The ability of three different models of frailty to predict all-cause mortality: Results from the European Male Aging Study (EMAS)

Few studies have directly compared the ability of the most commonly used models of frailty to predict mortality among community-dwelling individuals. Here, we used a frailty index (FI), frailty phenotype (FP), and FRAIL scale (FS) to predict mortality in the EMAS. Participants were aged 40–79 years (n = 2929) at baseline and 6.6% (n = 193) died over a median 4.3 years of follow-up. The FI was generated from 39 deficits, including self-reported health, morbidities, functional performance and psychological assessments. The FP and FS consisted of five phenotypic criteria and both categorized individuals as robust when they had 0 criteria, prefrail as 1–2 criteria and frail as 3+ criteria. The mean FI increased linearly with age (r² = 0.21) and in Cox regression models adjusted for age, center, smoking and partner status the hazard ratio (HR) for death for each unit increase of the FI was 1.49. Men who were prefrail or frail by either the FP or FS definitions, had a significantly increased risk of death compared to their robust counterparts. Compared to robust men, those who were FP frail at baseline had a HR for death of 3.84, while those who were FS frail had a HR of 3.87. All three frailty models significantly predicted future mortality among community-dwelling, middle-aged and older European men after adjusting for potential confounders. Our data suggest that the choice of frailty model may not be of paramount importance when predicting future risk of death, enabling flexibility in the approach used.     

Properties of Polyethylene Terephthalate (PET) after Thermo-Oxidative Aging

The influence of the thermo-oxidative aging semi-crystalline polyethylene terephthalate process on the thermal and mechanical properties was analysed in the article. For this purpose, PET was aged at 140 °C for 21, 35 and 56 days. The research showed that as a result of aging, the amount of the crystalline phase increases by about 8%, which translates into the properties of the aged material. The glass transition and melt temperature of lamellar crystals formed during first and second crystallisation increase with aging. The mechanical properties of the material were analysed in the temperature range of 25 to 75 °C. The tests were showing an increase in Young’s modulus and a decrease in elongation at the break as a result of aging. This phenomenon was particularly visible during tests at 75 °C and during the morphological observation of the fracture surface, where the fracture character of the material changes from ductile to brittle. In the case of the material aged for the longest time, the temperature has a negligible influence on the elongation at break.     

Longitudinal association between diabetes and cognitive decline: The National Health and Aging Trends Study

Type II diabetes mellitus (DM) is associated with increased risk of dementia; however, few studies have examined the longitudinal association between DM and cognitive outcomes in large nationally representative cohorts. We investigated these associations in 7605 participants enrolled in the National Health and Aging Trends Study, a nationally representative prospective study of Medicare beneficiaries ≥65, from 2011 to 2015. Participants or proxy respondents reported DM and dementia diagnosis, and participants completed immediate and delayed recall word list learning tests and the Clock Drawing Test. In multivariable-adjusted generalized linear mixed models, baseline DM diagnosis was associated with decline on immediate and delayed word recall and the Clock Drawing Test. In Cox proportional hazards models, DM also predicted incident dementia in older age groups at baseline. These findings further support the notion that DM is associated with cognitive outcomes, suggesting that treatment and prevention of DM may reduce the risk of these outcomes. However, more studies are needed to better understand whether DM treatments affect this relationship.     

Open-access colonoscopy in Ontario: Associated factors and quality

BACKGROUND

Open-access (OA) colonoscopy may increase efficiency and decrease wait times; however, because the patient is seen for the first time at the endoscopy appointment, previous processes, such as information about the procedure, preparation and appropriate triage, may be suboptimal.

OBJECTIVE:

To identify factors associated with OA colonoscopy and to determine the relationship between OA colonoscopy and an important quality measure, incomplete colonoscopy.

METHODS:

A population-based analysis of all adult outpatients undergoing a first-time colonoscopy between 1997 and 2007 in Ontario was performed. Colonoscopy was considered to be OA if there were no visits in the preceding five years with the physician performing the colonoscopy. Using logistic regression, patient, physician and institution factors associated with OA colonoscopy were identified. Using propensity score matching, the relationship between OA colonoscopy and incomplete colonoscopy in 2006 was examined.

RESULTS:

A total of 1,079,259 colonoscopies were performed. Of these, 14% were OA in 1997 compared with 26% in 2007. Patients 50 to 69 years of age, those from higher-income neighbourhoods and those with less comorbidity were more likely to undergo OA colonoscopy. The odds of receiving OA colonoscopy were six times greater in a nonhospital clinic compared with a community hospital. Colonoscopy was more likely to be complete if the procedure was OA (OR 1.3 [95% CI 1.2 to 1.4]; P<0.0001).

CONCLUSIONS:

Rates of OA colonoscopy have increased substantially since 1997. Institution type was most strongly associated with OA colonoscopy. Colonoscopy completeness, a recognized quality indicator, does not appear to be compromised by OA colonoscopy.     

Physical Activity and Executive Function in Aging: The MOBILIZE Boston Study

OBJECTIVES: To determine the relationship between physical activity and cognition, specifically executive function, and the possible mediating role of factors such as cardiovascular disease (CVD) and CVD risk factors, chronic pain, and depressive symptoms.
DESIGN: Cross-sectional study.
SETTING: Population-based study of individuals aged 70 and older in the Boston area.
PARTICIPANTS: Older community-dwelling adults (n=544; mean age 78, 62% female).  

MEASUREMENTS:

Presence of heart disease (self-reported physician diagnosed), pain, and depressive symptomatology were assessed using interviewer-administered questions. Blood pressure was measured. Engagement in physical activity was determined using the Physical Activity Scale for the Elderly (PASE). Cognitive function was measured using a battery of neuropsychological tests.
RESULTS: The older adults who engaged in more physical activity had significantly better performance on all cognitive tests, except for Letter Fluency and the memory test of delayed recall, after adjusting for age, sex, education, and total number of medications. With further adjustment for CVD and CVD risk factors (heart disease, diabetes mellitus, stroke, and hypertension), pain, and depressive symptoms, PASE score remained significantly associated with executive function tests.
CONCLUSION: Even after multivariate adjustment, neuropsychological tests that were executive in nature were positively associated with physical activity participation in this cohort of older community-dwelling adults. In contrast, delayed recall of episodic memory was not associated with physical activity, supporting the idea that the relationship with executive function represents a specific biologically determined relationship.     

The dynamic relationship between cognitive function and walking speed: the English Longitudinal Study of Ageing

Cognitive deficiency and oxidative stress have been well documented in aging and in neurodegenerative disorders such as Alzheimer’s disease. In this study, we assessed the therapeutic effect of polyprenols on d-galactose-induced cognitive impairment in mice by testing on of behavioral and cognitive performance. In order to explore the possible role of polyprenols against d-galactose-induced oxidative damages, we assessed various biochemical indicators. Chronic administration of d-galactose (150 mg/kg·d, s.c.) for 7 weeks significantly impaired cognitive performance (both in step-through passive and active avoidance tests) and locomotor activity (in open-field test) and the ability of spatial learning and memory (in Morris water maze test) compared with the control group. The results revealed that polyprenols treatment for 2 weeks significantly ameliorated model mice’s cognitive performance and oxidative defense. All groups of polyprenols enhanced the learning and memory ability in step-through passive and active avoidance tests, locomotor activity in open-field test, and the ability of spatial learning and memory in Morris water maze test. Furthermore, high and middle level of polyprenols significantly increased total antioxidative capacity (T-AOC), glutathione peroxidase (GSH-Px), super oxide dismutase (SOD) activity, neprilysin (NEP), and β-site AβPP cleaving enzyme 1 (BACE1) expression, while nitric oxide (NO), nitric oxide synthase (NOS) activity, malondialdehyde (MDA) concentration, and the level of Aβ1-42 and presenilin 1 (PS1) were decreased. Polyprenols have a significant relieving effect on learning, memory, and spontaneous activities in a d-galactose-induced mouse model and ameliorates cognitive impairment and biochemical dysfunction in mice. In summary, we have demonstrated that polyprenols may ameliorate memory and cognitive impairment via enhancing oxidative defense and affecting generation and dissimilation of Aβ-related enzymes, suggesting that polyprenols represent a novel drug for treating Alzheimer’s disease.     

The North Dakota Mental Health and Aging Education Project: Curriculum Design and Training Outcomes for a Train-the-Trainer Model

A training curriculum on mental health and aging was developed and disseminated to 32 natural caregivers throughout a frontier state using a train-the-trainer model. Those certified as trainers included social workers, religious professionals, volunteers, long-term care employees, nurses, home health workers, and professional and informal caregivers. Trainers then utilized the materials assembled into toolkits to provide 1,813 hours of education in all eight regions of North Dakota. The purpose of this study was to evaluate the impact of the training on the preparation of trainers to provide mental health and aging education. Several points of evaluation, including a pre/posttest to assess the trainers' knowledge, an appraisal of the self-perceived value of the education to the trainers, and an applied case study to ascertain the trainers' ability to apply what they had learned, demonstrated the benefits of this model.     

Moderate Alcohol Intake and Risk of Functional Decline: The Health, Aging, and Body Composition Study

OBJECTIVES: To investigate the prospective relationship between alcohol consumption and incident mobility limitation. DESIGN: Cohort study. SETTING: The Health Aging and Body Composition study, conducted in Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS: Three thousand sixty‐one adults aged 70 to 79 without mobility disability at baseline. MEASUREMENTS: Incidence of mobility limitation, defined as self‐report at two consecutive semiannual interviews of any difficulty walking one‐quarter of a mile or climbing stairs, and incidence of mobility disability, defined as severe difficulty or inability to perform these tasks at two consecutive reports. Alcohol intake, lifestyle‐related variables, diseases, and health status indicators were assessed at baseline. RESULTS: During a follow‐up time of 6.5 years, participants consuming moderate levels of alcohol had the lowest incidence of mobility limitation (total: 6.4 per 100 person‐years (person‐years); men: 6.4 per 100 person‐years; women: 7.3 per 100 person‐years) and mobility disability (total: 2.7 per 100 person‐years; men: 2.5 per 100 person‐years; women: 2.9 per 100 person‐years). Adjusting for demographic characteristics, moderate alcohol intake was associated with lower risk of mobility limitation (hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.55–0.89) and mobility disability (HR=0.66, 95% CI=0.45–0.95) than never or occasional consumption. Additional adjustment for lifestyle‐related variables substantially reduced the strength of the associations (HR=0.85, 95% CI=0.66–1.08 and HR=0.81, 95% CI=0.56–1.18, respectively). Adjustment for diseases and health status indicators did not affect the strength of the associations, suggesting that lifestyle is most important in confounding this relationship. CONCLUSION: Lifestyle‐related characteristics mainly accounted for the association between moderate alcohol intake and lower risk of functional decline over time. These findings do not support a direct causal effect of alcohol intake on physical function.