-certainty evidence). There was no evidence of an effect on mortality (RR 0.93, 95% CI 0.84 to 1.04; 4 studies; 11,487 participants; high-certainty evidence). There was high-certainty evidence for an interaction of the multi-domain intervention with ApoE4 status on the outcome of cognitive function measured with an NTB (carriers MD 0.14, 95% CI 0.04 to 0.25, noncarriers MD 0.04, 95% CI -0.02 to 0.10, P for interaction 0.09). There was no clear evidence for an interaction with baseline cognitive status (defined by MMSE-score) on cognitive function measured with an NTB (low baseline MMSE group MD 0.06, 95% CI 0.01 to 0.11, high baseline MMSE group MD 0.01, 95% CI -0.01 to 0.04, P for interaction 0.12), nor was there clear evidence for an effect in participants with a Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score > 6 points (MD 0.07, 95%CI -0.00 to 0.15). AUTHORS' CONCLUSIONS We found no evidence that multi-domain interventions can prevent incident dementia based on two trials. There was a small improvement in cognitive function assessed by a NTB in the group of participants receiving a multi-domain intervention, although this effect was strongest in trials offering cognitive training within the multi-domain intervention, making it difficult to rule out a potential learning effect. Interventions were diverse in terms of their components and intensity.
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Affiliation(s)
- Melanie Hafdi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marieke P Hoevenaar-Blom
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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27
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Barras L, Neuhaus M, Cyarto EV, Reid N. Effectiveness of Peer-Led Wellbeing Interventions in Retirement Living: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11557. [PMID: 34770069 PMCID: PMC8583038 DOI: 10.3390/ijerph182111557] [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] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
Retirement living (RL) communities may be an ideal setting in which to utilize peer-leaders to implement or support health and wellbeing interventions. To date, this literature has not been systematically summarized. The purpose of this study was to fill this gap with a particular focus on describing the extent to which interventions addressed each level of the social ecological model of behavior change. This review utilized established frameworks for assessing methodological quality of studies, including the CONSORT guidelines and RoB2 bias assessment for cluster randomized controlled trials. A total of 153 records were identified from database searches, and seven studies met inclusion criteria. Overall, there is emerging evidence that peer-led health and wellbeing programs in RL communities can positively impact both health behavior, such as increased physical activity or nutrition, and health status, such as lower blood pressure. The study quality was modest to very good, but only one study was deemed not to have a high risk of bias. Peers are generally cost-effective, more accessible, and relatable leaders for health interventions that can still produce impactful changes. Future studies are needed to better understand how to sustain promising interventions.
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Affiliation(s)
- Lilian Barras
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4102, Australia
| | - Maike Neuhaus
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4102, Australia; (M.N.); (N.R.)
| | - Elizabeth V. Cyarto
- Bolton Clarke, Brisbane, QLD 4059, Australia;
- Faculty of Health and Behavioral Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Natasha Reid
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, QLD 4102, Australia; (M.N.); (N.R.)
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28
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Kittel-Schneider S, Arteaga-Henriquez G, Vasquez AA, Asherson P, Banaschewski T, Brikell I, Buitelaar J, Cormand B, Faraone SV, Freitag CM, Ginsberg Y, Haavik J, Hartman CA, Kuntsi J, Larsson H, Matura S, McNeill RV, Ramos-Quiroga JA, Ribases M, Romanos M, Vainieri I, Franke B, Reif A. Non-mental diseases associated with ADHD across the lifespan: Fidgety Philipp and Pippi Longstocking at risk of multimorbidity? Neurosci Biobehav Rev 2021; 132:1157-1180. [PMID: 34757108 DOI: 10.1016/j.neubiorev.2021.10.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
Several non-mental diseases seem to be associated with an increased risk of ADHD and ADHD seems to be associated with increased risk for non-mental diseases. The underlying trajectories leading to such brain-body co-occurrences are often unclear - are there direct causal relationships from one disorder to the other, or does the sharing of genetic and/or environmental risk factors lead to their occurring together more frequently or both? Our goal with this narrative review was to provide a conceptual synthesis of the associations between ADHD and non-mental disease across the lifespan. We discuss potential shared pathologic mechanisms, genetic background and treatments in co-occurring diseases. For those co-occurrences for which published studies with sufficient sample sizes exist, meta-analyses have been published by others and we discuss those in detail. We conclude that non-mental diseases are common in ADHD and vice versa and add to the disease burden of the patient across the lifespan. Insufficient attention to such co-occurring conditions may result in missed diagnoses and suboptimal treatment in the affected individuals.
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Affiliation(s)
- Sarah Kittel-Schneider
- Center of Mental Health, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany.
| | - Gara Arteaga-Henriquez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Alejandro Arias Vasquez
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Departments of Psychiatry and Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Phil Asherson
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Isabell Brikell
- National Centre for Register-based Research, Department of Economics and Business Economics Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210 Aarhus V, Aarhus, Denmark; iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77, Stockholm, Sweden
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Catalonia, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, D-60528 Frankfurt am Main, Germany
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Jan Haavik
- Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Catharina A Hartman
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Jonna Kuntsi
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77, Stockholm, Sweden; Örebro University, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany
| | - Rhiannon V McNeill
- Center of Mental Health, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Marta Ribases
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Catalonia, Spain
| | - Marcel Romanos
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany
| | - Isabella Vainieri
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Barbara Franke
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Departments of Psychiatry and Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany
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29
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Ellwood A, Quinn C, Mountain G. Psychological and Social Factors Associated with Coexisting Frailty and Cognitive Impairment: A Systematic Review. Res Aging 2021; 44:448-464. [PMID: 34601993 PMCID: PMC9039321 DOI: 10.1177/01640275211045603] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Those living with coexistent frailty and cognitive impairment are at risk of poorer health outcomes. Research often focuses on identifying biological factors. This review sought to identify the association psychological and social factors have with coexisting physical and cognitive decline. Six databases were systematically searched in July 2020. Studies included individuals aged 60 years or older identified as being both frail and cognitively impaired. A narrative synthesis examined patterns within the data. Nine studies were included, most employed a cross-sectional design. Depression was investigated by all nine studies, those with coexistent frailty and cognitive impairment had higher levels of depressive symptoms than peers. Findings were mixed on social factors, although broadly indicate lower education, living alone and lower material wealth were more frequent in those living with coexistent decline. Further research is needed to explore potentially modifiable psychological and social factors which could lead to the development of supportive interventions.
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Affiliation(s)
- Alison Ellwood
- Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK.,Wolfson Centre of Applied Health Research, Bradford, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK.,Wolfson Centre of Applied Health Research, Bradford, UK
| | - Gail Mountain
- Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK
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A longitudinal view of successful aging with HIV: role of resilience and environmental factors. Qual Life Res 2021; 31:1135-1145. [PMID: 34460077 DOI: 10.1007/s11136-021-02970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to estimate the extent to which people aging with HIV meet criteria for successful aging as operationalized through HRQL and maintain this status over time. A second objective is to identify factors that place people at promise for continued successful aging, including environmental and resilience factors. METHODS Participants were members of the Positive Brain Health Now (BHN) cohort. People ≥ 50 years (n = 513) were classified as aging successfully if they were at or above norms on 7 or 8 of 8 health-related quality of life domains from the RAND-36. Group-based trajectory analysis, regression tree analysis, a form of machine learning, and logistic regression were applied to identify factors predicting successful aging. RESULTS 73 (14·2%) met criteria for successful aging at entry and did not change status over time. The most influential factor was loneliness which split the sample into two groups with the prevalence of successful aging 28·4% in the "almost never" lonely compared to 4·6% in the "sometimes/often" lonely group. Other influential factors were feeling safe, social network, motivation, stigma, and socioeconomic status. These factors identified 17 sub-groups with at least 30 members with the proportions classified as aging successfully ranging from 0 to 79·4%. The nine variables important to classifying successful aging had a predictive accuracy of 0.862. Self-reported cognition but not cognitive test performance improved this accuracy to 0.895. The two groups defined by successful aging status did not differ on age, sex or viral load, nadir and current. CONCLUSION The results indicate the important role of social determinants of health in successful aging among people living with HIV.
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Essery R, Pollet S, Smith KA, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Bradbury K, Grey E, Western MJ, Milton A, Hunter C, Ferrey AE, Müller AM, Stuart B, Mutrie N, Griffin S, Kendrick T, Brooker H, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Planning and optimising a digital intervention to protect older adults' cognitive health. Pilot Feasibility Stud 2021; 7:158. [PMID: 34407886 PMCID: PMC8371874 DOI: 10.1186/s40814-021-00884-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2050, worldwide dementia prevalence is expected to triple. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the theory-, evidence- and person-based development of 'Active Brains': a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults. METHODS During the initial planning phase, scoping reviews, consultation with PPI contributors and expert co-investigators and behavioural analysis collated and recorded evidence that was triangulated to inform provisional 'guiding principles' and an intervention logic model. The following optimisation phase involved qualitative think aloud and semi-structured interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes and additions to guiding principles, the behavioural analysis and the logic model which, in turn, informed changes to intervention content. RESULTS Scoping reviews and qualitative interviews suggested that the same intervention content may be suitable for individuals with higher and lower cognitive performance. Qualitative findings revealed that maintaining independence and enjoyment motivated engagement in intervention-targeted behaviours, whereas managing ill health was a potential barrier. Social support for engaging in such activities could provide motivation, but was not desirable for all. These findings informed development of intervention content and functionality that appeared highly acceptable amongst a sample of target users. CONCLUSIONS A digitally delivered intervention with minimal support appears acceptable and potentially engaging to older adults with higher and lower levels of cognitive performance. As well as informing our own intervention development, insights obtained through this process may be useful for others working with, and developing interventions for, older adults and/or those with cognitive impairment.
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Affiliation(s)
- Rosie Essery
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
| | - Sebastien Pollet
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Fiona Mowbray
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Joanna Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Victoria Hayter
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | | | | | - Alexander Milton
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Cheryl Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.,Centre for Sport & Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - John Niven
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK. .,School of Psychological Science, University of Bristol, Bristol, UK.
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Norheim KL, Bøggild H, Andersen JH, Omland Ø, Bønløkke JH, Madeleine P. Retirement status and frailty: a cross-sectional study of the phenotype of manual workers aged 50-70 years. Eur J Public Health 2021; 31:116-121. [PMID: 33164046 DOI: 10.1093/eurpub/ckaa188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The frailty phenotype is predictive of mortality and has been identified in the working population. This cross-sectional study aimed to investigate the prevalence of frailty and individual frailty symptoms among active and retired Danish manual workers and to delineate the relationship between frailty and lifestyle factors. METHODS Manual workers aged 50-70 years answered questions relating to the Fried criteria for frailty (weight loss, exhaustion, slowness, weakness and inactivity). Only men were included in the analyses and respondents were stratified according to work status: active workers (n = 1555), early retirees (n = 289) and workers retired at or after normal pension age (n = 291). Associations between pre-frailty/frailty, work status and various lifestyle factors were estimated using binomial logistic regression. RESULTS Overall, the prevalence of pre-frailty (one or two symptoms) and frailty (three or more symptoms) was 33.3% and 1.5%, respectively. Those who had retired early were more likely to be pre-frail/frail compared with active workers (odds ratio 2.20, 95% CI 1.61-3.01). Exhaustion was the most prominent symptom reported by 22.2% of active workers, 34.6% of early retirees and 16.5% of workers retired at normal retirement age. Lifestyle factors including obesity, physical inactivity and smoking but not alcohol intake were associated with pre-frailty/frailty. CONCLUSION Symptoms of frailty are identifiable and present among both active and retired manual workers. Data suggest discrepancies among Danish manual workers, with some having unhealthy lifestyles and being more prone to develop pre-frailty and frailty already in their sixth decade of life.
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Affiliation(s)
- Kristoffer L Norheim
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Johan Hviid Andersen
- Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
| | - Øyvind Omland
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob H Bønløkke
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Pascal Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Definitions of Frailty in Qualitative Research: A Qualitative Systematic Review. J Aging Res 2021; 2021:6285058. [PMID: 34123425 PMCID: PMC8189777 DOI: 10.1155/2021/6285058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
The purpose of this qualitative systematic review was to examine how frailty was conceptually and operationally defined for participant inclusion in qualitative research focused on the lived experience of frailty in community-living frail older adults. Search of six electronic databases, 1994-2019, yielded 25 studies. Data collection involved extracting the definition of frailty from the study aim, background, literature review, methods, and sampling strategy in each research study. Quality appraisal indicated that 13 studies (52%) demonstrated potential researcher bias based on insufficient information about participant recruitment, sampling, and relationship between the researcher and participant. Content analysis and concept mapping were applied for data synthesis. Although frailty was generally defined as a multidimensional, biopsychosocial construct with loss of resilience and vulnerability to adverse outcomes, most studies defined the study population based on older age and physical impairments derived from subjective assessment by the researcher, a healthcare professional, or a family member. However, 13 studies (52%) used objective or performance-based quantitative measures to classify participant frailty. There was no consistency across studies in standardized measures or objective assessment of frailty. Synthesis of the findings yielded four themes: Time, Vulnerability, Loss, and Relationships. The predominance of older age and physical limitations as defining characteristics of frailty raises questions about whether participants were frail, since many older adults at advanced age and with physical limitations are not frail. Lack of clear criteria to classify frailty and reliance on subjective assessment introduces the risk for bias, threatens the validity and interpretation of findings, and hinders transferability of findings to other contexts. Clear frailty inclusion and exclusion criteria and a standardized approach in the reporting of how frailty is conceptually and operationally defined in study abstracts and the methodology used is necessary to facilitate dissemination and development of metasynthesis studies that aggregate qualitative research findings that can be used to inform future research and applications in clinical practice to improve healthcare.
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Lee-Bravatti MA, O'Neill HJ, Wurth RC, Sotos-Prieto M, Gao X, Falcon LM, Tucker KL, Mattei J. Lifestyle Behavioral Factors and Integrative Successful Aging Among Puerto Ricans Living in the Mainland United States. J Gerontol A Biol Sci Med Sci 2021; 76:1108-1116. [PMID: 33045072 DOI: 10.1093/gerona/glaa259] [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] [Received: 04/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have assessed multidimensional models for predicting successful aging that incorporate both physical and cognitive-psychosocial elements among minority populations. This study aimed to establish a comprehensive lifestyle behavioral factors (cLBF) score and an integrative successful aging (ISA) score and explore their associations among older Puerto Rican adults. METHODS Data were assessed from 889 adults (45-75 years) participating in the longitudinal (baseline and 2-year follow-up) Boston Puerto Rican Health Study. Higher cLBF score (range 0-10) indicates healthier behaviors (nonsmoking, lack of sedentarism, physical activity, high diet quality, and adequate sleep). The physical domain score of ISA included 8 components (functional impairment, hypertension, diabetes, cancer, cardiovascular disease, respiratory disease, arthritis, osteoporosis) and ranged 0-11. The cognitive-psychosocial domain of ISA included 5 components (cognitive impairment, depressive symptoms, social support, perceived stress, and self-rated health) and ranged 0-10. The sum of both domains comprised the ISA score, ranging 0-21. Higher scores of ISA and its domains indicate more successful aging. RESULTS At 2 years, the mean ± SD of cLBF score was 4.9 ± 1.8, and ISA was 10.1 ± 3.3. In multivariable-adjusted models, cLBF score was significantly and positively associated with 2-year change in overall ISA (β [95% CI]: 0.15 [0.07, 0.24] points), in physical domain (0.09 [0.04, 0.13] points), and in cognitive-psychosocial domain (0.08 [0.02, 0.14] points). CONCLUSIONS Maintaining healthier lifestyle behaviors may contribute to successful aging through both physical and cognitive-psychosocial domains. The results support using a multidimensional definition of successful aging in Puerto Ricans and evaluating it in other populations.
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Affiliation(s)
| | - H June O'Neill
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Renee C Wurth
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Mercedes Sotos-Prieto
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts.,Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Spain
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, College Station
| | - Luis M Falcon
- College of Fine Arts, Humanities and Social Sciences, University of Massachusetts Lowell
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
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Watermeyer T, Goerdten J, Johansson B, Muniz-Terrera G. Cognitive dispersion and ApoEe4 genotype predict dementia diagnosis in 8-year follow-up of the oldest-old. Age Ageing 2021; 50:868-874. [PMID: 33196771 DOI: 10.1093/ageing/afaa232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cognitive dispersion, or inconsistencies in performance across cognitive domains, has been posited as a cost-effective tool to predict conversion to dementia in older adults. However, there is a dearth of studies exploring cognitive dispersion in the oldest-old (>80 years) and its relationship to dementia incidence. OBJECTIVE The main aim of this study was to examine whether higher cognitive dispersion at baseline was associated with dementia incidence within an 8-year follow-up of very old adults, while controlling for established risk factors and suggested protective factors for dementia. METHODS Participants (n = 468) were from the Origins of Variance in the Old-Old: Octogenarian Twins study, based on the Swedish Twin Registry. Cox regression analyses were performed to assess the association between baseline cognitive dispersion scores and dementia incidence, while controlling for sociodemographic variables, ApoEe4 carrier status, co-morbidities, zygosity and lifestyle engagement scores. An additional model included a composite of average cognitive performance. RESULTS Cognitive dispersion and ApoEe4 were significantly associated with dementia diagnosis. These variables remained statistically significant when global cognitive performance was entered into the model. Likelihood ratio tests revealed that cognitive dispersion and cognitive composite scores entered together in the same model was superior to either predictor alone in the full model. CONCLUSIONS The study underscores the usefulness of cognitive dispersion metrics for dementia prediction in the oldest-old and highlights the influence of ApoEe4 on cognition in very late age. Our findings concur with others suggesting that health and lifestyle factors pose little impact upon cognition in very advanced age.
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Affiliation(s)
- Tam Watermeyer
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Faculty of Health and Life Sciences, Department of Psychology, Northumbria University, Newcastle, UK
| | - Jantje Goerdten
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
| | - Boo Johansson
- Department of Psychology, Centre for Ageing and Health (AgeCap), University of Gothenburg, Gothenburg, Sweden
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Abstract
Purpose
Recent public health policy emphasizes the achievement of healthy aging as average life expectancy increases worldwide. Evidence for healthy aging from low- and middle-income countries (LMIC) is limited. The purpose of this paper is to assess the prospects of healthy aging and its associated factors in the Indian context.
Design/methodology/approach
The study was based on a national-level panel survey, the Indian Human Development Survey (IHDS) conducted in 2004-05 and 2011-12. The analytical sample consists of 10,218 elderly individuals who were 60 years old and above at the baseline. Change in health status was assessed based on disability and disease incidence at the follow-up. A generalized estimating equation (GEE) model was performed to assess health status change.
Findings
Increasing age was a risk factor for all dimensions of health outcomes. Elderly from the lowest wealth quintiles were more likely to lose health due to short-term morbidity, whereas the highest wealth quintiles were more likely to lose health due to long-term and multi-morbidity, indicating evidence for the presence of the “disease of affluence”. Social capital, such as living in a joint family acted as a protective factor against health risks.
Originality/value
With the results showing the evidence of the “disease of affluence” and “disease of poverty” in different health outcomes, there should be a health policy focus that copes with undergoing epidemiological transition. It is also important to pay attention to health-protecting factors such as social and familial support to achieve healthy aging.
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Tawiah R, Jagger C, Anstey KJ, Kiely KM. Trends in disability-free life expectancy at age 50 years in Australia between 2001 and 2011 by social disadvantage. J Epidemiol Community Health 2021; 75:1056-1062. [PMID: 33910959 DOI: 10.1136/jech-2020-214906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/15/2021] [Accepted: 04/11/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aims of this study were (1) to estimate 10-year trends in disability-free life expectancy (DFLE) by area-level social disadvantage and (2) to examine how incidence, recovery and mortality transitions contributed to these trends. METHODS Data were drawn from the nationally representative Household Income and Labour Dynamics in Australia survey. Two cohorts (baseline age 50+ years) were followed up for 7 years, from 2001 to 2007 and from 2011 to 2017, respectively. Social disadvantage was indicated by the Socio-Economic Indexes for Areas (SEIFA). Two DFLEs based on a Global Activity Limitation Indicator (GALI) and difficulties with activities of daily living (ADLs) measured by the 36-Item Short Form Survey physical function subscale were estimated by cohort, sex and SEIFA tertile using multistate models. RESULTS Persons residing in the low-advantage tertile had more years lived with GALI and ADL disability than those in high-advantage tertiles. Across the two cohorts, dynamic equilibrium for GALI disability was observed among men in mid-advantage and high-advantage tertiles, but expansion of GALI disability occurred in the low-advantage tertile. There was expansion of GALI disability for all women irrespective of their SEIFA tertile. Compression of ADL disability was observed for all men and for women in the high-advantage tertile. Compared to the 2001 cohort, disability incidence was lower for the 2011 cohort of men within mid-advantage and high-advantage tertiles, whereas recovery and disability-related mortality were lower for the 2011 cohort of women within the mid-advantage tertile. CONCLUSION Overall, compression of morbidity was more common in high-advantage areas, whereas expansion of morbidity was characteristic of low-advantage areas. Trends also varied by sex and disability severity.
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Affiliation(s)
- Richard Tawiah
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Kim M Kiely
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia .,Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
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Yang W, Wu B, Tan SY, Li B, Lou VWQ, Chen ZA, Chen X, Fletcher JR, Carrino L, Hu B, Zhang A, Hu M, Wang Y. Understanding Health and Social Challenges for Aging and Long-Term Care in China. Res Aging 2021; 43:127-135. [PMID: 32677535 PMCID: PMC7961665 DOI: 10.1177/0164027520938764] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The second King's College London Symposium on Ageing and Long-term Care in China was convened from 4 to 5th July 2019 at King's College London in London. The aim of the Symposium was to have a better understanding of health and social challenges for aging and long-term care in China. This symposium draws research insights from a wide range of disciplines, including economics, public policy, demography, gerontology, public health and sociology. A total of 20 participants from eight countries, seek to identify the key issues and research priorities in the area of aging and long-term care in China. The results published here are a synthesis of the top four research areas that represent the perspectives from some of the leading researchers in the field.
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Affiliation(s)
- Wei Yang
- Department of Global Health & Social Medicine, 4616King's College London, London, United Kingdom
| | - Bei Wu
- Rory Meyers College of Nursing, 5894New York University, New York, USA
| | - Si Ying Tan
- Lee Kuan Yew School of Public Policy, 37580National University of Singapore, Singapore
| | - Bingqin Li
- Social Policy Research Centre, 7800University of New South Wales, Sydney, Australia
| | - Vivian W Q Lou
- Sau Po Centre on Ageing, Department of Social Work & Social Administration, The 25809University of Hong Kong, China
| | - Zhuo Adam Chen
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA
- School of Economics, 56668University of Nottingham Ningbo China, Ningbo, Zhejiang, China
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Department of Economics, 5755Yale University, New Haven, CT, USA
| | - James Rupert Fletcher
- Department of Global Health & Social Medicine, 4616King's College London, London, United Kingdom
| | - Ludovico Carrino
- Department of Global Health & Social Medicine, 4616King's College London, London, United Kingdom
| | - Bo Hu
- Personal Social Services Research Unit, Department of Health Policy, 4905London School of Economics and Political Science, United Kingdom
| | - Anwen Zhang
- Adam Smith Business School, 3526University of Glasgow, United Kingdom
| | - Min Hu
- Department of Health Economics, School of Public Health, 12478Fudan University, Shanghai, China
| | - Yixiao Wang
- Department of Global Health & Social Medicine, 4616King's College London, London, United Kingdom
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Lekan DA, McCoy TP, Jenkins M, Mohanty S, Manda P, Yasin R. Comparison of a Frailty Risk Score and Comorbidity Indices for Hospital Readmission Using Electronic Health Record Data. Res Gerontol Nurs 2021; 14:91-103. [PMID: 33492402 DOI: 10.3928/19404921-20210115-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The purpose of the current study was to investigate the predictive properties of five definitions of a frailty risk score (FRS) and three comorbidity indices using data from electronic health records (EHRs) of hospitalized adults aged ≥50 years for 3-day, 7-day, and 30-day readmission, and to identify an optimal model for a FRS and comorbidity combination. Retrospective analysis of the EHR dataset was performed, and multivariable logistic regression and area under the curve (AUC) were used to examine readmission for frailty and comorbidity. The sample (N = 55,778) was mostly female (53%), non-Hispanic White (73%), married (53%), and on Medicare (55%). Mean FRSs ranged from 1.3 (SD = 1.5) to 4.3 (SD = 2.1). FRS and comorbidity were independently associated with readmission. Predictive accuracy for FRS and comorbidity combinations ranged from AUC of 0.75 to 0.77 (30-day readmission) to 0.84 to 0.85 (3-day readmission). FRS and comorbidity combinations performed similarly well, whereas comorbidity was always independently associated with readmission. FRS measures were more associated with 30-day readmission than 7-day and 3-day readmission. [Research in Gerontological Nursing, 14(2), 91-103.].
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Possible association of early menopause with worse physical function: a systematic review. ACTA ACUST UNITED AC 2021; 28:467-475. [PMID: 33399317 DOI: 10.1097/gme.0000000000001712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Menopause at younger ages is associated with a greater risk of adverse health outcomes such as osteoporosis, chronic diseases, and death. However, the association with physical function has not been well established. OBJECTIVE Assess the association between timing of menopause and different measures of physical function. EVIDENCE REVIEW Searches on the PubMed, Cochrane Library, SciELO, LILACS, and Web of Science databases were conducted. Observational studies on the association between age at menopause and measures of physical function were included, with no restriction for publication date or language. Methodological quality was assessed by the "Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies." FINDINGS Four cross-sectional studies were included, totaling 13,846 participants. These investigated five measures of physical function: gait speed, grip strength, standing balance, chair stand, and self-reported functional limitations. Poor physical function was associated with premature (<40 y) or early menopause (<45 y) in all the studies, with significant results only for grip strength, gait speed, and functional limitation. Premature and early menopause were associated with weaker grip strength [between 2.58 kg (95% CI = 0.74 to 4.43) and 5.21 kg (2.18 to 8.25)], and lower gait speed [between 0.03 m/s (0.01 to 0.06) and 0.06 m/s (0.02 to 0.09)]. Menopause after the age of 50 is associated with less likelihood of functional limitation [OR between 0.52 (95% CI = 0.29 to 0.95) and 0.61 (0.40 to 0.95)] compared with premature and early menopause. Two measures of physical function (chair stand test and standing balance) were not significantly associated with age at menopause. CONCLUSION Only four cross-sectional studies showed that earlier ages at menopause are associated with poor physical function (grip strength, gait speed, and self-reported functional limitations), but given the high heterogeneity of the studies, no consensus is possible. Longitudinal studies are needed to explore the association between age at menopause and different measures of physical function as well as the influence of different socioeconomic conditions between countries on functioning.
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fang EF, Xie C, Schenkel JA, Wu C, Long Q, Cui H, Aman Y, Frank J, Liao J, Zou H, Wang NY, Wu J, Liu X, Li T, Fang Y, Niu Z, Yang G, Hong J, Wang Q, Chen G, Li J, Chen HZ, Kang L, Su H, Gilmour BC, Zhu X, Jiang H, He N, Tao J, Leng SX, Tong T, Woo J. A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks. Ageing Res Rev 2020; 64:101174. [PMID: 32971255 PMCID: PMC7505078 DOI: 10.1016/j.arr.2020.101174] [Citation(s) in RCA: 223] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/13/2020] [Accepted: 09/03/2020] [Indexed: 12/18/2022]
Abstract
One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+). China has become an ageing society, and as it continues to age it will continue to exacerbate the burden borne by current family and public healthcare systems. Major healthcare challenges involved with caring for the elderly in China include the management of chronic non-communicable diseases (CNCDs), physical frailty, neurodegenerative diseases, cardiovascular diseases, with emerging challenges such as providing sufficient dental care, combating the rising prevalence of sexually transmitted diseases among nursing home communities, providing support for increased incidences of immune diseases, and the growing necessity to provide palliative care for the elderly. At the governmental level, it is necessary to make long-term strategic plans to respond to the pressures of an ageing society, especially to establish a nationwide, affordable, annual health check system to facilitate early diagnosis and provide access to affordable treatments. China has begun work on several activities to address these issues including the recent completion of the of the Ten-year Health-Care Reform project, the implementation of the Healthy China 2030 Action Plan, and the opening of the National Clinical Research Center for Geriatric Disorders. There are also societal challenges, namely the shift from an extended family system in which the younger provide home care for their elderly family members, to the current trend in which young people are increasingly migrating towards major cities for work, increasing reliance on nursing homes to compensate, especially following the outcomes of the 'one child policy' and the 'empty-nest elderly' phenomenon. At the individual level, it is important to provide avenues for people to seek and improve their own knowledge of health and disease, to encourage them to seek medical check-ups to prevent/manage illness, and to find ways to promote modifiable health-related behaviors (social activity, exercise, healthy diets, reasonable diet supplements) to enable healthier, happier, longer, and more productive lives in the elderly. Finally, at the technological or treatment level, there is a focus on modern technologies to counteract the negative effects of ageing. Researchers are striving to produce drugs that can mimic the effects of 'exercising more, eating less', while other anti-ageing molecules from molecular gerontologists could help to improve 'healthspan' in the elderly. Machine learning, 'Big Data', and other novel technologies can also be used to monitor disease patterns at the population level and may be used to inform policy design in the future. Collectively, synergies across disciplines on policies, geriatric care, drug development, personal awareness, the use of big data, machine learning and personalized medicine will transform China into a country that enables the most for its elderly, maximizing and celebrating their longevity in the coming decades. This is the 2nd edition of the review paper (Fang EF et al., Ageing Re. Rev. 2015).
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Affiliation(s)
- Evandro F Fang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway; Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, 510080, Guangzhou, China; Institute of Geriatric Immunology, School of Medicine, Jinan University, 510632, Guangzhou, China; Department of Geriatrics, The First Affiliated Hospital, Zhengzhou University, 450052, Zhengzhou, China.
| | - Chenglong Xie
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway; Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Joseph A Schenkel
- Durham University Department of Sports and Exercise Sciences, Durham, United Kingdom.
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, China; Duke Global Health Institute, Duke University, Durham, 27710, North Carolina, USA.
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, 215316, Kunshan, China.
| | - Honghua Cui
- Department of Endodontics, Shanghai Stomatological Hospital, Fudan University, China; Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, China.
| | - Yahyah Aman
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Johannes Frank
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Jing Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 510275, Guangzhou, China; Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, 510275, Guangzhou, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Ninie Y Wang
- Pinetree Care Group, 515 Tower A, Guomen Plaza, Chaoyang District, 100028, Beijing, China.
| | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, SE-405 30, Gothenburg, Sweden.
| | - Xiaoting Liu
- School of Public Affairs, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
| | - Tao Li
- BGI-Shenzhen, Beishan Industrial Zone, 518083, Shenzhen, China; China National GeneBank, BGI-Shenzhen, 518120, Shenzhen, China.
| | - Yuan Fang
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Zhangming Niu
- Aladdin Healthcare Technologies Ltd., 25 City Rd, Shoreditch, London EC1Y 1AA, UK.
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, SW3 6NP, UK; and National Heart and Lung Institute, Imperial College London, London, SW7 2AZ, United Kingdom.
| | | | - Qian Wang
- Department of Geriatrics, The First Affiliated Hospital, Zhengzhou University, 450052, Zhengzhou, China.
| | - Guobing Chen
- Institute of Geriatric Immunology, School of Medicine, Jinan University, 510632, Guangzhou, China.
| | - Jun Li
- Department of Biochemistry and Molecular Biology, The Institute of Basic Medical Sciences, The Chinese Academy of Medical Sciences (CAMS)& Peking Union Medical University (PUMC), 5 Dondan Santiao Road, Beijing, 100730, China.
| | - Hou-Zao Chen
- Department of Biochemistry and Molecular Biology, The Institute of Basic Medical Sciences, The Chinese Academy of Medical Sciences (CAMS)& Peking Union Medical University (PUMC), 5 Dondan Santiao Road, Beijing, 100730, China.
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Huanxing Su
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao.
| | - Brian C Gilmour
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway.
| | - Xinqiang Zhu
- Department of Toxicology, Zhejiang University School of Public Health, Hangzhou, 310058, Zhejiang, China; The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, 322000, Zhejiang, China.
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Na He
- School of Public Health, Fudan University, 200032, Shanghai, China; Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 200032, Shanghai, China; Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University, 200032, Shanghai, China.
| | - Jun Tao
- Department of Hypertension and Vascular Disease, The First Affiliated Hospital, Sun Yat-Sen University, 510080, Guangzhou, China.
| | - Sean Xiao Leng
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
| | - Tanjun Tong
- Research Center on Ageing, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing Key Laboratory of Protein Posttranslational Modifications and Cell Function, Beijing, China.
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Smith KA, Bradbury K, Essery R, Pollet S, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Kelly J, Somerville J, Zhang J, Grey E, Western M, Ferrey AE, Krusche A, Stuart B, Mutrie N, Robinson S, Yao GL, Griffiths G, Robinson L, Rossor M, Gallacher J, Griffin S, Kendrick T, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. The Active Brains Digital Intervention to Reduce Cognitive Decline in Older Adults: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18929. [PMID: 33216010 PMCID: PMC7718093 DOI: 10.2196/18929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/04/2020] [Accepted: 08/16/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Increasing physical activity, improving diet, and performing brain training exercises are associated with reduced cognitive decline in older adults. OBJECTIVE In this paper, we describe a feasibility trial of the Active Brains intervention, a web-based digital intervention developed to support older adults to make these 3 healthy behavior changes associated with improved cognitive health. The Active Brains trial is a randomized feasibility trial that will test how accessible, acceptable, and feasible the Active Brains intervention is and the effectiveness of the study procedures that we intend to use in the larger, main trial. METHODS In the randomized controlled trial (RCT), we use a parallel design. We will be conducting the intervention with 2 populations recruited through GP practices (family practices) in England from 2018 to 2019: older adults with signs of cognitive decline and older adults without any cognitive decline. Trial participants were randomly allocated to 1 of 3 study groups: usual care, the Active Brains intervention, or the Active Brains website plus brief support from a trained coach (over the phone or by email). The main outcomes are performance on cognitive tasks, quality of life (using EuroQol-5D 5 level), Instrumental Activities of Daily Living, and diagnoses of dementia. Secondary outcomes (including depression, enablement, and health care costs) and process measures (including qualitative interviews with participants and supporters) will also be collected. The trial has been approved by the National Health Service Research Ethics Committee (reference 17/SC/0463). RESULTS Results will be published in peer-reviewed journals, presented at conferences, and shared at public engagement events. Data collection was completed in May 2020, and the results will be reported in 2021. CONCLUSIONS The findings of this study will help us to identify and make important changes to the website, the support received, or the study procedures before we progress to our main randomized phase III trial. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number 23758980; http://www.isrctn.com/ISRCTN23758980. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18929.
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Affiliation(s)
- Kirsten Ailsa Smith
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Katherine Bradbury
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Rosie Essery
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Sebastien Pollet
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Fiona Mowbray
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Joanna Slodkowska-Barabasz
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - James Denison-Day
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Victoria Hayter
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Jo Kelly
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Somerville
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Elisabeth Grey
- Department for Health, University of Bath, Bath, United Kingdom
| | - Max Western
- Department for Health, University of Bath, Bath, United Kingdom
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Adele Krusche
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Sian Robinson
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Louise Robinson
- Institute of Population Health Sciences, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Martin Rossor
- Dementia Research Centre, University College London, London, United Kingdom
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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Gagliardi S, Morasso C, Stivaktakis P, Pandini C, Tinelli V, Tsatsakis A, Prosperi D, Hickey M, Corsi F, Cereda C. Curcumin Formulations and Trials: What's New in Neurological Diseases. Molecules 2020; 25:molecules25225389. [PMID: 33217959 PMCID: PMC7698610 DOI: 10.3390/molecules25225389] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023] Open
Abstract
Curcumin’s pharmacological properties and its possible benefits for neurological diseases and dementia have been much debated. In vitro experiments show that curcumin modulates several key physiological pathways of importance for neurology. However, in vivo studies have not always matched expectations. Thus, improved formulations of curcumin are emerging as powerful tools in overcoming the bioavailability and stability limitations of curcumin. New studies in animal models and recent double-blinded, placebo-controlled clinical trials using some of these new formulations are finally beginning to show that curcumin could be used for the treatment of cognitive decline. Ultimately, this work could ease the burden caused by a group of diseases that are becoming a global emergency because of the unprecedented growth in the number of people aged 65 and over worldwide. In this review, we discuss curcumin’s main mechanisms of action and also data from in vivo experiments on the effects of curcumin on cognitive decline.
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Affiliation(s)
- Stella Gagliardi
- Genomic and Post Genomic Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.G.); (C.P.)
| | - Carlo Morasso
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (C.M.); (V.T.); (D.P.); (F.C.)
| | | | - Cecilia Pandini
- Genomic and Post Genomic Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.G.); (C.P.)
- Department of Biology and Biotechnology “L. Spallanzani”, University of Pavia, 27100 Pavia, Italy
| | - Veronica Tinelli
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (C.M.); (V.T.); (D.P.); (F.C.)
| | - Aristides Tsatsakis
- Medical School, University of Crete, 70013 Heraklion, Greece; (P.S.); (A.T.)
| | - Davide Prosperi
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (C.M.); (V.T.); (D.P.); (F.C.)
- NanoBioLab, Dipartimento di Biotecnologie e Bioscienze, Università di Milano-Bicocca, 20126 Milano, Italy
| | - Miriam Hickey
- Department of Pharmacology, Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia;
| | - Fabio Corsi
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (C.M.); (V.T.); (D.P.); (F.C.)
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, 20157 Milano, Italy
| | - Cristina Cereda
- Genomic and Post Genomic Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.G.); (C.P.)
- Correspondence: ; Tel.: +39-0382380348
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Constitutions of Deficiency and Stasis of Traditional Chinese Medicine and Related Factors among Middle-Aged Women in Taiwan. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:7237029. [PMID: 33133216 PMCID: PMC7593736 DOI: 10.1155/2020/7237029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/26/2020] [Accepted: 09/29/2020] [Indexed: 01/07/2023]
Abstract
Background Traditional Chinese medicine (TCM) appears to be the common therapy in middle-aged women. The constitution serves as a guide for TCM treatment. However, little is known about the constitution and related factors in middle-aged women. The objectives of this study were to describe the yang-deficiency, yin-deficiency, and stasis constitutions in middle-aged women. Demographic and health factors related to yang deficiency, yin deficiency, and stasis were also examined. Methods A total of 1,000 women aged 40–65 years were selected from 2009 through 2018 using random sampling from the Taiwan Biobank Research Database in Taiwan. Yang-deficiency, yin-deficiency, and stasis were assessed using the body constitution questionnaire. Multiple logistic regression analysis was used to identify factors associated with constitution in deficiency or stasis. Results The proportions of middle-aged women who had the constitution in yang-deficiency, yin-deficiency, and stasis were 29.7%, 21.7%, and 17.7%, respectively. The result of binary logistic regression showed that current menstruation, abnormal spirometry, and education level were predictive factors of yang deficiency. Women with younger age, abnormal spirometry, or a vegetarian diet had a significantly associated yin deficiency. Younger age, abnormal spirometry, and coffee habit were predictors of stasis. Conclusions Middle-aged women in Taiwan with abnormal spirometry had a higher risk for deficiency or stasis constitutions, especially for those younger than 56 years. Healthcare providers should learn patients' constitutions and provide appropriate advice, referring them to safe providers of their desired method.
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Collins R, Silarova B, Clare L. Dementia Primary Prevention Policies and Strategies and Their Local Implementation: A Scoping Review Using England as a Case Study. J Alzheimers Dis 2020; 70:S303-S318. [PMID: 30507574 PMCID: PMC6700624 DOI: 10.3233/jad-180608] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Understanding the policy context and how policy is implemented at the local and clinical level is an important precursor to developing preventive strategies focusing on dementia risk reduction in primary healthcare settings. Objective: Using England as a case study, we review policies and strategies relevant to dementia prevention from the national to local level and how these are translated into primary healthcare services. Methods: We conducted a scoping review covering: 1) identification of national, regional, and local policies and strategies that include dementia prevention; 2) identification of national guidelines for implementing dementia prevention at the clinical level; and 3) evaluation of the implementation of these at the clinical level. Results: Dementia prevention is addressed in national policy, and this filters through to regional and local levels. Focus on dementia prevention is limited and variable. Reference to modifiable risk factors is associated with other non-communicable diseases, placing less emphasis on factors more dementia specific. Evidence of implementation of dementia prevention policies at the clinical level is limited and inconsistent. Available evidence suggests messages about dementia prevention may best be delivered through primary healthcare services such as the National Health Service (NHS) Health Check. Conclusion: The limitations identified in this review could be addressed through development of a national policy focused specifically on dementia prevention. This could provide a platform for increasing knowledge and understanding among the general population and healthcare professionals. It would be important for such a policy to cover the full range of modifiable risk factors relevant to dementia.
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Affiliation(s)
- Rachel Collins
- Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter, St Luke's Campus, Exeter, UK.,Centre for Research Excellence in Promoting Cognitive Health and Preventing Cognitive Decline, University of New South Wales and Neuroscience Research Australia, Barker Street, Randwick NSW, Australia
| | - Barbora Silarova
- Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter, St Luke's Campus, Exeter, UK.,Centre for Research Excellence in Promoting Cognitive Health and Preventing Cognitive Decline, University of New South Wales and Neuroscience Research Australia, Barker Street, Randwick NSW, Australia
| | - Linda Clare
- Centre for Research in Ageing and Cognitive Health (REACH), University of Exeter, St Luke's Campus, Exeter, UK.,NIHR CLAHRC South West Peninsula, St Luke's Campus, Exeter, UK.,Centre for Research Excellence in Promoting Cognitive Health and Preventing Cognitive Decline, University of New South Wales and Neuroscience Research Australia, Barker Street, Randwick NSW, Australia
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47
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Fung TT, Struijk EA, Rodriguez-Artalejo F, Willett WC, Lopez-Garcia E. Fruit and vegetable intake and risk of frailty in women 60 years old or older. Am J Clin Nutr 2020; 112:1540-1546. [PMID: 33022693 PMCID: PMC7727483 DOI: 10.1093/ajcn/nqaa256] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/17/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Prior research has suggested that the antioxidative and anti-inflammatory potential of fruits and vegetables may ameliorate aging-related frailty. OBJECTIVE We sought to prospectively examine the association between fruit and vegetable intake and incident frailty in older women. DESIGN We followed 78,366 nonfrail women aged ≥60 y from the Nurses' Health Study from 1990 to 2014. In this analysis, the primary exposure was the intake of total fruits and vegetables, assessed with an FFQ administered 6 times during follow-up. Frailty was defined as having ≥3 of the following 5 criteria from the FRAIL scale: fatigue, poor strength, low aerobic capacity, having ≥5 illnesses, and ≥5% weight loss. Cox models adjusted for potential confounders were used to estimate HRs and 95% CIs for the association between fruit and vegetable intake and incident frailty. RESULTS In total, 12,434 (15.9%) incident frailty cases were accrued during follow-up. Total fruit and vegetable intakes were associated with a lower risk of frailty (adjusted HR comparing 7+ servings/d compared with <3 servings/d: 0.92; 95% CI: 0.85, 0.99). The inverse association appeared to be stronger for those with physical activity above the median (P-interaction < 0.05). Among physically active women, compared with those who consumed <3 servings/d, the HR for 7+ servings/d was 0.68 (95% CI: 0.57, 0.81). CONCLUSION Higher fruit and vegetable intake was associated with a lower risk of frailty in this cohort of US women aged ≥60 y. Because of limited evidence on intakes of fruits and vegetables and the development of frailty, more data are needed to confirm our results.
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Affiliation(s)
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idi Paz, Madrid, Spain,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idi Paz, Madrid, Spain,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain,Instituto Madrileño De Estudios Avanzado-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid+Centro Superior de Investigaciones Científicas, Madrid, Spain
| | - Walter C Willett
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idi Paz, Madrid, Spain,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain,Instituto Madrileño De Estudios Avanzado-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid+Centro Superior de Investigaciones Científicas, Madrid, Spain
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48
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Wu Q, Qian S, Deng C, Yu P. Understanding Interactions Between Caregivers and Care Recipients in Person-Centered Dementia Care: A Rapid Review. Clin Interv Aging 2020; 15:1637-1647. [PMID: 32982198 PMCID: PMC7500833 DOI: 10.2147/cia.s255454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Good interactions are essential in caring for people with dementia. There is a lack of knowledge about interaction approaches used by caregivers in person-centered dementia care. This study aimed to understand interactions in person-centered dementia care. Methods A search for relevant publications was undertaken in 2020 on two electronic databases, MEDLINE with full text and CINAHL Plus with full text. This was supplemented by manual searching of the reference lists of relevant articles. Inclusion and exclusion criteria were applied to determine the relevance of the articles. Data extraction included publication year, country, study setting, aim, design, definition of person-centered dementia care, elements of person-centered dementia care and interaction approaches used by caregivers. A Donabedian quality framework was used to group the elements of person-centered dementia care into three categories: structure, process and outcome. Results A total of 25 articles were included in the review, all from developed countries. A conceptual framework was developed for the delivery of person-centered dementia care. It includes the organizational structure, ie, management and resources, a competent workforce and physical environment; the dementia care process, ie, respectful interaction underpinned by good knowledge about the care recipients in a calm, peaceful environment; and care outcome, ie, the social, psychological, and physical well-being of the care recipients. Interaction approaches used by caregivers in providing person-centered dementia care were classified according to the six purposes of interaction: to know and understand the care recipient, to keep the person happy and satisfied, to make the person feel safe and secure, to calm the person, to support self-identity, and to guide the person in conducting daily activities. Conclusion The delivery of person-centered dementia care needs to consider organizational structure, the dementia care process, and care outcome which together foster a positive environment for meaningful interactions between caregivers and care recipients. The identified interaction approaches could be used by dementia care trainers to develop training materials.
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Affiliation(s)
- Qiujuan Wu
- Oncology Department, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.,Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, 2500, Australia
| | - Chao Deng
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2500, Australia.,School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW 2500, Australia
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Breeze P, Thomas C, Thokala P, Lafortune L, Brayne C, Brennan A. The Impact of Including Costs and Outcomes of Dementia in a Health Economic Model to Evaluate Lifestyle Interventions to Prevent Diabetes and Cardiovascular Disease. Med Decis Making 2020; 40:912-923. [PMID: 32951510 PMCID: PMC7583453 DOI: 10.1177/0272989x20946758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives Economic evaluations of lifestyle interventions, which aim to prevent diabetes/cardiovascular disease (CVD), have not included dementia. Lifestyle interventions decrease dementia risk and extend life expectancy, leading to competing effects on health care costs. We aim to demonstrate the feasibility of including dementia in a public health cost-effectiveness analysis and quantify the overall impacts accounting for these competing effects. Methods The School for Public Health Research (SPHR) diabetes prevention model describes individuals’ risk of type 2 diabetes, microvascular outcomes, CVD, congestive heart failure, cancer, osteoarthritis, depression, and mortality in England. In version 3.1, we adapted the model to include dementia using published data from primary care databases, health surveys, and trials of dementia to describe dementia incidence, diagnosis, and disease progression. We estimate the impact of dementia on lifetime costs and quality-adjusted life years (QALYs) gained of the National Health Service diabetes prevention program (NHS DPP) from an NHS/personal social services perspective with 3 scenarios: 1) no dementia, 2) dementia only, and 3) reduced dementia risk. Subgroup, parameter, and probabilistic sensitivity analyses were conducted. Results The lifetime cost savings of the NHS DPP per patient were £145 in the no-dementia scenario, £121 in the dementia-only scenario, and £167 in the reduced dementia risk scenario. The QALY gains increased by 0.0006 in dementia only and 0.0134 in reduced dementia risk. Dementia did not alter the recommendation that the NHS/DPP is cost-effective. Conclusions Including dementia into a model of lifestyle interventions was feasible but did not change policy recommendations or modify health economic outcomes. The impact on health economic outcomes was largest where a direct impact on dementia incidence was assumed, particularly in elderly populations.
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Affiliation(s)
- Penny Breeze
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Louise Lafortune
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
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Sinclair A, Abdelhafiz A. Cognitive Dysfunction in Older Adults with Type 2 Diabetes: Links, Risks, and Clinical Implications. Clin Geriatr Med 2020; 36:407-417. [PMID: 32586471 DOI: 10.1016/j.cger.2020.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The prevalence of comorbid diabetes and cognitive dysfunction increases as the population ages. Diabetes increases the risk of progression of cognitive dysfunction through a spectrum of cognitive decline to mild cognitive impairment then to dementia. Cognitive dysfunction, especially impairment in the executive domain, has a negative impact on patients' self-care tasks. With further progression of dementia and the development of behavioral problems, the challenge to carers and health care professionals looking after these patients is significant. Therefore, clinical trials are needed to explore the impact of novel hypoglycemic therapy on cognitive function as an important outcome in this population.
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Affiliation(s)
- Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa WR9 0QH, UK; Kings College, London SE1 9NH, UK.
| | - Ahmed Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK
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