Social Vulnerability, Frailty and Self-Perceived Health: Findings from The Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

Social vulnerability interacts with frailty and influences individuals' health status. Although frailty and social vulnerability are highly predictive of adverse outcomes, their relationship with self-perceived health(SPH) has been less investigated.

METHODS

Data are from the Irish Longitudinal Study on Ageing(TILDA), a population-based longitudinal study of ageing. We included 4,222 participants aged ≥50 years (age 61.4±8.5 years;women 56%) from Wave 1 (2009-2011) followed over three longitudinal waves (2012,2014-2015,2016). Participants responded to single questions with five response options to rate their 1)physical health, 2)mental health, and 3)health compared to peers. 30-item Frailty (FI) and Social Vulnerability (SVI) indices were calculated using standardised methods. Multivariable regression analyses were performed to establish the association between FI and SVI cross-sectionally and longitudinally over 6 years.

RESULTS

Cross-sectionally, SVI (mean:0.40±0.08; range:0.14-0.81) and FI (mean: 0.13±0.08; range:0.10-0.58) were modestly correlated (r=0.256), and independently associated with poor physical health (SVI: OR 1.43, 95%CI 1.15-1.78; FI: OR 3.16, 95%CI 2.54-3.93), poor mental health (SVI: OR 1.65, 95%CI 1.17-2.35; FI: OR 3.64, 95%CI 2.53-5.24), and poor health compared to peers (SVI: OR 1.41,95%CI 1.06-1.89; FI: OR 3.86, 95%CI 2.9-5.14). Longitudinally, FI and SVI were independently and positively associated with poor physical health (SVI: β 1.08, 95%CI 0.76-1.39; FI: β 1.97, 95%CI 1.58-2.36), poor mental health (SVI: β 1.18, 95%CI 0.86-1.5; FI: β 1.58, 95%CI 1.2-1.97), and poor overall health compared to peers (SVI: β 0.78, 95%CI 0.89-1.33; FI: β 1.74, 95%CI 0.47-1.1).

CONCLUSIONS

In a large cohort of community-dwelling older adults, frailty and social vulnerability were associated with poor SPH and with risk of SPH decline over six years.

Older adults with slow sit to stand times show reduced temporal precision of audio-visual integration

Sustained integration of sensory inputs over increased temporal delays is associated with reduced cognitive and physical functioning in older adults and adverse outcomes such as falls. Here, we explored the relationship between multisensory integration and a clinically relevant measure of balance/postural control; Sit-to-Stand Time, the efficiency with which an older adult can transition between a seated and a standing posture. We investigated whether temporal multisensory integration was associated with performance on the Five-Times Sit-to-Stand Test (FTSST) in a large sample of 2556 older adults (mean age = 63.62 years, SD = 7.50; 55% female) drawn from The Irish Longitudinal Study on Ageing (TILDA). K-means clustering was applied to FTSST data, yielding three clusters characterised by fast (mean = 10.88 s; n = 1122), medium (mean = 14.34 s; n = 1133) and slow (mean = 18.97 s; n = 301) sit-to-stand times. At wave 3 of TILDA, older adults participated in the Sound Induced Flash Illusion (SIFI), a measure of the precision of temporal audio-visual integration, which included three audio-visual stimulus onset asynchronies (SOAs): 70, 150 and 230 ms. Older adults with the slowest sit-to-stand times were more susceptible to the SIFI at the longest SOA (230 ms) compared to the shortest SOA (70 ms) relative to those with the fastest times (p = 0.02). Older adults who take longer to repeatedly transition from a seated to a standing posture exhibit an expanded temporal binding window for audio-visual events, supporting a link between multisensory perception and balance/postural control in ageing.

173 ASSOCIATIONS BETWEEN CARDIOVASCULAR SIGNAL ENTROPY AND FUTURE FALLS, SYNCOPE, AND FEAR OF FALLING

Background

Previous studies have reported impaired blood pressure (BP) control during standing to be associated with future falls and syncope. Increased complexity in BP signals has been shown to be associated with poorer cognitive performance, frailty, and increased mortality risk. The aim of this study was to investigate associations between the level of complexity in beat-to-beat BP data during an active stand challenge and future occurrence of falls, syncope, and fear of falling in a cohort of older adults from The Irish Longitudinal Study on Ageing (TILDA).

Methods

Beat-to-beat BP was continuously measured during an active stand protocol at wave 1 of TILDA (2009-2011). Complexity of BP signals was quantified using sample entropy (SampEn) during rest, stand, and recovery sections of data. Self-reported occurrences of falls, syncope, and fear of falling were collected at waves 2 to 6 (2012-2021). Comprehensively controlled modified Poisson modelling was employed to investigate associations.

Results

Complete data were available for 4714 individuals (age: 61.0±8.8 years; 55.3% female). Higher BP SampEn during rest and stand was associated with increased risk of future recurrent falls (IRR=1.34, p=0.003, and IRR=1.22, p=0.044, respectively). Higher BP SampEn during recovery was associated with increased risk of future syncope (IRR=1.84, p=0.041). In a sub-cohort of participants aged 65+, higher BP SampEn was associated with increased risk of future fear of falling (N=1552; IRR=1.25, p=0.037). All reported IRRs are per one unit of SampEn.

Conclusion

This study reports significant associations between higher complexity in BP data during an active stand protocol and increased risk of future falls, syncope, and fear of falling over ten-year follow-up.

127 THE RELATIONSHIP BETWEEN RELIGIOUS INVOLVEMENT AND PSYCHOLOGICAL HEALTH DURING THE COVID-19 PANDEMIC: FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING

Background

Religious involvement has been shown to be protective against negative mental health outcomes and encourage positive coping behaviour among older adults. During the COVID-19 pandemic and lockdown in Ireland, public health restrictions created a barrier to in person religious participation. It is important to examine the effect this may have had on psychological health in older adults.

Methods

Data were from The Irish Longitudinal Study on Ageing (TILDA). Data from Wave 4 (2016), Wave 5 (2018) and the COVID-19 SCQ (2020) were used for analysis. The final sample was made up of 3,044 community-dwelling adults living in Ireland aged 60 and older. Relationships between religious participation, psychological health and loneliness were modelled using cross-sectional and longitudinal regression analyses.

Results

Religious attendance was positively associated with Purpose in Life [Beta(B)=0.01, 95% CI=-0.00, 0.02, p<0.05], Life Satisfaction [B=0.01, 95% CI= 0.00, 0.02, p<0.001] and Anxiety [Incident Rate Ratio= 1.04, 95% CI=1.01-1.08, p<0.01], during COVID-19. Self-Rated Mental Health significantly decreased between Wave 5 and COVID-19 relative to Religious Attendance reported at Wave 4 [OR= 0.87, 95% CI= 0.75, 0.99, p<0.05]. Loneliness also increased between Wave 5 and COVID-19 relative to Prayer Frequency reported at Wave 4 [OR=0.06, 95% CI= 0.02, 0.10, p<0.01].

Conclusion

These results suggest a complex relationship between psychological health and religious participation and the barriers to it during COVID in the older population. While it there was a protective effect carried into the lockdown, there was also a negative effect regarding some domains of religious participation. Future research should focus on measuring the relationship at later stages of the pandemic and the use of alternative forms of religious practice, such as streaming religious services.

336 ASYMPTOMATIC ORTHOSTATIC HYPOTENSION AND RISK OF FALLS IN COMMUNITY-DWELLING OLDER PEOPLE

Background

Many older people with Orthostatic Hypotension (OH) may not report typical symptoms of dizziness, light-headedness, or unsteadiness. However, the relationships between OH and falls in the absence of typical symptoms are not yet established.

Methods

Continuous orthostatic BP was measured during active stand using a Finometer at Wave 1 of TILDA in participants aged≥70 years. OH, with and without dizziness, was defined as a sustained drop in systolic BP≥20 and/or diastolic BP≥10 mm Hg at 30, 60 and 90 seconds post-standing. The association between symptoms of dizziness and orthostatic BP was assessed with multi-level mixed-effects linear regression; logistic regression models assessed the longitudinal relationship between OH and falls at 6-year follow-up (Waves 2-5).

Results

Almost 11% (n=934; mean age: 75 years; 51% female) had OH, two-thirds of whom were asymptomatic. Dizziness was not associated with systolic BP drop at 30 (β=1.54; –1.27, 4.36; p=0.256), 60 (β=2.6; –0.19, 5.47; p =0.476) or 90 (β=2.02; –0.91, 4.95; p=0.176) seconds after standing in adjusted models. Asymptomatic OH was independently associated with unexplained falls (Odds Ratio: 2.01; 1.11, 3.65; p=0.022) but not explained falls (OR 0.93; 0.53, 1.62; p=0.797) during follow-up.

Conclusion

Two-thirds of older people with OH did not report typical symptoms of light-headedness. Dizziness or unsteadiness after standing did not correlate with the degree of orthostatic BP drop or recovery. Participants with asymptomatic OH had a significantly higher risk of unexplained falls during follow-up, and this has important clinical implications for the assessment of older people with falls.

266 MINIMALLY-EFFECTIVE PHYSICAL ACTIVITY DOSE FOR DEPRESSION AMONG OLDER ADULTS: PRELIMINARY FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING

Background

Among older adults, depression is associated with increased risk of lower physical, social, and cognitive function. Physical Activity (PA) has been associated with lower odds of depression; however, the minimally sufficient dose for protection is unknown. Herein, we quantified the association between different PA doses and depressive symptoms and status among older adults across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing.

Methods

PA was measured at each wave using the short-form International Physical Activity Questionnaire (IPAQ-SF). Five dose categories (0, 1-&lt;600, 600-&lt;1,200, 1,200-&lt;2,400 and ≥2,400 MET.min.week-1) were examined. At all waves, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale short form (CES-D) and a score of ≥16 was used to define depression. From Waves 2-5, the Composite International Diagnostic Interview quantified diagnosis of a Major Depressive Episode during the past 12 months, or depression status. Poisson regression quantified associations between PA dose and depressive symptoms and status across time, adjusted for age, health/lifestyle variables and antidepressant medication.

Results

Among 4,017 participants, depression status changed from 8.2% at wave 1 to 12.2% at wave 5. The minimal PA dose associated with lower depressive symptoms was 1-&lt;600 MET.min.week-1 (coefficient = –0.06; 95%CI: –0.10, –0.02; p≤0.003). A dose of 600-&lt;1,200 MET.min.week-1 was significantly associated with lower odds of depression status (OR = 0.66; 95%CI: 0.50, 0.87; p≤0.004). Other positive predictors associated with lower odds of depression included greater age, higher education status, and sufficient vitamin D status.

Conclusion

Present findings suggest that even low physical activity doses appear protective against depressive symptoms among older adults. Moderate PA dose, consistent with WHO recommendations, was protective against major depression over a 10-year period among older adults. However, individuals with chronic conditions may have different PA dose requirements, which should be further investigated.

179 WHAT IS THE RISK OF FALLS DUE TO PSYCHOTROPIC MEDICATIONS IN A LARGE POPULATION-REPRESENTATIVE COHORT OF COMMUNITY-DWELLING OLDER PEOPLE?

Background

Psychotropic medications including antidepressants, anticholinergics, benzodiazepines, ‘Z’ drugs and antipsychotics, are frequently identified as Falls Risk Increasing Drugs (FRIDS), yet there is a relative lack of robust data detailing the prospective risk of falls associated with these drug classes.

Methods

Participants aged ≥65 years from the Irish Longitudinal Study on Ageing (TILDA) were included and followed from Waves 1 to 5 (Mean 7.6 years follow-up). Incidence of falls was ascertained by self-report and unexplained falls were defined as falls not caused by a slip or trip with no apparent cause. Medication lists were examined for medications of interest. Logistic Regression models, reporting odds ratio with 95% confidence intervals, were used to assess the association between medication classes and incident fall types and were adjusted for relevant covariates.

Results

2,090 participants were included (mean age at baseline 72 years, 53% female). During follow-up, over half of participants (52%, n=1,089) had a fall, with one quarter (25%, n=526) reporting an unexplained fall and almost one fifth (19%, n=394) reporting a fall causing injury. Anti-depressants were associated with an increased risk of falling (OR=3.01, 1.98-4.58, p&lt;0.001), injurious falls (OR=1.96, 1.37-2.81, p&lt;0.001) and unexplained falls (OR=2.71, 1.88-3.91, p&lt;0.001) in fully adjusted models. Anti-cholinergic medications were associated with an increased risk of falling (OR=1.79, 1.11-2.88, p=0.017) and of unexplained falls (OR=1.89, 1.19-3.01, p=0.007). ‘Z’ drugs were associated with an increased risk of falling (OR=2.96, 1.64-5.32, p&lt;0.001) and of injurious falls (OR=2.05, 1.26-3.34, p=0.004). Benzodiazepines and Anti-psychotics were not associated with incident falls in fully adjusted models.

Conclusion

Anti-depressants, anti-cholinergic medications and ‘Z’ drugs are independently associated with an increased falls risk. Given the profound impact falls can have on functional trajectory and quality of life, regular review of ongoing need for these medications should be central to the comprehensive geriatric assessment.

105 EVALUATION OF A NEW PHYSIOTHERAPY-LED VESTIBULAR SERVICE EMBEDDED IN THE FALLS AND SYNCOPE UNIT

Background

Clinical presentations in the falls and syncope unit (FASU) are diverse and require a range of skillsets. Vestibular disorders amount to a significant proportion of presentations. In our FASU, we embedded a 0.5 FTE specialist physiotherapist with expertise in vestibular disorders to work alongside medical and nursing staff. We conducted a service evaluation of the activity of this new service.

Methods

Retrospective Service Evaluation Approval was granted by our Research & Innovation Office. Pseudonymised data was collected corresponding to all new FASU physiotherapy service attendances between August 2021 and May 2022. Descriptive statistics were complemented by a binary logistic regression model to establish independent predictors of more than one physiotherapy session being required over the period.

Results

There were 104 episodes recorded by the new service, corresponding to 101 unique patients. Mean age was 67.7 (SD 19.0, range 17-93), and 73.1% were women. 67% were treated and discharged in 1 session. On average, patients had had a mean of 2 falls prior to the consultation (range 0-25). 28.8% were using a walking aid, and 54.8% self-reported fear of falling. 25% of the referrals to the service were due to suspected vestibular disorders, 62% of which were directly treated by the physiotherapy service. The logistic regression model adjusting by age, sex, use of walking aid, number of falls, and fear of falling showed that only referral for vestibular disorder was an independent predictor of patients needing more than 1 physiotherapy treatment (OR 3.91, 95% CI 1.32-11.58, P=0.014).

Conclusion

Vestibular disorders are common in FASU, and a majority can be treated by a specialist physiotherapy service. Repeated vestibular maneuvers are often needed in such patients. A responsive, embedded physiotherapy service in FASU can directly address this need and further evaluation will focus on the impact of this service on avoidance of ED attendances.

34 RELATIONSHIP BETWEEN SERUM CAROTENOID CONCENTRATIONS AND FRAILTY, PROBABLE SARCOPENIA, AND PHYSICAL FUNCTION IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)

Background

Lutein and zeaxanthin are antioxidant and anti-inflammatory carotenoids derived from foods such as fruit and vegetables. Serum concentrations of Lutein (Ls) and Zeaxanthin (Zs) reflect habitual dietary intake. This study examined the cross-sectional and longitudinal relationships between Ls and Zs and frailty, probable sarcopenia, and indices of physical function in TILDA.

Methods

The cross-sectional analysis included n=4672 community-dwelling adults aged ≥50 years with Ls and Zs at Wave 1 (2010). For the longitudinal analyses, changes in usual gait speed (at Wave 3, 2014), grip strength (Wave 4, 2016) and Timed Up-and-Go (TUG; Wave 5, 2018), incident probable sarcopenia (defined as grip strength &lt;27 kg in men, &lt;16 kg in women, at Wave 4) and incident frailty (Fried, at Wave 5) were determined. Multivariable linear and logistic regression analyses were adjusted for age, sex, waist circumference, education, malnutrition, smoking, chronic disease, alcohol intake and physical activity.

Results

Cross-sectionally, Ls and Zs were positively associated with gait speed (B [95% CI] per 100-nmol/L higher concentration: Ls 0.67 [0.22, 1.12], Zs 1.3 [0.21, 2.48] cm/s) and inversely associated with TUG time (Ls –0.07 [-0.11, –0.02], Zs –0.14 [-0.25, –0.03] s) and with frailty (OR: Ls 0.61 [0.42, 0.87], Zs 0.23 [0.08, 0.68]), all p &lt;0.05), but not with grip strength or probable sarcopenia. Longitudinally, Ls was inversely associated incident frailty (OR 0.85 [0.04, 0.84], p=0.03), whereas Zs was not (0.83 [0.56, 1.23], p=0.36). Neither Ls or Zs were related to changes in physical function measures or incident probable sarcopenia (p&gt;0.05).

Conclusion

Cross-sectionally, lower Ls and Zs were independently associated with frailty, slower gait speed and worse TUG performance. However, Wave 1 Ls and Zs were not predictive of changes in these outcomes over 4-8 years of follow up, with the exception of Ls which was inversely associated with incident frailty after 8 years.

302 MONITORING FALLS RISK IN THE COMMUNITY USING AN IMPLANTABLE CARDIAC MONITOR WITH EMBEDDED ACCELEROMETER

Background

Falls are the most common cause of injury amongst older adults. Falls can lead to hospitalisation, functional decline and are associated with increased morbidity and mortality. The holy grail for clinicians would be to predict increased likelihood of falls occurring and intervene before the event. Understanding underlying dynamic biophysiological changes may therefore inform novel predictor models and falls prevention. This study examines activity and cardiac data acquired from an implanted Medtronic Reveal LINQ™ Insertable Cardiac Monitor (ICM) with an embedded tri-axial accelerometer.

Methods

Thirty participants with at least one unexplained fall in the previous two years were prospectively recruited. All met criteria for ICM insertion following comprehensive assessment. Participants were followed for one year and attended every three-months for cardiac and gait assessment. Information pertaining to activity levels, posture changes and cardiac parameters were collected daily from the device. Summary metrics and trends were collected for inclusion in a continual assessment of falls risk.

Results

Mean age of participants was 68.0 years (±9.3). 19/30 (63.3%) were female. 22/30 (73.3%) had at least one cardiovascular condition documented in their medical history. There was seasonal variation in activity levels. Twelve participants had falls and cardiovascular, gait and activity variables were examined at the time of a fall to determine any trends in biophysiological changes.

Conclusion

Causes of falls are usually multifactorial. A holistic approach is necessary to manage and minimise risk factors. The use of an ICM with an embedded tri-axial accelerometer allows clinicians to formulate an algorithm to determine if a person is at an increased risk of falling based on biophysiological changes. This may create an opportunity for falls to be predicted and prevented.

121 INVESTIGATING THE RELATIONSHIP BETWEEN PROBABLE SARCOPENIA AND ORTHOSTATIC HYPOTENSION: FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING

Background

Sarcopenia and Orthostatic Hypotension (OH) are emerging age-related health burdens associated with adverse outcomes including falls and functional decline. Despite a possible pathophysiological link, the association between the two disorders is not well established. We sought to further investigate this relationship in The Irish Longitudinal Study on Ageing (TILDA).

Methods

Data from 2,858 participants at wave 3 of TILDA was analysed. Probable sarcopenia was defined as per the European Working Group on Sarcopenia in Older People revised cut-offs: Hand-Grip Strength (HGS) &lt;27kg in men, &lt;16kg in women and/or five-chair stand test (5CST) time &gt;15s. Participants underwent an active stand orthostatic test with non-invasive beat-to-beat blood pressure monitoring. Multivariable logistic regression models adjusting for age, sex, anthropometrics, cardiovascular diseases, medications and fear of falling were used to determine whether probable sarcopenia was a predictor of OH at multiple time-points after standing.

Results

In multivariable analysis, HGS was an independent predictor of OH at 30s, 40s, 60s (P&lt;0.01), 120s and 180s (P&lt;0.05) but not initial OH at 10s or 20s (P=0.531, 0.464) or consensus OH (P=0.064). 5CST time was only associated with OH at 120s (P=0.030). At follow up in wave 5, four years later, those with HGS-defined probable sarcopenia had higher proportions of recurrent falls (10.5% vs 5.7%, P = 0.014), fear of falling with activity limitation (12.4% vs 6.9%, P = 0.011), hospital admission (24.2% vs 12.5%, P &lt; 0.001) and death (4.8% vs 1.9%, P = 0.006) when compared to the non-sarcopenic group.

Conclusion

Probable sarcopenia as measured by HGS, but not 5CST time is an independent predictor of orthostatic hypotension, especially in the blood pressure recovery phase 30-60s after standing. The increased rates of adverse outcomes in this group underline the importance of identification of probable sarcopenia in those at risk of OH and falls.

246 THE ROLE OF AGEING ON SELF-REPORTED ABILITY ACROSS MULTIPLE SENSES: A LONGITUDINAL ANALYSIS OF DATA FROM THE TILDA STUDY

Background

During the healthy ageing process, sensory degeneration typically occurs and often in more than one sensory modality. This can present significant challenges to the well-being and quality of life of older adults. However, it is unclear whether senses decline into impaired functioning in a manner that is independent from each other or that is suggestive of a common, amodal mechanism related to the ageing process.

Methods

We used discrete survival analysis to explore the longitudinal (10-year) associations between a number of measures (including age, lifestyle factors and measures of sensory, physical, mental and cognitive health) and the probability of transitioning from normal to impaired sensory function for vision, audition, olfaction and gustation. Sensory impairment was captured as self-report measures for a large sample of older adults (N = 5,066) from The Irish Longitudinal Study on Ageing.

Results

Auditory impairment was most prevalent, followed by impaired vision, olfaction and gustation. Multivariable regression models revealed an increased probability of impairment in one modality for those reporting impairments in other modalities, although this pattern was not consistent for all modality combinations. Visual impairment was associated with socioeconomic status, education, eye disease, smoking and depression. Auditory impairment was associated with age, the sex of participant, hearing aid use and difficulty following group conversations. Olfactory impairment was associated with age, the sex of participant, smoking and difficulty following group conversations. Gustatory impairment was associated with age, smoking and depression. Importantly, self-rated decline in general health was associated with an increased probability of reporting an impairment across all sensory modalities.

Conclusion

Our results suggest that older adults report a decline across multiple senses over time, but the rates are of decline are not consistent. Sensory decline appears associated with both global and modality-specific factors, providing some insights into the impact of sensory health in ageing.

110 DEVELOPMENT AND DELIVERY OF A MULTI-DISCIPLINARY HYBRID EDUCATION PROGRAM IN SYNCOPE AND RELATED DISORDERS DURING THE COVID-19 PANDEMIC

Background

Syncope and related disorders is an important area for training of all health professionals. During the COVID-19 pandemic, we adapted the delivery of our annual face-to-face certified program to a 9-month hybrid program. Here, we describe the development, delivery, and evaluation of such new program.

Methods

A pre-existing curriculum was modified to incorporate online content, online lecture delivery and interactive group learning, in addition to individual practical placements in a syncope management unit, in line with government and hospital infection control guidance at the time. Monthly content included video consultant case presentations, ECG analysis and interpretation, and instructional videos of diagnostic testing and relevant technologies. A comprehensive online week-long lecture program was developed.

Results

The lecture week included 30 clinical lectures, 10 clinical case presentations and 10 ‘how to’ practical videos for testing/monitoring procedures. Further learning over zoom incorporated learner case presentations in a small group format. At the completion of the course the leaners attended a final online half day of lectures and completed the multi choice question examination.

Conclusion

“Thank you so much for putting together such a fantastic week of training.” “The quality and expertise of the speakers was outstanding.” “I have taken a huge amount away to incorporate into my practice and local unit.”

The above learner feedback is consistent with our aim to deliver a high-quality specialist program for those interested in advancing the management of syncope and related disorders. Over time, this specialist training will aid the development of regional syncope management units across Ireland. The benefits of a hybrid learning model include multiple options to cater for all categories of learners, thus suggesting it is the cornerstone of future learning modalities.

305 PHYSICAL ACTIVITY & DEPRESSION AMONG OLDER ADULTS WITH DIABETES: PRELIMINARY EVIDENCE FROM 10 YEARS OF THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)

Background

Older adults living with diabetes are at increased risk of physical and mental health issues, including depression. Among older adults living with diabetes, the salutary benefits of Physical Activity (PA), including increased insulin sensitivity and improved glycaemic control, are well established; however, less is known about the relationship between PA and depression. Thus, we quantified associations between different PA doses and depressive symptoms and status among older adults living with diabetes across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing.

Methods

Older adults (n=268) living with diabetes were identified through self-report and/or medication use. PA was measured with the short-form International Physical Activity Questionnaire. Five dose categories (0, 1-&lt;600, 600-&lt;1,200, 1,200-&lt;2,400 and ≥2,400 MET.minutes per week) were examined. At all waves, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale short form; a score of ≥16 classified depression. From Waves 2-5, the Composite International Diagnostic Interview quantified diagnosis of a Major Depressive Episode during the past 12 months, or depression status. Poisson regression models quantified the associations between PA dose and depressive symptoms and status across time, adjusted for age, health/lifestyle variables, and antidepressant medication.

Results

The minimal PA dose associated with lower depressive symptoms was 1-&lt;600 MET.mins (coefficient = –0.20; 95%CI: –0.35, –0.05; p≤0.009). A dose of 600-&lt;1200 MET.min was significantly associated with lower odds of depression status (OR = 0.66; 95%CI: 0.50, 0.87; p≤0.004). Additionally, being male, having sufficient vitamin D intake and lower age were associated with lower odds of depressive symptoms.

Conclusion

Present findings suggest that even low PA doses protect against depressive symptoms among older adults living with diabetes. This further supports the importance of promoting PA for mental health among this high-risk population group.

281 PREVALENCE OF STOPPFALL FALLS-RISK-INCREASING DRUGS (FRIDS) IN PATIENTS PRESENTING TO HOSPITAL WITH A FALL

Background

Falls cause presentation and admission to hospital. Falls-Risk-Increasing-Drugs (FRIDs) are a modifiable risk factor. STOPPFalls criteria was developed, using an expert Delphi panel, to achieve consensus on a comprehensive list of FRIDs. The aim of this study was to identify the prevalence of STOPPFall PRIDs in patients presenting to hospital with falls and identify whether review by a specialist Falls and Syncope Service (FASS) reduces FRIDs.

Methods

This was a retrospective observational study. Patients ≥65 years reviewed by the hospital FASS in the emergency department (over 6-months) and in house (over 2-months), were included. Medication appropriateness at admission and discharge were assessed using STOPPFall criteria. Ethical approval was received from the local research and innovation office (ref7013).

Results

Of 156 patients, 87(55.8%) were ≥65 years; 46% female, mean age 78.1(SD7.5) years. The mean number of conditions was 4(SD4.4); the mean number of regular medications was 6.9(SD4.5). Reasons for referral to FASS included falls (34.5%), dizziness/near fall (35.6%), and transient loss of consciousness (29.9%). For 21.8% there was an associated injury; 11.5% a fracture. Thirty-seven (42.5%) had experienced at least one fall in the previous 12-months.

Sixty-four (73.6%) were on ≥1 STOPPFall FRID. The most common STOPPFall FRID prescribed to older adults were diuretics (24.1%), anti-depressants (20.7%) and benzodiazepines/benzodiazepine-related drugs (13.8%). At least 1 STOPPFall FRID was stopped in 31.3%. The most commonly deprescribed STOPPFall FRIDs were diuretics (20%), alpha blockers (6%) and benzodiazepines/benzodiazepine-related drugs (4.7%). Adults &lt;65years (n=69) were more likely to be prescribed a STOPPFall FRID at admission than older adults (≥65years); 88.4% vs 73.6%, p=0.021.

Conclusion

STOPPFall FRIDs are prevalent in fallers of all ages. Even one review by a specialist FASS leads to medication optimization. The effectiveness of STOPPFalls criteria in the prevention of falls should be evaluated further in intervention studies.

148 ORTHOSTATIC HEMODYNAMICS AND ACCELERATED BRAIN AGING

Background

Impaired recovery of blood pressure (BP) in response to standing up is a prevalent condition in older individuals. We evaluated the relationship between the recovery of hemodynamic responses to standing and brain health in adults over 50.

Methods

Participants from The Irish Longitudinal Study on Aging (TILDA) (n=418) performed an active stand challenge while BP and heart rate (HR) were continuously monitored. The recovery of these parameters was determined as the difference in measurements taken at 10 s and 20 s after standing, in relation to the baseline value. The difference between biological and chronological brain age was determined using BrainPAD, a novel validated measure of accelerated brain ageing. The data was fitted using linear regression models, using age, sex, weight, height, cardiac disease prevalence, antihypertensive and antidepressant use, smoking status, standing speed and pulse wave velocity as covariates.

Results

Adjusting for age and sex only, each additional year of BrainPAD was associated with a –0.35 mmHg (95% CI: –0.54 – –0.16, P&lt;.001) change in orthostatic systolic BP recovery. In a fully adjusted model, the regression coefficient was estimated at –0.29 mmHg (95% CI: –0.48 – –0.10, P&lt;.01). Similarly, a year increase in BrainPAD was associated with –0.21 mmHg (95% CI: –0.32– –0.10, P&lt;0.001) and –0.14 mmHg (95% CI: –0.25– –0.04, P&lt;.01) change in orthostatic diastolic BP recovery, for minimally and fully adjusted models respectively. HR recovery was not significantly associated with BrainPAD.

Conclusion

These results demonstrate that impaired systolic and diastolic BP recovery after standing is associated with accelerated brain aging in older individuals. This suggests that the BP response to standing, measured using beat-to-beat monitoring, has potential to be used as a marker of accelerated brain aging, relying on a simple procedure and devices that are easily accessible for clinical use.

138 ORTHOSTATIC CEREBRAL OXYGENATION AND THE RELATIONSHIP WITH SYMPTOMS, SUPINE HYPERTENSION AND ORTHOSTATIC HYPOTENSION

Background

Cerebral hypoperfusion is implicated as a cause of orthostatic symptoms such as dizziness and light-headedness. In older adults, Orthostatic Hypotension (OH) may co-exist with Supine Hypertension (SH), with greater cerebral dysfunction being reported in those with SH-OH. It remains unclear whether orthostatic symptoms are indicative of a higher cerebral hypotensive burden in older adults. This study assessed cerebral oxygenation in a cohort of older adults experiencing orthostatic symptoms, via an active stand challenge, as well as the relationship with OH and SH.

Methods

We utilized data from Wave 3 of the Irish Longitudinal Study on Ageing (TILDA). Cerebral oxygenation was continuously measured via near infrared-spectroscopy, and blood pressure via a Finometer. Logistic regression was employed to assess cerebral hemodynamics in the sample (N=2,737, mean age=65 years [range: 54-93 years]). Models were adjusted for covariates such as age, sex, standing speed, medications, and cardiovascular conditions.

Results

In the whole sample, 29% of participants reported symptoms, 13% experienced OH30 and 49% had SH. Those who reported symptoms were less likely to have supine hypertension (OR=0.73, p&lt;0.001), but were more likely to experience OH30 (OR=1.69, p=0.005). They were also more likely to experience a larger initial drop in cerebral oxygenation upon standing (β=-0.07%, p=0.006). However, symptoms were not associated with an impaired recovery in cerebral oxygenation at 30 seconds, or 3 minutes after standing.

Conclusion

Supine hypertension is somewhat protective against symptoms, but there is still a relatively large discord between symptoms, cerebral oxygenation and OH during orthostasis. This implies asymptomatic OH may also be a risk factor for adverse outcome. There is a need for routine screening of OH and SH in older adults.

325 DISTINCT INTEGRATION OF RAPIDLY PRESENTED AUDIO-VISUAL EVENTS IN OLDER ADULT RECURRENT FALLERS

Background

The ability to precisely integrate sensory information is critical to everyday functions, including balance/postural control and navigation. Older adults typically integrate sensory information over longer time delays than younger adults, which can reduce the precision of their perceptual judgments. This is particularly evident in older adults with a recent history of falls. However, the extent to which longitudinal patterns of falling or fall risk are associated with the precision of multisensory integration in older adults remains uncertain.

Methods

A sample of 2,321 older adults were grouped into longitudinal trajectories via self-report fall number (decreasing, stable, increasing) and, separately, sensorimotor fall risk via Timed-Up-and-Go (TUG) performance (stable, moderately declining, severely declining). Multisensory integration was measured once with the Sound Induced Flash Illusion, which examines how sound influences vision. A single ‘flash’ and two ‘beeps’ were presented over short (70ms) and longer (150ms and 230ms) temporal delays and older adults were asked to report only the number of ‘flashes’ they perceived. Accuracy on this task was the main outcome measure.

Results

Our results showed that the likelihood of incorrectly perceiving two ‘flashes’ at longer temporal delays increased with age and this was particularly evident for those with an increasing fall number trajectory. Furthermore, the likelihood of incorrectly perceiving two ‘flashes’ at the short temporal delay decreased with age but only for those same recurrent fallers. There was no association between longitudinal TUG trajectories and task performance.

Conclusion

Experiencing increasing incidents of falling over ten years is associated with distinct patterns of audio-visual integration in ageing. In contrast, long-term functional mobility is not. This may reflect links between multisensory integration and perturbed balance function and/or compromised cognitive functions (e.g. inhibitory control). Our findings contribute to our understanding of the mechanisms underpinning brain health in older age.

177 GENOME-WIDE ASSOCIATION ANALYSIS OF THE FRAILTY PHENOTYPE IN UK BIOBANK HIGHLIGHTS CARDIOMETABOLIC AND AUTOIMMUNE SIGNATURES IN AGEING

Background

Frailty is a state of advanced biological age that is characterized by multisystem physiological decline and advanced risk to adverse health outcomes. One approach to defining frailty is using the Fried frailty phenotype, a five-point list of health-related criteria used to score individuals as non-frail, pre-frail, or frail. The biological basis of frailty is not fully understood, nor why some experience frailty at younger ages. Between 30%-45% of frailty risk is estimated to be genetic. This study aimed to investigate the genetic basis of frailty phenotype risk using data from UK Biobank.

Methods

UK Biobank is a large-scale biomedical database of community dwelling adults (n = 502,529, age range: 37-73 years, 54% female). UK Biobank has genome-wide genotyping (approx. 93 million variants), health, and demographic data for all participants. A genome-wide association study (GWAS) of the frailty phenotype was performed on British and Irish adults aged 60 to 70 years (n = 157,720) to identify heritable factors which predict frailty progression in later life. Functional mapping was performed to determine genes and biological pathways enriched in GWAS results.

Results

95 single nucleotide polymorphisms (SNPs) from three independent genomic risk loci were significantly associated (p &lt; 5e-8) with the frailty phenotype in UK Biobank participants. Three genes, PPP1R3A, LONRF2, and AIF1 were statistically enriched with genetic variants. Tissue-specific expression analysis indicated genes differentially expressed in blood vessels were enriched. Linkage Disequilibrium Score Regression (lambda = 1.2005, intercept = 1.0006) indicated GWAS test statistic inflation resulting from polygenicity. SNP-based heritability was estimated to be 6.34% (SE: 0.36%).

Conclusion

SNP-based heritability of the frailty phenotype was lower than expected in comparison to previous reports of 30%-45%. Statistically significant genomic risk loci, genes, and tissue-enrichment pointed towards dysregulation of cardiometabolic, cardiovascular, and immunological processes in frailty risk, contrasting to brain pathways enriched in previous genomic analyses of the frailty index.

249 MINIMALLY-EFFECTIVE PHYSICAL ACTIVITY DOSE FOR GENERALIZED ANXIETY DISORDER AMONG OLDER ADULTS: PRELIMINARY FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING

Background

Among older adults, Generalized Anxiety Disorder (GAD), a debilitating condition characterized by persistent excessive worry, is associated with poorer quality of life and estimated cost to the individual of €1,864 annually. Meeting recommended Physical Activity (PA) levels has been associated with lower odds of GAD; however, the minimally-sufficient dose associated with benefits is currently unknown. Herein, we quantified the association between different PA doses and worry symptoms and GAD status among older adults across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing.

Methods

PA was measured at each wave using the short-form International Physical Activity Questionnaire. Five dose categories were examined (0, 1-&lt;600, 600-&lt;1,200, 1,200-&lt;2,400, and ≥2,400 MET.min.week-1). At all waves, worry symptoms were assessed using the abbreviated Penn State Worry Questionnaire continuous score; a score of ≥23 classified GAD status. Additionally, for Waves 2-5, the CIDI GAD quantified diagnosis of GAD during the past 12 months. Poisson regression with Stata quantified associations between PA dose and GAD and worry symptoms, adjusted for age, health/lifestyle variables and antipsychotics/anxiolytic medication.

Results

Among 2,200 participants, compared to lowest PA dose, only the highest PA dose (i.e., ≥2,400 MET.min.week-1) was significantly associated with 35% lower odds of GAD (OR=0.65; 95%CI: 0.51, 0.82; p≤0.001). For continuous worry symptoms, meeting the recommendation of at least 600 MET.min.week-1 was significantly, inversely associated with worry symptoms (coefficient= –0.02; 95%CI: –0.033, –0.005; p≤0.009). Female sex, less education, taking anxiolytics, and current smoking were also associated with greater odds of GAD and greater worry severity.

Conclusion

High physical activity dose was associated with lower odds of GAD over 10 years among older adults. Present findings suggest that older adults, particularly females and smokers, may need to exceed recommended physical activity levels to protect against GAD.

136 DIABETES IS ASSOCIATED WITH IMPAIRED PERIPHERAL AND CEREBRAL HAEMODYNAMIC RESPONSES IN OLDER ADULTS

Background

Diabetes is associated with slower gait speed and adverse brain health outcomes in older adults. However, the putative mechanisms underlying these associations remain poorly explored. One such mechanism is via altered cerebral perfusion, which may represent an important intermediate phenotype in the association between diabetes and slower gait. We assessed the impact of diabetes on peripheral and cerebral haemodynamic responses during active stand as part of The Irish Longitudinal Study of Ageing (TILDA).

Methods

We assessed: (i) peripheral haemodynamic responses (heart rate, blood pressure, cardiac output) using finometry and (ii) Tissue Saturation Index (TSI) using Near-Infrared Spectroscopy (NIRS) during active stand in older adults.

Function-on-scalar regressions were used to model the impact of diabetes on the dynamic response to standing. Subsequently, multivariable linear models were used to model usual gait speed.

Results

Of 3,011 older adults (mean age: 64.2; 55.2% female) completing active stand, diabetes (n =193, 6.4%) was associated with significantly higher heart rate (mean 3.2, s.e. 0.02 bpm), higher cardiac output (mean 0.16, s.e. 0.04 L/min) and lower systolic blood pressure (mean –6.9, s.e. 1.8 mmHg) during standing. Additionally, diabetes was associated with significantly lower TSI from 10 seconds post-stand (mean –1.2%, s.e. 0.49%). Associations persisted following robust covariate adjustment. Diabetes was associated with significantly slower gait speed (-5.3 cm/s, CI (-8.4,-2.1)). In analysing the relationship between cerebral perfusion and gait speed, poorer recovery of TSI at 60-120 seconds post standing was associated with slower gait speed (0.53 cm/s slower gait speed per unit increase in TSI, p = 0.007).

Conclusion

Diabetes is associated with impaired peripheral and cerebral haemodynamic responses in addition to slower gait speed in community-dwelling older adults. Neuro-cardiovascular instability and altered cerebral perfusion may represent an important intermediate phenotype between diabetes and adverse health outcomes in older adults.

27 ASSOCIATIONS BETWEEN ORTHOSTATIC BLOOD PRESSURE BEHAVIOUR AND PROGRESSION OF AGE-RELATED MACULAR DEGENERATION IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)

Background

Age-Related Macular Degeneration (AMD) is a progressive disease and the leading cause of vision loss in over 50’s in developed countries. Age-related changes in the neuro-cardiovascular system, at times manifesting as exaggerated blood pressure drops on standing (orthostatic hypotension) may be associated with end-organ damage. The aim of this study was to examine if the pattern of recovery of blood pressure upon standing from a supine position (orthostatic blood pressure behaviour), was associated with progression of AMD.

Methods

We utilised data from TILDA participants who had AMD at the wave 1 health assessment and returned for retinal image grading during the wave 3 health assessment, four years later. Beat-to-beat BP data was measured non-invasively by digital photoplethysmography (Finometer® MIDI) during the wave 1 Active Stand (AS) test. Measures recorded during AS included Systolic (SBP) and Diastolic (DBP) blood pressure. Associations between systolic and diastolic orthostatic BP behaviour and AMD progression were examined using generalised linear models (GLM). Baseline characteristics were compared between progression groups with the 2-samples Mann-Whitney U test and the Chi-squared test.

Results

Of the 191 included participants, 46 (24%) were found to have progression of AMD, while 145 (76%) had no change or regression of the disease. GLMs revealed no significant differences in SBP orthostatic behaviour across groups. However, those with AMD progression had lower orthostatic DBP values (tests of between-subjects effects p=0.005), particularly between 30-60 seconds post-stand (AMD progression: 72±10mmHg vs. No AMD progression: 79±12mmHg; p&lt;0.001). Of the baseline participant characteristics considered, only age was associated with AMD progression (AMD progression: 66±8yrs vs. No AMD progression: 62±9yrs; p=0.005).

Conclusion

In this sample of TILDA participants with AMD, lower orthostatic DBP values were associated with AMD progression over four years. Reduced orthostatic diastolic perfusion may be a novel modifiable risk factor for AMD progression.

143 ASSOCIATIONS BETWEEN NTPROBNP AND COGNITION IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)

Background

Cardiovascular insults increase the risk for future neurological diseases in late life. NT-proB-type Natriuretic Peptide (NTproBNP) is a hormone released in response to pressure changes inside the heart, often related to heart failure and other cardiac problems. We investigated whether levels of this biomarker are related to cognition in older adults from the Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of adults aged 50 years and older living in Ireland.

Methods

NTproBNP levels were measured in 4,963 participants, mean age 62.6 years and 53.4% women, from blood drawn during wave 1 of the study (2009-2011). Cognitive outcomes collected at wave 1 included: memory function (the sum of scores of immediate word recall, delayed recall and prospective memory), a measure of global cognitive function (the Montreal Cognitive Assessment - MoCA), and a measure of semantic fluency (the Animal Naming task). Both NTproBNP and the MoCA scores were log-transformed to correct for skewedness.

Results

Cross-sectional analyses using multivariable linear regression found that NTproBNP was significantly and negatively associated with memory (std coeff. –0.049, std error 0.057, p=.001) and the MoCA (std coeff –0.034, std error .002, p=0.027) after adjusting for age, gender, education, and depressive symptoms. After further adjustment for cardiovascular risk factors (hypertension, high cholesterol, current smoking and problem drinking) and prevalent cardiovascular diseases (heart failure, myocardial infarction, angina pectoris, stroke, and transient ischemic attack), the associations remained for both cognitive measures (memory: std coeff –0.047, std error 0.061, p=.003; MoCA: std coeff. –0.036, std error .002, p=.029). No significant associations were found for the Animal Naming task (full model std coeff. –0.016, std error 0.087, p=0.37).

Conclusion

These results suggest that NTproBNP may be a useful early indicator for declines in some domains of cognitive function in older adults, with and without current cardiovascular diseases. Additional research is needed to evaluate the predictive value of this biomarker.

350 INTEGRATION OF VISION AND HEARING IS ASSOCIATED WITH GAIT VELOCITY IN A LARGE SAMPLE OF MIDDLE-AGED AND OLDER ADULTS

Background

Multisensory integration is the ability to appropriately merge information from several senses for the purpose of perceiving and acting in the environment. Its importance for higher level cognition and function has emerged in recent years. Walking requires to combine information from multiple senses to coordinate effective movements. In this study, we tested the association between a well characterised multisensory task, the Sound-Induced Flash Illusion (SIFI), and gait velocity in 3,255 participants from The Irish Longitudinal Study on Ageing. The SIFI is the illusory perception of two flashes when one flash is presented with two beeps. We hypothesised that high SIFI susceptibility would be associated with slower gait velocity

Methods

Gait was measured under three conditions; usual pace, cognitive dual tasking, and maximal walking speed. A separate logistic mixed effects regression was run for: (1) gait at usual pace, (2) change in gait speed for the cognitive dual-task relative to usual pace, and (3) change in maximal walking speed relative to usual pace. The model controlled for covariates including age, sex, education, vision and hearing abilities, Body Mass Index, and cognitive function.

Results

Slower gait was associated with more illusions, indicating that those who integrated incongruent sensory inputs over longer intervals, also walked slower. Relative change for cognitive dual tasking and maximal walking speed were also significantly associated with SIFI at longer SOAs.

Conclusion

These findings extend growing evidence showing that mobility is associated with multisensory processing in ageing; in particular, the mechanisms appear related to the temporal dynamics of sensory integration.

277 The ‘Bermuda Triangle’ of Orthostatic Hypotension, Cognitive Impairment and Reduced Mobility: Associations with Falls and Fractures in Community-dwelling Older People

Background

Orthostatic Hypotension (OH), cognitive impairment and mobility impairment frequently co-occur in older adults who fall. The aim of this study was to examine the clustering of these three geriatric syndromes and ascertain their longitudinal associations with falls and fractures in a large cohort of community-dwelling older people (≥65 years).

Methods

This study utilized data from Waves 1-5 of TILDA. OH was defined as a drop of ≥20 mmHg in systolic blood pressure when measured after standing from a seated position and/or reporting unsteadiness when getting up from a chair. Cognitive impairment was defined as MMSE ≤24 and/or self-reporting memory as fair or poor. Mobility impairment was defined as 'Timed Up and Go' ≥12 seconds. Logistic regression models, including 3-way interactions, were used to assess the longitudinal associations of the three geriatric syndromes with future falls (explained and unexplained) and fractures.

Results

Of those with at least one geriatric syndrome (993/2108, 47%), over two-thirds (644/993) had any one of the three, one-quarter had any two (261/993) and almost 10% (88/993) had all three syndromes. One-fifth of the study sample had an unexplained fall during follow-up (mean 6.6 years), while one-tenth had a fracture. In fully adjusted models, the cluster of OH, cognitive impairment and mobility impairment was associated with a greater than 4-fold likelihood of unexplained fall (Odds Ratio 4.36 (2.61–7.28); p&lt;0.001) and double the likelihood of incident fracture (Odds Ratio 2.51 (1.27–4.96); p=0.008) during follow-up, when compared to other clusters. There was no association with explained falls.

Conclusion

The ‘Bermuda Triangle’ of co-existing OH, cognitive impairment and mobility impairment, was independently associated with increased risk of future unexplained falls and fractures amongst community-dwelling older people. This simple risk identification scheme may represent an ideal target for multifaceted falls prevention strategies in community-dwelling older adults.

Frail by four different measures and new adverse events from lower blood pressure control in hypertensive older adults: a 2-year prospective study in The Irish Longitudinal Study on Ageing (TILDA)

Background

The 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for management of hypertension in adults aged ≥65 years recommend a blood pressure (BP) treatment target of 130–139/70–79 mmHg if tolerated [1]. Randomised controlled trials have advocated for lower BP, but this may lead to adverse outcomes in the frail. Yet, different operationalisations of frailty exist in the literature [2,3].

Purpose

We compared four frailty classifications in their ability to predict 2-year incident adverse outcomes (falls/fractures, syncope, transient ischaemic attack/stroke, heart attack, heart failure, hospitalisation, and mortality) associated with below-target BP control (&lt;130/70 mmHg) in The Irish Longitudinal Study on Ageing (TILDA).

Methods

Data from participants aged ≥65 years treated for hypertension in Wave 1 (W1) was analysed. Frailty was identified by Frailty Phenotype (FP) [4], the Clinical Frailty Scale-classification tree (CFS) [5], a 32-item self-reported Frailty Index (FI) [6], and the 5-item FRAIL (Fatigue, Resistance, Ambulation, Illnesses & Loss of Weight) scale [7]. We formulated 16 participant groups at W1 based on frailty-BP combinations. Outcomes at wave 2 (W2) two years later were analysed with binary logistic regression models adjusted for age, sex, education, polypharmacy, classic orthostatic hypotension, Montreal Cognitive Assessment (MOCA) score and number of chronic diseases.

Results

Of 1920 W1 participants aged ≥65 years and treated for hypertension, 1229 had full BP/FP data, 1282 for BP/CFS, 1274 for BP/FI, and 1276 for BP/FRAIL. The non-frail groups in all 4 frailty classifications with BP treated below or above target did not have an increased risk of any of the adverse health outcomes at W2. For the frail treated below target, hospitalisation by W2 was significantly more likely in those who were frail by FP and FRAIL. The frail by FRAIL and BP treated below target were the only with increased risk of mortality by W2. The frail by FI and FRAIL with BP treated below target had increased risk of new heart failure and falls/fractures by W2.

Conclusions

Frailty was independently associated with adverse outcomes in hypertensive older adults treated below the ESC/ESH target. However, different frailty classifications had different prognostic implications. For those below BP target, frailty by FRAIL was associated with the highest number of risks (falls/fractures, heart failure, hospitalisation and mortality), followed by the frail by FI (falls/fractures, heart failure). Based on our results and frailty measures considered, we recommend that FRAIL and FI are regarded as the methods of choice to identify frailty when applying the ESC/ESH guideline. Models of frailty that do not explicitly measure comorbidities (such as FP and CFS) may be less useful to capture risk of adverse events from lower blood pressure control.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Irish Department of HealthIrish LifeAtlantic PhilanthropiesRoman Romero-Ortuno is funded by a grant from Science Foundation Ireland

New definition of hypotension in patients with reflex syncope using 24-hour ambulatory blood pressure monitoring (SynABPM Study)

Background

Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking.

Purpose

We hypothesized that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM than control subjects and we aimed to define the SBP cut-off values that allow identification of patients with hypotensive susceptibility.

Methods

We compared ABPM data from reflex syncope patients and controls, matched by average 24-hour SBP, age, sex and hypertension. Patients with constitutional hypotension, orthostatic hypotension, predominant cardioinhibition or competing causes of syncope were excluded. Daytime and night-time SBP drops (&lt;110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent sample.

Results

In the Derivation cohort, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drop &lt;90 mmHg provided the best diagnostic yield (91% specificity, 32% sensitivity, Odds Ratio [OR]=4.6, p=0.001). Two or more-daytime drops &lt;100 mmHg achieved 84% specificity and 40% sensitivity (OR=3.5, p=0.001). Results were confirmed in the Validation cohort: one or more daytime SBP drop &lt;90 mmHg provided 94% specificity and 29% sensitivity (OR=6.2, p&lt;0.001), while two or more daytime SBP drops &lt;100 mmHg achieved 83% specificity and 35% sensitivity (OR=2.6, p&lt;0.001) (Figure 1).

Conclusion

SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.

Funding Acknowledgement

Type of funding sources: None.

76 PREDICTIVE MODEL FOR MOBILITY DECLINE: INDIVIDUAL TRIAL MISTAKE THRESHOLDS IN SUSTAINED ATTENTION TO RESPONSE TASK (SART)

Background

The Sustained Attention to Response Task (SART) is a standard computer-based cognitive test designed to measure the sustained attention, fundamental for completing tasks that require supervision over time (Robertson et al., 1997). However, commonly used average features may result in loss of information and data misinterpretation, leading to inability to detect clinically expected associations (O’Halloran et al., 2014).

Methods

Here, we present a new method to visualise the full information obtained from the SART test, ordering by age, and categorising in groups based on mobility status in a large population-based study of ageing in Ireland. A new threshold, derived from the visualisation and based on the individual trial number of mistakes, was employed to individuate poorer SART performances, and to predict mobility and cognitive decline after 4 years in binary logistic regression models.

Results

Raw SART data were available for 4,864 participants aged 50 years and over at baseline. The new variable bad performances, expressing the number of SART trials with at least 4 mistakes, was the most significant predictor of mobility decline, defined as the transition from Timed Up-and-Go (TUG) &lt; 12 to TUG ≥12 seconds (Odds Ratio (OR) = 1.29; 95% Confidence Interval (CI) 1.14–1.46; p &lt; 0.001), and the only significant predictor of new falls (OR = 1.11; 95% CI 1.03–1.21; p = 0.011) compared to traditional SART variables in models adjusted for multiple covariates. No SART-related variables resulted significant predictors of cognitive decline, defined as a decrease of at least 2 points in the Mini-Mental State Examination (MMSE) score.

Conclusion

This multimodal visualisation and the new threshold approach could help clinicians to easily develop relevant hypotheses, and better identify subjects at higher risk of future mobility decline.

168 ANXIETY SYMPTOMS AMONG OLDER PEOPLE DURING THE COVID-19 PANDEMIC: PREVALENCE AND ASSOCIATED FACTORS

Background

There are concerns that the COVID-19 pandemic could lead to a rise in mental health problems including anxiety amongst older people, especially those shielding alone during the pandemic.

The aim of this study therefore is to examine the prevalence of anxiety symptoms during the COVID-19 pandemic amongst older people and clarify factors associated with higher burden of symptoms.

Methods

We analysed data from the COVID-19 study of The Irish Longitudinal Study on Ageing, conducted on over 3,100 community dwelling people aged ≥60 years from July–November 2020.

Anxiety symptoms were measured with the Generalised Anxiety Disorder-7 Questionnaire with a score ≥ 10 indicating moderate–severe anxiety.

Linear regression models were used to assess the association of variables of interest with anxiety symptoms.

Results

Almost 9% of participants (n = 3,128; mean age 71 years) had moderate–severe symptoms of anxiety.

Factors independently associated with a higher burden of anxiety symptoms included female sex (β = 0.60 (0.33–0.87)); living alone (β = 0.72 (0.41–1.02)); ≥2 chronic diseases (β = 0.85 (0.41–1.30); heart disease (β = 0.95 (0.45–1.46)) and reporting frequent loneliness (β = 6.59 (6.03–7.16)). Age ≥ 80 years (β = −0.77 (−1.16—0.37)) and tertiary level education (β = −0.48 (−0.86—-0.10)) were associated with lower anxiety symptom burden.

Conclusion

Almost 1 in 10 of this population-representative sample of older people had moderate to severe anxiety symptoms during the COVID-19 pandemic.

Strategies to address loneliness, which was particularly strongly associated with anxiety symptoms during the pandemic, should be a priority.

136 ASSOCIATIONS OF FRAILTY WITH CONSECUTIVE GAIT SPEED TRAILS MEASURED BOTH WITH AND WITHOUT ADDITIONAL STRESSORS

Background

Frailty is associated with gait speed and is defined as increased vulnerability to stressors. While usual gait speed is often measured, gait speed under additional stressors such as simultaneously reciting alternate letters of the alphabet (cognitive dual task) or walking at maximum pace are also measured. Consecutive trials may introduce an additional temporal stressor and we hypothesise that frailty may be associated with a greater reduction in walking speed across trials.

Methods

Data from community-dwelling adults aged 50+ years at Wave 3 of The Irish Longitudinal Study on Ageing were utilized. Using a 32-item frailty index (FI) we derived non-frail, pre-frail and frail groups. Gait speeds were measured using a 4.88 m walkway (GAITRite, CIR Systems, NY, USA). We examined differences in gait speed between two consecutive walks in three conditions (usual pace, cognitive dual task, and maximum pace) for the entire cohort, and by frailty group. Related-samples Wilcoxon signed rank tests were employed, with statistical significance set at P &lt; 0.05.

Results

For the entire cohort, walk 2 speed for usual and cognitive conditions was higher by 1.0 cm/s (N = 4,097) and 1.1 cm/s (N = 3,927) respectively, and lower by 1.9 cm/s for maximum (N = 3,926). Stratified by FI, all groups walked more quickly in normal (1.0, 1.1, 1.2, respectively) and cognitive (1.3, 0.8, 0.5), and more slowly in maximum (−2.2, −1.6, −1.0).

Conclusion

In our analyses, higher frailty seemed to be associated with a higher increase for the usual walk, a smaller increase for the cognitive walk, and a smaller decrease in maximum speed. The clinical significance of the differences was very small. However, our results support that in research and clinical practice, frailty by FI should not be expected to lead to a different pattern of gait speed change across consecutive trials.

218 INCREASING PREVALENCE OF METABOLIC SYNDROME IN OLDER ADULTS IN IRELAND

Background

Metabolic syndrome (MetS) is a cluster of inter-related risk factors of metabolic origin, occurring together more often than by chance alone. MetS is a recognised risk factor for cardiovascular disease, several other chronic medical conditions and mortality. This study aimed to describe the prevalence of MetS in older adults in Ireland and to examine if this changed over a 4-year follow-up period.

Methods

This study used data collected as part of wave 1 and 3 of The Irish Longitudinal Study of Ageing (TILDA). Using objective measurements of triglycerides, high-density lipoprotein cholesterol, blood pressure, height, weight, waist circumference and glycated haemoglobin (HbA1c), in addition to medication usage, the prevalence of MetS using both the National Cholesterol Education Program Third Adult Treatment Panel criteria (ATPIII) and the International Diabetes Foundation criteria (IDF) were determined. Weights were used to allow the sample to be representative of the population. Weights for wave 3 included an adjustment for attrition between wave 1 and wave 3. Weighted logistic regression models were undertaken to examine the odds ratios for age, sex and educational attainment.

Results

32.5% of the community-dwelling population aged ≥50 years at wave 1 had MetS according to the ATPIII criteria, with 39.3% according to the IDF criteria. Males were 36% (ATPIII) or 53% (IDF) more likely than females to have MetS at wave 1. MetS was increasingly prevalent with age, and lower educational attainment at both waves. Prevalence had increased by wave 3 with 35.1% and 41.3% meeting the ATPIII and IDF criteria respectively.

Conclusion

The prevalence of MetS, a modifiable disorder, is very high and increasing in older adults in Ireland, with nearly 400,000 of the community-dwelling population ≥ 54 years at wave 3 meeting either the ATPIII or IDF criteria. More public health interventions are warranted.

165 WHAT FACTORS ARE ASSOCIATED WITH ADVANCED CARE PLANNING IN COMMUNITY-DWELLING OLDER PEOPLE?

Background

Advance Care Planning (ACP) involves expressing wishes regarding your future medical care and/or preferences about your end-of-life in the event of serious illness.

The aim of this study was to clarify the proportion of community-dwelling older people who engage in ACP and what factors are independently associated with ACP.

Methods

Participants aged ≥60 years (n = 4,831, mean age 71 years) at Wave 4 of the Irish Longitudinal Study on Ageing were asked: Have you made your wishes/preferences known about the kind of care that you would like to receive in the event of serious illness? If yes, they were asked if this had been documented informally (family/carers or medical professionals) or formally (by written advanced care plan).

Logistic regression models assessed the association of covariates of interest with ACP.

Results

One quarter of the study sample (1,153/4,831) had an ACP. Only 10% (119/1,153) had ACP documented in writing, while only 2% (27/1,153) had discussed ACP with a healthcare professional.

Age ≥ 80 years (OR 1.63 (1.31–2.02)), female sex (OR 1.58 (1.37–1.83)), higher educational attainment (OR 1.42 (1.18–1.71), poorer self-rated health (OR 1.58 (1.04–2.39) and lower levels of religiosity (OR 1.50 (1.03–2.19) were independently associated with ACP.

Conclusion

While ACP may have benefits in extending autonomy and facilitating decision-making, only 1 in 4 of this population-representative sample of older people had engaged in ACP, with only 1 in 50 having their ACP documented in writing.

Further work is therefore required to educate the public and healthcare professionals regarding the benefits of ACP.

190 FACTORS ASSOCIATED WITH ADHERENCE TO COVID-19 PUBLIC HEALTH GUIDELINES AMONG OLDER ADULTS IN IRELAND

Background

Older adults are at high risk from coronavirus 2019 (COVID-19). Even with the introduction of a widespread vaccination programme, adherence to public health guidelines continue to be of vital importance to reducing the spread of COVID-19. This study examines the factors associated with adherence to two public health guidelines, social distancing and mask wearing, among older adults (50 years and over) in Ireland.

Methods

Data from the Irish Longitudinal Study on Ageing (TILDA) COVID-19 study and previous waves of TILDA was used. The COVID-19 study data was collected between July 2020 and November 2020. Logistic regression analysis was conducted separately to examine the relationship between the independent variables and social distancing and mask wearing respectively. Along with socio-demographic variables, the Health Belief Model (HBM) was used to identify variables for inclusion in the analysis.

Results

In total, 2,816 participants were included in this study. Females were more likely than males to adhere to social distancing and mask wearing guidelines. Those most concerned about COVID-19 were more likely to adhere to both behaviours. Education levels were associated with adherence to both behaviours but the direction of the relationship differed. Those who trusted the Health Service Executive as a news source were more likely to socially distance, while those with less understanding of government guidance and those who trusted in government news sources were less likely to socially distance. Participants who were working were less likely to socially distance than those who weren’t. While, participants who were over 70 and those who returned the survey after the introduction of mandatory mask wearing were more likely to wear a mask. Participants who lived outside of Dublin were less likely to wear a mask.

Conclusion

Factors associated with adherence to public health guidelines vary according to the guideline. Differences between groups need to be considered when implementing policy around public health guidelines.

81 LONGER CHAIR-STAND TIME IS ASSOCIATED WITH ORTHOSTATIC INTOLERANCE IN AN OLDER IRISH POPULATION

Background

Hospital admissions for orthostatic hypotension (OH) have risen more than two-fold in the past ten years. OH can lead to orthostatic intolerance (OI), and both OH and OI are common causes of falls and injuries in older persons. Sarcopenia is also common in older persons and associated with adverse health outcomes. The 5-chair stand test (5-CST) can be used as a marker of sarcopenia and a cut-off of 15 s has been proposed. We hypothesized that those with a worse performance on the 5-CST would be at greater risk of OH and sought to investigate this in an older Irish population cohort study.

Methods

5-CST was measured in keeping with a standardised protocol. Beat-to-beat blood pressure was measured with the Finometer device according to the active stand protocol. Multivariable logistic regressions were performed to investigate the associations between OH at 40 seconds after standing (OH40), OI (dizziness after standing), and 5-CST time. Potential confounders were controlled for in the model including age, sex, education, body mass index and medications.

Results

Data from 3,119 participants were available for analysis. Mean age was 63.8 years, 55% were female, 25% took longer than 15s on the 5-CST and mean baseline blood pressure was 141/76 mmHg. Proportion of OH40 was 12.5% and 4.4% reported OI. In the multivariable model, OH40 was not independently associated with 5-CST time after controlling for age (p &gt; 0.05). Worse performance on the chair stands test was however an independent predictor of OI (odds ratio 1.06, p = 0.039).

Conclusion

Longer time taken on the 5-CST, a marker of sarcopenia, was an independent predictor of OI in a large population study. The relationship between sarcopenia and orthostatic blood pressure response is not well elucidated. We plan to further investigate this area in a future clinical cohort.

37 ‘FRAIL’ BY DIFFERENT MEASURES: A COMPARISON OF 8-YEAR MORTALITY IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)

Background

Frailty is a state of dysregulation in multiple physiological systems and vulnerability to stressors. Many frailty identification tools exist that differ in their conceptualisation vis-à-vis morbidity, disability, cognition, and other geriatric assessment dimensions. We compared the ability of four different frailty identification tools to predict 8-year mortality in TILDA.

Methods

We included TILDA Wave 1 (2010) participants who had data for frail state classification according to four tools: the Fried’s physical Frailty Phenotype (FP: frail if ≥3 features present), Morley’s FRAIL scale (frail if ≥3), a 32-item Frailty Index (FI ≥ 0.25), and the Clinical Frailty Scale classification tree (CFS ≥ 5). Mortality was ascertained at Wave 5 (2018). Binary logistic regression models controlling for age and sex were computed for the extraction of Odds Ratios (OR) and 95% Confidence Intervals (CI).

Results

At Wave 1, there were 5,700 participants (mean age 63, range 50–98 years, 54% women) with data for frailty classification according to all four tools. The prevalences of frailty were 2.3% by FRAIL, 3.8% by FP, 10.9% by CFS, and 12.8% by FI. 8-year mortality proportions were 41.2%, 44.9%, 25.3% and 27.0%, respectively. The highest age and sex-adjusted OR for 8-year mortality was for FRAIL (OR 4.86, 95% CI 3.18–7.41, P &lt; 0.001), followed by FP (OR 3.72, 95% CI 2.64–5.23, P &lt; 0.001), FI (OR 2.20, 95% CI 1.76–2.74, P &lt; 0.001), and CFS (OR 1.95, 95% CI 1.53–2.47, P &lt; 0.001).

Conclusion

All four frailty tools significantly predicted 8-year mortality in TILDA, but FRAIL and FP seemed more specific. Different frailty identification tools may suit different population screening purposes.

204 FRAILTY BUT NOT AGE IS ASSOCIATED WITH IMPAIRED ORTHOSTATIC CEREBRAL OXYGENATION

Background

The effects of age and frailty on cerebrovascular function are poorly understood. Here we investigate the hypotheses that aging, and frailty are accompanied by impaired regulation of cerebral oxygenation during standing in a patient population of older adults.

Methods

We recruited patients from a national Falls and Syncope service. All patients underwent an active stand test (5–10 min lying, 3 min standing) with continuous monitoring of blood pressure (BP) and heart rate. Tissue saturation index (TSI) was concurrently measured using near-infrared spectroscopy and its recovery measured at 30s after standing. Frailty was assessed as a comorbidity count using a 27-item questionnaire. Robust linear regression was used to investigate the association between TSI, age and frailty in a multivariate model with covariate adjustment, including the concurrent BP values. A p-value &lt;0.05 was considered significant.

Results

304 patients (median(IQR): 71(14) years, 57% females) were recruited. Age was not associated with cerebral oxygenation after standing (β: −0.001 (−0.017 0.015), p = 0.899), even after stratification by sex (males: β: −0.010 (−0.045 0.024), p = 0.558, females: β: 0.000 (−0.017 0.018), p = 0.967). Frailty, was associated with a lower TSI at 30s after standing (β: −0.153 (−0.248–0.058), p = 0.002). After sex stratification, no associations with frailty were observed in males (β: −0.052 (−0.226 0.123), p = 0.557), while frailer females demonstrated a lower TSI at 30 seconds after standing (β: −0.179 (−0.294–0.063), p = 0.003) despite BP correction.

Conclusion

Our results suggest alternative mechanisms of cerebral oxygenation regulation independent of blood pressure (and presumably cerebral autoregulation) are involved in frailty related impairments of brain haemodynamics which are also independent of ageing. Such impairments represent novel biomarkers of frailty and represent potentially novel modifiable risk factors (independent of BP management) of hypoperfusion related disorders in clinical ageing.

217 DO THE FRAIL EXPERIENCE ADVERSE EVENTS FROM INTENSIVE BLOOD PRESSURE CONTROL? FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING(TILDA)

Background

The 2018 ESC/ESH guidelines for the management of arterial hypertension in adults aged ≥65 years recommend a blood pressure (BP) treatment target of 130–139/70–79 mmHg if tolerated. Randomised controlled trials have recommended lower BP. However, low BP may cause adverse outcomes, especially in the frail.We aimed to identify if older adults, frail and non-frail, in wave 1 of TILDA being treated intensely for hypertension experienced more adverse events by wave 2.

Methods

Data from participants aged ≥65 years treated for hypertension in Wave 1 was analysed.Frail/non-frail was identified by Frailty Phenotype (FP) and the Clinical Frailty Scale (CFS).Two blood pressure thresholds defined intensive control:&lt;130/70 and &lt; 110/70 mmHg.We formulated 16 baseline participant groups based on frailty-BP combinations.Outcomes at wave 2 were analysed with adjusted binary logistic regression models.

Results

1,920 participants at Wave 1 were aged ≥65 years and treated for hypertension. 1,229 participants had full BP/FP data, while 1,288 had complete BP/CFS data.The frail by FP with treated BP &gt;130/70 or &gt; 110/70 had a statistically significant risk of new TIA or stroke by Wave 2.The frail by CFS with treated BP &gt;130/70 or &gt; 110/70 had a statistically increased risk of recurrent falls and/or fractures, as did the frail by FP with treated BP &gt;110/70. FP with treated BP &lt;130/70 was associated with new heart failure. None of the frail-BP groups was independently predictive of cognitive decline,myocardial infarction, syncope or hospitalization. For the non-frail-BP groups,there was no increased risk of any of the outcomes.

Conclusion

Frail older adults treated to higher BP thresholds seemed to have more adverse short-term health outcomes compared to the frail treated more intensely. Overall, a BP of &lt;130/70 did not seem associated with more adverse outcomes. This 2-year prospective study’s results of a community-dwelling cohort may not be generalisable to clinical populations.

171 THE ‘WISH TO DIE’ AMONGST OLDER PEOPLE IN IRELAND IN THE CONTEXT OF THE DYING WITH DIGNITY BILL

Background

‘Wish to Die’ (WTD) involves thoughts of or wishes for one’s own death or that one would be better off dead.

Assisted dying is the act of deliberately providing medical assistance to another person who wishes to end their own life. Currently, in Ireland, it is illegal to provide such assistance to people with WTD or suicidal ideation. However, a new bill that would legalise assisted dying for those with terminal illnesses, the Dying with Dignity Bill 2020, is due to be considered by lawmakers in Ireland in the coming months.

In order to inform discussion around this complex issue, we examine the prevalence and longitudinal course of WTD in a large population-representative sample of older people.

Methods

To define WTD, participants were asked: ‘In the last month, have you felt that you would rather be dead?’

Depressive symptoms were measured using the CES-D.

Mortality data were compiled by linking administrative death records to individual-level survey data from the study.

Results

At Wave 1, 3.5% of participants (279/8,174) reported WTD. Both persistent loneliness (OR 5.73 (95% CI 3.41–9.64)) and depressive symptoms (OR 6.12 (95% CI 4.33–8.67)) were independently associated with WTD.

Of participants who first reported WTD at Wave 1 or 2, 72% did not report WTD when reassessed after 2 years, and the prevalence of depressive symptoms (−44%) and loneliness (−19%) was more likely to decline in this group at follow-up.

Fifteen per cent of participants expressing WTD at Wave 1 died during a 6-year follow-up.

Conclusion

WTD amongst community-dwelling older people is frequently transient and is strongly linked with the course of depressive symptoms and loneliness.

An enhanced focus on improving access to mental health care and addressing social isolation in older people should therefore be a public health priority, particularly in the current context of the Covid-19 pandemic.

133 THE RELATIONSHIP BETWEEN DELAYED HEALTHCARE UTILISATION AND CHRONIC CONDITIONS AMONG OLDER ADULTS DURING THE COVID-19 PANDEMIC IN IRELAND

Background

The coronavirus 2019 (COVID-19) pandemic impacted significantly on the lives of older adults in Ireland, including the cancellation or postponement of healthcare services. This study examined the relationship between healthcare delay and older adults (50 years and over) with chronic conditions in Ireland.

Methods

This study used data from the Irish Longitudinal Study on Ageing (TILDA) COVID-19 study and previous waves of TILDA. The COVID-19 study data was collected between July 2020 and November 2020. Taking existing healthcare demand into account, logistic regression analysis was used to examine the relationship between healthcare delay and older adults with chronic conditions. Additional analysis, using multinomial logit regression, explored the reasons for healthcare delay, whether the delays were on the participants behalf or the health service provider.

Results

In total, 31.6% of participants reported healthcare delay. Older adults with two or more chronic conditions were more likely to experience healthcare delay than those with no chronic conditions. In the second analysis, older adults with two or more chronic conditions were more likely to have healthcare delayed by the provider and were also more likely to delay their own healthcare than those with no chronic conditions. Additionally, some other groups were more likely to experience healthcare delay such as: people aged 70 years and over, females, those with problematic alcohol consumption, those with third-level education, those who had visited the GP and those who reported polypharmacy. While older adults living with others and those living outside Dublin were less likely to experience healthcare delay.

Conclusion

The findings suggest that some groups of older adults may have been impacted more than others by healthcare delay during the pandemic. Policy and practice should focus on effective strategies to support the healthcare needs of these older adults going forward. Additionally, future research should examine the implications of healthcare delay on health outcomes.

201 THE BI-DIRECTIONAL ASSOCIATION BETWEEN LONELINESS AND DEPRESSION, BEFORE AND DURING THE COVID-19 PANDEMIC

Background

Methods

Results

Conclusion

123 ACUTE-PHASE BED-REST DURATION WAS ASSOCIATED WITH LOWER GRIP STRENGTH IN A POST-COVID-19 COHORT

Background

Though age-related muscle loss is traditionally associated with older cohorts, strong evidence suggests a life-spanning precipitation of decreasing muscle mass and strength beginning as early as the fourth decade of life, with established deleterious consequences for later-life morbidity and mortality. Periods of low activity and bed rest (LA/BR) can further compound this depletion of muscle strength. Our aim was to examine such associations in a post-COVID-19 cohort.

Methods

Participants reporting ongoing symptomatology and fatigue post COVID-19 underwent assessments of grip strength via hand-held dynamometry (2 measures on each hand). Demographics of COVID-19 illness, including time since diagnosis, duration of LA/BR during acute illness, and levels of fatigue were captured via self-reported questionnaires. Independent predictors of mean grip strength were investigated using a linear regression model.

Results

Forty-nine participants underwent assessments (69% female, mean age 44(12) years). At the time of assessment, days post COVID-19 diagnosis ranged from 39–522 (mean 262(140)). The mean self-reported period of LA/BR during the acute illness was 15(18) days. In general, participants reported significant levels of fatigue (median Chalder Fatigue Scale score 22(8)). Mean grip strength was 41.3(6.3) Kg for men and 22.8(6.7) Kg for women. When predictors of grip strength were investigated, an increased duration of LA/BR was found to be associated with lower grip strength, independently of age, gender, time since COVID-19 diagnosis, and self-reported fatigue (Beta = −0.158, 95% Confidence Interval − 0.242 to −0.074, p = 0.001).

Conclusion

In this cohort, every day of LA/BR during acute COVID-19 illness was independently associated with subsequent lower grip strength of approximately 150 g. These results underscore the importance of early mobilization and discouraging bed rest in the acute phase of COVID-19. Patients who are isolating should be encouraged to maintain physical activity and muscle strength as part of a modified isolation-friendly rehabilitation programme.

239 IS ORTHOSTATIC HYPOTENSION ASSOCIATED WITH ALTERED CEREBRAL PERFUSION DURING ACTIVE STANDING?

Background

Orthostatic Hypotension (OH) is associated with poor health outcomes in later life including depression, cognitive impairment, frailty and falls. Whilst it is hypothesised that OH compromises cerebral autoregulation leading to hypoperfusion, this has not been robustly demonstrated to date. This study investigated the association between OH and cerebral perfusion during orthostasis using a non-invasive surrogate of cerebral perfusion, Near Infrared Spectroscopy (NIRS).

Methods

Four hundred and ninety one participants (58% female, median age 65, IQR 38–92) attending a falls and syncope service underwent measurement of beat-to-beat blood pressure (BP) by finometry and real-time frontal lobe perfusion (% TSI: Tissue Saturation Index) by NIRS during the active stand manoeuvre. We examined the association between OH and change in cerebral perfusion (delta TSI) using mixed-effects linear regression, with adjustment for important clinical covariates.

Results

Nearly two-fifths of the sample (189/491,38.5%) met criteria for OH occurring between 30 and 120 seconds after standing. Using mixed effects linear regression models, we observed a significant relationship between OH and TSI at the same timepoint (β −0.53, −0.59 to −0.46, p &lt; 0.001) which persisted following adjustment for confounders including age, sex, baseline blood pressure, cerebrovascular and cardiovascular disease, depression/anxiety, diabetes, systolic blood pressure, antihypertensives, and antidepressants (β −0.51, −0.58 to −0.44, p &lt; 0.001). Cerebral perfusion levels differed for those with OH compared to those without.

Conclusion

OH is independently associated with lower frontal lobe cerebral perfusion. This association may indicate disruption to dynamic cerebral autoregulation and explain the significant link between OH and poor health outcomes.

224 METABOLIC SYNDROME ASSOCIATED WITH INCREASED LIKELIHOOD OF INCIDENT FRAILTY

Background

Frailty and metabolic syndrome (MetS) are both associated with increased mortality. This study aimed to examine the association between MetS and incident frailty in older adults in Ireland over a 4-year follow-up period.

Methods

This study used data from wave 1 and 3 of The Irish Longitudinal Study of Ageing (TILDA). Frailty status was operationalised using Fried’s frailty phenotype (FP). FP was determined at both waves. MetS was determined at wave 1, according to the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the International Diabetes Foundation (IDF) criteria. Those who were frail/pre-frail at wave 3 having been classified as non-frail at wave 1 were deemed to have ‘worsening frailty’, while those non-frail at both waves were deemed ‘stable non-frail’. Logistic regression models examined the association between MetS and worsening frailty compared to stable non-frail.

Results

FP was determined for 3,317 participants at both wave 1 and wave 3 of TILDA, of which 970 (29%) and 1,201 (36%) had MetS at wave 1 according to ATPIII and IDF criteria respectively. 664 (20%) had worsening frailty, while 1,624 (49%) were stable non-frail. Adjusted for age, sex and education, MetS was associated with an increased likelihood of worsening frailty, for both ATPIII and IDF criteria, OR 1.70 (p &lt; 0.001) and OR 1.63 (p &lt; 0.001) respectively. This association persisted when further adjusted for smoking history, chronic conditions (excluding diabetes and hypertension), renal function and micronutrients [OR 1.50, p = 0.001 (ATPIII) and OR 1.46, p = 0.001 (IDF)].

Conclusion

MetS increases the likelihood of incident frailty/pre-frailty by approximately 50% over a 4-year period. MetS should be considered a risk factor for frailty and should be considered in any comprehensive geriatric assessment given the dynamic nature of frailty and the potentially modifiable nature of MetS.

78 HIGHER NEUROVASCULAR SIGNAL ENTROPY IS ASSOCIATED WITH ACCELERATED BRAIN AGEING

Background

Often chronological age is not the most accurate marker of an individual’s health status since ageing is a heterogeneous process across individuals. Machine learning can be used to quantify the relationship between structural brain MRI data and chronological age, to estimate an individual’s ‘brain age’, which, when subtracted from chronological age, provides a brain predicted-age difference score (BrainPAD) [1]. BrainPAD reflects the biological ageing of the brain. Increased complexity in neurovascular signals has been shown to be associated with poorer cognitive performance and physical frailty [2]. The aim of this study was to investigate associations between the complexity of frontal-lobe oxygenation (tissue saturation index (TSI)) data and BrainPAD in a cohort of older community-dwelling adults.

Methods

To calculate BrainPAD, machine learning was applied to 1,359 T1-weighted MRI brain scans from various open-access repositories, and this model was subsequently applied to MRI data acquired from the study cohort. TSI was non-invasively measured in the left frontal lobe using near-infrared spectroscopy. TSI data were acquired continuously during five minutes of supine rest and the last minute was utilized in this analysis. The complexity of TSI signals was quantified using sample entropy (SampEn). Multivariable linear regression was employed, controlling for age, sex, education, antihypertensive medications, diabetes, cardiovascular conditions, smoking, alcohol, depression, BMI, physical activity, and blood pressure.

Results

Complete data were available for 397 individuals (age: 67.9 ± 7.7 years; 53.7% female). An increase in TSI SampEn of 0.1 was associated with an increase in BrainPAD of 0.9 years (P = 0.007, 95%CIs: 0.3 to 1.6). Similar results were found with and without the inclusion of chronological age in the models.

Conclusion

This study reports significant associations between higher complexity in peripherally measured frontal lobe oxygenation concentration and accelerated brain ageing.

References

1. Boyle R. et al. Brain Imaging and Behavior. 15,327–345 (2021) https://doi.org/10.1007/s11682-020-00260-3.

2. Knight S. et al. Entropy. 23(1):4 (2021) https://doi.org/10.3390/e23010004.

200 AN EXAMINATION OF THE FACTORS ASSOCIATED WITH PNEUMOCOCCAL VACCINATION UPTAKE IN THE OVER 50’S IN IRELAND

Background

Community acquired pneumonia presents a significant risk for morbidity and mortality in older adults. We aimed to look at the prevalence of pneumococcal vaccination in the over 50’s as well as which factors may influence it’s uptake by this group by using a nationally representative sample of adults from The Irish Longitudinal Study on Ageing (TILDA), a population-based study of community dwelling adults aged ≥50 years.

Methods

Cross-sectional data from the fifth wave of TILDA data collection (n = 5,020) was analysed. Several self-reported measures of pneumococcal vaccination uptake were examined that covered questions such as whether they had received a pneumococcal vaccination and whether any healthcare professionals had discussed vaccination with them. Logistic regression was performed to examine whether differing levels of healthcare entitlement was associated with higher pneumococcal vaccination uptake when adjusting for factors such as age, sex, education and self-reported health.

Results

Of the 5,206 participants over 50 who took part in Wave 5 data collection, 22.97% had reported receiving a pneumococcal vaccination. Of the 4,020 individuals who have not received a pneumococcal vaccination, only 5.79% had their GP discuss pneumococcal vaccination with them, 6.18% had discussed it with other providers such as nurses & pharmacists and 88.03% reported that they had never been spoken to about pneumococcal vaccination by any of their healthcare providers. Medical card coverage, OR = 2.48 (CI = 1.64:3.74, p = &lt;.000) and dual coverage, OR = 3.71 (CI = 2.45:5.61, p = &lt;.000) were associated with higher rates of pneumococcal vaccination but this association was not present with insurance coverage only, OR = 1.18 (CI = 0.778:1.79, p = &lt;.431).

Conclusion

These findings suggest that differences in levels of healthcare entitlement can affect access to preventative measures such as routine vaccinations, with those with both insurance coverage and a medical card being most likely to be vaccinated. It has also highlighted a need for more healthcare professionals to discuss routine pneumococcal vaccination with their patients.

Physical and mental health of older people while cocooning during the COVID-19 pandemic

BACKGROUND

Cocooning or shielding, i.e. staying at home and reducing face-to-face interaction with other people, was an important part of the response to the COVID-19 pandemic for older people. However, concerns exist regarding the long-term adverse effects cocooning may have on their physical and mental health.

AIM

To examine health trajectories and healthcare utilization while cocooning in a cohort of community-dwelling people aged ≥70 years.

DESIGN

Survey of 150 patients (55% female, mean age 80 years and mean Clinical Frailty Scale Score 4.8) attending ambulatory medical services in a large urban university hospital.

METHODS

The survey covered four broad themes: access to healthcare services, mental health, physical health and attitudes to COVID-19 restrictions. Survey data were presented descriptively.

RESULTS

Almost 40% (59/150) reported that their mental health was 'worse' or 'much worse' while cocooning, while over 40% (63/150) reported a decline in their physical health. Almost 70% (104/150) reported exercising less frequently or not exercising at all. Over 57% (86/150) of participants reported loneliness with 1 in 8 (19/150) reporting that they were lonely 'very often'. Half of participants (75/150) reported a decline in their quality of life. Over 60% (91/150) agreed with government advice for those ≥70 years but over 40% (61/150) reported that they disliked the term 'cocooning'.

CONCLUSIONS

Given the likelihood of further restrictions in coming months, clear policies and advice for older people around strategies to maintain social engagement, manage loneliness and continue physical activity and access timely medical care and rehabilitation services should be a priority.

Frailty is associated with impaired cerebral oxygenation recovery during

 

Frailty is associated with impaired peripheral circulatory responses to standing in older adults. However, little is known about how frailty affects cerebrovascular function during such activities of daily living. Here we investigate the association between frailty and cerebral oxygenation during standing in a large clinical cohort of fallers and fainters.

Participants were recruited from a national Falls and Syncope unit and underwent an active stand test (5–10 minutes lying supine, 3 minutes standing) with concurrent monitoring of continuous blood pressure (BP) and heart rate (HR) and tissue saturation index (TSI) using near-infrared spectroscopy (NIRS). Frailty was measured using a count of deficits (27 morbidities). Robust linear regression was applied to study the association between features of dynamic cerebral oxygenation (changes from baseline at nadir, overshoot, 30s and steady state; and recovery rate) and frailty while correcting for covariates. A p-value &lt;0.05 was considered significant.

Frailty was associated with deficits in TSI at 30s after standing (β: −0.165, CI: (−0.261, −0.069), p=0.005), as well as a lower diastolic BP at 30s (β: −1.346, CI: (−2.287, −0.405), p=0.032) and standing steady-state (β: −1.182, CI: (−2.038, −0.325), p=0.032). When stratified by gender, frailty was associated in women with a lower TSI at overshoot (β: −0.174, CI: (−0.312, −0.037), p=0.043) and 30s (β: −0.216 (−0.344, −0.089), p=0.010), and impaired DBP recovery at overshoot (β: −1.623, CI: (−2.865, −0.391), p=0.045) and attenuated HR response at 30s (β: −0.701, CI: (−1.246, −0.155), p=0.036). No associations were found in men.

Impaired cerebral oxygenation and BP responses to standing are associated with frailty in patients with falls and syncope, with stronger effects in women, suggesting that frailty may increase risk of hypoperfusion and consequent syncope, falls, and brain ageing. Our results demonstrate the clinical utility and feasibility of using NIRS in this context which can be used to further personalise patient management.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Irish Research Council Cerebral oxygenation and frailty

Verbal intelligence is a more robust cross-sectional measure of cognitive reserve than level of education in healthy older adults

BACKGROUND

Cognitive reserve is most commonly measured using socio-behavioural proxy variables. These variables are easy to collect, have a straightforward interpretation, and are widely associated with reduced risk of dementia and cognitive decline in epidemiological studies. However, the specific proxies vary across studies and have rarely been assessed in complete models of cognitive reserve (i.e. alongside both a measure of cognitive outcome and a measure of brain structure). Complete models can test independent associations between proxies and cognitive function in addition to the moderation effect of proxies on the brain-cognition relationship. Consequently, there is insufficient empirical evidence guiding the choice of proxy measures of cognitive reserve and poor comparability across studies.

METHOD

In a cross-sectional study, we assessed the validity of 5 common proxies (education, occupational complexity, verbal intelligence, leisure activities, and exercise) and all possible combinations of these proxies in 2 separate community-dwelling older adult cohorts: The Irish Longitudinal Study on Ageing (TILDA; N = 313, mean age = 68.9 years, range = 54-88) and the Cognitive Reserve/Reference Ability Neural Network Study (CR/RANN; N = 234, mean age = 64.49 years, range = 50-80). Fifteen models were created with 3 brain structure variables (grey matter volume, hippocampal volume, and mean cortical thickness) and 5 cognitive variables (verbal fluency, processing speed, executive function, episodic memory, and global cognition).

RESULTS

No moderation effects were observed. There were robust positive associations with cognitive function, independent of brain structure, for 2 individual proxies (verbal intelligence and education) and 16 composites (i.e. combinations of proxies). Verbal intelligence was statistically significant in all models. Education was significant only in models with executive function as the cognitive outcome variable. Three robust composites were observed in more than two-thirds of brain-cognition models: the composites of (1) occupational complexity and verbal intelligence, (2) education and verbal intelligence, and (3) education, occupational complexity, and verbal intelligence. However, no composite had larger average effects nor was more robust than verbal intelligence alone.

CONCLUSION

These results support the use of verbal intelligence as a proxy measure of CR in cross-sectional studies of cognitively healthy older adults.