Age and gender patterns in associations between lifestyle factors and physical performance in older Korean adults

Purpose

To investigate age and gender patterns in associations between lifestyle factors and physical performance in community-dwelling older Korean adults.

Design and methods

A cross-sectional study was conducted in a population-based sample of an urban area. Randomly sampled older Korean adults (n = 664; mean age, 74.6 years) participated. Data on current physical activity level and doing exercise, social participation and hobbies, smoking status, drinking status, sleep quality, and physical performance were obtained. Binary logistic regression analyses were used to identify the age and gender patterns in associations between various lifestyle factors and physical performance.

Results

In younger (age <85 years) men, significant predictors of poor physical performance by logistic regression analysis after adjusting for covariates were current physical activity time, doing exercise, and engagement in social activities. In younger women, current physical activity time and sleep quality were related to poor physical performance. In older (age ≥85 years) men, family gatherings were a significant factor. In older women, no lifestyle factor assessed showed a significant relationship with poor physical performance.

Conclusion

Interventions implemented to modify lifestyle factors need to focus on age and gender subgroups in the elderly population. Lifestyle modification should be emphasised as a targeted treatment program for Korean adults aged <85 years.     

Recovery from physical limitations among older Mexican adults

ObjectivesThis paper examines the key determinants of the likelihood of recovery from a physical disability among older adults.MethodsData come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003, 2012 and 2015. At baseline, we divided our sample of older adults aged 60+ by dimensions of physical limitations (ADLs, IADLs, mobility) and classified respondents as having physical limitations in zero, one, two or three dimensions. Each respondent was then categorized as “same”, “worse”, “improved” or “died” depending on the number of physical dimensions with a limitation in a 2-year span (2001–2003) and again, separately, in a 3-year span (2012–2015). We then used a multinomial logistic regression to analyze the relative risk of transitioning from one category to another.FindingsAround 21 % of our sample exhibited some recovery in 2003 and around 20 % recovered in 2015. Age, gender, poor self-rated health, depression and some chronic conditions were significant for shifting the relative risk from staying the same to getting worse, dying or even improving.ConclusionsDisability from a physical limitation is a reversible and dynamic process. Our results reflect the importance of considering the dimensions of physical ability while analyzing recovery, and illustrate that the presence of a chronic condition or depressive symptoms does not necessarily imply permanent disability.     

Association of unmet need with self-rated health in a community dwelling cohort of disabled seniors 75 years of age and over

Self-rated health (SRH) is a measure of perceived health that has been shown to predict use of community services, functional decline, pain, and mortality. Many factors associated with SRH have been identified, but unmet need for physical assistance with activities of daily living (ADL) has not yet been examined. The objective of this paper is to examine the association between unmet need and SRH while accounting for the effects of other, previously identified, correlates of SRH. We conducted a secondary analysis of a population-based study of 839 residents of Montréal, Québec who were 75 years of age or older, not cognitively impaired, and living in the community. Multivariable logistic regression was used to evaluate the association between met and unmet personal ADL (PADL) and instrumental ADL (IADL) need for physical assistance with SRH. Among 508 disabled community-dwelling elderly, for each additional unmet IADL need, subjects were 1.70 (95% CI: 1.11–2.61) times more likely to report poorer SRH. For each additional unmet PADL need, subjects were 2.26 (95% CI: 1.31–3.91) times more likely to report poorer SRH. Subjects at increased risk of malnutrition, with greater comorbidity and whose income was insufficient to meet their needs were also more likely to report poorer SRH. After adjustment for important correlates, unmet PADL and IADL needs retain a statistically significant association with poorer SRH, with nutritional status, comorbid conditions, and income satisfaction being important confounders of the relationship.     

The relationship between gender roles and self-rated health: A perspective from an international study

ObjectivesTo examine the relationship between gender roles and self-rated health in older men and women from different contexts.Methods2002 community-dwelling older adults from the International Mobility in Aging Study were recruited from 5 research sites. Gender role was measured with the 12-item Bem Sex Role Inventory, which categorized study participants into four gender roles: Masculine, Feminine, Androgynous, and Undifferentiated. Self-rated health was collapsed into a dichotomous variable (Very Good/Good and Fair/Poor/Very Poor). Prevalence risk ratios (PRR) of self-rated health relative to gender roles were estimated with Poisson regression models adjusted for all relevant confounders.ResultsAfter complete adjustment, feminine (PRR 1.22 (95 % CI 1.01–1.49)) and undifferentiated (PRR 1.25 (95 % CI 1.05–1.50)) gender roles were associated with poorer relative self-rated health.DiscussionGender roles confer independent risks and benefits for self-rated health in older adults.     

Bidirectional associations of accelerometer-assessed physical activity and sedentary time with physical function among older English adults: the EPIC-Norfolk cohort study

To develop healthy ageing interventions, longitudinal associations between objectively assessed physical behaviours and physical function need to be better understood. We assessed associations between accelerometer-assessed total physical activity (PA), moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary time and prolonged sedentary bout time, and clinically assessed physical function (grip strength, usual walking speed (UWS), chair stand speed) at two time-points in 3188 participants (≥ 60 years) of the EPIC-Norfolk study. Bidirectional associations were assessed using multivariable linear regression. Over an average of 6.1 years, baseline physical behaviours (greater total PA, MVPA and LPA, and less sedentary time) were associated with better subsequent walking and chair stand speed. Better baseline physical function was associated with better follow-up physical behaviours. There were no bidirectional associations between changes in physical behaviours and grip strength. Improvements in UWS were associated with improvements in all physical behaviours. Improvements in chair stand speed were associated with improvements in total PA, MVPA, and sedentary bout time. Improvements in physical behaviours were associated with improvements in UWS (3.1 cm/s/yr per 100 cpm/yr  total PA, 3.6 cm/s/yr per hr/day/yr MVPA, 2.5 cm/s/yr per hr/day/yr LPA, − 2.9 cm/s/yr per hour/day/yr sedentary time, and − 1.6 cm/s/yr per hr/day/yr prolonged sedentary bout time). Only improvements in total PA, MVPA and sedentary bout time were associated with improvements in chair stand speed. In conclusion, we found bidirectional associations between changes in some physical behaviours and physical function and between baseline physical behaviours and subsequent physical function, highlighting the importance of considering the full range of physical behaviours to promote healthy ageing.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-022-00733-y.     

Association of eating alone with oral frailty among community-dwelling older adults in Japan

BackgroundBecause the oral cavity plays an important role as the first digestive organ, thus, decreased oral function such as oral frailty may negatively affect the nutritional status of older adults. However, few studies have examined the relationship between oral frailty and dietary habits.ObjectiveThis cross-sectional study aimed to investigate the relationship between oral functions and dietary habits in a general population of older adults.MethodsParticipants were 722 older adults (mean age, 79.1 ± 4.5 [standard deviation] years) who had participated in the Takashimadaira Study conducted in 2018, in Tokyo, Japan. Oral frailty among them was determined by a modified version of a well-known method originally proposed by other researchers. Dietary habits were evaluated based on two aspects: dietary variety and eating behavior (eating alone or together). The independent association between oral frailty and dietary habits was analyzed with an ordinal logistic regression model, controlling for important covariates.ResultsOf the participants, 23.5 %, 57.2 % and 19.3 % were determined to have non-oral frailty, pre-oral frailty, and oral frailty, respectively. Eating alone (practiced by 36.0 % of the participants) was significantly associated with oral frailty status (adjusted odds ratio, 1.82 [95 % confidence interval, 1.14–2.90]) even after controlling for potential confounders including age, sex, body mass index, living arrangement, employment, chronic medical conditions, and depressive mood.ConclusionsWe found a significant association between eating alone and oral frailty in a general population of Japanese older adults. Because of the strong association, further investigation of potential mechanisms is warranted.     

Relationship of low muscle mass and obesity with physical function in community dwelling older adults: Results from the Nagahama study

AimRelationships of low muscle mass and obesity with physical function were investigated in older adults.MethodsThe participants were 1922 community dwelling persons aged 60 years or older (67.7 ± 5.2 years old, 643 men and 1279 women). One-leg standing time, knee extensor muscle strength, and maximum walking speed were assessed. Muscle mass was evaluated using the bioelectrical impedance analysis (BIA) method, and skeletal mass index (SMI) was determined. For the obesity index, waist circumference with a stronger association with visceral fat was used. Participants were classified into the following four groups based on standard values of waist circumference and SMI: non-obese low-SMI, obese low-SMI, non-obese normal-SMI, and obese normal-SMI.ResultsBy two-way analysis of variance (obesity × SMI), the main effects of waist circumference and muscle mass were noted in the one-leg standing time. The maximum walking speed was higher in the non-obese than the obese group, and in the normal than the low SMI group. In the muscle strength, a main effect was noted only in the muscle mass of women. An interaction was noted in men and significant differences were detected between all combinations except between the non-obese low SMI and obese low SMI groups.ConclusionLow muscle mass and obesity negatively influence balance and walking abilities. However, the influence of low muscle mass and obesity on muscle strength were different between the sexes. In men, the relationship between obesity and muscle strength would be different depending on whether muscle mass is retained.     

Changes in physical performance among high-functioning older adults: a 6-year follow-up study

Purposes of the study were (1) to investigate changes in physical performance during 6 years follow-up among high-functioning older adults and (2) to describe the selection of study sample with reference to measured performance. Subjects (n=1,133) born during 1917–1941 participated in the battery of health-related fitness (HRF) tests (6.1-m walk, stair climbing, backwards walk, trunk side-bending, dynamic back extension, 1-km walk and body mass index) in 1996. Six hundred and six subjects were retested in 2002. In general, poorer fitness in the baseline assessment predicted non-participation in retesting as well as test exclusions and interruptions in retesting. The 6-year changes in the HRF showed a linear trend (P<0.01) according to age group: performance of older groups deteriorated on average more than the performance of younger groups. In most of the tests, gender was statistically significantly (P<0.05) associated with the changes in performance. The mean performance of the women deteriorated in all tests during the follow-up, while the mean performance of the men deteriorated only in the trunk side-bending, 6.1-m walk and 1-km walk tests. It can be concluded that among the subjects who participated in the follow-up testing, older age and being a woman increased deterioration in several components of HRF. Considering the selection of the subjects, the deteriorations identified are very likely underestimations of real fitness changes among this sample.     

Falls efficacy and self-rated health in older African American adults

Fear of falling and mobility restrictions have a significant negative impact on the quality of life of older adults. Because older African American adults are at increased risk for various modifiable health problems, understanding potential constraints on their overall health and mobility is critical in this population. The current study investigated this issue by analyzing a dataset of 449 older African American adults (mean age = 72.3 years) living in Detroit. We characterized and investigated the relationships among the following falls- and health-related variables: previous falls, falls efficacy, mobility, self-rated health (SRH), and depression and well-being. As a whole, participants reported moderate health and well-being, little depression, few mobility problems (mean = 8.4/40), and very high falls efficacy (mean = 94.9/100) despite the fact that a quarter of the sample experienced a fall within the past year. Correlation results indicated that previous falls, falls efficacy, mobility, SRH and depression and well-being were all inter-related. Regression analyses revealed that higher falls efficacy was more closely associated with better SRH than was having previously fallen. Findings suggest that improving falls efficacy in older African American adults may be beneficial to their mobility and overall health and well-being. Further, by asking a single-item SRH question, clinicians may be able to quickly identify older African American adults who have low falls efficacy and are at high risk for falling.     

Gender,self-rated health and functional decline among community-dwelling older adults

ObjectiveThis paper examines the association between self-rated health (SRH) and functional decline (FD) in older Ghanaian cohorts and investigates whether the effect differs by gender and also modified by marital status.MethodsThe study used cross-sectional survey data (N = 1200) from an Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) study conducted in between August 2016 and January 2017. A four-level gendered-stratified logit modeling estimated the SRH-FD association and the interaction terms.ResultsOverall, 23% of male respondents and 34% of women revealed significant FD (p < 0.001). The fully-adjusted model showed that SRH status was a strong predictor of FD across genders but the effect was most pronounced among men. Compared with excellent/very good SRH, fair and poor SRH (β = 0.160; p < 0.05) and (β = 1.700; p < 0.001) for women and (β = 2.202; p < 0.001) and (β= 2.356; p < 0.001) for men respectively were significantly associated with increased FD. However, good (β = − 1.760; p < 0.001), fair (β = − 2.800; p < 0.001) and poor SRH (β = −2.088; p < 0.001) decreased FD if an older woman was married compared with unmarried women with excellent/very good SRH.ConclusionThe strength of SRH-FDs association largely differed with gender and also moderated by marital status for women. Improving the SRH and marital quality could be protective of functional abilities, independence and quality of life for older people.     

Self-rated health among older adults: a cross-national comparison

Self-rated health (SRH) may have different implications in various social and cultural settings. However, few studies are available concerning SRH among older persons across countries. The aim of this study was to analyse whether there are cross-national differences in the association between status characteristics, several diseases common among older persons, activities of daily living (ADL), and SRH. The study base was the Comparison of Longitudinal European Studies on Aging (CLESA), which includes data from six population-based studies on aging conducted in Finland, Israel, Italy, The Netherlands, Spain and Sweden. The study population comprised 5,629 persons, with participants from all countries except Italy. Logistic regression analyses were used to assess the relationship between status characteristics, health conditions, ADL and SRH. To examine whether the association among status characteristics, health conditions, ADL and outcome differed across the CLESA countries, interaction terms defined as variable*country were considered separately for each variable. Regression analyses revealed that sex, education, lifetime occupation, heart disease and respiratory disease were differently distributed across countries. Among homogeneous factors, marital status (OR=1.21), hypertension (OR=1.41), stroke (OR=1.67), diabetes (OR=2.15), cancer (OR=1.47), musculoskeletal diseases (OR=2.44), and ADL (OR=2.72) turned out to be significantly associated with fair or poor SRH. The results indicate that there are differences in self-ratings of health across countries. These differences cannot be explained entirely by status characteristics, self-reported diseases or functional ability. However, an important finding was that in all countries most of the indicators of medical and functional health were homogeneously associated with SRH.     

Self-rated health (SRH) and socioeconomic position (SEP) among urban home-dwelling older adults

The main purpose of this study was to examine the association of education and adequacy of income with self-rated health (SRH) among home-dwelling older people aged 75 and over living in the urban area. A cross-sectional survey from 2008 was used to study 1395 older adults aged 75 and over living in one of the central areas of the city center of Helsinki, the capital of Finland. Associations of SRH with, education and adequacy of income were tested using ordinal regression model. Those with a lower level of education had higher level of poor health. Self-assessed adequacy of income had also a strong association with SRH. For the oldest respondents this association was even stronger than the association between education and SRH. Subjective evaluation of financial situation should be used as a key indicator of socioeconomic position (SEP) in studies examining inequalities in health especially among older adults.     

Depressive symptoms and self-rated health in community-dwelling older adults: a longitudinal study

OBJECTIVES: To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self-rated health and decrease the likelihood of subsequent improvement in self-rated health. DESIGN: A 2-year prospective cohort study. SETTING: Six thousand seven hundred fourteen community-dwelling older persons who completed the first and second wave of the Asset and Health Dynamics among the Oldest-Old Survey in the United States. PARTICIPANTS: Community-dwelling older people in the United States. MEASUREMENTS: Baseline depressive symptoms were measured using a short-form of the Center for Epidemiological Studies Depression Scale. Self-rated health was measured using a single item of global health rating. RESULTS: After adjustment for covariates, a high burden of depressive symptoms at baseline was predictive of greater decline in self-rated health (odds ratio (OR) for decline in those with high burden of depressive symptoms vs those without = 1.47, 95% confidence interval (CI) = 1.26-1.70). Likewise, high burden of depressive symptoms at baseline predicted less improvement in self-rated health (OR for improvement in those with high burden of depressive symptoms vs those without = 0.57, 95% CI = 0.50-0.65). CONCLUSIONS: Depressive symptomatology is an independent risk factor for subsequent changes in self-rated health in older adults. Thus, early prevention and intervention of depressive symptoms in community-dwelling older adults might be critical to promote and maintain their self-rated health.     

Potential benefits of environmental volunteering programs of the health of older adults: a pilot study

PurposeTo study the effects of participating in a 12-week environmental volunteering program on the physical performance of older adults across different age groupsMaterials and MethodsWe conducted a pretest–posttest pilot study with a single group. The intervention consisted of twice-weekly recycling activities and once-weekly rehabilitation exercise at community-based care centers. The recycling activities of the environmental volunteering program included sorting and handling paper products, plastics, and metals; disposing electronic products; and sorting clothes. The rehabilitation exercise program comprised a 90-min course for special needs and 30 min of health education. The evaluation tools were the handgrip strength, five-times-sit-to-stand test, sit-and-reach test, Timed Up and Go (TUG) test and usual and fast gait speeds.ResultsIn total, 45 participants completed the program. After the program, the participants showed significantly great improvements compared to baseline in all outcome measures. We further divided these participants into two age subgroups [65–75 years (n = 31) and >75 years (n = 14)]. The 65–75-year subgroup only showed significant improvements in handgrip strength, TUG and usual gait speed. However, the >75-year subgroup showed significant improvements in all outcome measures.ConclusionsThis innovative environmental volunteering program conducted in a local Taiwanese community can be a sustainable and feasible model to improve physical performance in the participants, the subgroup aged >75 years in particular. It also provides a potential avenue for researchers and policymakers to address environmental and aging-related issues.     

The health advantage of volunteering is larger for older and less healthy volunteers in Europe: a mega-analysis

There is a vast literature on the health benefits associated with volunteering for volunteers. Such health advantages are likely to vary across groups of volunteers with different characteristics. The current paper aims to examine the health advantages of volunteering for European volunteers and explore heterogeneity in the association between volunteering and health. We carry out a mega-analysis on microdata from six panel surveys, covering 952,026 observations from 267,212 respondents in 22 European countries. We provide open access to the code we developed for data harmonization. We use ordinary least squares, fixed effects, first difference, and fixed effect quantile regressions to estimate how volunteering activities and changes therein are related to self-rated health for different groups. Our results indicate a small but consistently positive association between changes in volunteering and changes in health within individuals. This association is stronger for older adults. For respondents 60 years and older, within-person changes in volunteering are significantly related to changes in self-rated health. Additionally, the health advantage of volunteering is larger for respondents in worse health. The advantage is largest at the lowest decile and gradually declines along the health distribution. The magnitude of the association at the first decile is about twice the magnitude of the association at the ninth decile. These results suggest that volunteering may be more beneficial for the health of specific groups in society. With small health advantages from year to year, volunteering may protect older and less healthy adults from health decline in the long run.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-022-00691-5.     

Protein intake is not associated with functional biomarkers of physical frailty: A cross-sectional analysis of community-dwelling older adults with type 2 diabetes mellitus

Background and aimFrailty has emerged as a third category of complication in patients with type 2 diabetes mellitus (T2DM). It has been suggested that adequate protein intake is an important dietary strategy for counteracting frailty. Therefore, we explored the association between protein intake and functional biomarkers of frailty in older adults with T2DM.Methods and resultsFrailty was operationalized as the presence of three of the following: exhaustion, low muscle strength, low physical activity, slow gait speed, and weight loss. Functional biomarkers included handgrip strength (HGS), chair stands, the short physical performance battery and gait speed. Eighty-seven older adults (71.2 ± 8.2 years; 66.7% males) were included. A total of n = 6 (~7%) and n = 32 (~37%) participants were identified as frail and pre-frail respectively. No significant difference was observed for protein intake across staging of frailty (pre-frail/frail: 1.3 ± 0.4 g/kg BW; non-frail: 1.4 ± 0.4 g/kg BW; P = 0.320). A significant association was observed for total protein intake and HGS (β = 0.44; 95% CI: 0.23–1.8; P = 0.01). However, this was no longer significant after adjusting for age, gender, physical activity, energy intake and total appendicular lean muscle (β = 0.03; 95% CI: ?0.45–0.60; P = 0.78). Nil other associations were observed between total protein intake and functional biomarkers of frailty.ConclusionAdequate protein intake was not associated with functional biomarkers in older adults with T2DM. Future research should focus on the efficacy of protein on attenuating functional decline in vulnerable older adults with low protein intake.     

The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS)

BackgroundMultimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength.MethodsA cross-sectional analysis was conducted of 5877 respondents (2744 = male, 3103 = female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg).ResultsAs the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b = 3.1, 95% CI = 2.3–3.9, p < 0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength.ConclusionMultimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.     

Views on aging: older adults’ self-perceptions of age and of health

Perceptions of age and perceptions of health have each been found to predict future health and well-being, yet surprisingly, studies typically focused on one or the other. Studies on perceived age suggested that its effects on longevity may be mediated by perceived health. Within each of these lines of research, the constructs have not been consistently operationalized, making it difficult to generalize across studies. We aimed to investigate the associations of different measures of perceptions of age and of health with one another and with longevity. Data collected at baseline from the 851 participants of the Rutgers Aging and Health longitudinal study (mean age 73) included perceptions of age and health, each assessed with four different single-item measures, sociodemographic, and health measures. Mortality was followed-up for 10 years. All four health perceptions and two of the age perceptions (Age-group identity and nearness-to-death) were associated with survival time. Age and health perceptions had similar independent effects in models that included measures of both types, controlling for demographics and chronic conditions, though not after controlling for age. In contrast with our hypothesis, health perceptions did not mediate the association between age perceptions and mortality. Findings regarding health perceptions were generally consistent across measures, whereas age perception measures differed in their associations with various outcomes, indicating that they assess different subjective age constructs. The findings correspond with proposed explanations for the predictive effect of age and health perceptions and support the significant though weaker independent effects of age perceptions compared with health perceptions.     

Prevalence and correlates of physical inactivity among older adults in Malaysia: Findings from the National Health and Morbidity Survey (NHMS) 2015

Malaysia has an increasingly aging population. Despite the substantial benefits of physical activity for healthy aging, older adults are considered the most physically inactive segment of the Malaysian population. The purpose of this study was to determine the prevalence of physical inactivity among older adults in Malaysia and its correlates. We analysed data on adults aged ≥60 years (n = 3790) from the National Health and Morbidity Survey (NHMS) 2015, a cross-sectional, nationwide population-based survey covering information on socio-demographic characteristics, physical activity and other lifestyle-related variables, health conditions, and functional limitations. Individuals included in this study were classified as physically active or physically inactive. Logistic regression was used to determine factors associated with physical inactivity. The overall prevalence of physical inactivity among older adults aged ≥60 years old was 48.8%. Physical inactivity was significantly more prevalent among females, older age groups, Indians, those being single/widowed/divorced, those with no formal education, those who reported high sedentary time (≥7 h/day), those with diabetes, anaemia, and functional limitations (p < 0.001). In fully adjusted analyses, females, older age, high household income (≥MYR4000), inadequate fruits and vegetables consumption (<5 servings/day), high sedentary time, having diabetes, and having mobility impairment were all associated with physical inactivity. Approximately half of the Malaysian older population are physically inactive. Identifying the correlates of physical inactivity among Malaysian older adults will help to develop public health policies and interventions that encourage active living among older people and promote healthy aging in Malaysia.