Men Project Research Articles

Adequacy of nutritional intake among older men living in Sydney, Australia: findings from the Concord Health and Ageing in Men Project (CHAMP)

Previous research shows that older men tend to have lower nutritional intakes and higher risk of under-nutrition compared with younger men. The objectives of this study were to describe energy and nutrient intakes, assess nutritional risk and investigate factors associated with poor intake of energy and key nutrients in community-dwelling men aged ≥75 years participating in the Concord Health and Ageing in Men Project - a longitudinal cohort study on older men in Sydney, Australia. A total of 794 men (mean age 81·4 years) had a detailed diet history interview, which was carried out by a dietitian. Dietary adequacy was assessed by comparing median intakes with nutrient reference values (NRV): estimated average requirement, adequate intake or upper level of intake. Attainment of NRV of total energy and key nutrients in older age (protein, Fe, Zn, riboflavin, Ca and vitamin D) was incorporated into a 'key nutrients' variable dichotomised as 'good' (≥5) or 'poor' (≤4). Using logistic regression modelling, we examined associations between key nutrients with factors known to affect food intake. Median energy intake was 8728 kJ (P5=5762 kJ, P95=12 303 kJ), and mean BMI was 27·7 (sd 4·0) kg/m2. Men met their NRV for most nutrients. However, only 1 % of men met their NRV for vitamin D, only 19 % for Ca, only 30 % for K and only 33 % for dietary fibre. Multivariate logistic regression analysis showed that only country of birth was significantly associated with poor nutritional intake. Dietary intakes were adequate for most nutrients; however, only half of the participants met the NRV of ≥5 key nutrients.

Ischemic heart disease, prescription of optimal medical therapy and geriatric syndromes in community-dwelling older men: A population-based study

BackgroundGuideline recommended management of ischemic heart disease (IHD) suggests the concomitant use of antiplatelet, beta-blocker, renin angiotensin system blocker and statin therapy. In older people exposure to multiple medications has been associated with adverse events and geriatric syndromes. The study aimed to investigate the use of medications for IHD in older men with and without geriatric syndromes, and whether adherence to medication guidelines impacts on adverse outcomes. MethodsCommunity-dwelling men, aged ≥70years and enrolled in the Concord Health and Ageing in Men Project were studied. Data on self-reported IHD, number of guideline recommended medications (use of four guideline medications considered optimal medical therapy) and geriatric syndromes (frailty, falls, cognitive impairment and urinary incontinence) were obtained. Cox regression was used to assess the relationship between optimal medical therapy and adverse outcomes (mortality and institutionalization), stratifying by geriatric syndromes. ResultsAt baseline, 462 (27%) men self-reported a history of IHD and of these, 226 (49%) had at least one geriatric syndrome. Among men with IHD, no significant difference was observed in patterns of prescribing between those with and without geriatric syndromes. Compared to zero medications, optimal medical therapy among men with IHD was associated with lower mortality [hazard ratio, HR=0.40 (95% CI: 0.21–0.95)] and institutionalization risk (HR=0.31; 95% CI: 0.09–0.81). The presence of geriatric syndromes did not modify the association of increasing use of guideline recommended medications and clinical outcomes. ConclusionIn older men with IHD, greater adherence to medication guidelines appears to be positively associated with better clinical outcomes, independent of geriatric syndromes.

Longitudinal Relationships between Reproductive Hormones and Cognitive Decline in Older Men: The Concord Health and Ageing in Men Project.

The longitudinal relationship between declining levels of reproductive hormones and cognitive function remains unclear in older men. The objective of this study was to examine the temporal relationship between changes in major reproductive hormone levels and cognitive decline over time. Men age 70 years and older from the Concord Health and Ageing in Men Project (CHAMP) were assessed at baseline (2005-2007; n = 1705), 2-year followup (2007-2009; n = 1367), and 5-year followup (2010-2013; n = 958). At all assessments, T, dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry, and SHBG, LH, and FSH by immunoassay. Dementia was diagnosed at baseline by clinical assessment and review by a specialist panel. Cognitive function was measured at all three assessments by the Mini Mental State Examination. None of the baseline reproductive hormones predicted cognitive decline in men without dementia over 5 years. However, the change in serum hormones over time was associated with cognitive decline. In univariate analysis, change in all the studied hormones, except for E2, was significantly associated with cognitive decline. However, in multivariate-adjusted models accounting for potential confounders, only change in serum T (β = 0.067), DHT (β = 0.394), calculated free T (β = 0.005), and E1 (β = 0.009) remained significantly associated (P < .05) with cognitive decline. Men who had dementia at baseline had significantly greater decline in serum T levels, but not in other studied hormones, over the 5 years. Our findings show that decline in androgen status is associated with cognitive decline in older men, but the causality of this association requires further elucidation.

Cross-Sectional and Longitudinal Associations Between Anemia and Frailty in Older Australian Men: The Concord Health and Aging in Men Project

BackgroundAnemia and frailty are both common in older people and are associated with adverse health outcomes. There have been some cross-sectional studies of anemia and frailty but no longitudinal studies. The objectives of this study were to examine cross-sectional and longitudinal associations between anemia and frailty in older Australian men. MethodsA total of 1666 men aged 70 years and older from the Concord Health and Aging in Men Project were assessed at baseline (2005–2007), 1314 men came for the 2-year follow-up between 2007 and 2009, and of those, 917 men returned for the 5-year follow-up between 2012 and 2013. The main outcome measurement was frailty, assessed using the Cardiovascular Health Study method. Anemia was defined as a hemoglobin levels <13.0 g/dL. Covariates included age, income, body mass index, measures of health, estimated glomerular filtration rate, and inflammatory markers (white cell count and albumin). ResultsThe prevalence of anemia was 14.6% at baseline, 16.2% at 2-year follow-up, and 19.4% at 5-year follow-up. Prevalence of frailty was 9.1% at baseline and 9.7 % at both 2- and 5-year follow-up. Among men aged 70–74 at baseline, prevalence of frailty was 4.5%, but at 5-year follow-up the prevalence was 9.0%. There were significant cross-sectional associations between anemia and frailty in unadjusted [odds ratio, [OR 5.03 (95% confidence interval, CI 3.50, 7.25, P < .0001)] and in fully adjusted analysis [OR 2.90 (95% CI 1.87, 4.51, P < .0001)]. Generalized estimating equations time-lag models were used to examine the longitudinal associations between repeated measurements of hemoglobin and frailty. There were significant associations between measurements of anemia and frailty in unadjusted [OR 2.51 (95% CI 1.58, 4.00, P < .0001] and in fully adjusted analysis (OR 1.80, 95% CI 1.14, 2.85, P = .01). ConclusionsAnemia was associated with frailty in both cross-sectional and longitudinal analyses, and anemia precedes frailty in men who were nonfrail at baseline. Low hemoglobin levels among patients may alert clinicians to the increased risk of frailty.

PD39-08 VOIDING PARAMETERS IN ELDERLY MALES WITH 5 YEAR FOLLOWUP- WHAT HAPPENS TO MEN WITH ELEVATED POSTVOID RESIDUAL URINE?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology and Natural History1 Apr 2015PD39-08 VOIDING PARAMETERS IN ELDERLY MALES WITH 5 YEAR FOLLOWUP- WHAT HAPPENS TO MEN WITH ELEVATED POSTVOID RESIDUAL URINE? Giovanni Losco, Lewis Chan, Vincent Tse, Vasi Naganathan, and Robert Cumming Giovanni LoscoGiovanni Losco More articles by this author , Lewis ChanLewis Chan More articles by this author , Vincent TseVincent Tse More articles by this author , Vasi NaganathanVasi Naganathan More articles by this author , and Robert CummingRobert Cumming More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2403AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lower urinary tract symptoms (LUTS) are common in elderly men. We assessed symptom scores and voiding parameters in a group of community-dwelling elderly men over a period of 5 years with emphasis on the natural history of men with elevated postvoid residual urine at baseline. METHODS Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects were re-assessed after two years and five years with repeat survey and clinical assessment. We report results at baseline and five year follow-up. RESULTS A total of 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had died). 275 men with prostate cancer were omitted from analyses. Mean IPSS was 7.4 (mild 63%, moderate 29%, severe 8%) at baseline and 7.3 (mild 64%, moderate 30%, severe 6%) at 5 years. Mean peak flow rate at baseline was 12.7 mls/sec and at 5 years was 12.0 mls/sec (P<0.0001). Peak flow rate was lower in older men (>85 years) compared to younger men (70-80 years) both at baseline (P<0.02) and 5 years (P=<0.01). Mean post void residual volume was 66.5 mls at baseline and 76.0 mls at 5 years (P=0.001). Increased total IPSS correlated with reduced peak flow and increased post void residual, but not with age. 114 (7%) men had surgery for LUTS between baseline and 5 years. In men with residual volume > 200mls at baseline the residual volume did not change significantly over 5 years (P=0.51). Ten men were using a catheter at baseline and 9 at 5 year assessment. CONCLUSIONS Both urinary symptom scores and voiding parameters of uroflowmetry and post void residual volume remain remarkably stable over a five year period in elderly, community-dwelling men. Men with elevated postvoid residual urine did not deteriorate significantly and the number of men requiring surgical intervention was low. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e833 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Losco More articles by this author Lewis Chan More articles by this author Vincent Tse More articles by this author Vasi Naganathan More articles by this author Robert Cumming More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sarcopenia Is Associated With Incident Disability, Institutionalization, and Mortality in Community-Dwelling Older Men: The Concord Health and Ageing in Men Project

IntroductionSarcopenia is associated with an increased risk of adverse outcomes. The aim of this study was to explore the relationship between severity of sarcopenia and incident activities of daily living (ADL) disability, institutionalization, and all-cause mortality among community-dwelling older men participating in the Concord Health and Ageing in Men Project (CHAMP). MethodsLongitudinal analysis of 1705 participants aged 70 years or older at baseline (2005–2007) living in the community in Sydney, Australia. MeasurementsThe main outcome measures were incident ADL disability, institutionalization, and mortality. Of the 1705 participants who completed the baseline assessments, a total of 1678 men (mean age 77 years) had complete measures by dual-energy x-ray absorptiometry, to assess sarcopenia in terms of low appendicular lean mass (ALM), using the Foundation for the National Institutes of Health (FNIH) criteria. To differentiate between severity of sarcopenia we used low ALM alone (sarcopenia I), low ALM with weakness (sarcopenia II), and sarcopenia with weakness and poor gait speed (sarcopenia III). Cox proportional hazard models and logistic regression models were used to assess the risk of mortality and institutionalization, and incidence of ADL disability. ResultsFrom baseline to follow-up, 103 (11.3%) men had incident ADL disability, 191 (11.2%) men were institutionalized, and 535 (31.9%) had died. At baseline, 14.2% had sarcopenia I, 5.3% had sarcopenia II, and 3.7% had sarcopenia III. Fully adjusted analysis (adjusted for demographics, lifestyle factors, comorbidities and health conditions, and blood measures) showed that sarcopenia I, II, and III were associated with increased risk of disability, institutionalization, and mortality. Associations between sarcopenia I, II, and III and risk of incident disability were as follows: odds ratio (OR) 2.77 95% confidence interval (CI) 1.30–5.87, OR 3.78 95% CI 1.23–11.64, and OR 4.53 95% CI 0.90–22.72; associations with institutionalization were hazard ratio (HR) 1.96 95% CI 1.14–3.35, HR 2.53 95% CI 1.31–4.90, and HR 2.27 95% CI 1.08–4.80; and with mortality were HR 1.65 95% CI 1.30–2.09, HR 1.50 95% CI 1.08–2.08, and HR 1.69 95% CI 1.17–2.44. ConclusionsThis study shows that, in community-dwelling older men, sarcopenia defined by the FNIH criteria is associated with increased risk of incident disability, institutionalization, and mortality.

Relative Validity of a Diet History Questionnaire Against a Four-Day Weighed Food Record among Older Men in Australia: The Concord Health and Ageing in Men Project (CHAMP).

To evaluate the relative validity of the diet history questionnaire (DHQ) used in the Concord Health and Ageing in Men Project (CHAMP) against a four-day weighed food record (4dWFR) as the reference method. Detailed DHQ followed by a 4dWFR were completed between July 2012 and October of 2013. Burwood, Canada Bay and Strathfield in Sydney, Australia. Fifty six community- dwelling men aged 75 years and over (mean=79 years). DHQ estimates of intakes were generally higher than estimates from 4dWFR. Differences between the two methods were generally less than 20% with the exception of β-carotene (37%). Fixed and proportional biases were only present for retinol, β-carotene, magnesium, phosphorus and percentage of energy from protein; however, 95% limits of agreement were in some cases wide. Pearson correlation coefficient of log-transformed unadjusted values ranged from 0.15 (zinc) to 0.70 (alcohol), and from 0.06 (iron) to 0.63 (thiamin) after energy-adjustment. Spearman's correlation coefficients ranged from 0.16 (zinc) to 0.80 (alcohol) before energy adjustment, and from 0.15(zinc) to 0.81(alcohol) after energy adjustment. Our findings suggest that the DHQ used in CHAMP to measure the nutritional intake of its participants is appropriate to this age group and provides reasonably similar results to the 4dWFR for the majority of nutrients analysed.

Reproductive Hormones and Longitudinal Change in Bone Mineral Density and Incident Fracture Risk in Older Men: The Concord Health and Aging in Men Project.

The objectives of this study were to examine relationships between baseline levels of reproductive hormones in older men and (1) change in bone mineral density (BMD) over 5 years and (2) incident fractures over an average of 6 years' follow-up. A total of 1705 men aged 70 years and older from the Concord Health and Ageing in Men Project (CHAMP) study were assessed at baseline (2005-2007), 2 years follow-up (2007-2009), and 5 years follow-up (2010-2013). At baseline, testosterone (T), dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) by immunoassay. Hip BMD was measured by dual X-ray absorptiometry (DXA) at all three time-points. Fracture data were collected at 4-monthly phone calls and verified radiographically. Statistical modeling was by general estimating equations and Cox model regression. Univariate analyses revealed inverse associations for serum SHBG, FSH, and LH and positive association for E1 but not DHT or E2 with BMD loss at the hip across the three time points. Serum levels of SHBG (β = -0.071), FSH (β = -0.085), LH (β = -0.070), and E1 (β = 0.107) remained significantly associated with BMD loss in multivariate-adjusted models; however, we were unable to identify any thresholds for accelerated BMD loss according to reproductive steroids. Incident fractures (all, n = 171; hip, n = 44; and nonvertebral, n = 139) were all significantly associated with serum SHBG, FSH, and LH levels in univariate models but none remained significantly associated in multivariate-adjusted model. Serum T, DHT, E2, and E1 levels were not associated with incident fractures in univariate or multivariate-adjusted analyses. In older men, lower serum SHBG, FSH, and LH and higher E1 levels protected against loss of BMD without increasing fracture rate. This means these reproductive variables may be considered as novel biomarkers of bone health during male aging.

Cross-sectional and longitudinal associations between the active vitamin D metabolite (1,25 dihydroxyvitamin D) and haemoglobin levels in older Australian men: the Concord Health and Ageing in Men Project.

Anaemia and low 25 hydroxyvitamin D (25D) and 1,25 dihydroxyvitamin D (1,25D) levels are common in older people and may adversely affect morbidity and mortality. While there is some evidence for an association between low serum 25D levels and anaemia, there are limited studies among community-dwelling older people. In addition, the relationship between anaemia and the active vitamin D metabolite, 1,25D, has not been investigated. The aim of this study was to examine the associations between serum 25D and 1,25D with anaemia in community-living men aged ≥70years. Population-based, cross-sectional analysis of the baseline phase and longitudinal analysis of the Concord Health and Ageing in Men Project (CHAMP), a large epidemiological study conducted in Sydney among men aged 70years and older, were performed; 1666 men were seen at baseline (2005-2007), 1314 men at a 2-year follow-up (2007-2009) and 917 at a 5-year follow-up (2012-2013). The main outcome measurement was haemoglobin levels as a continuous measure. Covariates included 25D and 1,25D, estimated glomerular filtration rate, demographic information, lifestyle measures, health conditions and medication information. The prevalence of anaemia (Hb < 13.0g/dL, WHO definition) was 14.6%. In cross-sectional analysis, serum 25D concentrations were positively associated with haemoglobin levels in unadjusted analysis (β value 0.004; 95% confidence interval (CI) 0.0009, 0.007; p = 0.01), but the associations were no longer significant after multivariate adjustment. The association between 1,25D levels and haemoglobin levels was significant in unadjusted analysis (β value 0.003; 95% CI 0.002, 0.004; p < 0.0001) and remained significant in adjusted analysis (β value 0.001; 95% CI 0.004, 0.003; p = 0.01). Serum 1,25D (but not 25D) levels at baseline were significantly associated with changes in haemoglobin over 2 and 5years in unadjusted (β value 0.002; 95% CI 0.0009, 0.003; p < 0.0001) and in fully adjusted analyses (β value 0.001; 95% CI 0.0004, 0.002; p = 0.001). Serum 1,25D, but not 25D, concentrations are independently associated with haemoglobin levels in older men in both cross-sectional and longitudinal analyses. This raises the question whether vitamin D metabolites may influence anaemia states, mediated through different biological pathways, or represent a time-dependent biomarker of chronic ill health.

Swimming and other sporting activities and falls in older men: Longitudinal findings from the Concord Health and Ageing in Men Project (CHAMP)

Swimming and other sporting activities and falls in older men: Longitudinal findings from the Concord Health and Ageing in Men Project (CHAMP)

Multiple, but not traditional risk factors predict mortality in older people: the Concord Health and Ageing in Men Project.

This study aims to identify the common risk factors for mortality in community-dwelling older men. A prospective population-based study was conducted with a median of 6.7years of follow-up. Participants included 1705 men aged ≥70years at baseline (2005-2007) living in the community in Sydney, Australia. Demographic information, lifestyle factors, health status, self-reported history of diseases, physical performance measures, blood pressure, height and weight, disability (activities of daily living (ADL) and instrumental ADLs, instrumental ADLs (IADLs)), cognitive status, depressive symptoms and blood analyte measures were considered. Cox regression analyses were conducted to model predictors delete time until of mortality. During follow-up, 461 men (27%) died. Using Cox proportional hazards model, significant predictors of delete time to time to mortality included in the final model (p < 0.05) were older age, body mass index < 20kgm(2), high white cell count, anaemia, low albumin, current smoking, history of cancer, history of myocardial infarction, history of congestive heart failure, depressive symptoms and ADL and IADL disability and impaired chair stands. We found that overweight and obesity and/or being a lifelong non-drinker of alcohol were protective against mortality. Compared to men with less than or equal to one risk factor, the hazard ratio in men with three risk factors was 2.5; with four risk factors, it was 4.0; with five risk factors, it was 4.9; and for six or more risk factors, it was 11.4, respectively. We have identified common risk factors that predict mortality that may be useful in making clinical decisions among older people living in the community. Our findings suggest that, in primary care, screening and management of multiple risk factors are important to consider for extending survival, rather than simply considering individual risk factors in isolation. Some of the "traditional" risk factors for mortality in a younger population, including high blood pressure, hypercholesterolaemia, overweight and obesity and diabetes, were not independent predictors of mortality in this population of older men.

Swimming and other sporting activities and the rate of falls in older men: longitudinal findings from the Concord Health and Ageing in Men Project.

Balance training is the most efficacious exercise to prevent falls. This study examined the associations between common sporting activities and the incidence of falls, and whether lower risks can be attributed to the superior balance of sports participants. We studied a population-based cohort of 1,667 older Australian men (mean age = 76.8 years) in the Concord Health and Ageing in Men Project (CHAMP) between 2005 and 2011. Data on incident falls were captured by 12 triannual telephone call cycles per participant and were analyzed using negative binomial regression. The length of follow-up averaged 43.8 months (median, 48 months), during which time 2,662 falls were recorded. In unadjusted models, golfers (n = 160; incidence rate ratio (IRR) = 0.65, 95% confidence interval (CI): 0.47, 0.89) and swimmers (n = 88; IRR = 0.47, 95% CI: 0.30, 0.71) had significantly lower risks of falling. After adjustment for leisure-time physical activity, walking, lifestyle physical activity score (e.g., chores, gardening), and conventional risk factors for falling, swimming was the only activity that was associated with a protective effect (IRR = 0.67, 95% CI: 0.45, 1.00). Swimmers had significantly lower postural sway (β = -5.23 cm(2), P < 0.05) and shorter time to complete a narrow walk test than men who took part in only lifestyle physical activities. Balance indicators were strong predictors of the incidence of falls. The IRR for swimmers was 0.71 (95% CI: 0.48, 1.06) after adding balance measures to the adjusted model.

P498: Cross-sectional and longitudinal associations between anaemia and frailty in older Australian men: the Concord Health and Ageing in Men Project

P498: Cross-sectional and longitudinal associations between anaemia and frailty in older Australian men: the Concord Health and Ageing in Men Project

Low levels of 25-hydroxy vitamin D and active 1,25-dihydroxyvitamin D independently associated with type 2 diabetes mellitus in older Australian men: the Concord Health and Ageing in Men Project.

To examine the associations between serum 25-hydroxyvitamin D (25OHD) levels and the active vitamin D metabolite, 1,25-hydroxyvitamin D (1,25OHD), with type 2 diabetes mellitus (DM) in community-living men aged 70 and older. Cross-sectional. A population-based, cross-sectional analysis of the baseline phase of the Concord Health and Ageing in Men Project (CHAMP), a large epidemiological study conducted in Sydney between January 2005 and May 2007. Community dwelling men aged 70 and older taking part in CHAMP (N=1,659). Serum 25OHD and 1,25OHD levels, presence of DM, age, country of birth, season of blood collection, sun exposure, body mass index, vitamin D supplement use, statin use, income, measures of health, depression, activity of daily living disabilities, parathyroid hormone, estimated glomerular filtration rate, phosphate, and calcium. The prevalence of DM was 20.0%. There was a significant association between low 25OHD and 1,25OHD levels and DM that remained after adjustment for a wide range of confounders and covariates of clinical significance such as comorbidity, renal function, calciotropic hormones, and medications. 25OHD and 1,25OHD levels were associated with DM. The independent association between serum 25OHD and 1,25OHD concentrations and DM raises the question of whether each of the two vitamin D metabolites may influence DM through different biological mechanisms and pathways.

Active vitamin D (1,25 dihydroxyvitamin D) is associated with chronic pain in older Australian men: the Concord Health and Ageing in Men Project.

Although there is a conflicting evidence for an association between low serum 25-hydroxyvitamin D (25D) levels and pain, the relationship between pain and the active vitamin D metabolite, 1,25-hydroxyvitamin D (1,25D), has not been investigated. The aim of this study was to examine the associations between serum vitamin D metabolites: 25D and 1,25D with intrusive or chronic pain in community-living men aged ≥70 years. Population-based, cross-sectional analysis of the baseline phase of the Concord Health and Ageing in Men Project, a large epidemiological study conducted in Sydney between January 2005 and May 2007. Participants included 1,659 community dwelling men aged ≥70 years, taking part in Concord Health and Ageing in Men Project. Main outcome measurements were symptoms of chronic or intrusive pain. Covariates included 25D and 1,25D, parathyroid hormone, estimated glomerular filtration rate as well as age, country of birth, season of blood collection, body mass index, health conditions, and medication, including nonsteroidal anti-inflammatory drugs and statins. The prevalence of intrusive pain was 22.9% and of chronic pain was 29.7%. Low serum 25D concentrations were associated with intrusive and chronic pain in unadjusted analysis, but after adjustment, the associations were no longer significant. Low 1,25D levels (<62.0 pmol/L) remained independently associated with chronic pain (odds ratio: 1.53 [1.05, 2.21, p = .02]), even after adjustment for a wide range of potential confounders and covariates of clinical significance. Low serum 1,25D concentrations are associated with chronic pain in older men. This raises the question whether vitamin D metabolites may influence pain states, mediated through different biological mechanisms and pathways.

Associations Between Serum 25‐Hydroxyvitamin D Concentrations and Multiple Health Conditions, Physical Performance Measures, Disability, and All‐Cause Mortality: The Concord Health and Ageing in Men Project

To explore associations between serum 25-hydroxyvitamin D (25(OH)D) levels and a wide range of health conditions, physical performance measures, disability, and mortality in a large epidemiological study to identify an optimum range for 25(OH)D concentrations. Cross-sectional study, with additional prospective data on falls and mortality. Concord Health and Ageing in Men Project, Sydney, Australia. Community-dwelling men aged 70 and older (N = 1,659). Serum 25(OH)D levels, general health status, self-reported diseases, physical performance measures, disability (activities of daily living and instrumental activities of daily living) and falls. Fair, poor, and very poor health; self-reported diabetes mellitus; hyperglycemia; depression; muscle weakness; poor balance; and all-cause mortality were all associated with serum 25(OH)D levels less than 50 nmol/L, even after adjustment for confounding. The findings also suggest that, in older men, for a wide range of health conditions, physical performance measures, disability, falls, and mortality, the optimum range of 25(OH)D is between 50.0 and 74.9 nmol/L, with no additional benefit for 25(OH)D levels of 75.0 nmol/L or greater. Programs aimed at achieving an optimum range of serum 25(OH)D at levels between 50.0 and 74.9 nmol/L may have overall health benefits and such levels are adequate for older men.

Longitudinal and Cross-Sectional Relationships of Circulating Reproductive Hormone Levels to Self-Rated Health and Health-Related Quality of Life in Community-Dwelling Older Men

Self-rated health and health-related quality of life are inversely associated with increased morbidity and mortality; however, the temporal relationship with reproductive hormones is poorly understood. The objective of the study was to examine relationships between reproductive hormones, self-rated health, and quality of life in older men at baseline as well as changes over a 2-year follow-up. One thousand six hundred thirty-seven men aged 70 years and older from the Concord Health and Ageing in Men Project were assessed at baseline and 1316 men returned for the 2-year follow-up. Serum T, dihydrotestosterone, estradiol, and estrone (E1) were measured by liquid chromatography-tandem mass spectrometry and SHBG, LH, and FSH by immunoassay. Logistic regression and multivariate linear regression models were performed. Self-rated health and health-related quality of life measures (12-Item Short Form Health Survey) were determined. In the cross-sectional baseline data, univariate analyses revealed significant associations between many of the hormones and quality-of-life scores and self-rated health. In a multivariable analysis, the associations between T, E1, and calculated free T and self-rated health remained statistically significant. Compared with men in the highest T quartile, men in the lowest T quartile had an odds ratio of 1.47 (95% confidence interval 1.04-2.06) for reporting fair, poor, or very poor health vs excellent or good health. The findings for E1 and calculated free T were similar. In the longitudinal data, the only significant relationship was that between E1 and self-rated health. Compared with those in the highest E1 quartile, those in the lowest quartile experienced deterioration in self-rated health: adjusted odds ratio of 1.84 (95% confidence interval 1.10-3.06). Low serum T and E1 are associated with poorer self-rated health in older men, whereas lower serum levels of E1 are predictive of subsequent deterioration in self-rated health over time. Therefore, serum E1 is a novel potential risk factor for poor self-rated health in older men that warrants further investigation.

Predicting participation restriction in community-dwelling older men: the Concord Health and Ageing in Men Project

participation restriction, defined as 'problems an individual may experience in involvement in life situations' (e.g. work and leisure), reflects difficulty functioning at a societal level and is a key component of disability. Our objective was to describe changes in participation in older men over a 2-year period and to identify baseline variables associated with participation and change in participation over the 2-year period. one thousand and three hundred and twenty-seven community-dwelling men aged 70 years or over who completed the baseline and 2-year follow-up phases of the Concord Health and Ageing in Men Project, a population-based cohort study in Sydney, Australia, were studied. Participation restriction and a range of other variables were measured using self-report and performance measures. Regression analyses were conducted to examine factors associated with participation and change in participation. over the 2-year period, participation in life roles deteriorated in 47.3% (627/1,327) of men, stayed the same in 20.7% (275/1,327) and improved in the remainder (32.0%). Overall, there was a significant deterioration in participation (P < 0.001). Reduced participation at 2-year follow-up was significantly associated with the following baseline factors: age, more comorbidities, mild cognitive impairment or dementia, lower mood, weakness, slower gait, worse activities of daily living performance, driving and baseline participation score. These variables explained 56% of the variance in participation at 2 years. participation in life roles worsened over a 2-year period in some community-dwelling older men. A number of associated factors were identified, which may provide targets for intervention to improve participation among older men.

A longitudinal study of knee pain in older men: Concord Health and Ageing in Men Project

chronic knee pain is still considered a fairly benign disease by many, an 'unavoidable' consequence of ageing. This passive acceptance may be unnecessarily exposing older people to disability and serious co-morbidity. The aim of this study was to determine the disease burden associated with chronic knee pain and the role of knee extensor strength as a modifiable risk factor. a longitudinal cohort study with 2-year follow-up conducted among 1,587 community-dwelling men aged 70 years and over, 637 (40%) reported chronic knee pain. Of the 950 (60%) men without knee pain at baseline, 768 (81%) returned for the follow-up assessment with 150 (20%) reporting incident chronic knee pain. knee pain was significantly associated with marked mobility disability [odds ratio (OR) 2.38; 95% confidence interval (CI) 1.74-3.29], falls (OR: 1.31; 95% CI: 1.01-1.70) and having four or more co-morbidity (OR: 1.63; 95% CI: 1.16-2.30) as well as reduced knee extensor strength and mass (dual X-ray absorptiometry). Men with incident knee pain at the 2-year follow-up assessment demonstrated greater increases in these measures of disease burden and greater decreases in muscle strength and mass, compared with those without incident chronic knee pain. Obesity, high co-morbidity burden, back pain, higher levels of physical activity or low knee extensor strength were all significant risk factors for incident knee pain. prevention of chronic knee pain may reduce a considerable burden of mobility disability and increased risk of serious co-morbidity among older men.

The relationship between solar UV exposure, serum vitamin D levels and serum prostate-specific antigen levels, in men from New South Wales, Australia: the CHAMP study

We aim to determine the relationship between season, personal solar UV exposure, serum 25(OH)D and 1,25(OH)2D and serum prostate-specific antigen (PSA) levels. Questionnaire data and blood samples were collected at baseline from participants of the Concord Health and Ageing in Men Project (n = 1,705), aged 70 and above. They were grouped as men 'free of prostate disease' for those with no record of having prostate cancer, benign prostatic hyperplasia, or prostatitis and with serum PSA levels below 20 ng/mL, and 'with prostate disease' for those with a record of either of these diseases or with serum PSA levels 20 ng/mL or above. Personal solar UV exposure (sUV) was estimated from recalled hours of outdoor exposure and weighted against ambient solar UV radiation. Sera were analysed to determine levels of PSA, 25(OH)D and 1,25(OH)2D, and analysed using multiple regression, adjusting for age, BMI and region of birth. The association between sUV and serum PSA levels was conditional upon season (p interaction = 0.04). There was no direct association between serum PSA and 25(OH)D in both groups of men. There was a positive association between serum PSA and 1,25(OH)2D in men with prostate disease (mean = 110.6 pmol/L; p heterogeneity = 0.03), but there was no such association in men free of prostate disease (mean = 109.3 pmol/L; p heterogeneity = 0.8). The association between PSA and sUV may only be evident at low solar UV irradiance, and this effect may be independent of serum vitamin D levels.