Successful aging,a new challenge for developing countries: The Coyoacán Cohort

Objective

To determine the socio-demographic and health factors associated with a biomedical phenotype of successful aging (SA) among Mexican community-dwelling elderly.

Design, setting and participants

Cross-sectional study of 935 older adults aged 70 or older participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty.

Measurements

SA was operationalized in accordance with the phenotype proposed by Rowe and Kahn. Univariate and multivariate logistic regression analyses were carried out in order to identify the correlates of SA.

Results

The phenotype of SA was present in 10% of participants. Age (P < 0.001), illiteracy (P = 0.021), polypharmacy (P < 0.001), and physical pain (P < 0.001) were factors independently and inversely associated with the presence of the SA phenotype. The only variable positively associated with SA was good self-perceived health-status (P < 0.001).

Conclusion

Although age is not modifiable, several other factors associated with SA are. If we are to promote SA, efforts should be made towards improving those modifiable factors negatively associated with its presence, such as pain or polypharmacy. Also, enhancing factors positively associated to it might play a role in improving wellbeing.

     

Validity of knee-estimated height to assess standing height in older adults: A secondary longitudinal analysis of the Mexican health and aging study

Objective

The main objective was to test the validity of height estimated by knee height in Mexican older adults, as a surrogate for standing height.

Design

Cohort study.

Setting

Data were drawn from the first and third waves of the Mexican Health and Aging Study.

Participants

Included participants were community-dwelling 50-year or older adults with measured height at baseline and in follow-up. Subjects with a lower limb fracture in the follow-up were excluded.

Measurements

Main measurements were baseline standing height and 11-year follow-up and knee-estimated height in follow-up. Population specific equations were used to estimate standing height from knee height. Comparisons between baseline standing height and knee-derived height were done with simple correlations, limits of agreement (Bland-Altman plot) and Deming regressions.

Results

A total of 136 50-year or older adults were followed-up for eleven years, with a mean age of 60. There was a positive correlation between knee-estimated height and baseline standing height of 0.895 (p<0.001) for men and of 0.845 (p<0.001) for women. Limits of agreement for men were from -6.95cm to 7.09cm and for women from -6.58cm to 8.44cm.

Conclusion

According to our results, knee-estimated height could be used interchangeably with standing height in Mexican older adults, and these results might apply also to other populations.

     

A comparison of food portion size estimation by older adults,young adults and nutritionists

Objectives

To investigate the ability of older adults, younger adults and nutritionists to assess portion size using traditional methods versus a computer-based method. This was to inform the development of a novel dietary assessment method for older adults “The NANA system”.

Design

Older and younger adults assessed the portion size of self-served portions of foods from a buffet style set up using traditional and computerised portion size assessment aids. Nutritionists assessed the portion size of foods from digital photographs using computerised portion size aids. These estimates were compared to known weights of foods using univariate analyses of covariance (ANCOVA).

Setting

The University of Sheffield, United Kingdom.

Subjects

Forty older adults (aged 65 years and over), 41 younger adults (aged between 18 and 40 years) and 25 nutritionists.

Results

There was little difference in the abilities of older and younger adults to assess portion size using both assessment aids with the exception of small pieces morphology. Even though the methods were not directly comparable among the test groups, there was less variability in portion size estimates made by the nutritionists.

Conclusion

Older adults and younger adults are similar in their ability to assess food portion size and demonstrate wide variability of estimation compared to the ability of nutritionists to estimate portion size from photographs. The results suggest that the use of photographs of meals consumed for portion size assessment by a nutritionist may improve the accuracy of dietary assessment. Improved portion size assessment aids are required for all age groups.

     

Accelerometer assessment of physical activity and its association with physical function in older adults residing at assisted care facilities

Objectives

To describe levels of physical activity among older adults residing at assisted care facilities and their association with physical function.

Design

Cross-sectional analysis.

Setting

Assisted care facilities within the greater Boston, MA area.

Participants

Older adults aged 65 years and older (N = 65).

Measurements

Physical Activity Level (PAL) as defined by quartiles from accelerometry (counts and steps), Short Physical Performance Battery (SPPB) Score, gait speed, and handgrip strength.

Results

Participants in the most active accelerometry quartile engaged in 25 minutes/week of moderate to vigorous physical activity (MVPA) and walked 2,150 steps/day. These individuals had an SPPB score, 400 meter walk speed, and handgrip strength that was 3.7–3.9 points, 0.3–0.4 meters/second, and 4.5–5.1 kg greater respectively, than individuals in the lowest activity quartile, who engaged in less than 5 min/wk of MVPA or took fewer than 460 steps/day.

Conclusion

Despite engaging in physical activity levels far below current recommendations (150 min/week of MVPA or > 7000 steps/day), the most active older adults in this study exhibited clinically significant differences in physical function relative to their less active peers. While the direction of causality cannot be determined from this cross-sectional study, these findings suggest a strong association between PAL and physical function among older adults residing in an assisted care facility.

     

Factors influencing consumption of fruits and vegetables in older adults in New Orleans,Louisiana

Background: Objectives

The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana.

Design

A crosssectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household’s main grocery shopper.

Setting

All participants were in the New Orleans metro area and were surveyed in 2011.

Participants

Participants were 2,834 residents identified as the households’ main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older.

Measurements

Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, selfreported health, and frequency of grocery shopping.

Results

Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p<0.01). Bivariate associations with decreased FV included older age, receipt of government assistance, African American race, use of mobility aid, and poorer health. Multivariate factors associated with lower consumption include age, African American race, and poorer self-reported health. Women reported more fruit and vegetable consumption than men.

Conclusions

FV consumption is associated with improved health and reduced mortality. Older adults are less likely to consume fruits and vegetables, therefore addressing reduced FV consumption in older adults is a potential target for improving health outcomes in older adults. Specifically targeting African Americans and those with poorer health, as well as males may be an important focus for interventions.

     

Nutritional Status and Frailty in Community-Dwelling Older Korean Adults: The Korean Frailty and Aging Cohort Study

Objectives

To examine the association between nutritional status and frailty in older adults.

Design

Cross-sectional study.

Setting

Community-dwelling older adults were recruited from 10 study sites in South Korea.

Participants

1473 volunteers aged 70–84 years without severe cognitive impairment and who participated in the Korean Frailty and Aging Cohort Study (KFACS) conducted in 2016.

Measurements

Nutritional status was measured using the Mini Nutritional Assessment Short Form (MNA-SF). Frailty was assessed with the Fried’s frailty index. The relationship between nutritional status and frailty was examined using the multinomial regression analysis, adjusting for covariates.

Results

Of the respondents 14.3% had poor nutrition (0.8% with malnutrition, 13.5% at risk of malnutrition). There were 10.7% who were frail, with 48.5% being prefrail, and 40.8% robust. Poor nutrition was related to a significantly increased risk of being prefrail (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.09–2.32) and frail (OR: 3.30, 95% CI: 1.96–5.54).

Conclusion

Poor nutritional status is strongly associated with frailty in older adults. More research to understand the interdependency between nutritional status and frailty may lead to better management of the two geriatric conditions.

     

A new adaptive home-based exercise technology among older adults living in nursing home: A pilot study on feasibility,acceptability and physical performance

Objectives

To explore the feasibility and acceptability of a new home-based exercise technology among older adults and to evaluate its efficacy on physical performance measures.

Design

Longitudinal clinical trial.

Setting

Oak Hammock at the University of Florida, a nursing home located in Gainesville, Florida.

Participants

Twelve pre-disabled older adults (≥75 years) living in a nursing home with a Short Physical Performance Battery (SPPB) score between 6 and 9 and no diagnosis of dementia.

Intervention

Thirty minutes of light intensity exercise (aerobic, strength and balance) two times per week for four weeks using a home-based physical activity technology called Jintronix.

Measurements

Feasibility and acceptability were assessed through a 9-item self-administered questionnaire and by exploring the percentage of quality of movements and time performing exercise which was calculated automatically by Jintronix technology. Physical performance measures were assessed through the SPPB score at baseline, after 4 weeks of intervention and after 3 months from the completion of the intervention.

Results

Twelve older adults (80.5±4.2 years old) performed light intensity exercise with Jintronix for a total of 51.9±7.9 minutes per week. Participants reached 87% score of quality of movements in strength and balance exercises, a global appreciation score of 91.7% and a global difficulty score of 36%. Compared to baseline, there was a significant improvement in SPPB score at the end of the intervention and at 3 months following the completion of the exercise program (0.67±0.98 and 1.08±0.99 respectively, p-value <0.05).

Conclusion

Jintronix technology is feasible and acceptable among pre-disabled older adults without dementia living in nursing home and is beneficial in improving their physical performance.

     

Dietary risk factors by race/ethnicity,age-group,and gender in a representative sample of us older adults

Objective

To explore the relationships among ethnicity/race, gender, demographics, age-group and dietary health in a nationally representative sample of older adults.

Design

Cross-sectional study.

Setting

Data for this study were collected by interview in the mobile examination centers from the National Health and Nutrition Examination Surveys, 2011 - 2012.

Participants

U.S. representative sample of adults aged 55 years and older (N = 1860) from five ethnic/racial groups. All participants read, understood, and signed informed consent forms under data collection procedures by trained individuals.

Measurements

Sociodemographics were collected by trained interviewers using a general questionnaire. Food groups were determined by 24-hour recall using the validated USDA Automated Multiple-Pass Method. Data were presented by cross-tabulation and logistic regression to investigate relationships among race/ethnicity, gender, and age groups.

Results

Over 70% of older adults failed to consume 2.75 cups of combined fruits and vegetables. Other Hispanics (Hispanics excluding Mexican Americans) had higher Odds of sugar-containing food consumption compared to non-Hispanic Whites (adjusted model). Being older and female were protective factors for over-consumption of sugar.

Conclusion

Older Americans are not meeting dietary guidelines and there are differences by gender and ethnicity. Since diet has been associated with quality of life and medical costs, public health interventions can benefit by knowing age-, gender- and racial/ethnic- specific dietary behaviors.

     

Development of a short questionnaire to assess diet quality among older community-dwelling adults

Objective

To evaluate the use of a short questionnaire to assess diet quality in older adults.

Design

Cross-sectional study.

Setting

Hertfordshire, UK.

Participants

3217 community-dwelling older adults (59-73 years).

Measurements

Diet was assessed using an administered food frequency questionnaire (FFQ); two measures of diet quality were defined by calculating participants’ ‘prudent diet’ scores, firstly from a principal component analysis of the data from the full FFQ (129 items) and, secondly, from a short version of the FFQ (including 24 indicator foods). Scores calculated from the full and short FFQ were compared with nutrient intake and blood concentrations of vitamin C and lipids.

Results

Prudent diet scores calculated from the full FFQ and short FFQ were highly correlated (0.912 in men, 0.904 in women). The pattern of associations between nutrient intake (full FFQ) and diet scores calculated using the short and full FFQs were very similar, both for men and women. Prudent diet scores calculated from the full and short FFQs also showed comparable patterns of association with blood measurements: in men and women, both scores were positively associated with plasma vitamin C concentration and serum HDL; in women, an inverse association with serum triglycerides was also observed.

Conclusions

A short food-based questionnaire provides useful information about the diet quality of older adults. This simple tool does not require nutrient analysis, and has the potential to be of value to nonspecialist researchers.

     

Accessibility and suitability of residential alcohol treatment for older adults: a mixed method study

Background

Whilst alcohol misuse is decreasing amongst younger adults in many countries, it is increasing in older adults. Residential rehabilitation (rehab) is a vital component of the alcohol treatment system, particularly for those with relatively complex needs and entrenched alcohol problems. In this study, we sought to find out to what extent rehabs in England have upper age limits that exclude older adults, whether rehabs are responsive to older adults’ age-related needs and how older adults experience these services.

Method

This is a mixed method study. A search was carried out of Public Health England’s online directory of rehabs to identify upper age thresholds. Semi-structured qualitative interviews were carried out with 16 individuals who had attended one of five residential rehabs in England and Wales since their 50th birthday. A researcher with experience of a later life alcohol problem conducted the interviews.

Results

Of the 118 services listed on Public Health England’s online directory of rehabs, 75% stated that they had an upper age limit that would exclude older adults. Perceived differences in values, attitudes and behaviour between younger and older residents had an impact on older residents’ experience of rehab. Activities organised by the rehabs were often based on physical activity that some older adults found it difficult to take part in and this could create a sense of isolation. Some older adults felt unsafe in rehab and were bullied, intimidated and subjected to ageist language and attitudes.

Conclusion

This study identified direct and indirect age discrimination in rehabs contrary to the law. Further research is required to find out if age discrimination exists in rehabs in other countries. Rehabs should remove arbitrary age limits and ensure that they are responsive to the needs of older adults.

     

Impact of Home-Delivered Meals on Nutrition Status and Nutrient Intake among Older Adults in Central Texas

Objective

This study aimed to measure changes in nutrition risk and nutrient intake after older adults received home-delivered meals (HDM) for 3 months.

Design

This study used a pre-posttest study design, with data collected before and after 3 months of HDM services.

Setting

Two HDM programs that serve the metropolitan areas of Austin and San Antonio, Texas.

Participants

Study participants were aged 60 years or older, without dementia or terminal illness, and receiving HDM in Austin, Texas and San Antonio, Texas for 3 months.

Measurements

The Nutrition Screening Initiative (NSI) and Mini Nutrition Assessment-Short Form (MNA-SF) were used to assess nutritional risk. The National Cancer Institute Diet History Questionnaire II (DHQ II) was used to assess nutrient intake over the past month.

Results

After receiving 3 months of HDM, nutrition status significantly improved as measured by the NSI and MNA-SF. More participants met or exceeded the recommended dietary allowances (RDA) for magnesium and zinc after receiving HDM compared to before receiving HDM. Dietary supplement intake was associated with a higher nutritional risk.

Conclusion

Improvements in nutrition status were found after 3 months of receiving HDM, whereas intake of most nutrients did not change significantly. Results of this study provide further evidence that HDM can reduce nutritional risk of older adults, and may inform HDM programs on the differences of NSI and/or MNA-SF to assess nutritional risk of clients.

     

Indicators of healthy food consumption among older adults with diabetes and/or hypertension are similar to healthy older adults: results from a population based study in Southern Brazil

Objective

The objective of this study was to estimate the prevalence of indicators of healthy food consumption among older adults with diabetes and/or hypertension and whether or not they occur more frequently than in healthy older adults.

Methods

Cross-sectional study with 1656 older adults who participated in the first wave of a longitudinal, population-based study held in Florianopolis, Southern Brazil, EpiFloripa Idoso 2009/2010, using the self-reported diagnosis of diabetes and/or hypertension as exposure variable and indicators of healthy food consumption as outcomes.

Results

Only 22.7% (95% CI: 20.1–25.3) of females and 29.6% (95% CI:25.8–33.4) of males eat fruit ≥ 3 times/day and vegetables ≥ 2 times/day. More than one third of the sample had frequent consumption (> 2 times/week) of fats from meat/chicken, fried foods and whole milk.

Conclusion

We found that the indicators of healthy food consumption do not differ among older adults with and without diabetes and/or hypertension, indicating no adopting of the secondary prevention measures in the treatment of these diseases.

     

Association between body mass index and all-cause mortality among oldest old Chinese

Objectives

To examine the association between BMI and all-cause mortality in the oldest old (≥80 years).

Design

The study used a prospective cohort study design.

Setting

Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 1998/99 and 2011.

Population

8026 participants aged 80 years and older were followed every two to three years.

Measurements

Body weight and knee height were measured. Height was calculated based on knee height using a validated equation. Deaths were ascertained from family members during follow-up.

Results

The mean BMI was 19.8 (SD 4.5) kg/m². The prevalence of underweight, overweight and obese was 37.5%, 10.2% and 4.4%, respectively. There were 5962 deaths during 29503 person-years of follow-up. Compared with normal weight, underweight was associated with a higher mortality risk (HRs: 1.20 (95%CI 1.13-1.27) but overweight (HR 0.89 (95%CI 0.81-0.99)) were associated with a lower risk. Obesity had a HR 0.91 (95%CI 0.78-1.05) for mortality.

Conclusion

Among oldest old Chinese, underweight is associated with an increased risk of all-cause mortality but overweight is associated with a reduced risk. Interventions to reduce undernutrition should be given priority among the oldest old Chinese.

     

Handgrip strength predicts longitudinal changes in clock drawing test performance. An observational study in a sample of older non-demented adults

Objective

Impairment of physical performance might identify older people at higher risk of dementia over time. The present study evaluated handgrip strength as independent predictor of cognitive decline.

Design

Observational, prospective. Follow-up duration: 11.2 ± 0.8 months.

Setting and participants

Geriatric outpatients center. 104 consecutive stroke- and dementia-free older adults (44% men, ages 80.2±5.4 years).

Methods

The Clinical Dementia Rating scale and the Clock Drawing Test (CDT) were administered. Handgrip strength was assessed using a Jamar hand dynamometer. Brain magnetic resonance imaging studies at 1.5 T were performed. White matter damage was expressed as severity of white matter hyperintensities (WMHs). Longitudinal changes in cognitive function were expressed as 1-year decline in CDT performance.

Results

A robust association was observed between baseline handgrip strength and 1-year cognitive decline after multiple adjustment. Of note, the strength of such association was only minimally attenuated after adjusting for deep WMHs extent (β coefficient for handgrip strength = 0.183, SE= 0.038, p= 0.007, R2= 0.58).

Conclusions

Handgrip strength predicted accelerated 1-year decline in cognitive function, assessed by CDT, in a sample of older adults. Future studies are needed to elucidate the causal mechanisms linking limitations in physical function with dementia risk.

     

Dietary Behaviors Among Young and Older Adults in Brazil

Objectives

To describe healthy and unhealthy dietary behaviors among young and older Brazilian adults.

Design

Cross-sectional study based on secondary data from the Brazilian National Health Survey 2013/2014, conducted by the Brazilian Institute of Geography and Statistics (IBGE).

Settings

Brazil.

Participants

59,402 Brazilian adults (18 years or over), representative of the whole community-dwelling Brazilian adult population.

Measurements

Frequency of regular (5 days/week or more) consumption of food considered of a healthy diet (fruit, vegetables, greens, cooked vegetables, beans, milk, chicken, fish) and unhealthy diet (red meat, soda and sweets, meal replacement for fast food and high salt consumption) was investigated. Differences among young adults (18-39 years), middle-aged adults (40-59 years) and older adults (60+ years) were assessed through 95% confidence intervals and logistic regression models with contrast function, considering the complexity of the sample and the sample weight of the research.

Results

Less than half of the population reported consuming fruit regularly (41.3%, 95% CI = 40.5 - 42.2) and only one quarter reported consuming vegetables regularly (25.4%, 95% CI = 24.7–26.1). Regular consumption of soft drinks was cited by 26.6% (95% CI = 25.5 - 27.6) for men and 20.6% (95% CI = 19.8 - 21.4) for women. Young adults presented, in general, lower frequency of regular consumption of healthy food and higher frequency of unhealthy food when compared to middle-aged and the older adults.

Conclusion

Current dietary behaviors adopted by the Brazilian population is characterized by a high prevalence of inadequate food intake, mainly among young adults calling the attention to the necessity for age-specific public health interventions.

     

Feasibility,Acceptability and Effects of a Home-Based Exercise Program Using a Gerontechnology on Physical Capacities After a Minor Injury in Community-Living Older Adults: A Pilot Study

Context

Several studies have demonstrated that physical activity can help limit decline in functional capacities of older adults. Nevertheless, many adults aged 65 and over are inactive.

Objective

To explore the feasibility, the acceptability and the effects of a home-based exercise program (HEP) using a motion capture gerontechnology in independent community-living older adults at risk of function decline.

Design

Interventionnal clinical trial.

Participants

Sixteen previously independent individuals aged 65 and older recruited at the Emergency Department after being treated for a minor injury and discharged home were assigned to a home-based exercise program group (HEP=8) or to a control group (CONTR=8). Twelve participants completed the study, 6 in each group

Setting

Canadian Community-dwelling in Montreal area.

Intervention

The HEP group engaged in a twelve-week physical activity intervention using a gerontechnology while the CONTR group continued with discharge plan from ED.

Measurements

Participants were evaluated for functional status using validated questionnaires and objective physical measures at baseline, three and six months later. Feasibility and acceptability of the HEP was assessed using data reports from the gerontechnology and from self-reported assessments.

Results

There was no differences between groups at baseline except for the fallrelated self-efficacy: HEP=8.33/28±1.51 vs CONTR=7/28±0 p=0.022. The HEP was found to be feasible and acceptable (adherence rate at 86% and average quality of movements at 87.5%). Significant improvement in walking speed on 4m was observed three months after baseline for HEP vs CONTR group (+0.25 vs +0.05 m/sec, p=0.025). Effects remained at follow-up. Only CONTR group resulted in a significant increase in SF-36 global score.

Conclusion

This twelve-week HEP intervention using the Jintronix® gerontechnology is feasible, acceptable and safe for community-living older adults who sustained a minor injury. This intervention could increase walking speed, the most important predictor of adverse events in the elderly population, and that the improvement could be maintained over time.

     

Older adults in treatment for alcohol use disorders: service utilisation,patient characteristics and treatment outcomes

Background

In western countries demographic changes are leading to an ageing society. Consequently, the number of older adults with alcohol use disorders (AUDs) will rise and the demand of treatment is likely to increase. However, thus far not many older adults with an AUD are seeking treatment and little is known about the efficacy of treatment for older adults. The present study aimed at determining the proportion of older adults with an AUD in addiction treatment, particular characteristics and treatment outcomes of this clientele.

Methods

Using data of 10,860 patients with an AUD aged 60 and over that are documented within the national German addiction care system we conducted exploratory analyses with regard to prevalence, sociodemographic, disorder- and treatment-related variables.

Results

Overall, we found a low proportion of older patients in treatment due to AUDs, but highly positive treatment outcomes. With regard to sociodemographic and disorder-related characteristics, older females and late-onset patients in particular constitute a unique clientele.

Conclusions

The low service utilisation on the one hand but good treatment prognosis on the other emphasise the need to promote treatment seeking among older adults with AUDs. In this context, the special characteristics we found among older patients may contribute to better reach this population and to improve provisions of targeted treatment approaches.

     

Replacing sedentary time with physical activity: effects on health-related quality of life in older Japanese adults

Background

The isotemporal substitution (IS) approach can be used to assess the effect of replacing one activity with the equal duration of another activity on relevant outcomes. This study examined the associations of objectively assessed sedentary behavior (SB) and physical activity (PA) with health-related quality of life (HRQOL) in older Japanese adults, using the IS approach.

Methods

Participants were 287 older Japanese adults (aged 65–84?years) who wore accelerometers for at least 7 days. We calculated the average daily time spent in SB (≤1.5 METs); light-intensity PA (LPA: >?1.5 to <?3.0 METs); and moderate- to vigorous-intensity PA (MVPA: ≥3.0 METs) per day. HRQOL was assessed using the Medical Outcomes Survey Short Form-8 questionnaire.

Results

The IS models showed replacing SB or LPA with MVPA to be significantly associated with better physical component summary scores. Replacing SB with MVPA was marginally associated with better mental component summary scores.

Conclusion

These findings indicate that replacing SB with the same amount of MVPA may contribute to better physical HRQOL in older adults.