Impact of smoking, diabetes and hypertension on survival time in the elderly: the Dubbo Study

Specific versus general self-reported health indicators predicting mortality among older adults in Europe: disparities by gender employing SHARE longitudinal data

OBJECTIVES

The study aims at assessing the relative importance of specific versus general self-reported indicators of health and disability in predicting mortality among older adults and at exploring the potential value of the global activity limitation indicator (GALI), a recently validated general measure of activity restrictions, as predictor of death.

METHODS

Longitudinal data from two waves (2004 and 2006-2007) of the Survey of Health, Ageing and Retirement in Europe were employed. The sample comprises 17,941 persons aged 50+ at baseline, representing 11 countries. Associations were estimated by sex using Cox's proportional hazards regression models.

RESULTS

Most specific and general indicators of health and disability are strong and independent predictors. There are disparities by sex; among general measures, controlling for all indicators under consideration, self-rated health (SRH) only remains significantly associated with mortality among males and GALI among females.

CONCLUSIONS

A combination of specific and general measures is more efficient in predicting mortality than either of these alone. SRH and GALI seem to share some traits, adding health and disability dimensions over specific measures, representing though different aspects by gender.

Smoking trajectories, health, and mortality across the adult lifespan

This study extends research on the association between smoking behavior and chronic disease by following a cohort from the time of initiation of regular smoking patterns into old age and by examining the association of lifetime smoking trajectories with chronic disease and mortality. Participants consisted of 232 males selected from the Harvard classes of 1942-1944 and followed biennially through 2003. Five distinct smoking trajectories were identified based on the age at which participants quit daily smoking. Participants following smoking trajectories with later cessation had a higher likelihood of developing lung disease and lived shorter lives than those who quit smoking at an earlier age. This study confirms that the earlier a smoker quits, the greater the health benefits, and that these benefits are observed even decades after smoking cessation. Additionally, by showing different survival rates between trajectory groups 25 and 40 years after quitting, the results run counter to previous work that has found no difference in mortality between smokers and non-smokers 15 years after cessation.

Delaying dementia and nursing home placement: the Dubbo study of elderly Australians over a 14-year follow-up

In order to capture the "longevity dividend," modifiable risk factors for a diagnosis of dementia and nursing home placement were examined in a longitudinal study of an elderly cohort living in Dubbo, New South Wales, Australia. One thousand two-hundred thirty-three men and 1572 women 60 years and older living in the community were examined in 1988 and followed to 2002 for diagnosis of dementia and nursing home placement. There were 244 (8.7%) nursing home placements and 44% of these placements were primarily due to dementia, but dementia was a secondary diagnosis in another 20% of cases. In a proportional hazards model for dementia, any intake of alcohol predicted a 34% lower risk, and daily gardening a 36% lower risk. Daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in women. The lowest tertile of peak expiratory flow predicted an 84% higher risk of dementia, the upper tertile of depression score predicted a 50% higher risk. The Cox proportional hazards model for nursing home placement, showed placement increased significantly with age, urinary incontinence, impaired peak expiratory flow, physical disability, and depression. The hazard of placement was significantly reduced by alcohol intake and female gender. Socioeconomic factors were not significant. Similar risk factors for dementia and nursing home placement indicate that the continuation of moderate alcohol intake, the maintenance of physical activity, especially daily gardening, and improvement of respiratory function, and the treatment of depression are recommended targets for interventions to delay or prevent major negative late-life experiences.

Short term efficacy of a lifestyle intervention programme on cardiovascular health outcome in overweight Indigenous Australians with and without type 2 diabetes mellitus. The healthy lifestyle programme (HELP)

We aim to examine the short-term efficacy of a lifestyle intervention programme on cardiovascular risk factors in overweight urban Indigenous Australians with and without type 2 diabetes mellitus. One hundred and one urban Indigenous Australians in Queensland voluntarily participated in a culturally appropriate lifestyle intervention programme based on improving physical activity and dietary intake; 44 had type 2 diabetes, 11 had impaired fasting glucose and 46 were euglycaemic. Efficacy of the intervention on biochemical and physical markers of cardiovascular outcome will be monitored over 2 years. Diabetic subjects were overweight with good but suboptimal control of cardiovascular risk factors (mean systolic blood pressure 132 mmHg, diastolic blood pressure 85 mmHg, LDL cholesterol 2.8mM and urine albumin to creatinine ratio 10.8) at baseline. At the 6 months follow up, there were significant reductions in waist circumference (3.1cm, P=0.01) and diastolic blood pressure (4.6 mmHg, P=0.01). Although modest, these changes may improve clinical outcome if sustained.

Prevalence, risk factors and treatment for substance abuse in older adults

PURPOSE OF REVIEW

This paper briefly outlines new research on the epidemiology of alcohol and drug use in the older population, describes mental and cognitive consequences of substance use and summarizes recent treatment trials for alcohol dependence.

RECENT FINDINGS

Cross-sectional and longitudinal studies indicate that alcohol use is less prevalent in older groups, and it decreases over time. Comorbidity (alcohol and other drugs, alcohol with mental health disorders) is high. An inverse-U-shaped curve describes the association between alcohol consumption and cognitive impairment with increased impairment for abstainers and high users as compared with moderate users. Trials of alcohol use in the older population are rare, but they suggest that brief patient education may reduce drinking levels in primary care populations, and that, for some users, integrated primary care may be more useful than referral to specialist care.

SUMMARY

The basis for higher risk in abstainers is not resolved. More randomized controlled trials are needed, which target alcohol use and dependence and also focus on comorbid disorders.

Lifestyle factors and risk of dementia: Dubbo Study of the elderly

OBJECTIVE

To identify risk factors for dementia in an elderly Australian cohort.

DESIGN AND SETTING

A longitudinal cohort study conducted in Dubbo, NSW.

PARTICIPANTS

2805 men and women aged 60 years and older living in the community and initially free of cognitive impairment, first assessed in 1988 and followed for 16 years.

MAIN OUTCOME MEASURE

Admission to hospital or nursing home with any kind of dementia.

RESULTS

There were 115 cases of dementia in 1233 men (9.3/100) and 170 cases in 1572 women (10.8/100). In a proportional hazards model for dementia, any intake of alcohol predicted a 34% lower risk, and daily gardening a 36% lower risk. Daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in women. The lowest tertile of peak expiratory flow predicted an 84% higher risk of dementia, the upper tertile of depression score predicted a 50% higher risk.

CONCLUSION

While excess alcohol intake is to be avoided, it appears safe and reasonable to recommend the continuation of moderate alcohol intake in those already imbibing, as well as the maintenance of physical activity, especially daily gardening, in the hope of reducing the incidence of dementia in future years.