Physical Function In Later Life Research Articles

EPIGENETIC AGE AND MUSCLE CHARACTERISTICS IN BALTIMORE LONGITUDINAL STUDY OF AGING PARTICIPANTS

Abstract Changes in muscle, including loss of muscle mass and fat infiltration, contribute to loss of muscle strength and subsequent declines in physical function in later life. Measures of body composition are consistently associated with DNA methylation (DNAm) in cross sectional studies. Whether differences in DNAm are informative with respect to longitudinal muscle characteristics has not been fully explored. Here we evaluate the relationship between epigenetic age metrics and computed tomography (CT) derived measures, including areas of muscle, subcutaneous fat, and intermuscular fat, as well as the mean and standard deviation of muscle intensity at mid-femur, in the Baltimore Longitudinal Study of Aging. Participants were at least 50 years old at the evaluation of DNAm (n = 471, 51% female), 61.8% of participants had three or more CT scans and mean follow up time was 6.0 years. Relationships between epigenetic age metrics including Horvath and Hannum DNAm age, PhenoAge, GrimAge and DunedinPACE at the index visit, and the trajectory of muscle composition were evaluated using multivariable mixed effects models adjusted for key demographic characteristics, health behaviors and body size. Epigenetic age metrics at the index visit were negatively correlated with the trajectory of muscle area over follow-up. Higher GrimAge at the index visit was associated with faster loss in muscle area and faster increase in fat areas (p < .05). Our analyses suggest that further exploration of DNAm with trajectories of muscle parameters may elucidate novel pathways of muscle dysfunction.

Aging-Related Multisystem Dysregulation Over the Adult Life Span and Physical Function in Later Life: The Atherosclerosis Risk in Communities (ARIC) Study.

Multisystem dysregulation (Dm) shows promise as a metric of aging and predicts mortality. However, Dm needs to be studied with less severe endpoints indicating modifiable aging stages. Physical function, reflecting healthy longevity rather than just longevity, is more relevant to the goals of geroscience but has not been well investigated. We tested the association of midlife Dm and its change over ~20 years with physical function in later life in 5 583 the Atherosclerosis Risk in Communities Study cohort participants (baseline mean age 54.7). Dm quantifies the multivariate statistical deviation of 17 physiologically motivated biomarkers relative to their distribution in a young healthy sample at baseline. Physical function was assessed from grip strength and the Short Physical Performance Battery (SPPB). Associations were quantified using linear regression and ordinal logistic regression adjusting for age, sex, race, and education. Each unit increment in midlife Dm was associated with 1.71 times the odds of having a lower SPPB score. Compared to the first quartile of midlife Dm, the odds ratios of having a lower SPPB score were 1.25, 1.56, and 2.45, respectively, for the second-fourth quartiles. Similar graded association patterns were observed for each SPPB component test and grip strength. An inverse monotonic relationship also was observed between the annual growth rate of Dm and physical function. Greater Dm and progression in midlife were associated with lower physical function in later life. Future studies on the factors that lead to the progression of Dm may highlight opportunities to preserve physical function.

Association between oral health markers and decline in muscle strength and physical performance in later life: longitudinal analyses of two prospective cohorts from the UK and the USA

Poor oral health could be associated with changes in musculoskeletal health over time. This aim of this study was to investigate the longitudinal relationship between oral health and decline in physical function in later life. We did a prospective analysis of two cohorts of older adults (aged 70 years or older) including men from the British Regional Heart Study (BRHS; n=612), and men and women from the Health, Aging and Body Composition (Health ABC) Study (n=1572), followed up for about 8 years. Data were available for clinical or self-reported oral health measures, muscle (grip) strength, and physical performance (chair stand and gait speed). ANCOVA models were used to assess the association between oral health and follow-up physical function scores. Multivariate logistic regression models were used to examine the associations between oral health and decline in physical function over the follow-up period. In the BRHS, changes in oral health and physical function were also assessed. All models were adjusted for relevant sociodemographic, behavioural, and health-related factors. In the BRHS, complete tooth loss and difficulty eating were associated with weaker grip strength at follow-up, and periodontal status was associated with decline in gait speed. In the Health ABC Study, complete tooth loss, poor self-rated oral health, and the presence of one oral health problem were associated with slower gait speed at follow-up. In both studies, dry mouth was associated with declines in physical function. In the BRHS, deterioration of dentition (tooth loss) over the follow-up period was associated with decline in chair stand speed (adjusted odds ratio 2·34 [95% CI 1·20-4·46]), as was deterioration in difficulty eating (2·41 [1·04-5·60]). Oral health problems are associated with poorer physical function and greater decline in physical function in older adults, and could be an indicator of individuals at risk of reduced physical capacity and subsequent frailty and disability in later life. The Dunhill Medical Trust and the US National Institutes of Health-National Institute of Dental and Craniofacial Research.

Diet quality and exercise in older veterans with PTSD: a pilot study.

Older veterans with posttraumatic stress disorder (PTSD) are at increased risk of obesity and cardiometabolic disease. Physical activity and healthy eating are two behaviors that impact health, functional independence, and disease risk in later life, yet few studies have examined the relationship between PTSD and diet quality. This secondary analysis aimed to: (a) characterize the diet quality of older veterans with PTSD in comparison to U.S. dietary guidelines and (b) explore if participation in a supervised exercise intervention spurred simultaneous changes in dietary behavior. Diet quality was assessed with the Dietary Screener Questionnaire (DSQ), which measures daily intake of fiber, calcium, added sugar, whole grain, dairy, and fruits/vegetables/legumes. The sample included 54 military veterans ≥ 60 years old with PTSD who participated in a randomized controlled pilot trial comparing 12 weeks of supervised exercise (n = 36) to wait-list usual care (n = 18). The DSQ was administered at baseline and 12 weeks. Consumption of added sugar exceeded U.S. dietary guideline recommendations and consumption of whole grains, fruits/vegetables/legumes, fiber, calcium, and dairy fell short. Participation in the supervised exercise intervention was not associated with changes in diet quality. Results revealed that the diet quality of older veterans with PTSD is poor, and while the exercise intervention improved health through exercise, it did not make veterans any more likely to adopt a more healthful diet. Interventions targeting diet, or diet + exercise, are needed to manage the increased risk of obesity and cardiometabolic disease present in older veterans with PTSD.

Domain-specific self-perceptions of aging are associated with different gait patterns in older adults: a cross-sectional latent profile analysis

BackgroundPrevious studies have pointed to the impact of self-perceptions of aging (SPA) on self-reported physical function in later life. However, less is known about associations of SPA with objectively measured physical function, especially gait. Research that examined other psychological variables and objectively measured gait has focused on single gait parameters such as gait speed, which seems to fall short for the complexity of this movement. Some approaches have proposed ways to identify gait patterns in specific patient groups, but not in community samples. Our goal was (a) to identify gait patterns based on a combination of important gait parameters in a community sample, and (b) to investigate differential associations of gain- and loss-related SPA with these gait patterns.MethodsThe study used an electronic walkway to assess gait parameters of 150 community dwelling adults aged 71–93 years (61.0% women) at their usual and maximum gait speed. SPA were assessed with a questionnaire. We used latent profile analysis (LPA) to identify groups exhibiting distinct gait patterns and binary logistic regression to investigate associations of SPA with these groups, controlling for personality traits, number of illnesses, age, gender, and education. To compare overall function between groups, a t-test for scores in the Short Physical Performance Battery was used.ResultsLPA revealed two distinct groups in both gait speed conditions. The fit group exhibited a stable, well-coordinated and faster gait pattern, while the functionally limited group’s gait pattern was less stable, less coordinated and slower. The odds of belonging to the functionally limited group were increased by loss-related SPA at usual gait speed, while the odds of belonging to the fit group were increased by gain-related SPA at individual maximum speed.ConclusionsThe findings (a) suggest LPA as a useful approach to investigate complex gait patterns considering several gait parameters simultaneously, and (b) provide first evidence for differential associations of gain- and loss-related SPA with gait patterns at usual and maximum gait speed. Intervention studies addressing gait in older adults should additionally address gain-related views on aging.

Long-Term Exposure to Anticholinergic and Sedative Medications and Cognitive and Physical Function in Later Life.

Anticholinergic and sedative medications are frequently prescribed to older individuals. These medications are associated with short-term cognitive and physical impairment, but less is known about long-term associations. We therefore examined whether over 20 years cumulative exposure to these medications was related to poorer cognitive and physical functioning. Older adult participants of the Longitudinal Aging Study Amsterdam (LASA) were followed from 1992 to 2012. On seven measurement occasions, cumulative exposure to anticholinergic and sedative medications was quantified with the drug burden index (DBI), a linear additive pharmacological dose-response model. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE), Alphabet Coding Task (ACT, three trials), Auditory Verbal Learning Test (AVLT, learning and retention condition), and Raven Colored Progressive Matrices (RCPM, two trials). Physical functioning was assessed with the Walking Test (WT), Cardigan Test (CT), Chair Stands Test (CST), Balance Test (BT), and self-reported Functional Independence (FI). Data were analyzed with linear mixed models adjusted for age, education, sex, living with a partner, BMI, depressive symptoms, comorbidities (cardiovascular disease, diabetes, cancer, COPD, osteoarthritis, CNS diseases), and prescribed medications. Longitudinal associations were found of the DBI with poorer cognitive functioning (less items correct on the three ACT trials, AVLT learning condition, and the two RCPM trials) and with poorer physical functioning (longer completion time on the CT, CST, and lower self-reported FI). This longitudinal analysis of data collected over 20 years, showed that higher long-term cumulative exposure to anticholinergic and sedative medications was associated with poorer cognitive and physical functioning.

The scars of the past? Childhood health and health differentials in later life

This study estimates multilevel mixed effects models of three retrospective measures of childhood health – self-rated childhood health, exposure to parental smoking growing up, and missing school for 30 or more consecutive days due to a health event – on levels and changes in physical functioning at age 50 and beyond. Using data from 15 waves of the Household, Income and Labour Dynamics in Australia survey, the results show that variation in the level of later-life physical functioning is associated with childhood health. Poor childhood health however is not associated with the rate of physical functioning decline. Respondents who reported poor childhood health and were migrants to Australia from a non-English speaking country reported better physical functioning in later life, compared with non-Indigenous Australian-born respondents who reported poor childhood health. In contrast, women who reported poor self-rated childhood health reported worse physical functioning compared with men who reported poor self-rated childhood health. These findings are robust to the inclusion of a range of measures of childhood and adult characteristics and circumstances. These results suggest that Australia, with arguably a strong and supportive health care system as compared with the U.S., may mitigate the accumulation of disadvantages to those who reported poor childhood health. We note that though functional health differences due to childhood health are not exacerbated in later life, neither are they eliminated.

Prolongation of working life and physical functioning in old age in Sweden

Background The continuously aging population puts strain on social and welfare systems. This has led to many countries, including Sweden, to develop policies to encourage people to delay retirement and extend their working life. However, the discussion about delaying retirement often overlooks potential health inequalities. Previous studies examining the impact of retirement on physical health have shown mixed results, which may be due to socioeconomic differences or because of insufficiently addressing factors preceding retirement. Age of retirement is dependent on various factors such as health, financial security and socioeconomic status, lifestyle, spousal retirement and family circumstances. Individuals with high socioeconomic status (SES) who extend their working lives may have better working conditions, while those with poor with low SES may extend their working life for economic reasons despite health issues or poor working conditions, resulting in poor physical function in old-age. This study examines whether the association between retirement age and late life physical functioning differs by SES. The overall aim is to explore: –if there is an association between retirement age and late life physical functioning; –if the association differs by socioeconomic status. Methods Data are used from two interrelated nationally representative longitudinal studies: The Swedish Level of Living Survey (LNU) and the Swedish Panel Study of Living conditions of the Oldest Old (SWEOLD), linked to annual tax register data. We apply Propensity score matching using a rich set of control variables that are expected to influence both retirement age and late-life health. After successful matching we use Average treatment effects on the treated (ATT) to estimate the effect of prolonging working life on late life health. Finally we carried out a logistic regression analysis with the respective physical health indicator as dependent variable and socioeconomic status as independent variable. We report the marginal effects for the treated (retire after age 65) and untreated individuals (retiring before or at age 65) separately for manual and non-manual workers. Results Preliminary results showed that for mobility, musculoskeletal pain, self-rated health and ADL limitations, there are small but significant positive effects of delaying retirement beyond age 65 compared to those who retired earlier. People of lower SES had, in general, worse health outcomes in late life than those of higher SES, and results from stratified analysis by SES showed that manual workers had positive effects of delaying retirement, although the differences were not significant. Conclusions This article sought to reveal the causal effects of prolonging working life on individuals’ old-age health. Prolonging working life was generally associated with better physical functioning in later life and did not increase socioeconomic health differences in late life. This could have important policy implications as many countries create policies encouraging older work force to stay in employment.

Physical activity trajectories during midlife and subsequent risk of physical functioning decline in late mid-life: The Study of Women's Health Across the Nation (SWAN)

The purpose of this study was to examine the importance of midlife physical activity on physical functioning in later life. Data are from 1771 Study of Women's Health Across the Nation (SWAN) participants, aged 42–52 (46.4±2.7) years at baseline (1996–97). Latent class growth analysis was used to identify physical activity trajectory groups using reported sports and exercise index data collected at seven time-points from baseline to Visit 13 (2011–13); objective measures of physical functioning performance were collected at Visit 13. The sports and exercise index (henceforth: physical activity) is a measure of moderate to vigorous intensity physical activity during discretionary periods of the day. Multivariable linear regression analyses were used to model each continuous physical performance measure as a function of the physical activity trajectory class. Across midlife, five physical activity trajectory classes emerged, including: lowest (26.2% of participants), increasing (13.4%), decreasing (22.4%), middle (23.9%), and highest (14.1%) physical activity. After full adjustment, women included in the middle and highest physical activity groups demonstrated ≥5% better physical functioning performance than those who maintained low physical activity levels (all comparisons; p<0.05). Statistically significant differences were also noted when physical activity trajectory groups were compared to the increasing physical activity group. Results from the current study support health promotion efforts targeting increased (or maintenance of) habitual physical activity in women during midlife to reduce future risk of functional limitations and disability. These findings have important public health and clinical relevance as future generations continue to transition into older adulthood.

Prenatal Undernutrition and Physical Function and Frailty at the Age of 68 Years: The Dutch Famine Birth Cohort Study.

There is evidence suggesting that the aging process has its origins in utero. We have previously shown that prenatal exposure to the Dutch famine is associated with chronic noncommunicable diseases and poorer cognitive function in men and women and increased mortality in women. We investigated whether prenatal undernutrition during early gestation is associated with decreased physical function in later life. Between November 2012 and September 2013, we have studied a random subsample of 150 members of the Dutch famine birth cohort at the age of 68 years, of which 49 were exposed to prenatal undernutrition. In this observational study, we measured indicators of physical function including grip strength and the short physical performance battery. We composed categories of frailty, according to the Fried frailty scale. We also assessed self-reported activity and self-perceived health. Men, but not women, exposed to prenatal undernutrition had significantly lower grip strength (B = -4.2kg; 95% confidence interval: -8.2 to -0.3) and a lower physical performance score (B = -0.8 points; 95% confidence interval: -1.5 to 0.0) than unexposed men, independent of relevant confounders. There were no differences in frailty, self-reported activity, or self-perceived health between exposed and unexposed groups. Our study results suggest that prenatal undernutrition is associated with decreased physical function in later life in men, but not in women. Our findings provide further evidence for the hypothesis that prenatal undernutrition may lead to an accelerated aging process in humans. We currently do not have sufficient power to detect effects on frailty.

Age-associated declines in muscle mass, strength, power, and physical performance: impact on fear of falling and quality of life.

This 3-year longitudinal study among older adults showed that declining muscle mass, strength, power, and physical performance are independent contributing factors to increased fear of falling, while declines of muscle mass and physical performance contribute to deterioration of quality of life. Our findings reinforce the importance of preserving muscle health with advancing age. The age-associated loss of skeletal muscle quantity and function are critical determinants of independent physical functioning in later life. Longitudinal studies investigating how decrements in muscle components of sarcopenia impact fear of falling (FoF) and quality of life (QoL) in older adults are lacking. Twenty-six healthy older subjects (age, 74.1 ± 3.7; Short Physical Performance Battery (SPPB) score ≥10) and 22 mobility-limited older subjects (age, 77.2 ± 4.4; SPPB score ≤9) underwent evaluations of lower extremity muscle size and composition by computed tomography, strength and power, and physical performance at baseline and after 3-year follow-up. The Falls Efficacy Scale (FES) and Short Form-36 questionnaire (SF-36) were also administered at both timepoints to assess FoF and QoL, respectively. At 3-year follow-up, muscle cross-sectional area (CSA) (p < 0.013) and power decreased (p < 0.001), while intermuscular fat infiltration increased (p < 0.001). These decrements were accompanied with a longer time to complete 400m by 22 ± 46s (p < 0.002). Using linear mixed-effects regression models, declines of muscle CSA, strength and power, and SPPB score were associated with increased FES score (p < 0.05 for each model). Reduced physical component summary score of SF-36 over follow-up was independently associated with decreased SPPB score (p < 0.020), muscle CSA (p < 0.046), and increased 400m walk time (p < 0.003). In older adults with and without mobility limitations, declining muscle mass, strength, power, and physical performance contribute independently to increase FoF, while declines of muscle mass and physical performance contribute to deterioration of QoL. These findings provide further rationale for developing interventions to improve aging muscle health.

Are economic recessions at the time of leaving school associated with worse physical functioning in later life?

PurposeTo examine whether economic conditions at the time of leaving school or college are associated with physical functioning in later life among cohorts in 11 European countries. MethodsData came from 10,338 participants in the Survey of Health, Ageing and Retirement in Europe (SHARE) aged 50–74 who left school or college between 1956 and 1986. Data on functional limitations, as well as employment, marriage, and fertility retrospective histories were linked to national unemployment rates during the year individuals left school. Models included country-fixed effects and controls for early-life circumstances. ResultsGreater unemployment rates during the school-leaving year were associated with fewer functional limitations at ages 50–74 among men (rate ratio 0.63, 95% confidence interval 0.47–0.83), but more physical functioning limitations among women (rate ratio 1.30, 95% confidence interval 1.13–1.50), particularly among those with (post-)secondary education. Economic conditions at the age of leaving school were associated with several labor market, marriage, fertility, and health behavior outcomes, but controlling for these factors did not attenuate associations. Results were similar in models that controlled for selection into higher education due to measured covariates. ConclusionsWorse economic conditions during the school-leaving year predicted better health at later life among men but worse health among women. Both selection and causation mechanisms may explain this association.

The cross-domain correlates of subjective age in Chinese oldest-old

Objectives: This study examined subjective age and its cross-domain correlates in Chinese oldest-old.Method: We conducted a secondary data analysis using cross-sectional data drawn from the 2006 Sample Survey on the Aged Population in Urban/Rural China, which consisted of a sample of 860 community-dwelling Chinese older adults aged 85 years and above.Results: A small percentage (8%) of the oldest-old participants reported that they did not feel old. Binary logistic regression analyses revealed that urban living, better physical and self-reported cognitive functioning and mental health were all related to not feeling old, whereas chronological age was found to have no association with subjective age when controlling for indicators of physical and self-reported cognitive functioning.Conclusion: The findings revealed the key roles of functional limitations and mental health in the construction of subjective age in Chinese oldest-old. The possible cross-cultural similarity in the links of subjective age to mental health and physical functioning in later life suggests that maintaining a youthful subjective age may have adaptive value for the oldest-old and contribute to their successful aging.

Paying the price? The impact of smoking and obesity on health inequalities in later life

The aims of the study are twofold: (i) to explore the impact of socioeconomic position, as measured 13 years earlier, on cognitive functioning and mobility impairment in later life, and (ii) to explore the extent to which obesity and smoking status can explain socioeconomic inequalities in cognitive and mobility impairments in later life. Data from a nationally representative sample of Swedish adults aged 56-76 in 1991 who were re-interviewed 13 years later in 2004, was analysed to explore the impact of socioeconomic position, smoking, and obesity on cognitive and physical functioning in late life. The results showed that both smoking and obesity in late mid-life were stratified by socioeconomic position. Moreover, the results showed significant associations between socioeconomic position and both cognitive and physical functioning in later life. However, these inequalities in late life function could only partially be explained by the socioeconomic differences in smoking and obesity. The findings of this study suggest that socioeconomic differences in the rates of smoking and obesity may explain some, but not all, of the socioeconomic inequalities in physical and cognitive functioning during old age.