Loneliness in middle and old age: Demographics,perceived health,and social satisfaction as predictors

Purpose of the research(a) To identify the degree of much loneliness reported in the Portuguese population over 50 years of age and (b) test whether loneliness can be predicted by socio-demographic, health related or social characteristic of the sample other than age.Materials and methods1174 late middle age and older adults were interviewed face to face by different interviewers across the country; after the informed consent was signed, we asked the participants several socio-demographic and health-related questions; finally we asked “How often do you feel lonely?” and participants responded according to a five point Likert scale.Principal resultsThe results showed that 12% of participants reporting feeling lonely often or always, whereas 40% reporting never feeling lonely. The remaining 48% self-reported they felt lonely seldom or sometimes. Additionally, results show that, when taken together, variables such as marital status, type of housing, residence settings, health conditions, social satisfaction, social isolation, lack of interest, transportation, and age were predictors of loneliness.Major conclusions(1) The association of loneliness with advanced age has been greatly exaggerated by mass media and common sense; (2) But although our findings did not confirm the most alarmist views, the 12% of older adults reporting that they are feeling lonely always or often should be cause for attention and concern. It is necessary to understand the meaning, reasons and level of suffering implied on those feelings of loneliness. (3) Our findings suggest that it makes no sense to construe age as a singular feature or cause for feelings of loneliness. Instead, age and also a number of other features combine to predict feelings of loneliness. But even with our predictor variables there was a substantial of variance left unexplained. Therefore it is necessary to continue exploring how feelings of loneliness arise from the experience of living and how they can be changed.     

A population-based study on well-being in the very old: the role of cardiovascular diseases and drugs

Cardiovascular diseases constitute the most common health problems in very old people. Consequently, cardiovascular drugs are the medicines that are most frequently used by elderly subjects. Although many studies have examined the physiological effect and adverse reactions of these drugs, knowledge on their effect on emotional well-being is missing. The present study aims to examine the association between cardiovascular diseases and their medical treatment on the emotional well-being of very old people. We investigated a representative group of elderly subjects gathered from a population-based study (n = 235). Participants were 84 years or older and cognitively intact (mini-mental state examination (MMSE) ≥24 points). Well-being was assessed with the positive and negative affect schedule (PANAS), measuring different mood categories. Cardiovascular diseases were diagnosed following the International Classification of Diseases. In this population the prevalence of cardiovascular diseases was high (62%). Multivariate regression analysis showed that while being affected by a cardiovascular disease did not affect the emotional well-being of the subjects (PANAS-PA, p = 0.171; PANAS-NA, p = 0.209), the use of some cardiovascular drugs showed an association. Cardiac glycosides (p = 0.006) and nitrates (p = 0.008) were associated with increased negative feelings. Due to high prevalence of cardiovascular diseases and use of cardiovascular medicines, this finding has relevance on the quality of life of elderly people. However, due to the nature of this study we cannot assess cause–effect relationship of this positive association. Therefore, the present findings suggest that there is a need for clinical studies in this increasing and limited studied age group.     

Profiles of functioning as predictors of mortality in old age: The advantage of a configurative approach

This study proposes the concept of functioning profile, by which one's status is summarized across essential functioning domains, and validates its efficiency in predicting mortality. The study analyzed data of two cohorts of community-dwelling Israelis aged 75 and over, nationally sampled in 1989 (N = 1200) and 1999 (N = 421), respectively. Eight groups with differential profiles reflected higher versus lower levels of functioning in three domains: physical (activities of daily living), cognitive (Orientation-Memory-Concentration test = OMC) and affective (depressive symptoms). The analyses predicted mortality within 4 years, adjusting for sociodemographic and health variables. Relative to the optimal profile, most functioning profiles represented groups having elevated mortality risks of considerable consistency across cohorts. Physical functioning was the most predictive component in the profiles, but its combinations with cognitive and affective functioning produced unique contributions to mortality prediction. The study suggests that the functioning profile, representing a person-centered configurative approach (i.e., one that considers the person's combined standing on key factors), is a useful concept for delineating risk groups in late life and evaluating risk factors in predicting mortality.     

Moving in and out of public old age care among the very old in Sweden

In this paper, we present empirical results for the very old (75+) concerning transitions between independent living in ordinary home without public support, independent living in ordinary home or special accommodations with home help and home health care, and living in around the clock care. We investigate the role of age and gender, dependency in activities of daily living (ADL) and the informal support from a partner. We also study mortality conditional on the above-mentioned variables and on the mode of old age care. The results show that the propensity to move to a more intensive mode of care is less for males, higher with more limitations in personal ADL and increasing with age. There is also a stabilizing effect of the availability of informal care support, as measured by marriage or cohabitation, as it makes it less likely to move from the current care mode. In the case of mortality, the observed relations pointed in the expected directions—mortality increasing with increasing PADL-limitations and age and being higher for men than for women. The age relation, however, does not hold in the same way in around the clock care. The estimated relationships are used as input in a micro-simulation model intended for analysis of the effect of population aging on the needs and resource requirements for old age care in Sweden.     

Physical activity and subjective age across adulthood in four samples

The present study examined the prospective association between physical activity and subjective age across adulthood and factors that mediate this association. Participants were adults aged from 20 to 90 years (N > 10,000) drawn from the Wisconsin Longitudinal Study graduates and siblings samples, the Health and Retirement Study and the Midlife in the United States Survey. In the four samples, physical activity was assessed at baseline and subjective age was measured 8 to 20 years later. Personality, self-rated health, disease burden, depressive symptoms, and cognition were assessed as potential mediators. In the four samples, higher physical activity at baseline was associated with a younger subjective age at follow-up. Logistic regression revealed that physical activity was related to a 30–50% higher likelihood of feeling younger 8 to 20 years later. Significant indirect effects were found through openness to experience and self-rated health in the four samples. This study provides new evidence on the link between a health-related behavior and subjective age. Physically active individuals may sustain health and an open psychological disposition that is associated with feeling younger.     

Care-related quality of life in old age

Promoting quality of life is a central theme in recent ageing policies, but what quality of life means in concrete terms for people in different stages of old age is rather unclear. This study presents a multi-dimensional model of care-related quality of life (crQoL) and, based on analyses of three Finnish cross-sectional datasets from the years 2004–2007, examines the distinctions between dimensions of QoL by age and gender, with a special focus on older home care clients. Correlation analyses (Pearson) and stepwise linear regression were applied to analyse variation in QoL by age group and the association between QoL and perceived quality of home care. The results suggest that individual QoL and the priorities of (physical, psychical, social, and environmental) dimensions in the assessment of QoL by older persons vary considerably and exhibit distinct profiles in different stages of ageing. In addition, four dimensions for good care corresponding to the crQoL model were identified and their empirical relevance demonstrated. From the perspective of older people in need of help, home care is not just about giving them the instrumental help they need to perform their daily activities, but rather about giving responsive care that reflects their personal preferences or their view on a “good life”, and treats them with dignity and respect. The criteria for the evaluation of quality of home care should reflect these insights, and policy measures should take these differences into account.     

老年充血性心力衰竭患者心功能与甲状腺激素的关系

目的 探讨血清N末端B型脑钠肽前体（NT-proBNP）和甲状腺激素的关系,以及在老年充血性心力衰竭患者治疗中的临床价值.方法 测定老年慢性充血性心力衰竭（CHF）患者不同心功能状态下血清NT-proBNP和甲状腺激素的水平.结果 CHF组与对照组比较三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（FT3）水平降低,差异有统计学意义,且随心功能不全程度加重,T3、F-T3、甲状腺素（T4）、游离甲状腺素（FT4）水平依次降低,NT-proBNP水平依次升高,LVEF水平依次下降,差异有统计学意义（P＜0.01）.结论 监测血清甲状腺激素水平,对判断心衰程度、治疗及预后有一定临床价值.     

北京地区中老年人糖尿病和IGT患病率与增龄相关性的分析

目的　阐明中老年人糖尿病 (DM)和 IGT患病的增龄性特点及增龄的患病风险。方法　采用随机分级整群抽样方法 ,横断面调查北京市城乡 4个社区 2 35 4例≥ 4 0岁的中老年人。结果　 DM患病率为 11.36 % (标化率 :10 .6 4 % ) ,IGT患病率为 12 .17% (标化率 :11.5 6 % ) ,其与增龄有显著的相关性 (DM:r =0 .99,P =0 .0 0 2 ;IGT:r =0 .92 ,P =0 .0 2 9)。不同年龄组的血糖均值秩和分析 (IGT:χ2 =9.816 ,P =0 .0 4 4 ,总体 :χ2 =10 6 .94 4 ,P <0 .0 0 0 5 )在IGT和总体中证明有显著随年龄增加而增长的趋势。有 3个显著不同的患病风险 (OR)年龄阶段 ,即 4 0～ 4 9岁最低(DM:4 .95 % ,OR=0 .4 1;IGT:8.35 % ,OR=0 .6 6 ) ;5 0～ 6 9岁较高 (DM:12 .13%～ 13.5 7% ,OR=1.0 8～ 1.2 2 ;IGT:11.0 2 %～ 13.6 0 % ,OR=0 .89～ 1.13) ;70～ 99岁最高 (DM:19.0 2 %～ 2 1.0 5 % ,OR=1.83～ 2 .0 8;IGT:19.0 1%～2 1.0 5 % ,OR=1.6 9～ 1.92 )。患病高峰年龄为 DM(95 %可信区间 ,CI) :4 1.0～ 80 .4岁 ,IGT(95 % CI) :36 .9～ 82 .1岁。结论　因 DM和 IGT患者人数随增龄积累 ,年龄越大 ,患病率越高 ,表现出高龄群体高患病风险的增龄特点。年龄是 DM发生的一独立危险因素。     

老年慢性阻塞性肺疾病患者静息能量消耗与人体组成

目的探讨老年慢性阻塞性肺疾病（COPD）患者与老年正常对照组静息能量消耗（REE）与非脂体质（fat free mass,FFM）、瘦体质（lean mass,LM）的关系,为老年COPD患者营养支持治疗提供依据。方法用间接能量测定法测定43例老年COPD患者（男性25例,女性18例）和40例老年对照者（男性22例,女性18例）的REE,根据Harris-Benedict公式计算REE占预计值的百分比;同时运用双能X线吸收法测定人体组成,即FFM、LM值以及脂肪的比例。结果老年COPD患者FFM占体重比重（FFM%）、LM%均低于对照组,脂体质（FM）%则高于对照组,差异均有统计学意义;COPD组REE%也高于对照组,差异有统计学意义,COPD组基础代谢率（BMR）、REE与FFM和LM的比值（REE/FFM、REE/LM）都高于对照组;Pearson＇s相关性分析显示病例组和对照组REE与体重指数（BMI）、体表面积（BSA）、FFM和LM均呈中重度相关,差异都有统计学意义。结论老年COPD患者REE升高,FFM或LM的比例下降,提示COPD患者常常出现骨骼肌的萎缩。老年COPD患者和对照组REE和FFM和LM也有良好的正相关性。因此,如果样本量足够大,建立REE关于FFM或者LM的回归方程,对于指导临床营养支持治疗可能有一定的实际价值。     

高校社区中老年人群心血管病危险因素持探讨

目的：探讨高校社区中老年人群心血管病发病的危险因素。方法：对武汉大学社区1999年底中老年人群体检资料进行统计、分析,并分析体重指数（BMI,kg/m^2)及某些不良生活习惯对心脑血管病及其危险因素发生率的影响。结果：BMI≥25心血管病及其危险因素发生率呈上升趋势（P＜0．01或P＜0．05）,某些不良生活习惯也明显增加心血管病及其危险因素的发生率。结论：为中老年人群减肥,或控制其钠盐摄入及饮酒量,就可降低心血管病的发病率。     

Is the common presence of glucose intolerance in old age a reliable index for the subsequent occurrence of fasting hyperglycemia?

Summary The aim of the present study was to verify the validity of diagnostic criteria developed by the NDDG for the diagnosis of diabetes mellitus in old age. One hundred and fifty-one ambulatory old (range: 66–77 years) subjects (group A) underwent OGTT showing the following results: 33% normal, 12% non-diagnostic, 23% impaired glucose tolerance (IGT), 32% diabetic-type tolerance (DT). In addition, 84 subjects (group B) selected from 1978 to 1982 (42 aged 51–60 years, 30 aged 61–70, and 12 aged 71–80) with abnormalities of glucose tolerance during OGTT (IGT or DT) were asked to control their fasting plasma glucose every month during 1984. In group B a significant correlation between DT and subsequent development of fasting hyperglycemia was observed only in the subjects of the 6th and 7th decades of age. On the contrary, no subjects aged 71–80 years developed fasting hyperglycemia. The authors suggest that a high prevalence of abnormalities in glucose tolerance according to NDDG exists in old age which cannot be considered evidence of a true diabetes mellitus being unpredictive of a progression towards fasting hyperglycemia.     

Dimensional prefernces in middle and old age

Dimensional preferences in 40 middle-aged (M = 41.62 years) and 40 elderly (M = 72.22 years) females were assessed using a dimensional choice task. Significant age differences in reaction times of choice but not in number of dimensional choices were obtained. There was a perfect rank-order correspondence between the two age groups in dimensional choices with form being the most preferred and color the least preferred perceptual dimension.     

老年入及慢性非器质性腹泻患者的乳糖酶缺乏症

用乳糖氢呼吸试验检测了18例20～65岁正常人基础氢值均在30PPM以下,平均22.5±3.8PPM,服乳糖后氢上升≥20PPM者13例(72.2％),平均升高62.9±64.4MMP。基本健康的70～87岁老人共17例,基础氢值19.7±4.0PPM,乳糖试验异常者7例(41.1％),呼气中氢平均升高42.4±23.6PPM。21例非器质性慢性腹泻患者基础氢平均22.7±9.0PPM,有2例>30PPM,服乳糖后异常者18例(85.7％),平均升高60.4±34.5PPM。说明我国正常人中乳糖酶缺乏的阳性率约为72.2％。高龄老人中阳性率41.1％,有随年龄增高逐渐适应的趋势。非器质性腹泻组乳糖酶缺乏的阳性率85.7％,且有2例空腹氢含量升高,提示乳糖酶缺乏可能与部份慢性腹泻患者的病因有关,这类病人在症状发作期间限制乳类制品是值得推荐的。     

Six-year follow-up and predictors of urgency-associated urinary incontinence and bowel symptoms among the oldest old: A population-based study

Urinary urgency with incontinence, and fecal incontinence and constipation were followed up over a 6-year period in 398 subjects aged 70 years and over at baseline. Age- and gender-adjusted and multivariate Cox proportional hazard models were used to examine the associations of urinary urgency and fecal incontinence and constipation with mortality, and logistic regression models to determine predictors of incident symptoms among the survivors. The proportion of incident cases of urinary urgency with incontinence, fecal incontinence and constipation in the 252 survivors were 17% (n = 46), 9% (n = 34) and 13% (n = 36), respectively. Frequently reported urinary urgency (hazard ratio, HR = 2.23; 95% confidence interval, CI = 1.37–3.61) and frequently reported fecal incontinence (HR = 4.99; CI = 2.11–11.79) were associated with mortality when adjusted for age and gender only. In the multivariate analyses, comorbidity (odds ratio, OR = 5.54; CI = 2.03–15.14), depressive mood (OR = 5.78; CI = 1.35–24.79) and instrumental activities of daily living (IADL) disability (OR = 4.18, CI = 1.52–11.50) predicted incident urgency urinary incontinence. Comorbidity (OR = 2.91; CI = 1.09–7.77) predicted incident fecal incontinence, while no significant predictors were identified for the incident symptom of constipation. Comorbidities and disabilities explain the association of severe urinary and fecal incontinence with mortality.     

154例特需中老年住院患者反应性调查与分析

目的 通过对特需中老年住院患者反应性调查与分析,了解特需医疗服务的优势及需要改进之处,为提高工作绩效和整体决策提供科学依据。方法 采用随机抽样方法对上海市某三甲医院154位特需中老年住院患者进行了匿名式问卷调查。结果 特需中老年住院患者反应性总体评分高于上海市卫生系统反应性评分。结论 特需服务充分体现出高端医疗市场的定位,其优质、人性化的服务与需求者的期望基本符合。提高特需住院患者反应性,将有利于促进医院提高非医疗服务的质量。     

北京中老年自然人群颈-股动脉脉搏波速度的分布及相关因素

目的 了解我国中老年自然人群颈-股动脉脉搏波速度(CFPWV)的分布及相关因素.方法 对北京市石景山区1519名44～79岁居民进行心血管病危险因素调查及CFPWV测量.采用单因素方差分析、Pearson相关和偏相关、多元逐步回归分析CFPWV的相关因素.结果 (1)调整年龄后,男女CFPWV均值分别为11.4 m/s和11.1 m/s,男性显著高于女性(P<0.01).无论男女,随着年龄增长,CFPWV增加,趋势榆验有显著性(P<0.01).(2)调整年龄、件别后,高血压、糖尿病和心率较高组(≥70次/min)CFPWV显著高于非高血压、非糖尿病和心率较低组(<70次/min)(P均<0.01).(3)简单相关显示:不论男女,年龄、收缩压、舒张压、空腹血糖、心率均与CFPWV显著相关,相关系数为0.12～0.46(P均<0.01);女性CFPWV还与总胆固醇、甘油三酯显著相关,相关系数为0.11和0.13(P均<0.01);多元逐步同门显示年龄、性别、收缩压、舒张压、空腹血糖、心率是CFPWV的独市相关因素,年龄是CFPWV最大的相关因素.结论 我国中老年自然人群中,年龄、性别、收缩压、舒张压、空腹血糖、心率与CFPWV显著相关,高密度脂蛋白胆固醇、体质指数与CFPWV不相关.     

Left ventricular hypertrophy and blood pressure as predictors of cognitive decline in old age

BACKGROUND AND AIMS: The relationships between blood pressure (BP) and cognition are complex and are still partly unclear. The impact of history of hypertension, present BP levels, and left ventricular hypertrophy (LVH) on cognition was investigated in a 10-year follow-up study of an aged population. METHODS: The population-based sample consisted of 75-, 80- and 85-year-old individuals at baseline (N=650). Their history of hypertension was investigated, and present BP values were recorded several times. Echocardiographic examinations were performed twice at 3-year intervals, and electrocardiography (ECG) at entry. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) at baseline and at 10 years, and by the Clinical Dementia Rating (CDR) at baseline, at 1, 5 and 10 years. RESULTS: At baseline, elderly individuals with impaired cognition or dementia had lower BP, but thicker left ventricle posterior wall (LVPW), greater cardiac mass, and more often signs of LVH in ECG than those without cognitive deficits. Echocardiographic LVH, but not BP, predicted cognitive decline in a 5-year follow-up. Patients who died demented within 5 years were characterized by low BP and thin LVPW. Baseline BP and echocardiographic variables were not significantly different between those who had and had not cognitive decline at 10 years, but declining BP tended to precede cognitive deficits. CONCLUSIONS: Results indicate that, the closer cognitive decline, the lower the BP, and suggest that, although LVH is a risk factor of cognitive decline, it loses its predictive value in old age.     

The difference between self-perceived and chronological age in the elderly may correlate with general health,personality and the practice of good health behavior: A cross-sectional study

Background and objectiveFor the elderly, maintaining a young self-perceived age has a positive impact on physical and mental health. The purpose of this study was to investigate the impact of the discrepancy between self-perceived age and chronological age in regards to physical activity, instrumental activities of daily living, functional capacity, personality, general self-efficacy, depressive symptoms, and disease burden.MethodsParticipants were 3094 older adults from 2015 baseline data of the Keeping Active across Generations Uniting the Youth and the Aged study. The questionnaire was mailed to 8004 elderly people aged 65 years or older. Of the 3871 people who returned the questionnaire (collection rate, 48.3%), 3094 subjects were analyzed in this study (female, 52%). The questionnaire included aspects of physical activity, instrumental activity of daily living, functional capacity, personality traits, general self-efficacy, depressive symptoms, history of falls, fear of falling, communication with young people, medical history, and self-perceived age, as well as basic characteristics such as age, sex, living alone or not, and educational history.ResultsRegression analysis showed that the presence of high self-rated health, personality traits of extraversion and openness to experience, higher general self-efficacy, and the presence of fear of falling were positively associated with a younger self-perceived age.ConclusionsThe results identified personality and psychological factors related to of self-perceived age in community-dwelling elderly people. Therefore, changes in personality traits and subjective health accompanying aging affect the self-perceived age, which may also affect the extension of healthy life expectancy.     

Improvement and decline in health status from late middle age: modeling age-related changes in deficit accumulation

In a prospective multi-panel cohort study, we investigated how, from late middle age, individuals' health status improves or declines. In the Canadian National Population Health Survey, transition probabilities between different health states were estimated for 4330 people (58.8% women) aged 55+ at baseline over 2-year intervals from 1994 to 2000. Health status was defined by a deficit count, using 33 health-related variables combined in a frailty index. For each time interval, the chance of accumulating deficits increased linearly with the number of deficits. Older survivors (aged 70-85) showed a slightly lower chance of stability or improvement (52%; 95% confidence interval 50-54%) compared with those in late middle age (56%; 54-58%). Changes in health states can be described with high accuracy (R2=0.92) by a modified Poisson distribution, using four parameters: the background odds of accumulating additional deficits, the chance of incurring more or fewer deficits, given the existing number, and the corresponding probabilities of dying. An age-invariant limit to deficit accumulation was observed at 22 deficits. From late middle age, transitions in health states occur with a regularity that is easily modeled. Improvements in health can occur at any age. At all ages, there is a limit to deficit accumulation.     

Social relationships and health as predictors of life satisfaction in advanced old age: results from a Swedish longitudinal study.

This longitudinal study examines the relationship between family and friend social support, health, and life satisfaction for a single cohort of eighty-year-old persons living in Lund, Sweden. Results indicate that participants who remained in the study are healthier and score higher on life satisfaction when compared with those who either drop-out or die prior to age eighty-three. Even though well-integrated with family and friends, the number of friends decreases significantly from eighty to eighty-three years; those who reported no close friends nearly doubled from eighty to eighty-three years. However, for those with close friends, contact with friends increases with age. In contrast to previous research, a correlational analysis indicates that neither child nor friend support is related to life satisfaction at either eighty or eighty-three years. However, health measures and satisfaction with sibling contact are related to total life satisfaction at age eighty-three only. These findings indicate the multidimensionality of both social support and life satisfaction for the old-old.