Social participation and life-style: A longitudinal and cohort study

This study focuses on changes occurring in one area of life-style, social participation during retirement. The population consisted of four cohorts, born in 1905–06, 1909–10, 1917–18, and 1921–22. In the longitudinal study the members of the oldest cohort were interviewed five times at the ages of 66, 70, 74, 78 and 82 years. In the cohort study the subjects were interviewed at the age of 66. Interests decreased after the age of 78 among men and women. Also, formal social participation declined with age among men and women. There were no cohort differences among men, but among women formal social participation was higher in the younger cohorts than in the older ones. In the longitudinal study education correlated positively with the interests index at almost all ages among both men and women. In the cohort study correlations between interests index and education were lower in the younger cohorts than in the older ones.Paper originally presented at the XIVth International Congress of Gerontology, Acapulo, Mexico 18–23 June 1989.     

A longitudinal study of changes and adaptation in the support networks of Welsh elderly over 75

Despite conventional wisdom that urbanization has worsened the lot of the elderly and that rural or traditional societies are, therefore, more benign environments for the very old, data from a wide cross-section of developed and developing societies suggest that more similarity than difference exists. The evidence is that most old people in all societies rely on and receive comparable levels of support from their family, friends and neighbors. Less, however, is known about the process of social support over time. This paper reports the results of a longitudinal study of the support networks of the old elderly (75+), looking at changes over four years in a sample of 100 old people, 30 of whom were followed in-depth for 6 years. The findings demonstrate a high level of stability in network size, radius and close kin membership. Membership of distant kin, neighbors and friends is found to be more fluid. Within the network, considerable task flexibility was observed with the qualification that intimate physical care fell exclusively in the family domain. In this case, support networks appear to adjust to meet increasing need for support.An earlier version of this paper was presented at the XIIIth International Congress of Gerontology, New York, July, 1985.     

Depression and disability: comparisons with common physical conditions in the Ibadan study of aging

OBJECTIVES: To compare the effects of depression and chronic physical conditions on disability in elderly persons. SETTING: Yoruba‐speaking areas of Nigeria. DESIGN: Interviews. PATICIPANTS: Community‐dwelling persons aged 65 and older. METHOD: Face‐to‐face interviews were conducted with a representative sample of community‐dwelling persons aged 65 and older (N=2,152) in the Yoruba‐speaking areas of Nigeria (representing ～22% of the national population). Major depressive disorder (MDD) was assessed using the World Health Organization Composite International Diagnostic Interview. Chronic pain and medical disorders were assessed using self‐report. Disorder‐specific disability was evaluated using the Sheehan Disability Scale (SDS). RESULTS: MDD was highly comorbid with each of the medical conditions (odds ratio range 1.3–2.0). A higher proportion of persons with MDD (47.2%) were rated severely disabled globally than those with arthritis (20.6%), chronic spinal pain (24.2%), or high blood pressure (25.0%). Subjects with MDD were also more likely to be severely disabled in three of the four domains of the SDS. In pair‐wise comparisons, persons with MDD had significantly higher levels of disability than those with any of the disorders, with differences in mean scores ranging between ?3.74 and ?27.50. CONCLUSION: To reduce the public health burden of depression, its prevention and treatment require more clinical and research attention than currently given by developing countries.     

A socio-medical survey of the old citizens of Bialystok,Poland: 5 years longitudinal observation

The aim of the longitudinal study was the evaluation of the changing socio-medical conditions of the old citizens of Bialystok during a 5 year period of observation. The study was based on the analysis of 6 age/sex cohorts of 100 men and 100 women born in 1899, 1909, 1919. A stratified systematic sampling of the entire population of the city in the required generation was used. The survey was conducted twice, in 1979 and 1984, and employed a questionnaire prepared by the Editorial Board of the Comparative Study of Eleven Countries developed by WHO. The questionnaire included items concerning personal data, occupation, housing conditions, health status, functional ability, the use of health services, social activity and life satisfaction. The data allow us to consider aging in all its aspects — health status, life style, opinions and feelings of the elderly — according to age group (cross-sectional analysis) and according to the progression of chronological age in the same cohorts (longitudinal analysis).Paper presented at the XIIth International Congress of Anthropological and Ethnological Sciences, Zagreb, Yugoslavia, 24–30 July, 1988.     

Coping in longitudinal perspective: Findings from the bonn longitudinal study on aging

Within the Bonn Longitudinal Study on Aging (BOLSA) 221 women and men, born between 1890–95 and between 1900–05, were tested and interviewed in the year 1965 for the first time. Survivors were followed at seven measurement points until 1980. One of three lengthy interviews was related to the topic of stress and coping. Information on perceived stresses in the areas of housing, income, family and health were rated. Furthermore, responses to these different stress areas were analyzed by an empirically developed classification system. Findings point to a complex system of response patterns even in the group of very old participants. These response patterns were different for the four areas of stress, such as family or health etc. Response patterns related to the same problem area remained consistent over the 15-year span. Cluster analyses point to situation specific as well as person specific response patterns.This paper was originally presented at the XIV International Congress of Gerontology, Acapulco, Mexico, 18–23 June 1989.     

Faster decline of physical performance in older adults with higher levels of baseline locomotive function

Aim: The purpose of this longitudinal study was to determine whether the rate of decline in community‐dwelling older adults varies according to baseline locomotive function levels. Methods: This longitudinal study was conducted in community‐dwelling older adults in Kyoto, Japan. In addition to information about falls, physical performance was assessed using a series of tests, including 10‐m walking time, timed up and go (TUG) test, functional reach, one‐leg stand test, and five chair stand test. The outcomes for each patient were measured once in 2009 and then followed up 1 year later. The change in physical performance was then determined. We divided the participants into tertiles (T1, T2, and T3) according to timed up and go test results, and the differences among the three groups were compared. Results: Of the 252 individuals who were enrolled in the study, 231 (91.6%) completed the 12‐month follow‐up: 77 in the T1 group; 78 in the T2 group; and 76 in the T3 group. The T1 group showed a significantly larger decrease than the T2 and T3 groups in the 10‐m walking time and TUG tests (P < 0.05). However, there were no significant differences in functional reach, one‐leg standing test, or five chair stand test among the three groups. In the T1 group, the number of falls and elderly who had developed fear of falling increased during the study period. Conclusions: This study demonstrated that elderly with the highest baseline performances were more likely to show a greater decline in locomotive performance than the other groups. Further study is required to elucidate the mechanism of faster physical functional decline in robust elderly. Geriatr Gerontol Int 2012; 12: 238–246.     

Healthy behaviors and onset of functional disability in older adults: results of a national longitudinal study

OBJECTIVES: To examine the combined effect of healthy behaviors on the development of functional disability in an elderly cohort. DESIGN: Prospective cohort study. SETTING: Taiwan Longitudinal Study in Aging from 1989, 1993, 1996, 1999, and 2003. PARTICIPANTS: A national sample of 1,940 men and 1,247 women aged 60 and older without functional disability at baseline. MEASUREMENTS: Functional disability was defined as difficulty with activities of daily living: taking a bath or walking 200 to 300 m. Time to functional disability was the age at midpoint between the first occurrence of disability onset in the survey year and prior survey year. Considering that the onset of disability is probably a precursor of death, for those who died without disability, time to disability onset was set at the midpoint between the last follow‐up and death year. Four healthy behaviors were measured: not smoking, moderate alcohol consumption, regular exercise, and sleeping 6 to 8 hours per day. A Cox proportional hazards model with time‐dependent covariates was used to analyze the association between age at the first functional disability and prior healthy behavior, after controlling for sex, time‐varying disease status, marital status, and education. RESULTS: Healthy behaviors were linked to the onset of functional disability. Participants who performed one or more healthy behaviors were 15% to 75% less likely to be disabled than those who performed none. CONCLUSION: In the population studied, healthy behaviors were associated with lower incidence of functional disability. As the number of healthy behaviors increased, the likelihood of disability decreased.     

Factors contributing to longitudinal changes in activities of daily living (ADL): The Koganei study

The present study is based on a 10-year observation of the completely competent elderly people aged 69–71 years in 1976, living at home. The purpose of the study is to identify predictors of incompetence in ADL at the follow-up carried out 10 years later. Among all the items of ADL, i.e., walking, eating, toileting, bathing, and dressing, the most remarkable decline was found in walking. The incompetent, those who suffered loss of independence on one or more items of ADL at follow-up, accouned for 32.4% of men and 25.6% of women. In the univariate logistic regression analysis, low levels of social activities in both sexes, history of hypertension and ECG abnormalities in men, and overweight and anxiety about present health status in women had a significant relationship to incompetence in ADL. The significance of social activities for both sexes was still observed in the multivariate analysis.     

Selflessness and perfectionism as predictors of pathological eating attitudes and disorders: A longitudinal study

This paper examines the role that selflessness and perfectionism may play as possible predictors of pathological eating attitudes and eating disorders (ED). 1057 schoolgirls (seventh to ninth grade) participated in the initial screening phase. They were administered the Eating Attitudes Test (EAT‐26), Selflessness Scale (SS) and Multidimensional Perfectionism Scale (MPS). Based on their EAT‐26 scores, 150 girls were invited to a clinical interview 2 years later (second phase). In the third phase 4 years later, 243 girls who completed the questionnaires in the seventh grade were the target of re‐administration of these scales. Seventh‐grade selflessness scores at initial screening phase predicted ED status determined in clinical interview at the 2‐year interval and abnormal eating attitudes at the 4‐year interval, above and beyond baseline seventh‐grade eating‐attitude scores. Perfectionism was not found to predict the development of neither ED nor abnormal eating attitudes. Preventional and therapeutic implications of the role of selflessness as a predisposing factor for ED are discussed. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort

OBJECTIVES: To evaluate the effect of blood pressure (BP) and diabetes mellitus (DM) on cognitive and physical performance in older, independent-living adults. DESIGN: Longitudinal study with secondary data analysis from the Advanced Cognitive Training for Independent and Vital Elderly randomized intervention trial. SETTING: Six field sites in the United States. PARTICIPANTS: Two thousand eight hundred two independent-living subjects aged 65 to 94. MEASUREMENTS: Cognitive functions in different domains and physical functions measured using activities of daily living, instrumental activities of daily living (IADLs), and the physical function subscale from the Medical Outcomes Study Short Form-36 (SF-36) Health Survey. RESULTS: After the first annual examination, hypertension was associated with a faster decline in performance on logical reasoning tasks (ability to solve problems following a serial pattern), whereas DM was associated with accelerated decline on the Digit Symbol Substitution Test (speed of processing). The reasoning and Digit Symbol Substitution test are executive function tasks thought to be related to frontal-lobe function. Hypertension and DM were associated with a significantly faster pace of decline on the SF-36 physical function component score. Individuals with DM had a faster pace of decline in IADL functioning than nondiabetic subjects. There was no evidence for an interaction between BP and DM on cognitive or physical function decline. CONCLUSION: Hypertension and DM are associated with accelerated decline in executive measures and physical function in independent-living elderly subjects. Further research is needed to determine whether cardiovascular risk modification ameliorates cognitive and functional decline in elderly people.     

Metabolic syndrome and physical performance in elderly men: the osteoporotic fractures in men study

OBJECTIVES: To examine the association between metabolic syndrome (MetS) and objective measures of physical performance. DESIGN: Cross‐sectional analysis of the cohort study, the Osteoporotic Fractures in Men Study. SETTING: Six clinical sites in the United States. PARTICIPANTS: Five thousand four hundred fifty‐seven ambulatory men (mean age 73.6 ± 5.9). MEASUREMENTS: Physical performance assessed according to grip strength, narrow walk speed, walking speed, and time to complete five repeated chair stands. Individual scores were converted to quintiles (worst=1 to best=5; unable to complete=0) and summed for an overall score (mean 11.6 ± 4.3, range, 1–20). MetS was defined according to World Health Organization criteria that include evidence of glucose dysregulation (insulin resistance, diabetes mellitus, or hyperinsulinemia) and at least two additional characteristics: high blood pressure, low high‐density lipoprotein cholesterol, high triglycerides, obesity. RESULTS: More than one‐quarter (26.3%) of participants met criteria for MetS. In separate linear regression models, four of five MetS components were related to performance (P<.001); only high blood pressure was unrelated. Men with MetS had a 1.1‐point lower performance score (mean 10.8, 95% confidence interval (CI)=10.6–11.0) than men without MetS (mean 11.9, 95% CI=11.8–12.0) (P<.001), adjusting for age, race, education, and site. With further covariate adjustment, this difference was reduced but remained significant (β=?0.78, P<.001). A graded association was observed between number of MetS components (0, 1, 2, or ≥3) and performance (P for trend <.001). Findings were similar excluding men with diabetes mellitus or obese men. CONCLUSION: Metabolic dysregulation is related to objectively assessed poorer physical performance in relatively healthy older men.     

Impact of physical activity and performance on medical care costs among the Japanese elderly

Aim: Physical activity (PA) is known to be inversely associated with medical care costs. The amount of PA is strongly associated with the level of physical performance among the elderly population. Therefore, it is possible that known relation between PA and medical care merely shows the relation between physical performance and medical care. To know whether PA itself relates to medical care, considering physical performance is necessary. The aim of this study was to ascertain the impact of PA on medical care expenditure by considering the physical performance in an elderly community‐dwelling population. Methods: We investigated 483 subjects who did not have any history of diseases relating to limited PA and who completed both a self‐administered questionnaire including questions on PA and underwent a physical performance measurement. We ascertained the total medical care costs through a computerized linkage with claims lodged between August 2002 and March 2008 with the Miyagi National Health Insurance Association. Results: The physical performance was positively associated with their level of PA. After multivariate adjustment for covariables including the levels of physical performance, the per capita medical care costs were found to be $US 827.3 (598.0–1056.7) (mean, 95% confidence interval), $US 711.1 (476.4–945.8) and $US 702.0 (461.6–942.4) (P for linear trend = 0.02) per month for those who had the lowest, average and the highest level of PA, respectively. Conclusion: This prospective study indicates that a higher level of PA is associated with lower medical care costs among the Japanese elderly irrespective of physical performance. Geriatr Gerontol Int 2011; 11: 157–165.     

Effects of change in physical activity on physical function limitations in older women: mediating roles of physical function performance and self-efficacy

OBJECTIVES: To examine the hypothesis that changes in self-efficacy and functional performance mediate, in part, the beneficial effect of physical activity on functional limitations over time.
DESIGN: Prospective, observational study.
SETTING: Community-based.
PARTICIPANTS: Two hundred forty-nine community-dwelling older women.
MEASUREMENTS: Participants completed measures of self-reported physical activity, functional limitations, and self-efficacy. Four measures of physical function performance were also assessed. Measures were completed at baseline and 24 months. Data were analyzed using a panel model within a covariance modeling framework.
RESULTS: Results indicated that increases in physical activity over time were associated with greater improvements in self-efficacy, which was associated in turn with improved physical function performance, both of which mediated the association between physical activity and functional limitations. Fewer functional limitations at baseline were also associated with higher levels of self-efficacy at 24 months. Age, race, and health status covariates did not significantly change these relationships.
CONCLUSION: The findings support the mediating roles of self-efficacy and physical function performance in the relationship between longitudinal changes in physical activity and functional limitations in older women.     

Prevalence of depressive symptoms among the elderly: A longitudinal study

Aim:   Depression is a common psychiatric problem in late life. The purpose of the present study was to assess the prevalence of depressive symptoms among community-dwelling elderly, both cross-sectionally and longitudinally.
Methods:   This study was a part of the community study in a large cohort of elderly people aged 65 and over in Nangai Village, Japan. Data on depressive symptoms from the fifth survey in 2000 were analyzed cross-sectionally and also combined with data from the first survey in 1992 to assess aging and cohort effects. Depressive symptoms were measured by the short form of Geriatric Depression Scale.
Results:   Among 1195 respondents at the fifth survey, the prevalence of depressive symptoms was 22.3%. In 457 subjects who responded at both surveys, mean depression score or prevalence of depressive symptoms tended to be higher at the fifth survey than at the first survey. The difference in prevalence between the first survey and the fifth survey among individuals of the same age groups was significant only in the oldest group (77 years and over).
Conclusion:   Among Japanese community-dwelling elderly people, aging effects on depressive symptoms were found, though marked cohort effects were not confirmed.     

Impact of premature natural menopause on body composition and physical function in elderly women: A Korean frailty and aging cohort study

Induced premature menopause accelerates the rate of body composition changes (decrease in skeletal muscle mass and increase in fat mass) and deteriorating physical function. However, few studies have focused on the impact of premature natural menopause. This study aimed to investigate the impact of age at natural menopause (ANM) on body composition and physical function in elderly women.Using data from the Korean Frailty and Aging Cohort Study, 765 community-dwelling elderly women aged 70 to 85 years who experienced natural menopause were recruited in this study. Body composition was measured using dual-energy X-ray absorptiometry. Physical function was evaluated by grip strength, the timed up and go test (TUG), and the short physical performance battery (SPPB). Participants were categorized into 4 groups according to their ANM: <40 (premature natural menopause, PNM), 40 to 44 (early natural menopause, ENM), 45 to 54 (normal menopause, NM), and ≥55 (late menopause, LM) years.There were no significant differences in the body composition parameters, such as the appendicular skeletal muscle mass index (PNM: 5.90 ± 0.90 vs ENM: 5.91 ± 0.70 vs NM: 5.85 ± 0.73 vs LM: 5.90 ± 0.75, kg/m², P = .75) and trunk fat mass index (PNM: 19.4 ± 3.9 vs ENM: 19.9 ± 4.4 vs NM: 19.9 ± 3.9 vs LM: 20.0 ± 3.8, %, P = .87) between the groups. In the physical function evaluation, there was no significant difference between the groups in grip strength (PNM: 19.8 ± 0.6 vs ENM: 20.3 ± 0.4 vs NM: 20.6 ± 0.2 vs LM: 20.6 ± 0.4, kg, P = .53). However, in the TUG (PNM: 11.8 ± 0.4 vs ENM: 10.3 ± 0.3 vs NM: 10.6 ± 0.1 vs LM: 10.2 ± 0.3, seconds, P < .01) and SPPB (PNM: 10.0 ± 0.2 vs ENM: 10.5 ± 0.2 vs NM: 10.6 ± 0.1 vs LM: 10.8 ± 0.2, points, P < .05), the PNM group showed significantly lower values than the other groups did. There was no difference in physical function between the groups except the PNM.Premature natural menopause did not affect the body composition in elderly women but was associated with physical function deterioration. Therefore, more attention should be paid to the prevention of the physical function deterioration caused by premature natural menopause in elderly women.     

Comparison of appendicular lean mass indices for predicting physical performance in Korean hemodialysis patients: A cross-sectional study

Few studies have examined the optimal adjustment indices for predicting low muscle strength or physical performance in hemodialysis (HD) patients. Thus, the present study aimed to identify optimal adjustment indices for predicting strength and/or physical performance in HD patients.Our study was performed at an HD center (n = 84). Appendicular lean mass (ALM; kg) was calculated using dual-energy X-ray absorptiometry. ALM were adjusted to body weight, height² (Ht²), body surface area, or body mass index. Physical performance tests (sit-to-stand test performed 5 times test, sit-to-stand for 30 second test, 6-minute walk test, timed up and go test, gait speed, hand grip strength, average steps per day (AST), and short physical performance battery) were also evaluated. Participants with a below median value for each physical performance test were defined as the low group.The mean participant age was 55.6 ± 12.8 years; 44 (52.4%) were men. The univariate analysis revealed a significant difference in ALM/Ht² values between the low and normal physical performance group in all physical performance tests except short physical performance battery. The multivariate analysis revealed a significant difference in ALM/Ht² between the low and normal physical performance groups in hand grip strength, 5 times sit-to-stand test, sit-to-stand for 30-second test, and AST. In women on HD, most indices were not associated with physical performance or strength.We demonstrated that, in men on HD, ALM/Ht² may be the most valuable among various variables adjusted for ALM for predicting physical performance or strength.