All-cause Mortality In Older Women Research Articles

Physical activity and all-cause mortality in older women and men

Background: There is strong epidemiological evidence that physical activity in young-middle adulthood is associated with lower all-cause mortality in both women and men. The aim of this study was to examine the relationship between physical activity and mortality in older people.

Walking Ability and All-Cause Mortality in Older Women

In this study self-reported ability to walk 2 km and six-minute walking test (6MWT) performance were examined as predictors of all-cause mortality in 434 women, aged 63-76 years. The primary outcome measure was all-cause mortality (follow-up: 8 years). Predictors were self-reported difficulties in walking 2 km and 6-min walking distance tertiles of ≤495, 496-560 and ≥561 m, and no test result due to refusal by the physician to grant permission to perform the test or participant's inability or unwillingness to perform the test. During the follow-up, 39 participants died. Participants reporting minor (age- and body mass index-adjusted hazard ratio 2.53, 95% confidence interval 1.12-5.69) or major (7.93, 3.49-18.05) difficulties in walking 2 km had increased risk of death compared with those reporting no difficulties. Participants with no 6MWT result (6.99, 2.46-19.86) were at an increased risk of death when compared with participants who walked ≥561 m. A similar trend (2.47, 0.81-7.56) was found for participants with walking distance of ≤495 m during the 6MWT. The trends remained similar after adjustments for other confounders. In conclusion, self-reported difficulties in walking 2 km are associated with an increased risk of death in older community-dwelling women. Objectively measured walking ability gives similar results.

Visual Acuity, Contrast Sensitivity, and Mortality in Older Women: Study of Osteoporotic Fractures

To determine whether poorer visual acuity and contrast sensitivity are independent risk factors for all-cause and traumatic mortality in older women. Twelve-year prospective cohort study (1986-2003). Four U.S. clinical centers. Nine thousand seven hundred four postmenopausal white women aged 65 and older. Habitually corrected binocular visual acuity and low- and high-frequency contrast sensitivity were measured at baseline using a standard protocol. A study physician adjudicated the primary cause of death from death certificates and medical record review. During an average of 12.2 years of follow-up, 3,427 women died (35%), 72 (0.7%) from traumatic events. In multivariate models adjusted for age, chronic medical problems, and smoking, all-cause mortality risk was 19% greater for persons in the worst quartile of visual acuity than for those in the best (hazard ratio (HR) = 1.19, P = .008) and 39% greater for persons with the worst contrast sensitivity (HR = 1.39, P < .001) than for those with the best. Traumatic mortality risk was 2.4 times greater for women with the worst contrast sensitivity than for those with the best (HR = 2.44, P = .03). Poorer visual acuity and contrast sensitivity are associated with greater risk of traumatic and all-cause mortality in older women, even after controlling for demographic and clinical characteristics. Although further research is necessary to determine how treating reversible causes of visual impairment or improving current refraction affects mortality in older women, clinical detection and follow-up of these visual impairments holds promise for identifying those who are at risk of mortality from other systemic conditions.

Increased longevity in older users of postmenopausal estrogen therapy: the Leisure World Cohort Study

To examine the effect of postmenopausal estrogen therapy (ET), including duration and recency of use, on all-cause mortality in older women. As part of a prospective cohort study of residents of a California retirement community begun in the early 1980s, Leisure World Cohort women (median age, 73 y) completed a postal health survey including details on ET use and were followed up for 22 years (1981-2003). Age- and multivariate-adjusted risk ratios (RR) and 95% CIs were calculated using proportional hazard regression. Of the 8,801 women, 6,626 died during follow-up (median age, 88 y). ET users had an age-adjusted mortality rate of 52.9 per 1,000 person-years compared with 56.5 among lifetime nonusers (RR = 0.91; 95% CI, 0.87-0.96). Risk of death decreased with both increasing duration of ET and decreasing years since last use (P for trend <0.001). The risk was lowest among long-term (> or =15 y) users (RR = 0.83; 95% CI, 0.74-0.93 for 15-19 y and RR = 0.87; 95% CI, 0.80-0.94 for 20+ y). For long-term users, the age-adjusted mortality rate was 50.4 per 1,000 person-years. Lower-dose users (< or =0.625 mg) had a slightly better survival rate than higher-dose users (RR = 0.84; 95% CI, 0.78-0.91 vs RR = 0.91; 95% CI, 0.83-0.97). Risk did not differ by route of administration (P = 0.56). Further adjustment for potential confounders had little effect on the observed RRs for ET. Long-term ET is associated with lower all-cause mortality in older women.

Fiber from Whole Grains, but not Refined Grains, Is Inversely Associated with All-Cause Mortality in Older Women: The Iowa Women’s Health Study

Background: Inconsistencies in epidemiologic findings relating grain fiber to chronic disease may be explained by differentiating nutrient-rich fiber derived from whole grain vs. nutrient-poor fiber derived from refined grain.Objective: Given that phytochemicals are most varied and abundant in the outer layers of grains, we tested the hypothesis that whole grain fiber consumption is associated with a reduced mortality risk in comparison to a similar amount of refined grain fiber.Design: 11040 postmenopausal women enrolled in the Iowa Women’s Health Study, matched on total grain fiber intake, but differing in the proportion of fiber consumed from whole vs. refined grain, were followed from baseline in 1986 through 31 December, 1997, during which time 1341 deaths occurred in 124,823 observed woman-years.Results: After multivariate adjustment in proportional hazards regression, women who consumed on average 1.9 g refined grain fiber/2000 kcal and 4.7 g whole grain fiber/2000 kcal had a 17% lower mortality rate (RR=0.83, 95% CI=0.73–0.94) than women who consumed predominantly refined grain fiber: 4.5 g/2000 kcal, but only 1.3 g whole grain fiber/2000 kcal.Conclusion: Inferences from studies that have reported associations between grain fiber intake and morbidity or mortality may be limited by not differentiating fiber sources. Future studies should distinguish fiber from whole vs. refined grains. Public health policy should differentiate whole grains from refined, and recommend increased consumption of the former.