Gender-specific associations between functional autonomy and physical capacities in independent older adults: Results from the NuAge study

Background

Even with healthy and active aging, many older adults will experience a decrease in physical capacities. This decrease might be associated with diminished functional autonomy. However, little is known about the physical capacities associated with functional autonomy in older women and men.

Objective

This study aimed to examine gender-specific associations between functional autonomy and physical capacities in independent older women and men.

Methods

Secondary analyses were carried out using cross-sectional data from 652 women and 613 men who participated in the NuAge longitudinal study. The “functional autonomy measurement system” (SMAF) was used to evaluate functional autonomy. The physical capacities measured (tests used) were: biceps and quadriceps strength (Microfet dynamometer), grip strength (Martin vigorimeter), unipodal balance, changing position & walking (timed up and go), normal & fast walking (four-meter walking speed) and changing position (chair stand). Correlation and multiple linear regression analyses adjusted for age, depressive symptoms and body composition were performed.

Results

On average, participants were aged 73 years and had mild to moderate functional autonomy loss. In women, after controlling for age, depressive symptoms and body composition, greater functional autonomy was best explained by faster changing position & walking skills and superior biceps strength (R² = 0.46; p < 0.001). After controlling for depressive symptoms, faster changing position & walking skills and better unipodal balance best explained greater functional autonomy in men (R² = 0.21; p < 0.001).

Conclusion

According to these results, physical capacities are moderately associated with functional autonomy among independent older adults, especially women.     

Antioxidant-rich food intakes and their association with blood total antioxidant status and vitamin C and E levels in community-dwelling seniors from the Quebec longitudinal study NuAge

A cross-sectional study was designed to investigate the association between current consumption of a series of 26 common antioxidant-rich foods (ARF) with serum total antioxidant status (TAS) and plasma vitamin C and E levels in community-dwelling older adults. A convenience sample of the first 94 non-smoking Caucasian men (54%) and women (46%) enrolled in the Quebec Longitudinal Study NuAge were selected. The “Functional Foods Consumption Frequency Questionnaire” (FFCFQ) was administered at recruitment (T1) to ascertain patterns of consumption of ARF over the lifetime. The total Oxygen Radical Antioxidant Capacity (ORAC) of 25 ARF reported by subjects was estimated using published values. Serum TAS was determined based on the Trolox equivalent antioxidant capacity (TEAC) assay while plasma vitamins C and E (α- and γ-tocopherol) levels were analyzed by HPLC. The numbers of ARF eaten daily at T1, estimated from the FFCFQ and calculated from the diet recalls, were significantly correlated (r = 0.51, P < 0.0001) and each measure was associated with total ORAC content (r = 0.34, P < 0.001 and r = 0.59, P < 0.0001 for FFCFQ and recalls, respectively). No significant association was found between TAS and the total ORAC value of ARF determined from the quantitative 24-h diet recalls. However, daily ARF consumption at T1 obtained from the FFCFQ was significantly and positively correlated with TAS (r = 0.26, P < 0.05) and circulating levels of vitamin C (r = 0.25, P < 0.02) and α-tocopherol (r = 0.22, p < 0.05) and negatively correlated with plasma γ-tocopherol (r = − 0.25, P < 0.025). These results highlight associations between ARF consumption and circulating levels of antioxidants in the elderly and suggest benefits from antioxidant-rich foods during aging.     

Long-term effects of memory training in the elderly: a longitudinal study

The effects of different types of memory training in young and older adults reported in a previous study [Cavallini, E., Pagnin, A., Vecchi, T., 2003. Aging and everyday memory: the beneficial effect of memory training. Arch. Gerontol. Geriatr. 37, 241-257] were again investigated from a longitudinal perspective 2 years after the original memory training sessions. The authors retested the original participants to measure the long-term effectiveness of two mnemonic strategies: the loci technique and strategic training. Three groups of participants (13 adults, M=24.1, 13 younger elderly, M=64.2 and 13 older elderly, M=74.4) were tested using a battery of seven tasks and four questionnaires, to evaluate memory performance and metamemory variables. The three age groups and the two trainings showed similar results on memory performance. Long-term effects were found only on two memory tasks, both were highly related to everyday life showing that, without additional practice, memory performance tended to go back to the original level. Moreover, the beneficial effects of the previous training sessions were particularly evident for older adults in metamemory knowledge and for strategic training in memory complaints. Results partially support the durability of memory training in improving memory performance.     

Social networks, stress, and physical health: a longitudinal study of an inner-city elderly population

Research examining the relationship between social networks, stress, and physical symptoms has been limited by rudimentary network measures and the lack of longitudinal data. Using 19 network variables, the authors followed 133 elderly residents of mid-Manhattan hotels for 1 year. The findings indicated that social networks exert a direct effect on reducing subsequent physical symptoms. Moreover, social networks also act to reduce symptoms by buffering the effect of increased levels of stress. Of clinical relevance was the finding that combining knowledge of patients' social networks with their current health status predicts their future health status with an exceedingly high degree of certainty. Consequently, intervention to reinforce a network can be as clinically significant as implementing a medical procedure.     

Recent onset arthritis in the elderly: a 5 year longitudinal observational study

OBJECTIVE: To study the spectrum of diagnoses, course, and outcome of recent onset arthritis after the age of 60, presenting as rheumatoid arthritis (RA)-like disease. METHODS: A 5 year longitudinal observational study enrolled 92 consecutive patients (median age 73 yrs, 54/38 women/men, median duration of arthritis 12 weeks at inclusion). RESULTS: Forty-eight percent were classified as having RA according to the 1987 American Rheumatism Association criteria, 52% as non-RA (41.4% undifferentiated seronegative polyarthritis, 10.8% oligoarthritis with polymyalgic symptoms). Symmetrical involvement of small and medium size joints was more predominant in the RA (91 and 84%, respectively) than the non-RA patients (58 and 52%). The patients with RA compared to non-RA had more active and serious disease at onset, reflected by significant differences in number of swollen joints (median values 18 and 9, respectively), duration of morning stiffness (75 and 10 min), physician's global assessment of disease activity (45 and 28 mm on visual analog scale), and Health Assessment Questionnaire (HAQ) score for functional disability (1.8 and 1.0). Improvement during the course was observed in disease process variables as well as in HAQ disability score for both RA and non-RA patients. Risk factors for a poor 5 year functional outcome were female sex (OR 4.24), diagnosis of RA (OR 3.28), and baseline HAQ score > or =1.4 (OR 3.52). The median change in radiological progression (Larsen-Dale index) was zero. Twenty patients died during followup, the majority from cardiovascular diseases, infections, and malignancies. Mortality compared to the age and sex matched general population was increased for rheumatoid factor (RF) positive patients (standardized mortality ratio 272). Mortality risk factors within the patient cohort were male sex (OR 4.35), age (OR 1.17), and having RF+ RA (OR 11.93). CONCLUSION: Arthritis in the elderly is a heterogeneous group of arthritides with an overall favorable functional prognosis. The subgroup of women with elderly onset RA with functional disability at onset is at risk for a less favorable functional outcome. Mortality was increased for the patients with RF+ elderly onset RA only.     

Changes in hypnotic usage in residential homes for the elderly: a longitudinal study

The use of hypnotic drugs in 25 local authority homes for the elderly was recorded on a 1-day point prevalence study following a 6-mth monitoring programme involving all new admissions. From a total population of 1114 residents 390 (35%) were taking hypnotics on the night of the survey, showing a slight increase from similar surveys carried out in 1980 and 1981. The proportion of residents receiving hypnotics within each home varied from 0.0 to 61.8%. Correlation with levels of usage in the previous surveys was low, suggesting that pattern of hypnotic usage may change considerably over time within individual homes. Of the 156 residents who were admitted as permanent residents during the 6-mth period preceding the survey, 56 (35.9%) had been taking hypnotics on admission. Both the results of the drug monitoring programme and the survey show an association between hypnotic usage and source of admission: residents admitted from hospital being more likely to be taking sleeping tablets.A considerable change was found in the type of hypnotic currently prescribed with an increased preference being shown for short half-life hypnotics. A higher proportion of residents also were prescribed lower doses of hypnotics than previously, suggesting an increased awareness of the risks associated with hypnotic use in the elderly.     

Fat mass but not fat-free mass is related to physical capacity in well-functioning older individuals: nutrition as a determinant of successful aging (NuAge)--the Quebec Longitudinal Study

BACKGROUND: Aging is associated with increases in fat mass (FM) and decreases in fat-free mass (FFM) that may affect physical capacity. However, it is not clear whether high FM or low FFM contribute more to a reduction in physical capacity. METHODS: A structural equation modeling strategy was used to test an explanatory model of the association between body composition and physical capacity. The concept of physical capacity was assessed by walking speed at a normal pace and the one leg stand test. To test the model, 904 men and women between 67 and 84 years old were studied. Body composition was measured by dual-energy x-ray absorptiometry (DXA). Confounding factors related to body composition and physical capacities were included in the explanatory model (physical activity level, age, gender, and number of reported diseases). RESULTS: The final model showed that physical capacity can be represented by a factorial first-order model including generic measures of walking speed and balance. Moreover, our results showed that percentage of FM was significantly associated with physical capacity (p<.01), whereas no such association was observed with FFM. Other variables such as physical activity level, number of self-reported diseases, and age were associated with physical capacity (all p<.01). Overall, the proposed model explained 48% and 57% of the variance observed in men and women when using the one leg stand and the walking speed at normal pace tests as measures of physical capacity. CONCLUSION: FM was significantly and inversely correlated with physical capacity, whereas FFM was not associated when controlled for other potential confounding variables. More studies are needed to investigate the effect of different levels of obesity on physical capacity in older individuals.     

Adiposity,physical fitness and incident diabetes: the physical activity longitudinal study

Aims/hypothesis The purpose of this study was to investigate the relationships among adiposity, physical activity, physical fitness and the development of diabetes in a diverse sample of Canadians. Methods The sample included 1,543 adults (709 men and 834 women) from the Canadian Physical Activity Longitudinal Study who were free of diabetes at baseline (1988). Several indicators of adiposity (BMI, waist circumference, WHR, sum of skinfold thicknesses), musculoskeletal fitness (sit-ups, push-ups, grip strength, trunk flexibility), cardiorespiratory fitness (maximal metabolic equivalents [METs]) and leisure-time physical activity levels were measured at baseline. Participants were followed until 2002–2004 for the ascertainment of new cases of diabetes. Results The 15.5-year cumulative incidence of diabetes was 5.0% (5.2% in men, 4.9% in women). Adiposity and physical fitness, but not physical activity, were significant predictors of diabetes after adjustment for age, sex and several covariates. For each standard deviation of the indicators of adiposity, the risk of diabetes was 99–194% higher. Conversely, the risk was 70 and 61% lower for each standard deviation of maximal METs and composite musculoskeletal fitness score, respectively. Receiver operating characteristic curve analyses confirmed that neither adiposity nor physical fitness provided a superior prediction of incident diabetes. Conclusions/interpretation Adiposity and physical fitness were both important predictors of the development of diabetes in this cohort of Canadians.     

Postponed development of disability in elderly runners: a 13-year longitudinal study

BACKGROUND: The magnitude and duration of the benefit of running and other aerobic exercise on disability and mortality in elderly persons are not well understood. We sought to quantify the benefits of aerobic exercise, including running, on disability and mortality in elderly persons and to examine whether morbidity can be compressed into later years of life by regular exercise. METHODS: A 13-year prospective cohort study of 370 members of a runners' club for persons aged 50 and older and 249 control subjects initially aged 50 to 72 years (mean, 59 years), with annual ascertainment of the Health Assessment Questionnaire disability score, noting any deaths and their causes. Linear mixed models were used to compute postponement in disability, and survival analysis was conducted to determine the time to and causes of death. RESULTS: Significantly (P<.001) lower disability levels in runners' club members vs controls and in ever runners vs never runners were sustained for at least 13 years. Reaching a Health Assessment Questionnaire disability level of 0.075 was postponed by 8.7 (95% confidence interval [CI], 5.5-13.7) years in runners' club members vs controls. Running club membership and participation in other aerobic exercise protected against mortality (rate ratio, 0.36 [95% CI, 0.20-0.65] and 0.88 [95% CI, 0.77-0.99], respectively), while male sex and smoking were detrimental (rate ratio, 2.4 [95% CI, 1.4-4.2] and 2.2 [95% CI, 1.1-4.6], respectively). Controls had a 3.3 times higher rate of death than runners' club members, with higher death rates in every disease category. Accelerated rates of disability and mortality were still not seen in the runners' club members; true compression of morbidity was not yet observable through an average age of 72 years. CONCLUSION: Running and other aerobic exercise in elderly persons protect against disability and early mortality, and are associated with prolongation of a disability-free life.     

Mortality among elderly receiving long-term care: a longitudinal cohort study

BACKGROUND AND AIMS: To investigate mortality, determinants of mortality, and time until death among elderly subjects receiving public long-term care. METHODS: This study comprises 626 respondents (age: 65-98 years). Data were collected for two cohorts (2001 and 2002). Cox regression analysis was used to identify determinants of mortality. Those who died and those who did not die were compared by, for example, demographic data and activities of daily living (ADL). RESULTS: The crude mortality rate was 9% in cohort 2001 and 14% in cohort 2002 in the first year, and 23% in cohort 2001 and 18% in cohort 2002 in the second year after decisions about care and service. Determinants of death were gender (men), severe cognitive impairment, co-morbidity, and high ADL scores. Regression analysis also showed that malignant tumors, respiratory, urinary and genito-urinary diseases were found to be significant predictors for mortality. CONCLUSIONS: The mortality rate was quite high, several diseases were common, and the need for help with ADL was wide-ranging. Results also showed that ADL scores, together with a measure of cognitive impairment, may be useful in identifying elderly subjects at high risk of mortality.     

Relationship between ghrelin and the metabolic syndrome in the elderly: a longitudinal population-based study

Context Ghrelin regulates energy homeostasis and may contribute to the development of the metabolic syndrome (MS) in the elderly. Objective To study the relationship between ghrelin and the MS, IGF‐I and life style factors over a 2‐year follow‐up. Design Longitudinal population‐based study, starting from 2002; 2 years follow‐up. Participants Three hundred and thirteen (153 men/160 women) individuals living independently older than 70 years. Results MS was found in 54·9% of men and 61% of women. In the 229 subjects available at follow‐up, ghrelin was higher in men than in women at basal (P = 0·002) and 2‐year follow‐up (P = 0·004). Ghrelin decreased over time in both genders (P < 0·01). Ghrelin was lower in individuals showing MS compared to non‐MS (P = 0·08), but this difference was more evident at 2‐year follow‐up (P = 0·016), mostly due to men with MS (P = 0·002) and even after adjustment for BMI, gender and age. Individuals with MS had an OR of 1·67 (95% CI: 1·0–2·78) for low ghrelin (< first tertile); when adjusting by BMI, gender and age, only high triglycerides with OR 1·8 (1·0–3·3), remained statistically significant among the MS components. IGF‐I showed a positive correlation with ghrelin only in individuals without MS (r_s 0·403, P < 0·001) with no gender differences; this relationship was not found in MS (r_s 0·120, P = 0·129). A positive association of ghrelin was found with academic level, alcohol consumption and smoking. Conclusions Ghrelin is higher in old men in comparison to women and decreases over time with a steeper decline in subjects with MS; moreover, in these subjects ghrelin/IGF‐I correlation is lost.     

Assessing interviewer effects in a longitudinal study of bereaved elderly adults

In a 2-year study, bereaved elders who were personally interviewed were compared with those who completed a mailed questionnaire on measures of depression, life satisfaction, and five global measures constructed from a series of bereavement-related feelings and behaviors. Data were gathered at six separate measurement periods. Multiple analyses of variance with repeated measures revealed no effect due to group assignment. Although significant changes over time were observed on most measures, these changes were statistically independent of whether the respondents were interviewed or not. The presence of interviewers was, however, associated with higher and more consistent completion rates at each measurement period.     

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.     

Age-related changes in upper extremity performance of elderly people: a longitudinal study.

The objective of this research was to study age-related changes in the upper extremity performance of healthy community-dwelling elderly people, by using a longitudinal design. In 1995-1996. gross and fine manual dexterity, global performance, motor coordination, grip strength, tactile recognition, two-point discrimination, touch/pressure threshold, and tactile localization of 264 of the 360 subjects initially evaluated in 1992-1993 were reevaluated by using the same upper extremity measuring instruments. Those who did not participate (n = 96) were found to be significantly different from those who participated in the longitudinal study. Although the survivors were younger, more active, and perceived themselves in better health than the nonparticipants, their upper extremity performance significantly decreased in the 3-year period, with a few exceptions. In general, the decline was related to the initial score but not to age.