The Irish Longitudinal Study Of Ageing Research Articles

136 DIABETES IS ASSOCIATED WITH IMPAIRED PERIPHERAL AND CEREBRAL HAEMODYNAMIC RESPONSES IN OLDER ADULTS

Abstract Background Diabetes is associated with slower gait speed and adverse brain health outcomes in older adults. However, the putative mechanisms underlying these associations remain poorly explored. One such mechanism is via altered cerebral perfusion, which may represent an important intermediate phenotype in the association between diabetes and slower gait. We assessed the impact of diabetes on peripheral and cerebral haemodynamic responses during active stand as part of The Irish Longitudinal Study of Ageing (TILDA). Methods We assessed: (i) peripheral haemodynamic responses (heart rate, blood pressure, cardiac output) using finometry and (ii) Tissue Saturation Index (TSI) using Near-Infrared Spectroscopy (NIRS) during active stand in older adults. Function-on-scalar regressions were used to model the impact of diabetes on the dynamic response to standing. Subsequently, multivariable linear models were used to model usual gait speed. Results Of 3,011 older adults (mean age: 64.2; 55.2% female) completing active stand, diabetes (n =193, 6.4%) was associated with significantly higher heart rate (mean 3.2, s.e. 0.02 bpm), higher cardiac output (mean 0.16, s.e. 0.04 L/min) and lower systolic blood pressure (mean –6.9, s.e. 1.8 mmHg) during standing. Additionally, diabetes was associated with significantly lower TSI from 10 seconds post-stand (mean –1.2%, s.e. 0.49%). Associations persisted following robust covariate adjustment. Diabetes was associated with significantly slower gait speed (-5.3 cm/s, CI (-8.4,-2.1)). In analysing the relationship between cerebral perfusion and gait speed, poorer recovery of TSI at 60-120 seconds post standing was associated with slower gait speed (0.53 cm/s slower gait speed per unit increase in TSI, p = 0.007). Conclusion Diabetes is associated with impaired peripheral and cerebral haemodynamic responses in addition to slower gait speed in community-dwelling older adults. Neuro-cardiovascular instability and altered cerebral perfusion may represent an important intermediate phenotype between diabetes and adverse health outcomes in older adults.

The association between E. coli exceedances in drinking water supplies and healthcare utilisation of older people.

Evidence concerning the effects of indicators of waterborne pathogens on healthcare systems is of importance for policymaking, future infrastructure considerations and healthcare planning. This paper examines the association between the detection of E. coli in water tests associated with drinking water supplies and the use of healthcare services by older people in Ireland. Uniquely, three sources of data are linked to conduct the analysis. Administrative records of E. coli exceedances recorded from routine water quality tests carried out by Ireland's Environmental Protection Agency are first linked to maps of water systems infrastructure in Ireland. Then, residential addresses of participants of The Irish Longitudinal Study of Ageing (TILDA), a nationally representative survey of over 50-year-olds in Ireland, are linked to the water systems dataset which has the associated water quality monitoring information. Multivariate regression analysis estimates a greater incident rate ratio (IRR) of General Practitioner (GP) visits in the previous year where E. coli is detected in the water supply associated with an older person's residence (Incidence Rate Ratio (IRR) 1.118; [95% Confidence interval (CI): 1.019-1.227]), controlling for demographic and socio-economic factors, health insurance coverage, health, and health behaviours. Where E. coli is detected in water, a higher IRR is also estimated for visits to an Emergency Department (IRR: 1.292; [95% CI: 0.995-1.679]) and nights spent in hospital (IRR: 1.351 [95% CI: 1.004-1.818]).

Tooth loss and cognitive decline in community dwelling older Irish adults: A cross-sectional cohort study

ObjectivesTo investigate whether tooth loss and related loss of occluding tooth pairs, were associated with cognitive decline in a group of community dwelling older men and women from Ireland. MethodsA group of 2508 men and women, aged 50–93 years, underwent a dental examination as part of The Irish Longitudinal Study of ageing (TILDA). Global cognitive function was assessed using the mini-mental state examination (MMSE). Analysis included multiple logistic regression with adjustment for various confounders. ResultsThe mean age of participants was 65.5 years (SD 8.1) and 55.3% of the group were female. Three hundred and twenty-nine (13.1%) of the cohort were classified as having a low MMSE with a score ≤ 27. After adjustment for confounding variables, compared to subjects with ≥ 20 teeth, the odds ratio for a low MMSE amongst edentulous was 1.55 (95% CI 1.03–2.34) p = 0.03, and for those with 1–19 teeth was 1.38 (95% CI 1.03–1.84) p = 0.04. Having < 10 natural occluding pairs and < 4 posterior occluding pairs also associated with a low MMSE. ConclusionsIn this cross-sectional cohort study, tooth loss and related loss of occluding tooth pairs were associated with a low MMSE in a group of older adults from Ireland, independent of various known confounders. Clinical SignificanceDentists should be aware of the potential systemic health implications of patients presenting with tooth loss. Tooth loss may be an important risk indicator for cognitive decline.

Expecting the best or fearing the worst: Discrepancies between self-rated health and frailty in an ageing Irish population.

ObjectivesAgeing populations have the propensity to rate their health status more inaccurately than their younger counterparts. As a result, we (1) devised a metric which categorized older adults into groups based on the discrepancy between their self‐rated health (SRH) and Frailty Index (FI) scores, and (2) investigated which factors predict group membership.DesignA cross‐sectional design was employed using data from The Irish Longitudinal Study of Ageing (TILDA).MethodsA health asymmetry metric was derived: this categorized 6907 participants (aged 50+ years) into three groups: ‘health pessimistic’ where participants underestimated their healthiness, ‘health realistic’ where participants accurately assessed their health, and ‘health optimistic’ where participants overestimated their healthiness. A multinomial logistic regression modelled the ability of a set of sociodemographic, psychosocial, and health behaviour variables in predicting membership of these categories.ResultsA significant proportion of the study population were categorized as ‘health realistic’ (~69%). The prevalence rates of health optimistic individuals increased in older age groups, and conversely, health pessimistic rates decreased in older age groups. Most notably, psychosocial factors significantly predicted being health pessimistic: such as anxiety (OR = 1.03), loneliness (OR = 1.04), and decreased social connectedness (OR = 0.87). However, less clear sociodemographic, psychosocial, and health behaviour associations were found for being health optimistic.ConclusionHealth asymmetry is a useful method of identifying at‐risk individuals for inaccurate SRH. The ability of this metric to predict clinical mental health outcomes should be investigated.

224 METABOLIC SYNDROME ASSOCIATED WITH INCREASED LIKELIHOOD OF INCIDENT FRAILTY

Abstract Background Frailty and metabolic syndrome (MetS) are both associated with increased mortality. This study aimed to examine the association between MetS and incident frailty in older adults in Ireland over a 4-year follow-up period. Methods This study used data from wave 1 and 3 of The Irish Longitudinal Study of Ageing (TILDA). Frailty status was operationalised using Fried’s frailty phenotype (FP). FP was determined at both waves. MetS was determined at wave 1, according to the National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) and the International Diabetes Foundation (IDF) criteria. Those who were frail/pre-frail at wave 3 having been classified as non-frail at wave 1 were deemed to have ‘worsening frailty’, while those non-frail at both waves were deemed ‘stable non-frail’. Logistic regression models examined the association between MetS and worsening frailty compared to stable non-frail. Results FP was determined for 3,317 participants at both wave 1 and wave 3 of TILDA, of which 970 (29%) and 1,201 (36%) had MetS at wave 1 according to ATPIII and IDF criteria respectively. 664 (20%) had worsening frailty, while 1,624 (49%) were stable non-frail. Adjusted for age, sex and education, MetS was associated with an increased likelihood of worsening frailty, for both ATPIII and IDF criteria, OR 1.70 (p &amp;lt; 0.001) and OR 1.63 (p &amp;lt; 0.001) respectively. This association persisted when further adjusted for smoking history, chronic conditions (excluding diabetes and hypertension), renal function and micronutrients [OR 1.50, p = 0.001 (ATPIII) and OR 1.46, p = 0.001 (IDF)]. Conclusion MetS increases the likelihood of incident frailty/pre-frailty by approximately 50% over a 4-year period. MetS should be considered a risk factor for frailty and should be considered in any comprehensive geriatric assessment given the dynamic nature of frailty and the potentially modifiable nature of MetS.

218 INCREASING PREVALENCE OF METABOLIC SYNDROME IN OLDER ADULTS IN IRELAND

Abstract Background Metabolic syndrome (MetS) is a cluster of inter-related risk factors of metabolic origin, occurring together more often than by chance alone. MetS is a recognised risk factor for cardiovascular disease, several other chronic medical conditions and mortality. This study aimed to describe the prevalence of MetS in older adults in Ireland and to examine if this changed over a 4-year follow-up period. Methods This study used data collected as part of wave 1 and 3 of The Irish Longitudinal Study of Ageing (TILDA). Using objective measurements of triglycerides, high-density lipoprotein cholesterol, blood pressure, height, weight, waist circumference and glycated haemoglobin (HbA1c), in addition to medication usage, the prevalence of MetS using both the National Cholesterol Education Program Third Adult Treatment Panel criteria (ATPIII) and the International Diabetes Foundation criteria (IDF) were determined. Weights were used to allow the sample to be representative of the population. Weights for wave 3 included an adjustment for attrition between wave 1 and wave 3. Weighted logistic regression models were undertaken to examine the odds ratios for age, sex and educational attainment. Results 32.5% of the community-dwelling population aged ≥50 years at wave 1 had MetS according to the ATPIII criteria, with 39.3% according to the IDF criteria. Males were 36% (ATPIII) or 53% (IDF) more likely than females to have MetS at wave 1. MetS was increasingly prevalent with age, and lower educational attainment at both waves. Prevalence had increased by wave 3 with 35.1% and 41.3% meeting the ATPIII and IDF criteria respectively. Conclusion The prevalence of MetS, a modifiable disorder, is very high and increasing in older adults in Ireland, with nearly 400,000 of the community-dwelling population ≥ 54 years at wave 3 meeting either the ATPIII or IDF criteria. More public health interventions are warranted.

The effect of eye disease, cataract surgery and hearing aid use on multisensory integration in ageing

Sensory impairment is common in ageing, as are approaches to treat it. However, the impact of age-related sensory impairment upon multisensory perception remains unexplored, despite the multisensory nature of our environment. Here, we used data from The Irish Longitudinal Study of Ageing (TILDA) to investigate whether common, age-related eye diseases (cataracts, glaucoma and Age-Related Macular Degeneration, ARMD) and clinical intervention to improve sensory function (cataract removal and hearing aids) influence multisensory integration in older adults. Integration was measured using the Sound-Induced Flash Illusion (SIFI), and the extent to which identifying two flashes was improved by accompanying auditory information (“visual gain”). Visual gain was not influenced by eye disease or treatment. For the SIFI, participants self-reporting cataracts, ARMD or glaucoma were as susceptible as healthy controls, even when controlling for age, sex, cognition, self-reported vision/hearing and visual acuity. In a second analysis using retinal photographs, glaucoma and ARMD (hard drusen) did not influence susceptibility relative to controls. However, participants with soft drusen ARMD were more susceptible to the illusion at long Stimulus-Onset Asynchronies (SOAs) compared with controls. Following this, we identified groups reporting bilateral cataract removal or hearing aid acquisition >4 years and <2 years prior to assessment, enabling comparison of longer- and shorter-term effects of interventions. Cataract removal groups did not differ from controls. Longer-term hearing aid users were less susceptible to the SIFI at short SOAs compared with controls. Our findings suggest that multisensory integration in ageing might be specifically influenced by ARMD (soft drusen) and hearing aid use.

Sedentary behaviours and cognitive function among community dwelling adults aged 50+ years: Results from the Irish longitudinal study of ageing

BackgroundSedentary behaviours (SB) are risk factors for poor cardiovascular health and all-cause mortality. However, their role in cognitive health in older adults is unclear. A few studies have examined associations between sedentary behaviours and cognition, but are limited by heterogeneity and insufficient longitudinal analyses. Therefore more robust studies, which would address identified limitations, are needed to accurately determine associations. MethodThis study analysed data collected from participants aged 50+ years of The Irish Longitudinal Study of Ageing (TILDA). We conducted cross-sectional linear regression with multivariate imputation analyses of baseline data from wave 1 (N = 8163, weekday-sitting time), and wave 3 (N = 6400, weekday-television viewing); longitudinal analyses between waves 1–3 (sitting) and waves 3–4 (television). Sedentary behaviours were analysed as both categorical and continuous variables. Outcome of cross-sectional analyses was standardised regression co-efficient of associations between sedentary exposures and cognitive function in respective waves, while for longitudinal analyses was cognitive change (verbal memory, verbal fluency, and global cognition) between waves based on standardised residuals. ResultStudy found significant but mild cross-sectional associations between 1-h increase in weekday-television viewing and poorer verbal memory (b = −0.02, CI: −0.04, −0.003, P < 0.05) and verbal fluency (b = −0.02, CI: −0.04, −0.002, P < 0.05). Baseline television viewing of 3.5+ h/day had mild but significant association with a decline in verbal fluency 2 years later in participants aged 65+ years, when compared with a reference category of <1.5 h of TV viewing (b = −0.12, CI: −0.23, −0.001, P < 0.05). ConclusionOur study findings indicated some association between increased levels of weekday-television viewing time, independent of physical activity, and poor cognition cross-sectionally and longitudinally in middle-aged and older adults. Intervention studies are needed to confirm the effects of SB on cognition in older adults. Public health campaigns should be targeted at displacing high levels of television viewing, in excess of 3.5 h/day among older adults.

Life-course social class is associated with later-life diabetes prevalence in women: evidence from the Irish Longitudinal Study on Ageing

This study aimed to investigate the independent and synergistic effects of childhood and adult social class, as well as the effect of social mobility, on type 2 diabetes (T2D) risk in later life. Cross-sectional data from The Irish Longitudinal Study of Ageing (TILDA) (n = 4,998), a nationally representative probability sample of adults aged 50 and older, were analysed. Prevalent diabetes was defined using subjective (self-reported doctor’s diagnosis) and objective data (medications usage and glycated haemoglobin testing). Social class was classified as a three-level variable based on fathers’ occupation in childhood and respondents’ primary occupation in adulthood. A five-level social mobility variable was created from cross-classification of childhood and adulthood social class. Logistic regression was employed to assess the relationship between social class variables and T2D. Mean (SD) age of the sample was 63.8y (9.9) and 46.4% were male. Incidence of T2D was 11.6% of men and 7.7% of women. Some 57.4% of the sample were classified as Manual social class in childhood. Compared to those in Professional/Managerial occupations, belonging to the Manual social class in childhood was associated with an increased risk of T2D in men (Odds Ratio (OR): 1.36, 95% CI: 0.88, 2.10) and women (OR: 2.16, 95% CI: 1.21, 3.85). This association was attenuated in women when controlled for adulthood social class (OR: 1.84, 95% CI: 1.00–3.37), suggesting that the effect of childhood social class may be modified by improving social circumstance over the life course.

The impact of glucocorticoid medication use on hair cortisol and cortisone in older adults: Data from the Irish Longitudinal Study on Ageing

Research focusing on the hair concentration of cortisol and cortisone has significantly developed over the last two decades and has huge potential to provide relevant insights into stress-related diseases. However it is not clearly understood exactly how glucocorticoid (GC) medications, which are commonly prescribed drugs particularly among older adults, may affect hair cortisol and cortisone levels. The aim of this study was to examine associations of the use of GC medications with hair cortisol and cortisone concentrations in a sample of older adults. Hair samples and data were collected from participants at Wave 3 of The Irish Longitudinal Study of Ageing (TILDA). Results showed that before and after controlling for socio-demographic, health and hair characteristics, the use of systemic GCs was associated with decreased hair cortisone (B= -0.34 95 % CI -0.53, -0.16, p < 0.001). However, the use of local GCs was associated with increased hair cortisol (B = 0.39 95 % CI 0.18, 0.61). Further analysis suggests that the latter finding may be the result of use of topical steroid creams/ointments. These data add to the scant literature on the impact of steroid medication use on hair cortisol and cortisone in non-clinical populations, providing further evidence that future hair GC studies need to consider steroid medication use.

How do subjective life expectancies compare with mortality tables? Similarities and differences in three national samples

Abstract Estimates of personal longevity play a vital role in decisions relating to asset accumulation and decumulation. Subjective life expectancy (SLE) is a measure of individuals’ expectation of remaining years of life. Either explicitly or implicitly, it is a key determinant of consumption and savings behaviour, and may be guided by a person’s own health and health behaviours. The Gateway to Global Aging, a platform for the Health and Retirement Study’s (HRS) family of population surveys, provides harmonised longitudinal datasets for many countries, each based on individual survey responses from respondents aged 50 and above. In this paper, we analyse SLE three of these datasets: the English Longitudinal Study of Ageing (ELSA), The Irish Longitudinal Study of Ageing (TILDA) and Healthy Ageing in Scotland (HAGIS). First, we focus on measurement of SLE, followed by the SLE differential – the discrepancy between SLE and mortality risk indicated by population life tables. One novel finding from our analysis is that the SLE differential is positive for Ireland and is negative for Scotland and England. This difference does not appear to be explained by differences of survey design or population characteristics.

Working Beyond age 65 in Ireland

Extending working lives is often proposed as one route through which the costs associated with population ageing can be managed. In that context, understanding who currently works for longer can help policymakers to design policies to facilitate longer working. In particular, it is important to know if longer working is a choice or a necessity, where necessity arises from a lack of pension income. In this paper, we use data from the first four waves of the Irish Longitudinal Study of Ageing (TILDA), covering the period 2010–2016, to examine patterns of employment among men and women aged 65+. We find that a lack of pension income is an important determinant of later-life working and that this applies for both men and women. Although older women are significantly less likely to work than older men, we find few differences in the pattern of determinants of longer working among older men and women. However, while women are significantly less likely to work than men, this effect is stronger among married women compared to single women. This suggests that older women without immediate access to family-provided financial support may need to work to support themselves. This adds to the picture of later life work being a necessity as opposed to a choice. However, an alternative explanation is that older married women may also have caring responsibilities that reduce their labour force participation.

More than health: quality of life trajectories among older adults-findings from The Irish Longitudinal Study of Ageing (TILDA).

To test whether ill-health is associated with a decrease in quality of life (QoL) over time and if positive social circumstances are beneficial to QoL, using the shorter form CASP-12 in a sample drawn from a nationally representative cohort of older adults. To do so, the association between factors from a number of life domains and QoL was investigated. Data were from the first three waves of The Irish Longitudinal Study on Ageing, a prospective nationally representative study of community dwelling older adults in the Republic of Ireland. QoL was measured using the shorter form CASP-12 and the latent growth curve method was used to describe within- and between-person variation in longitudinal QoL trajectories. There was considerable variation in QoL scores cross-sectionally and longitudinally. QoL did not decline linearly with age but increased from age 50 and peaked at 68years before declining in older age. QoL differed significantly between individuals and decreased over time. A variety of demographic, health, and social characteristics were associated with changes in QoL over time. These included cohabiting; self-rated health; functional limitations; fear of falling; mental health; loneliness; social networks; social activities; caring for grandchildren; income; and death of a spouse. Changes in QoL over time were not merely a function of ageing, or declining health but resulted from factors from a variety of domains with loneliness and social participation particularly important. Policies concerned with successful ageing and QoL among older adults must consider social circumstances as well as physical and psychological well-being.

Working, Volunteering and Mental Health in the Later Years

This paper examines the effect that working for pay and volunteering has on the mental health of older Irish women and men. Data from four waves of The Irish Longitudinal Study of Ageing (TILDA) are used. Three measures that capture different dimensions of mental health are considered. Ordinary least squares regression estimates suggest that both working for pay and volunteering have statistically significant and substantially large positive effects on mental health. However, these effects are less well defined when fixed effects regression is used. The analysis also suggests that combining working for pay with volunteering is more beneficial in terms of mental health than either working for pay or volunteering on their own. That is, there is something extra from engaging in both activities. The estimates also suggest a possible trade-off between working for pay and volunteering in terms of mental health benefits. Volunteering may be a good mental health substitute for working for pay. The extent of this substitutability is particularly important amongst older people, since participation in paid employment decreases while volunteering increases in older age. Higher levels of volunteering may compensate for the mental health loss associated with lower levels of working for pay. If this is the case, policies that promote volunteering may be cost-effective if they result in higher levels of self-sufficiency amongst older people.

Intergenerational Occupational Mobility and Objective Physical Functioning in Midlife and Older Ages.

This study investigates the relationship between intergenerational occupational mobility and objective physical functioning in later life. Data come from The Irish Longitudinal Study of Ageing (TILDA), a nationally representative probability sample of 5,985 respondents aged 50 and older. Walking speed and grip strength are the functional health measures. The intergenerational occupational mobility measure characterizes origin and destination position as: professional/managerial, non-manual, skilled manual/semi-skilled, unskilled, never worked, and farmer. Results indicated no direct association of childhood origin with walking speed or grip strength in later life, except for individuals from farming backgrounds. Those who experienced upward mobility were comparable in speed and strength with those who enjoyed high status (e.g., stable professional/managerial origin and destination) at both time points, whereas the downwardly mobile were comparable with those who were stable across generations at lower occupational positions. The results did not support the central tenets of the accumulation hypothesis. Respondents from farming backgrounds exhibited a clear performance advantage irrespective of destination, which, we speculate, may represent a critical period effect. The mechanisms through which childhood origin affects health in later life are complex, but the position attained in adult life is most important. Intergenerational mobility is important only insofar as it leads to a destination occupation. The present findings suggest that the musculoskeletal system may accommodate environmental modification in adulthood.

OP34 Are older people with diabetes an at-risk group for falls? a cross-sectional analysis of community-dwelling adults ≥50 years in Ireland

Background Falls are a common and serious concern facing older adults and the prevalence is increasing internationally. Falls lead to injury, hospitalisation, and substantial healthcare costs. Older people with diabetes may be at increased risk of falls, given the potential for polypharmacy and the development of microvascular complications. We aimed estimate prevalence of falls and examine the association between diabetes and a risk of falls in the older population using The Irish Longitudinal Study of Ageing (TILDA). Methods Cross-sectional analysis was conducted on the first wave of TILDA data (2009–2011): a nationally representative sample of community-dwelling adults aged ≥50 years. Data were collected using a computer-assisted personal interview, self-completion survey and health assessment. Diabetes was based on self-report of doctor-diagnosis, the prevalence of falls in the previous year was also ascertained by self-report. The relationship between diabetes and falls risk was assessed using Pearson’s Chi-squared test. Multivariate poisson regression was used to examine the association between diabetes and falls, adjusted for age, sex, polypharmacy (≥5 different medications) and multimorbidity (≥3 chronic illnesses). Results In the sample (n = 8175), the prevalence of falls in those with diabetes was 24% (n = 152 95% CI: 21–28%; P When adjusted for age and gender, diabetes was significantly associated with an increased risk of falling (IRR: 1.23 95% CI: 1.04–1.45%; P Polypharmacy (IRR: 1.24 95% CI: 1.09–1.42%; P Conclusion One-quarter of adults with diabetes experienced a fall in the preceding year. Our analysis showed an association between those who had fallen at least once in the previous year and diabetes, adjusted for age and gender. The relationship was not significant after adjustment for polypharmacy and multimorbidity. Given the potential for multimorbidity and polypharmacy in this group, people with diabetes may benefit from early recognition of their fall-risk and interventions to reduce risk.

OP33 Attendance and frequency of health service use among older people with diabetes: results from the irish longitudinal study of ageing (TILDA)

<h3>Background</h3> There is international consensus that optimal management of uncomplicated diabetes involves structured multidisciplinary management in primary care with specialist input when required. In Ireland care arrangements for people with diabetes range from traditional specialist care to structured GP-led management. In an effort to standardise the service, a national model of integrated care has been proposed. Our aim was to estimate current primary, secondary and ancillary health service use (HSU) among older people with diabetes. <h3>Methods</h3> Cross-sectional analysis of a population-based sample of adults aged ≥50 years who participated in wave 1 of TILDA (2009–2011). Diabetes was based on self-reported doctor diagnosis. Self-reported HSU in the previous 12 months included the attendance and number of GP visits, out-patient department visits (OPD), and attendance at ancillary services (dietician, chiropodist or optician). Multivariate negative binomial regression was used to estimate the association between diabetes and frequency of visits, adjusted for age, sex, locality, education, health insurance, complications, presence of other chronic illness, and insulin use. <h3>Results</h3> Among 8175 participants, diabetes was reported by 634 individuals (weighted prevalence 8.1% [95% CI: 7.5% –8.8%]). Participants with diabetes were older (mean age 66.6 years vs. 63.5 years) and a higher proportion were male (57.3% vs. 47.2%). Most people with diabetes attended the GP in the previous 12 months (n = 604, 95.7% [95% CI: 94–97%]); 61% of those also attended the OPD (n = 367, [95% CI: 57%–65%]). Among healthcare users, the median (IQR) number of visits per annum was higher in those with diabetes compared to the general population (GP visits: 4 [3–7.5] vs. 3 [2–5]; p ≤ 0.001; OPD visits: 4 [3–9] vs. 4 [3–9]; p ≤ 0.001). A much higher proportion of those with diabetes accessed ancillary state services compared to the general population (dietician 11.3% [95% CI: 8.9%–14.2%] v 0.6% [95% CI: 0.5%–0.8%]; chiropody: 15.7% [95% CI: 12.9%–18.8%] v 3.8% [95% CI: 3.3%–4.4%]; optician: 20.5% [95% CI: 17.4%–24.1%] v 11.5% [95% CI: 10.4%–12.4%]; p ≤ 0.001). In fully adjusted model, diabetes was independently associated with more frequent use of GP services (IRR 1.3 [95% CI 1.2–1.4] p ≤ 0.001) and OPD services (IRR 1.3 [95% CI: 1.1–1.6] p ≤ 0.001). <h3>Discussion</h3> Among older people in Ireland, diabetes is associated with increased frequency of GP and OPD visits, independent of diabetes-related complications. Less than 25% of those with diabetes attended state-provided dietetic and chiropody services; this may reflect the use of private services in the face of limited public access.

Educational influences on early retirement through disability in Ireland.

Studies suggest a higher prevalence of early retirement through disability among older people with lower educational attainment. There have been no national studies in Ireland on the factors that affect early withdrawal from the labour force through disability or long-term illness. To identify and analyse potential impacts of education on early retirement through disability in the over 50 age cohort of the Irish Labour force. We analysed the educational attainment of participants using The Irish Longitudinal Study of Ageing (TILDA). The group of interest were those aged 50-75 who had retired early. The sample was dichotomized on disability. Examination of interviewer-recorded information on background influences determining early retirement decisions included the following factors: age, gender, education, family and socio-economic circumstances, including parental education. A total of 334 of 1179 study subjects (28%) retired early through disability. Comparison of those retired early with and without disability showed a significantly higher frequency of lower educational attainment both personally and for parents. Men with lower educational attainment and from a non-professional background were more likely to retire early through disability. Non-professional disabled respondents with less well-educated parents had lower educational attainment than non-disabled respondents. Among TILDA participants, educational attainment appears to influence early retirement through disability. The sector of previous employment was also a significant factor. Behaviour, lifestyle and employment choice are influenced by educational level, which may affect cognitive ability to process health information. Factors affecting the education-disability relationship could include parental education, employment status and socio-economic characteristics.

Body mass index and health service utilisation in the older population: results from The Irish Longitudinal Study on Ageing.

obesity is associated with higher healthcare costs in older people; however, estimates are predominantly based on the use of primary and secondary services. Our objective was to estimate the effect of overweight and obesity on the use and cost of allied health services among middle-aged and older people. the study used data from The Irish Longitudinal Study of Ageing (TILDA), a nationally representative study of adults aged ≥50 sampled using multistage stratified clustered sampling, which included objective measures of height and weight. Body mass index was categorised as normal (18.5-24.99 kg/m(2)), overweight (25.00-29.99 kg/m(2)), moderate obesity (30.00-34.99 kg/m(2)), severe obesity (35.00-39.99 kg/m(2)) or morbid obesity (≥40 kg/m(2)). Participants were asked about a range of allied health services including dietetic services, public health nurse visits, chiropody and home help. Adjusted seemingly unrelated biprobit models were used to account for unobserved heterogeneity associated with the use of services. among 5,841 participants, 77.6% (95% CI = 76-79%) were overweight or obese (n = 4,534). All classes of obesity were significantly associated with higher general practitioner service use (P < 0.05). Moderate and severe obesity were associated with increased use of out-patient services, while only moderate obesity was associated with increased hospital admissions (P < 0.05). Moderate and severe obesity were significantly associated with chiropody service use (P < 0.05) with an estimated annual cost of €919,662. Morbid obesity was associated with dietetic service use (P < 0.001) with an annual cost of €580,013. given these costs and improvements in life expectancy, an increasingly obese older population presents new challenges for healthcare delivery.

CASP-19 special section: how does chronic disease status affect CASP quality of life at older ages? Examining the WHO ICF disability domains as mediators of this relationship

Objectives: The effect of chronic disease status on quality of life (QoL) has been well established. However, less is known about how chronic diseases affect QoL. This article examines impairment in three domains of the WHO International Classification of Functioning, Health and Disability (ICF) – body function, activity and participation, as well as affective well-being, – as potential mediators of the relationship between chronic disease and QoL.Method: A cross-sectional sample (n = 4961) of the general Irish community-dwelling population aged 50+ years was obtained from the Irish Longitudinal Study of Ageing (TILDA). The CASP measure of QoL was examined as two dimensions – control/autonomy and self-realisation/pleasure. Structural equation modelling was used to test the direct and indirect effects of chronic disease on QoL, via variables capturing body function, activity, participation and positive affect.Results: A factor analysis showed that indicators of body function and activity loaded onto a single overall physical impairment factor. This physical impairment factor fully mediated the effect of chronic disease on positive affect and QoL. The total effect of chronic disease on control/autonomy (−0.160) was primarily composed of an indirect effect via physical impairment (−0.86), and via physical impairment and positive affect (−0.45). The decomposition of effects on self-realisation/pleasure was similar, although the direct effect of physical impairment was weaker. The model fitted the data well (RMSEA = 0.02, TLI = 0.96, CFI = 0.96).Conclusion: Chronic disease affects QoL through increased deficits in physical body function and activity. This overall physical impairment affects QoL both directly and indirectly via reduced positive affect.