Smoking, physical activity, and active life expectancy

Healthy lifestyle and preventable death: findings from the Japan Collaborative Cohort (JACC) Study

OBJECTIVE

To evaluate the effect of baseline combination of 6 lifestyle factors on all-cause mortality.

METHODS

A total of 62,106 Japanese men and women aged 40-79 years were followed for 12.5 years on average. Hazard ratios and 95% confidence intervals (CIs) of all-cause mortality in relation to healthy lifestyle factors (not currently smoking, not heavily drinking, walking 1 h or more per day, sleeping 6.5 to 7.4 h per day, eating green-leafy vegetables almost daily and BMI between 18.5 and 24.9) were calculated from proportional-hazards regression models. We also estimated population-attributable fractions of death to address the impact of potential lifestyle modifications on mortality.

RESULTS

Until 2003, 8497 deaths were observed. Age-adjusted HR of all-cause mortality for the group with 6 healthy lifestyle factors was 0.42 (95% CI: 0.32-0.56) among men and 0.49 (0.39-0.60) among women, respectively, compared with the group with 0-2 healthy lifestyle factors. Even at ages 60-79 years, a healthy lifestyle has a major impact on mortality. Had the subjects achieved even a 1-point increment in their lifestyle scores, death rates of 24.7% among men and 18.5% among women could have been reduced.

CONCLUSION

We found an inverse association between baseline combination of 6 healthy lifestyle factors and all-cause mortality as well as its impact on preventable fraction of death. Our results also demonstrated that healthy lifestyle behaviors are important even in old age.

Smoking cessation behavior in older adults by race and gender: the role of health problems and psychological distress

INTRODUCTION

Initial research on older smokers suggests that a subgroup of smokers with higher levels of psychological distress and health problems may be more likely to quit smoking than older smokers with fewer such problems. The present study, based on prospective data from a biracial sample of older adults (N = 4,162), examined characteristics of older adult smokers by race and gender.

METHODS

The present study uses both cross-sectional and prospective data to examine the association between smoking behavior, smoking cessation, health functioning, and psychological distress in a biracial sample of community-dwelling older adults.

RESULTS

We found baseline psychological distress to be associated with poor health functioning. Consistent with hypotheses, baseline (Time 1) psychological distress predicted smoking cessation 3 years later (Time 2). Moreover, the change in health problems between Time 1 and Time 2 fully mediated the association between Time 1 distress and smoking cessation.

DISCUSSION

Smoking cessation behavior of older adults is best explained by higher levels of distress and health problems regardless of race or gender. These findings may have important treatment implications regarding smoking cessation programs among older adults. Older adult smokers with higher levels of psychological distress and health problems may be more motivated to quit smoking than those with fewer such problems. These difficulties should be targeted within the context of the smoking cessation protocol. Also, we identified a subgroup of older smokers who are reporting fairly good health and lower levels of distress and who are less likely to quit smoking. Motivational methods may need to be developed to engage this group in smoking cessation treatment.

Optimal health and function among the elderly: lessening severity of ADL disability

Despite mounting evidence implicating sedentary behavior as a significant risk factor among the elderly, there is a limited amount of information on the type and amount of activity needed to promote optimal health and function in older people. Overall muscle strength and mass decline 30–50% between the ages of 30 and 80. The loss of muscle mass accounts for most of the observed loss of strength. The loss of muscle tissue is due to a decrease in the number of muscle fibers and to atrophy of the type II muscle fibers. The declining strength reduces the capacity to carry out basic activities of daily life and puts people at risk for falls and dependence on others. The objective of the present review is to examine the role of exercise training as a primary tool for increasing cardiopulmonary and muscular fitness in order to lessen the severity of disability in activities of daily living and to attain optimal health and functioning among the elderly.

The urban elderly in the United States: health status and the environment

A large number of elderly persons live in United States metropolitan areas and center cities. Although the urban environment can be supportive of health, the urban elderly face issues of decrease in organ function and reserves; impaired chemical clearance and detoxification; vulnerability to medication-environment adverse interactions (heat/psychotropic drugs); legacy of past occupational and environmental cumulative exposures to persistent agents; overall poorer health status; decreased ability to respond to disasters, emergencies, and extreme conditions; decreased ability to access good and services outside their homes; and increased sensitivity to environmental conditions. Planning for these challenges can create a supportive environment and improve the health of the urban elderly.

Cardiovascular aging and exercise in healthy older adults

OBJECTIVE

Physical inactivity in an aging population is a major contributing factor to the rising numbers of older persons with chronic illnesses and disabilities. The purpose of this article is to review the relationship between physical inactivity and age-associated changes to the cardiovascular system, and provide guidance on prescribing exercise to healthy older persons in order to mitigate the adverse effects of cardiovascular aging.

DESIGN

Interpretive review of the literature.

RESULTS

A number of structural and functional changes occur in the cardiovascular system with advancing age, many of which are mediated by changes in vascular stiffness. These changes lead not only to cardiovascular events and strokes, but also to frailty, functional decline, and cognitive impairment. A substantial proportion of the decline in aerobic capacity with age may result from physical inactivity. Guidelines for the prescription of aerobic, resistance, and balance training for otherwise healthy older persons are provided.

CONCLUSIONS

Lack of physical activity is a major risk factor for the epidemic of chronic disease and disability facing an aging population. Many age-associated changes in cardiovascular function result from physical inactivity. The benefits of regular exercise include prevention of cardiovascular events, disability, and cognitive impairment. Age is not a contraindication to exercise, which can usually be initiated safely in older persons.

Lifestyle and Successful Aging: An Overview

Since the 1950s, the phrase successful aging has been used increasingly to represent the factors and conditions underlying healthy aging and is often attributed to the healthy elderly. In this short review, the authors discuss the transformation in the social theories of aging that allowed for the evolution of successful aging as a construct and ultimately a theoretical basis for investigation. Because of the multifactorial nature of the psychosocial and biomedical domains, there is no clear consensus on the definition of successful aging or its determinants. What is clear, however, is that successful aging is related to the human health span, or healthy life expectancy. Moreover, the accumulating information from multidimensional studies suggests that many age-associated changes in physiological and cognitive functioning can be explained by such modifiable lifestyle factors as smoking, physical activity, and nutrition choice. The evidence presented supports the promotion of a healthy lifestyle as an effective strategy for successful aging.

Exercise as an adjunct to nicotine gum in treating tobacco dependence among women

This was the first randomized, controlled smoking cessation trial assessing the efficacy of an exercise intervention as an adjunct to nicotine gum therapy in comparison with both equal contact control and standard care control conditions. Sedentary female smokers aged 18-55 years were provided with nicotine gum treatment along with brief behavioral counseling and were randomized into one of these three behavioral adjunct conditions. In the "intent-to-treat" sample (N = 182), at end of treatment and at 1-year follow-up, there were clear, but nonsignificant, trends in univariate analyses in which the exercise and equal contact control conditions both had higher rates of abstinence than the standard care control. However, when adjusting for other predictors of relapse in a multiple logistic regression, both exercise and equal contact control showed an advantage over standard care control in avoiding early relapse (i.e., after 1 week). In a multivariate survival model adjusting for other predictors, the equal contact condition had a significantly lower likelihood of relapse compared with the standard care condition and there was a near significant trend in which exercise offered an advantage over standard care as well. While these findings suggest a slightly improved likelihood of abstinence with exercise compared with standard care, exercise did not differ from equal contact control in its efficacy. Potential explanations for these equivalent levels of efficacy and implications for the findings are discussed.

Physical function, physical activity and recent falls. Results from the "Invecchiamento e Longevità nel Sirente (ilSIRENTE)" Study

BACKGROUND AND AIMS

A fall is a common and traumatic event in the life of older persons. This study aims: 1) to explore the relationship between recent falls and measures of physical function in elders, and 2) to examine the role played by habitual physical activity in the relationship between recent falls and physical function.

METHODS

We used baseline data from 361 community-dwelling persons aged > or = 80 years (mean age 85.9 yrs) enrolled in the "Invecchiamento e Longevità nel Sirente (ilSIRENTE)" study. Physical performance was assessed using the Short Physical Performance Battery (SPPB) and usual gait speed. Muscle strength was measured by hand grip strength. Functional status was assessed by the Basic (ADL) and Instrumental Activities of Daily Living (IADL) scales. Self-reported recent falls over the previous three months were recorded. Analyses of covariance were performed to evaluate the relationship between recent fall events and physical function measures.

RESULTS

Fifty participants (13.9%) reported at least one recent fall. Physically active participants had fewer falls and significantly higher physical function compared with sedentary subjects, regardless of recent falls. Significant interactions for physical activity were found in the relationships of usual gait speed and SPPB with recent fall history (p for interaction terms <0.01). A difference in usual gait speed and SPPB according to history of recent falls was found only in physically active subjects.

CONCLUSIONS

Physical performance measures are negatively associated with recent falls in physically active, but not sedentary, participants. Physical activity is associated with better physical function, independently of recent fall history.

Fatores associados à atividade física na população portuguesa

OBJETIVO: Avaliar como as características demográficas, sociais e comportamentais se associam a diferentes tipos de atividade física. MÉTODOS: Avaliaram-se 37.692 indivíduos de amostra representativa da população portuguesa, no âmbito do Inquérito Nacional de Saúde, 1998-99. A maioria era constituída por mulheres (53,1%) e idade 20 anos. A avaliação da atividade física diária foi baseada em questionário e classificada como: total, de lazer e exercício. Cada tipo foi dicotomizado em baixa intensidade (atividades leves/moderadas) e alta intensidade (atividades pesadas/muito pesadas). Calcularam-se odds ratios (OR) e respectivos intervalos de confiança de 95% por regressão logística não condicional. RESULTADOS: Em ambos os sexos, verificou-se associação inversa significativa entre idade e diferentes tipos de atividade física, e entre a obesidade e a atividade de lazer e exercício. A escolaridade (<4; 5-11; 12 anos) associou-se positivamente com a atividade física de lazer (OR 1; 1,58; 2,39 nas mulheres e OR 1; 1,44; 2,08 nos homens) e com o exercício (OR 1; 3,50; 9,77 nas mulheres e OR 1; 3,42; 7,61 nos homens) e de forma inversa com a AF total (OR 1; 0,65; 0,20 nas mulheres e 1; 0,47; 0,09 nos homens). Independentemente da idade, os solteiros eram frequentemente mais ativos. A atividade de lazer associou-se negativamente ao consumo de bebidas alcoólicas para ambos os sexos e nos homens, ao consumo de tabaco. CONCLUSÕES: Os jovens, normoponderais, solteiros, não-bebedores e os homens não-fumadores apresentaram maior probabilidade de serem fisicamente ativos. Em ambos os sexos, observou-se um efeito diferencial da escolaridade segundo os tipos de atividade física.

Predictors of changes in physical activity in a prospective cohort study of the Danish adult population

AIM

To investigate predictors of changes in physical activity, in a prospective population-based study.

METHODS

Data were from the Danish Health Interview Surveys in 1994 and 2000, and included persons between 16 and 64 years of age who answered the questions on physical activity and various covariates in 1994, and who were re-interviewed in 2000. In total 2,957 subjects participated (62% of the original sample). Data were analysed using logistic regression.

RESULTS

Predictors of physical inactivity were, for men and women respectively, heavy smoking (odds ratio (OR) 2.07, 95% confidence interval (CI) 1.24-3.48, and OR 2.23, 95% CI 1.34-3.71), poor self-rated health (OR 2.11, 95% CI 1.25-3.58, and OR 1.75, 95% CI 1.10-2.80), and believing that one's own effort has no effect on health (OR 1.86, 95% CI 1.20-2.88, and OR 1.63, 95% CI 1.00-2.65). For men, further predictors for physical inactivity were obesity as compared to normal weight (OR 2.10, 95% CI 1.11-3.98), and being unmarried as compared to being married (OR 2.22, 95% CI 1.40-3.51). The only predictor for becoming physically active among initially sedentary respondents was meeting often with family (p=0.011).

CONCLUSIONS

Our results show a number of strong predictors for physical inactivity. Variables of an unhealthy lifestyle tend to cluster in some individuals, and physical inactivity interventions may therefore be more successful if they also address smoking, self-belief, and obesity. Interventions tailored to raise inactive people's level of activity should focus on social support from the family.

Disentangling the roles of disability and morbidity in survival to exceptional old age

BACKGROUND

Although it is commonly held that survival to age 100 years entails markedly delaying or escaping age-related morbidities, nearly one-third of centenarians have age-related morbidities for 15 or more years. Yet, we have previously observed that many centenarians compress disability toward the end of their lives. Therefore, we hypothesize that for some centenarians, compression of disability rather than morbidity is a key feature for survival to old age.

METHODS

This cross-sectional, nationwide study included 523 women and 216 men 97 years or older. The participants were stratified by sex and age at onset (age <85 years [termed survivors] and age >or=85 years [termed delayers]) of chronic obstructive pulmonary disease, dementia, diabetes, heart disease, hypertension, osteoporosis, Parkinson disease, and stroke. Dependent variables were the Barthel Activities of Daily Living Index (Barthel Index) and the Information-Memory-Concentration test of the Blessed Dementia Scale.

RESULTS

Thirty-two percent of the participants were survivors. For men with hypertension and/or heart disease for 15 or more years, the median Barthel Index score was 90 (independence range, 80-100). For female survivors with hypertension, heart disease, and/or osteoporosis, the median Barthel Index score was 65 (minimal assistance range, 60-79). Generally, men had better function than women: 60% of male survivors had Barthel Index scores of 90 or higher compared with 18% of female survivors (P < .001) and 50% of male delayers had Barthel Index scores of 90 or higher compared with 27% of females delayers (P < .001).

CONCLUSIONS

Whereas the compression of both morbidity and disability are essential features of survival to old age for some centenarians, for others, the compression of disability alone may be the key prerequisite. Though far fewer in number, male centenarians tend to have significantly better cognition and physical function than their female counterparts.

Skeletal muscle protein anabolic response to resistance exercise and essential amino acids is delayed with aging

Skeletal muscle loss during aging leads to an increased risk of falls, fractures, and eventually loss of independence. Resistance exercise is a useful intervention to prevent sarcopenia; however, the muscle protein synthesis (MPS) response to resistance exercise is less in elderly compared with young subjects. On the other hand, essential amino acids (EAA) increase MPS equally in both young and old subjects when sufficient EAA is ingested. We hypothesized that EAA ingestion following a bout of resistance exercise would stimulate anabolic signaling and MPS similarly between young and old men. Each subject ingested 20 g of EAA 1 h following leg resistance exercise. Muscle biopsies were obtained before and 1, 3, and 6 h after exercise to measure the rate of MPS and signaling pathways that regulate translation initiation. MPS increased early in young (1-3 h postexercise) and later in old (3-6 h postexercise). At 1 h postexercise, ERK1/2 MNK1 phosphorylation increased and eIF2alpha phosphorylation decreased only in the young. mTOR signaling (mTOR, S6K1, 4E-BP1, eEF2) was similar between groups at all time points, but MNK1 phosphorylation was lower at 3 h and AMP-activated protein kinase-alpha (AMPKalpha) phosphorylation was higher in old 1-3 h postexercise. We conclude that the acute MPS response after resistance exercise and EAA ingestion is similar between young and old men; however, the response is delayed with aging. Unresponsive ERK1/2 signaling and AMPK activation in old muscle may be playing a role in the delayed activation of MPS. Notwithstanding, the combination of resistance exercise and EAA ingestion should be a useful strategy to combat sarcopenia.

Lifestyle factors and incident mobility limitation in obese and non-obese older adults

OBJECTIVE

This study examines the association between incident mobility limitation and 4 lifestyle factors: smoking, alcohol intake, physical activity, and diet in well-functioning obese (n = 667) and non-obese (n = 2027) older adults.

RESEARCH METHODS AND PROCEDURES

Data were from men and women, 70 to 79 years of age from Pittsburgh, PA and Memphis, TN, participating in the Health, Aging and Body Composition (Health ABC) study. In addition to individual lifestyle practices, a high-risk lifestyle score (0 to 4) was calculated indicating the total number of unhealthy lifestyle practices per person. Mobility limitation was defined as reported difficulty walking 1/4 mile or climbing 10 steps during two consecutive semiannual assessments over 6.5 years.

RESULTS

In non-obese older persons, significant risk factors for incident mobility limitation after adjustment for socio-demographics and health-related variables were current and former smoking [hazard ratio (HR) = 1.51; 95% confidence interval (CI), 1.20 to 1.89; HR = 1.40; 95% CI, 1.12 to 1.74), former alcohol intake (HR = 1.30; 95% CI, 1.05 to 1.60), low and medium physical activity (HR = 1.78; 95% CI, 1.45 to 2.18; HR = 1.29, 95% CI, 1.07 to 1.54), and eating an unhealthy diet (HR = 1.57; 95% CI, 1.17 to 2.10). In the obese, only low physical activity was associated with a significantly increased risk of mobility limitation (HR = 1.44; 95% CI, 1.08 to 1.92). Having two or more unhealthy lifestyle factors was a strong predictor of mobility limitation in the non-obese only (HR = 1.98; 95% CI, 1.61 to 2.43). Overall, obese persons had a significantly higher risk of mobility limitation compared with non-obese persons, independent of lifestyle factors (HR = 1.73; 95% CI, 1.52 to 1.96).

CONCLUSIONS

These results underscore the importance of a healthy lifestyle for maintaining function among non-obese older adults. However, a healthy lifestyle cannot overcome the effect of obesity in obese older adults; this stresses the importance of preventing obesity to protect against mobility loss in older persons.

Ageing and physical activity: evidence to develop exercise recommendations for older adultsThis article is part of a supplement entitled Advancing physical activity measurement and guidelines in Canada: a scientific review and evidence-based foundation for the future of Canadian physical activity guidelines co-published by Applied Physiology, Nutrition, and Metabolism and the Canadian Journal of Public Health. It may be cited as Appl. Physiol. Nutr. Metab. 32(Suppl. 2E) or as Can. J. Public Health 98(Suppl. 2)

An abundance of epidemiological research confirms the benefits of physical activity in reducing risk of various age-related morbidities and all-cause mortality. Analysis of the literature focusing on key exercise variables (e.g., intensity, type, and volume) suggests that the requisite beneficial amount of activity is that which engenders improved cardiorespiratory fitness, strength, power, and, indirectly, balance. Age-related declines in these components are such that physical limitations impinge on functional activities of daily living. However, an exercise programme can minimize declines, thus preventing older adults (age 65+ years) from crossing functional thresholds of inability. Cross-sectional and longitudinal data demonstrate that cardiorespiratory fitness is associated with functional capacity and independence; strength and, importantly, power are related to performance and activities of daily living; and balance-mobility in combination with power are important factors in preventing falls. Exercise interventions have documented that older adults can adapt physiologically to exercise training, with gains in functional capacities. The few studies that have explored minimal or optimal activity requirements suggest that a threshold (intensity) within the moderately vigorous domain is needed to achieve and preserve related health benefits. Thus, physical activity and (or) exercise prescriptions should emphasize activities of the specificity and type to improve components related to the maintenance of functional capacity and independence; these will also delay morbidity and mortality. An appropriate recommendation for older adults includes moderately vigorous cardiorespiratory activities (e.g., brisk walking), strength and (or) power training for maintenance of muscle mass and specific muscle-group performance, as well as “balance-mobility practice” and flexibility (stretching) exercise as needed.

[Utility of the number of steps walked daily as a health promotion parameter in community-dwelling elderly persons]

AIM

To clarify the usefulness of the number of steps walked daily as a health promotion parameter in the elderly.

METHODS

The study was performed at five welfare centers for the elderly in the suburban area of Takatsuki-city, Japan. Subjects comprised 339 community-dwelling persons (96 men and 243 women) aged 60-89 years. The number of steps walked daily, usual walking speed, "timed up and go" (TUG) time, handgrip strength, body muscle mass and bone density were measured. Psychological and physical status and lifestyle factors were determined vie questionnaire. Subjects were classified into one of two groups, a low- or high-level walking group, according to the Healthy Japan 21 criteria. Differences between the two groups were analyzed.

RESULTS

Men walked 8,075 steps (mean number) daily, and women walked 7,902 steps daily. The number decreased with age in both men and women and correlated with usual walking speed and TUG time. Low-level walking was found in 41.7% of men and 28.8% of women. Intermittent claudication and fear of falling were the main contributors to low-level walking, whereas walking almost daily and engaging in physical activity with a view toward health promotion were the main contributors to high-level walking.

CONCLUSION

For the elderly population, the number of steps walked daily was related to their walking ability, such as walking speed and walking balance, and could be considered as a useful health promotion parameter. Taking a walk daily could be the main approach to increase the number of steps walked daily in the elderly.

Physical activity and physical activity adherence in the elderly based on smoking status

This study assessed the impact of current smoking status and lifetime smoking status on physical fitness and physical activity regimen adherence as part of a larger study on walking for exercise in elderly primary care patients at a Veterans Affairs Medical Center. At baseline, 218 participants self-reported smoking status which was verified by carbon monoxide expiration. Former and current smokers responded to questions about length of time quit, average daily cigarette intake, and years a smoker. Smoking measures were re-collected at 6- and 12-month follow-ups if the participants indicated a change in smoking status. Veterans completed multiple measures of physical activity (e.g., 6-min walk, 7-day Physical Activity Recall), and adherence to a physical activity goal was assessed. The Physical Component Summary (PCS) subscale of the Medical Outcomes Study Short Form-36 (MOS SF-36) was used to assess health-related quality of life. Hierarchical regression models indicated smoking status was a predictor of the baseline 6-min walk such that smokers walked significantly shorter distances than nonsmokers. In addition, smoking status was found to be a significant predictor of adherence; however, the overall model that included smoking status as a predictor did not demonstrate a significant effect on adherence. Neither smoking status nor pack years were predictors of baseline self-reported physical activity or changes in physical activity post intervention. Results are consistent with recommendations to use physical exercise as an aid to tobacco cessation, even in aging men with extensive smoking histories.

Impact of selected risk factors on expected lifetime without long-standing, limiting illness in Denmark

OBJECTIVE

To estimate the impacts of tobacco smoking, high alcohol consumption, physical inactivity and overweight on expected lifetime with and without long-standing, limiting illness.

METHODS

Life tables for each level of exposure to the risk factors were constructed, mainly on the basis of the Danish National Cohort Study. Expected lifetime without long-standing, limiting illness was estimated for exposed and unexposed persons by combining life tables and prevalence data from the Danish Health Interview Survey 2000 (14,503 participants aged 25+).

RESULTS

The life expectancy of 25-year-olds was 9-10 years shorter for heavy smokers than for those who never smoke, and all the lifetime lost would have been without long-standing, limiting illness. Similarly, all 5 years of expected lifetime lost by men with high alcohol consumption would have been without illness. The expected lifetime without long-standing, limiting illness was 8-10 years shorter among sedentary than physically active people. Obesity shortened lifetime without illness by 5 years for men and ten years for women.

CONCLUSION

The results of this study could be used in health policy-making, as the potential gains in public health due to interventions against these risk factors could be evaluated, when the prevalence of exposure to the risk factor is available.

Resistance exercise reverses aging in human skeletal muscle

Human aging is associated with skeletal muscle atrophy and functional impairment (sarcopenia). Multiple lines of evidence suggest that mitochondrial dysfunction is a major contributor to sarcopenia. We evaluated whether healthy aging was associated with a transcriptional profile reflecting mitochondrial impairment and whether resistance exercise could reverse this signature to that approximating a younger physiological age. Skeletal muscle biopsies from healthy older (N = 25) and younger (N = 26) adult men and women were compared using gene expression profiling, and a subset of these were related to measurements of muscle strength. 14 of the older adults had muscle samples taken before and after a six-month resistance exercise-training program. Before exercise training, older adults were 59% weaker than younger, but after six months of training in older adults, strength improved significantly (P<0.001) such that they were only 38% lower than young adults. As a consequence of age, we found 596 genes differentially expressed using a false discovery rate cut-off of 5%. Prior to the exercise training, the transcriptome profile showed a dramatic enrichment of genes associated with mitochondrial function with age. However, following exercise training the transcriptional signature of aging was markedly reversed back to that of younger levels for most genes that were affected by both age and exercise. We conclude that healthy older adults show evidence of mitochondrial impairment and muscle weakness, but that this can be partially reversed at the phenotypic level, and substantially reversed at the transcriptome level, following six months of resistance exercise training.

The Japanese Centenarian Study: autonomy was associated with health practices as well as physical status

OBJECTIVES

To investigate the prevalence of centenarians who have preserved activities of daily living (ADLs) and good cognitive and psychosocial status in Japan.

DESIGN

Census-based survey.

SETTING

Cross-Sectional Investigation of Half of All Japanese Centenarians Study, 2000.

PARTICIPANTS

A nationwide census-based study was conducted of all of the male centenarians and a random sample of half of all the female centenarians who were included in the National Census of Japan. After excluding those who had died and whose addresses could not be identified, 1,907 centenarians (53.0%) participated in the present visitation interview survey.

MEASUREMENTS

ADLs, cognitive status, and psychosocial status. Centenarians who have preserved ADLs and good cognitive and psychosocial status were defined as autonomous centenarians.

RESULTS

Of the study subjects, 10.4% were judged to be autonomous centenarians. Multiple logistic regression analyses revealed that autonomy in centenarians was associated with better visual acuity, getting regular exercise, spontaneous awakening regularly in the morning, preserved masticatory ability, having no history of drinking, having no history of severe falls after the age of 95, more frequent intake of protein, living at home, and being male. It was also demonstrated that autonomous centenarians were not associated with appetite, vegetable or seaweed intake, smoking habits, auditory capacity, body mass index, or present illness.

CONCLUSION

These findings suggest that health practices play an important role in preserving ADLs and good cognitive and psychosocial status after reaching the age of 100 and should be useful for establishing an educational program for the ever-increasing "super elderly" population in Japan.

Functional ability at age 75: is there an impact of physical inactivity from middle age to early old age?

The aim of this study is to analyze the impact of physical inactivity from middle age to early old age on functional ability at age 75. Physical activity is measured both as cumulated activity from age 50 to 60 to 70 and at three separate points in time. Three hundred eighty-seven men and women born in 1914 and living in seven municipalities in the western part of the County of Copenhagen were followed for 25 years with examinations in 1964, 1974, 1984 and 1989. Analyses were conducted with physical inactivity as an independent variable (accumulated and separately for each point in time) and smoking, sex, school education, household composition, chronic disease at baseline and functional ability at age 70 as possible confounders. There was a strong association between physical inactivity at age 70 and disability at age 75. However, the analyses showed no effect of cumulated physical inactivity from age 50 to 60 to 70 on disability at age 75 when adjusting for functional ability at age 70. Physical inactivity is a risk factor for disability among old people. Thus, old people should be encouraged to take up and maintain physical training throughout the aging process.

A decomposition of income-related health inequality applied to EQ-5D

Income-related inequality in health and its relationship to sociodemographic characteristics have received considerable attention in the health economic literature. Recently a method was suggested for decomposing income-related health inequality to contributions from individual characteristics via additive dimensions, and this was applied to a Finnish case based on 15D health scores, where health is considered to be a sum of 15 individual health dimensions. The present study adds to this literature in several ways. First, we apply the decomposition approach to a Danish case which can be benchmarked to the Finnish. Second, we show how to apply the method to EQ-5D scores, which deviate from 15D scores by expressing health as individual depreciations of an equal endowment of perfect health. Third, we add life-style factors to the determinants of income-related health inequality. The empirical part of the study reveals discrepancies which can be attributed to differences between Finland and Denmark and to differences between the construction of 15D and EQ-5D scores. Finally, evidence of impact of life-style factors on income-related health inequality is found.

Life Expectancy and Productivity Loss Among Narcotics Addicts Thirty-Three Years After Index Treatment

This study computed the life expectancy of a cohort of male narcotics addicts followed for 33 years and assessed the productivity lost as a result of premature mortality. The future life expectancy was constructed for the narcotics addicts and for a comparable cohort from the general U.S. population. The average future life expectancy of the cohort was 18.84 years compared to 33.48 years for comparable U.S. males (t = 49.49, p < .00001). As a result of this premature mortality, the estimated monetary value of lost productivity was greater than 174 million dollars. The lives of heroin addicts were severely truncated at productive ages resulting in a loss of potential productivity that increases social and economic burdens.

Effects of a Physical Activity Intervention on Measures of Physical Performance: Results of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Study

BACKGROUND

The Short Physical Performance Battery (SPPB), which includes walking, balance, and chair stands tests, independently predicts mobility disability and activities of daily living disability. To date, however, there is no definitive evidence from randomized controlled trials that SPPB scores can be improved. Our objective was to assess the effect of a comprehensive physical activity (PA) intervention on the SPPB and other physical performance measures.

METHODS

A total of 424 sedentary persons at risk for disability (ages 70-89 years) were randomized to a moderate-intensity PA intervention or a successful aging (SA) health education intervention and were followed for an average of 1.2 years.

RESULTS

The mean baseline SPPB score on a scale of 0-12, with 12 corresponding to highest performance, was 7.5. At 6 and 12 months, the PA versus SA group adjusted SPPB (+/- standard error) scores were 8.7 +/- 0.1 versus 8.0 +/- 0.1, and 8.5 +/- 0.1 versus 7.9 +/- 0.2, respectively (p < .001). The 400-meter walking speed was also significantly improved in the PA group. The PA group had a lower incidence of major mobility disability defined as incapacity to complete a 400-meter walk (hazard ratio = 0.71, 95% confidence interval = 0.44-1.20).

CONCLUSIONS

A structured PA intervention improved the SPPB score and other measures of physical performance. An intervention that improves the SPPB performance may also offer benefit on more distal health outcomes, such as mobility disability.

Physical exercise and comorbidity. Results from the Fitness and Arthritis in Seniors Trial (FAST)

BACKGROUND AND AIMS

Physical exercise is associated with a lower risk of disability. The impact of comorbidity on the benefits from physical exercise has not been clearly investigated. Elders with comorbidity may benefit from physical exercise to preserve physical function.

METHODS

Data are from 435 participants with knee osteoarthritis aged > or = 60 years enrolled in the Fitness and Arthritis in Seniors Trial (FAST), who were randomly assigned to 18-month health educational (HE), weight training (WT), or aerobic exercise (AE) interventions. Comorbidity was defined as the presence of osteoarthritis and > or = 2 clinical conditions. Percent changes in the 6-minute walk test, self-reported disability and knee pain from baseline to 3-, 9-, and 18-month follow-up visits were analyzed according to comorbidity, using analysis of variance. Significances were adjusted using the Bonferroni method.

RESULTS

Mean age of the sample was 68.7 years. In participants with comorbidity (n=197), those in the AE intervention showed significant improvement in walking speed, compared to WT and HE groups, since the beginning of follow-up. Subjects with comorbidity in AE and WT groups showed improvement of the disability score at the 3-month follow-up visit compared to those in the HE group. This improvement was maintained at the end of the follow-up by the only AE group compared to the HE one (p=0.06). In participants with comorbidity, the pain score was improved by the AE intervention.

CONCLUSIONS

AE and WT interventions improve physical function in individuals with comorbidity. AE improves physical function and knee pain independently of the presence of comorbidity.

Midlife physical activity and mobility in older age: The InCHIANTI study

BACKGROUND

Among older adults, loss of mobility represents a critical stage in the disablement process, whereby the risk for disability is significantly increased. Physical activity is a modifiable risk factor that is associated with reduced risk of losing mobility in older adulthood; however, few studies have examined physical activity performed earlier in life in relation to mobility later in life.

METHODS

Data from a population-based study of 1155 adults aged 65 years and older living in the Chianti region of Italy in 1998-2000 were analyzed in 2005 and 2006. Participants retrospectively recalled their physical activity levels in midlife and underwent mobility testing and medical examination. Two objective mobility outcomes were examined as a function of past physical activity: the Short Physical Performance Battery (SPPB) and the ability to walk 400 meters.

RESULTS

Older Italian adults (mean age 74.8, standard deviation 7.3) who engaged in higher levels of physical activity in midlife were significantly more likely to perform better on the SPPB than individuals who were less physically active in midlife. In addition, failure to complete the 400-meter walk test was significantly less likely among physically active men (Level II) (odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.15-0.93) and very active men (Level III) (OR = 0.23, 95% CI = 0.09-0.63) when compared to men who were less active (Level I) in the past (p for trend, 0.008). These associations remained after adjustment for demographic factors, medical conditions, and physiologic impairments.

CONCLUSIONS

Older adults who reported higher levels of physical activity in midlife had better mobility in old age than less physically active ones.

Group cohesion and social support in exercise classes: results from a danish intervention study

This study examines the formation of group cohesion and social support in exercise classes among former sedentary adults, participating in a Danish community-based intervention. Furthermore, the aim is to analyze the impact of this process on exercise activity among the participants. A multimethod approach was used, analyzing both survey data and 18 personal interviews collected among 87 participants who completed the intervention project. Analysis was performed according to the grounded theory method. The formation of group cohesion was conditioned by the social composition of the group, the teaching ability by the instructors, and the activity by itself. The cohesive group was characterized by an attitude of mutual support toward exercise activities. This mutual support facilitated development of self-efficacy beliefs among the participants improving their mastery expectation regarding exercise. Manipulating group dynamics may be a promising intervention tool in the promotion of leisure-time physical activity.

Successful aging: measuring the years lived with functional loss

Current research of risk factors potentially associated with successful aging faces the difficulty of taking into consideration two distinct outcome measures: survival and functioning. Previous studies either used successful aging measures restricted to survivors or presented more than one outcome measure to handle the dual outcome. This article illustrates the utility of health expectancy measures, based on life tables, to integrate the effects of survival and functioning across all ages. It is shown that three hypothetical successful aging strategies, considered equally successful according to the traditional measures restricted to survivors, are associated with vastly different changes in the years lived with and without disability. Furthermore, the intervention considered most successful when considering multiple successful aging measures, was associated with the largest increase in the time lived with disability. It is recommended that research on successful aging should be based on summary measures of population health that reflect both survival and functioning throughout life. These will provide more relevant information than is currently available for individuals and societies to evaluate and choose between successful aging strategies.

Physical Activity and Pet Ownership in Year 3 of the Health ABC Study

Pet ownership among older adults was investigated to determine whether dog owners were more likely to engage in physical activity than non-dog-pet or non–pet owners. The relationship between pet ownership and physical activity was examined using data from the Health ABC study. After age, race, education level, number of assets, family income, and site were adjusted for dog owners were more likely than non–pet owners to have engaged in non-exercise-related walking in the preceding week but did not differ from non–pet owners in walking for exercise or any physical activity. In contrast, non-dog-pet owners did not differ from non–pet owners in non-exercise-related walking in the preceding week and were less likely than non–pet owners to have engaged in walking for exercise or any physical activity in the preceding week. The activity-related benefits of pet ownership in older adults were limited to dog owners, who engaged in greater overall physical activity—non-exercise-related walking, in particular. Whether pet-related physical activity is sufficient to provide health benefits requires longitudinal investigation.

Tobacco harm reduction strategies: The case for physical activity

Since the effects of tobacco smoke are so detrimental to health, growing consideration has been given to the development of harm reduction strategies for those smokers who are unable or unwilling to stop using tobacco. The term harm reduction refers to a policy, strategy, or particular intervention that assumes continued use of an undesired behavior and aspires to lower the risk of adverse consequences associated with the continuation of this addictive behavior. Up to this point, tobacco harm reduction interventions have focused on reducing tobacco-related harm through the utilization of innovative tobacco products, reduced tobacco consumption, and pharmaceutical medications. With the possible exception of medicinal nicotine products, these strategies remain unproven and thus far no scientific or medical literature exists to suggest these harm reduction strategies reduce tobacco-related exposure, morbidity, or mortality. Consequently, a need exists for broadening the range of potentially effective harm reduction strategies. This preliminary review suggests that physical activity has the potential to become one such strategy. Of the eight principles that characterize a harm reduction strategy, all are at least partially satisfied by physical activity. Further, emerging evidence indicates that physical activity may delay the occurrence of disease and premature death initiated by tobacco consumption. Significant concerns remain regarding the practicality of physical activity as a harm reduction strategy and the extent to which participation in physical activity may be used to justify continued smoking.

Modifiable factors for the length of life with disability before death: mortality retrospective study in Japan

BACKGROUND

Past studies have measured and described the length of life with disability before death, but there has been no study of the relationship between modifiable lifestyle factors and duration of disability.

OBJECTIVE

To examine whether there are modifiable factors influencing the length of life with disability before death.

METHODS

The study was designed as a retrospective observation of the deceased who had earlier been enrolled in a prospective cohort study. During the follow-up period (1996-1999), we documented 781 deaths among those who were 70-79 years of age at the baseline survey in 1994 (n=10,216). In 2000, we interviewed family members of the deceased about the duration of the subjects' disability before death (n=655).

RESULTS

The median duration of disability before death was approximately 6 months. Both higher Body Mass Index (BMI) and shorter time spent walking were significantly associated with an increased risk of long-term disability (more than 6 months). The odds ratios of long-term disability were 1.3 in those with BMI 20-25 and 2.1 in those with BMI>25, compared with BMI<20. The odds ratios of long-term disability were 1.3 in those walking for 0.5-0.9 h/day and 1.7 in those walking for <0.5 h/day, compared with those walking for >1.0 h/day. These relationships were unchanged after stratification for causes of death.

CONCLUSION

Weight control and walking in later life may shorten the length of life with disability before death.

Factors explaining disability-free life expectancy in Japan: the proportion of older workers, self-reported health status, and the number of public health nurses

BACKGROUND

Disability-free life expectancy (DFLE) data for 47 prefectures in Japan were reported in 1999; however, few studies have identified the factors associated with the length of the DFLE. The objective of this study was to elucidate the primary factors that explain differences in DFLEs in Japan.

METHODS

In our ecological study, 47 prefectures in Japan were used as units of analysis. The DFLEs for men and women at 65 years of age (DFLE65), calculated by Hashimoto et al using Sullivan's method, were set as dependent variables. From various national surveys, 181 factors associated with demographics, socioeconomic status, health status and health behaviors, medical environment, social relationships, climate, and other areas were gathered as independent variables. Pearson's or Spearman's correlation coefficients were calculated to screen independent variables potentially associated with the DFLE65s. Then, multivariate linear regression analyses were conducted for the selected 24 independent variables after adjusting for the proportion of older people (65 years or more) and population density.

RESULTS

Multivariate linear regression analyses revealed that the large number of public health nurses per 100,000 population, a good self-reported health status, and a high proportion of older workers were significantly associated with long DFLE65s for both genders.

CONCLUSIONS

These three factors could potentially explain the differences in DFLE of the older population in Japan.

Cardiovascular Risk Factors Predictive for Survival and Morbidity-Free Survival in the Oldest-Old Framingham Heart Study Participants

OBJECTIVES

To examine whether midlife cardiovascular risk factors predict survival and survival free of major comorbidities to the age of 85.

DESIGN

Prospective community-based cohort study.

SETTING

Framingham Heart Study, Massachusetts.

PARTICIPANTS

Two thousand five hundred thirty-one individuals (1,422 women) who attended at least two examinations between the ages of 40 and 50.

MEASUREMENTS

Risk factors were classified at routine examinations performed between the ages of 40 and 50. Stepwise sex-adjusted logistic regression models predicting the outcomes of survival and survival free of morbidity to age 85 were selected from the following risk factors: systolic and diastolic blood pressure, total serum cholesterol, glucose intolerance, cigarette smoking, education, body mass index, physical activity index, pulse pressure, antihypertensive medication, and electrocardiographic left ventricular hypertrophy.

RESULTS

More than one-third of the study sample survived to age 85, and 22% of the original study sample survived free of morbidity. Lower midlife blood pressure and total cholesterol levels, absence of glucose intolerance, nonsmoking status, higher educational attainment, and female sex predicted overall and morbidity-free survival. The predicted probability of survival to age 85 fell in the presence of accumulating risk factors: 37% for men with no risk factors to 2% with all five risk factors and 65% for women with no risk factors to 14% with all five risk factors.

CONCLUSION

Lower levels of key cardiovascular risk factors in middle age predicted overall survival and major morbidity-free survival to age 85. Recognizing and modifying these factors may delay, if not prevent, age-related morbidity and mortality.

Future demand for formal long-term care in Sweden

Ageing population will have a significant effect on demand for human resources in health care and social care for the older people. Here we are presenting, using different scenarios, how projected demographic development may influence the demand for formal long-term care (LTC) for the people older than 65 years in Sweden 2000-2030. Our method uses information on utilisation of current services per gender and age group, demographic projections of number of older people per gender and age group and assumptions on health status changes per gender and age group. Our assumptions on health status changes were based on estimates from Swedish National Survey of Living Conditions, covering 32,502 observations during the period 1975-1999. The assumption that trends in severe ill-health in Sweden between 1975 and 1999 will continue (meaning expected improvements in age/gender-specific health and functional ability among the older people) results in the projected increase in the demand by year 2030 being almost halved, compared with an estimate that is based on unchanged age/gender-specific health and functional ability. The assessment of future demand for LTC for the people older than 65 years should involve extrapolations based on expected changes in health status, as well as the question how decreasing mortality incorporated into population forecasts is to be associated with future trends on severe morbidity/disability.

Estimates of Active and Disabled Life Expectancy Based on Different Assessment Intervals

BACKGROUND

Although disability in activities of daily living (ADLs) is a highly dynamic process, analytic strategies for estimating active and disabled life expectancy have assumed stability in ADL function between periodic surveys spanning 12--24 months or have used interval estimation or instantaneous rates based on long assessment intervals. We performed a prospective cohort study to compare estimates of active and disabled life expectancy based on traditional assessment intervals of 1--2 years with those based on more frequent assessments at 1-month intervals.

METHODS

Participants included 754 initially nondisabled community-dwelling persons, aged 70 years or older, who were interviewed monthly for 4 years to ascertain ADL disability. Estimates of active and disabled life expectancy were calculated using an increment-decrement life table for assessment intervals of 1 month, 1 year, and 2 years.

RESULTS

For each of five age groups, the monthly assessment strategy yielded the highest values for active life expectancy and the lowest values for disabled life expectancy. The 95% confidence intervals for these values, however, overlapped the corresponding point estimates for the annual and biennial strategies.

CONCLUSIONS

Accurate estimates of active and disabled life expectancy may be obtained from epidemiologic studies that assess ADL function no more frequently than every other year.

Cigarette smoking, regular exercise, and peripheral blood flow

Acute and chronic smoking reduces peripheral blood flow and shear stress, contributing to the increased incidence of peripheral arterial disease in smokers. Currently, it is not known whether physical activity status influences peripheral blood flow among chronic smokers. Blood flow was measured using Doppler ultrasound on the common femoral artery in nine young otherwise healthy sedentary smokers (eight males/one female) and nine physically-active smokers (six males/three females). Physically-active smokers performed strenuous exercise 4.4 times/week for 8 h/week. No significant differences in body fat, blood pressure, and total cholesterol were observed between groups. Basal femoral artery blood flow was approximately 50% higher in physically-active smokers compared with sedentary smokers (259+/-108 ml min(-1) versus 173+/-47 ml min(-1), P<0.05). The higher basal femoral artery blood flow in physically-active smokers compared with sedentary smokers was associated with a 47% higher femoral artery vascular conductance (2.99+/-1.2 U versus 2.03+/-0.5 U, P<0.05) and a 39% lower vascular resistance (0.38+/-0.13 U versus 0.53+/-0.15 U, P<0.05). Cardiac output, systemic vascular resistance, femoral intima-media thickness, and plasma norepinephrine concentration were not different between the groups. We concluded that smokers who habitually perform physical activity demonstrate greater levels of peripheral blood flow and peripheral vascular conductance. The findings from the present cross-sectional study suggest that chronic smokers may be able to negate, at least in part, the adverse effects of chronic smoking on the peripheral vasculature by performing regular physical activity.

A gender-based dynamic multidimensional longitudinal analysis of resilience and mortality in the old-old in Israel: the cross-sectional and longitudinal aging study (CALAS)

The objective was to examine gender differences and similarities in health, function, familial and non-familial social networks; longitudinal resilience in those factors; and their association with risk of mortality in Israeli men and women aged 75-94. We used the Cross-Sectional and Longitudinal Aging Study (CALAS), a stratified random sample of 960 Israeli Jews aged 75-94, drawn on January 1, 1989 from National Population Registry, stratified by gender, age (75-79, 80-84, 85-89, 90-94), and place of birth (Europe/America, Middle East/North Africa, Israel), interviewed twice (Wave 1, 1989-1992; Wave 2, 1993-1995); Wave 1 values and longitudinal resilience predicted the 1999 mortality risk for those alive at both waves. Gender differences and similarities were found at Wave 1 in longitudinal resilience and in risk factors for mortality, partially supporting a gender paradox. Men were more physically active, had better cognition, gave more help to children, relied less on paid caretakers, and attended synagogue more than women, factors associated with better health and functioning. Women had poorer health and functional status and more help from children. More physical activity, synagogue attendance, and resilience in activities of daily living (ADL) were associated with lower risk of mortality for both genders. Women's risk of mortality was reduced by smoking reduction and higher cognitive vitality, and men's by emotional support and solitary leisure activity. Both men and women were resilient, yet there were differences. Gender-neutral mortality reduction programs would include physical activity, religious services, maintenance and improvement of ADL, and engaging in solitary leisure activities; for women, smoking cessation and cognitively challenging activities; and for men, maintaining or increasing emotional ties.

Physical functioning in end-stage renal disease patients: Update 2005

Physical functioning in patients with end-stage renal disease treated with dialysis is low, whether measured using objective laboratory measures, physical performance testing, or self-reported measures. Peak oxygen uptake (VO2peak), self-reported functioning measures, and physical activity levels are independent predictors of mortality in these patients. Cardiovascular exercise training studies result in improvements in VO2peak, physical performance tests, and self-reported functioning. Resistance exercise training improves muscle strength. Exercise training may have positive benefits on other factors that are important clinical issues in dialysis patients, including cardiovascular risk profile, oxidative stress, and inflammation. Endothelial function, a surrogate marker of atherosclerosis, has been shown to improve with exercise training in dialysis patients. Although there have been numerous recent studies on benefits of exercise, few dialysis clinics or nephrologists provide encouragement or programs as a part of their routine care of their patients. There are many national guidelines that include exercise or increasing physical activity as a part of the treatment of many conditions that are relevant in dialysis patients, including hypertension, hyperlipidemia, and high cardiovascular disease risk. The nephrology community continues to state concern for outcomes; however, a simple, low-tech intervention that has many benefits to their patients (i.e., encouragement, recommendations, and opportunity for increasing physical activity) has not been adopted as part of the standard care. Adoption of routine counseling and encouragement for physical activity has the potential to improve outcomes, improve physical functioning, and optimize quality of life and overall health of dialysis patients.

Impact of smoking, diabetes and hypertension on survival time in the elderly: the Dubbo Study

OBJECTIVE

To study the impact of various risk factors on survival time in a cohort of elderly Australians.

DESIGN, SETTING AND PARTICIPANTS

A longitudinal, prospective cohort study conducted in Dubbo, NSW. Participants were men and women aged 60 years or over living in the community, first assessed in 1988-1989 and followed for 15 years.

MAIN OUTCOME MEASURES

Mortality rates; risk factors; survival times.

RESULTS

There were 668 deaths in 1233 men (54%) and 625 deaths in 1572 women (40%). Coronary heart disease was the major cause of death, rates being higher in men than women until age group 80+ years; stroke death rates were similar in both sexes; cancer and respiratory death rates were higher in men than women across all ages. In a proportional hazards model, the independent predictors of mortality were cigarette smoking, diabetes, very high blood pressure (BP), impaired peak expiratory flow (PEF), physical disability, and zero intake of alcohol. Over 15 years, the average reductions in survival time associated with various risk factors, in men and women respectively, were smoking, 22 and 15 months; diabetes, 18 and 18 months; very high BP, 16 and 9 months; impaired PEF, 14 and 17 months; physical disability, 16 and 12 months; zero alcohol intake, 9 and 5 months. Combinations of selected risk factors were associated with a multiplier effect.

CONCLUSION

The reduction in survival time in elderly citizens demonstrated in the presence of smoking, diabetes and hypertension highlights a potential benefit to healthy ageing to be gained from prevention and intervention.

Caloric restriction versus drug therapy to delay the onset of aging diseases and extend life

There are two firmly established methods of prolonging life. Calorie restriction (CR) using nutrient-rich diets to prolong life in lower animals, and life saving medications in humans to delay the development of the major diseases of middle and old age. These two approaches have different mechanisms of action. In rats, CR at 40% below ad libitum intake begun soon after weaning and continued until death, reduces body weight by about 40% and increases lifespan. There have been no lifelong CR studies performed on humans. However, in healthy adult human subjects about 20% CR over a period of 2-15 years, lowers body weight by about 20% and decreases body mass index (BMI) to about 19. This CR treatment in humans reduces blood pressure and blood cholesterol to a similar extent as the specific drugs used to delay the onset of vascular disease and so extend human life. These same drugs may act by mechanisms that overlap with some of the mechanisms of CR in retarding these pathologies and thus may have similar antiaging and life prolonging actions. Such drugs may be regarded as CR mimetics which inhibit the development of certain life shortening diseases, without the need to lower calorie intake. In developed countries, better medical care, drug therapy, vaccinations, and other public health measures have extended human life by about 30 years during the 20th century without recourse to CR, which is so effective in the rat. The percentage gain in human life expectancy during the 20th century is twice that achieved by CR in rat survival. However, rat longevity studies now use specific pathogen-free animals and start CR after weaning or later, thereby excluding deaths from infectious diseases and those associated with birth and early life. There is a need to develop CR mimetics which can delay the development of life-threatening diseases in humans. In the 21st century due to the human epidemic of overeating with a sedentary lifestyle, it may necessary to utilize CR to counter the aging effects of overweight. Since the greatest life-extending effects of CR in the rodent occur when started early in life, long-term antiaging therapy in humans should be initiated soon after maturity, when physiological systems have developed optimally.

Prevalence, Attributes, and Outcomes of Fitness and Frailty in Community-Dwelling Older Adults: Report From the Canadian Study of Health and Aging

BACKGROUND

Frailty and fitness are important attributes of older persons, but population samples of their prevalence, attributes, and outcomes are limited.

METHODS

The authors report data from the community-dwelling sample (n = 9008) of the Canadian Study of Health and Aging, a representative, 5-year prospective cohort study. Fitness and frailty were determined by self-reported exercise and function level and testing of cognition.

RESULTS

Among the community-dwelling elderly population, 171 per 1000 were very fit and 12 per 1000 were very frail. Frailty increased with age, so that by age 85 years and older, 44 per 1000 were very frail. The risk for adverse health outcomes increased markedly with frailty: Compared with older adults who exercise, those who were moderately or severely frail had a relative risk for institutionalization of 8.6 (95% confidence interval, 4.9 to 15.2) and for death of 7.3 (95% confidence interval, 4.7 to 11.4). These risks persist after adjustments for age, sex, comorbid conditions, and poor self-rated health. At all ages, men reported higher levels of exercise and less frailty compared with women. Decreased fitness and increased frailty were also associated with poor self-ratings of health (42% in the most frail vs 7% in the most fit), more comorbid illnesses (6 vs 3), and more social isolation (34% vs 29%).

CONCLUSIONS

Fitness and frailty form a continuum and predict survival. Exercise influences survival, even in old age. Relative fitness and frailty can be determined quickly in a clinical setting, are potentially useful markers of the risk for adverse health outcomes, and add value to traditional medical assessments that focus on diagnoses.

Physical Activity and Obesity in Canadian Women

HEALTH ISSUE: Overweight and obesity have been recognized as major public health concern in Canada and throughout the world. Lack of physical activity, through its impact on energy balance, has been identified as an important modifiable risk factor for obesity. Physical activity and obesity are also important risk factors for a variety of chronic diseases. This chapter provides an overview of the current state of physical activity and overweight/obesity among Canadian women. KEY FINDINGS: For all ages combined more women (57%) than men (50%) are physically inactive (energy expenditure <1.5 KKD). Physical activity increases as income adequacy and educational level decrease. Physical inactivity also varies by ethnicity. The prevalence of both overweight (BMI 25.0 - 29.9 kg/m2) and obese (BMI >/= 30 kg/m2) Canadian women has increased 7% since 1985. Obesity increases with age and is highest among women reporting low and lower middle incomes and lower levels of education. The prevalence of obesity is highest among Aboriginal women and men (28% and 22% respectively). DATA GAPS AND RECOMMENDATIONS: There is currently no surveillance system in Canada to monitor the level of physical activity among children, those performing activity at work, at school or in the home. There is a gap in the knowledge surrounding socio-cultural and ecological determinants of physical activity and obesity and the associations of these to chronic disease among women and minority populations. Multi-sectoral policy interventions that act to decrease the broad systemic barriers to physical activity and healthy weights among all women are needed.

Mortality: life and health expectancy of Canadian women

HEALTH ISSUE: The sex differences in mortality, life expectancy, and, to a lesser extent, health expectancy, are well recognized in Canada and internationally. However, the factors explaining these differences between women and men are not well understood. This chapter explores the contribution of various causes of death (such as preventable, and sex-specific deaths) on these differences between women and men. KEY FINDINGS: "External" preventable causes of death (e.g. smoking-related, injuries, etc.) were responsible for a large portion of the sex gap in mortality and life expectancy. When excluding these causes from the calculations, the sex gap in life expectancies were largely reduced, decreasing from approximately 5.5 years (life expectancy being 81.4, years in women, and 75.9 years in men) to approximately 2.2 years (84.9 in women and 82.7 in men). Sex gaps in corresponding health expectancies entirely disappeared when these preventable causes of death were excluded. Moreover, a larger death burden was observed among women than men for sex-specific causes of death (eg. excess breast cancer, gynaecological cancers, maternal mortality). Significant disparities were also observed in the mortality rates of various subgroups of women by geographic regions of Canada. DATA GAPS AND RECOMMENDATIONS: These results indicate that women do not appear to have a large biological survival advantage but, rather, are at lower risk of preventable deaths. They also provide additional information needed for the development of policies aimed at reducing disparities in life and health expectancies in Canada and other developed countries.

A follow-up study found that cardiovascular risk in middle age predicted mortality and quality of life in old age

OBJECTIVE

Cardiovascular risk reduction, while saving lives, may prolong the time with disability and impair the quality of life in survivors. We compared the consequences of middle age cardiovascular risk in old age.

STUDY DESIGN AND SETTING

In 1974, risk was low in 593 (low-risk group) and high in 610 men (high-risk group). At baseline, all were healthy with similar age and socioeconomic status. Lifestyle and clinical factors, including quality of life (RAND-36), were surveyed with a questionnaire in 2000, and mortality was determined up to 2002.

RESULTS

During the follow-up, 303 men died, with mortality 54% higher in the high-risk group (P=.001). In the 2000 survey, high-risk men still had significantly greater BMI, higher blood glucose, higher prevalence of smoking, and more sedentary lifestyle, and they reported more both cardiovascular and noncardiovascular diseases. All the RAND-36 scales were worse in the high-risk group; of the two component summary scores, physical (PCS), but not mental (MCS) score, was significantly lower in the high-risk group.

CONCLUSION

Low cardiovascular risk in middle age was associated with lower mortality, morbidity, and better quality of life in old age 26 years later. The results may support the theory of compression of morbidity.

Looking Forward to a General Theory on Population Aging

The main theories on population aging based on recent data on human longevity, life expectancy, morbidity changes, disability trends, and mortality decrease are presented and discussed within their own geographic, cultural, socioeconomic, and medical contexts. The complex interactions between all these components do not facilitate trend forecasting of aging population (healthy aging versus disability pandemic). In the context of population aging, four elements were introduced with their implications: 1) an increase in the survival rates of sick persons, which would explain the expansion of morbidity, 2) a control of the progression of chronic diseases, which would explain a subtle equilibrium between the decrease in mortality and the increase in disability, 3) an improvement of the health status and health behaviors of new cohorts of elderly people, which would explain the compression of morbidity, and eventually 4) an emergence of very old and frail populations, which would explain a new expansion of morbidity. Obviously, all these elements coexist today, and future trend scenarios-expansion or compression of disability-depend on their respective weights leading to the need of elaborating "a general theory on population aging." This theory has to be based on a world harmonization of functional decline measurements and a periodic "International Aging Survey" to monitor global aging through a sample of carefully selected countries.

Predictors of mortality in 2,249 nonagenarians--the Danish 1905-Cohort Survey

OBJECTIVES

: To elucidate whether well-known predictions of mortality are reduced or even reversed, or whether mortality is a stochastic process in the oldest old.

DESIGN

: A multidimensional survey of the Danish 1905 cohort conducted in 1998 with follow-up of vital status after 15 months.

SETTING

: Denmark.

PARTICIPANTS

: All Danes born in 1905, irrespective of physical and mental status were approached. Two thousand two hundred sixty-two persons of 3,600 participated in this survey.

MEASUREMENTS

: Professional interviewers collected data concerning sociodemographic factors, smoking, alcohol consumption, body mass index, physical and cognitive performance, and health during a visit at the participant's residency. Cox regression models were used to evaluate predictors of mortality.

RESULTS

: Five hundred seventy-nine (25.7%) of the 2,249 participants eligible for the analysis died during the 15 months follow-up. Multivariate analyses showed that marital status, education, smoking, obesity, consumption of alcohol, and number of self-reported diseases were not associated with mortality. Disability and cognitive impairment were significant risk factors in men and women. In addition poor self-rated health was associated with an increase in mortality in women.

CONCLUSION

: In the oldest old, several known predictors of mortality, such as sociodemographic factors, smoking, and obesity, have lost their importance, but a high disability level, poor physical and cognitive performance, and self-rated health (women only), predict mortality, which shows that mortality in the oldest old is not a stochastic process.

Smoking and Aging Clinical Implications Part I: Health and Consequence

Smoking is the number one preventable cause of disability and mortality in older adults. In the past few decades there has been an enhanced focus on smoking behaviors and smoking cessation, however, the older smoker has been excluded. Even though nonsmoking status can provide older smokers with a chance for increased quality as well as quantity of life, they are asked less often to quit, given fewer resources, and provided less guidance than younger smokers. There is limited knowledge about how to design and deliver interventions for smoking cessation among older adults. The explanation for the absence of an empirical and clinical focus on smoking cessation for the older adult is in part because of the belief in myths rather than reality. These beliefs about the health consequences of smoking behaviors and the benefits of smoking cessation for older smokers are held by older adults and their health care providers. However, the truth is that older adults can stop smoking, and the benefits are vast.