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.

     

Comparing dialysis centre mortality outcomes across Australia and New Zealand: identifying unusually performing centres 2008–2013

Background

Comparing the mortality profiles of dialysis centres is important to ensure that high standards of care are maintained. We compare the performance of dialysis centres in Australia and New Zealand in their treatment of haemodialysis patients, accounting for the competing risks of kidney transplantation and transfer to peritoneal dialysis.

Methods

Observational cohort study. We included data from all adult patients (5574 patients) commencing haemodialysis at home or in a facility between 2008 and 2010 across 62 dialysis centres, from the Australia and New Zealand Dialysis and Transplant Registry. Standardised mortality ratios were calculated by estimating mortality probabilities from a pooled random effects logistic regression model, accounting for the competing risk of transplantation using an inverse probability weighting approach. Models were adjusted for patient comorbidities, sex, height, weight, late referral to a nephrologist, age, race, primary kidney disease, smoking status, and serum creatinine (μmol/l).

Results

Two dialysis centres were found to have relatively higher levels of risk-adjusted mortality lying outside the prediction intervals for “usual” performance. Risk adjusted mortality rates were not associated with centres’ compliance with guidelines for vascular access and biochemical and haematological targets.

Conclusions

We demonstrate that standardised mortality ratios are useful to identify facilities that have statistically outlying mortality risk. Our criterion for determining whether a centre has better or worse performance than expected is statistical, and thus analyses such as ours can serve only as a screening tool, and are only one aspect of assessment of “quality” of performance.

     

Adherence to the Mediterranean Diet and all-cause mortality risk in an elderly Italian population: Data from the ILSA study

Objective

The aim of this study was to evaluate adherence to the Mediterranean Diet (MD) and its association with all-cause mortality in an elderly Italian population.

Design

Data analysis of a longitudinal study of a representative, age stratified, population sample.

Setting

Study data is based upon the Italian Longitudinal Study on Aging (ILSA) a prospective, community-based cohort study. The baseline evaluation was carried out in 1992 and the follow-up in 1996 and 2000.

Participant

Participant food intake assessment was available at baseline for 4,232 subjects; information on survival was available for 2,665 at the 2000 follow-up.

Measurements

Adherence to the MD was evaluated with an a priori score based on the Mediterranean pyramid components. Cox proportional hazard models were used to assess the relationship between the MD score and all-cause mortality. Six hundred and sixty five subjects had died at the second follow-up (identified up to the first and second follow-up together; mean follow-up: 7.1±2.6 years).

Results

At the 2000 follow-up, adjusting for other confounding factors, participants with a high adherence to MD (highest tertile of the MD score distribution) had an all-cause mortality risk that was of 34% lower with respect to the subjects with low adherence (Hazard Ratio=0.66; 95% CI: 0.49-0.90; p=0.0144).

Conclusion

According to study results, a higher adherence to the MD was associated with a low all-cause mortality risk in an elderly Italian population.

     

Overweight and abdominal obesity association with all-cause and cardiovascular mortality in the elderly aged 80 and over: A cohort study

Objective

To evaluate the association between overweight and abdominal obesity with all-cause and cardiovascular mortality in the elderly aged 80 and over.

Design

A prospective cohort study.

Setting

A population-based study of community-dwelling very elderly adults in a city in southern Brazil.

Participants

236 very elderly adults, number that represents 85% of the population aged 80 and over living in the city in the period (mean age 83.4 ± 3.2).

Measurements

Overweight and abdominal obesity were assessed using recommended cut-off points for body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). The association between these anthropometric measurements and all-cause and cardiovascular mortality were independently estimated by Cox proportional hazards model. Kaplan-Meier was used to assess survival time.

Results

Increased WC (>80cm F and >94cm M) and WHtR (>0.53 F and >0.52 M) were associated with lower all-cause mortality, but only WHtR remained associated even after controlling for residual confounding (HR 0.55 CI95% 0.36-0.84; p<0.001). Additionally increased WC was independently associated with lower mortality from cardiovascular diseases (HR 0.57 CI95% 0.34-0.95; p<0.030). BMI and WHR did not show significant independent association with mortality in the main analysis.

Conclusion

Greater abdominal fat accumulation, as estimated by WC and WHtR, presented an association with lower allcause and cardiovascular mortality in the elderly aged 80 and over, but not by BMI and WHR.

     

Mini nutritional assessment and mortality after hip fracture surgery in the elderly

Background

Hip fracture surgery in elderly patients is associated with a poor postoperative outcome and a high mortality. Malnutrition is a frequent problem in elderly patients and may be associated with mortality after hip fracture surgery. The Mini Nutritional Assessment (MNA) is a valuable tool to identify malnourished patients and those at risk for malnutrition.

Objective

To evaluate the association between the preoperative MNA score and mortality after surgery for hip fractures in elderly patients.

Methods

Patients with a hip fracture and an indication for surgery were included in our study. This study was part of a randomized trial on the effect of taurine on postoperative outcome in elderly hip fracture patients. The MNA was assessed on admission before surgery. Length of stay, postoperative complications and mortality were documented. The association of the MNA score on postoperative outcome and mortality was analyzed using Cox regression analysis.

Results

The one-year survival rate in 226 elderly hip fracture patients was 79%. In-hospital mortality rates and 1-year mortality were 27% and 46% in malnourished patients, 12% and 26% in patients at risk for malnutrition and 7% and 17% in well-nourished patients as assessed by MNA.

Conclusion

Preoperative malnutrition measured by the MNA is associated with mortality in elderly hip fracture patients.

     

Association of dynamics in lean and fat mass measures with mortality in frail older women

Objective

The relationship between body composition and mortality in frail older people is unclear. We used dual-x-ray absorptiometry (DXA) data to examine the association between dynamics in whole-body composition and appendicular (4 limbs) and central (trunk) compartments and all-cause mortality in frail older women.

Design

Prospective study with up to 19 years of follow up.

Setting

Community dwelling older (≥65) women.

Participants

876 frail older participants of the Women’s Health Initiative Observational Study with a single measure of body composition and 581 participants with two measures.

Measurements

Frailty was determined using modified Fried’s criteria. All-cause mortality hazard was modeled as a function of static (single-occasion) or dynamic changes (difference between two time points) in body composition using Cox regression.

Results

Analyses adjusted for age, ethnicity, income, smoking, cardiovascular disease, diabetes, stroke, number of frailty criteria and whole-body lean mass showed progressively decreased rates of mortality in women with higher appendicular fat mass (FM) (P for trend=0.01), higher trunk FM (P for trend=0.03) and higher whole-body FM (P for trend=0.01). The hazard rate ratio for participants with more than a 5% decline in FM between two time points was 1.91; 1.67 and 1.71 for appendicular, trunk and whole-body compartment respectively as compared to women with relatively stable adiposity (p<0.05 for all). Dynamics of more than 5% in lean mass were not associated with mortality.

Conclusion

Low body fat or a pronounced decline in adiposity is associated with increased risks of mortality in frail older women. These results indicate a need to re-evaluate healthy weight in persons with frailty.

     

BUN as an Independent Predictor of Post-Hospital-Discharge Mortality among Older Veterans

Background/Objectives

An elevated blood urea nitrogen (BUN) in known to be an important prognostic indicator in patients with end-stage heart or kidney disease or certain other life-threatening illnesses. However, it is less certain as to whether an elevated BUN is an independent predictor of long-term mortality risk in less seriously ill patients. To address this issue, we examined the relationship between BUN and long-term mortality after adjusting for potential confounders and other indicators of health status/disease severity, in a select population of older medically stable Veterans.

Design

Long-term prospective cohort study.

Setting

Outpatient follow-up of patients discharged from a recuperative care and rehabilitation unit (RCRU) of a Department of Veterans Affairs Community Living Center.

Participants

383 older Veterans (mean age = 78.6±7.6 years, 98% male, and 87% white) discharged alive and in stable medical condition.

Measurements

At discharge, each subject completed a comprehensive assessment and was then monitored as an outpatient for up to 9.3 years. Associations between blood urea nitrogen at RCRU discharge and mortality were identified utilizing Cox proportional hazards (PH) regression analyses adjusting for conditions known to confound this relationship.

Results

Within the follow-up period, 255 subjects (67%) died. In the unadjusted Cox PH model, a BUN > 30 mg/dL was associated with a nearly 2-fold increased risk of mortality (hazard ratio 1.90, 95%CI 1.41 - 2.56). The association between BUN and long-term mortality remained highly significant after adjusting for potential confounders (hazard ratio 1.78, 95%CI 1.29 - 2.44).

Conclusion

Our findings support BUN levels as an independent predictor of long-term mortality in older, medically stable Veterans. An elevated BUN may be reflective of global health status rather than solely an indicator of the severity of acute illness or unstable chronic disease.

     

Appendicular lean mass and mortality among prefrail and frail older adults

Objective

Prefrail and frail older adults are a heterogeneous population. The measurement of appendicular lean mass (ALM) may distinguish those at higher versus lower risk of poor outcomes. We examined the relationship between ALM and mortality among prefrail and frail older adults.

Design

This was a population-based cohort study.

Setting

The Third National Health and Nutrition Survey (NHANES III; 1988-1994).

Participants

Older adults (age ≥65 years) with pre-frailty or frailty defined using the Fried criteria.

Measurements

ALM was quantified using bioimpedance analysis. Multivariable-adjusted Cox regression analysis examined the relationship between ALM and mortality. Logistic regression analysis was used to determine if ALM added to age and sex improved the predictive discrimination of five-year and ten-year mortality.

Results

At baseline, the average age was 74.9 years, 66.7% were female, 86.3% and 13.7% were prefrail and frail, respectively. The mean ALM was 18.9 kg [standard deviation (SD): 5.5]. During a median 8.9 years of follow-up, 1,307 of 1,487 study participants died (87.9%). Higher ALM was associated with a lower risk of mortality. In a multivariable-adjusted regression model that accounted for demographic, behavioral, clinical, physical function, and frailty characteristics, each SD increase in ALM was associated with an 50% lower risk of mortality [Hazard Ratio: 0.50 (95% CI: 0.27-0.92); P=0.026]. The addition of ALM to age and sex improved the predictive discrimination of five-year (P=0.027) and ten-year (P=0.016) mortality.

Conclusion

ALM distinguishes the risk of mortality among prefrail and frail older adults. Additional research examining ALM as a therapeutic target is warranted.

     

Association between Cognitive Impairment,Vascular Disease and All-Cause Mortality

Objective

The purpose of this study was to investigate the association between elder’s cognitive impairment and mortality. Additionally, interaction between cognitive impairment and cardio- and cerebrovascular diseases was considered.

Methods

Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2014 was assessed using 10,026 participants at baseline with no missing information. Chi-square test, log-rank test, and Cox proportional hazards models were used to investigate the association between cognitive impairment and mortality.

Results

Cognitive impairment was significantly associated with mortality. With normal cognitive functioning group as reference: HR=2.329 (p<.0001) for severe cognitive impairment, HR=1.238 (p.009) for mild cognitive impairment. The association remained significant even after considering for cardio- and cerebrovascular diseases.

Conclusion

This study provided additional support to previous findings in regards to the relationship between cognitive impairment and mortality. Worse cognitive functioning increased the risk of mortality and the presence of cardio- and cerebrovascular diseases exacerbated this relationship.

     

Social Frailty is Associated with Physical Functioning,Cognition, and Depression,and Predicts Mortality

Objective

Social frailty is related to adverse health-related outcomes. However, the measurement thereof is controversial and research into the relationship between social frailty and physical functioning remains limited. This study aimed to determine social frailty status via developing a simple self-reported screening tool, termed the HALFT scale, and to examine the association between social frailty and physical functioning, cognition, depression, and mortality among community-dwelling older adults.

Design

Prospective cohort study.

Setting

Community.

Participants

1697 community-dwelling adults aged ≥60 years from Beijing Longitudinal Study of Aging were included.

Measurements

The HALFT scale was developed based on 5 items: unhelpful to others, limited social participation, loneliness, financial difficulty, and not having anyone to talk to. Socioeconomic and demographic data were collected, and physical functioning, frailty index, cognition, and depression were assessed.

Results

The prevalence of social frailty was 7.7% (weighted, 4.5%). Participants with physical frailty, low levels of physical activity, and poor physical functioning had a higher prevalence of social frailty. Social frailty was associated with dementia, subjective memory decline, depression, cognitive impairment, and having experienced a recent significant life event. After adjusting for age and sex, the 8-year mortality hazard ratios were 2.5-4.3 and 1.6-2.3, respectively, for those with social frailty or pre-social frailty. Each component of the HALFT scale predicted 8-year mortality.

Conclusion

Social frailty is associated with physical functioning, cognition, and depression, and predicts mortality. The HALFT scale could be a useful screening tool for determining social frailty in older adults. Interventions aimed at preventing or delaying social frailty are warranted.

     

Simple Physical Activity Index Predicts Prognosis in Older Adults: Beijing Longitudinal Study of Aging

Objective

Frailty, which involves low physical activity (PA), is as a well-established factor of increased risk of hospitalization, disability, and mortality. To date, there are no specific tools to assess PA among Chinese elderly. As part of the Beijing Longitudinal Study of Aging (BLSA), we aimed to develop the BLSA Leisure-Time Physical Activity Questionnaire (BLSA-PAQ) and assess its prediction of mortality.

Design

Longitudinal study.

Setting

Community.

Participants

1810 Chinese older adults completed the BLSA-PAQ questionnaire.

Measurements

BLSA-PAQ questionnaire containing four items: walking, outdoor chores, low-intensity exercise, and moderate-intensity exercise. Physical function was assessed through the balance test, chair-stand test, and the activities of daily living (ADL), and instrumental activities of daily living (IADL). Frailty was evaluated using a modified frailty phenotype and frailty index.

Results

The following equation was obtained based on the 8-year mortality for the four BLSA-PAQ components: BLSA-PAQ index (BLSA-PAQ total score) = Walking score + Outdoor chores score + 2 × (low-intensity exercise score) + 3 × (moderate-intensity exercise score). The BLSA-PAQ index decreased with age, and was negatively related to modified frailty phenotype score and frailty index. Low PA and pre-low PA statuses were associated with poorer results in the balance and chair-stand tests, ADL dependency, IADL dependency, and frailty. After adjusting for age and gender, the 8-year mortality HRs were 1.453 (95% CI, 1.166-1.811) and 2.358 (95% CI, 1.856-2.995) for low PA and pre-low PA, respectively. Low PA defined by the BLSA-PAQ index was associated with frailty, disability, worse physical function, and higher mortality.

Conclusion

The BLSA-PAQ seems to be a reliable tool to measure PA in Chinese older adults. Further studies are needed to confirm these findings and validate the use of the BLSA-PAQ for frailty assessments of older adults.

     

Estimating the contribution of mortality selection to the East–West German mortality convergence

Background

Before German reunification, old-age mortality was considerably higher in East Germany than West Germany but converged quickly afterward. Previous studies attributed this rapid catch-up to improved living conditions. We add to this discussion by quantifying for the first time the impact of mortality selection.

Methods

We use a gamma-Gompertz mortality model to estimate the contribution of selection to the East–West German mortality convergence before and after reunification.

Results

We find that, compared to the West, frailer East Germans died earlier due to deteriorating mortality conditions leading to converging mortality rates for women and men already over age 70 before 1990. After 1990, the selection of frailer individuals played only a minor role in closing the East–west German mortality gap. However, our study suggests that, after reunification, old-age mortality improved quickly because the more robust population in the East benefitted greatly from ameliorating external factors such as health care and better living standards.

Conclusion

Our results from a natural experiment show that selection of frail individuals plays an important role in population-level mortality dynamics. In the case of the German reunification, East German old-age mortality already converged before 1990 because of stronger selection pressure.

     

Dynapenic Abdominal Obesity Increases Mortality Risk Among English and Brazilian Older Adults: A 10-Year Follow-Up of the ELSA and SABE Studies

Background/Objective

There is little epidemiological evidence demonstrating that dynapenic abdominal obesity has higher mortality risk than dynapenia and abdominal obesity alone. Our main aim was to investigate whether dynapenia combined with abdominal obesity increases mortality risk among English and Brazilian older adults over ten-year follow-up.

Design

Cohort study.

Setting

United Kingdom and Brazil.

Participants

Data came from 4,683 individuals from the English Longitudinal Study of Ageing (ELSA) and 1,490 from the Brazilian Health, Well-being and Aging study (SABE), hence the final sample of this study was 6,173 older adults.

Measurements

The study population was categorized into the following groups: nondynapenic/ non-abdominal obese, abdominal obese, dynapenic, and dynapenic abdominal obese according to their handgrip strength (< 26 kg for men and < 16 kg for women) and waist circumference (> 102 cm for men and > 88 cm for women). The outcome was all-cause mortality over a ten-year follow-up. Adjusted hazard ratios by sociodemographic, behavioural and clinical characteristics were estimated using Cox proportional hazards models. Results: The fully adjusted model showed that dynapenic abdominal obesity has a higher mortality risk among the groups. The hazard ratios (HR) were 1.37 for dynapenic abdominal obesity (95% CI = 1.12–1.68), 1.15 for abdominal obesity (95% CI = 0.98–1.35), and 1.23 for dynapenia (95% CI = 1.04–1.45).

Conclusions

Dynapenia is an important risk factor for mortality but dynapenic abdominal obesity has the highest mortality risk among English and Brazilian older adults.

     

Effects of food price inflation on infant and child mortality in developing countries

Background

After a historic low level in the early 2000s, global food prices surged upwards to bring about the global food crisis of 2008. High and increasing food prices can generate an immediate threat to the security of a household’s food supply, thereby undermining population health. This paper aims to assess the precise effects of food price inflation on child health in developing countries.

Methods

This paper employs a panel dataset covering 95 developing countries for the period 2001–2011 to make a comprehensive assessment of the effects of food price inflation on child health as measured in terms of infant mortality rate and child mortality rate.

Results

Focusing on any departure of health indicators from their respective trends, we find that rising food prices have a significant detrimental effect on nourishment and consequently lead to higher levels of both infant and child mortality in developing countries, and especially in least developed countries (LDCs).

Discussion

High food price inflation rates are also found to cause an increase in undernourishment only in LDCs and thus leading to an increase in infant and child mortality in these poorest countries. This result is consistent with the observation that, in lower-income countries, food has a higher share in household expenditures and LDCs are likely to be net food importing countries.

Conclusions

Hence, there should be increased efforts by both LDC governments and the international community to alleviate the detrimental link between food price inflation and undernourishment and also the link between undernourishment and infant mortality.

     

Increased Mortality Despite Successful Multifactorial Cardiovascular Risk Reduction in Healthy Men: 40-Year Follow-Up of the Helsinki Businessmen Study Intervention Trial

Objectives

In a 5-year multifactorial risk reduction intervention for healthy men with at least one cardiovascular disease (CVD) risk factor, mortality was unexpectedly higher in the intervention than the control group during the first 15-year follow-up. In order to find explanations for the adverse outcome, we have extended mortality follow-up and examined in greater detail baseline characteristics that contributed to total mortality.

Design

Long-term follow-up of a controlled intervention trial.

Setting

The Helsinki Businessmen Study Intervention Trial.

Participants and Intervention

The prevention trial between 1974–1980 included 1,222 initially healthy men (born 1919–1934) at high CVD risk, who were randomly allocated into intervention (n=612) and control groups (n=610). The 5-year multifactorial intervention consisted of personal health education and contemporary drug treatments for dyslipidemia and hypertension. In the present analysis we used previously unpublished data on baseline risk factors and lifestyle characteristics.

Main outcome measures

40-year total and cause-specific mortality through linkage to nation-wide death registers.

Results

The study groups were practically identical at baseline in 1974, and the 5-year intervention significantly improved risk factors (body mass index, blood pressure, serum lipids and glucose), and total CVD risk by 46% in the intervention group. Despite this, total mortality has been consistently higher up to 25 years post-trial in the intervention group than the control group, and converging thereafter. Increased mortality risk was driven by CVD and accidental deaths. Of the newly-analysed baseline factors, there was a significant interaction for mortality between intervention group and yearly vacation time (P=0.027): shorter vacation was associated with excess 30-year mortality in the intervention (hazard ratio 1.37, 95% CI 1.03–1.83, P=0.03), but not in the control group (P=0.5). This finding was robust to multivariable adjustments.

Conclusion

After a multifactorial intervention for healthy men with at least one CVD risk factor, there has been an unexpectedly increased mortality in the intervention group. This increase was especially observed in a subgroup characterised by shorter vacation time at baseline. Although this adverse response to personal preventive measures in vulnerable individuals may be characteristic to men of high social status with subclinical CVD, it clearly deserves further investigation.

     

Association between adiposity and disability in the Lc65+ cohort

Objectives

To examine the longitudinal association between body mass index (BMI) and waist circumference (WC) with mortality and incident disability in Lc65+ cohort.

Design

Population-based cohort of non-institutionalized adults with up to 8.9 years of follow-up.

Setting

City of Lausanne, Switzerland.

Participants

1,293 individuals aged 65 to 70 at baseline (58% women).

Measurements

BMI, WC and covariates were measured at baseline in 2004-2005. Vital status was obtained up to the 31st December 2013 and difficulty with basic activities of daily living (BADL) was reported in a self-administered questionnaire sent to participants every year. Main outcomes were total mortality and disability, defined as difficulty with BADL for ≥2 years or institutionalization. Cox regression was used with BMI/WC quintiles 2 as the reference.

Results

130 persons died over a median follow-up of 8.47 years (crude mortality rate, men: 16.5/1,000 person-years, women: 9.7/1,000 person-years). In Cox regression adjusted for age, sex, education, financial situation, smoking and involuntary weight loss (IWL) at baseline, mortality was significantly associated with neither BMI nor WC, but there were trends towards non-significant J-curves across both BMI and WC quintiles. Disability (231 cases) tended to increase monotonically across both BMI and WC quintiles and was significantly associated with BMI quintile 5 (HR=2.44, 95% CI [1.65-3.63]), and WC quintiles 4 (HR=1.81 [1.15-2.85]) and 5 (HR=2.58, [1.67-4.00]).

Conclusion

Almost half of the study population had a substantially increased HR of disability, as compared to the reference BMI/WC categories. This observation emphasizes the need for life-long strategies aimed at preventing excess weight, muscle loss and functional decline through adequate nutrition and regular physical activity, starting at early age and extending throughout life.

     

The impact of Fruit-Vegetable Diet on High Signal Resolution Pulse Wave (HSR-PW) Parameters

Objectives

The diet and lifestyle affect our life. Inadequate nutrition can cause various diseases including cardiovascular diseases. The aim of this study was to show the correlations between the fruit and vegetable diet and high signal resolution pulse wave parameters.

Design

This was an observational study.

Settings

The study was done during two-weeks rehabilitation treatment.

Participants

In this study 154 people using the fruit and vegetable diet have been examined.

Measurements

The participants were monitored using a new diagnostic method high signal resolution pulseoximetry (HSR-PW). They were examined two times: before starting the diet and after two weeks of using it. The high signal resolution pulse wave and its characteristic parameters have been compared.

Results

Analyzing the research results at the beginning and after two weeks of using this diet, the improvement of selected parameters has been noticed. With the improvement in the pulse wave was observed weight loss, improved blood counts (e.g. cholesterol, triglycerides) as well as decreased blood pressure particularly in people with treated hypertension.

Conclusions

The study shows that applied fruit and vegetable diet influenced favorably the people using it and contributed to the improvement of the HSR-PW parameters which are the source of information about the state of the cardiovascular system.

     

Selenium Concentrations and Mortality Among Community-Dwelling Older Adults: Results from ilSIRENTE Study

Background

Selenium has a wide range of pleiotropic effects, influencing redox homeostasis, thyroid hormone metabolism, and protecting from oxidative stress and inflammation. Serum selenium levels are reduced in the older population.

Objectives

to investigate the association of serum selenium levels with all-cause mortality in a sample of community-dwelling older adults.

Design and Setting

Data are from the ‘Invecchiamento e Longevità nel Sirente’ (Aging and Longevity in the Sirente geographic area, ilSIRENTE) study, a prospective cohort study that collected information on individuals aged 80 years and older living in an Italian mountain community (n=347). The main outcome was risk of death after ten years of follow-up.

Participants and measurements

Participants were classified according to the median value of selenium (105.3 μg/L) in two groups: high selenium and low selenium.

Results

A total of 248 deaths occurred during a 10-year follow-up. In the unadjusted model, low levels of selenium was associated with increased mortality (HR, 0.66; 95% CI 0.51-0.85). After adjusting for potential confounders the relationship remained significant (HR, 0.71; 95% CI 0.54-0.92).

Conclusions

Low serum levels of selenium are associated with reduced survival in elderly, independently of age and other clinical and functional variables.

     

The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia

Background

One of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia.

Methods

A pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff.

Results

The results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care.

Conclusion

Provider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization.

Abstract in Russian

See the full article online for a translation of this abstract in Russian.