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Barha CK, Best JR, Rosano C, Newman AB, Ayonayon HN, Rubin S, Catov JM, Liu-Ambrose T. O3‐05‐03: GAINS FOR BRAINS: EVIDENCE FOR SEX‐DEPENDENT EFFECTS OF EXERCISE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cindy K. Barha
- Djavad Mowafaghian Centre for Brain HealthVancouverBCCanada
- University of British ColumbiaVancouverBCCanada
| | - John R. Best
- Centre for Hip Health and MobilityVancouverBCCanada
| | | | | | | | - Susan Rubin
- University of California - San FranciscoSan FranciscoCAUSA
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Kilpatrick L, Houston DK, Wilson VK, Lovato J, Ayonayon HN, Cauley JA, Harris T, Simonsick EM, Yaffe K, Kritchevsky SB, Sink KM. Low 25-Hydroxyvitamin D Concentrations and Risk of Incident Cognitive Impairment in Black and White Older Adults: The Health ABC Study. J Nutr Gerontol Geriatr 2018; 37:1-13. [PMID: 29505349 PMCID: PMC5931701 DOI: 10.1080/21551197.2017.1419899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Using data from the Health, Aging, and Body Composition study, we examined whether low 25-hydroxyvitamin D (25[OH]D) concentrations were associated with prevalent or incident cognitive impairment. Serum 25(OH)D concentrations were measured in 2,786 older adults and categorized as <20 ng/mL, 20 to <30 ng/mL, or ≥30 ng/mL. Cognitive impairment was defined as a score >1.5 standard deviations below race and education specific means on either digit symbol substitution test or modified mini-mental state test. Logistic regression determined the odds of cognitive impairment at baseline and year 5 by 25(OH)D category. 25(OH)D concentrations were <30 ng/mL in 57.3% of whites and 84.6% of blacks. After excluding participants with baseline cognitive impairment (n = 340), 13% of whites and 13% of blacks developed cognitive impairment by year 5. In whites, 25(OH)D concentrations <30 ng/mL were not associated with prevalent or incident cognitive impairment. Black participants with 25(OH)D concentrations <20 ng/mL had a higher odds of prevalent, but not incident cognitive impairment (OR (95% CI): 2.05 (1.08-3.91), p = 0.03) compared to participants with 25(OH)D concentrations ≥30 ng/mL. Low 25(OH)D concentrations were associated with twofold higher odds of prevalent cognitive impairment in blacks.
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Affiliation(s)
- Laurel Kilpatrick
- Department of Internal Medicine, Baylor Scott & White Health, Temple, Texas, USA
| | - Denise K. Houston
- Wake Forest School of Medicine, Sticht Center on Aging, Section of Gerontology and Geriatric Medicine, Winston-Salem, North Carolina, USA
| | - Valerie K. Wilson
- James H. Quillen VA Medical Center, Mountain Home VA Medical Center, East Tennessee State University, Mountain Home, Tennessee, USA
| | - James Lovato
- Wake Forest School of Medicine, Department of Biostatistical Sciences, Section of Gerontology and Geriatric Medicine, Winston-Salem, North Carolina, USA
| | - Hilsa N. Ayonayon
- University of California at San Francisco, San Francisco, California, USA
| | - Jane A. Cauley
- University of Pittsburgh Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Tamara Harris
- National Institute on Aging, Intramural Research Program, Washington DC, USA
| | | | - Kristine Yaffe
- University of California at San Francisco, San Francisco, California, USA
| | - Stephen B. Kritchevsky
- Wake Forest School of Medicine, Sticht Center on Aging, Section of Gerontology and Geriatric Medicine, Winston-Salem, North Carolina, USA
| | - Kaycee M. Sink
- MAS for the Health ABC Study, Wake Forest School of Medicine, Sticht Center on Aging, Winston-Salem, North Carolina, USA
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Brown PJ, Badreddine D, Roose SP, Rutherford B, Ayonayon HN, Yaffe K, Simonsick EM, Goodpaster B. Muscle fatigability and depressive symptoms in later life. Int J Geriatr Psychiatry 2017; 32:e166-e172. [PMID: 28198046 DOI: 10.1002/gps.4678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/11/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Fatigability is the degree to which performance decreases during a specific activity of a given intensity and duration. Depression is known to heighten subjective fatigue, but whether its association with physical fatigability is unknown. Further, whether fatigability is a precursor or risk factor for the development of subsequent depressive symptoms is also unclear. METHODS Data are from the Health Aging and Body Composition Study with fatigability assessed using isokinetic dynamometry of the knee extensors at year 3, and depressive symptoms ascertained longitudinally using the Center for Epidemiologic Studies Depression (CES-D) scale. The relationship between fatigability and depressive symptoms was evaluated using linear and Cox regression models. RESULTS There was a significant cross-sectional association between fatigability and depressive symptomatology (β = -0.06, p = 0.02), after adjusting for demographic variables, medical comorbidities, cognition, gait speed, and physical activity levels. Greater fatigability was associated with greater adjusted scores on the 10-item CES-D (F2, 1695 = 38.65, p < 0.001), with individuals with greater fatigability on average reporting an adjusted CES-D score 0.5 point greater than those individuals with higher levels of resistance to fatigability (mean of 70% or better; p < 0.001). Fatigability however was not associated with the development of depression at follow-up (p = 0.828). CONCLUSIONS This study found an association between skeletal muscle fatigability and higher depressive symptoms in older adults, but no longitudinal association was identified. These findings suggest that age-related changes in energy capacity may affect the phenomenology of late life depression. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Patrick J Brown
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | | | - Steven P Roose
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - Bret Rutherford
- Division of Geriatric Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kristine Yaffe
- Neurology, Psychiatry, Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Eleanor M Simonsick
- Intramural Research Program, Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, USA
| | - Bret Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital and Sanford Burnham Presbys Medical Discovery Institute, Orlando, FL, USA
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- Translational Research Institute for Metabolism and Diabetes, Florida Hospital and Sanford Burnham Presbys Medical Discovery Institute, Orlando, FL, USA
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Hajjar I, Rosenberger KJ, Kulshreshtha A, Ayonayon HN, Yaffe K, Goldstein FC. Association of JNC-8 and SPRINT Systolic Blood Pressure Levels With Cognitive Function and Related Racial Disparity. JAMA Neurol 2017; 74:1199-1205. [PMID: 28828478 DOI: 10.1001/jamaneurol.2017.1863] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance The Eighth Joint National Committee (JNC-8) recommended treating systolic blood pressure (SBP) to a target below 150 mm Hg in older adults, whereas data from the Systolic Blood Pressure Intervention Trial (SPRINT) suggested that a SBP level of lower than 120 mm Hg decreases cardiovascular event rates. Target SBP guidelines have not addressed the potential that black patients may have greater morbidity and mortality from hypertension, especially with regard to cognitive outcomes. The association of these discordant SBP targets with cognition and differences by race have not been systematically evaluated in the same population. Objectives To assess the long-term outcomes of the various recommended SBP levels and to determine if racial differences exist based on long-term cognitive trajectories. Design, Setting, and Participants A total of 1657 cognitively intact older adults receiving treatment for hypertension were studied from 1997 to 2007 in the Health Aging and Body Composition study. Data analysis was conducted from October 1, 2016, to January 1, 2017. Main Outcomes and Measures Cognition was assessed using the Modified Mini-Mental State Examination (3MSE) 4 times and the Digit Symbol Substitution Test (DSST) 5 times. At each visit, participants were classified as having an SBP level of 120 mm Hg or lower, 121 to 139 mm Hg, 140 to 149 mm Hg, or 150 mm Hg or higher based on the mean SBP level of 2 seated readings. Mixed models assessed the association of SBP levels with 10-year cognitive trajectories. The impact of race was tested using a race interaction term. Results During the 10-year study period, among the 1657 individuals (908 women and 784 black patients; mean [SE] age, 73.7 [0.1] years), there was a differential decrease in 3MSE and DSST scores by the SBP levels, with the greatest decrease in the group with SBP levels of 150 mm Hg or higher (adjusted decrease was 3.7 for 3MSE and 6.2 for DSST) and the lowest decrease in the group with SBP levels of 120 mm Hg or lower (adjusted decrease was 3.0 for 3MSE and 5.0 for DSST) (P < .001 for both). Compared with white patients, black patients had a greater difference between the higher and lower SBP levels in the decrease in cognition; adjusted differences between the group with SBP levels of 150 mm Hg or higher and the group with SBP levels of 120 mm Hg or lower were -0.05 in white patients and -0.08 in black patients for 3MSE (P = .03) and -0.07 in white patients and -0.13 in black patients for DSST (P = .05). Conclusions and Relevance For patients 70 years of age or older receiving treatment for hypertension, a SPRINT SBP level of 120 mm Hg or lower was not associated with worsening cognitive outcome and may be superior to the JNC-8 target for cognition. Lower SBP treatment levels may result in improved cognition in black patients.
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Affiliation(s)
- Ihab Hajjar
- Department of Medicine, Emory School of Medicine, Atlanta, Georgia.,Department of Neurology, Emory School of Medicine, Atlanta, Georgia
| | | | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, Emory School of Medicine, Atlanta, Georgia
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco.,Department of Neurology, University of California, San Francisco.,Department of Psychiatry, University of California, San Francisco
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Best JR, Rosano C, Aizenstein HJ, Tian Q, Boudreau RM, Ayonayon HN, Satterfield S, Simonsick EM, Studenski S, Yaffe K, Liu-Ambrose T. Long-term changes in time spent walking and subsequent cognitive and structural brain changes in older adults. Neurobiol Aging 2017. [PMID: 28648916 DOI: 10.1016/j.neurobiolaging.2017.05.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previous studies have shown that more active older adults have better cognition and brain health based on a variety of structural neuroimaging measures. Nevertheless, the effects of maintaining physical activity (PA) over an extended period of time on future changes in older adults' cognition and brain structure are unknown. Participants were 141 initially well-functioning community-dwelling older adults (aged 70-79 years at baseline; 60% female; 42% black) studied over a 13-year period. PA (self-reported time spent walking) was assessed annually from years 1 to 10. Magnetic resonance imaging with diffusion tensor was performed at years 10 and 13. Time spent walking decreased on average by 8.4% annually from year 1 to year 10. Independent of initial time spent walking, demographics, and APOE e4 status, better maintenance of time spent walking over the decade predicted less reduction in hippocampal volume (p = 0.03), smaller increases in global gray matter mean diffusivity and white matter axial diffusivity (p < 0.01), and maintenance of general cognitive performance (p < 0.01). Maintenance of cognitive performance was associated with smaller increases in white matter axial diffusivity (p < 0.01). PA at baseline and at year 10, as well as changes in PA over a 5-year period, was less predictive of future changes in brain structure and cognition. Thus, how PA levels change over longer periods of aging may be an important contributor to cognitive and neural protection.
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Affiliation(s)
- John R Best
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Qu Tian
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Stephanie Studenski
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Departments of Psychiatry and Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Albert SM, Lunney JR, Ye L, Boudreau R, Ives D, Satterfield S, Kaplan CM, Waters T, Ayonayon HN, Rubin SM, Newman AB, Harris T. Are Preferences for Aggressive Medical Treatment Associated with Healthcare Utilization in the Very Old? J Palliat Med 2017; 20:618-624. [PMID: 28333569 PMCID: PMC5455611 DOI: 10.1089/jpm.2016.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives: To examine the relationship between end-of-life (EOL) treatment preferences and recent hospitalization or emergency department (ED) care in the very old. Design: Quarterly telephone follow-up of participants in the EOL in the Very Old cohort. Setting: The EOL in the Very Old Age cohort drew from 1403 participants in the Health, Aging, and Body Composition (Health ABC) study who were alive in year 15 of follow-up. 87.5% (n = 1227) were successfully recontacted and enrolled. Participants: Preferences for treatment at the EOL and reported hospital and ED use were examined for 1118 participants (18% involving proxy reports) over 6 months, 1021 (16% with proxy reports) over 12 months, and 945 (23% with proxy reports) over 18 months in 6-month intervals. Measurements: Preferences for eight EOL treatments, elicited once each year; hospitalization and ED use reported every six months. Results: Preferences for more aggressive treatment (endorsing ≥5 of 8 options) were not significantly associated with inpatient or ED treatment. Inpatient and ED treatment were not associated with changes in preferences for aggressive EOL treatment over 12 months. Conclusion: Alternative measures that tap attitudes toward routine care, rather than EOL treatment preferences, may be more highly associated with healthcare utilization.
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Affiliation(s)
- Steven M. Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - June R. Lunney
- Hospital and Palliative Nursing Association, Pittsburgh, Pennsylvania
| | - Lei Ye
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Diane Ives
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee
| | - Cameron M. Kaplan
- Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee
| | - Teresa Waters
- Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee
| | - Hilsa N. Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Susan M. Rubin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Anne B. Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tamara Harris
- Laboratory of Epidemiology, Biometry, and Demography, National Institute on Aging, Bethesda, Maryland
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7
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Albert SM, Lunney JR, Ye L, Boudreau R, Ives D, Satterfield S, Ayonayon HN, Rubin SM, Newman AB, Harris T. Symptom Burden and End-of-Life Treatment Preferences in the Very Old. J Pain Symptom Manage 2016; 52:404-11. [PMID: 27265815 PMCID: PMC5023468 DOI: 10.1016/j.jpainsymman.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/10/2016] [Accepted: 03/07/2016] [Indexed: 11/29/2022]
Abstract
CONTEXT End-of-life (EOL) treatment preferences among the very old (age 85+) may differ from preferences in younger aged populations because of high levels of symptom burden and disability and high risk of mortality. It is unclear if symptom burden or level of disability is more important for such preferences. OBJECTIVES To investigate whether distress from daily symptom burden was an independent correlate of EOL treatment preferences over two years of follow-up in people with median age 86 (participants) and 88 (reported by proxies) at baseline. METHODS The End of Life in Very Old Age is an ancillary study to the Health, Aging and Body Composition study. At baseline in Year 15 of Health, Aging and Body Composition, 1038 participants and 189 proxies reported levels of symptom distress every quarter, as well as 0-8 EOL treatment preferences elicited once each year. RESULTS At baseline, the mean (SD) count of EOL treatment preferences was 4.2 (2.1) in participants, and 2.9 (2.3) in proxies. EOL treatment preference was not associated with symptom distress. By contrast, black race, male gender, and reported ease walking a quarter mile were independently associated with more aggressive EOL treatment preferences. CONCLUSION Preferences for more aggressive EOL treatment were not related to daily symptom distress but were significantly more likely to be endorsed among those with better mobility, suggesting that disability is an independent predictor of EOL treatment preferences in the very old.
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Affiliation(s)
- Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - June R Lunney
- Hospital and Palliative Nursing Association, Pittsburgh, Pennsylvania, USA
| | - Lei Ye
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Diane Ives
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee, USA
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - Susan M Rubin
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tamara Harris
- Laboratory of Epidemiology, Biometry, and Demography, National Institute on Aging, Bethesda, Maryland, USA
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Contrera KJ, Betz J, Deal J, Choi JS, Ayonayon HN, Harris T, Helzner E, Martin KR, Mehta K, Pratt S, Rubin SM, Satterfield S, Yaffe K, Simonsick EM, Lin FR. Association of Hearing Impairment and Anxiety in Older Adults. J Aging Health 2016; 29:172-184. [PMID: 26916793 DOI: 10.1177/0898264316634571] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the study is was investigate the association between hearing impairment and anxiety. METHOD We conducted a cross-sectional analysis of 1,732 community-based adults aged 76 to 85 years who participated in the Health Aging and Body Composition (ABC) study. Logistic regression models were adjusted for demographic and cardiovascular risk factors. Hearing impairment was defined by the speech-frequency pure tone average. Anxiety was defined as reporting two symptoms of at least "a little" or one symptom "quite a bit" on the three-item Hopkins Symptom Checklist. RESULTS Compared with individuals with no hearing impairment, the odds of prevalent anxiety were higher among individuals with mild hearing impairment (odds ratio [OR] = 1.32, 95% confidence interval [CI] = [1.01, 1.73]) and moderate or greater hearing impairment (OR = 1.59, 95% CI = [1.14, 2.22]). Hearing aid use was not significantly associated with lower odds of anxiety. DISCUSSION Hearing impairment is independently associated with greater odds of anxiety symptoms in older adults.
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Affiliation(s)
| | - Josh Betz
- 1 Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Elizabeth Helzner
- 4 State University of New York Downstate Medical Center, Brooklyn, New York City, USA
| | - Kathryn R Martin
- 5 Institute of Applied Health Sciences School of Medicine and Dentistry, Aberdeen, UK
| | - Kala Mehta
- 6 VA Pittsburgh Healthcare System, PA, USA
| | - Sheila Pratt
- 1 Johns Hopkins University, Baltimore, MD, USA.,6 VA Pittsburgh Healthcare System, PA, USA
| | | | | | | | | | - Frank R Lin
- 1 Johns Hopkins University, Baltimore, MD, USA
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Kaup AR, Byers AL, Falvey C, Simonsick EM, Satterfield S, Ayonayon HN, Smagula SF, Rubin SM, Yaffe K. Trajectories of Depressive Symptoms in Older Adults and Risk of Dementia. JAMA Psychiatry 2016; 73:525-31. [PMID: 26982217 PMCID: PMC5082978 DOI: 10.1001/jamapsychiatry.2016.0004] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Depression has been identified as a risk factor for dementia. However, most studies have measured depressive symptoms at only one time point, and older adults may show different patterns of depressive symptoms over time. OBJECTIVE To investigate the association between trajectories of depressive symptoms and risk of dementia in older adults. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cohort investigation of black and white community-dwelling older adults in the Health, Aging, and Body Composition study. Participants were enrolled between May 1997 and June 1998 and followed up through 2001-2002. The dates of this analysis were September 2014 to December 2015. The setting was community research centers in Memphis, Tennessee, and Pittsburgh, Pennsylvania. Trajectories of depressive symptoms were assessed from baseline to year 5. Symptoms were measured with the Center for Epidemiologic Studies Depression Scale Short Form, and trajectories were calculated using latent class growth curve analysis. MAIN OUTCOMES AND MEASURES Incident dementia through year 11, determined by dementia medication use, hospital records, or significant cognitive decline (≥1.5 SD race-specific decline on the Modified Mini-Mental State Examination). We examined the association between depressive symptom trajectories and dementia incidence using Cox proportional hazards regression models adjusted for demographics, health factors that differed between groups, and cognition during the depressive symptom assessment period (baseline to year 5). RESULTS The analytic cohort included 2488 black and white older adults with repeated depressive symptom assessments from baseline to year 5 who were free of dementia throughout that period. Their mean (SD) age at baseline was 74.0 (2.8) years, and 53.1% (n = 1322) were female. The following 3 depressive symptom trajectories were identified: consistently minimal symptoms (62.0% [n = 1542] of participants), moderate and increasing symptoms (32.2% [n = 801] of participants), and high and increasing symptoms (5.8% [n = 145] of participants). Compared with the consistently minimal trajectory, having a high and increasing depressive symptom trajectory was associated with significantly increased risk of dementia (fully adjusted hazard ratio, 1.94; 95% CI, 1.30-2.90), while the moderate and increasing trajectory was not associated with risk of dementia after full adjustment. Sensitivity analyses indicated that the high and increasing trajectory was associated with dementia incidence, while depressive symptoms at individual time points were not. CONCLUSIONS AND RELEVANCE Older adults with a longitudinal pattern of high and increasing depressive symptoms are at high risk for dementia. Individuals' trajectory of depressive symptoms may inform dementia risk more accurately than one-time assessment of depressive symptoms.
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Affiliation(s)
- Allison R. Kaup
- Research Service, San Francisco Veterans Affairs Medical Center, San Francisco, California2Department of Psychiatry, University of California, San Francisco
| | - Amy L. Byers
- Research Service, San Francisco Veterans Affairs Medical Center, San Francisco, California2Department of Psychiatry, University of California, San Francisco
| | - Cherie Falvey
- Department of Psychiatry, University of California, San Francisco
| | | | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Hilsa N. Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Stephen F. Smagula
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan M. Rubin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco7Department of Neurology, University of California, San Francisco8Department of Epidemiology and Biostatistics, University of California, San Francisco9San Francisco Veterans Affairs Medical
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Marcum ZA, Perera S, Thorpe JM, Switzer GE, Castle NG, Strotmeyer ES, Simonsick EM, Ayonayon HN, Phillips CL, Rubin S, Zucker-Levin AR, Bauer DC, Shorr RI, Kang Y, Gray SL, Hanlon JT. Antidepressant Use and Recurrent Falls in Community-Dwelling Older Adults: Findings From the Health ABC Study. Ann Pharmacother 2016; 50:525-33. [PMID: 27066988 DOI: 10.1177/1060028016644466] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few studies have compared the risk of recurrent falls across various antidepressant agents-using detailed dosage and duration data-among community-dwelling older adults, including those who have a history of a fall/fracture. OBJECTIVE To examine the association of antidepressant use with recurrent falls, including among those with a history of falls/fractures, in community-dwelling elders. METHODS This was a longitudinal analysis of 2948 participants with data collected via interview at year 1 from the Health, Aging and Body Composition study and followed through year 7 (1997-2004). Any antidepressant medication use was self-reported at years 1, 2, 3, 5, and 6 and further categorized as (1) selective serotonin reuptake inhibitors (SSRIs), (2) tricyclic antidepressants, and (3) others. Dosage and duration were examined. The outcome was recurrent falls (≥2) in the ensuing 12-month period following each medication data collection. RESULTS Using multivariable generalized estimating equations models, we observed a 48% greater likelihood of recurrent falls in antidepressant users compared with nonusers (adjusted odds ratio [AOR] = 1.48; 95% CI = 1.12-1.96). Increased likelihood was also found among those taking SSRIs (AOR = 1.62; 95% CI = 1.15-2.28), with short duration of use (AOR = 1.47; 95% CI = 1.04-2.00), and taking moderate dosages (AOR = 1.59; 95% CI = 1.15-2.18), all compared with no antidepressant use. Stratified analysis revealed an increased likelihood among users with a baseline history of falls/fractures compared with nonusers (AOR = 1.83; 95% CI = 1.28-2.63). CONCLUSION Antidepressant use overall, SSRI use, short duration of use, and moderate dosage were associated with recurrent falls. Those with a history of falls/fractures also had an increased likelihood of recurrent falls.
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Affiliation(s)
| | | | - Joshua M Thorpe
- University of Pittsburgh, Pittsburgh, PA, USA VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Galen E Switzer
- University of Pittsburgh, Pittsburgh, PA, USA VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | | | | | | | | | - Susan Rubin
- University of California-San Francisco, CA, USA
| | | | | | | | | | | | - Joseph T Hanlon
- University of Pittsburgh, Pittsburgh, PA, USA VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Best JR, Liu-Ambrose T, Boudreau RM, Ayonayon HN, Satterfield S, Simonsick EM, Studenski S, Yaffe K, Newman AB, Rosano C. An Evaluation of the Longitudinal, Bidirectional Associations Between Gait Speed and Cognition in Older Women and Men. J Gerontol A Biol Sci Med Sci 2016; 71:1616-1623. [PMID: 27069098 DOI: 10.1093/gerona/glw066] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 03/20/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few cohort studies have examined longitudinal associations between age-related changes in cognition and physical performance. Further, whether these associations differ for men versus women or can be attributed to differences in physical activity (PA) is unknown. METHODS Participants were 2,876 initially well-functioning community-dwelling older adults (aged 70-79 years at baseline; 52% female; 39% black) studied over a 9-year period. Usual gait speed, self-reported PA, and two cognitive measures-Digit Symbol Substitution Test (DSST) and Mini-Modified Mental State examination (3MS)-were assessed years 0 (ie, baseline), 4, and 9. RESULTS Early decline between years 0 and 4 in gait speed predicted later decline between years 4 and 9 in performance on the 3MS (β = 0.10, p = .004) and on the DSST (β = 0.16, p < .001). In contrast, the associations between early decline in cognition and later decline in gait speed were weaker and were non-significant after correcting for multiple comparisons (β = 0.08, p = .019 for 3MS and β = .06, p = .051 for DSST). All associations were similar for women and men and were unaltered when accounting for PA levels. CONCLUSIONS The results indicate declining gait speed as a precursor to declining cognitive functioning, and suggest a weaker reciprocal process among older women and men.
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Affiliation(s)
- John R Best
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Stephanie Studenski
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco.,Departments of Psychiatry and Neurology, University of California, San Francisco
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
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12
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Contrera KJ, Betz J, Deal JA, Choi JS, Ayonayon HN, Harris T, Helzner E, Martin KR, Mehta K, Pratt S, Rubin SM, Satterfield S, Yaffe K, Garcia M, Simonsick EM, Lin FR. Association of Hearing Impairment and Emotional Vitality in Older Adults. J Gerontol B Psychol Sci Soc Sci 2016; 71:400-4. [PMID: 26883806 DOI: 10.1093/geronb/gbw005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/11/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To better understand the potential impact of hearing impairment (HI) and hearing aid use on emotional vitality and mental health in older adults. METHOD We investigated the cross-sectional association of HI with emotional vitality in 1,903 adults aged 76-85 years in the Health ABC study adjusted for demographic and cardiovascular risk factors. Hearing was defined by the speech frequency pure tone average (no impairment < 25 dB, mild impairment 25-40 dB, and moderate or greater impairment > 40 dB). Emotional vitality was defined as having a high sense of personal mastery, happiness, low depressive symptomatology, and low anxiety. RESULTS Compared with individuals with no HI, participants with moderate or greater HI had a 23% lower odds of emotional vitality (odds ratio [OR] = 0.77; 95% confidence interval [CI]: 0.59-0.99). Hearing aid use was not associated with better emotional vitality (OR = 0.98; 95% CI: 0.81-1.20). DISCUSSION HI is associated with lower odds of emotional vitality in older adults. Further studies are needed to examine the longitudinal impact of HI on mental health and well-being.
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Affiliation(s)
- Kevin J Contrera
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Josh Betz
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Janet S Choi
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Tamara Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland
| | - Elizabeth Helzner
- Department of Epidemiology and Biostatistics, State University of New York Downstate Medical Center, Brooklyn
| | - Kathryn R Martin
- Institute of Applied Health Sciences School of Medicine and Dentistry, University of Aberdeen, Scotland
| | - Kala Mehta
- Division of Geriatrics, Department of Medicine University of California, San Francisco
| | - Sheila Pratt
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pennsylvania
| | - Susan M Rubin
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Kristine Yaffe
- Department of Psychiatry and Department of Neurology, University of California, San Francisco
| | - Melissa Garcia
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Frank R Lin
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
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13
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Kamil RJ, Betz J, Powers BB, Pratt S, Kritchevsky S, Ayonayon HN, Harris TB, Helzner E, Deal JA, Martin K, Peterson M, Satterfield S, Simonsick EM, Lin FR. Association of Hearing Impairment With Incident Frailty and Falls in Older Adults. J Aging Health 2015; 28:644-60. [PMID: 26438083 DOI: 10.1177/0898264315608730] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We aimed to determine whether hearing impairment (HI) in older adults is associated with the development of frailty and falls. METHOD Longitudinal analysis of observational data from the Health, Aging and Body Composition study of 2,000 participants aged 70 to 79 was conducted. Hearing was defined by the pure-tone-average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better hearing ear. Frailty was defined as a gait speed of <0.60 m/s and/or inability to rise from a chair without using arms. Falls were assessed annually by self-report. RESULTS Older adults with moderate-or-greater HI had a 63% increased risk of developing frailty (adjusted hazard ratio [HR] = 1.63, 95% confidence interval [CI] = [1.26, 2.12]) compared with normal-hearing individuals. Moderate-or-greater HI was significantly associated with a greater annual percent increase in odds of falling over time (9.7%, 95% CI = [7.0, 12.4] compared with normal hearing, 4.4%, 95% CI = [2.6, 6.2]). DISCUSSION HI is independently associated with the risk of frailty in older adults and with greater odds of falling over time.
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Affiliation(s)
| | - Joshua Betz
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Sheila Pratt
- U.S. Department of Veterans Affairs, Washington, DC, USA University of Pittsburgh, PA, USA
| | | | | | | | - Elizabeth Helzner
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | | | | | - Matthew Peterson
- U.S. Department of Veterans Affairs, Washington, DC, USA Duke University, Durham, NC, USA
| | | | - Eleanor M Simonsick
- Johns Hopkins University, Baltimore, MD, USA National Institute on Aging, Bethesda, MD, USA
| | - Frank R Lin
- Johns Hopkins University, Baltimore, MD, USA
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14
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Brown PJ, Roose SP, Zhang J, Wall M, Rutherford BR, Ayonayon HN, Butters MA, Harris T, Newman AB, Satterfield S, Simonsick EM, Yaffe K. Inflammation, Depression, and Slow Gait: A High Mortality Phenotype in Later Life. J Gerontol A Biol Sci Med Sci 2015; 71:221-7. [PMID: 26392405 DOI: 10.1093/gerona/glv156] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/11/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Inflammation, slow gait, and depression individually are associated with mortality, yet little is known about the trajectories of these measures, their interrelationships, or their collective impact on mortality. METHODS Longitudinal latent class analysis was used to evaluate trajectories of depression (Center for Epidemiologic Studies Depression ≥ 10), slow gait (<1.0 m/s), and elevated inflammation (interleukin 6 > 3.2 pg/mL) using data from the Health Aging and Body Composition Study. Logistic regression was used to identify their associations with mortality. RESULTS For each outcome, low-probability (n inflammation = 1,656, n slow gait = 1,471, n depression = 1,458), increasing-probability (n inflammation = 847, n slow gait = 880, n depression = 1,062), and consistently high-probability (n inflammation = 572, n slow gait = 724, n depression = 555) trajectories were identified, with 22% of all participants classified as having increasing or consistently high-probability trajectories on inflammation, slow gait, and depression (meaning probability of impairment on each outcome increased from low to moderate/high or remained high over 10 years). Trajectories of slow gait were associated with inflammation (r = .40, p < .001) and depression (r = .49, p < .001). Although worsening trajectories of inflammation were independently associated with mortality (p < .001), the association between worsening trajectories of slow gait and mortality was only present in participants with worsening depression trajectories (p < .01). Participants with increasing/consistently high trajectories of depression and consistently high trajectories of inflammation and slow gait (n = 247) have an adjusted-morality rate of 85.2%, greater than all other classification permutations. CONCLUSIONS Comprehensive assessment of older adults is warranted for the development of treatment strategies targeting a high-mortality risk phenotype consisting of inflammation, depression, and slow gait speed.
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Affiliation(s)
- Patrick J Brown
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons. and
| | - Steven P Roose
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons. and
| | - Jun Zhang
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons. and Division of Biostatistics, Columbia University's Mailman School of Public Health
| | - Melanie Wall
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons. and Division of Biostatistics, Columbia University's Mailman School of Public Health
| | - Bret R Rutherford
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons. and
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pennsylvania
| | - Tamara Harris
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland
| | - Anne B Newman
- Medicine and Clinical & Translational Science, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | | | - Eleanor M Simonsick
- Translational Gerontology Branch, National Institute on Aging, Harbor Hospital, Baltimore, Maryland
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco. Department of Neurology and Department of Psychiatry, University of California, San Francisco
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15
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Murphy RA, Hagaman AK, Reinders I, Steeves JA, Newman AB, Rubin SM, Satterfield S, Kritchevsky SB, Yaffe K, Ayonayon HN, Nagin DS, Simonsick EM, Penninx BWJH, Harris TB. Depressive Trajectories and Risk of Disability and Mortality in Older Adults: Longitudinal Findings From the Health, Aging, and Body Composition Study. J Gerontol A Biol Sci Med Sci 2015; 71:228-35. [PMID: 26273025 DOI: 10.1093/gerona/glv139] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/17/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Depression and disability are closely linked. Less is known regarding clinical and subclinical depressive symptoms over time and risk of disability and mortality. METHODS Responses to the Center for Epidemiologic Studies Short Depression scale (CES-D10) were assessed over a 4-year period in men (n = 1032) and women (n = 1070) aged 70-79 years initially free from disability. Depressive symptom trajectories were defined with group-based models. Disability (2 consecutive reports of severe difficulty walking one-quarter mile or climbing 10 steps) and mortality were determined for 9 subsequent years. Hazard ratios (HRs) were estimated using Cox proportional hazards adjusted for covariates. RESULTS Three trajectories were identified: persistently nondepressed (54% of men, 54% of women, mean baseline CES-D10: 1.16 and 1.46), mildly depressed and increasing (40% of men, 38% of women, mean baseline CES-D10: 3.60 and 4.35), and depressed and increasing (6% of men, 8% of women, mean baseline CES-D10: 7.44 and 9.61). Disability and mortality rates per 1,000 person years were 41.4 and 60.3 in men and 45.8 and 41.9 in women. Relative to nondepressed, men in the mildly depressed (HR = 1.45, 95% confidence interval [CI] 1.11-1.89) and depressed trajectories (HR = 2.12, 95% CI 1.33-3.38) had increased disability; women in the depressed trajectory had increased disability (HR = 2.02, 95% CI 1.37-2.96). Men in the mildly depressed (HR = 1.24, 95% CI 1.01-1.52) and depressed trajectories (HR = 1.63, 95% CI 1.10-2.41) had elevated mortality risk; women exhibited no mortality risk. CONCLUSIONS Trajectories of depressive symptoms without recovery may predict disability and mortality in apparently healthy older populations, thus underscoring the importance of monitoring depressive symptoms in geriatric care.
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Affiliation(s)
- Rachel A Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, Canada. Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland.
| | - Ashley K Hagaman
- School of Human Evolution and Social Change, Arizona State University, Tempe
| | - Ilse Reinders
- Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland. Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Jeremy A Steeves
- Cancer Prevention Fellowship Program, National Cancer Institute/Division of Cancer Control and Population Sciences, Rockville, Maryland
| | - Anne B Newman
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Susan M Rubin
- Department of Psychiatry, University of California at San Francisco
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Kristine Yaffe
- Department of Psychiatry, University of California at San Francisco
| | - Hilsa N Ayonayon
- Department of Psychiatry, University of California at San Francisco
| | - Daniel S Nagin
- Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Eleanor M Simonsick
- Translational Gerontology Branch, National Institute on Aging, Baltimore, Maryland
| | - Brenda W J H Penninx
- Department of Psychiatry and the EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Science, National Institute on Aging, Bethesda, Maryland
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Kaup AR, Falvey C, Byers A, Simonsick EM, Satterfield S, Ayonayon HN, Rosano C, Rubin S, Yaffe K. P1‐265: Trajectories of depressive symptoms in older adults and incident dementia. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Allison R. Kaup
- San Francisco VA Medical Center/University of California San FranciscoSan FranciscoCAUSA
| | - Cherie Falvey
- University of California San FranciscoSan FranciscoCAUSA
| | - Amy Byers
- University of California San Francisco/San Francisco VA Medical CenterSan FranciscoCAUSA
| | | | | | | | | | - Susan Rubin
- University of California - San FranciscoSan FranciscoCAUSA
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Best JR, Rosano C, Boudreau RM, Ayonayon HN, Satterfield S, Simonsick EM, Studenski S, Yaffe K, Newman AB, Liu-Ambrose T. P2‐172: The impact of maintaining physical activity in late life on subsequent change in brain micro‐ and macro‐structure: Findings from the health, aging, and body composition study. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- John R. Best
- University of British ColumbiaVancouverBCCanada
- Djavad Mowafaghian Centre for Brain HealthVancouverBCCanada
| | | | | | | | | | | | | | | | | | - Teresa Liu-Ambrose
- University of British ColumbiaVancouverBCCanada
- Djavad Mowafaghian Centre for Brain HealthVancouverBCCanada
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18
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Best JR, Liu-Ambrose T, Boudreau RM, Ayonayon HN, Satterfield S, Simonsick EM, Studenski S, Yaffe K, Newman AB, Rosano C. P3‐214: Longitudinal relations among walking activity, gait speed, and cognitive functioning over a 10‐year period: Findings from the health, aging, and body composition study. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- John R. Best
- Djavad Mowafaghian Centre for Brain HealthVancouverBCCanada
- University of British ColumbiaVancouverBCCanada
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain HealthVancouverBCCanada
- University of British ColumbiaVancouverBCCanada
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Hoffelder Wynne J, Lunney J, Ives D, Newman AB, Satterfield S, Garcia M, Harris T, Ayonayon HN, Rubin SM, Albert SM. Perceptions of very old adults about informed care in medical encounters. J Am Geriatr Soc 2015; 63:612-4. [PMID: 25800920 DOI: 10.1111/jgs.13291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kaup AR, Nettiksimmons J, Harris TB, Sink KM, Satterfield S, Metti AL, Ayonayon HN, Yaffe K. Cognitive resilience to apolipoprotein E ε4: contributing factors in black and white older adults. JAMA Neurol 2015; 72:340-8. [PMID: 25599330 DOI: 10.1001/jamaneurol.2014.3978] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Apolipoprotein E (APOE) ε4 is an established risk factor for cognitive decline and the development of dementia, but other factors may help to minimize its effects. OBJECTIVE Using APOE ε4 as an indicator of high risk, we investigated factors associated with cognitive resilience among black and white older adults who are APOE ε4 carriers. DESIGN, SETTING, AND PARTICIPANTS Participants included 2487 community-dwelling older (aged 69-80 years at baseline) black and white adults examined at 2 community clinics in the prospective cohort Health, Aging, and Body Composition (Health ABC) study. The baseline visits occurred from May 1997 through June 1998. Our primary analytic cohort consisted of 670 APOE ε4 carriers (329 black and 341 white participants) who were free of cognitive impairment at baseline and underwent repeated cognitive testing during an 11-year follow-up (through 2008) using the Modified Mini-Mental State Examination. MAIN OUTCOMES AND MEASURES We stratified all analyses by race. Using the Modified Mini-Mental State Examination scores, we assessed normative cognitive change in the entire cohort (n = 2487) and classified the APOE ε4 carriers as being cognitively resilient vs nonresilient by comparing their cognitive trajectories with those of the entire cohort. We then conducted bivariate analyses and multivariable random forest and logistic regression analyses to explore factors predictive of cognitive resilience in APOE ε4 carriers. RESULTS Among white APOE ε4 carriers, the strongest predictors of cognitive resilience were, in relative order of importance, no recent negative life events, a higher literacy level, advanced age, a higher educational level, and more time spent reading. Among black APOE ε4 carriers, the strongest predictors of cognitive resilience were, in relative order of importance, a higher literacy level, a higher educational level, female sex, and the absence of diabetes mellitus. In follow-up logistic regression models, higher literacy level (adjusted odds ratio [OR], 9.50 [95% CI, 2.67-60.89]), a higher educational level (adjusted OR for college graduate vs less than high school, 3.81 [95% CI, 1.13-17.56]), and age (adjusted OR for 73-76 vs 69-72 years, 2.01 [95% CI, 1.13-3.63]) had significant independent effects in predicting cognitive resilience among white APOE ε4 carriers. Among black APOE ε4 carriers, a higher literacy level (adjusted OR, 2.27 [95% CI, 1.29-4.06]) and a higher educational level (adjusted OR for high school graduate/some college vs less than high school, 2.86 [95% CI, 1.54-5.49]; adjusted OR for college graduate vs less than high school, 2.52 [95% CI, 1.14-5.62]) had significant independent effects in predicting cognitive resilience. CONCLUSIONS AND RELEVANCE Although APOE ε4 carriers are at high risk for cognitive decline, our findings suggest possible intervention targets, including the enhancement of cognitive reserve and improvement of other psychosocial and health factors, to promote cognitive resilience among black and white APOE ε4 carriers.
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Affiliation(s)
- Allison R Kaup
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California2Department of Psychiatry, University of California, San Francisco
| | | | - Tamara B Harris
- Laboratory of Epidemiology and Populations Science, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | - Kaycee M Sink
- Section on Gerontology and Geriatric Medicine, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Andrea L Metti
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kristine Yaffe
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California2Department of Psychiatry, University of California, San Francisco7Department of Epidemiology and Biostatistics
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Koyama A, Houston DK, Simonsick EM, Lee JS, Ayonayon HN, Shahar DR, Rosano C, Satterfield S, Yaffe K. Association between the Mediterranean diet and cognitive decline in a biracial population. J Gerontol A Biol Sci Med Sci 2015; 70:354-9. [PMID: 24994847 PMCID: PMC4351391 DOI: 10.1093/gerona/glu097] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/22/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Results from numerous studies suggest protective effects of the Mediterranean diet for cardiovascular disease, cancer, and mortality. Evidence for an association with a decreased risk of cognitive decline is less consistent and studies are limited by a lack of diversity in their populations. METHODS We followed 2,326 older adults (38.2% black, 51.3% female, aged 70-79 at baseline) over 8 years in a prospective cohort study in the United States (Health, Aging and Body Composition study). To measure adherence to a Mediterranean diet, we calculated race-specific tertiles of the MedDiet score (range: 0-55) using baseline food frequency questionnaires. Cognitive decline was assessed using repeated Modified Mini Mental State Examination scores over the study. We used linear mixed models to assess the association between MedDiet score and trajectory of cognitive decline. RESULTS Among blacks, participants with high MedDiet scores had a significantly lower mean rate of decline on the Modified Mini Mental State Examination score compared with participants with lower MedDiet scores (middle and bottom tertiles). The mean difference in points per year was 0.22 (95% confidence interval: 0.05-0.39; p = .01) after adjustment for age, sex, education, body mass index, current smoking, physical activity, depression, diabetes, total energy intake, and socioeconomic status. No association between MedDiet scores and change in Modified Mini Mental State Examination score was seen among white participants (p = .14). CONCLUSIONS Stronger adherence to the Mediterranean diet may reduce the rate of cognitive decline among black, but not white older adults. Further studies in diverse populations are needed to confirm this association and pinpoint mechanisms that may explain these results.
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Affiliation(s)
- Alain Koyama
- Northern California Institute For Research and Education, San Francisco. San Francisco VA Medical Center, California.
| | - Denise K Houston
- Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | | | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Danit R Shahar
- S. Daniel International Center for Health and Nutrition, Department of Epidemiology and Health Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Caterina Rosano
- Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | | | - Kristine Yaffe
- San Francisco VA Medical Center, California. Department of Epidemiology and Biostatistics, University of California San Francisco. Departments of Psychiatry and Neurology, University of California San Francisco
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Hall MH, Smagula SF, Boudreau RM, Ayonayon HN, Goldman SE, Harris TB, Naydeck BL, Rubin SM, Samuelsson L, Satterfield S, Stone KL, Visser M, Newman AB. Association between sleep duration and mortality is mediated by markers of inflammation and health in older adults: the Health, Aging and Body Composition Study. Sleep 2015; 38:189-95. [PMID: 25348127 DOI: 10.5665/sleep.4394] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/21/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Inflammation may represent a common physiological pathway linking both short and long sleep duration to mortality. We evaluated inflammatory markers as mediators of the relationship between sleep duration and mortality in community-dwelling older adults. DESIGN Prospective cohort with longitudinal follow-up for mortality outcomes. SETTING Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS Participants in the Health, Aging and Body Composition (Health ABC) Study (mean age 73.6 ± 2.9 years at baseline) were sampled and recruited from Medicare listings. MEASUREMENTS AND RESULTS Baseline measures of subjective sleep duration, markers of inflammation (serum interleukin-6, tumor necrosis factor-α, and C-reactive protein) and health status were evaluated as predictors of all-cause mortality (average follow-up = 8.2 ± 2.3 years). Sleep duration was related to mortality, and age-, sex-, and race-adjusted hazard ratios (HR) were highest for those with the shortest (< 6 h HR: 1.30, CI: 1.05-1.61) and longest (> 8 h HR: 1.49, CI: 1.15-1.93) sleep durations. Adjustment for inflammatory markers and health status attenuated the HR for short (< 6 h) sleepers (HR = 1.06, 95% CI = 0.83-1.34). Age-, sex-, and race-adjusted HRs for the > 8-h sleeper group were less strongly attenuated by adjustment for inflammatory markers than by other health factors associated with poor sleep with adjusted HR = 1.23, 95% CI = 0.93-1.63. Inflammatory markers remained significantly associated with mortality. CONCLUSION Inflammatory markers, lifestyle, and health status explained mortality risk associated with short sleep, while the mortality risk associated with long sleep was explained predominantly by lifestyle and health status.
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Affiliation(s)
- Martica H Hall
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Stephen F Smagula
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Robert M Boudreau
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Hilsa N Ayonayon
- Departments of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Suzanne E Goldman
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD
| | - Barbara L Naydeck
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Susan M Rubin
- Departments of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Laura Samuelsson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | | | - Katie L Stone
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA
| | - Marjolein Visser
- Institute of Health Sciences, VU University Medical Center and EMGO Institute, VU Medical Center, Amsterdam, the Netherlands
| | - Anne B Newman
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.,Graduate School of Public Health, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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Chen DS, Betz J, Yaffe K, Ayonayon HN, Kritchevsky S, Martin KR, Harris TB, Purchase-Helzner E, Satterfield S, Xue QL, Pratt S, Simonsick EM, Lin FR. Association of hearing impairment with declines in physical functioning and the risk of disability in older adults. J Gerontol A Biol Sci Med Sci 2014; 70:654-61. [PMID: 25477427 DOI: 10.1093/gerona/glu207] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/08/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Identifying factors associated with functional declines in older adults is important given the aging of the population. We investigated if hearing impairment is independently associated with objectively measured declines in physical functioning in a community-based sample of older adults. METHODS Prospective observational study of 2,190 individuals from the Health, Aging, and Body Composition study. Participants were followed annually for up to 11 visits. Hearing was measured with pure-tone audiometry. Physical functioning and gait speed were measured with the Short Physical Performance Battery (SPPB). Incident disability and requirement for nursing care were assessed semiannually through self-report. RESULTS In a mixed-effects model, greater hearing impairment was associated with poorer physical functioning. At both Visit 1 and Visit 11, SPPB scores were lower in individuals with mild (10.14 [95% CI 10.04-10.25], p < .01; 7.35 [95% CI 7.12-7.58], p < .05) and moderate or greater hearing impairment (10.04 [95% CI 9.90-10.19], p < .01; 7.00 [95% CI 6.69-7.32], p < .01) than scores in normal hearing individuals (10.36 [95% CI 10.26-10.46]; 7.71 [95% CI 7.49-7.92]). We observed that women with moderate or greater hearing impairment had a 31% increased risk of incident disability (Hazard ratio [HR] =1.31 [95% CI 1.08-1.60], p < .01) and a 31% increased risk of incident nursing care requirement (HR = 1.31 [95% CI 1.05-1.62], p = .02) compared to women with normal hearing. CONCLUSIONS Hearing impairment is independently associated with poorer objective physical functioning in older adults, and a 31% increased risk for incident disability and need for nursing care in women.
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Affiliation(s)
- David S Chen
- Johns Hopkins University School of Medicine, Baltimore, Maryland. Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Joshua Betz
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn R Martin
- Laboratory of Epidemiology and Population Sciences and Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland. Epidemiology Group, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences and Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland
| | - Elizabeth Purchase-Helzner
- Department of Epidemiology and Biostatistics, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sheila Pratt
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Frank R Lin
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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24
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Barry LC, Thorpe RJ, Penninx BW, Yaffe K, Wakefield D, Ayonayon HN, Satterfield S, Newman AB, Simonsick EM. Race-related differences in depression onset and recovery in older persons over time: the health, aging, and body composition study. Am J Geriatr Psychiatry 2014; 22:682-91. [PMID: 24125816 PMCID: PMC3984378 DOI: 10.1016/j.jagp.2013.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate race-related differences in depression onset and recovery in older persons, overall and by sex, and examine race-related differences in mortality according to depression. DESIGN Prospective cohort study. SETTING General community in pre-designated zip code areas in Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS 3,075 persons aged 70-79 years at baseline in the Health, Aging, and Body Composition study. MEASUREMENTS Depression was assessed at eight time points over 10 years using the 10-item Center for Epidemiologic Studies-Depression scale; patients were categorized as nondepressed (score less than 8) or depressed (score of 8 or higher). We created variables for transitions across each 18-month time interval, namely, from nondepressed or depressed to nondepressed, depressed, or death, and determined the association between race and the average likelihood of these transitions over time. RESULTS A higher percentage of blacks than whites were depressed at nearly all time points. Adjusting for demographics, common chronic conditions, and body mass index, blacks had a higher likelihood of experiencing depression onset than whites (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.03-1.43); among men, blacks were more likely to experience depression onset than whites (OR: 1.44; 95% CI: 1.24-2.89). Blacks also had a higher likelihood of transitioning from nondepressed to death (OR: 1.79; 95% CI: 1.30-2.46). Overall and in sex-stratified analyses, race was not associated with recovery from depression or with the transition from depression to death. CONCLUSION Our findings highlight race differences in depression in older persons and encourage further research on the course of depression in older black patients.
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Affiliation(s)
- Lisa C. Barry
- Center on Aging, University of Connecticut, Farmington, Connecticut 06030-5215, US
| | - Roland J. Thorpe
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | - Brenda W.J.H. Penninx
- Department of Psychiatry, VU University Medical Center in Amsterdam, The Netherlands
| | - Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, California, US
| | - Dorothy Wakefield
- Center on Aging, University of Connecticut, Farmington, Connecticut, US
| | - Hilsa N. Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, US
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, US
| | - Anne B. Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, US
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Kaup AR, Simonsick EM, Harris TB, Satterfield S, Metti AL, Ayonayon HN, Rubin SM, Yaffe K. Older adults with limited literacy are at increased risk for likely dementia. J Gerontol A Biol Sci Med Sci 2014; 69:900-6. [PMID: 24158765 PMCID: PMC4067115 DOI: 10.1093/gerona/glt176] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/06/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Low literacy is common among the elderly and possibly more reflective of educational attainment than years of school completed. We examined the association between literacy and risk of likely dementia in older adults. METHODS Participants were 2,458 black and white elders (aged 71-82) from the Health, Aging and Body Composition study, who completed the Rapid Estimate of Adult Literacy in Medicine and were followed for 8 years. Participants were free of dementia at baseline; incidence of likely dementia was defined by hospital records, prescription for dementia medication, or decline in Modified Mini-Mental State Examination score. We conducted Cox proportional hazard models to evaluate the association between literacy and incidence of likely dementia. Demographics, education, income, comorbidities, lifestyle variables, and apolipoprotein E (APOE) ε4 status were included in adjusted analyses. RESULTS Twenty-three percent of participants had limited literacy (<9th-grade level). Limited literacy, as opposed to adequate literacy (≥9th-grade level), was associated with greater incidence of likely dementia (25.5% vs17.0%; unadjusted hazard ratio [HR] = 1.75, 95% confidence interval 1.44-2.13); this association remained significant after adjustment. There was a trend for an interaction between literacy and APOE ε4 status (p = .07); the association between limited literacy and greater incidence of likely dementia was strong among ε4 noncarriers (unadjusted HR = 1.85) but nonsignificant among ε4 carriers (unadjusted HR = 1.25). CONCLUSIONS Limited literacy is an important risk factor for likely dementia, especially among APOE ε4-negative older adults, and may prove fruitful to target in interventions aimed at reducing dementia risk.
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Affiliation(s)
- Allison R Kaup
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Medical Center, California. Department of Psychiatry, University of California San Francisco.
| | - Eleanor M Simonsick
- National Institute on Aging, Translational Gerontology Branch, Harbor Hospital, Baltimore, Maryland
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, Maryland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis
| | - Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | | | | | - Kristine Yaffe
- Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco VA Medical Center, California. Department of Psychiatry, University of California San Francisco. Department of Epidemiology and Biostatistics and Department of Neurology, University of California San Francisco
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Metti AL, Yaffe K, Boudreau RM, Simonsick EM, Carnahan RM, Satterfield S, Harris TB, Ayonayon HN, Rosano C, Cauley JA. Trajectories of inflammatory markers and cognitive decline over 10 years. Neurobiol Aging 2014; 35:2785-2790. [PMID: 24997674 DOI: 10.1016/j.neurobiolaging.2014.05.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/22/2014] [Accepted: 05/31/2014] [Indexed: 10/25/2022]
Abstract
We aimed to examine trajectories of inflammatory markers and cognitive decline over 10 years. Cox proportional hazards models were used to examine the association between interleukin-6 and C-reactive protein (CRP) trajectory components (slope, variability, and baseline level) and cognitive decline among 1323 adults, aged 70-79 years in the Health, Aging, and Body Composition Study. We tested for interactions by sex and apolipoprotein E (APOE) genotype. In models adjusted for multiple covariates and comorbidities, extreme CRP variability was significantly associated with cognitive decline (hazard ratio [HR] 1.6, 95% confidence interval [CI]: 1.1-2.3). This association was modified by sex and APOE e4 (p < 0.001 for both), such that the association remained among women (HR = 1.8; 95% CI: 1.1, 3.0) and among those with no APOE e4 allele (HR = 1.6; 95% CI: 1.1, 2.5). There were no significant associations between slope or baseline level of CRP and cognitive decline nor between interleukin-6 and cognitive decline. We believe CRP variability likely reflects poor control of or greater changes in vascular or metabolic disease over time, which in turn is associated with cognitive decline.
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Affiliation(s)
- Andrea L Metti
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ryan M Carnahan
- Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, IA, USA
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee, Memphis, TN, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - Hilsa N Ayonayon
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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27
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Murphy RA, Reinders I, Register TC, Ayonayon HN, Newman AB, Satterfield S, Goodpaster BH, Simonsick EM, Kritchevsky SB, Harris TB. Associations of BMI and adipose tissue area and density with incident mobility limitation and poor performance in older adults. Am J Clin Nutr 2014; 99:1059-65. [PMID: 24522448 PMCID: PMC3985211 DOI: 10.3945/ajcn.113.080796] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Obesity is a risk factor for disability, but risk of specific adipose depots is not completely understood. OBJECTIVE We investigated associations between mobility limitation, performance, and the following adipose measures: body mass index (BMI) and areas and densities of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intermuscular adipose tissue (IMAT) in older adults. DESIGN This was a prospective population-based study of men (n = 1459) and women (n = 1552) initially aged 70-79 y and free from mobility limitation. BMI was determined from measured height and weight. Adipose tissue area and density in Hounsfield units were measured in the thigh and abdomen by using computed tomography. Mobility limitation was defined as 2 consecutive reports of difficulty walking one-quarter mile or climbing 10 steps during semiannual assessments over 13 y. Poor performance was defined as a gait speed <1 m/s after 9 y of follow-up (n = 1542). RESULTS In models adjusted for disability risk factors, BMI, and areas of VAT, abdominal SAT, and IMAT were positively associated with mobility limitation in men and women. In women, thigh SAT area was positively associated with mobility limitation risk, whereas VAT density was inversely associated. Associations were similar for poor performance. BMI and thigh IMAT area (independent of BMI) were particularly strong indicators of incident mobility limitation and poor performance. For example, in women, the HR (95% CI) and OR (95% CI) associated with an SD increment in BMI for mobility limitation and poor performance were 1.31 (1.21, 1.42) and 1.41 (1.13, 1.76), respectively. In men, the HR (95% CI) and OR (95% CI) associated with an SD increment in thigh IMAT for mobility limitation and poor performance were 1.37 (1.27, 1.47) and 1.54 (1.18, 2.02), respectively. CONCLUSIONS Even into old age, higher BMI is associated with mobility limitation and poor performance. The amount of adipose tissue in abdominal and thigh depots may also convey risk beyond BMI.
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Affiliation(s)
- Rachel A Murphy
- Laboratory of Epidemiology, and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD (RAM, IR, and TBH); the Sections on Comparative Medicine Pathology, Radiology (TCR), and Gerontology and Geriatrics (SBK), Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC; the Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (HNA); the Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (ABN); the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN (SS); the Center for Aging and Population Health, Department of Medicine, University of Pittsburgh, Pittsburgh, PA (BHG); and the Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, Baltimore, MD (EMS)
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Wilson VK, Houston DK, Kilpatrick L, Lovato J, Yaffe K, Cauley JA, Harris TB, Simonsick EM, Ayonayon HN, Kritchevsky SB, Sink KM. Relationship between 25-hydroxyvitamin D and cognitive function in older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc 2014; 62:636-41. [PMID: 24635412 DOI: 10.1111/jgs.12765] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine the relationship between 25-hydroxyvitamin D (25(OH)D) levels and cognitive performance over time in older adults in the Health, Aging and Body Composition (Health ABC) Study. DESIGN Prospective cohort study. SETTING Community-dwelling participants in Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS Well-functioning adults aged 70 to 79 at baseline with serum 25(OH)D measured at the 12-month follow-up visit and cognitive function measured at baseline and 4-year follow-up visit (N = 2,777). MEASUREMENTS Vitamin D status was categorized as 25(OH)D levels of less than 20.0 ng/mL, 20.0 to 29.9 ng/mL, or 30.0 ng/mL or greater. Cognition was measured using the modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST). Linear regression models adjusting for multiple covariates, including age, education, sex, race, site, season, physical activity, and comorbidities, were used in the analysis. RESULTS Sixty-eight percent of participants had 25(OH)D levels of less than 30.0 ng/mL. Lower 25(OH)D levels were associated with lower baseline cognitive scores on the 3MS (adjusted mean 89.9, 95% confidence interval (CI) = 89.4-90.4 for <20.0 ng/mL; adjusted mean 90.8, 95% CI = 90.4-91.3 for 20.0-29.9 ng/mL; adjusted mean 90.6, 95% CI = 90.2-91.1 for ≥ 30.0 ng/mL; P trend = .02) and the DSST (adjusted mean 35.2, 95% CI = 34.5-36.0 for <20.0 ng/mL; adjusted mean 35.9, 95% CI = 35.2-36.6 for 20.0-29.9 ng/mL; adjusted mean 37.0, 95% CI = 36.3-37.8 for ≥ 30.0 ng/mL; P trend = .01). Participants with low 25(OH)D levels had greater declines in 3MS scores over 4 years than those with higher levels (least square mean change -1.0, 95% CI = -1.5 to -0.6 for <20.0 ng/mL; least square mean change -0.8, 95% CI = -1.2 to -0.3 for 20.0-29.9 ng/mL; least square mean change -0.2, 95% CI = -0.7 to 0.2 for ≥30.0 ng/mL; P = .05). There was no significant difference in DSST decline according to 25(OH)D level. CONCLUSION Low 25(OH)D levels were associated with worse global cognitive function and greater decline over time according to the 3MS. Intervention trials are needed to determine whether vitamin D supplementation can reduce cognitive decline.
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Affiliation(s)
- Valerie K Wilson
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
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29
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Groffen DA, Koster A, Bosma H, van den Akker M, Kempen GI, van Eijk JTM, van Gool CH, Penninx BW, Harris TB, Rubin SM, Pahor M, Schulz R, Simonsick EM, Perry SE, Ayonayon HN, Kritchevsky SB. Unhealthy lifestyles do not mediate the relationship between socioeconomic status and incident depressive symptoms: the Health ABC study. Am J Geriatr Psychiatry 2013; 21:664-74. [PMID: 23567402 PMCID: PMC3402597 DOI: 10.1016/j.jagp.2013.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 10/05/2011] [Accepted: 11/30/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship between low socioeconomic status (SES) and depressive symptoms is well described, also in older persons. Although studies have found associations between low SES and unhealthy lifestyle factors, and between unhealthy lifestyle factors and depressive symptoms, not much is known about unhealthy lifestyles as a potential explanation of socioeconomic differences in depressive symptoms in older persons. METHODS To study the independent pathways between SES (education, income, perceived income, and financial assets), lifestyle factors (smoking, alcohol use, body mass index, and physical activity), and incident depressive symptoms (Center for Epidemiologic Studies-Depression [CES-D 10] and reported use of antidepressant medication), we used 9 years of follow-up data (1997-2007) from 2,694 American black and white participants aged 70-79 years from the Health, Aging, and Body Composition (Health ABC) study. At baseline, 12.1% of the study population showed prevalent depressive symptoms, use of antidepressant medication, or treatment of depression in the 5 years prior to baseline. These persons were excluded from the analyses. RESULTS Over a period of 9 years time, 860 participants (31.9%) developed depressive symptoms. Adjusted hazard ratios for incident depressive symptoms were higher in participants from lower SES groups compared with the highest SES group. The strongest relationships were found for black men. Although unhealthy lifestyle factors were consistently associated with low SES, they were weakly related to incident depressive symptoms. Lifestyle factors did not significantly reduce hazard ratios for depressive symptoms by SES. CONCLUSION In generally healthy persons aged 70-79 years, lifestyle factors do not explain the relationship between SES and depressive symptoms.
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Affiliation(s)
- Daniëlle A.I. Groffen
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands,Correspondence address: DAI Groffen, CAPHRI School for Public Health and Primary Care, Department of Social Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands, tel: +31 43 38 82 290, fax: +31 43 38 84 169,
| | - Annemarie Koster
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Hans Bosma
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Marjan van den Akker
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands,Katholieke Universiteit Leuven, Department of General Practice, Belgium
| | - Gertrudis I.J.M. Kempen
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Jacques Th M. van Eijk
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Coen H. van Gool
- Center for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Brenda W.J.H. Penninx
- Department of Psychiatry/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Tamara B. Harris
- Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Susan M. Rubin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Richard Schulz
- University Center for Social and Urban Research, University of Pittsburgh, Pennsylvania, USA
| | - Eleanor M. Simonsick
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland, USA,Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sara E. Perry
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Hilsa N. Ayonayon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Stephen B. Kritchevsky
- Sticht Center on Aging, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Lin FR, Yaffe K, Xia J, Xue QL, Harris TB, Purchase-Helzner E, Satterfield S, Ayonayon HN, Ferrucci L, Simonsick EM. Hearing loss and cognitive decline in older adults. JAMA Intern Med 2013; 173:293-9. [PMID: 23337978 PMCID: PMC3869227 DOI: 10.1001/jamainternmed.2013.1868] [Citation(s) in RCA: 956] [Impact Index Per Article: 86.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown. METHODS We studied 1984 older adults (mean age, 77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, ≥80) who underwent audiometric testing in year 5. Participants were followed up for 6 years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and 11 and consisted of the 3MS (measuring global function) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was defined as a 3MS score of less than 80 or a decline in 3MS score of more than 5 points from baseline. Mixed-effects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors. RESULTS In total, 1162 individuals with baseline hearing loss (pure-tone average >25 dB) had annual rates of decline in 3MS and Digit Symbol Substitution test scores that were 41% and 32% greater, respectively, than those among individuals with normal hearing. On the 3MS, the annual score changes were -0.65 (95% CI, -0.73 to -0.56) vs -0.46 (95% CI, -0.55 to -0.36) points per year (P = .004). On the Digit Symbol Substitution test, the annual score changes were -0.83 (95% CI, -0.94 to -0.73) vs -0.63 (95% CI, -0.75 to -0.51) points per year (P = .02). Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual's baseline hearing loss. CONCLUSIONS Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. Further studies are needed to investigate what the mechanistic basis of this association is and whether hearing rehabilitative interventions could affect cognitive decline.
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Affiliation(s)
- Frank R Lin
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Metti AL, Cauley JA, Newman AB, Ayonayon HN, Barry LC, Kuller LM, Satterfield S, Simonsick EM, Yaffe K. Plasma beta amyloid level and depression in older adults. J Gerontol A Biol Sci Med Sci 2012; 68:74-9. [PMID: 22499763 DOI: 10.1093/gerona/gls093] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Older adults with depression have an increased risk of developing dementia. Low plasma beta-amyloid 42 (Aβ42) and Aβ42/Aβ40 have emerged as promising biomarkers of dementia. The association between depression and plasma Aβ is unclear. METHODS In this longitudinal study of 988 community-dwelling elders from the Health Aging and Body Composition study, depression was assessed with the Center for Epidemiologic Studies-Depression Scale 10-item version. We determined the association between Aβ42 and Aβ42/Aβ40 tertile and depression at baseline and over 9 years. We also stratified the models to determine if apolipoprotein E e4 allele status modified the associations. RESULTS Mean baseline age was 74.0 ± 3.0 years, 51 (5.2%) participants had depression, 545 (55.2%) were women, 531 (53.7%) were black, and 286 (30.7%) had one or more apolipoprotein E e4 allele. At baseline, there was no association between Aβ42/Aβ40 or Aβ42 and depression. Over 9 years, 220 (23.5%) participants developed depression. In adjusted Cox proportional hazards models, among those with one or more e4 allele, low Aβ42/Aβ40 was associated with an increased risk of developing depression over time (low 10.8% vs high 3.2%, hazard ratio = 2.38, 95% confidence interval: 1.15-4.92). Among those with no e4 allele, there was no association between Aβ42/Aβ40 and risk of depression over time (13.3% vs 17.5%, hazard ratio = 0.80, 95% confidence interval: 0.52-1.23; p value for interaction = .003). CONCLUSIONS The association between low plasma Aβ42/Aβ40 and increased risk of incident depression among those with one or more apolipoprotein E e4 allele implies a synergistic relationship similar to that found with dementia. Future work should investigate the interrelationships among plasma Aβ42/Aβ40, depression, and dementia.
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Affiliation(s)
- Andrea L Metti
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Tolea MI, Costa PT, Terracciano A, Ferrucci L, Faulkner K, Coday MMC, Ayonayon HN, Simonsick EM. Associations of openness and conscientiousness with walking speed decline: findings from the Health, Aging, and Body Composition Study. J Gerontol B Psychol Sci Soc Sci 2012; 67:705-11. [PMID: 22451484 DOI: 10.1093/geronb/gbs030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The objective of this study was to explore the associations between openness to experience and conscientiousness, two dimensions of the five-factor model of personality, and usual gait speed and gait speed decline. METHOD Baseline analyses were conducted on 907 men and women aged 71-82 years participating in the Cognitive Vitality substudy of the Health, Aging, and Body Composition study. The longitudinal analytic sample consisted of 740 participants who had walking speed assessed 3 years later. RESULTS At baseline, gait speed averaged 1.2 m/s, and an average decline of 5% over the 3-year follow-up period was observed. Higher conscientiousness was associated with faster initial walking speed and less decline in walking speed over the study period, independent of sociodemographic characteristics. Lifestyle factors and disease status appear to play a role in the baseline but not the longitudinal association between conscientiousness and gait speed. Openness was not associated with either initial or decline in gait speed. DISCUSSION These findings extend the body of evidence suggesting a protective association between conscientiousness and physical function to performance-based assessment of gait speed. Future studies are needed to confirm these associations and to explore mechanisms that underlie the conscientiousness mobility connection in aging adults.
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Affiliation(s)
- Magdalena I Tolea
- Gerontology Program, School of Social Work, University of Missouri-St Louis, St Louis, MO 63121, USA.
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Tolea MI, Ferrucci L, Costa PT, Faulkner K, Rosano C, Satterfield S, Ayonayon HN, Simonsick EM. Personality and reduced incidence of walking limitation in late life: findings from the Health, Aging, and Body Composition Study. J Gerontol B Psychol Sci Soc Sci 2012; 67:712-9. [PMID: 22437204 DOI: 10.1093/geronb/gbs001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine the association between openness to experience and conscientiousness and incident reported walking limitation. METHOD The study population consisted of 786 men and women aged 71-81 years (M = 75 years, SD = 2.7) participating in the Health, Aging, and Body Composition-Cognitive Vitality Substudy. RESULTS Nearly 20% of participants (155/786) developed walking limitation during 6 years of follow-up. High openness was associated with a reduced risk of walking limitation (hazard ratio [HR] = 0.83, 95% confidence interval [CI] = 0.69-0.98), independent of sociodemographic factors, health conditions, and conscientiousness. This association was not mediated by lifestyle factors and was not substantially modified by other risk factors for functional disability. Conscientiousness was not associated with risk of walking limitation (HR = 0.91, 95% CI = 0.77-1.07). DISCUSSION Findings suggest that personality dimensions, specifically higher openness to experience, may contribute to functional resilience in late life.
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Affiliation(s)
- Magdalena I Tolea
- Gerontology Program, School of Social Work, University of Missouri-St. Louis, St. Louis, MO 63121, USA.
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Venkatraman VK, Aizenstein HJ, Newman AB, Yaffe K, Harris T, Kritchevsky S, Ayonayon HN, Rosano C. Lower Digit Symbol Substitution Score in the Oldest Old is Related to Magnetization Transfer and Diffusion Tensor Imaging of the White Matter. Front Aging Neurosci 2011; 3:11. [PMID: 21991255 PMCID: PMC3180637 DOI: 10.3389/fnagi.2011.00011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 08/15/2011] [Indexed: 11/25/2022] Open
Abstract
Background: Slowing information processing is common among community-dwelling elderly and it predicts greater mortality and disability risk. Slowing information processing is related to brain macro-structural abnormalities. Specifically, greater global atrophy and greater small vessel disease of the white matter (WM) have been associated with slower processing speed. However, community-dwelling elderly with such macro-structural abnormalities can maintain processing speed. The roles of brain micro-structure for slow processing in very old adults living in the community is uncertain, as epidemiological studies relating these brain markers to cognition and in the context of other health characteristics are sparse. Hypothesis: Information processing is cross-sectionally associated with WM micro-structure independent of overt macro-structural abnormalities and also independent of health related characteristics. Methods: Imaging indices of micro-structure diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI), macro-structure white matter hyperintensities (WMH), gray matter (GM) volume, digit symbol substitution test (DSST), and health characteristics were measured in 272 elderly (mean age 83 years old, 43% men, 40% black) living in the community. Results: The DTI- and MTI-indices of micro-structure from the normal appearing WM and not from the normal appearing GM were associated with DSST score independent of WMH and GM volumes. Associations were also independent of age, race, gender, mini-mental score, systolic blood pressure, and prevalent myocardial infarction. Interpretation: DTI and MTI-indices of normal appearing WM are indicators of information processing speed in this cohort of very old adults living in the community. Since processing slowing is a potent index of mortality and disability, these indices may serve as biomarkers in prevention or treatment trials of disability.
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Affiliation(s)
- Vijay K Venkatraman
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh Pittsburgh, PA, USA
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Thorpe RJ, Koster A, Kritchevsky SB, Newman AB, Harris T, Ayonayon HN, Perry S, Rooks RN, Simonsick EM. Race, socioeconomic resources, and late-life mobility and decline: findings from the Health, Aging, and Body Composition study. J Gerontol A Biol Sci Med Sci 2011; 66:1114-23. [PMID: 21743093 DOI: 10.1093/gerona/glr102] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study examines the relationship between race and mobility over 5 years in initially well-functioning older adults and evaluates how a broad set of socioeconomic status indicators affect this relationship. METHODS Data were from 2,969 black and white participants aged 70-79 from the Health, Aging, and Body Composition study. Mobility parameters included self-reported capacity to walk a quarter mile and climb 10 steps and usual gait speed. Incident mobility limitation was defined as reported difficulty walking a quarter mile or climbing 10 steps at two consecutive semiannual assessments. Gait speed decline was defined as a 4% reduction in speed per year. RESULTS At baseline, even though all participants were free of mobility limitation, blacks had slower walking speed than their white counterparts, which was not explained by poverty, education, reading level, or income adequacy. After 5 years, accounting for age, site, and baseline mobility, blacks were more likely to develop mobility limitation than whites. Adjusting for prevalent conditions at baseline eliminated this difference in women; controlling for education eliminated this difference in men. No differences in gait speed decline were identified. CONCLUSIONS Higher rates of mobility loss observed in older blacks relative to older whites appear to be a function of both poorer initial mobility status and existing health conditions particularly for women. Education may also play a role especially for men.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ste. 441, Baltimore, MD 21205, USA.
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Yaffe K, Weston A, Graff-Radford NR, Satterfield S, Simonsick EM, Younkin SG, Younkin LH, Kuller L, Ayonayon HN, Ding J, Harris TB. Association of plasma beta-amyloid level and cognitive reserve with subsequent cognitive decline. JAMA 2011; 305:261-6. [PMID: 21245181 PMCID: PMC3108075 DOI: 10.1001/jama.2010.1995] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Lower plasma β-amyloid 42 and 42/40 levels have been associated with incident dementia, but results are conflicting and few have investigated cognitive decline among elders without dementia. OBJECTIVE To determine if plasma β-amyloid is associated with cognitive decline and if this association is modified by measures of cognitive reserve. DESIGN, SETTING, AND PARTICIPANTS We studied 997 black and white community-dwelling older adults from Memphis, Tennessee, and Pittsburgh, Pennsylvania, who were enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998 with 10-year follow-up in 2006-2007. Participant mean age was 74.0 (SD, 3.0) years; 55.2% (n = 550) were female; and 54.0% (n = 538) were black. MAIN OUTCOME MEASURES Association of near-baseline plasma β-amyloid levels (42 and 42/40 measured in 2010) and repeatedly measured Modified Mini-Mental State Examination (3MS) results. RESULTS Low β-amyloid 42/40 level was associated with greater 9-year 3MS cognitive decline (lowest β-amyloid tertile: mean change in 3MS score, -6.59 [95% confidence interval [CI], -5.21 to -7.67] points; middle tertile: -6.16 [95% CI, -4.92 to -7.32] points; and highest tertile: -3.60 [95% CI, -2.27 to -4.73] points; P < .001). Results were similar after multivariate adjustment for age, race, education, diabetes, smoking, and apolipoprotein E [APOE ] e4 status and after excluding the 72 participants with incident dementia. Measures of cognitive reserve modified this association whereby among those with high reserve (at least a high school diploma, higher than sixth-grade literacy, or no APOE e4 allele), β-amyloid 42/40 was less associated with multivariate adjusted 9-year decline. For example, among participants with less than a high school diploma, the 3MS score decline was -8.94 (95% CI, -6.94 to -10.94) for the lowest tertile compared with -4.45 (95% CI, -2.31 to -6.59) for the highest tertile, but for those with at least a high school diploma, 3MS score decline was -4.60 (95% CI,-3.07 to -6.13) for the lowest tertile and -2.88 (95% CI,-1.41 to -4.35) for the highest tertile (P = .004 for interaction). Interactions were also observed for literacy (P = .005) and for APOE e4 allele (P = .02). CONCLUSION Lower plasma β-amyloid 42/40 is associated with greater cognitive decline among elderly persons without dementia over 9 years, and this association is stronger among those with low measures of cognitive reserve.
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Affiliation(s)
- Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
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Lewis TT, Sutton-Tyrrell K, Penninx BW, Vogelzangs N, Harris TB, Vaidean GD, Ayonayon HN, Kim L, Lakatta EG, Newman AB. Race, psychosocial factors, and aortic pulse wave velocity: the Health, Aging, and Body Composition Study. J Gerontol A Biol Sci Med Sci 2010; 65:1079-85. [PMID: 20522528 DOI: 10.1093/gerona/glq089] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Increasingly, researchers have begun to explore pathways through which psychosocial factors might influence cardiovascular disease, with some emphasis on early markers. The current study examined the cross-sectional association between psychosocial factors and aortic pulse wave velocity (an early marker of cardiovascular disease) in a biracial cohort of older adults. We were particularly interested in determining whether the association between psychosocial factors and aortic pulse wave velocity differed for older blacks compared with whites. METHODS Participants were 2,488 (40% black and 52% female) older adults from the Health, Aging, and Body Composition Study. Carotid-femoral aortic pulse wave velocity was assessed using standard methodologies. Depressive symptoms, anxiety symptoms, negative life events, and inadequate emotional support were assessed, and a summary psychosocial risk index was created. RESULTS In multivariable linear regression models, psychosocial risk was not associated with aortic pulse wave velocity (Estimate [Est] = .00, p = .83), but there was a significant Race × Psychosocial risk interaction (Est = .07, p = .01), after adjusting for age, race, sex, and education. Further analyses revealed that this association was driven by the inadequate emotional support component of psychosocial risk (Race × Inadequate emotional support, p = .005). In race-stratified analyses, inadequate emotional support was associated with higher levels of arterial stiffness in older blacks (Est = .05, p = .04) but not whites (Est = -.04, p = .13). This association persisted after adjusting for demographics, cardiovascular risk factors, and social network characteristics. CONCLUSIONS Findings suggest that older blacks may be particularly vulnerable to the effects of inadequate emotional support on vascular health. Interventions aimed at increasing social support among this population might be beneficial in reducing cardiovascular disease risk.
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Affiliation(s)
- Tené T Lewis
- Department of Epidemiology and Public Health, Yale University, New Haven, Connecticut, USA.
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Yaffe K, Lindquist K, Vittinghoff E, Barnes D, Simonsick EM, Newman A, Satterfield S, Rosano C, Rubin SM, Ayonayon HN, Harris T. The effect of maintaining cognition on risk of disability and death. J Am Geriatr Soc 2010; 58:889-94. [PMID: 20406308 DOI: 10.1111/j.1532-5415.2010.02818.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether long-term maintenance of cognition is associated with health advantages such as lower mortality or incident disability in older adults. DESIGN Longitudinal cohort study. SETTING Community clinics at two sites. PARTICIPANTS Two thousand seven hundred thirty-three adults with a mean age of 74 at baseline and 80 at follow-up. MEASUREMENTS Cognitive function was assessed using the Modified Mini-Mental State Examination (3MS), a test of global cognition, at least two times. Three cognitive groups were defined based on 4-year participant-specific slopes (maintainers, slopes of >or=0; minor decliners, slopes <0 but no more than 1 standard deviation (SD) below the mean; major decliners, slopes >1 SD below the mean). Whether the cognitive groups differed in mortality and incident disability during the subsequent 3 years was determined. RESULTS Nine hundred eighty-four (36%) participants were maintainers, 1,314 (48%) were minor decliners, and 435 (16%) were major decliners. Maintainers had lower mortality (7% vs 14%, hazard ratio (HR)=0.48, 95% confidence interval (CI)=0.36-0.63) and incident disability (22% vs 29%, HR=0.74, 95% CI=0.62-0.89) than minor decliners. After adjustment for age, race, sex, education, apolipoprotein E epsilon4, depression, body mass index, stroke, hypertension, and diabetes mellitus, these differences remained. As expected, major decliners had greater mortality (20%) and incident disability (40%) than minor decliners. CONCLUSION A substantial proportion of older adults maintain cognitive function in their eighth and ninth decades of life. These older adults demonstrate lower risk of death and functional decline than those with minor cognitive decline, supporting the concept of "successful" cognitive aging.
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Affiliation(s)
- Kristine Yaffe
- Department of Psychiatry, University of California at San Francisco, San Francisco, California 94121, USA.
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Yaffe K, Lindquist K, Kluse M, Cawthon R, Harris T, Hsueh WC, Simonsick EM, Kuller L, Li R, Ayonayon HN, Rubin SM, Cummings SR. Telomere length and cognitive function in community-dwelling elders: findings from the Health ABC Study. Neurobiol Aging 2009; 32:2055-60. [PMID: 20031273 DOI: 10.1016/j.neurobiolaging.2009.12.006] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/04/2009] [Accepted: 12/08/2009] [Indexed: 10/20/2022]
Abstract
Telomere shortening is a marker of cellular aging and has been associated with risk of Alzheimer's disease. Few studies have determined if telomere length is associated with cognitive decline in non-demented elders. We prospectively studied 2734 non-demented elders (mean age: 74 years). We measured cognition with the Modified Mini-Mental State Exam (3MS) and Digit Symbol Substitution Test (DSST) repeatedly over 7 years. Baseline telomere length was measured in blood leukocytes and classified by tertile as "short", "medium", or "long". At baseline, longer telomere length was associated with better DSST score (36.4, 34.9 and 34.4 points for long, medium and short, p<0.01) but not for change in score. However, 7-year 3MS change scores were less among those with longer telomere length (-1.7 points vs. -2.5 and -2.9, p=0.01). Findings were similar after multivariable adjustment for age, gender, race, education, assay batch, and baseline score. There was a borderline statistically significant interaction for telomere length and APOE e4 on 3MS change score (p=0.06). Thus, telomere length may serve as a biomarker for cognitive aging.
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Affiliation(s)
- Kristine Yaffe
- Department of Psychiatry, School of Medicine, University of California, San Francisco, CA 94143, USA.
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Maraldi C, Harris TB, Newman AB, Kritchevsky SB, Pahor M, Koster A, Satterfield S, Ayonayon HN, Fellin R, Volpato S. Moderate alcohol intake and risk of functional decline: the Health, Aging, and Body Composition study. J Am Geriatr Soc 2009; 57:1767-75. [PMID: 19737328 DOI: 10.1111/j.1532-5415.2009.02479.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the prospective relationship between alcohol consumption and incident mobility limitation. DESIGN Cohort study. SETTING The Health Aging and Body Composition study, conducted in Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS Three thousand sixty-one adults aged 70 to 79 without mobility disability at baseline. MEASUREMENTS Incidence of mobility limitation, defined as self-report at two consecutive semiannual interviews of any difficulty walking one-quarter of a mile or climbing stairs, and incidence of mobility disability, defined as severe difficulty or inability to perform these tasks at two consecutive reports. Alcohol intake, lifestyle-related variables, diseases, and health status indicators were assessed at baseline. RESULTS During a follow-up time of 6.5 years, participants consuming moderate levels of alcohol had the lowest incidence of mobility limitation (total: 6.4 per 100 person-years (person-years); men: 6.4 per 100 person-years; women: 7.3 per 100 person-years) and mobility disability (total: 2.7 per 100 person-years; men: 2.5 per 100 person-years; women: 2.9 per 100 person-years). Adjusting for demographic characteristics, moderate alcohol intake was associated with lower risk of mobility limitation (hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.55-0.89) and mobility disability (HR=0.66, 95% CI=0.45-0.95) than never or occasional consumption. Additional adjustment for lifestyle-related variables substantially reduced the strength of the associations (HR=0.85, 95% CI=0.66-1.08 and HR=0.81, 95% CI=0.56-1.18, respectively). Adjustment for diseases and health status indicators did not affect the strength of the associations, suggesting that lifestyle is most important in confounding this relationship. CONCLUSION Lifestyle-related characteristics mainly accounted for the association between moderate alcohol intake and lower risk of functional decline over time. These findings do not support a direct causal effect of alcohol intake on physical function.
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Affiliation(s)
- Cinzia Maraldi
- Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology and Geriatric, University of Ferrara, Ferrara, Italy.
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Yaffe K, Fiocco AJ, Lindquist K, Vittinghoff E, Simonsick EM, Newman AB, Satterfield S, Rosano C, Rubin SM, Ayonayon HN, Harris TB. Predictors of maintaining cognitive function in older adults: the Health ABC study. Neurology 2009; 72:2029-35. [PMID: 19506226 DOI: 10.1212/wnl.0b013e3181a92c36] [Citation(s) in RCA: 237] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although several risk factors for cognitive decline have been identified, much less is known about factors that predict maintenance of cognitive function in advanced age. METHODS We studied 2,509 well-functioning black and white elders enrolled in a prospective study. Cognitive function was measured using the Modified Mini-Mental State Examination at baseline and years 3, 5, and 8. Random effects models were used to classify participants as cognitive maintainers (cognitive change slope > or = 0), minor decliners (slope < 0 and > 1 SD below mean), or major decliners (slope < or = 1 SD below mean). Logistic regression was used to identify domain-specific factors associated with being a maintainer vs a minor decliner. RESULTS Over 8 years, 30% of the participants maintained cognitive function, 53% showed minor decline, and 16% had major cognitive decline. In the multivariate model, baseline variables significantly associated with being a maintainer vs a minor decliner were age (odds ratio [OR] = 0.65, 95% confidence interval [CI] 0.55-0.77 per 5 years), white race (OR = 1.72, 95% CI 1.30-2.28), high school education level or greater (OR = 2.75, 95% CI 1.78-4.26), ninth grade literacy level or greater (OR = 4.85, 95% CI 3.00-7.87), weekly moderate/vigorous exercise (OR = 1.31, 95% CI 1.06-1.62), and not smoking (OR = 1.84, 95% CI 1.14-2.97). Variables associated with major cognitive decline compared to minor cognitive decline are reported. CONCLUSION Elders who maintain cognitive function have a unique profile that differentiates them from those with minor decline. Importantly, some of these factors are modifiable and thus may be implemented in prevention programs to promote successful cognitive aging. Further, factors associated with maintenance may differ from factors associated with major cognitive decline, which may impact prevention vs treatment strategies.
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Affiliation(s)
- K Yaffe
- Department of Psychiatry, School of Medicine, University of California, San Francisco, 4150 Clement St., San Francisco, CA 94117, USA
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Spencer SM, Schulz R, Rooks RN, Albert SM, Thorpe RJ, Brenes GA, Harris TB, Koster A, Satterfield S, Ayonayon HN, Newman AB. Racial differences in self-rated health at similar levels of physical functioning: an examination of health pessimism in the health, aging, and body composition study. J Gerontol B Psychol Sci Soc Sci 2009; 64:87-94. [PMID: 19176485 DOI: 10.1093/geronb/gbn007] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The health pessimism hypothesis suggests that Black elders are more pessimistic about health than Whites and therefore tend to report lower self-rated health (SRH) at comparable health status. The current analysis examined the factors associated with SRH and tested the health pessimism hypothesis among older adults at similar levels of physical functioning. METHODS The study example included 2,729 Health, Aging, and Body Composition study participants aged 70-79 years. We used hierarchical logistic regression to examine the association between race and SRH while adjusting for demographic, physical health, and psychosocial factors. The analyses were repeated for participants at similar levels of objective functioning to test the health pessimism hypothesis. RESULTS The association between race and SRH remained independent of physical and psychosocial health variables, with Whites being 3.7 times more likely than Black elders to report favorable SRH. This association was significant at each level of physical functioning and greater at the higher (odds ratio [OR] = 5.5) versus lower (OR = 2.2) levels of functioning. CONCLUSIONS The results suggest greater health pessimism among Black elders and expand previous work by including objective functioning in multidimensional models to deconstruct race variations in the SRH of older adults.
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Affiliation(s)
- S Melinda Spencer
- Department of Health Promotion, Education, and Behavior and the Institute for Southern Studies, University of South Carolina, Columbia, 29208, USA.
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Catov JM, Newman AB, Sutton-Tyrrell K, Harris TB, Tylavsky F, Visser M, Ayonayon HN, Ness RB. Parity and cardiovascular disease risk among older women: how do pregnancy complications mediate the association? Ann Epidemiol 2008; 18:873-9. [PMID: 19041585 PMCID: PMC2614660 DOI: 10.1016/j.annepidem.2008.09.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 09/05/2008] [Accepted: 09/30/2008] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine whether parity is associated with increased risk of cardiovascular disease (CVD) after accounting for perinatal complications. METHODS CVD prevalence, number of births, and a history of preeclampsia, term low birth weight, preterm or stillbirth were evaluated among 540 women (mean age, 80 years; 47% black) enrolled in the Pittsburgh, PA site of the Health, Aging and Body Composition Study. Biomarkers were measured and CVD status was determined by self-report and hospital records. RESULTS Nulliparous women (n = 89) had lower CVD prevalence compared with parous women (18.0% vs. 30.2%). Parous women without perinatal complications of interest (n = 321) had higher statin use compared with nulliparas, a trend accompanied by lower high-density lipoprotein (HDL) and higher triglycerides among women with perinatal complications (n = 130). After adjustment, parous women with no complicated births had a 1.95-fold (95% confidence interval [CI], 1.03-3.7) higher CVD prevalence compared to nulliparas. Among women with one or more pregnancy complications, CVD prevalence was 2.67 times (CI, 1.34-5.33) higher. Women with five or more births had the highest CVD prevalence (odds ratio [OR], 2.60; CI, 1.17-5.76) that was attenuated to 2.27 (1.00-5.15) after adjustment for complications of interest. CONCLUSIONS History of pregnancy complications and higher statin use accounted for some but not all of the excess CVD prevalence among older parous women.
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Affiliation(s)
- Janet M Catov
- University of Pittsburgh, Department of Obstetrics, Gynecology & Reproductive Sciences, Pittsburgh PA 15213, USA.
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Fredman L, Cauley JA, Satterfield S, Simonsick E, Spencer SM, Ayonayon HN, Harris TB. Caregiving, mortality, and mobility decline: the Health, Aging, and Body Composition (Health ABC) Study. ACTA ACUST UNITED AC 2008; 168:2154-62. [PMID: 18955646 DOI: 10.1001/archinte.168.19.2154] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Although caregivers report more stress than noncaregivers, few studies have found greater health decline in older caregivers. We hypothesized that caregivers may be more physically active than noncaregivers, which may protect them from health decline. METHODS The sample included 3075 healthy adults from the Health, Aging, and Body Composition (Health ABC) Study. They were aged 70 to 79 years in April 1997 to June 1998 and resided in Memphis, Tennessee, or Pittsburgh, Pennsylvania. Caregivers (680 [22.1%]) were participants who provided regular care or assistance for a child or a disabled or sick adult. Outcomes included all-cause mortality and incident mobility limitation (defined as difficulty walking one-quarter mile or climbing 10 steps on 2 consecutive semiannual contacts) during 8 years. Total physical activity included daily routine, exercise, and caregiving activity. RESULTS Overall, 20.6% of caregivers died and 50.9% developed mobility limitations vs 22.0% and 48.9% of noncaregivers, respectively. Associations differed by race and sex. Mortality and mobility limitation rates were 1.5 times higher in white caregivers (eg, among white female caregivers, adjusted hazard ratio for mortality, 1.6; 95% confidence interval, 1.0-2.5) but not for black female caregivers vs noncaregivers (adjusted hazard ratio for mortality, 0.9; 95% confidence interval, 0.5-1.4). Physical activity mediated these associations in most race-sex groups. High-intensity caregivers (ie, caregiving > or =24 hours per week) had elevated rates of decline when adjusted for physical activity but lower rates when not adjusted for activity. CONCLUSION Older white caregivers have poorer health outcomes than black female caregivers. Physical activity appears to mask the adverse effects of high-intensity caregiving in most race-sex groups.
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Affiliation(s)
- Lisa Fredman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
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Mast BT, Miles T, Penninx BW, Yaffe K, Rosano C, Satterfield S, Ayonayon HN, Harris T, Simonsick EM. Vascular disease and future risk of depressive symptomatology in older adults: findings from the Health, Aging, and Body Composition study. Biol Psychiatry 2008; 64:320-6. [PMID: 18367153 DOI: 10.1016/j.biopsych.2008.01.025] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 01/10/2008] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND The vascular depression hypothesis suggests that age-related vascular diseases and risk factors contribute to late-life depression. Although neuroimaging studies provide evidence for an association between depression and severity of vascular lesions in the brain, studies of depression and indicators of vascular risk have been less consistent. METHODS We examined 1796 elders ages 70-79 from the Health, Aging and Body Composition study without depression at baseline and examined the association between prevalent vascular disease and related conditions at baseline and 2-year incidence of elevated depressive symptoms, defined as a score > 8 on the 10-item Center for Epidemiologic Studies Depression (CES-D) scale. RESULTS After adjustment for demographic data and physical and cognitive functioning, several vascular conditions remained associated with increased risk of depressive symptomatology including metabolic syndrome and its components (low high-density lipoprotein cholesterol and high fasting glucose), coronary heart disease, a positive Rose questionnaire for angina, and high hemoglobin a1c. Cumulative vascular risk based upon a composite of 10 vascular diseases and risk factors was independently associated with incident elevated depression at 2-year follow-up after controlling for demographic data, physical and cognitive functioning, and selected comorbid medical conditions. CONCLUSIONS These results provide support for the vascular depression hypothesis in demonstrating an association between vascular conditions and risk factors and subsequent risk of depressive symptomatology. Older adults with vascular conditions and risk factors require close monitoring of depressive symptoms.
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Affiliation(s)
- Benjamin T Mast
- Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA.
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Rooks RN, Simonsick EM, Klesges LM, Newman AB, Ayonayon HN, Harris TB. Racial disparities in health care access and cardiovascular disease indicators in Black and White older adults in the Health ABC Study. J Aging Health 2008; 20:599-614. [PMID: 18625758 DOI: 10.1177/0898264308321023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Black adults consistently exhibit higher rates of and poorer health outcomes due to cardiovascular disease (CVD) than other racial groups, independent of differences in socioeconomic status (SES). Whether factors related to health care access can further explain racial disparities in CVD has not been thoroughly examined. METHOD Using logistic regression, the authors examined racial and health care (i.e., health insurance and access to care) associations with CVD indicators (i.e., hypertension, low ankle-arm index, and left ventricular hypertrophy) in the Health, Aging, and Body Composition Study, a longitudinal study of well-functioning older adults. RESULTS Older Black versus White adults had significantly worse health care. Overall, health care reduced the significant association between being Black and CVD only slightly, while race remained strongly associated with CVD after adjusting for demographics, SES, body mass index, and comorbidity. DISCUSSION Research on health care quality may contribute to our understanding of these disparities.
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Affiliation(s)
- Ronica N Rooks
- Department of Health and Behavioral Sciences, University of Colorado Denver, P.O. Box 173364, CB 188, Denver, CO 80217-3364, USA.
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Maraldi C, Volpato S, Penninx BW, Yaffe K, Simonsick EM, Strotmeyer ES, Cesari M, Kritchevsky SB, Perry S, Ayonayon HN, Pahor M. Diabetes mellitus, glycemic control, and incident depressive symptoms among 70- to 79-year-old persons: the health, aging, and body composition study. ACTA ACUST UNITED AC 2007; 167:1137-44. [PMID: 17563021 DOI: 10.1001/archinte.167.11.1137] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Cross-sectional studies find an elevated prevalence of depression among subjects with diabetes mellitus (DM). The causal mechanisms and temporal sequence of this association have not been clearly delineated. This study investigated the prospective relationship between DM and depressive symptoms. METHODS The Health, Aging, and Body Composition Study was a cohort study conducted in the metropolitan areas of Memphis, Tenn, and Pittsburgh, Pa. The analysis included 2522 community-dwelling subjects, aged 70 to 79 years, without baseline depressive symptoms. Incident depressed mood was defined as use of antidepressants at follow-up visits or presence of depressive symptoms (score >or=10 on the 10-item Center for Epidemiological Studies Depression scale). Presence of incident depressed mood at 2 consecutive annual clinic visits defined the incidence of recurrent depressed mood. Diabetes mellitus status, glycosylated hemoglobin (HbA1c) level, and DM-related comorbidities were assessed at baseline. Diabetes mellitus status was further characterized as absent, controlled (HbA1c level <7%), or uncontrolled (HbA1c level >or=7%). Discrete time survival analysis was used to estimate depressive events risk. RESULTS During a mean follow-up of 5.9 years, participants with DM had a higher age-, sex-, race-, and site-adjusted incidence of depressed mood (23.5% vs 19.0%) (P = .02) and recurrent depressed mood (8.8% vs 4.3%) (P<.001) than those without DM. Diabetes mellitus was associated with a 30% increased risk of incident depressed mood (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.07-1.61), which was attenuated after adjustment for DM-related comorbidities (OR, 1.20; CI, 0.97-1.48). A stronger relationship was observed between DM and recurrent depressed mood (OR, 1.91; CI, 1.32-2.76), particularly among participants with poor glycemic control. CONCLUSION Among well-functioning older adults, DM is associated with increased risk of depressive symptoms.
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Faulkner KA, Redfern MS, Cauley JA, Landsittel DP, Studenski SA, Rosano C, Simonsick EM, Harris TB, Shorr RI, Ayonayon HN, Newman AB. Multitasking: Association Between Poorer Performance and a History of Recurrent Falls. J Am Geriatr Soc 2007; 55:570-6. [PMID: 17397436 DOI: 10.1111/j.1532-5415.2007.01147.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the association between poorer performance on concurrent walking and reaction time and recurrent falls. DESIGN Cross-sectional analysis. SETTING Community. PARTICIPANTS Three hundred seventy-seven older community-dwelling adults (mean age+/-standard deviation 78+/-3). MEASUREMENTS Reaction times on push-button and visual-spatial decision tasks were assessed while seated and while walking a 20-m course (straight walk) and a 20-m course with a turn at 10 m (turn walk). Walking times were recorded while walking only and while performing a reaction-time response. Dual-task performance was calculated as the percentage change in task times when done in dual-task versus single-task conditions. A history of recurrent falls (> or = 2 vs < or = 1 falls) in the prior 12 months was self-reported. Multivariate logistic regression models were used to predict the standardized odds ratios (ORs) of recurrent falls history. The standardized unit for dual-task performance ORs was interquartile range/2. RESULTS On the push-button task during the turn walk, poorer reaction time response (slower) was associated with 28% lower (P=.04) odds of recurrent fall history. On the visual-spatial task, poorer walking-time response (slower) was associated with 34% (P=.02) and 42% (P=.01) higher odds of recurrent falls history on the straight and turn walks, respectively. CONCLUSION These findings suggest that walking more slowly in response to a visual-spatial decision task may identify individuals at risk for multiple falls. Prospective studies are needed to confirm the prognostic value of poor walking responses in a dual-task setting for multiple falls.
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Affiliation(s)
- Kimberly A Faulkner
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Mehta KM, Yaffe K, Brenes GA, Newman AB, Shorr RI, Simonsick EM, Ayonayon HN, Rubin SM, Covinsky KE. Anxiety symptoms and decline in physical function over 5 years in the health, aging and body composition study. J Am Geriatr Soc 2007; 55:265-70. [PMID: 17302665 PMCID: PMC2939733 DOI: 10.1111/j.1532-5415.2007.01041.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the relationship between anxiety and functional decline. DESIGN A 5-year longitudinal cohort study of well-functioning adults. SETTING The Health, Aging and Body Composition (Health ABC) Study. PARTICIPANTS Two thousand nine hundred forty adults aged 70 to 79 (48% male, 41% black), initially free of self-reported mobility difficulty. MEASUREMENTS In 1997/98, presence of three anxiety symptoms (feeling fearful, tense or keyed up, or shaky or nervous) from the Hopkins Symptom Checklist were ascertained. Physical function was examined over 5 years using the Health ABC performance battery (continuous range 0-4) consisting of chair stands, usual and narrow course gait speed, and difficulty with standing balance and self-reported mobility, defined as difficulty walking one-quarter of a mile or difficulty climbing 10 steps. RESULTS Participants with anxiety symptoms had similar baseline physical performance scores. After adjustment for potential confounders, subjects with anxiety symptoms had similar declines in physical performance over 5 years as participants without anxiety symptoms. Adults with anxiety symptoms were more likely to report incident mobility difficulty, with a hazard ratio of 1.4 (95% confidence interval=1.3-1.6), compared with adults without anxiety symptoms. These results persisted after adjustment for depressive symptoms, demographics, comorbidity, and use of antianxiety, depressant, and sedative hypnotic medications. CONCLUSION Anxiety symptoms are not associated with declines in objectively measured physical performance over 5 years but are associated with declines in self-reported functioning. Future studies are needed to determine why anxiety has a differential effect on performance-based and self-reported measures of functioning.
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Affiliation(s)
- Kala M Mehta
- Division of Geriatrics, Department of Psychiatry, University of California at San Francisco, San Francisco, California, USA.
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Brenes GA, Kritchevsky SB, Mehta KM, Yaffe K, Simonsick EM, Ayonayon HN, Rosano C, Rubin SM, Satterfield S, Penninx BWJH. Scared to death: results from the Health, Aging, and Body Composition study. Am J Geriatr Psychiatry 2007; 15:262-5. [PMID: 17322138 PMCID: PMC2879643 DOI: 10.1097/jgp.0b013e31802e21f0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study is to determine if anxiety is associated with mortality and if race moderates and depression mediates this relationship. METHOD Participants are 3,015 adults aged 70-79 years. RESULTS Anxiety symptoms were significant predictors of all-cause, cardiovascular, and noncardiovascular mortality among blacks but not whites. Depression was not related to mortality. CONCLUSIONS Although the mechanisms that underlie the relationship between anxiety and mortality are unknown, routine assessment of anxiety symptoms in clinical practice, particularly in black older adults, seems prudent.
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Affiliation(s)
- Gretchen A Brenes
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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