Psychosocial factors associated with fall-related hip fractures

BACKGROUND: fall-related injuries in older people are a major public health concern. This study examined the relationship between psychosocial determinants of healthy ageing and risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for promotion of healthy ageing strategies in population-based interventions for fall injury prevention. METHODS: a case-control study was conducted with 387 participants, with at least two controls recruited per case. Cases of fall-related hip fracture in community-dwelling people aged 65 and older were recruited from hospital admissions in Brisbane, Australia, in 2003-2004. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire assessing psychosocial factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. RESULTS: psychosocial factors having a significant independent protective effect on hip fracture risk included being currently married [OR: 0.44 (0.22 to 0.88)], living in present residence for 5 years or more [OR: 0.43 (0.22 to 0.84)], having private health insurance [OR: 0.49 (0.27 to 0.90)], using proactive coping strategies [OR: 0.52 (0.29 to 0.92)], having a higher level of life satisfaction [OR: 0.47 (0.27 to 0.81)], and engagement in social activities in older age [OR: 0.30 (0.17 to 0.54)]. CONCLUSION: this study suggests that psychosocial determinants of healthy ageing are protective in fall-related hip fracture injury in older people. Reduction in the public health burden caused by this injury may then be achieved by implementing healthy ageing strategies involving community-based approaches to enhance the psychosocial environments of older people.     

Review Article: Healthy ageing in rural Australia: Issues and challenges

Approximately 36% of the rural Australian population is 65 years and older. In fact, many rural and remote communities have higher proportions of older people than metropolitan centres. The rate of growth, patterns of migration, higher levels of health risk factors and of social and economic disadvantage all impact on rural healthy ageing. Older people in rural communities have become marginalised by longstanding misconceptions about rural life and urban‐centric policies, much of which goes unchallenged because of a paucity of research in key areas and a lack of intrarural research. Understanding the complexities of rural healthy ageing is challenging, and more research is required to develop a stronger empirical base. The aim of this review is to critique the literature related to rural ageing in Australia to identify the issues and challenges for rural healthy ageing and implications for policy and practice.     

Volunteering as a productive ageing activity: the association with fall-related hip fracture in later life

This paper aims to contribute to the literature on the relationship between productive and healthy ageing as two key theoretical concepts in contemporary ageing. Specifically, volunteering as a productive activity in later life has been associated with social and health benefits for older people. Evidence from the literature has generally focused on global outcomes, such as mortality and self-rated health, or on measures of psychological well-being. This study explored whether volunteering is protective of an important adverse health outcome in later life, that of fall-related hip fracture, utilising data from a case control study of 387 participants. The results showed that volunteer activity in older age remained significantly protective of hip fracture risk [OR: 0.61 (0.38–0.99)], independent of social and physical activity, social support and health status, supporting the hypothesis of a relationship between the concepts of productive and healthy ageing. Whilst further studies are clearly needed to establish causality, these results suggest that health benefits of volunteering in later life might be more extensive than previous studies have shown.     

Promoting life course vaccination

Infectious diseases remain a significant cause of morbi-mortality in adults aged over 60 years, and many of these diseases are vaccine-preventable (VPDs). There is a pressing need to promote a lifelong vaccine schedule to increase vaccination against VPDs during the different stages of life. We outline the impact of vaccines on the burden of common infectious diseases and consider the negative clinical impact of VPDs in the unvaccinated population. We further illustrate that vaccine uptake is associated with a reduction in the burden of VPDs at any age of life, due to herd immunity. Disability-free and healthy aging is closely linked to childhood health and medical conditions in young adulthood. The midlife vaccine gap drastically impacts health in later life, especially in unvaccinated and older populations. These arguments underline the need for a preventive lifelong health perspective from childhood through old age.     

Harsh physical punishment as a specific childhood adversity linked to adult drinking consequences: evidence from China

Aims The aim of the current study is to estimate the association between childhood physical punishment (CPP) and level of alcohol use disorder (AUD), using two different approaches to take other childhood adversities into account. Design and setting Population survey using face‐to‐face interviews to a representative sample of non‐institutionalized adult residents of Beijing and Shanghai, China. Participants A total of 5201 participants aged 18–70 years. Measurements A version of the World Mental Health Composite International Diagnostic Interview was used. Standardized assessments covered early life experiences of childhood physical punishment, other childhood adversities, parental drinking problems, childhood conduct problems and clinical features of AUD. Findings A robust association linking CPP and level of AUD was found, holding other childhood adversities constant (probit coefficient = 0.70, 95% CI = 0.40, 1.00) via covariate terms in structural equations modeling. Furthermore, there was evidence that CPP might exert an additional influence on level of AUD over and above a generally noxious family environment (probit coefficient = 0.20, 95% CI = 0.02, 0.38). Conclusions There appears to be a robust association between reports of harsh punishment in childhood and alcohol dependence in adulthood adjusting for a range of possible confounding factors. Whether the association is causal or whether both are related to a common underlying factor or recall bias needs to be investigated further.     

Challenges and Directions for Gerontological Research Beyond 2000

Abstract. There is a world-wide demographic revolution taking place. The population is ageing, causing us to rethink health, disease and ageing globally. New strategies must be developed to provide medical and social services for the increasing numbers of older people. In addition we are challenged to expand our knowledge of causes of morbidity and mortality and to explore new strategies to prevent excess disability and promote the health span of older people world-wide. Increased effort in three promising areas of research will help us to reach this goal. These include research into reducing disability, increasing healthy life span, and conquering Alzheimer's disease. Although major scientific advances have been made, there is still much to be done to understand the major causes of disability and to develop and implement preventive strategies to decrease the incidence of excess disability. Promoting healthy life styles as well as understanding the biological bases of ageing and age-related diseases hold the key to increasing healthy life span. Alzheimer's disease is a major cause of disability, and while our understanding of Alzheimer's disease is expanding, continued efforts are necessary to conquer this devastating disease. The demographic revolution has caused us to rethink health, disease and ageing globally. World-wide, epidemiologists are predicting a shift in the disease burden from infectious diseases prevalent in the developing world (eg. respiratory and diarrheal diseases) to the chronic diseases of more developed societies (eg. ischaemic heart disease, depression and cerebrovascular disease). The ageing of the population world-wide and the shift in the global burden of disease pose many challenges to research scientists, clinicians and policy makers. Not only will we need to develop new strategies to provide medical and social services for the increased numbers of older people, but we are also challenged to expand knowledge of the causes of morbidity and mortality among the old and to explore new strategies to prevent excess disability and promote the health span of people world-wide.     

Which model of successful ageing should be used? Baseline findings from a British longitudinal survey of ageing

BACKGROUND: there is increasing interest in how to age 'successfully' and in reaching consensus over its definition. OBJECTIVE: to assess different models of successful ageing, using a British longitudinal survey of ageing in 2000-1. SETTING: community settings in Britain. METHODS: five models of successful ageing were tested on a British cross-sectional population survey of 999 people aged 65+. The models were biomedical, broader biomedical, social, psychological and lay based. RESULTS: the lay model emerged as the strongest. Respondents who were classified as successfully aged with this model, compared with those not successfully aged, had over five times the odds of rating their quality of life (QoL) as good rather than not good [odds ratio (OR) = 5.493, 95% confidence interval (95% CI) = 2.655-11.364]. CONCLUSION: the lay-based, more multidimensional, model of successful ageing predicted perceived QoL more powerfully than unidimensional models and should be used to evaluate the outcomes of health promotion in older populations.     

Health-protective behaviours and risk of fall-related hip fractures: a population-based case-control study

BACKGROUND: Fall-related hip fractures are one of the most common causes of disability and mortality in older age. The study aimed to quantify the relationship between lifestyle behaviours and the risk of fall-related hip fracture in community-dwelling older people. The purpose was to contribute evidence for the promotion of healthy ageing as a population-based intervention for falls injury prevention. METHODS: A case-control study was conducted with 387 participants, with a case-control ratio of 1:2. Incident cases of fall-related hip fracture in people aged 65 and over were recruited from six hospital sites in Brisbane, Australia, in 2003-04. Community-based controls, matched by age, sex and postcode, were recruited via electoral roll sampling. A questionnaire designed to assess lifestyle risk factors, identified as determinants of healthy ageing, was administered at face-to-face interviews. RESULTS: Behavioural factors which had a significant independent protective effect on the risk of hip fracture included never smoking [adjusted odds ratio (AOR): 0.33 (0.12-0.88)], moderate alcohol consumption in mid- and older age [AOR: 0.49 (0.25-0.95)], not losing weight between mid- and older age [AOR: 0.36 (0.20-0.65)], playing sport in older age [AOR: 0.49 (0.29-0.83)] and practising a greater number of preventive medical care [AOR: 0.54 (0.32-0.94)] and self-health behaviours [AOR: 0.56 (0.33-0.94)]. CONCLUSION: With universal exposures, clear associations and modifiable behavioural factors, this study has contributed evidence to reduce the major public health burden of fall-related hip fractures using readily implemented population-based healthy ageing strategies.     

What are the benefits of cognitive enhancers for Alzheimer's Disease: use of Population Impact Measures

Increases in longevity resulting from improvements in health care and living conditions together with a decrease in fertility rates have contributed to a shift towards an aged population profile. For the first time the UK has more people over age 60 than below 16 years of age. The increase in longevity has not been accompanied by an increase in disease-free life expectancy and research into ageing is required to improve the health and quality of life of older people. However, as the House of Lords reported, ageing research in the UK is not adequately structured and a clear vision and plan are urgently required. Hence, with the aim of setting a common vision for action in ageing research in the UK, a 'Spark Workshop' was organised. International experts from different disciplines related to ageing research gathered to share their perspectives and to evaluate the present status of ageing research in the UK. A detailed assessment of potential improvements was conducted and the prospective secondary gains were considered, which were subsequently distilled into a list of 'ten commandments'. We believe that these commandments, if followed, will help to bring about the necessary implementation of an action plan for ageing research in the UK, commensurate with the scale of the challenge, which is to transform the manifold opportunities of increased longevity into actual delivery of a society living not only for longer, but also healthier, wealthier and happier.     

Relationship between age and plasma esterases

INTRODUCTION: the older population is the most medicated. Despite high drug usage, older people are generally excluded from the research underpinning new drug development. This means that drugs are prescribed to older people with very little understanding of how they are likely to metabolize them. More research is needed to investigate the possible effects of ageing on the biotransformation of drugs. We therefore undertook a cross-sectional study examining the effect of age on the activities of benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase and aspirin esterase. METHODS: we measured the activities of benzoylcholinesterase and butyrylcholinesterase in 70 healthy volunteers aged 18-85 years. We measured the activities of acetylcholinesterase and aspirin esterase in 43 healthy volunteers aged 18-85 years. We determined plasma activities of benzoylcholinesterase, butyrylcholinesterase, acetylcholinesterase and aspirin esterase spectrophotometrically. RESULTS: we found no correlation between the activities of any of the enzymes measured and advancing age. CONCLUSION: age per se is not associated with reductions in the activities of esterase enzymes.     

Childhood adversities and mid-late depressive symptoms over the life course: evidence from a retrospective cohort study in China

Background

The cumulative effect of childhood adversities on depressive symptoms in later life is well documented in many countries. However, there is a dearth of accurate information about this effect in the Chinese population. We aimed to examine the cumulative effect of childhood adversities on depressive symptoms in mid-to-late life, using data from the Chinese population.

Lay perceptions of successful ageing: findings from a national survey of middle aged and older adults in Britain

The main aim of the research presented here was to identify perceptions of successful ageing among people in middle and older age groups. The method was a British population survey of 854 community-dwelling men and women aged 50 or more. Just over three-quarters of respondents rated themselves as ageing successfully (“very well” or “well”). Respondents’ definitions of successful ageing, and the reasons given for their self-ratings, based on open-ended questioning, illustrated the multidimensionality of the concept. Definitions varied with respondents’ characteristics. Self-rated health status and quality of life consistently retained significance in the multivariate models of predictors of self-rated successful ageing, while self-rated quality of life made the greatest contribution to the models. Reporting a longstanding, limiting illness was not significant. The overall models explained about a third of the variation in self-rated successful aging. Lay definitions of successful ageing were multidimensional. A biomedical perspective of successful ageing therefore needs balancing with a psycho-social perspective, and vice versa. This is particularly relevant for biomedical approaches which have largely ignored the rich tradition of social and psychological research on this topic. Self-rated successful ageing should be included in measuring instruments to enhance social relevance. This research, with the use of open-ended questioning, makes a novel methodological contribution to the literature, is unique in questioning middle aged as well as older people, and provides a British perspective on a largely US and German topic.An erratum to this article can be found at     

Frailty syndrome and risk of cardiovascular disease: Analysis from the International Mobility in Aging Study

ObjectiveTo investigate the association between frailty and a summary cardiovascular risk measure (Framingham Risk Score, FRS) in a sample of older adults from different epidemiologic contexts participating in the multicenter International Mobility in Aging Study (IMIAS).Material and MethodsThis cross-sectional study used data from the IMIAS, which is composed of older adults from four different countries (Canada, Albania, Colombia and Brazil). A total of 1724 older adults aged 65–74 years were assessed. Frailty was defined as the presence of 3 or more of the following criteria: unintentional weight loss in the last year, exhaustion, muscle weakness, slowness in gait speed, and low levels of physical activity. The FRS was calculated to estimate the 10-year risk for cardiovascular disease (CVD), based on: sex, age, systolic blood pressure (SBP), and treatment for hypertension, total and high–density lipoprotein (HDL) cholesterol, diabetes mellitus status and smoking habits. Confounders included measures of childhood social and economic adversity, as well as mid-life and adult adversity.ResultsAfter adjustment for adversities which occurred during in early, adult or current life, frail individuals presented higher FRS values (β = 3.81, 95 %CI: 0.97–6.65, p-value <0.001) when compared to robust participants. A statistically significant relationship was also observed in prefrail participants with FRS (β = 1.61, 95 % CI: 0.72–3.02, p-value <0.05).ConclusionFrailty and prefrailty were associated to FRS, independent of life course adversities. Screening cardiovascular risk factors should be a target, mainly in those who present frailty syndrome.     

Physical limitations and loneliness: The role of guilt related to self-perception as a burden

Background

Limitations in performing physical activities have been associated with greater loneliness in older adults. This association could be moderated by maladaptive social cognition or feelings, such as guilt related to perceiving oneself as a burden. This study analyzes the effect of guilt related to self-perception as a burden on the relationship between physical limitations and loneliness in older adults.

Methods

Participants were 190 community-dwelling people aged over 60 years who did not show cognitive or functional limitations in daily life activities. We used linear regression to test the influence of guilt related to self-perception as a burden on the association between physical limitations and loneliness.

Results

The interaction between physical limitations and guilt related to self-perception as a burden was found to be significant in the explanation of loneliness, explaining 18.10% of the variance. Specifically, the relationship between physical limitations and loneliness was stronger when levels of guilt related to self-perception as a burden were high or medium than when these levels were low.

Conclusions

The findings suggest that feelings of loneliness are more frequent in people who report more physical limitations and, at the same time, report guilt for perceiving themselves as a burden. Guilt related to perceiving oneself as a burden seems to be a relevant modulator variable for understanding the effects of physical limitations on loneliness.     

The potential of older adults to enhance community quality of life: Links between positive psychology and productive aging

Enhancing quality of life in aging is an important goal of gerontologists. Quality of life research tends to view aging persons as recipients of external influences rather than active agents operating in context. Quality of life and subjective well-being can be regarded as functions of the extent of fit between the person and the environment, a fit which can be improved by enhancing personal abilities, reducing environmental press, and/or a combination of these. It follows that the expression of individual talents and competencies can be facilitated by removing barriers to their development and expression. This paper combines recent empirical work on productive ageing with concepts from the emerging science of positive psychology in order to illustrate the potential of the person-environment fit concept to enhance the ability of older people to contribute to society and improve the quality of life of the whole community. It is argued that older people have unique talents in the realms of community development and citizenship. A paradigm shift in attitudes to older people is required, towards viewing them as a resource rather than a burden. Proactive ageing can enhance an older individual’s quality of life and by extension the quality of life of the whole community. The paper concludes with implications for professionals, families and caregivers, policy-makers, and gerontological researchers. Rob Ranzijn is a Senior Lecturer in Psychology and the President of the Australian Association of Gerontology (SA/NT Division). His publications in social gerontology include papers on well-being, productive ageing, mature aged employment, fear of crime, and Indigenous ageing.     

Health, valuation of life, and the wish to live.

This research investigated the relationship of an affective-cognitive schema, valuation of life (VOL), to older people's responses to a set of health utility (years of desired life) questions. Six hundred healthy and chronically ill elders aged 70 and older were interviewed to measure quality of life (QOL), mental health, and VOL. Valuation of life was significantly correlated with longer Years of Desired Life under 8 of 10 health conditions when background, health, QOL, and mental health states were controlled. We concluded that VOL is an internal representation of the many positive and negative features of the person and her everyday life that is necessary to comprehend how people may cling to life or welcome its end.     

Drug use and ageing: older people do take drugs!

While usually perceived as behaviour of the young, use of illicitdrugs by people aged 50 and over is increasing in Europe andthe USA. This increase largely reflects the ageing of generalpopulations, and people who use drugs continuing to do so asthey age. For those people dependent upon drugs [usually usersof opiates (heroin) and stimulants (cocaine, crack cocaine andamphetamine)], the last 30 years has seen the advent of effectivetreatment and harm minimisation initiatives and, coupled withgeneral advances in medicine, has increased the life expectancyof these drug users. Drug use by older people presents uniqueproblems; biological systems and processes alter naturally acrossthe life course and the effect of concurrent drug use on someof these systems is not well understood. The natural progressionof certain diseases means that symptoms only manifest in olderage and the lives of older drug users are likely to be characterisedby considerable levels of morbidity. Further work is neededon the epidemiology of drug use by older people---a group ofpeople who currently represent a hidden and vulnerable population.     

Successful ageing: The case of Taiwan

Aim: To investigate the conditions of successful ageing in Taiwan. Methods: The respondents included two age groups, namely, 45–64 years (n = 1143), and 65 years and older (n = 1309), from a cross‐section national representative survey conducted in 2007. Results: Older people faced more problems that cause depression than their counterparts. Eleven per cent of older people were in the labour market. Neither middle‐aged people nor older people were actively involved in volunteer services. Those who lived longer had less social support. Over 50% felt their financial preparations for later life were not adequate. Educational levels and family income were the significant factors affecting the levels of successful ageing. Conclusions: Improvement in the four dimensions of successful ageing must be re‐emphasised for both age groups.     

Getting Old with a Good Life: Research on the Everyday Life Patterns of Active Older People

In 2030, 22% of Hong Kong??s total population will be aged 60 or older. Unfortunately, the Hong Kong Government still views ageing within the context of ??disengagement theory??, and discussions of ??Active Ageing?? remain scarce in Hong Kong. In order to define and advocate Active Ageing in our local context, and to urge the Government to plan comprehensively for the ageing society, we conducted a research (from 2007 to 2009) on the life patterns of active older people. Our objectives were to discover: (1) how active older people organized their everyday lives; and (2) how the urban environment enabled older people to maintain a quality lifestyle. Invited to semi-structured interviews, 50 informants had responded to a set of questions about their everyday life patterns. They also commented freely on the quality of their lives and the city??s degree of age-friendliness. We tried to categorize and analyze the daily life patterns of our informants according to the themes established by the Quality of Life model established by Gabriel and Bowling Ageing and Society, 24(5), 675?C691 (2004) and that of Raphael et al. Health & Place, 7, 179?C196. (2001). With the findings, we construct a schematic summary of ??Active Ageing?? for the local context. We conclude that older people, when in good health and possessing sufficient resources, strive for a quality life filled with possibilities. Our research aims to help enact a ??paradigm shift?? that goes beyond the disengagement theory, while establishing a context planning for the coming of the ageing society in Hong Kong.