Trail Making Test Predicts Physical Impairment and Mortality in Older Persons

OBJECTIVES: To examine whether performance in the Trail Making Test (TMT) predicts mobility impairment and mortality in older persons. DESIGN: Prospective cohort study. SETTING: Community‐dwelling older persons enrolled in the Invecchiare in Chianti (InCHIANTI) Study. PARTICIPANTS: Five hundred eighty‐three participants aged 65 and older and free of major cognitive impairment (Mini‐Mental State Examination score >21) with baseline data on TMT performance. Of these, 427 performed the Short Physical Performance Battery (SPPB) for the assessment of lower extremity function at baseline and after 6 years. Of the initial 583 participants, 106 died during a 9‐year follow‐up. MEASUREMENTS: The TMT Parts A and B (TMT‐A and TMT‐B) and SPPB were administered at baseline and 6‐year follow‐up. Impaired mobility was defined as an SPPB score less than 10. Vital status was ascertained over a 9‐year follow‐up. RESULTS: InCHIANTI participants in the fourth quartile of the time to complete TMT‐B minus time to complete TMT‐A (TMT (B‐A)) were significantly more likely to develop an SPPB score less than 10 during the 6‐year follow‐up than those in the first quartile (relative risk (RR)=2.4, 95% confidence interval (CI)=1.4–3.9, P=.001). After adjusting for potential confounders, these findings were substantially unchanged (RR=2.2, 95% CI=1.4–3.6, P=.001). Worse performance on the TMT was associated with significantly greater decline in SPPB score over the 6‐year follow‐up, after adjusting for age, sex, and baseline SPPB scores (β=?0.01, standard error=0.003, P=.004). During the 9‐year follow‐up, 18.2% of the participants died. After adjustment for age and sex, the proportion of participants who died was higher in participants in the worst than the best performance quartile of TMT (B‐A) scores (hazard ratio (HR)=1.7, 95% CI=1.0–2.9, P=.048). Results were similar in a parsimonious adjusted model (HR=1.8, 95% CI=1.0–3.2, P=.04). CONCLUSION: Performance on the TMT is a strong, independent predictor of mobility impairment, accelerated decline in lower extremity function, and death in older adults living in the community. The TMT could be a useful addition to geriatric assessment.     

Sleep duration and health in young adults

BACKGROUND: Both long and short sleep durations have been associated with negative health outcomes in middle-aged and older adults. This study assessed the relationship between sleep duration and self-rated health in young adults. METHODS: Using anonymous questionnaires, data were collected from 17 465 university students aged 17 to 30 years who were taking non-health-related courses at 27 universities in 24 countries. The response rate was greater than 90%. Sleep duration was measured by self-report; the health outcome was self-rated health; and age, sex, socioeconomic background, smoking, alcohol consumption, body mass index, physical activity, depression (Beck Depression Inventory), recent use of health services, and country of origin were included as covariates. RESULTS: Sixty-three percent of respondents slept for 7 to 8 hours; 21% were short sleepers (6%, <6 hours; 15%, 6-7 hours); and 16% were long sleepers (10%, 8-10 hours; 6%, >10 hours). Compared with the reference category (7-8 hours), the adjusted odds ratio of poor health was 1.56 (95% confidence interval [CI], 1.22-1.99) for respondents sleeping 6 to 7 hours and 1.99 (95% CI, 1.31-3.03) for those sleeping less than 6 hours. The same significant pattern was seen when the results were analyzed separately by sex. When respondents from Japan, Korea, and Thailand (characterized by relatively short sleep durations) were excluded, the adjusted odds ratios were 1.33 (95% CI 1.03-1.73) and 1.62 (95% CI, 1.06-2.48) for those sleeping 6 to 7 hours and less than 6 hours, respectively. There were no significant associations between self-rated health and long sleep duration. CONCLUSION: Our data suggest that short sleep may be more of a concern than long sleep in young adults.     

Weekend catch-up sleep is associated with the alleviation of non-alcoholic fatty liver disease

Introduction and objectivesRecently, interest in the relationship between weekend catch-up sleep (WCUS) and chronic diseases is increasing. We aimed to study the correlation between sleep duration and non-alcoholic fatty liver disease (NAFLD), an emerging metabolic disease.Materials and methodsData on sleep duration from the Korea National Health and Nutrition Examination Survey was recorded. The subjects were divided into three groups according to the duration of WCUS: Group 1, those who slept for less than 7 hours in a week; Group 2, those who slept for less than 7 hours on weekdays but more than 7 hours on weekends (those with WCUS pattern); and Group 3, those who slept for more than 7 hours in a week. Multivariate logistic regression analysis was used to analyze the correlation between sleep duration and NAFLD.ResultsA mean sleep time of 7 hours or more showed a significant negative relationship with NAFLD (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.79–0.89 in all; OR 0.91, 95%CI 0.84–0.99 in males; OR 0.86, 95%CI 0.79–0.94 in females). Groups 2 and 3 showed significant negative relationships with NAFLD when Group 1 was used as a reference (Group 2; OR: 0.80, 95%CI: 0.70–0.92, Group 3; OR: 0.73, 95%CI: 0.66–0.82). WCUS showed similar correlations with NAFLD, regardless of sex.ConclusionsWCUS and sleep duration are significantly associated with NAFLD. A prospective cohort study is needed to prove the causal effects.     

Sleep Disturbances and Frailty Status in Older Community-Dwelling Men

OBJECTIVES: To test the hypothesis that sleep disturbances are independently associated with frailty status in older men. DESIGN: Cross‐sectional analysis of prospective cohort study. SETTING: Six U.S. centers. PARTICIPANTS: Three thousand one hundred thirty‐three men aged 67 and older. MEASUREMENTS: Self‐reported sleep parameters (questionnaire); objective parameters of sleep–wake patterns (actigraphy data collected for an average of 5.2 nights); and objective parameters of sleep‐disordered breathing, nocturnal hypoxemia, and periodic leg movements with arousals (PLMAs) (in‐home overnight polysomnography). Frailty status was classified as robust, intermediate stage, or frail using criteria similar to those used in the Cardiovascular Health Study frailty index. RESULTS: The prevalence of sleep disturbances, including poor sleep quality, excessive daytime sleepiness, short sleep duration, lower sleep efficiency, prolonged sleep latency, sleep fragmentation (greater nighttime wakefulness and frequent, long wake episodes), sleep‐disordered breathing, nocturnal hypoxemia, and frequent PLMAs, was lowest in robust men, intermediate in men in the intermediate‐stage group, and highest in frail men (P‐for‐trend ≤.002 for all sleep parameters). After adjusting for multiple potential confounders, self‐reported poor sleep quality (Pittsburgh Sleep Quality Index >5, multivariable odds ratio (MOR)=1.28, 95% confidence interval (CI)=1.09–1.50), sleep efficiency less than 70% (MOR=1.37, 95% CI=1.12–1.67), sleep latency of 60 minutes or longer (MOR=1.42, 95% CI=1.10–1.82), and sleep‐disordered breathing (respiratory disturbance index ≥15, MOR=1.38, 95% CI=1.15–1.65) were each independently associated with higher odds of greater frailty status. CONCLUSION: Sleep disturbances, including poor self‐reported sleep quality, lower sleep efficiency, prolonged sleep latency, and sleep‐disordered breathing, are independently associated with greater evidence of frailty.     

Self-reported napping and duration and quality of sleep in the lifestyle interventions and independence for elders pilot study

OBJECTIVES: To determine the prevalence of self‐reported napping and its association with subjective nighttime sleep duration and quality, as measured according to sleep‐onset latency and sleep efficiency. DESIGN: Cross‐sectional study. SETTING: Lifestyle Interventions and Independence for Elders Pilot Study. PARTICIPANTS: Community‐dwelling older adults (N=414) aged 70 to 89. MEASUREMENTS: Self‐report questionnaire on napping and sleep derived from the Pittsburgh Sleep Quality Index (PSQI) scale. RESULTS: Fifty‐four percent of participants reported napping, with mean nap duration of 55.0±41.2 minutes. Nappers were more likely to be male (37.3% vs 23.8%, P=.003) and African American (20.4% vs 14.4%, P=.06) and to have diabetes mellitus (28% vs 14.3%, P=.007) than non‐nappers. Nappers and non‐nappers had similar nighttime sleep duration and quality, but nappers spent approximately 10% of their 24‐hour sleep occupied in napping. In a multivariate model, the odds of napping were higher for subjects with diabetes mellitus (odds ratio (OR)=1.9, 95% confidence interval (CI)=1.2–3.0) and men (OR=1.9, 95% CI=1.2–3.0). In nappers, diabetes mellitus (β=12.3 minutes, P=.005), male sex (β=9.0 minutes, P=.04), higher body mass index (β=0.8 minutes, P=.02), and lower Mini‐Mental State Examination score (β=2.2 minutes, P=.03) were independently associated with longer nap duration. CONCLUSION: Napping was a common practice in community‐dwelling older adults and did not detract from nighttime sleep duration or quality. Given its high prevalence and association with diabetes mellitus, napping behavior should be assessed as part of sleep behavior in future research and in clinical practice.     

Resilience of community-dwelling older persons

OBJECTIVES: To assess resilience of community-dwelling older persons using a new scale based on response to a stressful life event and to identify the demographic, clinical, functional, and psychosocial factors associated with high resilience. DESIGN: Cross-sectional study. SETTING: Community. PARTICIPANTS: Five hundred forty-six nondisabled persons aged 70 and older who had experienced a stressful life event. MEASUREMENTS: Resilience (as assessed using a simple six-item scale), demographic factors, chronic conditions, medications, cognitive status, grip strength, functional status, physical activity, self-efficacy, depressive symptoms, self-rated health, and social support. RESULTS: Participants showed a wide range of resilience in response to a stressful event, with a mean score+/-standard deviation of 8.9+/-4.0 on an 18-point scale. In bivariate analyses, male sex, living with others, high grip strength, independence in instrumental activities of daily living (IADLs), having few depressive symptoms, and having good to excellent self-rated health were associated with high resilience, defined as a score in the best tertile (>10). Independence in IADLs (relative risk (RR)=1.36, 95% confidence interval (CI)=1.05-1.69), having few depressive symptoms (RR=1.59, 95% CI=1.13-2.11), and good to excellent self-rated health (RR=1.38, 95% CI=1.01-1.79) remained independently associated with high resilience in multivariate analysis. Depressive symptoms and self-rated health remained associated with high resilience after controlling for the perceived stressfulness of the event. CONCLUSION: Functional and psychosocial factors are associated with high resilience. Further research is needed to determine the relationship between resilience and future well-being.     

Health-related quality of life predicts mortality in older but not younger patients following cardiac surgery

The investigators assessed preoperative health-related quality of life as a predictor of 6-month mortality after cardiac surgery in older (65 years of age and older) vs. younger patients. Multivariable regression, stratified by age groups, was used to compare the association between preoperative Physical Component Summary and Mental Component Summary scores from the Short Form-36 health status survey and mortality. In multivariable analyses of older patients, lower preoperative Physical Component Summary (odds ratio, 1.54; 95% confidence interval, 1.19–2.00; p=0.01) and Mental Component Summary (odds ratio, 1.26; 95% confidence interval, 1.06–1.49; p=0.03) scores were independently associated with mortality. In contrast, neither Physical Component Summary (p=0.82) nor Mental Component Summary (p=0.79) scores were associated with mortality in the younger subgroup. This study demonstrated that preoperative health status is an independent predictor of mortality following cardiac surgery in older but not younger patients. Preoperative patient self-report of health status may be particularly useful in refining risk stratification and informing decision-making before and following cardiac surgery in older patients.     

Influence of zolpidem and sleep inertia on balance and cognition during nighttime awakening: a randomized placebo-controlled trial

OBJECTIVES: To determine whether sleep inertia (grogginess upon awakening from sleep) with or without zolpidem impairs walking stability and cognition during awakenings from sleep. DESIGN: Three within‐subject conditions hypnotic medication (zolpidem), placebo (sleep inertia), and wakefulness control randomized using balanced Latin square design. SETTING: Sleep laboratory. PARTICIPANTS: Twelve older and 13 younger healthy adults. INTERVENTION: Five milligrams of zolpidem or placebo 10 minutes before scheduled sleep (double‐blind: zolpidem or sleep inertia); placebo before sitting in bed awake for 2 hours after their habitual bedtime (single‐blind: wakefulness control). MEASUREMENTS: Tandem walk on a beam and cognition, measured using computerized performance tasks, approximately 120 minutes after treatment. RESULTS: No participants stepped off the beam on 10 practice trials. Seven of 12 older adults stepped off the beam after taking zolpidem, compared with none after sleep inertia and three after wakefulness control. Fewer young adults stepped off the beam: three after taking zolpidem, one after sleep inertia, and none after wakefulness control. Number needed to harm analyses showed one tandem walk failure for every 1.7 (95% confidence interval (CI)=1.4–2.0) older and 5.5 (95% CI=5.2–5.8) younger adults treated with zolpidem. Cognition was significantly more impaired after zolpidem exposure than with wakefulness control in older and younger participants (working memory: older, ?4.3 calculations, 95% CI=?7.0 to ?1.7; younger, ?12.4 calculations, 95% CI=?18.2 to ?6.7; Stroop: older, 76‐ms increase (95% CI=13.5–138.4 ms); younger, 126‐ms increase, 95% CI=34.7–217.5 ms), whereas sleep inertia significantly impaired cognition in younger but not older participants. CONCLUSION: Zolpidem produced clinically significant balance and cognitive impairments upon awakening from sleep. Because impaired tandem walk predicts falls and hip fractures and because impaired cognition has important safety implications, use of nonbenzodiazepine hypnotic medications may have greater consequences for health and safety than previously recognized.     

Interleukin-6, C-reactive protein, and tumor necrosis factor-alpha as predictors of mortality in frail, community-living elderly individuals

To investigate whether interleukin‐6 (IL‐6), C‐reactive protein (CRP) and tumor necrosis factor‐alpha (TNF‐α) protein levels predict all‐cause mortality in older persons living in the community. DESIGN: Prospective cohort study. SETTING: Data were from the Aging and Longevity Study in the Sirente Geographic Area, a prospective cohort study. PARTICIPANTS: Individuals aged 80 and older living in an Italian mountain community (N=362). MEASUREMENTS: Participants were classified according to the median value of the three inflammation markers (IL‐6, 2.08 pg/mL; TNF‐α, 1.43 pg/mL; CRP, 3.08 mg/L). A composite summary score of inflammation was also created. The main outcome was risk of death after 4 years of follow‐up. RESULTS: One hundred fifty deaths occurred during 4 years of follow‐up. In the unadjusted model, high levels of each of the three markers were associated with greater mortality. After adjusting for potential confounders, high levels of IL‐6 (hazard ratio (HR)=2.18, 95% confidence interval (CI)=1.29–3.69) and CRP (HR=2.58, 95% CI=1.52–4.40) were associated with a significantly greater risk of death, whereas the association between TNF‐α protein levels and mortality was no longer significant (HR=1.26, 95% CI=0.74–2.15). The composite summary score of inflammation was strongly associated with mortality, with the highest risk estimated for individuals with all three inflammatory markers above the median. CONCLUSION: Low levels of inflammatory markers are associated with better survival in older adults, independent of age and other clinical and functional variables.     

Development of a Frailty Index for Patients with Coronary Artery Disease

OBJECTIVES: To construct a brief frailty index for older patients with coronary artery disease (CAD) undergoing coronary angiography that includes physical, cognitive, and psychosocial criteria and accurately predicts future disability and decline in health‐related quality of life (HRQL). DESIGN: Prospective cohort. SETTING: An urban tertiary care hospital in Alberta, Canada. PARTICIPANTS: Three hundred seventy‐four patients aged 60 and older (73% male) undergoing cardiac catheterization for CAD between October 2003 and May 2007. MEASUREMENTS: Potential frailty criteria examined at baseline (before the procedure) included measures of balance, gait speed, cognition, self‐reported health, body mass index (BMI), depressive symptoms, and living alone. The outcomes assessed over 1 year were dependency in activities of daily living (ADLs) and HRQL. RESULTS: The five best‐fitting criteria from regression analyses for ADL decline were poor balance (risk ratio (RR)=2.4, 95% confidence interval (CI)=1.4–4.0), abnormal BMI (RR=1.8, 95% CI=1.1–3.0), impaired Trail‐Making Test Part B performance (RR=2.3, 95% CI=1.3–4.2), depressive symptoms (RR=1.8, 95% CI=1.1–3.1), and living alone (RR=2.2, 95% CI=1.3–3.8). Using the five criteria as separate variables or as a summary frailty index yielded identical areas under the receiver operating characteristic curve (0.76, 95% CI=0.66–0.84). Patients with three or more criteria (vs none) were at statistically significant greater risk for increased disability (RR=10.4, 95% CI=4.4–24.2) and decreased HRQL (RR=4.2, 95% CI=2.3–7.4) after 1 year. CONCLUSION: This brief frailty index including physical, cognitive, and psychosocial criteria was predictive of increased disability and decreased HRQL at 1 year in older patients with CAD undergoing angiography. This index may have applications for clinicians and researchers but requires further validation.     

Self-Reported Sleep and Nap Habits and Risk of Mortality in a Large Cohort of Older Women

OBJECTIVES: To determine the association between self-reported sleep and nap habits and mortality in a large cohort of older women.
DESIGN: Study of Osteoporotic Fractures prospective cohort study.
SETTING: Four communities within the United States.
PARTICIPANTS: Eight thousand one hundred one Caucasian women aged 69 and older (mean age 77.0).
MEASUREMENTS: Sleep and nap habits were assessed using a questionnaire at the fourth clinic visit (1993/94). Deaths during 7 years of follow-up were confirmed with death certificates. Underlying cause of death was assigned according to the International Classification of Diseases, Ninth Revision, Clinical Modification.
RESULTS: In multivariate models, women who reported napping daily were 44% more likely to die from any cause (95% confidence interval (CI)=1.23–1.67), 58% more likely to die from cardiovascular causes (95% CI=1.25–2.00), and 59% more likely to die from noncardiovascular noncancer causes (95% CI=1.24–2.03) than women who did not nap daily. This relationship remained significant in relatively healthy women (those who reported no comorbidities). Women who slept 9 to 10 hours per 24 hours were at greater risk of death from cardiovascular and other (noncardiovascular, noncancer) causes than those who reported sleeping 8 to 9 hours.
CONCLUSION: Older women who reported napping daily or sleeping at least 9 hours per 24 hours are at greater risk of death from all causes except cancer. Future research could determine whether specific sleep disorders contribute to these relationships.     

Sleep duration and self-rated health in Chinese university students

Purpose

Little is known about the association between sleep duration and health status in Chinese university students. This study examined the association between sleep duration and self-rated health in university students in China.

Methods

Altogether, 2312 subjects (928 in Macao, 446 in Hong Kong, and 938 in mainland China) were recruited. Standardized measures of sleep and self-reported health were administered. Sleep duration was categorized in the following way: <?6 h/day, 6 to <?7 h/day, 7–9 h/day, and >?9 h/day.

Results

Overall, 71% of university students reported poor health, 53% slept 7–9 h/day, 14% slept less than 6 h/day, 32% slept 6 to <?7 h/day, and 1% slept >?9 h/day. Univariate analysis revealed that compared to students with medium sleep duration (7–9 h/day), those with short sleep duration (<?6 h/day and 6 to <?7 h/day) were more likely to report poor health. Multivariate logistic regression analysis found that after controlling for age, gender, body mass index, university location, being a single child, religious beliefs, interest in academic major, academic pressure, nursing major, pessimism about the future, and depression, sleep duration of less than 6 h/day (odds ratio (OR) 1.98, 95% confidence interval (CI) 1.34–2.92, p?<?0.01) was independently and significantly associated with poor self-reported health.

Conclusions

Poor health status is common in Chinese university students, which appears to be closely associated with short sleep duration. Further longitudinal studies are warranted to gain a better understanding of the interaction between sleep patterns and health status in university students.

     

Self-Reported Sleep Duration and Hypertension in Older Spanish Adults

OBJECTIVES: To examine the association between self-reported sleep duration, prevalent and incident hypertension, and control of high blood pressure in older adults.
DESIGN: Logistic regression models were used to investigate the associations of interest in a prospective cohort study conducted from 2001 to 2003.
SETTING: Cohort representative of the noninstitutionalized Spanish population.
PARTICIPANTS: Three thousand six hundred eighty-six persons aged 60 and older.
MEASUREMENTS: Sleep duration was reported in 2001 by asking the participants "How many hours do you usually sleep per day (day and night)" and classified into categories (4–5, 6, 7, 8, 9, and 10–15 h/d. The outcome variables were prevalent hypertension (systolic blood pressure ≥140 mmHg, diastolic pressure ≥90 mmHg, or antihypertensive treatment in 2001), control of blood pressure (systolic blood pressure <140 mmHg and diastolic pressure <90 mmHg in subjects receiving antihypertensive treatment in 2001), and incident hypertension (diagnosis of hypertension during 2001–2003 in individuals with normal pressure in 2001).
RESULTS: Compared with sleeping 7 hours, sleeping more or fewer hours was not significantly associated with prevalent hypertension (odds ratios (ORs) ranged from 0.82 (95% confidence interval (CI)=0.64–1.05) to 1.10 (95% CI 0.83–1.46)), control of blood pressure (ORs ranged from 0.70 (95% CI 0.46–1.08) to 0.97 (95% CI 0.60–1.56)), or incident hypertension (OR ranged from 0.54 (95% CI 0.29–1.01) to 0.83 (95% CI 0.43–1.60)). The results were similar in both sexes.
CONCLUSION: Self-reported sleep duration is not associated with hypertension in older adults.     

Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study

OBJECTIVES: To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. DESIGN: A 2‐year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. SETTING: Community‐dwelling and institutionalized participants. PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini‐Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible anticholinergic properties, and 4% used a drug with definite anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonanticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite anticholinergic effects was associated with a 0.33‐point greater decline in MMSE score (95% confidence interval (CI)=0.03–0.64, P=.03) than not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI=?0.14–0.11, P=.79). Two‐year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30–2.16; P<.001) and possible (OR=1.56; 95% CI=1.36–1.79; P<.001) anticholinergics. CONCLUSION: The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.     

Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation

OBJECTIVES: To identify clinical outcomes and variables associated with 6‐month mortality in very elderly patients admitted for nonacidotic acute exacerbation of chronic obstructive pulmonary disease (AECOPD). DESIGN: Prospective cohort study. SETTING: General medicine acute care ward. PARTICIPANTS: Two hundred forty‐four elderly patients with COPD (mean age±standard deviation 82±7, 55.7% female) admitted to the hospital because of non‐acidotic AECOPD. MEASUREMENTS: Cognitive and mood status and physiological variables were measured. Self‐reported comorbidities were assessed using the Charlson Comorbidity Index. In‐hospital and long‐term mortality and clinical outcomes were recorded. RESULTS: At admission, this elderly population with AECOPD had low cognitive performance (mean Mini‐Mental State Examination score 21±5), no presence of significant depressive symptoms (Geriatric Depression Scale score 4±3), good nutritional status (body mass index (BMI) 25.1±5.5), moderate comorbidity (Charlson Comorbidity Index 4.0±1.9), high functional disability (Barthel Index (BI) 52±34), and moderate severity of acute exacerbation (Acute Physiology and Chronic Health Evaluation (APACHE) II score 9.7±4.2). Two hundred twenty‐five inpatients with AECOPD were successfully discharged, whereas 15 were transferred to the intensive care unit, and four died in the hospital. The 6‐month cumulative mortality rate in discharged patients with AECOPD was 20%. Multivariate Cox analysis shows that lower BMI (β=?0.16; 95% confidence interval (CI)=0.73–0.99), higher APACHE II score (β=0,17; 95% CI=1.03–1.36), and lower BI at discharge (β=?0.02; 95% CI=0.96–0.99) were independently associated with 6‐month mortality. CONCLUSION: Malnutrition, severity of exacerbation and disability status could be identified as risk factors associated with 6‐month mortality of elderly patients admitted for nonacidotic AECOPD.     

Circadian Activity Rhythms and Mortality: The Study of Osteoporotic Fractures

OBJECTIVES: To determine whether circadian activity rhythms are associated with mortality in community‐dwelling older women. DESIGN: Prospective study of mortality. SETTING: A cohort study of health and aging. PARTICIPANTS: Three thousand twenty‐seven community‐dwelling women from the Study of Osteoporotic Fractures cohort (mean age 84). MEASUREMENTS: Activity data were collected using wrist actigraphy for a minimum of three 24‐hour periods, and circadian activity rhythms were computed. Parameters of interest included height of activity peak (amplitude), midline estimating statistic of rhythm (mesor), strength of activity rhythm (robustness), and time of peak activity (acrophase). Vital status, with cause of death adjudicated through death certificates, was prospectively ascertained. RESULTS: Over an average of 4.1 years of follow‐up, there were 444 (14.7%) deaths. There was an inverse association between peak activity height and all‐cause mortality rates, with higher mortality rates observed in the lowest activity quartile (hazard ratio (HR)=2.18, 95% confidence interval (CI)=1.63–2.92) than in the highest quartile after adjusting for age, clinic site, race, body mass index, cognitive function, exercise, instrumental activity of daily living impairments, depression, medications, alcohol, smoking, self‐reported health status, married status, and comorbidities. A greater risk of mortality from all causes was observed for those in the lowest quartiles of mesor (HR=1.71, 95% CI=1.29–2.27) and rhythm robustness (HR=1.97, 95% CI=1.50–2.60) than for those in the highest quartiles. Greater mortality from cancer (HR=2.09, 95% CI=1.04–4.22) and stroke (HR=2.64, 95% CI=1.11–6.30) was observed for later peak activity (after 4:33 p.m.; >1.5 SD from mean) than for the mean peak range (2:50–4:33 p.m.). CONCLUSION: Older women with weak circadian activity rhythms have higher mortality risk. If confirmed in other cohorts, studies will be needed to test whether interventions (e.g., physical activity, bright light exposure) that regulate circadian activity rhythms will improve health outcomes in older adults.     

Overweight and Obesity in Old Age Are Not Associated with Greater Dementia Risk

OBJECTIVES: To describe the association between body mass index (BMI) and dementia risk in older persons. DESIGN: Prospective population‐based study, with 8 years of follow‐up. SETTING: The municipality of Lieto, Finland, 1990/91 and 1998/99. PARTICIPANTS: Six hundred five men and women without dementia aged 65 to 92 at baseline (mean age 70.8). MEASUREMENTS: Weight and height were measured at baseline and at the 8‐year follow‐up. Dementia was clinically assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: Eighty‐six persons were diagnosed with dementia. Cox regression analyses, adjusted for age, sex, education, cardiovascular diseases, smoking, and alcohol use, indicated that, for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio (HR)=0.92, 95% confidence interval (CI)=0.87–0.97). This association remained significant when individuals who developed dementia early during the first 4 years of follow‐up were excluded from the analyses (HR=0.93, 95% CI=0.86–0.99). Women with high BMI scores had a lower dementia risk (HR=0.90, 95% CI=0.84–0.96). Men with high BMI scores also tended to have a lower dementia risk, although the association did not reach significance (HR=0.95, 95% CI=0.84–1.07). CONCLUSION: Older persons with higher BMI scores have less dementia risk than their counterparts with lower BMI scores. High BMI scores in late life should not necessarily be considered to be a risk factor for dementia.     

Obesity, physical function, and mortality in older adults

OBJECTIVES: To estimate the effects of excess body weight on objective and subjective physical function and mortality risks in noninstitutionalized older adults. DESIGN: Population‐based cohort study. SETTING: The English Longitudinal Study of Ageing (ELSA). PARTICIPANTS: Three thousand seven hundred ninety‐three participants in the ELSA aged 65 and older followed up for 5 years. MEASUREMENTS: Analyses compared the risks of impaired physical function and mortality for subjects who were at the recommended weight (body mass index (BMI)=20.0–24.9) with those who were overweight (BMI=25.0–29.9), obese (BMI=30.0–34.9) or severely obese (BMI≥35.0). Outcome measures were difficulties with activities of daily living (ADLs), score on the Short Physical Performance Battery, and mortality. RESULTS: Participants in higher BMI categories had greater risk of impaired physical function at follow‐up but little or no greater risk of mortality. For example, compared with men of recommended weight, obese men (BMI=30.0–34.9) had relative risk ratios of difficulties with ADLs of 1.99 (95% confidence interval (CI)=1.42–2.78), of measured functional impairment of 1.51 (95% CI=1.05–2.16), and of mortality of 0.99 (95% CI=0.60–1.61). Findings were robust when excluding those who lost weight, smoked, or had poor self‐rated health. CONCLUSION: Excess body weight in people aged 65 and older is associated with greater risk of impaired physical function but not with greater mortality risk. Societies with growing numbers of overweight and obese older people are likely to face increasing burdens of disability‐associated health and social care costs.     

Relationship Between Quality of Care of Hospitalized Vulnerable Elders and Postdischarge Mortality

OBJECTIVES: To assess the relationship between quality of hospital care, as measured by Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QI), and postdischarge mortality for hospitalized seniors. DESIGN: Observational cohort study. SETTING: Single academic medical center. PARTICIPANTS: Patients aged 65 and older who were identified as “vulnerable” using the Vulnerable Elder Survey (VES‐13). MEASUREMENTS: Adherence to 16 ACOVE measures through chart audit; postdischarge mortality obtained from Social Security Death Index. RESULTS: One thousand eight hundred fifty‐six inpatient vulnerable older adults were enrolled. Mean quality‐of‐care score was 59.5±19.2%, and 495 (26.7%) died within 1 year of discharge. In multivariate logistic regression, controlling for sociodemographic and disease severity variables (Charlson comorbidity score, VES‐13 score, number of QIs triggered, length of stay, baseline activity of daily living limitations, code status), higher quality of care appeared to be associated with lower risk of death at 1 year. For each 10% increase in quality score, patients were 7% less likely to die (odds ratio=0.93, 95% confidence interval (CI)=0.87–1.00; P=.045). In Cox proportional hazard models, hospitalized patients receiving quality of care better than the median quality score were less likely to die during the 1‐year period after discharge (hazard ratio (HR)=0.82, 95% CI=0.68–1.00; P=.05). Patients who received a nutritional status assessment were less likely to die during the year after discharge (HR=0.61, 95% CI=0.40–0.93; P=.02). CONCLUSION: Higher quality of care for hospitalized seniors, as measured using ACOVE measures, may be associated with a lower likelihood of death 1 year after discharge. Given these findings, future work testing interventions to improve adherence to these QIs is warranted.     

Associations of sleep duration and sleep quality with life satisfaction in elderly Chinese: The mediating role of depression

This study investigated whether sleep duration and quality were related to life satisfaction (LS) among older Chinese adults and whether depression mediated those relationships. Cross-sectional data from the aging arm of the Rugao Longevity and Aging Study were used. Sleep duration, sleep quality, depression, LS and covariates were analyzed using logistic regressions. To assess the potential mediation of depression on the association between sleep duration and quality and LS, Aroian tests were used. Of 1756 older Chinese adults aged 70–84 years, 90.7% of the men and 83.3% of the women reported being satisfied with their lives. After adjusting for covariates, older adults who slept ≤6 h per night were more likely to suffer from life dissatisfaction compared with those who slept 7–8 h (OR = 2.67, 95% CI 1.86–3.79), and individuals who slept poorly were almost 2 times (OR = 2.91, 95% CI 2.16–3.91) more likely to have life dissatisfaction. The Aroian tests confirmed that these relationships were partially mediated by depression (p < 0.001). Between short sleep and LS, the mediating effect of depression accounted for 13.9% of the total effects. Moreover, the mediating effect of depression on the association between sleep quality and LS was 13.3%. Short sleep duration and poor sleep quality were inversely associated with LS, and the relationships were partially mediated by depression. Our study suggests that both sleep and depression status are important factors for LS among the elderly.