Older drivers are at increased risk of fatal crash involvement: Results of a systematic review and meta-analysis

Older adults have become a larger part of the driving population, but whether they are at increased risk of being involved in fatal crashes remains unclear.MethodsWe performed a systematic review of studies investigating fatal crash involvement of older vs non-older drivers by searching the following databases: PubMed, Cochrane Library, Embase, LILACS, SciELO, Web of Science, and ProQuest. Studies that used fatal crash involvement rates per distance driven as a measure of frequency were selected for meta-analysis.ResultsWe analyzed 14 studies published between 2001 and 2018. Of these, 12 reported a higher rate of fatal crashes involving older drivers than non-older drivers; 9 of them used involvement rates per distance driven, which is considered the most appropriate metric. The meta-analysis revealed high heterogeneity between studies. The meta-regression attributed 40% of the heterogeneity to age (older vs non-older drivers) (p<0.005).ConclusionAge appears to be associated with higher driver involvement rates for fatal crashes among older persons.     

Subjective age and verbal fluency among middle aged and older adults: A meta-analysis of five cohorts

ObjectivesThis study aimed to examine the relation between subjective age and verbal fluency in five large samples of older adults to advance knowledge on the role of subjective age in a complex cognitive function that is an intermediate marker of cognitive impairment and dementia risk.MethodsParticipants (N > 27,000), aged 32 to 99 years old, predominantly white, were from the Wisconsin Longitudinal Study Graduate (WLSG) and Siblings (WLSS) samples, the Health and Retirement Study (HRS), the Midlife in the United States Study (MIDUS), and the English Longitudinal Study of Ageing (ELSA). They provided complete data on subjective age, demographic factors and verbal fluency. Estimates from each sample were combined in a meta-analysis.ResultsAcross each of the five samples and in the meta-analysis, an older subjective age was related to lower performance on the verbal fluency task. This association was independent of chronological age and was not moderated by age, sex, nor education. The difference in fluency between individuals with an older and younger subjective age ranged from d = 0.09 to d = 0.37 across the five samples.ConclusionsThis study found replicable evidence for an association between an older subjective age and lower verbal fluency, extending knowledge about an intermediate marker of cognitive function.     

Risk of sarcopenia among older persons with Type 2 diabetes mellitus with different status of albuminuria: A dose-responsive association

BackgroundThe association between type 2 diabetes mellitus (T2DM) and sarcopenia has been reported before, but little was known regarding associations between albuminuria status in the development of sarcopenia. This study aimed to explore the associations between albuminuria status and sarcopenia among older patients with T2DM.MethodsThis cross-sectional study recruited T2DM patients aged 65 years and older from the DM shared care center in a regional hospital who were grossly absent from functional impairment. Demographic characteristics were collected and functional assessments were performed for all participants. Urinary albumin-to-creatinine ratio (UACR) was obtained by spot urine exams, whereas UACR ≥ 30 mg/g was defined as microalbuminuria, and UACR > 300 mg/g as macroalbuminuria. Appendicular lean mass (ASM) was measured by the dual X-ray absorptiometry, and the relative appendicular muscle mass (RASM) was calculated as the ASM divided by height square (kg/m²).The definition of sarcopenia was made according to the Asian Working Group for Sarcopenia and muscle quality was defined as handgrip strength (kg) divided by RASM.ResultsOverall, 180 participants (mean age: 72.5±5.3 years, 53.3% males) were enrolled for study. Higher HbA1c levels and poorer renal function were significantly associated with more severe albuminuria status.Besides, sarcopenia and low handgrip strength also showed dose-responsive associations with albuminuria status, which was similar in muscle quality.The receiver operating characteristic curve determine that the UACR of 13.7 mg/g was the optimal cutoff for sarcopenia diagnosis, which was lower than the conventionally definition of microalbuminuria (<30 mg/g).ConclusionsAlbuminuria status was dose-responsively associated with sarcopenia among older persons with T2DM, and the risk started to escalate from minimal albuminuria (UACR 9.18 mg/g in men and 18.4 mg/g in women). Further intervention studies are needed to evaluate potential benefits of better diabetes control in preventing sarcopenia and its outcomes.     

The empty nest,depressive symptoms and loneliness of older parents: Prospective findings from the German Ageing Survey

ObjectivesThe aim of this study was to analyse the longitudinal association between the transition to an empty nest and depressive symptoms and loneliness, respectively.MethodLongitudinal data was used from the German Ageing Survey, a representative sample of community-dwelling adults aged 40 and over. The indication of children living outside the respondent's household was defined as an empty nest. A 6‐item version of the validated De Jong Gierveld Loneliness scale was used to assess perceived loneliness. The 15 item version of the Center for Epidemiological Studies Depression Scale was used to measure depressive symptoms. Fixed‐effects regression analyses adjusted for time‐varying socio‐demographic and health‐related variables were applied.ResultsThe unadjusted regression yielded that transitioning to an empty nest led to decreased loneliness in men (b =  -0.05; p < 0.05) and increased depressive symptoms in women (b =  0.48; p =  0.05). However, when controlling for potential confounders, the transition was no longer associated with a change in loneliness or depressive symptom scores.ConclusionThe empty nest is an expected phase of the family life cycle that most parents will experience. In this longitudinal study, this phase of the family life cycle was shown not to be associated with parents' psychosocial health in terms of loneliness and depressive symptoms. Our study suggests that the consequences of an empty nest have been overestimated in the past. Future longitudinal studies with panel regression models in different cultural settings are needed to confirm our findings.     

Childhood socioeconomic disadvantage as a determinant of late-life physical function in older Japanese people

BackgroundIn this study, we examined the relationship between childhood socioeconomic status and physical function among older Japanese people, and investigated whether there is a sex variation in this association.MethodsWe administered a cross-sectional questionnaire survey to all independent community-dwelling individuals ≥65 years old, living in Adachi Ward, Tokyo (N = 132,005). Participants self-reported their physical function using the Motor Fitness Scale, and we divided the scores into quartiles for analysis. Childhood socioeconomic status was retrospectively assessed according to a single item.ResultsWe analyzed 75,358 questionnaires. The average age of participants was 73.8 ± 6.0 years, and 55.0% were women. An ordered logistic regression analysis showed that lower childhood socioeconomic status was associated with lower physical function, independent of adult sociodemographic factors, health behaviors, and health conditions. This association was stronger in women than in men.ConclusionsOur findings indicate that low childhood socioeconomic status might have a long-term influence on physical function in late life and that this influence varies by sex. Assessment of socioeconomic disadvantage in childhood is important for developing strategies to help older people maintain their physical function longer.     

Treatment Efficacy and Acceptabilityof Pharmacotherapies for Dementia with Lewy Bodies: A Systematic Review and Network Meta-Analysis

IntroductionWe investigated the efficacy and acceptability of pharmacotherapy for dementia with Lewy bodies (DLB) while simultaneously considering the neuropsychiatric symptoms (NPS), cognitive function, motor symptoms, and acceptability.MethodsElectronic databases were searched from inception through June 5, 2019, for randomized controlled trials (RCTs) and open-label trials (OLTs) in patients with DLB. We performed a pairwise conventional meta-analysis (PWMA) and network meta-analysis (NMA) within a frequentist framework. The main outcomes were mean change scores in NPS, general cognition, motor symptoms and acceptability. The effect sizes and odds ratios with 95% confidence intervals (CIs) were calculated. This study was registered with PROSPERO (CRD42018096996).ResultsIn total, we included 29 studies (9 RCTs and 20 OLTs). In the NMA with 9 RCTs, both high- (mean difference [MD] 2.00, 95% CIs, 0.69 to 3.31) and low-dose (1.86, 0.58 to 3.15) donepezil were associated with a greater cognitive improvement than placebo. High-dose zonisamide was associated with greater motor symptom improvement ( -4.10, -7.03 to -1.17]). No medications reached statistical significance regarding improving neuropsychiatric symptoms or developing intolerable adverse effects as compared to placebo. In the second NMA, with 29 studies as an exploratory analysis, aripiprazole and yokukansan may be effective for neuropsychiatric symptoms, while levodopa may be associated with cognitive impairment.ConclusionsWe report the most comprehensive evidence for the selection of pharmacotherapy for treating different clusters of DLB-related symptoms. Due to the limited availability of RCTs on DLB, more well-conducted RCTs are needed for MMA to warrant clinical efficacy in the future.     

Global Single Clustering of Phenotype-Associated Human Aging Genes in the Co-Expression and Physical Interaction Networks: An OMIM-Based Investigative Review.

BACKGROUND: While a large wealth of literature on aging pertains to in silico, experimental, and predicted genes, many of those genes do not have validated phenotypic consequences in human. Online Mendelian Inheritance in Man (OMIM) provides an exceptional compendium of authoritative, validated aging genes and phenotypes, the interactions among which may enhance the overall perspective of aging mechanisms in human. METHODS: Here, we reviewed and investigated the global clustering pattern of the OMIM-indexed aging genes (until April 2021) in the gene co-expression and physical interaction networks, using the two keywords “aging” and “ageing”. To allow for validity check, we randomly selected six sets of genes from the human genome as control genes, each set consisting of a similar number of genes obtained from the OMIM search. STRING was implemented in the weighted setting and using the edge betweenness parameter, to construct the integrated and tissue-specific networks of the age-related and control genes. RESULTS: 286 aging (ageing) genes and a wide spectrum of 96 associated phenotypes were detected, including late-onset neurodegenerative disorders, cancers, osteoarthritis, and longevity. Despite the general terms used and the vast range of age-related phenotypes, we detected single clustering of the OMIM-extracted aging (ageing) genes in each of the integrated weighted co-expression and physical interaction networks (p<0.0005), as opposed to multiple clustering of the control genes (p≥0.04). TP53 was the overlapping hub gene in each of the networks. Three genes, TP53, APP, and SIRT1 were the consistent hub genes co-expressed across eleven selected human tissues frequently affected by age-related phenotypes.CONCLUSION: We propose predominant single clustering of the human phenotype-associated aging genes in the co-expression and physical interaction networks, and list the top pathways and genes involved.     

Association between activity diversity and frailty among community-dwelling older Japanese: A cross-sectional study

PurposeDeterioration of daily activities increases frailty risk. Most of the previous research has examined the association between frailty and specific activities; nevertheless, the diversity of daily activities is also important. Although the type, frequency, and evenness of daily activities have been proposed as indicators of activity diversity, the association between these indicators and frailty remains unclear. In this study, we examined the association between activity diversity and frailty in community-dwelling older adults.Materials and MethodsThis cross-sectional study comprised 658 community-dwelling older adults aged ≥ 65 years who participated in comprehensive health check-ups in 2018. Frailty was defined using the Japanese version of the Cardiovascular Health Study criteria. Three indicators, type, frequency, and evenness of daily activities, were used to assess activity diversity across one week. Multiple logistic regression analyses were performed, with frailty as the dependent variable and the three activity diversity indicators as independent variables. Socio-demographic, physical, and mental functioning factors were adjusted as covariates.ResultsOf the 658 participants (median age: 72 years; age range: 65–91 years; 60.5% women), 27 (4.1%) met the criteria for frailty. The frail group had significantly lower scores for type, frequency, and evenness of daily activities, as well as Mini-Mental State Examination scores (all at p < 0.01). We found significant independent associations in all activity diversity indicators with frailty, in multiple logistic models.ConclusionActivity diversity is independently associated with frailty in community-dwelling older adults.