Comparison of the Physical Function Trajectories in Three Birth Cohorts of Chinese Older Adults: A 14-Year Longitudinal Study

OBJECTIVES

It remains uncertain whether the favorable trend of reduction in physical disabilities has become reversed in the recent-born cohorts of older adults. This study aimed to compare the rate of decline with time in self-reported Instrumental Activity of Daily Living (IADL) difficulties, objective measurement of gait speed and grip strength, in three birth cohorts of Chinese older adults.

DESIGN

A prospective cohort study.

SETTING AND PARTICIPANTS

Four thousand Chinese older adults aged 65 years or above in three birth cohorts (1934-1938, 1929-1933, 1905-1928) were recruited from the community in Hong Kong.

MEASUREMENTS

Grip strength, gait speed and IADL difficulties were measured between 2001 to 2017. Joint models were used to examine the trajectories of grip strength, gait speed and IADL difficulties over time, and the interaction effect of age-by-cohort (or also age2-by-cohort) was also examined.

RESULTS

The recently born cohort (1934 - 1938) had worse grip strength and more IADL difficulties at the same age than the earlier two cohorts (1929 - 1933; 1905 - 1928). Furthermore, the most recently born cohort also followed a more rapid decline longitudinally with a greater decline observed in gait speed, grip strength and IADL difficulties for women whereas a greater decline in grip strength and IADL difficulties for men.

CONCLUSIONS

The continuous improvement of physical limitations in old age may have halted and there appears to be a reversal of this favourable trend in the recent born cohort of older adults living in Hong Kong.

How Dietary Patterns are Related to Inflammaging and Mortality in Community-Dwelling Older Chinese Adults in Hong Kong - A Prospective Analysis

INTRODUCTION

Studies examining dietary patterns and inflammageing in relation to mortality are limited.

OBJECTIVE

We examined the influence of various dietary patterns on all-cause and cardiovascular disease (CVD) mortality, taking into account demographics, lifestyle factors, and serum inflammatory markers.

METHODS

We conducted multivariate Cox regression analyses using data from a cohort of community-dwelling older Chinese adults (1,406 men, 1,396 women) in Hong Kong. Baseline interviewer administered questionnaires covered dietary intake estimation and dietary pattern generation from the food frequency questionnaire, demographic and lifestyle factors, cognitive function and depressive symptoms. Serum high-sensitivity C-reactive protein (hsCRP) and 25-hydroxyvitamin D (25OHD) were measured. All-cause and CVD mortality data at 14-year follow up were retrieved from an official database.

RESULTS

In men, higher hsCRP level was associated with lower Diet Quality Index-International (DQI-I) score, Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND) score, Okinawan diet score, "vegetables-fruits" pattern score and "snacks-drinks-milk" pattern score. Higher serum 25OHD level was associated with higher Mediterranean Diet Score (MDS) but lower "snacks-drinks-milk" pattern score. None of the dietary pattern scores was associated with all-cause or CVD mortality after adjusting for all covariates. In women, hsCRP level and serum 25OHD level were not associated with any dietary patterns. Higher DQI-I score (HR=0.77 (95% CIs: 0.59, 0.99) highest vs. lowest tertile, p-trend=0.038) and Okinawan diet score (HR=0.78 (95% CIs: 0.61, 1.00) highest vs lowest tertile, p-trend=0.046) was associated with a lower risk of all-cause mortality, whereas higher MIND score (HR=0.63 (95% CI: 0.36, 1.09) highest vs. lowest tertile, p-trend=0.045) was associated with a reduced risk of CVD morality in the multivariate adjusted model.

CONCLUSION

Higher DQI-I score and Okinawan diet score were associated with a lower risk of all-cause mortality, and higher adherence to the MIND diet was related to a reduced risk of CVD mortality in community-dwelling Chinese older women.

Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: an age-period-cohort analysis

Background

there is little evidence to suggest that older people today are living in better health than their predecessors did at the same age. Only a few studies have evaluated whether there are birth cohort effects on frailty, an indicator of health in older people, encompassing physical, functional and mental health dimensions.

Objectives

this study examined longitudinal trajectories of frailty among Chinese older people in Hong Kong.

Methods

this study utilised data from the 18 Elderly Health Centres of the Department of Health comprising a total of 417,949 observations from 94,550 community-dwelling Chinese people aged ≥65 years in one early birth cohort (1901-23) and four later birth cohorts (1924-29, 1930-35, 1936-41, 1942-47) collected between 2001 and 2012, to examine trajectories of the frailty index and how birth cohorts may have contributed to the trends using an age-period-cohort analysis.

Results

more recent cohorts had higher levels of frailty than did earlier cohorts at the same age, controlling for period, gender, marital status, educational levels, socioeconomic status, lifestyle and social factors. Older age, being female, widowhood, lower education and smoking were associated with higher levels of frailty.

Conclusion

more recent cohorts had higher levels of frailty than did earlier cohorts. Frailty interventions, coupled with early detection, should be developed to combat the increasing rates of frailty in Hong Kong Chinese.

Diabetes in older people: position statement of The Hong Kong Geriatrics Society and the Hong Kong Society of Endocrinology, Metabolism and Reproduction

Following a survey on the clinical practice of geriatricians in the management of older people with diabetes and a study of hypoglycaemia in diabetic patients, a round-table discussion with geriatricians and endocrinologists was held in January 2015. Consensus was reached for six domains specifically related to older diabetic people: (1) the considerations when setting an individualised diabetic management; (2) inclusion of geriatric syndrome screening in assessment; (3) glycaemic and blood pressure targets; (4) pharmacotherapy; (5) restrictive diabetic diet; and (6) management goals for nursing home residents.

Trends in activities of daily living disability in a large sample of community-dwelling Chinese older adults in Hong Kong: an age-period-cohort analysis

BACKGROUND

To examine the trends in activities of daily living (ADL) disability in older Chinese adults in Hong Kong between 2001 and 2012.

METHODS

Using data from the Elderly Health Centres (EHCs) of the Department of Health comprising a total of 54 808 community-dwelling Chinese adults aged ≥65 years in 1 early cohort (1904-1917) and 10 3-year birth cohorts (1918-1920, 1921-1923, 1924-1926, 1927-1929, 1930-1932, 1933-1935, 1936-1938, 1939-1941, 1942-1944, 1945-1947), we examined trends in ADL disability by using age-period-cohort (APC) models. ADL disability was defined as being unable to perform at least 1 of 7 ADL activities (bathing, dressing, toileting, transferring, feeding, grooming, walking) independently. Cross-classified random-effects logistic regressions were performed for each of the APC trends with adjustment for age, period, cohort, sociodemographic, lifestyle, comorbidity and self-rated health.

RESULTS

The mean age of the cohort was 70.9±4.7 (range 65-99) years. The prevalence rate of ADL disability was 1.6%. ADL disability increased with age (p<0.001) and the gradient of the increase was steeper in the older age groups. At the same age, women (1.7%) were more likely to report ADL disability than men (1.4%, p=0.001). For both genders, there was an increase in ADL disability between 2003 and 2012; adjustment for age, cohort and other covariates has diminished the trends observed among men. There was no cohort effect in ADL disability.

CONCLUSIONS

ADL disability in older adults has increased over the last decade. Further study is required to identify possible causes behind the disability trends.

The selection of a screening test for frailty identification in community-dwelling older adults

BACKGROUND

Frailty in older Chinese has been less often studied and the selection of one screening test feasible in primary care and population survey is needed. We attempted to examine the sensitivity and specificity of each of the five Fried's criteria as a single screening test in the identification of frailty.

METHODS

We recruited 4000 community-dwelling Chinese adults 65 years or older stratified by 3 age-stratum and identified frailty as having 3 or more of Fried's criteria: underweight(BMI<18.5), handgrip strength(

RESULTS

The proportion of frailty in the 3 age groups (65-69 years, 70-74 years, 75 years and above) were 2.3%, 3.4% and 11.9% respectively in men and 1.4%, 2.6% and 11.6% in women. Among the 5 criteria, walking speed, grip strength and physical activity (PASE score) divided at their respective lowest quintile values, achieved similar Area Under Curve in the Receiver Operating Characteristics analysis. For walking speed, the sensitivity and specificity were 82.7% and 83.1% in men and 91.9% and 84.5% in women respectively. For grip strength, the corresponding values were 89.5% and 80.6% in men; and 84.5% and 81.9% in women. For physical activity, they were 83.7% and 83.5% in men; and 82.8% and 84.7% in women.

CONCLUSION

Either walking speed or grip strength measurement may be suitable for frailty screening in primary care or population health survey. A cut-off value of 0.9 m/s in walking speed and 28 kg in grip strength for older men; and a corresponding value of 0.8 m/s and 18 kg for older women is recommended for the screening of frailty in community-dwelling older Chinese adults.

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MESH Headings

• Aged
• Asian People
• Body Mass Index
• Fatigue
• Female
• Frail Elderly
• Geriatric Assessment/methods
• Hand Strength
• Humans
• Male
• Prospective Studies
• ROC Curve
• Socioeconomic Factors
• Thinness
• Walking

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Affiliation(s)

T W Auyeung Tung Wai Auyeung, The S. H. Ho Centre for Gerontology and Geriatrics, The Chinese University of Hong Kong, Department of Medicine and Geriatrics, Pok Oi Hospital, Au Tau, NT, Hong Kong, Email : , Telephone: 852 24868985, Fax: 852 24868976
J S W Lee
J Leung
T Kwok
J Woo

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Physical frailty predicts future cognitive decline - a four-year prospective study in 2737 cognitively normal older adults

OBJECTIVE

To examine the association between baseline frailty measurements and cognitive function 4 years later.

DESIGN

Prospective observational study.

SETTING

Community.

PARTICIPANTS

Two thousand seven hundred and thirty seven cognitively normal older adults.

MEASUREMENT

The appendicular muscle mass (ASM), hand grip strength, timed chair-stand test, walking speed and step length were measured at baseline. The Mini-mental state examination (MMSE) was administered at baseline and 4 years later.

RESULTS

In men, all baseline frailty measurements, namely, being underweight, lower ASM, weaker grip strength, slower chair-stand test, shorter step length, slower timed walk were significantly associated with a lower MMSE score 4 years afterwards. After adjustment for age, years of education and baseline MMSE score, ASM and timed walk became insignificant. In women, all frailty measurements except underweight and low ASM were significantly associated with MMSE score 4 years later. Moreover, only weaker grip strength persisted to be significant after adjustment for age, years of education and baseline MMSE score.

CONCLUSION

Physical frailty, as represented by being underweight, weaker grip strength, slower chair-stand test, shorter step-length in men and weaker grip strength in women, was associated with cognitive decline over a four year period.

The effect of diabetes mellitus on age-associated lean mass loss in 3153 older adults

AIMS

Diabetes mellitus may be associated with excessive lean mass loss. Other diabetes-related conditions may also play a role. We assessed body composition changes associated with diabetes in older adults with adjustment for diabetes-related co-morbidities.

METHODS

Three thousand, one hundred and fifty-three community-living adults aged ≥ 65 years were examined for lifestyle factors, diabetes-related medical conditions and body composition by dual energy X-ray absorptiometry at baseline and 4 years later. Body composition changes were compared between participants with diabetes and those without diabetes. Multivariate linear regression was used to examine the relationship between appendicular lean mass loss and confounders.

RESULTS

Appendicular lean mass loss in men with diabetes was two times that of men without diabetes (-1.5% in 'no diabetes' vs. -3.0% in 'diabetes') and in women with diabetes was 1.8 times that of those without diabetes (-1.9% in 'no diabetes' vs. -3.4% in 'diabetes') over 4 years. Men with diabetes also had higher total body mass loss and higher total body fat loss than men without diabetes. Women with diabetes had higher total body mass loss but total body fat loss was similar. After adjusting for age, body mass index, diabetes-related conditions, lifestyle factors and total body mass loss, diabetes remained an independent predictor of appendicular lean mass loss in both men and women.

CONCLUSION

Diabetes was associated with higher body mass loss and higher appendicular lean mass loss in older adults. In men, diabetes was also associated with total body fat loss.

Estimation of stature by measuring fibula and ulna bone length in 2443 older adults

Estimation of Stature by Measuring Fibula and Ulna Bone Length in 2443 Older Adults.

OBJECTIVES

Knee height has been commonly used to estimate stature but may not always be possible in the frail older adults with compromised posture. Measurement of fibula and ulna bone length could be an alternative method. We attempted to develop and validate regression models to predict measured and reported height using age, fibula length, ulna length, hip circumferences and body weight.

DESIGN

A cross-sectional survey.

SETTING

The study was conducted in the Jockey Club Centre for Osteoporosis Care and Control, School of Public Health, The Chinese University of Hong Kong.

PARTICIPANTS

Two thousand four hundred and forty three community-dwelling older Chinese aged from 65 to 98 years were recruited.

MEASUREMENTS

The standing height, fibula length, ulna length, hip circumference and body weight were measured and the reported height was recorded. Three separate multiple linear regression models were developed to predict measured-height and reported-height respectively.

RESULTS

In predicting measured-height by the bone-length model, the mean errors were +0.52 cm (over-estimation) in men and +0.45 cm (over-estimation) in women and the SDs were +/- 3.5 cm in both genders. The 95% limits of agreement were: -6.65 to +7.70 cm for men and -6.59 to +7.49 cm for women.

CONCLUSION

The accuracy and precision of stature estimation by fibula and ulna bone length is comparable to that by knee height. This may be an acceptable alternative method when knee height measurement is difficult or when the knee height caliper is not available.

A case of oral myiasis due to Chrysomya bezziana

Chrysomya bezziana is a causative agent of obligatory myiasis. We report the first case of human infestation of Chrysomya bezziana in Hong Kong in an 89-year-old woman who had previously had a stroke. One day after hospital admission for fever, a small fissure at the labial gingiva of the upper incisors and several ulcerative lesions at the hard palate were noticed during routine mouth care. A live maggot was seen protruding from the small fissure. In the following few days, a total of seven maggots were removed by forceps. Urgent computed tomography and magnetic resonance imaging of the oral cavity showed an ulcerative soft-tissue lesion over the anterior palate, with a fistula communicating to the labial gingiva. The tissue loss was limited to the bony margin of the hard palate. The infestation was managed by manual removal of maggots and surgical debridement. Medical personnel taking care of old or debilitated patients need to bear in mind the possibility of Chrysomya bezziana infestation to be able to make a prompt diagnosis and implement relevant intervention to prevent extensive tissue destruction.

The first patient with locally acquired dengue fever in Hong Kong

This report is of the first locally acquired case of dengue fever. The diagnosis was made even in the absence of a history of travel outside Hong Kong. The patient was a 21-year-old man, who presented with high fever, leukopenia, thrombocytopenia, and elevated liver enzymes. His haematocrit revealed mild haemoconcentration but the albumin was normal throughout the course of the illness. His blood pressure remained low with no tachycardia or overt shock syndrome. The pyrexia subsided 4 days after admission to hospital and all haematological and biochemical abnormalities eventually normalised. The pathogenesis, diagnostic criteria of dengue haemorrhagic fever and dengue shock syndrome, and control of dengue infection are discussed.

Three patients with lead poisoning following use of a Chinese herbal pill

We report on three patients with lead poisoning following use of the Chinese herbal pill Bao ning dan, prepared by the same traditional Chinese medicine practitioner. The patients had varying degrees of exposure to Bao ning dan and different clinical manifestations. Blood lead concentrations did not correlate with clinical severity. Two patients received chelating therapy and blood lead concentrations subsequently rapidly decreased. One patient was managed conservatively and end-organ complications resolved gradually. With increasing use of traditional Chinese medicines, related adverse reactions are expected to become increasingly common. Practitioners of western medicine should remain alert to this possibility. A comprehensive drug review, including the use of herbal medicines, should form a routine part of medical history taking.