Longitudinal Study Of Older People Research Articles

Thematic engagements: Affects and learning in older age

In this paper, we propose a sociocultural perspective to consider affects in older age. The psychology of learning throughout the whole life course, including in the life of older adults, suggest that affects play an important role. However, developmental psychology has paid little attention to affects in learning and development, and even less to these aspects in older age. We believe that it is important to examine affects in older age because of their centrality in the lifecourse; but how to account for them? We propose the notion of thematic engagement to highlight the role of affects in older persons' learning and development, and to designate transversal and pluri-thematic interests across activities and domains of knowledge, which enable us to show that some topics, domains or interests become more important than others for a given person across time. We base our claims on a longitudinal study of older people engaging in different activities at home, in their neighbourhood, as well as in a daycare centre for older people, and provide three dialogical exemplars. We finally highlight some theoretical and empirical implications of our proposition.

Using magnetic resonance imaging to measure head muscles: An innovative method to opportunistically determine muscle mass and detect sarcopenia.

Sarcopenia is associated with multiple adverse outcomes. Traditional methods to determine low muscle mass for the diagnosis of sarcopenia are mainly based on dual-energy X-ray absorptiometry (DXA), whole-body magnetic resonance imaging (MRI) and bioelectrical impedance analysis. These tests are not always available and are rather time consuming and expensive. However, many brain and head diseases require a head MRI. In this study, we aim to provide a more accessible way to detect sarcopenia by comparing the traditional method of DXA lean mass estimation versus the tongue and masseter muscle mass assessed in a standard brain MRI. The H70 study is a longitudinal study of older people living in Gothenburg, Sweden. In this cross-sectional analysis, from 1203 participants aged 70years at baseline, we included 495 with clinical data and MRI images available. We used the appendicular lean soft tissue index (ALSTI) in DXA images as our reference measure of lean mass. Images from the masseter and tongue were analysed and segmented using 3D Slicer. For the statistical analysis, the Spearman correlation coefficient was used, and concordance was estimated with the Kappa coefficient. The final sample consisted of 495 participants, of which 52.3% were females. We found a significant correlation coefficient between both tongue (0.26) and masseter (0.33) with ALSTI (P<0.001). The sarcopenia prevalence confirmed using the alternative muscle measure in MRI was calculated using the ALSTI (tongue=2.0%, masseter=2.2%, ALSTI=2.4%). Concordance between sarcopenia with masseter and tongue versus sarcopenia with ALSTI as reference has a Kappa of 0.989 (P<0.001) for masseter and a Kappa of 1 for the tongue muscle (P<0.001). Comorbidities evaluated with the Cumulative Illness Rating Scale were significantly associated with all the muscle measurements: ALSTI (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.07-1.26, P<0.001), masseter (OR 1.16, 95% CI 1.07-1.26, P<0.001) and tongue (OR 1.13, 95% CI 1.04-1.22, P=0.002); the higher the comorbidities, the higher the probability of having abnormal muscle mass. ALSTI was significantly correlated with tongue and masseter muscle mass. When performing the sarcopenia diagnostic algorithm, the prevalence of sarcopenia calculated with head muscles did not differ from sarcopenia calculated using DXA, and almost all participants were correctly classified using both methods.

Aging in place and the places of aging: A longitudinal study

Aging in place policies have been adopted internationally as a response to population aging. The approach historically referred to the goal of helping people to remain in their own homes so that they can retain connections with friends and family in their community. However, the places in which people grow old are often hostile and challenging, presenting potential barriers to the policy ideal of aging in place. This may be especially the case in cities characterized by rapid population turnover and redevelopment of buildings through urban regeneration. Yet, to date, there has been limited research focusing on the places of aging, and how these affect the experience of aging in place over time. This paper addresses this gap by presenting four in-depth case-studies from a qualitative longitudinal study of older people living in neighborhoods characterized by high levels of deprivation and rapid population change. The analysis illustrates how aging in place is affected by changing life-course circumstances and the dynamics of these neighborhoods over time. The conclusion suggests that further attention must be given to the changing dynamics of the places where people grow older. It also makes policy suggestions for how aging in place could be supported, taking account of the needs of people as they grow older as well as changes in the communities in which they live. The paper extends theoretical understanding of the interrelationship between aging in place and the places of aging, revealing how these processes change over time.

Survey participation to the first Wave of a longitudinal study of older people: the case of the Italian InveCe.Ab study

Longitudinal surveys of older people are very powerful research resources to study social inequalities and monitor older people’s health conditions. However, these surveys pose specific methodological challenges. Response at Wave 1 is a very serious issue; when respondents differ from non-respondents on the variables of interest, research findings may not be accurate. There is currently little knowledge on the processes that drive Wave 1 survey participation in longitudinal surveys of older people. Using a rich set of administrative and survey data from an Italian longitudinal study of older people, we explore the determinants of Wave 1 response and investigate the reasons for refusing to participate. Key findings are that (1) individuals whose partners took part in the survey are nearly four times more likely to participate than those whose partners did not, (2) older men and women show different response patterns, with widowers and women from deprived areas being less likely to respond, (3) the main reason for refusing survey participation is lack of interest in the study.

Te Pākeketanga: living and dying in advanced age--a study protocol.

BackgroundThe number of people dying in advanced old age is increasing rapidly and building the evidence base regarding end - of - life care for older people has been identified as an international policy priority. The unique opportunity to link longitudinal studies of ageing with studies exploring the end of life circumstances of older people remains under-exploited internationally. Very little is known about the specific circumstances, cultural needs and care preferences of indigenous older people, including Māori, at end - of - life and the needs of their whānau/ extended family carers.MethodsWe will use rigorous qualitative methods to conduct post-bereavement interviews with bereaved whānau and family of 50–60 people who died >80 years; approximately half of participants will be Maori. The older decedents were participants in the first longitudinal study of older people involving a specific indigenous cohort internationally: Te Puāwaitanga O Ngā Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). Prior to death, they completed a questionnaire regarding their end-of-life preferences and nominated a family or whānau member to participate in this separate study exploring end-of-life circumstances of those in advanced age.DiscussionRecommendations to improve care will be formulated in collaboration with participants and their local hapū (sub-tribe). Ultimately this study has the potential to inform better outcomes for the growing numbers of people dying in advanced old age both in New Zealand and internationally, as well as their whānau and family caregivers. It also highlights the ability to generate an in-depth understanding of end-of-life circumstances by appending studies of palliative and end-of-life care onto existing longitudinal studies.

Is there a bidirectional relationship between depressive symptoms and cognitive ability in older people? A prospective study using the English Longitudinal Study of Ageing

BackgroundCross-sectional surveys of older people commonly find associations between higher levels of depressive symptoms and poorer cognitive performance, but the direction of effect is unclear. We examined whether there was a bidirectional relationship between depressive symptoms and general cognitive ability in non-demented older people, and explored the role of physical health, smoking, exercise, social class and education as potential confounders of this association and as possible determinants of the rate of change of cognitive decline and depressive symptoms.MethodThe English Longitudinal Study of Ageing consists of people aged 50 years and over. Cognitive function and self-reported depressive symptoms were measured in 2002–2003, 2004–2005, 2006–2007 and 2008–2009. We fitted linear piecewise models with fixed knot positions to allow different slopes for different age groups. Analyses are based on 8611 people.ResultsMean cognitive function declined with age; there was no trend in the trajectory of depressive symptoms. Better cognitive function was associated with less depression up to the age of 80 years. Greater depression was associated with a slightly faster rate of cognitive decline but only in people aged 60–80 years. There were no consistent associations across age groups between sex, smoking, education, social class, exercise or number of chronic physical illnesses and the rate of change of cognitive decline or depressive symptoms.ConclusionsIn this longitudinal study of older people, there was no consistent evidence that being more depressed led to an acceleration in cognitive decline and no support for the hypothesis that there might be reciprocal dynamic influences between cognitive ability and depressive symptoms.

Epidemiological Pathology of Dementia: Attributable-Risks at Death in the Medical Research Council Cognitive Function and Ageing Study

Dementia drug development aims to modulate pathological processes that cause clinical syndromes. Population data (epidemiological neuropathology) will help to model and predict the potential impact of such therapies on dementia burden in older people. Presently this can only be explored through post mortem findings. We report the attributable risks (ARs) for dementia at death for common age-related degenerative and vascular pathologies, and other factors, in the MRC Cognitive Function and Ageing Study (MRC CFAS). A multicentre, prospective, longitudinal study of older people in the UK was linked to a brain donation programme. Neuropathology of 456 consecutive brain donations assessed degenerative and vascular pathologies. Logistic regression modelling, with bootstrapping and sensitivity analyses, was used to estimate AR at death for dementia for specific pathologies and other factors. The main contributors to AR at death for dementia in MRC CFAS were age (18%), small brain (12%), neocortical neuritic plaques (8%) and neurofibrillary tangles (11%), small vessel disease (12%), multiple vascular pathologies (9%), and hippocampal atrophy (10%). Other significant factors include cerebral amyloid angiopathy (7%) and Lewy bodies (3%). Such AR estimates cannot be derived from the living population; rather they estimate the relative contribution of specific pathologies to dementia at death. We found that multiple pathologies determine the overall burden of dementia. The impact of therapy targeted to a specific pathology may be profound when the dementia is relatively "pure," but may be less impressive for the majority with mixed disease, and in terms of the population. These data justify a range of strategies, and combination therapies, to combat the degenerative and vascular determinants of cognitive decline and dementia. Please see later in the article for the Editors' Summary.

Bone Marrow in Aging: Changes? Yes; Clinical Malfunction? Not So Clear.

Like every organ system, the bone marrow undergoes changes with age. The most readily apparent change is a decline in marrow cellularity. The percentage of marrow space occupied by hematopoietic tissue goes from 40–60% in young adults to 20–40% in older people, with the remaining space being taken up by fat. It is unclear whether the expansion of marrow fat with age is a cause or an effect of aging. A similar change happens in the thymus much earlier in adulthood. At about age 30, thymic fibroblasts become fat-laden and the expansion of fatty tissue essentially replaces the cellular elements of thymopoiesis. In late life, this thymic inactivity is manifested by a reduction in naïve T cells and a compromise in cellular immunity. It is unclear whether the processes in the marrow and the thymus are qualitatively similar. Bone remodeling and osteoporosis can also lead to a decrease in trabecular bone in the marrow. Several age-related changes have been noted in hematopoietic cells, including shortening of telomeres, accumulation of mitochondrial DNA mutations, skewed X-inactivation, and others. However, in the absence of disease, sufficient stem cell proliferation and maturation is preserved so that people are capable of living their entire life span, up to 120 years, without running out of blood cells. Indeed, even when a person is given stem cells from another person, presumably in numbers far less than were present in the host before myeloablation, the transferred stem cells appear to be capable of maintaining normal hematopoiesis throughout the lifespan of their adoptive host. Normal blood counts are maintained throughout life. Physiologic compensations may be necessary to achieve this end. A longitudinal study of older people with normal hemoglobin levels over a period of 30 years showed that people increase serum levels of erythropoietin over time to maintain normalcy. Older people also seem to increase their neutrophil count to a lower extent and somewhat more slowly in response to pharmacological G-CSF than younger people, though such an intervention is generally done in people with underlying disease. Qualitative neutrophil defects in older people may include impaired phagocytosis and respiratory burst response to soluble signals. Enhanced in vitro platelet aggregation in older people does not have a clear in vivo functional correlate.

Neuropathology in older people with disequilibrium of unknown cause.

To identify the neuropathologic features associated with disequilibrium in older people. Disequilibrium of unknown cause is common in older people. Postmortem specimens from six patients and four control subjects, who were part of a longitudinal study of older people with disequilibrium, were studied. Cerebral atrophy, ventriculomegaly, and histologic appearance were assessed. Astrocytic hypertrophy, arteriolar sclerotic index (1 - [inner diameter/outer diameter]), and arteriolar density were quantified in the frontal periventricular white matter (FPVWM). In comparison with control subjects, most patients had prominent frontal atrophy and ventriculomegaly. There were no other gross pathologic findings, microscopic infarcts, or areas of necrosis in patients or control subjects. Markedly reactive astrocytes were found in FPVWM of most patients and not in control subjects. Patients tended to have higher mean sclerotic indices compared with control subjects, but arteriolar density was no different in the two groups. Senile plaques and neurofibrillary tangles were no different in patients and control subjects except in one patient, in whom AD developed after entry. One patient had cerebral amyloid angiopathy (CAA) without intraparenchymal hemorrhage. Although there was some overlap between the two groups, the main differences between patients and control subjects were prominent frontal atrophy and ventriculomegaly, reactive astrocytes in FPVWM, and increased arteriolar wall thickness (sclerotic index). These findings suggest an association between subcortical leukoencephalopathy and disequilibrium in older nonhypertensive patients.

Refusal rates in a longitudinal study of older people: implications for field methods.

Use of a carefully designed refusal conversion protocol at first follow-up in a longitudinal study of a representative sample of over 4,000 older people was investigated. Respondents who refused initially did not differ from respondents by age or gender but were more functionally independent, citing disinterest most frequently as the reason for refusal. The protocol was successful in convincing 43 percent of these initial refusals to continue participation, but less successful with proxy respondents (27% converted). Most of the refusals that were converted were done by telephone at minimal cost. Results show that it is possible, given appropriate field methods, to retain the very old and disabled in longitudinal studies.

Subjective Age, Health, and Survivorship in Old Age

The power of subjective health and subjective age in predicting survivorship among older people is evaluated relative to the predictive power of objective health and life expectancy, respectively, using data from a four-year longitudinal study of older people in San Antonio, Texas. While deceased persons and survivors differ significantly on all four measures at Time 1, discriminant function analysis shows that subjective health is not a significant predictor of survivorship when the other three variables are controlled. Subjective age, however, is at least equally predictive of survivorship as life expectancy.