Taiwan Longitudinal Study In Aging Research Articles

Employment status and depressive symptoms in taiwanese older adults: an 11-year prospective cohort study

BackgroundTaiwan became an aged society in March 2018, and it is expected to become a super-aged society by 2025. The trend of increasing proportions of older adults continuing to work is inevitable. However, few studies have been conducted to investigate the effects of employment on the mental health of older adults. Therefore, we longitudinally explored the relationship between employment status and depressive symptoms in Taiwanese older adults.MethodsThe study included 5,131 individuals aged 50 and above, of which 55.6% were men, who had participated in the national-wide Taiwan Longitudinal Study of Aging in 1996, 1999, 2003, and 2007. Of them, 1,091 older adults had completed all four surveys. Depressive symptoms were assessed using the Center for Epidemiological Studies of Depression scale; the total score on this scale ranges from 0 to 30. Employment status was assessed during each survey wave. Logistic regression was performed using a cross-sectional design. The effects of unemployment on depressive symptoms were analyzed using a generalized estimating equation model with a repeated measures design.ResultsIn each survey wave, employed older adults exhibited better mental health than did unemployed ones. After adjustments for potential confounders, unemployment was found to exert a significant adverse effect on depressive symptoms. The repeated measures analysis revealed that employment protected against depressive symptoms, as noted in the subsequent surveys conducted after 3 to 4 years (aOR [95% CI] = 0.679 [0.465–0.989]).ConclusionEmployment may reduce the risk of depressive symptoms in community-dwelling older adults in Taiwan.

Associations of fish oil with cardiovascular disease events: results from the Taiwan longitudinal study in aging

BackgroundThe effectiveness of fish oil in preventing cardiovascular events is still debating. Some studies indicate a correlation between the use of fish oil supplements and reduced mortality or decreased incidence of stroke. However, other studies show no significant association between fish oil intake and stroke prevention, indicating an ongoing debate. This study aimed at exploring which subjects may benefit more from fish oil supplementation.MethodsThis study utilized the data obtained through face-to-face interview from the Taiwan Longitudinal Study in Aging (TLSA). A total of 3,652 participants were included from the 2003 baseline data, after excluding patients with pre-existing ischemic heart disease or stroke. Participants were divided into two groups based on whether taking fish oil supplement or not. Participants were followed until 2015, estimating and comparing the all-cause mortality and cumulative incidence rate of stroke between both groups.ResultsThe results of the 12-year longitudinal study showed that the cumulative incidence rate of stroke in the fish oil supplementation group was 5.7%, compared to 7.7% in the non-supplemented group (P < 0.05). Additionally, the crude hazard ratio for stroke was significantly lower in the fish oil supplementation group (HR = 0.686;95% CI 0.476–0.987). However, after adjusting potential confounders, the adjusted risk of stroke was lower only for the diabetic patients supplemented with fish oil (aHR = 0.123; 95% CI 0.016–0.930) compared to non-diabetic patients (aHR = 0.917; 95% CI 0.616–1.364).ConclusionThis study suggests that there is an association between fish oil supplementation and a lower cumulative incidence rate of subsequent stroke among diabetic patients.

The effects of diabetes, hypertension and subsequent health control behavior on the survival of a Taiwan cohort aged over 50 years

PurposeThis study used the Taiwan Longitudinal Study in Aging from 1996 to 2011 to investigate the effects of diabetes, hypertension, and healthy living behaviors of those aged over 50 years on the survival status in Taiwan. MethodsAmong the 5,131 participants aged 50 years and above in the 1996 survey were included in this study. Cox’s proportional hazards model was used to examine the incidence of diabetes, hypertension, and related mortality risk in those aged over 50 years. ResultsAfter adjusting for age, gender, education level, diabetes, hypertension, health behavior, and leisure activity, results from the Cox model show that the elderly without diabetes have a lower mortality risk than those with diabetes. Regular exercise was associated with a lower risk of mortality. The hazard ratios of elderly with regular exercise were 0.78 (95 % CI: 0.64–0.96) for two times a week or less, 0.81 (95 % CI: 0.69–0.96) for 3–5 times a week, and 0.84 (95 % CI: 0.77–0.93) for 6 + times a week, respectively. On the other hand, leisure activity positively reduces mortality risk. For example, the hazard ratios of the elderly with watching TV and reading were 0.63 (95 % CI: 0.55–0.72) and 0.80 (95 % CI: 0.72–0.89), respectively. Moreover, smoking can increase mortality risk 23 % whether the elderly are with diabetes or hypertension or not. ConclusionsRegarding preventing and controlling chronic diseases in the future, continuously encouraging improvement in health behavior and engaging in leisure activities for the middle-aged and over should be considered essential markers.

The benefits of leisure activities on healthy life expectancy for older people with diabetes

PurposeThe purpose of this study is to examine whether leisure activities can help reduce years lived with disability and increase healthy life expectancy of diabetics aged 50 years and above.MethodsAnalysis was based on five waves of follow-up survey data (Taiwan Longitudinal Study of Aging, TLSA) from 1996 to 2011. A total of 5131 participants aged 50 years and above in 1996 were included in the analysis, and gender, leisure activity participation, and diabetes mellitus were used as primary variables to examine the variation trend in health status in the participants. The health status in the various waves of surveys was measured using the activities of daily living scale, and nondisabled was defined as healthy. A multivariate logistic regression model was used to calculate the life expectancy (LE) and healthy life expectancy (HLE) of the people aged 50 years and above.ResultsThe diabetes older people with a high frequency of leisure activities have longer HLE than those with lower activity frequency. Using 50-year-old diabetic women as an example, the LE (HLE) of those with six or more leisure activities and those with three or fewer leisure activities was 30.40 (25.34) and 24.90 (20.87), respectively. The LE (HLE) of men with the same conditions was 24.79 (22.68) and 20.30 (18.45), respectively.ConclusionsThis study used life expectancy and healthy life expectancy as markers to evaluate health benefits and provided evidence that leisure activities can help extend the life span and maintain the health status of middle-aged and older diabetics.

The Impact of Social Vulnerability on Alcohol Consumption and Mortality: A 20-year Age, Sex-stratified Analysis from the Taiwan Longitudinal Study of Aging

ObjectiveThis study aimed to use the Social Vulnerability Index (SVI) to encapsulate the complex and multidimensional nature of social determinants and their influence on alcohol intake and mortality in middle-aged and older individuals. DesignCohort study. Setting and ParticipantsData were obtained from the Taiwan Longitudinal Study on Aging (TLSA), with 3945 study participants aged 50 years and older. MethodsThe TLSA questionnaire defined SVI (51 items including living conditions, social support, socially oriented activities of daily living, social engagement and leisure, empowerment of life, satisfaction about life, and socioeconomic status) and alcohol intake (behavior as well as type and frequency of alcohol intake). Multivariate Cox proportional hazard models were used to estimate the association between alcohol intake and mortality, stratified by sex and SVI groups. ResultsMen with high social vulnerability and high alcohol intake exhibit an elevated mortality risk [adjusted hazard ratio (aHR), 1.51; 95% CI, 1.01–2.24], whereas notably, women in similar social circumstances but with moderate alcohol intake face a quintupled mortality risk (>35 g/wk; aHR, 5.67; 95% CI, 2.37–13.61). The impact of alcohol and social vulnerability on mortality was more pronounced in men younger than 65. Among them, those with high social vulnerability and moderate (35–140 g/wk; aHR, 2.83; 95% CI, 1.50–5.36) to high (>140 g/wk; aHR, 2.24; 95% CI, 1.15–4.35) alcohol intake was associated with an increased risk of mortality. Conclusions and ImplicationsVarious factors throughout the life course of both men and women significantly impact the risk of all-cause mortality due to alcohol intake, underscoring the importance of social vulnerability as a determinant of both alcohol intake behavior and mortality risk.

Domain-specific Physical Activity and the Risk of All-cause Mortality among Middle-aged and Older Adults in Taiwan: A Prospective Cohort Study.

The impact of meeting leisure time physical activity (LTPA) recommendations and household physical activity (HPA) on all-cause mortality in the Taiwanese population is unclear. We aimed to investigate the relationship between sufficient LTPA and all-cause mortality in middle-aged and older Taiwanese adults and the role of HPA in those with insufficient LTPA. This nationwide prospective cohort study included 4,960 participants aged ≥50 years from the Taiwan Longitudinal Study in Aging (TLSA) survey. Physical activity patterns were assessed in 2003 and then followed up until 2015 for mortality through the National Death Registration Record. Cox proportional hazards regression was conducted to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Of the 4,960 participants, 1712 died of all-cause mortality. Compared to those who had insufficient LTPA, participants who engaged in sufficient LTPA showed a significantly lower risk of all-cause mortality (HR=0.84, 95% CI, 0.73-0.97). For those with insufficient LTPA, HPA also had a significantly reduced risk of all-cause mortality (HR=0.85, 95% CI, 0.75-0.96) among general population. Similar associations were observed in subsequent sensitivity analyses. The subgroup analysis showed that the relationship between HPA and reduced mortality risk was only found in the women with insufficient LTPA group. This study confirmed that sufficient LTPA is associated with a lower risk of all-cause mortality. If sufficient LTPA cannot be performed, additional HPA is related to lower mortality.

Transitions of self-management behaviors and frailty status among community-dwelling older adults: a national longitudinal population-based cohort study

BackgroundFrailty in older adults is a common geriatric syndrome that could be prevented; thus, coping strategies for the aging population are essential. Self-management behaviors may represent cost-effective strategies to prevent physical frailty in community-dwelling older adults. This study aimed to describe the changes in frailty status among community-dwelling older adults in Taiwan and investigate the association between transitions of self-management behaviors and frailty status over 4 years of follow-up (2007 to 2011).MethodsData were retrieved from the Taiwan Longitudinal Study of Aging (TLSA), years 2007 and 2011. In this prospective cohort study, 1283 community-dwelling older adults aged 65 years and older without cognitive impairment were recruited. Frailty was defined based on Fried’s frailty phenotype. Self-management behaviors (maintaining body weight, quitting smoking or no smoking, drinking less or no drinking, exercising, keeping diet control, and maintaining a regular lifestyle) were assessed using a questionnaire. Multinomial logistic regression analyses were used to investigate the associations between changes in self-management behaviors and in frailty status. The age group was further stratified to examine the moderation effect in the relationship between changes in self-management behaviors and in frailty status among older adults.ResultsThe prevalence of frailty was 8.7% at baseline and 14.9% after 4 years of follow-up, with 196 (15.3%) deaths. Overall, 514 (40.1%) participants maintained their frailty status, 424 (33.0%) worsened, and only 149 (11.6%) improved. Being aged ≥75 years old, having chronic diseases, and an absence of self-management behaviors were associated with frailty at baseline and after follow-up. Among individuals aged 65–74, compared to those who maintained no self-management behaviors, those who decreased the exercise behaviors (yes-to-no) had a higher risk of worsening (RRR = 2.518), while increasing (no-to-yes) and maintaining (yes-to-yes) frequent physical exercise were associated with a lower risk of worsening (RRR = 0.466 and 0.572, respectively) than stable frailty; those who maintained body weight (yes-to-yes) were associated with a lower risk of worsening (RRR = 0.327) than stable frailty after controlling for individual covariates and chronic diseases. Among individuals over 75 years old, compared to no exerciser, older old who decreased their physical exercise had a higher risk of frailty worsening (RRR = 3.255), and increasing frequent physical exercise (no-to-yes) was associated with an improvement in frailty status (RRR = 3.684). Age was a moderator between the effects of maintaining body weight on frailty worsening. There were no associations between the behavioral transitions of smoking, drinking, diet control, or regular lifestyle on the frailty status changes.ConclusionsMaintaining body weight and frequent physical exercise increased the ratio of frailty stability among individuals 65–74 years old. Increasing exercise behavior is the only factor to improve their frailty status among older adults aged 75 years and over. Older adults should be encouraged to perform adequate physical exercise and maintain a healthy body weight to maintain the frailty status in younger old aged 65–74 years, and especially perform more frequent exercise to improve frailty status in older old over 75 years.

The relationship between physical activity trajectories and frailty: a 20-year prospective cohort among community-dwelling older people

BackgroundStudies on examining the relationship between physical activity patterns and frailty are lacking. This study examined physical activity patterns in older people and investigated the relationship between physical activity and frailty as well as identifying the predictors of frailty.MethodsWe used a nationally representative longitudinal database, the Taiwan Longitudinal Study of Aging (TLSA) database, and data for a 20-year period were extracted and analyzed. A total of 5131 participants aged ≥ 60 years in 1996 were included in the current analysis. Information regarding demographic characteristics, frailty, physical activity, comorbidities, oral health, and depressive symptoms was extracted from the TLSA database. Physical activity patterns were examined using group-based trajectory modeling from 1996 to 2015. Potential predictors were examined by performing multivariate logistic regression.ResultsFour trajectories of the physical activity pattern were found: consistently physically inactive (33.7%), consistently physically active (21.5%), incline (21.6%), and decline (23.2%). Throughout the period, the trajectories of the four groups significantly differed from each other at year 2015, with the incline and decline groups exhibiting the lowest and highest frailty scores, respectively (p < 0.001). Older age, male, poor oral health, diabetes, chronic kidney disease, and depressive symptoms were identified as risk factors for frailty.ConclusionPhysical activity reduces the risk of chronic conditions, which contributes to healthy longevity. This study can guide the development of future research and interventions to manage frailty in older people, particularly in considering previous physical activity trajectories within the life course.

Higher dietary diversity and better healthy aging: A 4-year study of community-dwelling middle-aged and older adults from the Taiwan Longitudinal Study of Aging.

To investigate the relationship between dietary diversity and healthy aging (in terms of mobility performance, physical functions, cognitive functions, and depressive symptoms) among community-dwelling middle-aged and older adults by using a nationally representative population-based cohort study. Data from 3213 study participants in the Taiwan Longitudinal Study on Aging (TLSA) were retrieved for analysis, and all participants were divided into five groups according to the quintile of dietary variety scores (DVSs). In the 4-year follow-up study, multivariate logistic regression models were applied to investigate the associations between DVS subgroups and declines in mobility performance, physical function (activities of daily living (ADLs) and instrumental activities of daily living (IADLs)), cognitive function and depressive symptoms. In this study, the DVS quintile identified people who were significantly vulnerable in diet quality. Among those in the lowest DVS quintile, the proportions consuming seafood, eggs, and beans/legumes per week were 0.3%, 7.8% and 12.6%, respectively, while among those in the highest DVS quintile, the proportions were 40.2%, 83.1%, and 82.7%, respectively. "Inverse" dose-response associations were observed between the DVS and the risks of decline in mobility performance, physical function (ADLs and IADLs), cognitive function, and depressive symptoms. These risks decreased with the higher DVS quintile group as compared to the lowest DVS quintile group. Even after adjustments for demographics, health behaviors (e.g., physical activity) and comorbidities, participants in the highest DVS quintile group were still associated with the lowest risk of decline in ADLs (adjusted odds ratio (aOR) 0.59 [95% confidence interval (CI) 0.37-0.94], p<0.05) and IADLs (aOR 0.53 [0.39-0.73], p<0.01). However, no such association was observed in the risk of worsened mobility performance, cognitive function and depressive symptoms. In conclusion, higher dietary diversity has protective effects in declines in multidimensional outcomes associated with healthy aging, particularly physical functions (ADL and IADL), among community-dwelling middle-aged and older adults. Intervention studies are needed to confirm the causal relationships between dietary diversity and healthy aging.

The Influence of Exercise, Nutritional Status, and Disease on the Functional Ability to Undertake Activities of Daily Living and Instrumental Activities of Daily Living in Old Taiwanese People

This study aimed to examine the influence of changes in exercise status, nutritional status, and a number of comorbidities on functional ability in Taiwanese community-dwelling older adults. Data were obtained from the Taiwan Longitudinal Study of Aging. The results revealed that current exercise and consistent exercise were negatively associated with subsequent 4- and 8-year activities of daily living (ADL) and instrumental ADL (IADL) decline (all p &lt; 0.05). The Mini-Nutritional Assessment (MNA) score was negatively associated with subsequent 8-year IADL decline (all p &lt; 0.05), while the number of diseases was positively associated with subsequent 4- and 8-year IADL decline (all p &lt; 0.05). Current exercise and consistent exercises are beneficial for adults aged ≥65 years to maintain their functional ability in ADL and IADL and to prevent declines in functional ability. Consistency of exercise, MNA score, and the number of chronic diseases are good predictors of IADL decline.

How Does Diabetes Accelerate Normal Aging? An Examination of ADL, IADL, and Mobility Disability in Middle-aged and Older Adults With and Without Diabetes

ObjectivesTo build an age norm to quantify and compare the different progression rates of disability in people with and without diabetes. MethodsData were extracted from 5,131 adults aged 50 and older from the Taiwan Longitudinal Study in Aging (TLSA) conducted in 1996. Using multilevel mixed models, the disabilities were measured in 1999, 2003, and 2007. ResultsDiabetes accelerated the occurrence and progression of disabilities during aging. Participants with diabetes developed to mobility, IADL, and ADL at the age of 55, near the age of 60, and near the age of 70, respectively. Diabetes accelerated the onset of disabilities of mobility by 3 years, IADL by 7 years, and ADL by 11 years. In the fully adjusted model, diabetes remains a robust predictor for levels of disability (MobilityβDM = 1.668, p < 0.001, IADLβDM = 1.031, p < 0.001) (IADβDM = 0.690, p < 0.001), and rate of change for developing mobility disability (MobilityβDM*age = 0.088, p < 0.001). ConclusionsThis study showed that diabetes accelerated the occurrence and progression of disabilities starting in middle age. A three to eleven years of acceleration on disability development on mobility, IADL, and ADL was observed.

Prevalence of Loneliness and Related Factors Among Older Adults in Taiwan: Evidence From a Nationally Representative Survey.

BackgroundLoneliness is a common problem among older populations, and very few studies have examined loneliness among older adults in Taiwan.AimThis study aimed to understand the prevalence of loneliness and factors associated with it among older adults in Taiwan.MethodsData from the Taiwan Longitudinal Study of Aging collected in 2015 were analyzed and involved 4588 participants aged ≥65 years. The outcome variable was a self-reported loneliness question, and independent variables included demographic characteristics, a self-reported health status, physical function, number of comorbidities, cognitive function, and social support. A multivariate logistic regression was used to identify predictors of loneliness.ResultsThe prevalence of loneliness among older adults in Taiwan was 10.5%. The multivariate logistic regression showed that old persons who were male, lived alone, perceived that they had a poor health condition, had no spouse, had no job, and had poor emotional support had higher likelihood of feeling lonely.ConclusionsThis study investigated loneliness in a nationally representative sample of older adults and revealed that one-tenth of this older population might experience loneliness which requires immediate action. Special attention should be given to the aforesaid factors in older adults to identify problems and provide interventions as early as possible in order to prevent loneliness and thus reduce the resultant negative effects on physical and mental conditions. Appropriate interventions should be developed to prevent or ameliorate feelings of loneliness among older populations using rigorous research designs such as randomized controlled trials.

Age trajectories of disability in instrumental activities of daily living and disability-free life expectancy among middle-aged and older adults in Taiwan: an 11-year longitudinal study

BackgroundThis study aims to identify the age trajectories of disability in instrumental activities of daily life (IADLs) over 11 years and their correlates, and to estimate disability-free life expectancy for identified trajectory groups in middle-aged and older adults.MethodsWe included 3118 participants aged 50 and over without IADL limitations at baseline from the Taiwan Longitudinal Study in Aging, followed across 1996–2007. We used group-based trajectory models to identify age trajectories of IADL disability, and multiple logistic regressions to examine their correlates. Sullivan method was used to compute IADL disability-free life expectancy for trajectory groups at different ages.ResultsWe identified two trajectories groups: 67.7% of participants classified as the late-onset group and 32.3% as the early-onset group. Female (adjusted odds ratio [aOR]: 1.93, 95% confidence interval [95% CI]: 1.54, 2.41), not being employed (aOR: 1.30, 95% CI: 1,08, 1,56), poor/fair self-rated health (aOR: 1.31, 95% CI:1.09, 1.58), hypertension (aOR: 1.32, 95% CI: 1.07, 1.63), diabetes mellitus (aOR: 2.29, 95% CI: 1.72, 3.07), arthritis (aOR: 1.42, 95% CI: 1.11, 1.81), stroke (aOR: 2.21, 95% CI: 1.04, 4.70), and one-point increase in a 10-item depression scale (aOR: 1.04, 95% CI: 1.02, 1.06) were associated with early-onset of disability, whereas higher education (aOR: 0.59, 95% CI: 0.42, 0.81), regular exercise (aOR: 0.76, 95% CI: 0.62, 0.93), and participating voluntary or club activities (aOR: 0.78, 95% CI: 0.65, 0.93) related to the late-onset. IADL disability-free life expectancies at 65 years old in the late-onset group were 15.6 years for women and 14.4 for men, respectively, comprising 56.6 and 64.2% of their remaining life, whereas those of the early-onset group were 4.8 and 4.6 years for women and men respectively, comprising 22.5 and 27.2% of remaining life.ConclusionsEarly-onset of IADLs disability may correlate to chronic conditions, and engagement in employment, exercise, and social participation were associated with a reduced risk of early disability in IADLs.

THE IMPACT OF SOCIOECONOMIC STATUS ON AGE TRAJECTORY OF BODY MASS INDEX AMONG MIDDLE-AGED AND OLDER ADULTS

Body weight tends to decrease along with age. Weight loss and low body mass index (BMI) in the elderly, associated with socioeconomic status, are both strong predictors of subsequent mortality.This study aims to investigate the relation between income and BMI changes in later life. We used data from the Taiwan Longitudinal Study in Aging (TLSA) from 1999 to 2007. There were 5,131 participants aged 50 and over, who were excluded for those without primary study variables. Income was evaluated by asking the amount of annual income, including salary, pension, rent, interest, welfare benefit, etc. Participants’ BMI were assessed in each survey. General estimating equation models were performed to examine the association between age, annual income, and their interaction with BMI adjusting for covariates including sex, education, marital status, smoking, exercise frequency, appetite, and number of comorbidities. Totaling 11,350 person-times was in three follow-up surveys, which left 9,723 person-times of observations after exclusion. After adjusted for covariates, the low income group compared to the higher income, would have higher estimated BMI at age of 50 (BMI= 24.75 kg/m2 and 24.19 kg/m2 respectively), and more rapid reduction (-0.08 kg/m2 per year), while relatively stable BMI was found in higher income group (0.01 kg/m2 per year, slope difference= 0.10 kg/m2 per year, 95% confidence interval [CI] = 0.03-0.17). In conclusion, compared to invariable BMI observed among individuals with higher financial status, the economically disadvantaged experienced BMI decline with age among middle-aged and older adults.

THE RELATIONSHIP BETWEEN MARITAL STATUS, COHORT, AND DEPRESSION SYMPTOMS IN TAIWAN

Objectives: The relationship between marital status and depression symptoms is well documented. However, how the negative economic shock affect relationship differ by gender and cohort is still indecisive. The dataset “2011 wave of the Taiwan Longitudinal Study in Aging” and logistic regression models were used in the study. The results: Marital status is related to depression symptoms, but it differs by gendered cohort. With considering financial shock, there is no difference of depressive symptom between divorced and married female. The divorced and widowed have 4.81 and 2.47 times higher of getting depression symptom than the married for baby boom female. Being divorced is 3.67 times higher of getting depressive symptoms than being married for baby boom male. For WWII female, the widows are 1.78 times higher to have depressive symptoms than the married. being divorced, widowers, and single are 3.32, 2.21 and 2.90 times higher of getting depressive symptoms than being married for WWII male. Being divorced is 3.67 times higher of getting depressive symptoms than being married for baby boom male. In conclusions, people with unstable marital statuses are more depressed than the married. In particular, the effect of unstable marital statuses on depression could be account for by financial decline for women but not men. Given the policy emphasis on those with unstable marital status and economic decline, divorce female and single baby boom female may represent particular groups in whom interventions designed to financially support.

WHAT ARE THE PATHWAYS TO RETIREMENT: DO HEALTH AND COHORT MATTER?

Studies about retirement often neglect ethnic identity. Yet, racial and ethnic inequality plays an important role in retirement decisions. For instance, minorities are less likely to continue working in old age beyond the normal retirement age because of some individual factors such as poor or fair health, cognitive impairment, functional limitation (Green, 2005; Ghilarducci & Moore, 2015; Mudrazija, 2010), physical limitations (Radl, 2014; Solem et al., 2016; Pienta & Hayward, 2002), retirement benefit and eligibility of pension (Radl, 2014; Honig, 1996). This research examined the influence of ethnicity on whether working for people aged above 60 in Taiwan. In addition to testing the pathways to retirement, we scrutinized how occupational sector mediates the likelihood of ethnic effect on retirement. After comparing two cohorts from the dataset “Taiwan Longitudinal Study in Aging”, we found that working in public sector, white-collar workers, being a Mainlander, being non-married, higher education, self-reported bad health and functional limitation are all associated with the higher likelihood of retirement. Finding suggested that the incentive structure of the public pension for public sector workers, who are mostly Mainlanders, could contribute to the higher likelihood of retirement. However, the magnitude of mediator is much larger for the older cohort than the younger cohort. The study not only could benefit cumulative advantage approach by analyzing East Asia data but also bring policy implication, that retirement policy makers should reduce public pension incentive for public sector workers to delay the retirement age.

The Co-Occurrence Of Frailty (Accumulation Of Functional Deficits) And Depressive Symptoms, And Its Effect On Mortality In Older Adults: A Longitudinal Study.

PurposeThe co-occurrence of frailty and depression in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality have rarely been investigated. We aimed to examine the co-occurrence of frailty and depressive symptoms in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality using all the information from a longitudinal study.Patients and methodsWe used the Taiwan Longitudinal Study of Aging (TLSA) for this study. TLSA was initiated in 1989 and followed periodically. We included participants from 1989 to 2007, who had data on frailty and depressive symptoms. Frailty was assessed by accumulation of functional deficits in 6 dimensions including disease status, sensory dysfunction, balance, functional limitations, health risk behaviors, and life satisfaction. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). A multistate model with interval censoring was used to examine the transition between states of frailty with or without depressive symptoms, and finally to death. A mixed model was used to examine the relationships between frailty and depressive symptoms.ResultsThe coexistence of frailty and depressive symptoms was associated with higher mortality. Individuals with depressive symptom had a lower probability of reversal to a better state. Previous depression score predicted current frailty, but the coefficient was smaller than that of previous frailty. Previous frailty predicted current depression score, and the coefficient was stronger than that of previous depression.ConclusionDepressive symptoms increased the mortality and decreased the probability of reversal in the frail older adults.

Associations of exercise, nutritional status, and smoking with cognitive decline among older adults in Taiwan: Results of a longitudinal population-based study

This study aimed to explore the long-term effects of exercise, smoking, and nutritional status on cognitive reserve and changes in cognitive function among Taiwanese adults aged ≥65 years. Data were obtained from the Taiwan Longitudinal Study of Aging, a national representative population-based cohort study. Results showed that the average baseline scores on the Short Portable Mental Status Questionnaire (SPMSQ) and Mini-Nutritional Assessment (MNA) were 9.07 and 26.01, respectively. The proportions of smoking and exercising at baseline were 24.12% and 58.67%, respectively. A linear regression analysis indicated that old adults who were current and consistent exercisers had better subsequent 4-year SPMSQ scores than those who were not exercisers (P < 0.05). The MNA score was positively associated with subsequent 4- and 8-year SPMSQ scores for the 65–74-year-old adults (P < 0.05). The logistic regression analysis showed that current and consistent exercise was negatively associated with subsequent 4-year cognitive decline (P < 0.05). Previous exercise experience was positively associated with subsequent 8-year cognitive decline for the ≥75-year-old adults (P < 0.05). The MNA score was negatively correlated with subsequent 4- and 8-year cognitive decline among the 65–74-year-old adults. Among the adults aged ≥75 years, consistent smoking was positively associated with cognitive decline over 4 years (P < 0.05). Therefore, current and consistent exercise and good nutritional status benefit cognitive function and reserve, and have protective effects on cognitive decline among old adults, whereas discontinued exercise, poor nutrition, and cigarette smoking are likely to raise the risk of cognitive decline.

Changes in Physical Functioning as Short-Term Predictors of Mortality.

Both performance-based and self-reported measures of physical functioning are predictors of mortality. There has been relatively little research examining whether their changes predict mortality. This study examines whether 5-year changes in performance-based and self-reported measures of functioning predict subsequent mortality. Data are from the 2006 wave of the Social Environment and Biomarkers of Aging Study, 2011 wave of the Taiwan Longitudinal Study of Aging, and mortality follow-up through 2015. Gompertz proportional hazard models predict mortality from changes in ability to complete performance-based tests and changes in performance-based and self-reported functioning. Incident inability to complete at least one performance-based test of functioning is associated with twice the risk of subsequent 4-year mortality. Conditional on the baseline measurement, a one standard deviation (SD) decline in grip strength is associated with a 61% increased risk of 4-year mortality; a one-SD decline in walking speed and a one-SD increase in self-reported limitations are both associated with around a 40% increased risk of 4-year mortality. Conditional on the most recent measurement of functioning, prior change is not significantly associated with subsequent mortality. Repeated measures of performance-based and self-reported functioning are valuable in that they provide an updated measurement of functioning.

WITHDRAWN: Effect of Social Support on Changes in Instrumental Activities of Daily Living in Older Adults: A National Population-based Longitudinal Study

Background: Performance of instrumental activities of daily living (IADL) is important to active aging. Different types of social support may play roles in the process of performing IADLs. This study investigated effect of social support on changes of IADL function in older adults over a 10-year period. Methods: The Taiwan Longitudinal Study in Aging (TLSA) database from 1996 to 2007 was used. IADL disability was defined as difficulties in either grocery shopping or using telephones as a dichotomous variable. A total of 1742 older adults (60-70 years) without IADL disability in 1996 were included. Receiving instrumental (ISS) and emotional social support (ESS), giving ISS and ESS to others, being a member of any association, or engaging in volunteering were assessed. Results: Among these elders in 1996, 85% received ISS and ESS, and 10.8% provided ISS to others. Only 5% engaged in volunteering, and 44.9% were a member of an association. The GEE model showed that receiving ESS decreased the risk of IADL disability; giving ISS and being a member of an association were associated with a lower probability of IADL disability after adjustment for personal characteristics, comorbidities, physical performance, cognition and depression. Conclusions: Receiving emotional support, giving instrumental support to others, and engaging in memberships have protective effects on IADL disability. These results demonstrate the needs of supporting systems and resources that older adults can provide for themselves.