Risk Factors In Older Adults Research Articles

Prevalence of Loneliness and Associated Factors among Older Adults in South Africa

OBJECTIVE: Loneliness can be detrimental to health. The aim of this study is to estimate the prevalence of loneliness as well as its risk factors in older adults in South Africa.MATERIALS & METHODS: This cross-sectional population based study investigated factors associated with loneliness in a nationally representative sample (n=3624) of older South Africans who took part in the “Study of Global Ageing and Adults Health (SAGE)” wave 1 in 2008. The outcome variable was self-reported prevalence of loneliness and the exposure variables were socio-demographic characteristics and health variables.RESULTS: The overall prevalence of self-reported loneliness was 9.9%. Prevalence of loneliness was 10.2% for females and 9.5% for males, lowest among those married (7.5%), and highest among the 70+ years olds (12.5%). Individuals with highest level of education had the lowest prevalence of loneliness (5.9%). Indians or Asians were significantly more likely to experience loneliness than other population groups (Adjusted Odds Ratio=AOR: 3.20; 95% Confidence Interval=CI: 1.31, 7.80). Married or cohabiting individuals were significantly less likely to experience loneliness than unmarried or non-cohabiting ones, respectively (AOR: 0.55; 95% CI: 0.37, 0.81). In multivariable logistic regression, individuals with good subjective health were less likely to experience loneliness than those with poor health (AOR: 0.40, 95% CI: 0.22, 0.73). Similarly, individuals with good cognitive functioning were significantly less likely to experience loneliness than those with poor cognitive functioning (AOR: 0.55, 95% CI: 0.32, 0.97).CONCLUSION: The study found that the prevalence of loneliness among older adults in South Africa is significant. Preventative interventions that address the identified factors, including poor health status and low cognitive functioning, associated with loneliness need to be developed.

Identifying characteristics and outcomes that are associated with fall-related fatalities: multi-year retrospective summary of fall deaths in older adults from 2005\u20132012

BackgroundFall-related deaths continue to be the leading cause of accidental deaths in the older adult (65+ year) population. However, many fall-related fatalities are unspecified and little is known about the fall characteristics and personal demographics at the time of the fall. Therefore, this report describes the characteristics, circumstances and injuries of falls that resulted in older adult deaths in one U.S. County and explores the variables associated with fatal injuries from falls.MethodsThis is a continued retrospective analysis of 841older adults whose underlying cause of death was due to a fall over an 8-year period (2005–2012). Demographics and logistic regression of fall characteristics and injuries were analyzed.ResultsFalls that led to death most often occurred when walking in one’s own home. Most of the residents in this study were community-dwellers who had previous comorbidities taking an average of six medications prior to their fall. Survival after a fall was on average 31 days. The two most common injuries after a fatal fall were hip fractures (54%), and head injuries (21%). A logistic regression identified two variables associated with hip fracture, advancing age (OR = 1.05, 95% confidence interval [CI] = 1.02–1.08) and diagnosis of a prior neurological condition (OR = 2.1, 95% CI = 1.4–3.1). Variables associated with head injuries included younger age (OR = .91, 95% CI = .89–.94), male gender (OR = 2.5, 95% CI = 1.7–3.8), prescribed anticoagulants (OR = 2.4, 95% CI = 1.5–3.9) and negative musculoskeletal comorbidity (OR = 1.9. 95% CI = 1.1–3.0).ConclusionHip fractures and head injuries were the most common injury after a fall that led to death in older adults greater than 65 years. There are opposing risk factors for older adults who incur a hip fracture compared to a head injury. Thus, health professionals will need to individualize prevention efforts to reduce fall fatalities.

Changes in Cardiometabolic Risk Factors after High-Velocity Circuit Resistance or Treadmill Training in Older Adults

Cardiometabolic syndrome (CMS) is an aggregation of major risk factors that increases a person’s risk for developing cardiovascular disease, diabetes mellitus and the risk of mortality from cardiovascular disease. Continuous treadmill training (TM) has been shown to effectively attenuate the magnitude of CMS risk factors in a multitude of clinical populations. However, there is a paucity of research on the effects of high-velocity circuit resistance training (CRT) on CMS risk factors in older adults. PURPOSE: To compare the effects of CRT versus TM versus no exercise (CONT) on older adults with CMS risk factors. METHODS: Thirteen subjects (1M, 12F; 68.5 ± 7.3 years) with multiple risk factors for CMS participated in 12-weeks of CRT or TM. BMI, body fat % (BF), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), fasting glucose (GLUC), glycated hemoglobin (A1C), and c-Reactive Protein (CRP) were measured before and after the training. Nutritional intake was monitored to eliminate influence on CMS biomarkers. RESULTS: A within-group analysis showed that CRT exhibited significant decreases in A1C (MD= -0.367, SE= .142, p=0.03), SBP (MD= -21.67, SE= 6.35, p<.01), and DBP (MD= 9.33, SE= 2.53, p=.01), while TM had a trend toward decreased LDL-C (MD= 15.25, SE= 8.16, p=.09), and CONT showed a trend toward increases in CRP (MD= -0.16, SE= .08, p=.08). CRT also exhibited greater decreases in BMI, BF, and CRP than TM and CONT after the intervention, although statistical significance was not reached. There were no significant changes in TC, LDL-C, TG, or GLUC in any group. A between-group analysis showed CRT had significantly greater decreases in DBP compared to TM (MD= -10.58, SE= 3.34, p=.03) and CONT (MD= -12.13, SE= 3.19, p= .01) and a trend toward decreased SBP compared to CONT (MD= -19.47, SE= 8.03, p= .08). CONCLUSION: These preliminary results indicate that CRT results in greater improvements in CMS risk factors than TM. Although statistical significance was not reached for certain risk factors, a larger subject pool may strengthen our results.

Prevalence of depressive symptoms and its associated factors in older adults: a cross-sectional study in Kathmandu, Nepal

ABSTRACTObjective: Globally, depression is one of the most prevalent and burdensome conditions in older adults. However, there are few population-based studies of depression in older adults in developing countries. In this paper, we examine the prevalence of depressive symptoms and explore possible contributory risk factors in older adults living in Nepal.Methods: A cross-sectional study was conducted in two semi-urban communities in Kathmandu, Nepal. Depression was assessed using the 15-item Geriatric Depression Scale in 303 participants, aged 60 years and over. Multivariate logistic regression was then used to assess associations between potential risk factors and depression.Results: More than half of the participants (n = 175, 60.6%) had significant depressive symptomatology, with 27.7% having scores suggesting mild depression. Illiteracy (aOR = 2.01, 95% CI: 1.08–3.75), physical immobility (aOR = 5.62, 95% CI: 1.76–17.99), the presence of physical health problems (aOR = 1.97, 95% CI: 1.03–3.77), not having any time spent with family members (aOR = 3.55, 95% CI: 1.29–9.76) and not being considered in family decision-making (aOR = 4.02, 95% CI: 2.01–8.04) were significantly associated with depression in older adults.Conclusion: The prevalence of depression was significant in older adults. There are clear associations of depression with demographic, social support and physical well-being factors in this population. Strategies that increase awareness in the community along with the health and social care interventions are needed to address the likely drivers of depression in older adults.

Management of Atherosclerotic Cardiovascular Disease Risk Factors in the Older Adult Patient With Diabetes.

: Older adults with diabetes are at higher risk for atherosclerotic cardiovascular disease (ASCVD) than younger adults with diabetes and older adults without diabetes. The rationale to implement ASCVD risk-lowering therapies in older adults with diabetes is compelling. Recommendations for lifestyle modification, lipid-lowering therapy, blood pressure management, blood glucose control, and aspirin therapy are often based on studies that show their efficacy in younger populations. However, the risks associated with each of these interventions increase with age, and favorable risk-to-benefit ratios demonstrated in younger adults with diabetes are less certain in older populations. The variability in health status among older adults is pertinent. Those with robust health are more likely to tolerate and derive benefit from many therapies when compared with those who have more complex health including frailty. Age- and/or frailty-stratified data to help clarify these relationships are sparse. In this Perspective, current recommendations for modifying ASCVD risk are described with a review of the pertinent literature that guides their application in older adults. A pragmatic approach to the treatment of ASCVD risk factors in older adults with diabetes is presented.

Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength, power and balance in healthy older adults: a randomised control trial.

BackgroundIt is well documented that both balance and resistance training have the potential to mitigate intrinsic fall risk factors in older adults. However, knowledge about the effects of simultaneously executed balance and resistance training (i.e., resistance training conducted on unstable surfaces [URT]) on lower-extremity muscle strength, power and balance in older adults is insufficient. The objective of the present study was to compare the effects of machine-based stable resistance training (M-SRT) and two types of URT, i.e., machine-based (M-URT) and free-weight URT (F-URT), on measures of lower-extremity muscle strength, power and balance in older adults.MethodsSeventy-five healthy community-dwelling older adults aged 65–80 years, were assigned to three intervention groups: M-SRT, M-URT and F-URT. Over a period of ten weeks, all participants exercised two times per week with each session lasting ~60 min. Tests included assessment of leg muscle strength (e.g., maximal isometric leg extension strength), power (e.g., chair rise test) and balance (e.g., functional reach test), carried out before and after the training period. Furthermore, maximal training load of the squat-movement was assessed during the last training week.ResultsMaximal training load of the squat-movement was significantly lower in F-URT in comparison to M-SRT and M-URT. However, lower-extremity resistance training conducted on even and uneven surfaces meaningfully improved proxies of strength, power and balance in all groups. M-URT produced the greatest improvements in leg extension strength and F-URT in the chair rise test and functional reach test.ConclusionAside from two interaction effects, overall improvements in measures of lower-extremity muscle strength, power and balance were similar across training groups. Importantly, F-URT produced similar results with considerably lower training load as compared to M-SRT and M-URT. Concluding, F-URT seems an effective and safe alternative training program to mitigate intrinsic fall risk factors in older adults.Trial registrationThis trial has been registered with clinicaltrials.gov (NCT02555033) on 09/18/2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0366-3) contains supplementary material, which is available to authorized users.

Associations of walking with sarcopenic obesity and cardiovascular disease risk factors in older adults

Associations of walking with sarcopenic obesity and cardiovascular disease risk factors in older adults

Falls and Fall Prevention in Older Adults With Early-Stage Dementia: An Integrative Review.

Older adults with mild cognitive impairment (MCI) and early-stage dementia have an increased risk of falling, with risks to their health and quality of life. The purpose of the current integrative review was to evaluate evidence on fall risk and fall prevention in this population. Studies were included if they examined falls or fall risk factors in older adults with MCI or early-stage dementia, or reported interventions in this population; 40 studies met criteria. Evidence supports the increased risk of falls in individuals even in the early stages of dementia or MCI, and changes in gait, balance, and fear of falling that may be related to this increased fall risk. Interventions included exercise and multifactorial interventions that demonstrated some potential to reduce falls in this population. Few studies had strong designs to provide evidence for recommendations. Further study in this area is warranted. [Res Gerontol Nurs. 2017; 10(03):139-148.].

Risk of skin cancer in patients with diabetes mellitus: A nationwide retrospective cohort study in Taiwan.

Increasing evidence suggests that certain types of cancers are more common in people with diabetes mellitus (DM). This study aimed to investigate the risk of skin cancer in patients with DM in Taiwan. In this retrospective cohort study using data from the Taiwan Longitudinal Health Insurance Research Database, the risk of developing overall skin cancer, including nonmelanoma skin cancer (NMSC) and melanoma, was compared by Poisson regression analysis and Cox regression analysis between the DM and non-DM cohorts. The DM cohort with newly diagnosed DM (n = 41,898) and a non-DM cohort were one-to-one matched by age, sex, index date, and comorbidities (coronary artery disease, hyperlipidemia, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and obesity). Compared with non-DM cohort statistically, for the people with DM aged ≥60 years, the incidence rates of overall skin cancer and NMSC were significantly higher (overall: DM/non-DM: number [n] = 99/76, incidence rate ratio [IRR] = 1.44, P = 0.02; NMSC: DM/non-DM: n = 94/66, IRR = 1.57, P = 0.005). By Cox regression analysis, the risk of developing overall skin cancer or NMSC was significantly higher after adjusting for sex, comorbidities, and overall diseases with immunosuppression status (overall: adjusted hazard ratio [AHR] = 1.46, P = 0.01; NMSC: AHR = 1.6, P = 0.003). Other significant risk factors were older males for skin cancer (overall: AHR = 1.68, P = 0.001; NMSC: AHR = 1.59, P = 0.004; melanoma: AHR = 3.25, P = 0.04), chronic obstructive pulmonary disease for NMSC (AHR = 1.44, P = 0.04), and coronary artery disease for melanoma (AHR = 4.22, P = 0.01). The risk of developing melanoma was lower in the DM cohort than in the non-DM cohort, but without significance (AHR = 0.56, P = 0.28; DM/non-DM: n = 5/10). The incidence rate and risk of developing overall skin cancer, including NMSC, was significantly higher in older adults with DM. Other significant risk factors for older adults with DM were males for NMSC and melanoma, chronic obstructive pulmonary disease for NMSC, and coronary artery disease for melanoma.

Design of the Mobility and Independent Living in Elders Study: An older adult cohort in rural India.

The Mobility and Independent Living in Elders Study (MILES) was established in 2012 to estimate the prevalence, incidence, and risk factors for disability and age-related disease in rural older Indians. Here we describe the main goals of MILES, the essential elements of its design and examinations, and the initial findings from the baseline visit. A random sample of 562 men and women aged ≥60 years was enrolled from the Medchal region in Telangana State. Baseline examination consisted of two separate clinical visits, and included measurements of blood pressure, anthropometry, physical function, peripheral artery disease, cognitive function, bone and muscle quality, knee osteoarthritis, carotid intima-media thickness, and blood biomarkers. A comprehensive interview was carried out for demographics, disability and disease history. Annual follow-up visits are ongoing to collect information on incident disability and disease. The median age of participants was 66 years (range 60-92 years); median body mass index 21.7 kg/m2 , median gait speed 0.67 m/s and 55% self-reported their health status as fair or poor. These findings suggest a more frail population in the MILES cohort compared with older adults in USA cohorts. MILES will provide estimates of burden of disease, and disability and risk factors in older adults. Findings will be used to identify potential interventions to prevent disability in this rural Indian population. Geriatr Gerontol Int 2017; 17: 31-40.

Targeting Vascular Risk Factors in Older Adults

For many years vascular disease prevention strategies have been focused on reducing undertreatment, often using a “one-size-fits-all” approach to increase patient adherence. The paradigm of this approach has been the proposal of a polypill targeting multiple vascular risk factors, a standard treatment aimed at maximizing vascular protection. Conversely, during recent years an increasing emphasis has been placed on the issue of potential overtreatment, frequently resulting from the same treatment approach in all patients despite significant individual differences in comorbidity and life expectancy. In type 2 diabetes mellitus (T2DM), data from randomized clinical tr ials1 have shown uncertain or negative benefit-risk trade-offs associated with aggressive treatment of hypertension and hyperglycemia. These results, added to the well-known exclusion of elderly individuals with multiple morbidities from nearly all clinical trials, have informed recent guidelines, which now recommend more moderate targets for treatment of T2DM and hypertension in older participants, especially those considered frail or affected by important comorbidities.1 These treatment recommendations raise thepossible strategyof treatmentdeintensification forhighbloodpressure and hyperglycemia inpatientswithvaluespreviously identified as optimal and now labeled as low. This issue was addressed by Sussman and colleagues2 in a large retrospective sample of older individuals with T2DM (mean age, 78 years) from the Veterans Health Administration actively treated for T2DM or high blood pressure. They found that treatment deintensification (ie, dosage reduction or drug withdrawal) was performed in one-quarter or less of participants with low blood pressure (systolicbloodpressure<130mmHgordiastolicblood pressure <65 mm Hg) or a low hemoglobin A1c (HbA1c) level (<6.5%) (to convert to a proportion of total hemoglobin,multiply by 0.01). Moreover, whether treatment reduction occurredwasonlyweakly associatedwith apatient’s bloodpressure or HbA1c level and predicted life expectancy, suggesting that physicians are generally reluctant to deintensify treatment even in conditions that make benefits of therapy limited in comparison with potential harms. This interpretation is confirmed by a further study from theDepartmentofVeteransAffairs in thepresent issueofJAMA Internal Medicine. Caverly et al3 surveyed a national sample of health care professionals providing primary care, showing that almost half of themwouldnotworry aboutharmsof tight glycometabolic control obtained with an insulin secretagogue in an older patient at high risk for hypoglycemia. This approach to therapy was largely explained by the concern of making the patient’s HbA1c level fall out of Department of VeteransAffairs performancemeasures,which, as the authors point out, have never targeted values less than 7.0%. Nearly one-quarterof thehealthcareprofessionals interviewedwould even be concerned about malpractice liability risk with deintensification of hypoglycemic medications. In keepingwith these data, Sussman and colleagues2 call for a change in guidelines, qualitymeasures, and clinical performance management that should include recommendations and incentives to avoid overtreatment. This statement is alsoconsistentwitha recentanalysisofoutpatientandemergencydepartmentperformancemeasures in theUnitedStates that shows a lack of measures addressing overuse, especially regarding treatments.4 Yet, somecaveats shouldbe raised.Although studies ofmore aggressive control of risk factors have generally failed to show a reduction of cardiovascular events inT2DM, fewdataexist regarding theprognostic effectofdeintensification, especially in patients with good treatment tolerance. Conversely, more stringent targets are still recommended, although with a low level of evidence, for younger patients with a low risk for adverse events.1 In addition, incentives for treatmentwithdrawalmight carry a risk of avoiding potentially useful preventive strategies, especially in the present time of resource constraints. Less is not alwaysmore, andweshouldnot riskeliminating thebenefitsof therapywhile attempting to lower the risk. A proposed stratification of antihypertensive and antidiabetic treatment strategies according to patient vulnerability is described in the Figure, including issues that should be further clarified andpossible solutions. A first step is represented bytheneedforsimplebutclear indicatorsofvulnerability,which Related articles pages 1942 and 1994 Treatment Deintensification in Older Patients With Diabetes Mellitus Original Investigation Research

Alcohol Use as Risk Factors for Older Adults' Emergency Department Visits: A Latent Class Analysis.

IntroductionLate middle-aged and older adults’ share of emergency department (ED) visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns.MethodsData came from the 2013 National Health Interview Survey’s Sample Adult file (n=15,713). Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA) modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/moderate drinkers, and current heavy drinkers), chronic health and mental health status, and past-year ED visits as indicators.ResultsLCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group) were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/mental health problems; Class 2 (21%; low-risk group) consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group) was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group) included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors.ConclusionAlcohol nonuse/use (and quantity of use) and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex-drinkers improve chronic illnesses self-management.

Abstract 18258: High-intensity Interval Training Improves Aerobic Capacity and Metabolic Risk Factors in Older Adults: A Randomized Controlled Trial

Introduction: Aging is associated with increased cardiovascular disease risk including reduced aerobic capacity and increased metabolic risk factors. Aerobic exercise training improves the risk for cardiovascular disease. The optimal exercise regimen for older adults, however, remains unknown. We tested the hypothesis that high-intensity interval training (HIIT) would be more effective than isocaloric moderate-intensity continuous training (MICT) in improving aerobic capacity and metabolic risks factors in older adults. Methods: Thirty eight sedentary older adults (age 65±1.0 yrs; mean±SE), free of cardiovascular disease, were randomly assigned to HIIT (n=13), MICT (n=13) or non-exercise control group (n=12). HIIT consisted of cycling at alternating intensities of 90 and 70% maximal heart rate for 40 minutes while MICT consisted of cycling at 70% maximal heart rate for 47 minutes. HIIT and MICT were performed on Airdyne bicycles, 4 days/week for 8 weeks, under supervision. Aerobic capacity was assessed by peak oxygen consumption during an incremental treadmill test. Metabolic risk factors included fasting lipid profile, glucose, insulin, and insulin resistance (homeostasis model assessment; HOMA-IR). Body composition was assessed using dual-energy x-ray absorptiometry. All measures were obtained at baseline and following the intervention. Results: Peak oxygen consumption increased by 2.8 ml/kg/min (23.0±1.6 vs. 25.7±1.5, pre- vs. post-intervention; P &lt;0.05) in HIIT, but did not change in MICT and control group (26.0±1.5 vs. 26.2±1.4 and 23.5±1.4 vs. 24.0±1.4, respectively; P &gt;0.05). Insulin and HOMA-IR improved only in HIIT (-1.9±0.6μU/ml and -0.42±0.16, P &lt;0.05; respectively) and these changes were negatively associated with the change in peak oxygen consumption (r=-0.37, P &lt;0.05 for both). Overall, lipids, body weight, body fat, and fat-free mass did not change in response to the intervention in any of the groups (P&gt;0.05). Conclusions: HIIT but not MICT improves aerobic capacity and glucose control in healthy older adults without affecting lipids or body composition.

Resistance exercise training and circulatory responses to feeding and skeletal muscle protein anabolism in older men.

Sarcopenia, the age-related loss of muscle mass, contributes to frailty and the loss of independence in older adults. It is well known that ageing results in a decreased sensitivity of skeletal muscle to the anabolic effects of dietary protein, and one explanation for this may be the age-related reduction in muscle leg blood flow and microvascular blood volume (MBV). Low MBV could compromise the postprandial transport of key amino acids and insulin to skeletal muscle where they are known to stimulate muscle protein synthesis (MPS) and arrest rates of muscle protein breakdown (MPB), respectively. As a result, strategies that enhance MBV in older adults may augment the delivery of amino acids and insulin to skeletal muscle following a meal and thus serve as a viable means to combat sarcopenia.

The prevalence of fecal incontinence and associated risk factors in older adults participating in the SABE study.

To assess the prevalence of fecal incontinence (FI) and associated factors in older adults. The prevalence and factors associated with FI in older adults were studied by means the SABE study (Health, Well-being, and Aging). A group of 1,345 subjects were interviewed during the third wave of the SABE study performed in Sao Paulo, in 2010. The study included 64.3% females; the mean age of the participants was 70.4 years. The dependent variable was the positive answer for the question "In the last 12 months, have you ever lost control of bowel movements or stools?". Descriptive analysis and hierarchical logistic regression were performed. The independent variables were as follows: (a) demographics: gender, age and (b) clinical characteristics: self-reported chronic diseases, presence of cognitive and/or functional decline, depression and urinary incontinence symptoms, and nutritional status. The overall prevalence of FI was 11,7%, being 8.3% and 13.2% for males and females respectively. Among male subjects, the presence of malnutrition was associated with FI and thus presented a high relative risk index for its occurrence. Among female subjects, age group 70-74 years and some self-reported diseases or conditions such as mild depression, heart disease, urinary incontinence, and polypharmacy were associated with FI. For the first time in literature, polypharmacy appeared as an associated factor for FI for female older adults. The prevalence of FI in older adults was 11.7% and was mainly associated with advanced age and presence of heart disease, symptoms of depression, polypharmacy and urinary incontinence and malnutrition. Neurourol. Urodynam. 35:959-964, 2016. © 2015 Wiley Periodicals, Inc.

Cardiovascular disease (CVD) risk factors in older adults – Perception and reality

ObjectiveCVD are the leading causes of death and disability in the world. Since there are no published data about the knowledge of CVD risk factors among Croatian older adults, this was the primary aim of this study. Another aim was to determine relationship between actual CVD risk (total cholesterol – TC and triglyceride levels – TG, blood pressure – BP, body mass index – BMI, smoking) and self-assessed CVD risk among older adults. MethodsWe used a cross-sectional epidemiological study in which participants (969 subjects aged >70 years) answered a written questionnaire. Participants’ BMI, BP, TC and triglycerides were measured. ResultsThe actual presence of CVD risk factors in participants did not appear to alter their perceptions of risk compared to participants without CVD risk factors (the percentage of participants who think that they have moderate/high CVD risk is almost the same: 75.5% among participants with actual CVD risk factors; 75.7% among those without CVD risk factors). Accordingly, 24.5% of participants with actual CVD risk factors failed to recognize that risk.Only 23.4% of participants correctly recognized BP target values, while 49.8% participants successfully recognized TC target levels. The knowledge of target BP and/or TC levels did not influence participants’ ability to assess their own CVD risk.Surprisingly, 41.8% of participants reported that they have not discussed CVD risk factors with their physicians. ConclusionThe results suggest insufficient awareness of CVD risk factors among Croatian older adults and a need for improved promotion of CVD prevention in this population segment.

The effects of progressive resistance training combined with a whey-protein drink and vitamin D supplementation on glycaemic control, body composition and cardiometabolic risk factors in older adults with type 2 diabetes: study protocol for a randomized controlled trial.

BackgroundWhile physical activity, energy restriction and weight loss are the cornerstone of type 2 diabetes management, less emphasis is placed on optimizing skeletal muscle mass. As muscle is the largest mass of insulin-sensitive tissue and the predominant reservoir for glucose disposal, there is a need to develop safe and effective evidence-based, lifestyle management strategies that optimize muscle mass as well as improve glycaemic control and cardiometabolic risk factors in people with this disease, particularly older adults who experience accelerated muscle loss.Methods/DesignUsing a two-arm randomized controlled trial, this 6-month study builds upon the community-based progressive resistance training (PRT) programme Lift for Life® to evaluate whether ingestion of a whey-protein drink combined with vitamin D supplementation can enhance the effects of PRT on glycaemic control, body composition and cardiometabolic health in older adults with type 2 diabetes. Approximately 200 adults aged 50 to 75 years with type 2 diabetes, treated with either diet alone or oral hypoglycaemic agents (not insulin), will be recruited. All participants will be asked to participate in a structured, supervised PRT programme based on the Lift for Life® programme structure, and randomly allocated to receive a whey-protein drink (20 g daily of whey-protein plus 20 g after each PRT session) plus vitamin D supplements (2000 IU/day), or no additional powder and supplements. The primary outcome measures to be collected at baseline, 3 and 6 months will be glycated haemoglobin (HbA1c) and insulin sensitivity (homeostatic model assessment). Secondary outcomes will include changes in: muscle mass, size and intramuscular fat; fat mass; muscle strength and function; blood pressure; levels of lipids, adipokines and inflammatory markers, serum insulin-like growth factor-1 and 25-hydroxyvitamin D; renal function; diabetes medication; health-related quality of life, and cognitive function.DiscussionThe findings from this study will provide new evidence on whether increased dietary protein achieved through the ingestion of a whey-protein drink combined with vitamin D supplementation can enhance the effects of PRT on glycaemic control, muscle mass and size, and cardiometabolic risk factors in older adults with type 2 diabetes.Trial registrationAustralian New Zealand Clinical Trials ACTRN12613000592741.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-431) contains supplementary material, which is available to authorized users.

A multidimensional risk factor model for suicide attempts in later life.

BackgroundElderly suicide is a public health problem worldwide, and the risk factors are multidimensional. Chronic mental health problems, personality traits, stressful life events, comorbid medical conditions, social isolation, unemployment, and poverty are associated with higher risk for suicide in later life. There was a relative paucity of data on the neurobiological markers of elderly suicide.ObjectiveThis study examines the conjoint roles of cerebrovascular risk factors (CVRFs) and other established biopsychosocial risk factors in older adults who had made a recent suicide attempt.DesignA cross-sectional, case-controlled study.SettingA tertiary care setting in a public sector and a community setting.Subjects and methodsCases (N=77) were nondemented Chinese adults aged ≥65 years, enrolled in a regional psychogeriatric service following a suicide attempt; comparison subjects (N=99) were community-dwelling nondemented older adults with no lifetime history of suicide. Measures of sociodemographic profile, life events, suicidal behavior, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I psychopathology, personality traits, functional status, physical health, CVRFs, and executive cognitive functions were administered.ResultsWeighted sum of CVRF score was significantly higher in older women who had made a recent suicide attempt (mean: 10.56; standard deviation [SD]: 5.46) than comparison subjects (mean: 7.24; SD: 4.04) (t=3.52, P=0.001; df=99). Logistic regression showed that CVRF score (Exp[B]: 1.289, P=0.033), DSM-IV depressive disorders (current) (Exp[B]: 348, P<0.001), number of life events in the past 12 weeks (Exp[B]: 10.4; P<0.001), and being married (Exp[B]: 12.2, P<0.048) significantly increased odds for suicide attempt status in older women (Nagelkerke R2: 0.844). Association of CVRF score and suicide attempt status was not observed in older men for whom number of life events in the past 12 weeks (Exp[B]: 9.164; P<0.001), higher neuroticism (Exp[B]: 1.028; P=0.048), and impaired performance on a Modified Card Sorting Test (Exp[B]: 0.646; P=0.032) significantly increased odds for suicide attempt status in a logistic regression model (Nagelkerke R2: 0.611).ConclusionRisk factors for cerebrovascular diseases may be associated with higher risk for attempted suicide in older women, but not in older men. Older men and women have distinct risk factor profiles that may inform targeted intervention and prevention strategies.

Problems and fall risk determinants of quality of life in older adults with increased risk of falling.

Determine quality of life and its association with fall risk factors in older adults with increased risk of falling. A total of 597 community-dwelling Taiwanese older adults who were screened to have increased risk of falling participated in the present study. The fall risk factors included sociodemographics, physical and psychological function, Timed Up and Go, past fall/medical histories, fear of falling and medications. The Euro QOL EQ-5D was used to measure health-related quality of life. Pain/discomfort was the EQ-5D dimension most frequently reported to be impaired (35%), regardless of the level of fall risk or age groups, followed by mobility (25%). Hierarchical regression analysis showed that Geriatric Depression Scale, Mini-Mental State Examination, physiological function, up-and-go, fear of falling and psychotropic medication were independent predictors for total EQ-5D, explaining 68.37% of the variance. Logistic regression analysis showed that for the five EQ-5D dimensions, Geriatric Depression Scale and Up and Go time were the most common determinants. Pain/discomfort was the leading impairment, and greater Geriatric Depression Scale and longer up-and-go time were the main contributing factors in declines in quality of life in older adults with increased risk of falling. These factors are often modifiable, and their management might be considered a priority in falls prevention.

Risk Factors for Self-reported Driving Under the Influence of Alcohol and/or Illicit Drugs Among Older Adults.

Despite the increasing number of older adults who have a history of substance use, little research has been done on alcohol- and drug-related driving safety among older drivers. This study (a) examined risk factors for older adults' driving under the influence of alcohol and/or drugs (DUI) and (b) discerned differences between those aged 50-64 and those aged 65+. Data came from the public use files of the 2008-2012 National Survey on Drug Use and Health for respondents aged 50+ (N = 29,634). Descriptive statistics were used to present sample characteristics by past year substance use and self-reported DUI status for age groups 50-64 and 65+. Age group separate binary logistic regression analysis was used to identify risk factors for DUI. Of past-year substance users in the 50-64 and the 65+ age groups, 14.54% and 6.19%, respectively, self-reported DUI. Higher frequency alcohol use, binge drinking, marijuana use, and major depressive episode significantly increased the odds of DUI in both age groups. Lifetime arrest history was a predictor in the 65+ age group only. Research is needed to improve identification of older drivers at high risk of DUI. Driving safety assessments for older adults can incorporate screening for substance abuse and comorbid mental conditions to identify those at high DUI risk. Older adults who engage in risky substance use should be directed to appropriate services that address substance use and mental health problems concurrently.