Depression after stroke: a prospective epidemiological study

OBJECTIVES: To elucidate the relationship between stroke and depressive symptoms and to determine whether disability or cerebrovascular risk factors mediate that relationship. DESIGN: A prospective longitudinal epidemiological survey. SETTING: The mid-Monongahela Valley, a rural, nonfarm, low-socioeconomic-status community. PARTICIPANTS: Random sample of 1,134 subjects aged 65 and older. MEASUREMENTS: The dependent variable was clinically significant depressive symptoms, as defined by five or more symptoms on the modified Center for Epidemiological Studies Depression scale. The independent variables were demographics (age, sex, education), stroke, number of impaired instrumental activities of daily living (IADLs), diabetes mellitus, hypertension, atherosclerotic heart disease, and smoking. Logistic regression analyses were conducted for cross-sectional and longitudinal models examining whether stroke was associated with or predicted depressive symptoms, with other associated factors included as covariates. RESULTS: Clinically significant depressive symptoms were cross-sectionally associated with stroke (odds ratio (OR)=3.5, 95% confidence interval (CI)=1.4-8.3), diabetes mellitus (OR=2.8, 95% CI=1.7-4.6; P相似文献   

Health status indicators among community-dwelling elders with arthritis: the Bambuí health and aging study

OBJECTIVE: To investigate the association of arthritis with health status indicators among elders living in Bambuí, Brazil. METHODS: A cross-sectional study was conducted among 1606 elders using baseline data from the Bambuí Health and Aging Study, a population based cohort study of older adults. Arthritis was self-reported and defined as a physician diagnosis of arthritis or rheumatism, and/or chronic hand and knee symptoms. Health status indicators, defined a priori as the main independent variables, were self-rated health, psychological distress (based on the General Health Questionnaire), report of sleep complaints, disability in activities of daily living (ADL), "2-week" disability, mobility disability, and 2 composite indexes of mental health problems and physical disability problems. Logistic regression compared health status indicators among elders reporting arthritis (N = 833) and non-arthritis subjects. RESULTS: After controlling for sociodemographics and chronic conditions, all measures were found to be associated with arthritis: sleep complaints (OR 1.81, 95% CI 1.43-1.92), fair (OR 2.17, 95% CI 1.62-2.90) and poor self-rated health (OR 3.48, 95% CI 2.46-4.94), ADL disability (OR 1.73, 95% CI 1.02-2.87), mobility disability (OR 2.65, 95% CI 2.06-3.41), 2-week disability (OR 1.86, 95% CI 1.35-2.57), 2 mental health problems (OR 2.25, 95% CI 1.67-3.04), and one (OR 2.46, 95% CI 1.91-3.16) and 2 physical disability problems (OR 4.19, 95% CI 2.02-8.59). CONCLUSION: Considering the paucity of similar studies addressing the impact of arthritis in developing nations, these findings may be applied to similar communities and support better planning of resource allocations to minimize the effects of arthritis among the elderly.     

Twin study of depressive symptoms among older african-american women

This study examines factors associated with depressive symptoms in a genetically informative sample of African-American female twins aged 65 years and older. A telephone interview was conducted with 180 pairs of twins. Questions included demographics, health behaviors, health status, activities of daily living (ADLs), instrumental ADLs, and depressive symptoms as measured by the Center for Epidemiologic Studies-Depression scale. Regression methods for clustered data were used to examine the associations. In univariate analyses, ADLs (odds ratio or OR = 1.4, 95% confidence interval or CI = 1.1-1.7), fractures (OR = 4.4, 95% CI = 1.3-15.6), and vision problems (OR = 1.9, 95% CI = 1.0-3.8) were significantly associated with depressive symptoms. In multivariable analyses, ADLs (OR = 1.4, 95% CI = 1.2-1.7) and vision problems (OR = 2.0, 95% CI = 1.2-3.5) remained significantly associated with depressive symptoms. A within-pair analysis, controlling for genetic or familial influences, produced similar results. The results suggest that efforts targeted at reducing levels of disability may reduce depressive symptoms in this population.     

Depressive symptoms and self-rated health in community-dwelling older adults: a longitudinal study

OBJECTIVES: To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self-rated health and decrease the likelihood of subsequent improvement in self-rated health. DESIGN: A 2-year prospective cohort study. SETTING: Six thousand seven hundred fourteen community-dwelling older persons who completed the first and second wave of the Asset and Health Dynamics among the Oldest-Old Survey in the United States. PARTICIPANTS: Community-dwelling older people in the United States. MEASUREMENTS: Baseline depressive symptoms were measured using a short-form of the Center for Epidemiological Studies Depression Scale. Self-rated health was measured using a single item of global health rating. RESULTS: After adjustment for covariates, a high burden of depressive symptoms at baseline was predictive of greater decline in self-rated health (odds ratio (OR) for decline in those with high burden of depressive symptoms vs those without = 1.47, 95% confidence interval (CI) = 1.26-1.70). Likewise, high burden of depressive symptoms at baseline predicted less improvement in self-rated health (OR for improvement in those with high burden of depressive symptoms vs those without = 0.57, 95% CI = 0.50-0.65). CONCLUSIONS: Depressive symptomatology is an independent risk factor for subsequent changes in self-rated health in older adults. Thus, early prevention and intervention of depressive symptoms in community-dwelling older adults might be critical to promote and maintain their self-rated health.     

Effect of widowhood on disability onset in elderly men from three European countries

OBJECTIVES: To investigate in different countries the effects of becoming widowed, duration of widowhood, and household composition of widowed men on disability onset in different disability domains. DESIGN: Longitudinal data from a cohort study collected around 1990, 1995, and 2000. SETTING: Three cohorts from Finland, The Netherlands, and Italy. PARTICIPANTS: Seven hundred thirty-six men, aged 70 and older at baseline. MEASUREMENTS: Disability was measured using standardized questionnaire on activities of daily living (ADLs). Three domains were assessed: instrumental ADLs (IADLs), mobility, and basic ADLs (BADLs). Duration of widowhood was divided into less than 5 years and 5 or more years and household composition into living alone and living with family or in an institution. RESULTS: Men who became widowed developed more IADL disabilities (odds ratio (OR)=2.15; 95% confidence interval (CI)=1.22-3.81) and mobility (OR=1.84; 95% CI=1.15-2.96) than men who were still married. Men who had been widowed for less than 5 years developed more IADL disabilities than those who had been widowed for 5 years or more (OR=2.27; 95% CI=1.14-4.54). Widowed men living alone showed fewer disabilities in mobility (OR=0.25; 95% CI=0.09-0.73) and BADLs (OR=0.02; 95% CI=0.001-0.33) than those living with others. The effects on disability onset did not differ between countries. CONCLUSION: Widowhood in elderly men is a risk factor for dependency in IADLs and mobility. The growth in the number of widowers may lead to higher demands on family care and professional care.     

Musculoskeletal pain and incident disability in community‐dwelling older adults

Objective

To test the hypothesis that the number of areas of musculoskeletal pain reported is related to incident disability.

Methods

Subjects included 898 older persons from the Rush Memory and Aging Project without dementia, stroke, or Parkinson's disease at baseline. All participants underwent detailed baseline evaluation of self‐reported pain in the neck or back, hands, hips, knees, or feet, as well as annual self‐reported assessments of instrumental activities of daily living (IADLs), basic activities of daily living (ADLs), and mobility disability. Mobility disability was also assessed using a performance‐based measure.

Results

The average followup was 5.6 years. Using a series of proportional hazards models that controlled for age, sex, and education, the risk of IADL disability increased by ～10% for each additional painful area reported (hazard ratio [HR] 1.10, 95% confidence interval [95% CI] 1.01–1.20) and the risk of ADL disability increased by ～20% for each additional painful area (HR 1.20, 95% CI 1.11–1.31). The association with self‐report mobility disability did not reach significance (HR 1.09, 95% CI 0.99–1.20). However, the risk of mobility disability based on gait speed performance increased by ～13% for each additional painful area (HR 1.13, 95% CI 1.04–1.22). These associations did not vary by age, sex, or education and were unchanged after controlling for several potential confounding variables including body mass index, physical activity, cognition, depressive symptoms, vascular risk factors, and vascular diseases.

Conclusion

Among nondisabled community‐dwelling older adults, the risk of disability increases with the number of areas reported with musculoskeletal pain.     

Disability transitions in the oldest old in the general population. The Leiden 85-plus study

Transitions between disability states in older people occur frequently. This study investigated predictors of disability transitions in the oldest old and was performed in the Leiden 85-plus study, a population-based prospective cohort study among 597 participants aged 85 years. At baseline (age 85 years), data on sociodemographic characteristics and chronic diseases were obtained. Disabilities in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured annually for 5 years with the Groningen Activities Restriction Scale (GARS). Mortality data were obtained. A statistical multi-state model was used to assess the risks of transitions between no disabilities, IADL disability, BADL disability, and death. At baseline, 299 participants (50.0 %) were disabled in IADL only, and 155 participants (26.0 %) were disabled in both BADL and IADL. During 5-year follow-up, 374 participants (62.6 %) made >1 transition between disability states, mostly deterioration in disability. Males had a lower risk of deterioration [hazard ratio (HR), 0.75 (95 % CI, 0.58–0.96)] compared to females. No gender differences were observed for improvement [HR, 0.64 (95 % CI, 0.37–1.11)]. Participants with depressive symptoms were less likely to improve [HR, 0.50 (95 % CI, 0.28–0.87)]. Participants with depressive symptoms [HR, 1.46 (95 % CI, 1.12–1.91)], >1 chronic disease [HR, 1.60 (95 % CI, 1.27–2.01)], and with cognitive impairment [HR, 1.60 (95 % CI, 1.20–2.13)] had the highest risk of deteriorating. Disability is a dynamic process in the oldest old. Deterioration is more common than improvement. Older men are less likely to deteriorate than women. The presence of depressive symptoms, chronic disease, and cognitive impairment predicts deterioration.     

Health-protective and adverse effects of the apolipoprotein E epsilon2 allele in older men

OBJECTIVES: To reexamine a health‐protective role of the common apolipoprotein E (APOE) polymorphism focusing on connections between the APOE?2—containing genotypes and impairments in instrumental activities of daily living (IADLs) in older (≥65) men and women and to examine how diagnosed coronary heart disease (CHD), Alzheimer's disease, colorectal cancer, macular degeneration, and atherosclerosis may mediate these connections. DESIGN: Retrospective cross‐sectional study. SETTING: The unique disability‐focused data from a genetic subsample of the 1999 National Long Term Care Survey linked with Medicare service use files. PARTICIPANTS: One thousand seven hundred thirty‐three genotyped individuals interviewed regarding IADL disabilities. MEASUREMENTS: Indicators of IADL impairments, five geriatric disorders, and ?2‐containing genotypes. RESULTS: The ?2/3 genotype is a major contributor to adverse associations between the ?2 allele and IADL disability in men (odds ratio (OR)=3.09, 95% confidence interval (CI)=1.53–6.26), although it provides significant protective effects for CHD (OR=0.55, 95% CI=0.33–0.92), whereas CHD is adversely associated with IADL disability (OR=2.18, 95% CI=1.28–3.72). Adjustment for five diseases does not significantly alter the adverse association between ?2‐containing genotypes and disability. Protective effects of the ?2/3 genotype for CHD (OR=0.52, 95% CI=0.27–0.99) and deleterious effects for IADLs (OR=3.50, 95% CI=1.71–7.14) for men hold in multivariate models with both these factors included. No significant associations between the ?2‐containing genotypes and IADL are found in women. CONCLUSION: The ?2 allele can play a dual role in men, protecting them against some health disorders, while promoting others. Strong adverse relationships with disability suggest that ?2‐containing genotypes can be unfavorable factors for the health and well‐being of aging men.     

Peripheral arterial disease and depressed mood in older men and women

The objective of this study was to determine whether lower extremity peripheral arterial disease (PAD) is associated with depressive symptoms and whether PAD-related disability mediates the association between PAD and depressive symptoms. The study used a cross-sectional design set in an academic medical center. A cohort of men and women aged 55 years and older with (n = 93) or without (n = 74) PAD was recruited. PAD subjects were identified from a blood flow laboratory and a general medicine practice. Non-PAD subjects were identified from the same general medicine practice. PAD was diagnosed and quantified using the ankle-brachial index (ABI). Depressive symptoms were assessed by the 15-item short version of the Geriatric Depression Scale (GDS-S; score range 0-15, 0 = no depressive symptoms). The six-minute walk test and the Walking Impairment Questionnaire (WIQ) distance score (score range 0-100, 100 = better walking ability) were measures of walking impairment. PAD subjects had depressive mood (DM) (defined by GDS-S score >5) twice as often as controls (24% vs 12%, p = 0.06). After adjustment for age, education, and number of comorbidities, the prevalence of depressive mood among PAD subjects was increased, but this association was not significant (OR = 1.8, 95% CI 0.7-4.4). The WIQ distance score weakened the association between PAD and DM, and higher distance scores were associated with a lower likelihood of DM (OR = 0.98 per one unit of the WIQ, 95% CI 0.96-0.99). Among PAD subjects, severe PAD (ABI <0.5) was not significantly associated with DM (OR = 1.4, 95% CI 0.5-4.1), but a greater 6-min walk distance was associated with a lower likelihood of DM (OR = 0.8 per 100 feet, 95% CI 0.70-0.97). Substituting the WIQ scores for six-min walk distance in the model showed that higher WIQ scores were associated with lower likelihood of DM among PAD subjects (OR= 0.98 per one unit of the WIQ, 95% CI 0.95-1.0), though the association did not achieve statistical significance. In conclusion, these data suggest that PAD may be associated with an increased risk of DM and that this relationship may be related to PAD-associated disability. An evaluation for depression may be appropriate in men and women with PAD. Findings should be evaluated in a larger study cohort.     

The role of education on the association between disability and depressive symptoms among community-dwelling older adults: Evidence from Frailty in Brazilian Older People (Fibra) study

ObjectivesTo explore whether higher socioeconomic status attenuates the effects of depressive symptoms on disability among older adults.MethodsWe conducted a cross-sectional study based on 596 older adults, aged 65 and over, from a large city (Belo Horizonte) in Brazil. Disability was defined as limitation in activities such as Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Covariates were age, comorbidities, Body Mass Index (BMI) and grip strength. Statistical analyses were based on Ordinal Logistic Regression and calculated separately for men and women.ResultsElderly women with disability and higher education levels have similar prevalence of depressive symptoms compared to those without disability (17.9% and 16.1%, respectively), but lower compared to those disabled with lower education (37.2%). A positive gradient trend was observed for depressive symptoms across disability categories among women (OR = 2.61; 95% CI 1.52, 4.48). However, these patterns were not observed among men.ConclusionA higher level of education attenuates odds of depressive symptoms in elderly women with disability but does not eliminate it. Therefore, screening for depressive symptoms in low-educated elderly women is important in order to identify them and start early prevention care for target risk population and decrease the disability expenses for health services.     

Association of diuretic use and overactive bladder syndrome in older adults: a propensity score analysis

Diuretic use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n=172) had a mean age of 79+/-7.5 (+/-S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients, respectively, reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio (OR)=3.48; 95% confidence interval (CI)=1.73-7.03) and urgency (74% versus 57% non-diuretic; OR=2.17; 95% CI=1.11-4.24) but not with incontinence (OR=1.74; 95% CI=0.87-3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR=3.09; 95% CI=1.20-7.97) and urgency (adjusted OR=2.50; 95% CI=1.00-6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR=2.54; 95% CI=1.09-5.91), which lost significance after propensity adjustment (adjusted OR=1.88; 95% CI=0.57-6.17). Overall summary mean Urge-IIQ score was 1.83+/-0.85 with 1.75+/-0.86, 1.68+/-0.76, and 2.03+/-0.88, respectively, for no diuretic, non-loop, and loop-diuretic patients (one-way analysis of variance (ANOVA) p=0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use.     

Association of geriatric conditions and cardiovascular diseases with disability in older adults with diabetes: Findings from a nationally representative survey

Aim: To examine how diabetes in combination with cardiovascular diseases (hypertension, heart disease and stroke) and geriatric conditions (cognitive impairment and depressive symptoms) affects the odds of disability in older adults. Methods: We analyzed data from a nationally representative sample of people aged 65 years and over (n = 2727) participating in the 2005 National Health Interview Survey in Taiwan. A total of 473 participants had a history of self‐reported physician diagnosed diabetes. Disability was defined as reporting limitations in one or more tasks of activities of daily living (ADL), instrumental activities of daily living (IADL) or general physical activities (GPA). The Mini‐Mental State Examination was used to assess cognitive function. The Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. Results: After adjustment for other factors, cardiovascular diseases and geriatric conditions independently contributed to the excess odds of disability among participants with diabetes. Participants who had diabetes combined with cardiovascular diseases and geriatric conditions had odds ratios for ADL, IADL and GPA disability of 18.02 (95% CI 5.13–63.34), 7.95 (95% CI 4.07–15.50) and 5.89 (95% CI 3.19–10.90), respectively. Conclusion: Our results highlight the high prevalence of co‐occurrence of cardiovascular diseases with geriatric conditions in people with diabetes. Furthermore, the combined presence of these diseases and conditions is strongly associated with an excess odds of disability. These findings highlight the critical importance of preventing cardiovascular disease morbidity, and improving depressed mood and cognitive function in order to reduce disability risk in older adults with diabetes. Geriatr Gerontol Int 2013; 13: 563–570.     

The mediating role of cognition in the relationship between sleep duration and instrumental activities of daily living disability among middle-aged and older Chinese

ObjectiveTo explore the effect of sleep duration at baseline on the incident IADL disability among middle-aged and older Chinese, and test whether cognition mediates this causality.MethodsData were collected from wave 1 (2011-2012) to wave 3 (2015-2016) of the China Health and Retirement Longitudinal Study (CHARLS). Sleep duration was self-reported at baseline. Cognitive function, including episodic memory and mental intactness were measured via a questionnaire. IADL was assessed at baseline and follow-up. Baron and Kenny's causal steps and Karlson/Holm/Breen (KHB) method were conducted to examine the mediating effect.ResultsA total of 10,328 participants free of IADL disability at baseline were included in this study. Over 4 years of follow-up, 17.1% of participants developed IADL disability. Compared to 7-8 h sleep duration, both short sleep (OR=1.460; 95% CI: 1.261-1.690 for sleeping ≤5 h; OR= 1.189; 95% CI: 1.011-1.400 for sleeping 5-7 h) and long sleep (OR=1.703; 95% CI: 1.269-2.286 for sleeping >9 h) were linked with incident IADL disability. KHB method identified significant mediating effect of cognition on the relationship between extreme sleep durations (≤5 h or >9 h) and IADL disability and the proportional mediation through cognition was 21.32% and 21.06% for sleeping ≤5 h and >9 h, respectively.ConclusionBoth short (sleeping ≤5 h) and long sleep duration (sleeping >9 h) predicted incident IADL disability. Cognition partially mediated the effect of extreme sleep durations on IADL disability.     

Association of individual activities of daily living with self-rated health in older people

OBJECTIVE: to evaluate the associations of 18 activities of daily living with self-rated health in older people. DESIGN AND SETTING: cross-sectional study of a representative sample of 781 people aged 65 or over (response rate: 89.9%). METHODS: self-rated health was assessed by the question: "Overall, how would you rate your current health status-very good, good, fair, poor or very poor?" We used the Barthel index and Lawton and Brody's index for basic and instrumental activities of daily living, respectively. We classified subjects into three groups according to their Barthel index score: level 1 (score 100), level 2 (score 91-99) and level 3 (score 0-90). Logistic regression was used to identify associations between each activity and self-rated health. RESULTS: use of stairs [odds ratio (OR) = 4.28, 95% confidence interval (95% CI): 2.82-6.52], ambulation (OR = 3.67, 95% CI: 2.39-5.64) and chair/bed transfer (OR = 3.00, 95% CI: 1.68-5.36) were the basic activities of daily living best associated with self-rated health. Among instrumental activities of daily living, ability to handle finances (OR = 2.20), laundry (OR = 2.15) and transport (OR = 2.12) were associated with self-rated health. On the Barthel index, only transport was associated with self-rated health in subjects at levels 1 (OR = 2.55) and 2 (OR = 2.72). For subjects with poor functional status (level 3), no instrumental activities of daily living were related to self-rated health. CONCLUSION: in terms of self-rated health, the most important activities of daily living were those involving mobility. The effect of each instrumental activity of daily living on self-rated health depends on the level of functional capacity in basic activities of daily living.     

Instrumental activities of daily living as a potential marker of frailty: a study of 7364 community-dwelling elderly women (the EPIDOS study).

BACKGROUND: A number of clinical conditions have been shown to be associated with frailty in elderly people. We hypothesized that incapacities on the Instrumental Activities of Daily Living (IADLs) scale could make it possible to identify this population. We investigated the associations between IADL incapacities and the various known correlates of frailty in a cohort of community-dwelling elderly women. METHODS: Cross-sectional analysis was carried out on the data from 7364 women aged over 75 years (EPIDOS Study). The IADL was the dependent variable. Sociodemographic, medical, and psychological performance measures were obtained during an assessment visit. Falls in the previous 6 months and fear of falling were also ascertained. Body composition was measured by dual-energy x-ray absorptiometry. The factors associated with disability in at least one IADL were included in a logistic regression model. RESULTS: Thirty-two percent of the population studied had disability in at least one IADL item. This group was significantly older (81.7 +/- 4.1 yr vs 79.8 +/- 3.4 yr), had more frequent histories of heart disease, stroke, depression or diabetes, and was socially less active (p =.001). These associations persisted after multivariate analysis. Cognitive impairment as assessed by the Pfeiffer test (Pfeiffer score <8) was closely associated with disabilities on the IADL (OR 3.101, 95% confidence interval [CI] 2.19-4.38). Falls and fear of falling were also more frequent in the group of women with an abnormal IADL (p =.001) but only fear of falling remained significantly associated with incapacities on at least one IADL item after logistic regression (OR 1.47, 95% CI 1.28-1.69). Women with disability on at least one IADL item also had lower bone mineral density, this was independent of the other factors. CONCLUSION: Our results confirmed that women with disability on at least one IADL item are frailer because they had more associated disorders, poorer cognitive function and more frequent falls. Disabilities on this scale could be a good tool for identifying individuals at risk of frailty among elderly persons living at home and in apparent good health. This finding requires confirmation by longitudinal studies.     

Relationship of homocysteine levels to quadriceps strength, gait speed, and late-life disability in older adults

BACKGROUND: Elevated homocysteine, causing tissue injury by such mechanisms as oxidative stress, endothelial damage, and protein homocysteinylation, is associated with multiple age-related problems including cardiovascular diseases, dementia, and osteoporotic fracture. Disability is one of the most common features in older adults. However, little is known about the role of homocysteine in physical disability among older adults. METHODS: Participants (>60 years, N = 1677) were from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Nineteen questionnaires in five major domains were administered to assess the level of difficulty in performing various tasks: activities of daily living (ADL), instrumental ADL (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA). Peak quadriceps strength was obtained by using an isokinetic dynamometer. Habitual gait speed was obtained from a 20-foot timed walk. Homocysteine levels were measured by the Abbott homocysteine assay, an automated fluorescence polarization immunoassay (FPIA). RESULTS: Elevated homocysteine was associated with disability in ADL, IADL, LSA, and GPA after multivariate adjustment. The odds ratios (ORs) for disability in these domains comparing participants in the highest quartile of homocysteine to those in the lowest were 2.18 (95% confidence interval [CI], 1.32-3.59) for ADL; 1.62 (95% CI, 1.02-2.57) for IADL; 2.00 (95% CI, 1.14-3.51) for LSA; and 1.52 (95% CI, 1.05-2.21) for GPA. The strength of associations weakened somewhat after additional adjustment of quadriceps strength and/or gait speed, suggesting a mediating role of quadriceps strength and gait speed in the association between homocysteine and disability. Homocysteine had an inverse relationship to quadriceps strength and gait speed. Likewise, quadriceps strength seemed to mediate the inverse association between homocysteine and gait speed. CONCLUSIONS: Elevated homocysteine is associated with multiple domains of disability mediated in part by muscle strength and gait speed. The results suggest that homocysteine levels may be important indicators of performance status in older adults.     

Pulmonary Function and Cognitive Decline in an Older Chinese Population in Singapore

Abstract

Introduction: Various cognitive deficits associated with reduced pulmonary function are reported in different studies, but the pattern of cognitive deficits across multiple domains and its associated everyday functional disability remain unclear. Methods: We analyzed neuropsychological functioning, cognitive impairment and accompanying disability in instrumental activities of daily living (IADL) associated with reduced pulmonary function in community-living middle-aged and older adults in Singapore. Performance on a comprehensive battery of neuropsychological tests, spirometry and cognitively demanding IADLs were assessed in the population-based Singapore Longitudinal Ageing Studies. Results: Consecutive 10% increase in forced expiratory volume in 1 s (FEV1) as percent of predicted was positively associated with 0.18 points increase in Mini-mental state examination (MMSE) and 0.04 points increase in executive function, independent of age, education and other variables. Subjects with moderate-to-severe airway obstruction showed significantly poorer MMSE score (p for linear trend = 0.001), and information processing speed (p for linear trend < 0.001). FEV1 (per 10% of predicted) was significantly associated with lower risk of cognitive impairment (OR = 0.92, 95% CI: 0.87-0.98, P = 0.005) and cognitive IADL disability (OR = 0.86,95% CI:0.79–0.93, P < 0.001). Pulmonary restriction was associated with greater risk of cognitive impairment (OR = 1.98, 95% CI: 1.26-3.11, P = 0.003) and cognitive IADL disability (OR = 2.43, 95% CI: 1.31-4.53, P = 0.005). Moderate-to-severe airway obstruction (OR = 2.04, 95% CI: 1.11–3.74, P = 0.022) was positively associated with cognitive IADL disability. Conclusion: The findings suggest a measurable but modest cognitive effect of low pulmonary function that was accompanied by corresponding disability in living activities. The effect on executive functioning should be further investigated in longitudinal studies.     

The mediating and moderating effects of depressive symptoms on the prospective association between cognitive function and activities of daily living disability in older adults

ObjectivesThis study aimed to examine to what extent depressive symptoms mediated and moderated the association between cognitive function and activities of daily living (ADL) disability in older adults.MethodsIn older participants from the China Health and Longitudinal Retirement Survey (CHARLS), structural equation modeling and multiple regression were performed to examine the mediating and moderating role of depressive symptoms (measured by the 10-item Center for Epidemiologic Studies Depression Scale) in the association between baseline cognitive function (episodic memory, attention, orientation to time, and visuospatial ability) and endpoint disability in basic ADL (BADL) or instrumental ADL (IADL).ResultsOver a 2-year follow-up, among 1677 participants (67.5 ± 6.0 years old) free of BADL disability and 1194 participants (66.9 ± 5.6 years old) free of IADL disability, 8.3% and 22.9% developed BADL disability and IADL disability, respectively. Good baseline cognitive performance was significantly associated with the reduced incidence of BADL/IADL disability. The indirect effects of baseline depressive symptoms explained 16.9% and 14.5% of the total effect between cognition and BADL and IADL dependency, respectively. The Johnson-Neyman technique identified a threshold of 7.88 for endpoint depressive symptoms, beyond which the protective effect of baseline cognitive function on BADL emerged.ConclusionsIn older adults, good cognitive function reduces the risk of BADL/IADL disability. Depressive symptoms downregulate the protective effect of cognitive function on BADL/IADL over time. Intervention techniques focusing on the simultaneous improvement of cognitive dimensions and depression help improve ADL difficulty and prevent disability in older adults.     

Leisure activity, mobility limitation and stress as modifiable risk factors for depressive symptoms in the elderly: results of a national longitudinal study

Few national longitudinal studies have investigated the modifiable risk factors for depression in the elderly. This study investigated the risk factors and health-related behaviors associated with depressive symptoms using a national survey of Taiwanese elderly with a 4-year follow-up period. In this prospective cohort study, 1481 non-demented population-based elderly were interviewed at baseline in 2003 and at follow-up in 2007. The independent variables included demographics, chronic medical diseases and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms assessed at follow-up. Reduced rank regression was applied to characterize independent factors related to depressive symptoms. The prevalence of depressive symptoms at follow-up was 21.1%. The results of multivariate analyses revealed three independent risk factors for depressive symptoms: fewer leisure activities (odds ratio, OR=0.56, 95% confidence interval, CI=0.38-0.83, p=0.0034), more mobility limitations (OR=1.93, 95% CI=1.30-2.86, p=0.0011) and higher stress levels (OR=2.43, 95% CI=1.68-3.50, p<0.0001). The leisure activities least associated with depression were reading newspapers/books and doing outdoor building projects; the two mobility limitations most associated with depression were difficulty in lifting things and in climbing stairs. The two stresses most associated with depression were perceived health stress and financial stress. These results indicated that interventions to prevent or reduce depression in older adults should include practical strategies aimed at these modifiable risk factors.     

Frailty: emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study

OBJECTIVES: To define frailty using simple indicators; to identify risk factors for frailty as targets for prevention; and to investigate the predictive validity of this frailty classification for death, hospitalization, hip fracture, and activity of daily living (ADL) disability. DESIGN: Prospective study, the Women's Health Initiative Observational Study. SETTING: Forty U.S. clinical centers. PARTICIPANTS: Forty thousand six hundred fifty-seven women aged 65 to 79 at baseline. MEASUREMENTS: Components of frailty included self-reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow-up. Death, hip fractures, ADL disability, and hospitalizations were ascertained during an average of 5.9 years of follow-up. RESULTS: Baseline frailty was classified in 16.3% of participants, and incident frailty at 3-years was 14.8%. Older age, chronic conditions, smoking, and depressive symptom score were positively associated with incident frailty, whereas income, moderate alcohol use, living alone, and self-reported health were inversely associated. Being underweight, overweight, or obese all carried significantly higher risk of frailty than normal weight. Baseline frailty independently predicted risk of death (hazard ratio (HR)=1.71, 95% confidence interval (CI)=1.48-1.97), hip fracture (HR=1.57, 95% CI=1.11-2.20), ADL disability (odds ratio (OR)=3.15, 95% CI=2.47-4.02), and hospitalizations (OR=1.95, 95% CI=1.72-2.22) after adjustment for demographic characteristics, health behaviors, disability, and comorbid conditions. CONCLUSION: These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women. Underweight, obesity, smoking, and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention.