Outcomes In Old Age Research Articles

Social isolation, loneliness and health in old age: a scoping review.

The health and well-being consequences of social isolation and loneliness in old age are increasingly being recognised. The purpose of this scoping review was to take stock of the available evidence and to highlight gaps and areas for future research. We searched nine databases for empirical papers investigating the impact of social isolation and/or loneliness on a range of health outcomes in old age. Our search, conducted between July and September 2013 yielded 11,736 articles, of which 128 items from 15 countries were included in the scoping review. Papers were reviewed, with a focus on the definitions and measurements of the two concepts, associations and causal mechanisms, differences across population groups and interventions. The evidence is largely US-focused, and loneliness is more researched than social isolation. A recent trend is the investigation of the comparative effects of social isolation and loneliness. Depression and cardiovascular health are the most often researched outcomes, followed by well-being. Almost all (but two) studies found a detrimental effect of isolation or loneliness on health. However, causal links and mechanisms are difficult to demonstrate, and further investigation is warranted. We found a paucity of research focusing on at-risk sub-groups and in the area of interventions. Future research should aim to better link the evidence on the risk factors for loneliness and social isolation and the evidence on their impact on health.

Cognitive Frailty: A Systematic Review of Epidemiological and Neurobiological Evidence of an Age-Related Clinical Condition.

Advancing age is the focus of recent studies on familial and sporadic Alzheimer's disease (AD), suggesting a prolonged pre-clinical phase several decades before the onset of dementia symptoms. Influencing some age-related conditions, such as frailty, may have an impact on the prevention of late-life cognitive disorders. Frailty reflects a nonspecific state of vulnerability and a multi-system physiological change with increased risk for adverse health outcomes in older age. In this systematic review, frailty indexes based on a deficit accumulation model were associated with late life cognitive impairment and decline, incident dementia, and AD. Physical frailty constructs were associated with late-life cognitive impairment and decline, incident AD and mild cognitive impairment, vascular dementia, non-AD dementias, and AD pathology in older persons with and without dementia, thus also proposing cognitive frailty as a new clinical condition with co-existing physical frailty and cognitive impairment in non-demented older subjects. Considering both physical frailty and cognitive impairment as a single complex phenotype may be central in the prevention of dementia and its subtypes with secondary preventive trials on cognitive frail older subjects. The mechanisms underlying the cognitive-frailty link are multi-factorial, and vascular, inflammatory, nutritional, and metabolic influences may be of major relevance. There is a critical need for randomized controlled trials of intervention investigating the role of nutrition and/or physical exercise on cognitive frail subjects with the progression to dementia as primary outcome. These preventive trials and larger longitudinal population-based studies targeting cognitive outcomes could be useful in further understanding the cognitive-frailty interplay in older age.

Prevalence and Risk Factors for Low Habitual Walking Speed in Nursing Home Residents: An Observational Study

ObjectiveTo quantify habitual walking speed and estimate the prevalence of low habitual walking speed (<0.8m/s and <0.5m/s) in nursing home residents; and secondarily to gain some insight into whether demographic, health, and functional outcomes could predict the nursing home residents' walking speed. DesignCross-sectional study. SettingEleven nursing homes. ParticipantsNursing home residents (N=102 [37%] of 273 eligible, randomly selected residents from 11 nursing homes consented to participate in this study). InterventionsNot applicable. Main Outcome MeasuresThe primary outcome was habitual walking speed assessed over a distance of 2.4m. Secondary outcomes including body composition, muscle strength, balance and physical performance as assessed via the Short Physical Performance Battery, and historical and current demographic and health measures were all assessed as potential predictors of walking speed. ResultsMean walking speed was .37±.26m/s, meaning that 97% and 75% of participants had walking speeds <0.8m/s and <0.5m/s, respectively. Multivariable linear regression identified physical activity status before 50 years of age and daily sitting time as independent predictors of walking speed (r2=.25, P<.05), although this regression only accounted for 25% of the variance in walking speed. ConclusionsAlmost all participants in this study had below-normal walking speed, a known clinical predictor of physical performance. Because walking speed is a clinical marker of many age-related adverse outcomes in older age, efforts to increase or at least maintain walking speed in nursing home residents should be considered. Some evidence suggests that progressive resistance training may offset these declines in walking speed.

Poorer Financial and Health Literacy Among Community-Dwelling Older Adults With Mild Cognitive Impairment.

Literacy is an important determinant of financial and health outcomes in old age, and cognitive decline has been linked with lower literacy. We tested the hypothesis that mild cognitive impairment (MCI) is associated with poorer financial and health literacy. Participants (n = 730) from the Rush Memory and Aging Project were given a clinical evaluation and an assessment of total, financial, and health literacy. Regression was used to examine whether MCI was associated with lower literacy. In secondary analyses, we investigated the association of particular cognitive systems with literacy. MCI was associated with lower total, financial, and health literacy. An interaction was observed such that higher education reduced the effect of MCI on total and financial literacy. Multiple cognitive systems were associated with literacy in participants with MCI, and semantic memory accounted for the most variance. Persons with MCI exhibit poorer financial and health literacy, and education mitigates this effect.

P.3.b.017 Second language reflects more psychopathology but compensates the verbal fluency in bilinguals with schizophrenia

Brain signal complexity increases with development and is associated with better cognitive outcomes in older age. Research has also shown that bilinguals are able to stave off cognitive decline for longer periods of time than monolinguals, but no studies to date have examined whether bilinguals have more complex brain signals than monolinguals. Here we explored the hypothesis that bilingualism leads to greater brain signal complexity by examining multiscale entropy (MSE) in monolingual and bilingual young adults while EEG was recorded during a task-switching paradigm. Results revealed that bilinguals had greater brain signal complexity than monolinguals in occipital regions. Furthermore, bilinguals performed better with increasing occipital brain signal complexity, whereas monolinguals relied on coupling with frontal regions to demonstrate gains in performance. These findings are discussed in terms of how a lifetime of experience with a second language leads to more automatic and efficient processing of stimuli and how these adaptations could contribute to the prevention of cognitive decline in older age.

Nutrition, frailty, and Alzheimer's disease.

Currently, available drugs for the treatment of Alzheimer's disease (AD) have only symptomatic effects, and there is an unmet need of preventing AD onset and delaying or slowing disease progression in absence of disease-modifying therapies. Substantial epidemiological evidence suggested the hypothesis that modifiable metabolic, vascular, and lifestyle-related factors may be linked to the development of late-life cognitive disorders (Solfrizzi et al., 2011). Among these proposed factors, one appealing link is the association between dietary habits and the occurrence of AD (Tangney, 2014). Among age-related conditions closely associated to dementia and cognitive disorders in late life, frailty is a multidimensional geriatric condition that reflects a multisystem physiological change and a nonspecific state of vulnerability (Fried et al., 2001), with an increased risk for different adverse health outcomes in older age, including disability, falls, hospitalizations, and all-cause mortality (Fried et al., 2001). Although the operational definition of frailty is still controversial, in general, two approaches predominate. The “phenotypic” or physical definition of frailty or the “biological syndrome model” proposed five components: exhaustion, unintentional weight loss, weakness, slow walking speed, and low levels of physical activity. The frail state is defined by the presence of three or more of these components, the pre-frail state is defined by only one or two of these characteristics, while older individuals are “robust” when they have none of these frailty components (Fried et al., 2001). Other definitions, criticizing this concept, promote a multidimensional approach with a definition of frailty based on a cumulative model, employing frailty indexes for the evaluation of this condition, calculated by considering the accumulation of potential deficits, i.e., the presence of diseases, abnormal laboratory values, symptoms, signs, or disabilities (Rockwood et al., 2004). For all frailty models, cognitive and affective disorders, physical activity, and nutritional status have been suggested as markers of frailty (Kelaiditi et al., 2014). In particular, cognition has been considered a major component of frailty, also associated with adverse health outcomes (Rockwood et al., 2004). Therefore, possible preventive interventions on cognitive-related outcomes of frailty, including AD and dementia, may be operated though the prevention of this geriatric syndrome and its associated components (Panza et al., 2011; Robertson et al., 2013). Of note, in frailty prevention, the impaired nutrition, and weight loss of frail older subjects may be addressed by focused nutritional interventions.

Younger subjective age is associated with lower C-reactive protein among older adults.

Subjective age, or how young or old individuals experience themselves to be, is related to a range of health-related outcomes in old age, including mortality risk. Little is known, however, about its association with markers of systemic inflammation. Using data from the Health and Retirement Study (HRS), the present study examined the relation between subjective age and C-reactive protein (CRP). Participants were 4120 older adults from the 2008 wave of the HRS who provided measures of subjective age, CRP, demographic variables, Body Mass Index (BMI), depression, smoking, physical activity and disease burden. Regression analyses revealed that a younger subjective age was related to lower CRP, controlling for demographic factors. This association was reduced by half but remained significant when health and behavioral covariates were adjusted for, suggesting that BMI, physical activity and disease burden may partially account for lower inflammation in individuals with a younger subjective age. Furthermore, a logistic regression revealed that feeling younger than one's age was associated with reduced risk of exceeding the clinical threshold of CRP, controlling for covariates. The present study provides the first evidence of an association between subjective age and systemic inflammation among older adults. It suggests that individuals' ratings of their subjective age may help identify individuals at greater risk for immune dysfunction related to morbidity and mortality.

Retrospective lifetime dietary patterns predict cognitive performance in community-dwelling older Australians

Dietary intake is a modifiable exposure that may have an impact on cognitive outcomes in older age. The long-term aetiology of cognitive decline and dementia, however, suggests that the relevance of dietary intake extends across the lifetime. In the present study, we tested whether retrospective dietary patterns from the life periods of childhood, early adulthood, adulthood and middle age predicted cognitive performance in a cognitively healthy sample of 352 older Australian adults >65 years. Participants completed the Lifetime Diet Questionnaire and a battery of cognitive tests designed to comprehensively assess multiple cognitive domains. In separate regression models, lifetime dietary patterns were the predictors of cognitive factor scores representing ten constructs derived by confirmatory factor analysis of the cognitive test battery. All regression models were progressively adjusted for the potential confounders of current diet, age, sex, years of education, English as native language, smoking history, income level, apoE ɛ4 status, physical activity, other past dietary patterns and health-related variables. In the adjusted models, lifetime dietary patterns predicted cognitive performance in this sample of older adults. In models additionally adjusted for intake from the other life periods and mechanistic health-related variables, dietary patterns from the childhood period alone reached significance. Higher consumption of the 'coffee and high-sugar, high-fat extras' pattern predicted poorer performance on simple/choice reaction time, working memory, retrieval fluency, short-term memory and reasoning. The 'vegetable and non-processed' pattern negatively predicted simple/choice reaction time, and the 'traditional Australian' pattern positively predicted perceptual speed and retrieval fluency. Identifying early-life dietary antecedents of older-age cognitive performance contributes to formulating strategies for delaying or preventing cognitive decline.

Thyrotoxicosis in an Elderly Patient Simulating Infectious Gastroenteritis

A case of “apathetic” hyperthyroidism in which an elderly lady presented with symptoms of gastroenteritis was described. Thorough clinical assessment and systematic diagnostic work up are imperative to confirm an occult thyroid disorder as undiagnosed thyroid illness could cause a variety of adverse outcomes in old age.

It's Complicated: Age, Gender, and Lifetime Discrimination Against Working Women -The U.S. and the U.K. as Examples

This article considers the effect on women of a lifetime of discrimination using material from both the U.S. and the U.K. Government reports in both countries make clear that women workers suffer from multiple disadvantages during their working lives, which result in significantly poorer outcomes in old age when compared to men. Indeed, the numbers are stark. In the U.S., for example, the poverty rate of women 65 years old and up is nearly double that of their male counterparts. Older women of color are especially disadvantaged. The situation in the U.K. is comparable. To capture the phenomenon, the article develops a model of Lifetime Disadvantage, which considers the major factors that on average produce unequal outcomes for working women at the end of their careers.

Association among ageing‐related stereotypic beliefs, self‐efficacy and health‐promoting behaviors in elderly Korean adults

To examine the impact of ageing-related stereotypic beliefs on self-efficacy and health-promoting behaviours and to test the mediating effect of self-efficacy on the relationship between ageing-related stereotypic beliefs and health-promoting behaviours in older Korean people. Despite the growing attention given to ageing-related beliefs that can lead to better health outcomes in old age, little is known about the associations between ageing-related stereotypic beliefs, self-efficacy and health-promoting behaviours. A cross-sectional, descriptive study. A total of 123 community-dwelling older women were recruited from three cities in south-east Korea. Direct and indirect effects of ageing-related stereotypic beliefs on self-efficacy and health-promoting behaviours were examined using path analyses. Ageing-related stereotypic beliefs significantly predicted self-efficacy and health-promoting behaviours. A significant indirect effect of ageing-related stereotypic beliefs on health-promoting behaviours through self-efficacy was detected, indicating that self-efficacy mediated the detrimental impact of ageing-related stereotypic beliefs on health-promoting behaviours. Ageing-related stereotypic beliefs function as a factor lowering self-efficacy as well as decreasing health-promoting behaviours. Self-efficacy mediates the influence of ageing-related stereotypic beliefs on health-promoting behaviours, indicating that ageing-related stereotypic beliefs decrease self-efficacy which, in turn, could lead to fewer health-promoting behaviours. The findings demonstrate the significance of ageing-related stereotypic beliefs and self-efficacy in guiding the health-promoting behaviours of older people. Healthcare providers should play an active role in understanding ageing-related stereotypic beliefs and decreasing the perceptual barriers to health-promoting behaviours of older people. The development of nursing interventions to improve positive attitudes towards old age and self-efficacy is essential for enhancing health-promoting behaviours.

Do bonding and bridging social capital affect self-rated health, depressive mood and cognitive decline in older Japanese? A prospective cohort study

Little is known regarding the longitudinal effects of bonding and bridging social capital on health. This study examined the longitudinal associations of bonding and bridging social capital with self-rated health, depressive mood, and cognitive decline in community-dwelling older Japanese. Data analyzed in this study were from the 2010 (baseline) and 2012 (follow-up) Hatoyama Cohort Study. Bonding social capital was assessed by individual perception of homogeneity of the neighborhood (the level of homogeneity among neighbors) and of networks (the amount of homogeneous personal networks) in relation to age, gender, and socioeconomic status. Bridging social capital was assessed by individual perception of heterogeneity of networks (the amount of heterogeneous personal networks) in relation to age, gender, and socioeconomic status. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the effects of baseline social capital on poor health outcome at follow-up by logistic regression analysis. In total, 681 people completed baseline and follow-up surveys. The mean age of participants was 71.8 ± 5.1 years, and 57.9% were male. After adjusting for sociodemographics, lifestyle factors, comorbidity, functional capacity, baseline score of each outcome, and other bonding/bridging social capital, stronger perceived neighborhood homogeneity was inversely associated with poor self-rated health (OR = 0.55, 95% CI = 0.30–1.00) and depressive mood assessed by the Geriatric Depression Scale (OR = 0.58, 95% CI = 0.34–0.99). When participants who reported a depressive mood at baseline were excluded, stronger perceived heterogeneous network was inversely associated with depressive mood (OR = 0.40, 95% CI = 0.19–0.87). Neither bonding nor bridging social capital was significantly associated with cognitive decline assessed by the Mini-Mental State Examination. In conclusion, bonding and bridging social capital affect health in different ways, but they both have beneficial effects on the health of older Japanese. Our findings suggest that intervention focusing on bonding and bridging social capital may improve various health outcomes in old age.

Same-sex cohabiting elders versus different-sex cohabiting and married elders: Effects of relationship status and sex of partner on economic and health outcomes

In this article, I use pooled data from the 2008–2010 American Community Surveys to examine outcomes for different-sex married, different-sex cohabiting, and same-sex cohabiting elders across several key economic and health indicators, as well as other demographic characteristics. The findings suggest that elders in same-sex cohabiting partnerships differ from those in different-sex marriages and different-sex cohabiting relationships in terms of both financial and health outcomes, and that women in same-sex cohabiting partnerships fare worse than men or women in other couple types. The results indicate that financial implications related to the sex of one’s partner might be more predictive of economic and health outcomes in old age, rather than solely access to legal marriage. Nonetheless, findings suggest that individuals in same-sex cohabiting partnerships might experience worse outcomes in old age as a result of cumulative effects across the life course from both the sex of their partner (in the case of female couples) as well as their lack of access to benefits associated with marriage. Accordingly, these findings demonstrate that persons in same-sex cohabiting partnerships require unique policy considerations to address health and economic concerns in old age.

Vitamin D and bone health outcomes in older age

The aim of this review is to summarise the evidence linking vitamin D to bone health outcomes in older adults. A plethora of scientific evidence globally suggests that large proportions of people have vitamin D deficiency and are not meeting recommended intakes. Older adults are at particular risk of the consequences of vitamin D deficiency owing to a combination of physiological and behavioural factors. Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism. There seems to be inconsistent evidence for a protective role of vitamin D supplementation alone on bone mass. However, it is generally accepted that vitamin D (17·5 μg/d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects. Evidence for a benefit of vitamin D supplementation alone on reducing fracture risk is varied. According to a recent Agency for Healthcare Research and Quality review in the USA the evidence base shows mixed results for a beneficial effect of vitamin D on decreasing overall fracture risk. Limitations such as poor compliance with treatment, incomplete assessment of vitamin D status and large drop-out rates however, have been highlighted within some studies. In conclusion, it is generally accepted that vitamin D in combination with Ca reduces the risk of non-vertebral fractures particularly those in institutional care. The lack of data on vitamin D and bone health outcomes in certain population groups such as diverse racial groups warrants attention.

Neuroticism, Extraversion, and Motor Function in Community-Dwelling Older Persons

Personality traits are associated with adverse health outcomes in old age, but their association with motor function is unclear. We tested the hypothesis that neuroticism and extraversion are associated with motor decline in older persons. Prospective, observational cohort study. Retirement communities across metropolitan Chicago. Nine hundred eighty-three older persons without dementia. At baseline, neuroticism and extraversion were assessed and annual assessment of 18 motor measures were summarized in a composite measure. Average follow-up was 5 years. Separate linear mixed-effects models controlling for age, sex, and education showed that baseline levels of neuroticism and extraversion were associated with the rate of motor decline. For each 7-point (∼1 SD) higher neuroticism score at baseline, the average annual rate of motor decline was more than 20% faster. This amount of motor decline was associated with a 10% increased risk of death compared to a participant with an average neuroticism score. Each 6-point (∼1 SD) lower extraversion score at baseline was associated with an 8% faster rate of motor decline. This amount of motor decline was associated with about a 9% increased risk of death compared to a participant with an average extraversion score. Neuroticism and extraversion were relatively independently associated with motor decline. These associations were unchanged when controlling for depressive symptoms and current health status but were partially attenuated when controlling for late-life cognitive and social activities. Higher levels of neuroticism and lower levels of extraversion are associated with more rapid motor decline in old age.

Healthy Lifestyle Through Young Adulthood and the Presence of Low Cardiovascular Disease Risk Profile in Middle Age

Background— A low cardiovascular disease risk profile (untreated cholesterol &lt;200 mg/dL, untreated blood pressure &lt;120/&lt;80 mm Hg, never smoking, and no history of diabetes mellitus or myocardial infarction) in middle age is associated with markedly better health outcomes in older age, but few middle-aged adults have this low risk profile. We examined whether adopting a healthy lifestyle throughout young adulthood is associated with the presence of the low cardiovascular disease risk profile in middle age. Methods and Results— The Coronary Artery Risk Development in (Young) Adults (CARDIA) study sample consisted of 3154 black and white participants 18 to 30 years of age at year 0 (1985–1986) who attended the year 0, 7, and 20 examinations. Healthy lifestyle factors defined at years 0, 7, and 20 included average body mass index &lt;25 kg/m 2 , no or moderate alcohol intake, higher healthy diet score, higher physical activity score, and never smoking. Mean age (25 years) and percentage of women (56%) were comparable across groups defined by number of healthy lifestyle factors. The age-, sex-, and race-adjusted prevalences of low cardiovascular disease risk profile at year 20 were 3.0%, 14.6%, 29.5%, 39.2%, and 60.7% for people with 0 or 1, 2, 3, 4, and 5 healthy lifestyle factors, respectively ( P for trend &lt;0.0001). Similar graded relationships were observed for each sex-race group (all P for trend &lt;0.0001). Conclusions— Maintaining a healthy lifestyle throughout young adulthood is strongly associated with a low cardiovascular disease risk profile in middle age. Public health and individual efforts are needed to improve the adoption and maintenance of healthy lifestyles in young adults.

Age at Immigration and the Incomes of Older Immigrants, 1994 to 2010

Immigrants who enter the United States later in life comprise a growing share of legal permanent resident admissions. Due to their short working lives in the US and barriers to obtaining earned and means-tested public benefits since 1996, late-age immigrants may be at significant economic disadvantage relative to their counterparts who immigrate at younger ages. Using data on immigrants aged 65 and above from the 1994 to 2010 Current Population Surveys, we show that late-age immigration is associated with significantly lower personal incomes and lower participation in Social Security and Medicare, both of which have minimal work requirements. Entry at an older age is also associated with higher rates of participation in means-tested benefit programs, such as Supplemental Security Income (SSI) and Medicaid. For older immigrants, entry after the 1996 welfare reform law is associated with lower personal incomes and lower rates of receipt of SSI and Medicaid; however, we find only modest differences between pre- and post 1996 entrants in the relationship between age at entry and economic outcomes in older age.

The LUCAS* consortium

Decline in functional competence is a major determinant of older persons' needs, the development of dependency, use of care, clinical outcome and mortality. The interactions between rising life expectancy and changes in morbidity and disability warrant interdisciplinary research on functional disability, health promotion and prevention. The LUCAS (Longitudinal Urban Cohort Ageing Study) research consortium was established to study particular aspects of functional competence, its changes with ageing, to detect preclinical signs of functional decline, and to address questions on how to maintain functional competence and to prevent adverse outcome. The questions originate from problems encountered in practical health care provision in different settings, i.e. community, hospital and nursing home. The subprojects apply a longitudinal cohort follow-up study, an embedded randomised controlled intervention, cross-sectional comparative, and prospective intervention studies. The results will provide instruments to screen for preclinical signs of functional decline and concrete recommendations to sustain independence and prevent adverse outcomes in older age in daily practice.

Combinations of motor measures more strongly predict adverse health outcomes in old age: the rush memory and aging project, a community-based cohort study

ObjectiveMotor impairment in old age is a growing public-health concern, and several different constructs have been used to identify motor impairments in older people. We tested the hypothesis that combinations of motor constructs more strongly predict adverse health outcomes in older people.MethodsIn total, 949 people without dementia, history of stroke or Parkinson's disease, who were participating in the Rush Memory and Aging Project (a longitudinal community-based cohort study), underwent assessment at study entry. From this, three constructs were derived: 1) physical frailty based on grip strength, timed walk, body mass index and fatigue; 2) Parkinsonian Signs Score based on the modified motor section of the Unified Parkinson's Disease Rating Scale; and 3) a motor construct, based on nine strength measures and nine motor performances. Disability and cognitive status were assessed annually. A series of Cox proportional-hazards models, controlling for age, sex and education, were used to examine the association of each of these three constructs alone and in various combinations with death, disability and Alzheimer's disease (AD).ResultsAll three constructs were related (mean r = 0.50, all P < 0.001), and when considered individually in separate proportional-hazards models, were associated with risk of death, incident disability and AD. However, when considered together, combinations of these constructs more strongly predicted adverse health outcomes.ConclusionsPhysical frailty, parkinsonian signs score and global motor score are related constructs that capture different aspects of motor function. Assessments using several motor constructs may more accurately identify people at the highest risk of adverse health consequences in old age.

Long-Term Effects of Early Childhood Malaria Exposure on Education and Health: Evidence from Colonial Taiwan

We estimate the effects of early childhood malaria exposure on education and health at older ages by exploiting variations in malaria exposure risk around birth that resulted from a universal malaria eradication campaign in colonial Taiwan in the early 20th century. We find that malaria exposure around birth leads to lower life-time educational attainment and to worse mental and physical health outcomes in old age as reflected in particular in worse cognitive function, a higher likelihood of cardiovascular diseases and a higher mortality hazard, compared to those who were not exposed.