Risk Of Mortality In Older Adults Research Articles

Depressive Symptoms Increase the Risk of Mortality for White but Not Black Older Adults.

Introduction. Long-term studies have shown that depressive symptoms predict the risk of mortality. However, it is unknown if this effect is present in shorter time intervals. In addition, recent research suggests that the salience of the negative affect on the risk of mortality is not similar across racial groups. The current study uses data from a national study of Black and White older adults to examine racial differences in the effect of baseline depressive symptoms on mortality risk over three years in the United States. Methods. This study used a longitudinal prospective design and followed 1493 older adults who were either White (n = 759) or Black (n = 734) for three years from 2001 to 2004. Depressive symptoms measured at baseline was the independent variable. Demographic factors, socio-economic characteristics (education, income, marital status), health behaviors (smoking and drinking), and health (self-rated health) measured at baseline in 2001 were covariates. The dependent variable was all-cause mortality between 2001 and 2004. Race was the moderator. Logistic regressions were used for data analysis. Results. In the pooled sample, high depressive symptoms at baseline were not associated with the three-year risk of mortality. In the pooled sample, we found a significant interaction between race and depressive symptoms on mortality, suggesting a stronger effect for Whites in comparison to Blacks. In race stratified models, depressive symptoms at baseline were predictive of mortality risk for Whites, but not Blacks. Conclusions. In the United States, Black-White differences exist in the effects of depressive symptoms on mortality risk in older adults. White older adults may be more vulnerable to the effects of depressive symptoms on mortality risk.

Physical activity and cause-specific mortality: the Rotterdam Study.

Physical activity (PA) is associated with lower risk for all-cause mortality. However, in elderly people, it remains unknown which types of PA are associated with mortality and whether the association between PA and mortality differs by cause of death. We assessed the association of total PA, walking, cycling, domestic work, sports and gardening with all-cause mortality, and the association of total PA with cause-specific mortality, using Cox proportional hazard models among 7225 older adults (mean age: 70 years) from the prospective population-based Rotterdam Study. Deaths were classified as due to cardiovascular diseases (CVDs), cancer, infections, external causes, dementia, chronic lung diseases or other causes. Activities were categorized into tertiles (lowest tertile as reference). To account for the possibility of reverse causation, we excluded the first 5 and 10 years of follow-up. Over a median of 13.1 years of follow-up (interquartile range: 8.4-14.6 years), 3261 participants died. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with high total PA compared with low were 0.69 (0.63, 0.75), 0.69 (0.58, 0.81), 0.44 (0.27, 0.71), 0.47 (0.32, 0.71) and 0.56 (0.46, 0.69) for mortality from all causes, CVDs, chronic lung diseases, infections and other causes, respectively. With longer exclusion times, the strength of these associations was attenuated. All PA types were associated with lower all-cause mortality risk. Engagement in higher PA levels was associated with lower risk of mortality from CVDs, chronic lung diseases, infections and other causes. Participating in any PA might reduce mortality risk in older adults.

Segregating the Distinct Effects of Sedentary Behavior and Physical Activity on Older Adults' Cardiovascular Structure and Function: Part 1-Linear Regression Analysis Approach.

Physical behavior [PB, physical activity (PA), and sedentary behavior (SB)] can adjust cardiovascular mortality risk in older adults. The aim of this study was to predict cardiovascular parameters (CVPs) using 21 parameters of PB. Participants [n = 93, 73.8 (6.23)y] wore a thigh-mounted accelerometer for 7 days. Phenotype of the carotid, brachial, and popliteal arteries was conducted using ultrasound. Sedentary behavior was associated with one of the 19 CVPs. Standing and light-intensity PA was associated with 3 and 1 CVP, respectively. Our prediction model suggested that an hourly increase in light-intensity PA would be negatively associated with popliteal intima-media thickness [0.09mm (95% confidence interval, 0.15 to 0.03)]. sMVPA [moderate-vigorous PA (MVPA), accumulated in bouts <10min] was associated with 1 CVP. 10MVPA (MVPA accumulated in bouts ≥10min) had no associations. W50% had associations with 3 CVP. SB%, alpha, true mean PA bout, daily sum of PA bout time, and total week 10MVPA each were associated with 2 CVP. Patterns of PB are more robust predictors of CVP than PB (hours per day). The prediction that popliteal intima-media thickness would be negatively associated with increased standing and light-intensity PA engagement suggests that older adults could obtain health benefits without MVPA engagement.

Odnos funkcionalnog i nutritivnog statusa kod starih

Introduction: Adding years to life is a great achievement when this is accompanied by a good level of health and well-being and independence. Major indicators for prediction mortality risk in older adults are the nutrition status and physical functional ability. The aim of this study is to present the nutritive and functional status among institutionalized elderlies and the relatedness with certain risk factors. Material and methods: Cross-sectional study has been conducted at certain nursing homes with participation of individuals over 60 years old. As for the research Scale of Daily Living Activities (ADL) has been used to present the functional capacity of the elderly and MNA has been used to detect the nutrition status. Results: The results from the research conducted among elderlies have shown the following socio-demographic characteristics: out of 127 participants, most of them were females-77% and 69% at the age between 75 and 84. Most of the elderlies (in 68%) have completed secondary education. The results from MNA have shown that 69,2% are wellnourished, 27,6% are at risk for malnutrition and 3,2% are malnourished. There is a relatedness of the nutrition status with the gender (p &lt; 0,001) and the level of education (p &lt; 0,001).ADL scale among 127 elderly participants has shown that 37% are independent, 45% are with a moderate impairment and 18% are with severe functional impairment. In comparison with the females, the males show higher level of functional ability in all ADL components except the continence. Conclusion: The results from the research have shown that the nutrition status among elderlies is satisfactory, emphasizing the factors such as gender, education level and functional ability as key points for the level of nutrition status at the elderlies.

Biopsychosocial predictors of perceived life expectancy in a national sample of older men and women.

Perceived life expectancy (PLE) is predictive of mortality risk in older adults, but the factors that may contribute to mental conceptions of PLE are unknown. We aimed to describe the sociodemographic, biomedical, behavioral, and psychological predictors of self-reported PLE estimates among older English adults. Data were from 6662 adults aged 50–79 years in the population-based English Longitudinal Study of Ageing (cross-sectional sample from 2012/13). PLE was assessed in the face-to-face study interview (“What are the chances you will live to be age x or more?” where x = current age plus 10–15 years). Responses were categorized as ‘low’ (0–49%), ‘medium’ (50–74%), and ‘high’ (75–100%). Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for low vs. high PLE were estimated using population-weighted modified Poisson regression with robust error variance. Overall, 1208/6662 (18%) participants reported a low PLE, 2806/6662 (42%) reported a medium PLE, and 2648/6662 (40%) reported a high PLE. The predictors of reporting a low PLE included older age (PR = 1.64; 95% CI: 1.50–1.76 per 10 years), male sex (PR = 1.14; 95% CI: 1.02–1.26), being a smoker (PR = 1.39; 95% CI: 1.22–1.59 vs. never/former smoker), and having a diagnosis of cancer or diabetes. A low sense of control over life was associated with low PLE, as was low satisfaction with life and worse self-rated health. Those with a higher perceived social standing were less likely to report a low PLE (PR = 0.90; 95% CI: 0.87–0.93 per 10-point increase, out of 100). This study provides novel insight into potential influences on older adults’ expectations of their longevity, including aspects of psychological well-being. These results should be corroborated to better determine their implications for health-related decision-making, planning, and behavior among older adults.

A Point-based Mortality Prediction System for Older Adults with Diabetes

The mortality prediction models for the general diabetic population have been well established, but the corresponding elderly-specific model is still lacking. This study aims to develop a mortality prediction model for the elderly with diabetes. The data used for model establishment were derived from the nationwide adult health screening program in Taiwan in 2007–2010, from which we applied a 10-fold cross-validation method for model construction and internal validation. The external validation was tested on the MJ health screening database collected in 2004–2007. Multivariable Cox proportional hazards models were used to predict five-year mortality for diabetic patients ≥65 years. A total of 220,832 older subjects with diabetes were selected for model construction, of whom 23,241 (10.5%) died by the end of follow-up (December 31, 2011). The significant predictors retained in the final model included age, gender, smoking status, body mass index (BMI), fasting glucose, systolic and diastolic blood pressure, leukocyte count, liver and renal function, total cholesterol, hemoglobin, albumin, and uric acid. The Harrell’s C in the development, internal-, and external-validation datasets were 0.737, 0.746, and 0.685, respectively. We established an easy-to-use point-based model that could accurately predict five-year mortality risk in older adults with diabetes.

Individual and Combined Associations of Cognitive and Mobility Limitations on Mortality Risk in Older Adults

ObjectiveTo evaluate the potential independent and combined associations of cognitive and mobility limitations on risk of all-cause mortality in a representative sample of the US older adult population who, at baseline, were free of cardiovascular and cerebrovascular disease. Patients and MethodsData from the 1999 to 2002 National Health and Nutrition Examination Survey were used to identify 1852 adults (age, 60-85 years) with and without mobility and/or cognitive limitations. Hazard ratios (HRs) for mortality risk were calculated for 4 mutually exclusive groups: no limitation (group 1 as reference), mobility limitation only (group 2), cognitive limitation only (group 3), both cognitive and mobility limitations (group 4). ResultsCompared with group 1, the adjusted HRs (95% CI) for groups 2, 3, and 4 were 1.72 (1.24-2.38), 2.00 (1.37-2.91), and 2.18 (1.57-3.02), respectively. The mortality risk when comparing group 4 (HR, 2.18) with group 3 (HR, 2.00), however, was not statistically significant (P=.65). Similarly, the mortality risk when comparing group 4 (HR, 2.18) with group 2 (HR, 1.72) was not statistically significant (P=.16). ConclusionAlthough the highest mortality risk occurred in those with both limitations (group 4), this point estimate was not statistically significantly different when compared with those with cognitive or mobility limitations alone.

Exposure to urban life and mortality risk among older adults in China

We examined whether exposure to urban environments was linked with mortality in a longitudinal survey dataset of nearly 28,000 Chinese adults who were 65 years of age or older in the years 2002–2014. Urban life exposure was measured by residential status at birth, current residential status, and urban-related primary lifetime occupation, which generated eight different categories of urban life exposure: no exposure, mid-life-only exposure, late-life-only exposure, mid-late-life exposure, early-life-only exposure, early-mid-life exposure, early- & late-life exposure, and full life exposure. We also included a measure of migration, whether the respondent lived in the same county/city at birth and at first interview, to further classify these eight categories. Overall, we found that when demographics were controlled for, compared to those with no urban life exposure and no migration, mortality risk was lower for older adults with mid-late life exposure with or without migration and for older adults with full-life exposure with migration; mortality risk was higher for older adults with early-life-only exposure. Once socioeconomic status, family/social support, health behaviors, and baseline health were simultaneously controlled for, only the higher mortality risk for older adults with early-life-only exposure was still significant. Our findings provided valuable information about how urban life exposure at different life stages was associated with elderly mortality in China.

Changes in perceived uselessness and risks for mortality: evidence from a National sample of older adults in China

BackgroundSelf-perception of uselessness is associated with increased mortality risk in older adults. However, it is unknown whether and to what extent changes in perceived uselessness are associated with mortality risk.MethodsUsing four waves of national longitudinal data of older adults from China (2005, 2008, 2011, and 2014), this study examines the association between changes in perceived uselessness and risk of subsequent mortality. Perceived uselessness is classified into three major categories: high levels (always/often), moderate levels (sometimes), and low levels (seldom/never). Five categories are used to measure change over three-year intervals: (1) persistently high levels, (2) increases to moderate/high levels, (3) persistent moderate levels, (4) decreases to moderate/low levels, and (5) persistently low levels. Cox proportional hazard models were used to estimate mortality risk associated with changes in levels of perceived uselessness.ResultsCompared to those with persistently low levels of perceived uselessness, those with persistently high levels of feeling useless had 80% increased hazard ratio (HR) in mortality [HR =1.80, 95% CIs: 1.57–2.08, p < 0.001]; and those with increasing levels, persistently moderate levels, and decreasing levels of perceived uselessness had 42% [HR = 1.42, 95% CIs: 1.27–159, p < 0.001], 50% [HR = 1.50, 95% CIs: 1.32–1.71, p < 0.001], and 23% [HR = 1.23, 95% CIs: 1.09–1.37, p < 0.001] increased hazard ratio in mortality, respectively, when background characteristics were taken into account. The associations were partially attenuated when socioeconomic, family/social support, behavioral, and health-related covariates were individually taken into account. Older adults with persistently high and moderate levels of perceived uselessness still exhibited significantly higher risks of mortality (16% [HR = 1.16, 95% CIs: 1.00–1.135, p < 0.05] and 22% [HR = 1.16, 95% CIs: 1.06–1.139, p < 0.015], respectively) after adjusting for all covariates, although no significant mortality risks were found for either increasing to moderate/high levels or decreasing to moderate/low levels of perceived uselessness.ConclusionsPersistently high and moderate levels of perceived uselessness are associated with significant increases in mortality risk. These findings have important implications for promoting successful aging in China.

Gender differences in the association between grip strength and mortality in older adults: results from the KORA-age study.

BackgroundReduced muscular strength in the old age is strongly related to activity impairment and mortality. However, studies evaluating the gender-specific association between muscularity and mortality among older adults are lacking. Thus, the objective of the present study was to examine gender differences in the association between muscular strength and mortality in a prospective population-based cohort study.MethodsData used in this study derived from the Cooperative Health Research in the Region of Augsburg (KORA)-Age Study. The present analysis includes 1,066 individuals (mean age 76 ± 11 SD years) followed up over 3 years. Handgrip strength was measured using the Jamar Dynamometer. A Cox proportional hazard model was used to determine adjusted hazard ratios of mortality with 95% confidence intervals (95% CI) for handgrip strength. Potential confounders (i.e. age, nutritional status, number of prescribed drugs, diseases and level of physical activity) were pre-selected according to evidence-based information.ResultsDuring the follow-up period, 56 men (11%) and 39 women (7%) died. Age-adjusted mortality rates per 1,000 person years (95% CI) were 77 (59–106), 24 (13–41) and 14 (7–30) for men and 57 (39–81), 14 (7–27) and 1 (0–19) for women for the first, second and third sex-specific tertile of muscular strength, respectively. Low handgrip strength was significantly associated with all-cause mortality among older men and women from the general population after controlling for significant confounders. Hazard ratios (95% CI) comparing the first and second tertile to the third tertle were 3.33 (1.53–7.22) and 1.42 (0.61-3.28), respectively. Respective hazard ratios (95% CI) for mortality were higher in women than in men ((5.23 (0.67–40.91) and 2.17 (0.27–17.68) versus 2.36 (0.97–5.75) and 0.97 (0.36–2.57)).ConclusionsGrip strength is inversely associated with mortality risk in older adults, and this association is independent of age, nutritional status, number of prescribed drugs, number of chronic diseases and level of physical activity. The association between muscular strength and all-cause mortality tended to be stronger in women. It seems to be particularly important for the weakest to enhance their levels of muscular strength in order to reduce the risk of dying early.

Physical activity and long-term mortality risk in older adults: A prospective population based study (NEDICES).

To analyze whether Physical activity (PA) reduces mortality risk at thirteen years' follow-up in a population-based cohort of Spanish older adults. The NEDICES (Neurological Disorders in Central Spain) is a prospective population-based survey of older adults (age ≥ 65 years) that comprised 5278 participants at baseline. A modified version of the Rosow-Breslau questionnaire was applied to categorize the PA (sedentary, light, moderate and high) and dates of death were collected from the Official Spanish Death Registry. Cox regression models adjusted for different covariates (age, sex, marital status, smoking, previous stroke, Parkinson disease, incident dementia, body mass index, comorbidity indexes and functional assessment) were used to evaluate the hazard of death at thirteen years' interval according to different levels of PA. 1710 deaths (52.9% men vs. 47.1% women) were identified among 3633 individuals at thirteen years' follow-up. Hazard ratios (HRs) of the light, moderate, and high PA groups (vs. sedentary group) were 0.64 (95% confidence interval (CI) [0.56, 0.72], p < 0.001), 0.61 (95% CI [0.53, 0.70], p < 0.001) and 0.48 (95% CI [0.41, 0.55], p < 0.001), respectively. Significant dose effects were observed between light versus the sedentary group and intense versus the moderate group. PA prevents long-term mortality in older Spanish adults, with the highest intensity levels being those related to the lowest risk of mortality. These findings indicate that health policies for old age care should include PA as one of the main targets.

MPS 03-08 ON-TREATMENT BLOOD PRESSURE AND CARDIOVASCULAR OUTCOMES IN OLDER ADULTS WITH ISOLATED SYSTOLIC HYPERTENSION

Objective: Data are sparse regarding on-treatment blood pressure (BP) levels at which cardiovascular disease (CVD) and all-cause mortality risks are minimized in older adults with isolated systolic hypertension (ISH). Our aim was to assess optimal on-treatment BP in older Japanese adults with ISH. Design and Method: We used data from the Valsartan in Elderly Isolated Systolic Hypertension (VALISH) Study, which recruited older adults (n = 3,035; mean age: 76 years) with systolic BP (SBP)>160 mmHg and diastolic BP (DBP) < 90 mmHg. Patients were randomly assigned to receive intensive (SBP target < 140 mmHg) or moderate (>140 and < 150 mmHg) BP-lowering treatment with Valsartan, and were also categorized into three groups based on their achieved on-treatment SBP: those with SBP < 130 mmHg (n = 317), 130 to <145 mmHg (n = 2,025), or >145 mmHg (n = 693). The primary outcome was composite CVD (coronary heart disease, stroke, heart failure, cardiovascular deaths, other vascular diseases, and kidney diseases) and the secondary outcome was all-cause mortality. Cox proportional hazards models were used to assess the CVD risk for each group. Results: Over a median 3-year follow-up (8022.13 person-years), 93 CVD events and 52 deaths occurred. With on-treatment SBP of 130 to <145 mmHg as the reference stratum, the multivariable-adjusted hazard ratios and 95% confidence intervals of CVD and all-cause mortality risks for those with on-treatment SBP<130 were 2.08 (1.12–3.83) and 2.09 (0.93–4.71), and for those with on-treatment SBP>145 mmHg were 2.29 (1.44–3.62) and 2.51 (1.35–4.66), respectively (Figure 1). Results were similar by baseline clinical characteristics (i.e., sex, <80 years and >80 years, and prevalent diabetes or CVD). On-treatment DBP yielded no relationships with CVD or all-cause mortality risk. Conclusions: A J-shaped relationship was observed between on-treatment SBP and CVD and all-cause mortality risk in older adults with ISH. On-treatment SBP of 130 to <145 mmHg was associated with minimal adverse outcomes.

Thyroid Status and Mortality Risk in Older Adults With Normal Thyrotropin: Sex Differences in the Milan Geriatrics 75+ Cohort Study

Thresholds of optimal thyroid status in old age are controversial. We investigated the longitudinal association between thyroid parameters and 10-year all-cause mortality risk in older outpatients with normal thyrotropin (TSH) and modification by sex and age. Baseline TSH, free thyroxine (fT4), and free triiodothyronine (fT3) were assessed in the Milan Geriatrics 75+ Cohort Study. 324 men and 609 women older than 75 years had normal TSH. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for the associations between thyroid parameters and mortality risk using Cox regression. Sex-stratified analyses were adjusted for sociodemographic factors and comorbidities. 233 men and 367 women died during follow-up. After adjustment, each 1-mU/L higher TSH was associated with decreased mortality risk in men (HR 0.83, 95% CI 0.69-0.98), but not in women (HR 1.09, 95% CI 0.95-1.24) (p for sex interaction = .006). Each 1-ng/L higher fT4 was associated with increased mortality risk in men (HR 1.11, 95% CI 1.02-1.22), but not in women (HR 0.98, 95% CI 0.93-1.04) (p for sex interaction = .013). Each 1-pg/mL higher fT3 was associated with decreased mortality risk in women (HR 0.77, 95% CI 0.60-0.98), but not in men (HR 0.80, 95% CI 0.57-1.13). The inverse association between TSH and mortality was most pronounced in men older than 85 years. Among older outpatients with normal TSH, higher TSH and lower fT4 were associated with decreased mortality risk in men but not in women. When assessing thyroid status, sex and age should be taken into account.

Associations Between Tooth Loss, With or Without Dental Prostheses, and Malnutrition Risk in Older Adults

A systematic review was conducted to investigate the associations between missing teeth, teeth replaced with dental prostheses, and malnutrition risk, as determined by the Mini Nutritional Assessment (MNA), among community-dwelling older adults. A comprehensive search strategy was designed to identify studies published between 2000 and 2014 that met inclusion criteria. Searches were conducted in Medline, CINAHL, and Cochrane Libraries. Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were followed and risk-of-bias analyses were performed. Study data were abstracted and synthesized in narrative and summary tables. Of the 8 studies that met inclusion criteria, 5 found significant associations between MNA score and tooth loss. Those with fewer teeth/limited occlusion had lower MNA scores, hence were at greater risk for malnutrition than those with a greater number of teeth and/or more occluding teeth pairs. Provision of dentures to older adults was associated with significant increases in MNA scores. The studies reviewed support associations between tooth loss, replacement with prostheses, and malnutrition risk; individuals with more missing teeth and limited occlusion were at increased risk of malnutrition. Additional high-quality research seems warranted to substantiate a causal relationship between dental and nutritional status. Inadequate oral health and poor nutritional status are associated with increased mortality risk in older adults. Efforts to optimize oral health and nutritional status of older adults are needed.

Association between Objectively Measured Physical Activity and Mortality in NHANES.

We examined total activity, light activity, and moderate-to-vigorous physical activity (MVPA) as predictors of mortality in a nationally representative sample of older adults. Then we explored the theoretical consequences of replacing sedentary time with the same duration of light activity or MVPA. Using accelerometer-measured activity, the associations between total activity, light activity (100-2019 counts per minute), and MVPA (>2019 counts per minute) counts and mortality were examined in adults age 50 to 79 yr in the National Health and Nutrition Examination Survey, 2003-2006 (n = 3029), with mortality follow-up through December 2011. Cox proportional hazard models were fitted to estimate mortality risks. An isotemporal substitution model was used to examine the theoretical consequences of replacing sedentary time with light activity or MVPA on mortality. After adjusting for potential confounders, including age, sex, race/ethnicity, education, BMI, and the presence of comorbid conditions, those in the highest tertile of total activity counts had one fifth the risk of death of those in the lowest tertile (hazard ratio [HR] = 0.21, 95% confidence interval [CI] = 0.12-0.38), and those in the middle tertile had one third the risk of death (HR = 0.36, 95% CI = 0.30-0.44). In addition, replacing 30 min of sedentary time with light activity was associated with significant reduction in mortality risk (after 5 yr of follow-up: HR = 0.80, 95% CI = 0.75-0.85). Replacing 30 min of sedentary time with MVPA was also associated with reduction in mortality risk (HR = 0.49, 95% CI = 0.25-0.97). Greater total activity is associated with lower all-cause mortality risk. Replacing sedentary time with light activity or MVPA may reduce mortality risk for older adults.

Positive affect and mortality risk in older adults: A meta-analysis.

We performed a meta-analysis on the relationship between positive affect (PA) and mortality risk in older adults (55 years and older) and reviewed evidence on the Main Effect Model and the Stress-buffering Model of PA. Four databases (ISI Web of Knowledge, APA PsycNET, PubMed, and Embase) were used to identify potential studies. Three types of effect sizes (ESs), odds ratio, relative risk, and hazard ratio (OR, RR, and HR), were calculated and analyzed within a random effects model. The analysis of the studies in which the effects of other variables were not controlled indicated that older adults with higher levels of positive affect had lower mortality risk (75%, HR = 0.75, 95% confidence interval [CI] = 0.66-0.85) than those with lower positive affect. In studies in which the effects of covariates were controlled, this rate was 85% (HR = 0.85, 95% CI = 0.81-0.89), which was still significant. These results suggest that higher positive affect is associated with lower mortality risk in community-dwelling older adults, even after controlling for medical, psychological, and social factors. The results point to potential methods of improving longevity, and to achieving healthy aging in older adults.

Normal-Weight Central Obesity and Mortality Risk in Older Adults With Coronary Artery Disease

ObjectiveTo study the relationship between body mass index (BMI) and central obesity and mortality in elderly patients with coronary artery disease (CAD). Patients and MethodsWe identified 7057 patients 65 years or older from 5 cohort studies assessing mortality risk using either waist circumference (WC) or waist-hip ratio (WHR) in patients with CAD from January 1, 1980, to December 31, 2008. Normal weight, overweight, and obesity were defined using standard BMI cutoffs. High WHR was defined as 0.85 or more for women and 0.90 or more for men. High WC was defined as 88 cm or more for women and 102 cm or more for men. Separate models examined WC or WHR in combination with BMI (6 categories each) as the primary predictor (referent = normal BMI and normal WC or WHR). Cox proportional hazards models investigated the relationship between these obesity categories and mortality. ResultsPatients' mean age was 73.0±6.0 years (3741 [53%] women). The median censor time was 7.1 years. A normal BMI with central obesity (high WHR or high WC) demonstrated highest mortality risk (hazard ratio [HR], 1.29; 95% CI, 1.14-1.46; HR, 1.29; 95% CI, 1.12-1.50, respectively). High WHR was also predictive of mortality in the overall (HR, 2.14; 95% CI, 1.93-2.38) as well as in the sex-specific cohort. In the overall cohort, high WC was not predictive of mortality (HR, 1.04; 95% CI, 0.97-1.12); however, it predicted higher risk in men (HR, 1.12; 95% CI, 1.01-1.24). ConclusionIn older adults with CAD, normal-weight central obesity defined using either WHR or WC is associated with high mortality risk, highlighting a need to combine measures in adiposity-related risk assessment.

The ODIN project: Development of food‐based approaches for prevention of vitamin D deficiency throughout life

AbstractVitamin D deficiency has significant implications for human health throughout life and impacts on healthy growth and development and successful ageing. Persistent knowledge gaps are barriers to developing and implementing a safe and effective public health strategy to prevent vitamin D deficiency and maintain nutritional adequacy throughout the year. The European Commission‐funded ODIN project (Food‐based solutions for optimal vitamin D nutrition and health through the life cycle) will provide the evidence base to prevent vitamin D deficiency and improve nutrition and public health through food. ODIN will deliver the first internationally comparable dataset of vitamin D status and report the prevalence of vitamin D deficiency across Europe for the first time. In a series of dose‐response randomised controlled trials, ODIN will estimate dietary requirements for vitamin D in pregnant women, children, adolescents and adults of South Asian and East African origin resident in Northern European countries. Using clinically validated, disease‐specific cohorts with standardised 25(OH)D data, ODIN will investigate associations between vitamin D status and perinatal outcomes, atopic disease and bone growth in children, and cardiovascular and mortality risk in older adults. We will publish estimates of the distribution of vitamin D intake and serum 25(OH)D concentration resulting from changes in vitamin D in the food supply, accounting for latitude, sun exposure and diet. Utilising advanced food production systems and targeted animal and human feeding studies, ODIN will propose safe, novel and effective food‐based strategies to eradicate vitamin D deficiency that are inclusive, sustainable and affordable.

Optimal Dietary and Plasma Magnesium Statuses Depend on Dietary Quality for a Reduction in the Risk of All-Cause Mortality in Older Adults.

The association between dietary or plasma magnesium (Mg) with diabetes incidence and with mortality in free-living elderly was investigated. A total of 1400 participants from the Taiwanese Nutrition Survey, aged ≥ 65 years, and diabetes-free from the 1999–2000 were assessed. The dietary intake and plasma Mg concentration were obtained through 24h dietary recall and health examination at baseline. Participants were classified by quartiles (Q) of dietary Mg or by the plasma Mg normal range (0.75–0.95 mmol/L). Dietary diversity score (DDS, range 1–6) represented the dietary quality. During 8 and 10 years, 231 incident diabetes cases and 475 deaths were identified. Cox’s proportional-hazards regression was used to evaluate the association between Mg and health outcomes. The hazard ratios (95% confidence interval) for death in Q2 and Q3 of Mg intakes with DDS > 4 were 0.57 (0.44–0.74) and 0.59 (0.39–0.88), respectively, compared with the lowest intake and DDS ≤ 4 participants. Participants with normal and high plasma Mg in conjunction with high DDS had relative risks of 0.58 (0.37–0.89) and 0.46 (0.25–0.85) in mortality compared with low plasma Mg and lower DDS. Optimal dietary Mg intake and plasma Mg depend on dietary quality to reduce the mortality risk in older adults.

New research on anxiety disorders in the elderly and an update on evidence-based treatments.

Anxiety disorders are frequently encountered in the elderly, but they are largely undetected and untreated. Epidemiological studies indicate a prevalence ranging from 1.2 to 15 %. With the exception of generalized anxiety disorder and agoraphobia, which can often start in late life, most anxiety disorders in older patients are chronic and have their onset earlier in life. Anxiety disorders are an often unrecognized cause of distress, disability, and mortality risk in older adults, and they have been associated with cardiovascular disease, stroke, and cognitive decline. The mechanisms of anxiety in older adults differ from that in younger adults due to age-related neuropathology, as well as the loss and isolation so prominent in late life. Our review intends to provide a comprehensive summary of the most recent research done in the field of anxiety disorders in the elderly. Recent findings in clinical research, neuroimaging, neuroendocrinology, and neuropsychology are covered. An update on treatment options is discussed, including pharmacological and non-pharmacological alternatives.