Health, function and survival of a cohort of very old Canadians: results from the second wave of the Canadian Study of Health and Aging

Are centenarians successful agers? Evidence from China

BACKGROUND

It is unclear to what degree centenarians are successful agers. We assess successful aging (SA) and its subtypes in a large Chinese sample.

METHODS

Based on a large national sample of 18,311 Chinese centenarians, we first estimated the prevalence of SA among centenarians, and then used the Latent Class Analysis to classify centenarians into different types based on the five dimensions of SA. Multinomial regression analysis was used to examine how demographic, socioeconomic, and lifestyle covariates are associated with these identified types.

RESULTS

5.7% of centenarians fulfilled all five criteria of SA, and 1.3% failed all five criteria. The remainder could be classified into six types of SA. The regression analysis further revealed that these SA types were related to various social factors. For example, with timely access to medical care, centenarians were three times more likely to be successful agers.

CONCLUSIONS

Centenarians demonstrate substantial heterogeneity in terms of achieving five SA criteria. Social factors are found to be significantly associated with centenarians' aging performances. Specific subtypes of SA among centenarians may be associated with and help explore different underlying biological-environmental mechanisms of exceptional longevity.

Association of cognitive impairment and grip strength trajectories with mortality among middle-aged and elderly adults

ABSTRACTBackground:This study investigates whether maintaining high levels of cognitive impairment and weak grip strength will predict a higher risk for mortality.

METHODS

Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2014 was assessed using longitudinal data analysis and included 5,812 research subjects. Our modeling approach jointly estimated multi-period trajectories of grip strength and cognitive impairment, and the primary analysis was based on Cox proportional hazards models.

RESULTS

A four-class linear solution fit the data best in both cognitive impairment and grip strength based on the model fitness, respectively. The hazard ratio (HR) of mortality in group 1 (consistently low) of cognitive impairment and of grip strength were 2.114 times higher (p-value 0.001) and 3.405 times higher (p-value <.0001) compared with group 3 (consistently high) and group 4 (consistently high), respectively.

CONCLUSION

This study provides insightful scientific evidence into the specificity of longitudinal changes in grip strength and cognitive impairment on mortality. Our findings suggest that declined cognitive ability and weak grip strength are predictors of mortality in older Korean people.

Sixteen-year predictors of successful aging from a Southern Brazilian cohort The PALA study

Successful aging (SA) is a current positive aging-related perspective and it is important to determine the variables associated with this concept. Most longitudinal population-based studies on predictors of SA were carried out in developed countries.

Frailty and cognitive impairment as predictors of mortality in older Mexican Americans

OBJECTIVE

Examine the association between frailty and cognitive impairment as predictors of mortality over a 10-year period in a selected sample of older Mexican Americans.

DESIGN

Longitudinal analyses using data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (1995-96/2004-05).

SETTING

Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California.

PARTICIPANTS

Mexican Americans aged 67 and older with complete information on the frailty index and the Mini Mental State Examination (MMSE) (n=1,815).

MEASUREMENTS

Cognitive impairment determined by a score in the MMSE < 21. Frailty defined as three or more of the following components: 1) weight-loss, 2) weakness, 3) self-reported exhaustion, 4) slow walking speed, and 5) low physical activity level. Sociodemographic characteristics and chronic medical conditions were used as covariates. Mortality was determined using the National Death Index or by proxy.

RESULTS

As MMSE score declines over time, the percent of frail individuals increases in a linear fashion. Frailty and cognitive impairment are independent risk factors for mortality after controlling for all covariates (HR 2.03 95% CI 1.57-2.62; HR 1.26 95% CI 1.05-1.52, respectively). When both cognitive impairment and frailty were added to the model, HR for individuals with cognitive impairment was no longer statistically significant.

CONCLUSION

The relation between frailty and cognitive impairment needs careful analysis in this population to establish pathways increasing mortality and decreasing quality of life. Our results suggest frailty is a stronger predictor of mortality for older Mexican Americans than cognitive impairment.

Mortality and refusal in the longitudinal 90+ project

Attrition is one of the most important threats for longitudinal studies on aging mainly due to refusal and mortality. This study deals with those individuals who were assessed in the base line of 90+ project but died, dropped out or were examined in the follow-up. Participants of the 90+ project baseline consist of a sample of 188 older than 90 years, independent individuals (mean age = 92.9; 67 men and 121 women) living in the community (n = 76) or in residences (n = 112). They were assessed through the European Survey on Aging Protocol (ESAP) by collecting anthropometric, health and life styles, bio-behavioral, psychological and social data. After 6-14 months from the baseline, 55% individuals were re-assessed, 11% died and 34% dropped out for several reasons. Comparisons between the individuals deceased, interviewed and those who dropped out yielded significant differences mainly due to contextual variables. The mortality rate of participants living in residences is three times greater than those of participants living in the community. Trying to determine the differences between these three groups due to bio-psycho-social variables, we found that regular physical activity, mental status, leisure activities, fitness, perceived control and openness assessed at the baseline differentiate our three groups. Finally, 90% of those individuals who died were identified at the baseline as "non successful agers", while more than a half of those who participated and a third of the non-participants were identified as "successful agers". It can be concluded that among those independent but very old people, mortality is less important than willing to participate and contextual, behavioral and psychological factors are relevant for distinguishing mortality, survival and participation.

A health profile of community-living nonagenarians in Canada

Due to increasing life expectancy over time, persons who live into their ninety, known as nonagenarians, are an important and growing segment of the Canadian population. In 2001, there were 130,325 nonagenarians (compared to 3,795 centenarians), and it is estimated that they will top 400,000 by 2026. This paper provides a health profile and an exploratory analysis of selected social determinants of health for community-living nonagenarians, using the 2001 Canadian Community Health Survey (Statistics Canada, 2003). Perceived health, selection of prevalent chronic illnesses, and several health behaviours are examined. One dominant pattern is the tendency for male nonagenarians to be in better health than their female counterparts. This finding is consistent with research on centenarians and is discussed in terms of a mortality selection effect. Other key findings include the strength of sense of belonging, income, and physical activity as potential social determinants of health, connected to particular dimensions of health status.

Factors Associated with Perceived Health of Very Old Inhabitants of Japan

BACKGROUND

Perceived health or self-rated subjective health of the oldest inhabitants of Japan was studied to identify its associated impact on their lives.

OBJECTIVE

The health status of the aged was evaluated to elucidate the correlation between their health complaints and perceived health status as expressed on a comprehensive rating scale.

METHODS

A health questionnaire including the Todai Health Index (THI) was applied to 529 inhabitants of Central Japan, aged 85 years or older. THI is a symptom checklist composed of 130 questions. Twelve scale scores and two discriminant function values were calculated. Response rate was 99.8% (528/529). Other items included sex, age, prevalence of chronic disease and its treatment, marital status, academic career, and friendship. A question 'How is your health?' with five ordinal response options was used to assess perceived health.

RESULTS

The mean values of THI scale scores of lie and aggression of poor (poor or extremely poor) perceived health were significantly lower than those of good (extremely good or good) perceived health. The mean values of other THI scale scores of poor perceived health except impulsiveness and nervousness in male subjects were significantly higher than those of good perceived health. Spearman's rank correlation coefficients between perceived health score and THI scale scores were all statistically significant. Furthermore, multiple logistic regression analysis was conducted to identify significant factors predicting perceived health. THI scale scores of physical symptoms, depressive state, and irregular daily life were significant. Odds ratios and 95% confidence intervals in parentheses on each factor were 1.15 (1.07-1.23), 1.14 (1.02-1.30), and 1.15 (1.02-1.30), respectively.

CONCLUSIONS

Poor perceived health was significantly associated with irregular lifestyle, physical and mental complaints. Perceived health reflects the health status of the oldest inhabitants of Japan.

Does patient-centered care improve provision of preventive services?

OBJECTIVES

While patient-centered care (PCC) is desirable for many reasons, its relationship to treatment outcomes is controversial. We evaluated the relationship between PCC and the provision of preventive services.

METHODS

We obtained facility-level estimates of how well each VA hospital provided PCC from the 1999 ambulatory Veterans Satisfaction Survey. PCC delivery was measured by the average percentage of responses per facility indicating satisfactory performance from items in 8 PCC domains: access, incorporating patient preferences, patient education, emotional support, visit coordination, overall coordination of care, continuity, and courtesy. Additional predictors included patient population and facility characteristics. Our outcome was a previously validated hospital-level benchmarking score describing facility-level performance across 12 U.S. Preventive Services Task Force-recommended interventions, using the 1999 Veterans Health Survey.

RESULTS

Facility-level delivery of preventive services ranged from an overall mean of 90% compliance for influenza vaccinations to 18% for screening for seat belt use. Mean overall PCC scores ranged from excellent (>90% for the continuity of care and courtesy of care PCC domains) to modest (<70% for patient education). Correlates of better preventive service delivery included how often patients were able to discuss their concerns with their provider, the percent of visits at which patients saw their usual provider, and the percent of patients receiving >90% of care from a VA hospital.

CONCLUSION

Improved communication between patients and providers, and continuity of care are associated with increased provision of preventive services, while other aspects of PCC are not strongly related to delivery of preventive services.

More than the epidemiology of Alzheimer's disease: contributions of the Canadian Study of Health and Aging

OBJECTIVE

To highlight contributions to knowledge made by the Canadian Study of Health and Aging (CSHA).

METHOD

The CSHA began in 1991, with follow-ups in 1996 and 2001. It was national in scope, with 18 study centres and a coordinating centre. It included 10 263 participants; of these, 9008 were in the community, and 1255 were in institutions. In each phase, community participants were screened for cognitive impairment, and where appropriate, cognitive status was determined by a detailed clinical examination. Data on possible risk factors for dementia were collected at baseline. Data on caring for people with dementia were collected in each phase.

RESULTS

The prevalence of dementia was established at 8% of those aged 65 years and over; incidence (new cases each year) was about 2%. Cognitive impairment not dementia (CIND) was more than twice as common as dementia. Factors affecting the risk of institutionalization, mortality, and the health of caregivers were examined. The costs of dementia were conservatively estimated at dollar 3.9 billion in 1991. Risk factors for Alzheimer's disease (AD) and vascular dementia are presented; it is noteworthy that physical activity appeared to protect against all forms of cognitive decline, particularly for women. Clinical contributions include the development of norms for several neuropsychological tests. Other topics include the health of those with CIND, predicting dementia, medication use, frailty and healthy aging, and urinary incontinence.

CONCLUSION

The CSHA has contributed substantially to knowledge of the epidemiology of dementia, including AD, and to many other topics relevant to seniors' health.