Association of lung function with physical, mental and cognitive function in early old age

Prospective association between social isolation, loneliness and lung function among Chinese middle-aged and older adults

OBJECTIVE

Previous research has highlighted a heightened occurrence of social isolation and loneliness in older adults diagnosed with chronic lung diseases. Nevertheless, there exists a dearth of studies that have explored the influence of impoverished social relationships on lung function. This study aimed to examine the longitudinal association between social isolation, loneliness and lung function over 4 years among middle-aged and older Chinese adults.

METHODS

This study employed two waves (2011 and 2015) of data from the China Health and Retirement Longitudinal Study (CHARLS). The analysis was limited to participants aged 45 years and above and stratified based on gender (3325 men and 3794 women). The measurement of peak expiratory flow (PEF) served as an indicator for assessing lung function. Lagged dependent variable regression models, accounting for covariates, were employed to explore the relationship between baseline social isolation and loneliness and the subsequent PEF.

RESULTS

For women, social isolation was significantly associated with the decline in PEF at follow-up (β = -.06, p < .001) even after adjusting for all covariates; no significant correlation was observed between loneliness and PEF. Among men, there was no significant association found between either social isolation or loneliness and PEF.

CONCLUSIONS

Social isolation is prospectively associated with worse lung function in middle-aged and older Chinese women but not men. The results highlight the importance of promoting social relationships in public health initiatives, especially in groups that are more vulnerable.

Effects of High-Intensity Interval Training on the Parameters Related to Physical Fitness and Health of Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND

As a novel and time-efficient exercise form, high-intensity interval training (HIIT) has shown great potential in improving health-related physical fitness among diverse populations. However, empirical evidence on its efficacy among the elderly has not been well summarized. This systematic review and meta-analysis aimed to determine the effect of HIIT interventions on the parameters related to physical fitness and health of older adults, including resting heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), cardiorespiratory fitness (CRF), body mass index (BMI), body fat percent (BF%), waist circumference (WC), muscular endurance (ME), muscular strength (MS), muscular power (MP), balance and flexibility, compared to non-exercise and other-exercise (e.g., moderate-intensity continuous training, resistance training) conditions.

METHODS

Literature published from January 2000 to May 2023 was collected through extensive searches across eight databases and relevant review papers. Randomized controlled trials (RCTs) featuring a minimum 2-week exercise intervention for older adults (≥ 60 years) were included. The pooled effect size of Hedges'g was estimated using random-effects models in R. Meta-regression was performed for both categorical (health status, duration of training programme, and frequency) and continuous moderators (mean age, male rate, and attrition rate).

RESULTS

Forty-four eligible RCTs with 1863 participants (52.1% female; 60.5-81.2 years) were included in the quantitative analysis. Compared to non-exercise condition, HIIT significantly improved resting HR (g = -0.36, 95%CI = [-0.67, -0.05], P = 0.032), SBP (g = -0.29, 95%CI = [-0.54, -0.03], P = 0.008), CRF (g = 0.77, 95%CI = [0.51, 1.04], P < 0.001), BF% (g = -0.26, 95%CI = [-0.41, -0.11], P = 0.006), MS (g = 0.47, 95%CI = [0.23, 0.71], P = 0.004), ME (g = 0.65, 95%CI = [0.10, 1.19], P = 0.036), and balance (e.g., timed-up-and-go) (g = -0.79, 95%CI = [-1.19, -0.40], P = 0.035). Compared to other-exercise condition, HIIT significantly improved resting HR (g = -0.11, 95%CI = [-0.21, -0.01], P = 0.029), SBP (g = -0.14, 95%CI = [-0.28, -0.01], P = 0.038), and CRF (g = 0.23, 95%CI = [0.07, 0.38], P = 0.008). No significant difference was found between HIIT and non-exercise condition for DBP, BMI and WC, as well as between HIIT and other-exercise condition for DBP, BMI, BF%, WC, ME, and balance (all P > 0.05). Meta-regression indicated that mean age moderated the HIIT effect on resting HR (b = -0.02, P = 0.014; HIIT vs. other-exercise condition) and SBP (b = 0.03, P = 0.048; HIIT vs. non-exercise), and attrition rate moderated the effect on CRF (b = 0.03, P = 0.007; HIIT vs. non-exercise).

CONCLUSION

This study supports the efficacy of HIIT in improving resting HR, SBP, CRF, BF%, MS, ME and balance among older adults. More empirical evidence is needed to determine the efficacy of HIIT for MP and flexibility in this population.

TRIAL REGISTRATION

PROSPERO CRD42022316246.

Association of peak expiratory flow with motoric cognitive risk syndrome among older adults

Background

The association between lung function and motoric cognitive risk syndrome (MCR) is unclear. We aimed to explore the association of peak expiratory flow (PEF) with MCR using cross-sectional and longitudinal analyses.

Methods

Within the CHARLS, 5095 participants were included in the cross-sectional analysis, and 4340 MCR-free participants were included in the longitudinal analysis. The PEF was assessed with a lung peak flow meter. MCR was characterized by cognitive complaints and a slow walking speed with normal mobility and without dementia. Logistic regression, Cox regression, and Laplace regression models were employed for data analysis.

Results

In this cross-sectional study, logistic regression analyses revealed that continuous PEF was associated with MCR (odds ratio [OR], 0.998; 95% confidence interval [CI], 0.998, 0.999), and the ORs (95% CIs) of MCR prevalence were 0.857 (0.693, 1.061) for the middle tertile and 0.665 (0.524, 0.845) for the highest tertile compared to the lowest tertile. In a longitudinal cohort study, continuous PEF was dose-dependently associated with the risk of MCR. Compared with those in the lowest tertile of PEF, the hazard ratios (95% CIs) of incident MCR were 0.827 (0.661, 1,036) for the middle tertile and 0.576 (0.432, 0.767) for the highest tertile. Furthermore, compared with the lowest tertile, the highest tertile was associated with a delayed onset time of MCR of 0.484 (95% CI: 0.151, 0.817) years.

Conclusion

A higher PEF was related to a lower prevalence of MCR and a lower risk for MCR, and a higher PEF also prolonged the onset time of MCR.

The longitudinal association between adverse childhood experiences, childhood socioeconomic status, and lung function among middle-aged and older adults

OBJECTIVES

This study aims to investigate the association between adverse childhood experiences (ACEs), childhood socioeconomic status (SES) with lung function among general Chinese middle-aged and older adults.

METHODS

Participants at baseline were 9052 individuals aged 45 years old and above from the China Health and Retirement Longitudinal Study (CHARLS), a population-based cohort of Chinese adults. Analyses were conducted with data from three waves (2011, 2013, and 2015). The ACEs included five threat-related indicators (i.e., physical abuse, household substance abuse, domestic violence, unsafe neighborhood, and bullying) and five deprivation-related adversities (i.e., emotional neglect, household mental illness, incarcerated household member, parental separation or divorce, and parental death). The cumulative score of threat-related and deprivation-related ACEs was used for analysis. Lung function was assessed by peak expiratory flow (PEF). Two-level linear mixed growth models were used to evaluate the longitudinal association between and ACEs, childhood SES, and PEF.

RESULTS

Participants with more than three deprivation-related ACEs were significantly associated with lower PEF (b = -11.45 L/min, 95%CI: -18.40, -4.49) after adjusting for multiple confounding factors. Threat-related ACEs were not associated with PFF. Father's illiterate education predicted lower lung function (b = -8.49 L/min, 95%CI: -11.68, -5.31) for all middle-aged and older adults while mother's illiterate education was only significantly associated with PEF among the men (b = -9.21 L/min, 95%CI: -18.20, -0.22), and middle-aged adults (b = -7.96 L/min, 95%CI: -14.35, -1.57).

DISCUSSION

ACEs and disadvantaged childhood SES are important predictors of lower lung function during adulthood. Reducing ACEs and improving childhood SES may be beneficial for long-term health development.

Association between physical activity, peak expiratory flow, and cognitive function in aging: a cross-sectional analysis

BACKGROUND

The aging global population is experiencing escalating challenges related to cognitive deficits and dementia. This study explored the interplay between pulmonary function, physical activity, and cognitive function in older U.S. adults to identify modifiable risk factors for cognitive decline.

METHODS

Utilizing NHANES 2011-2012 data, we conducted a cross-sectional analysis of 729 participants aged ≥ 60 years. Cognitive function, peak expiratory flow (PEF), and physical activity were assessed. Weighted logistic regression and mediation analyses were employed to examine associations.

RESULTS

The sample size was 729 (weighted mean [SD] age, 67.1 [5.3] years; 53.6% female participants). Preliminary correlation analysis indicated a positive correlation between the global cognitive score and physical activity (β = 0.16; p < 0.001), recreational activity (β = 0.22; p < 0.001), and PEF in percent predicted (PEF%) (β = 0.18; p < 0.001). Compared to those with a PEF% >100%, the PEF% (80-100%) group (OR, 2.66; 95% CI, 1.34-5.29; p = 0.005) and PEF% <80% group (OR, 3.36; 95% CI, 1.67-6.76; p = 0.001) were significantly associated with higher cognitive deficits risk. Recreational activity meeting guidelines was linked to a lower risk of cognitive deficits (OR, 0.24; 95% CI, 0.10-0.57; p = 0.001). Mediation analysis demonstrated that PEF mediates the relationship between physical activity and cognitive function.

CONCLUSION

This study revealed significant associations between lower PEF, diminished physical activity, and increased cognitive deficits in elderly individuals. The results supported the hypothesis that pulmonary function may mediate the connection between activity and cognitive health, emphasizing the importance of respiratory health in cognitive aging. Recognizing these associations is crucial for clinical care and public health policy aiming to mitigate cognitive decline in aging populations. While these findings are intriguing, validation through longitudinal design studies is deemed necessary.

Pulmonary function and trajectories of cognitive decline in aging population

BACKGROUND

The number of older people with cognitive impairment is increasing worldwide. Impaired lung function might be associated with cognitive decline in older age; however, results from large longitudinal studies are lacking. In this study, we examined the longitudinal associations between pulmonary function and the trajectories of cognitive decline using prospective population-based SHARE data from 14 countries.

METHODS

The analytic sample included N = 32,049 older adults (Mean age at baseline = 64.76 years). The dependent variable was cognitive performance, measured repeatedly across six waves in three domains: verbal fluency, memory, and numeracy. The main predictor of interest was peak expiratory flow (PEF). The data were analyzed in a multilevel accelerated longitudinal design, with models adjusted for a variety of covariates.

RESULTS

A lower PEF score was associated with lower cognitive performance for each domain as well as a lower global cognitive score. These associations remained statistically significant after adjusting for all covariates Q4 vs Q1 verbal fluency: unstandardized coefficient B = -3.15; numeracy: B = -0.52; memory: B = -0.64; global cognitive score B = -2.65, all p < .001). However, the PEF score was not found to be associated with the rate of decline for either of the cognitive outcomes.

CONCLUSIONS

In this large multi-national longitudinal study, the PEF score was independently associated with lower levels of cognitive functions, but it did not predict a future decline. The results suggest that pre-existing differences in lung functions are responsible for variability in cognitive functions and that these differences remained stable across aging.

Short-term residential exposure to endotoxin emitted from livestock farms in relation to lung function in non-farming residents

BACKGROUND

Evidence on the public health relevance of exposure to livestock farm emissions is increasing. Research mostly focused on chemical air pollution, less on microbial exposure, while endotoxins are suggested relevant bacterial components in farm emissions. Acute respiratory health effects of short-term exposure to livestock-related air pollution has been shown for NH3 and PM10, but has not yet been studied for endotoxin. We aimed to assess associations between lung function and short-term exposure to livestock farming emitted endotoxin in co-pollutant models with NH3 and PM10.

METHODS

In 2014/2015, spirometry was conducted in 2308 non-farming residents living in a rural area in the Netherlands. Residential exposure to livestock farming emitted endotoxin during the week prior to spirometry was estimated by dispersion modelling. The model was applied to geo-located individual barns within 10 km of each home address using provincial farm data and local hourly meteorological conditions. Regional week-average measured concentrations of NH3 and PM10 were obtained through monitoring stations. Lung function parameters (FEV1, FVC, FEV1/FVC, MMEF) were expressed in %-predicted value based on GLI-2012. Exposure-response analyses were performed by linear regression modelling.

RESULTS

Week-average endotoxin exposure was negatively associated with FVC, independently from regional NH3 and PM10 exposure. A 1.1% decline in FVC was estimated for an increase of endotoxin exposure from 10th to 90th percentile. Stratified analyses showed a larger decline (3.2%) for participants with current asthma and/or COPD. FEV1 was negatively associated with week-average endotoxin exposure, but less consistent after co-pollutant adjustment. FEV1/FVC and MMEF were not associated with week-average endotoxin exposure.

CONCLUSIONS

Lower lung function in non-farming residents was observed in relation to short-term residential exposure to livestock farming emitted endotoxin. This study indicates the probable relevance of exposure to microbial emissions from livestock farms considering public health besides chemical air pollution, necessitating future research incorporating both.

Too depressed to breathe: The longitudinal association between depressive symptoms and lung function among general middle-aged and older adults

Objective Most previous studies focusing on the association between depressive symptoms and lung function were conducted in patients with chronic lung diseases. This study aims to investigate the association of depressive symptoms with lung function among general Chinese middle-aged and older adults. Participants This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Analyses were conducted with data from three waves (2011, 2013, and 2015) and restricted to those respondents aged 45 and older. Finally, 9487 individuals [mean age (SD) = 58.47 (9.19); female, 53.1%] were included in analysis. Methods Depressive symptoms were measured by the Chinese version of 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Lung function was assessed by peak expiratory flow (PEF). Two-level linear mixed growth models were used to evaluate the longitudinal association between depressive symptoms and PEF. Results Depressive symptoms were significantly associated with PEF among general middle-aged and older adults (b = -1.85, p < 0.001) after adjusting for multiple confounding factors. A significant interaction between depressive symptoms and gender was found (b = 1.29, p < 0.001). The association between depressive symptoms and PEF was greater for men (b = -2.36, p < 0.001) than for women (b = -1.46, p < 0.001). Conclusions This longitudinal study found that increased depressive symptoms were associated with reduced PEF in middle-aged and older adults in China. Compared with women, men with a higher level of depressive symptoms experienced a greater decrement in PEF. Our findings suggest that it is possible to reduce the effects of PEF by improving psychological health among general middle-aged and older populations.

Association of Pulmonary Function With Motor Function Trajectories and Disability Progression Among Older Adults: A Long-Term Community-Based Cohort Study

BACKGROUND

The association of pulmonary function (PF) with motor function and disability remains unclear. We investigate the association of PF with motor function trajectories and disability progression, and explore the role of social activity, cognitive function, and cardiovascular diseases (CVDs) in this relationship.

METHODS

Within the Rush Memory and Aging Project, 1 403 disability-free participants (mean age: 79.28 years) were followed for up to 22 years. PF was measured with a composite score based on peak expiratory flow, forced expiratory volume in 1 second, and forced vital capacity at baseline. Global motor function including dexterity, gait, and hand strength was assessed annually using 10 motor tests. Disability was evaluated according to the basic activities of daily living. Social activity was defined as the frequency of common types of social interaction. Global cognitive function was assessed using a battery of 19 cognitive performance tests. CVDs (including stroke, congestive heart failure, and heart diseases) were ascertained at baseline. Linear mixed-effects models were used.

RESULTS

Compared to high PF, low PF was related to faster decline in global motor function (β = -0.005, 95% confidence interval [CI]: -0.008 to -0.001) and all 3 specific motor abilities (p < .05), as well as faster progression of disability (β = 0.012, 95% CI: 0.009 to 0.014). There was a statistically significant interaction between PF and social activity/cognitive function on disability progression (β = 0.005, 95% CI: 0.001 to 0.009, p = .010/β = 0.004, 95% CI: 0.001 to 0.009, p = .025).

CONCLUSION

Poor PF accelerates motor function decline and the progression of disability. A high level of social activity and cognitive function appear to decelerate disability progression related to poor PF.

A lifecourse approach to the relationship between lung function and cognition function in late life: findings from the Mysore studies of Natal effect on Ageing and Health (MYNAH) in South India

Background: Emerging evidence from high income settings indicates that lung function may be an independent determinant of cognitive abilities in late life. Despite a high burden of chronic lung disorders and neurocognitive disorders, there are limited data exploring the relationship between lung and cognitive function in later life in low- and middle-income (LMIC) settings. Methods: Between 2013 and 2016, 721 men and women from the Mysore Birth Records Cohort in South India, aged 55-80 years, were retraced and underwent standardised assessments for sociodemographic characteristics, cardiometabolic risk factors, lung function, cognitive function and mental health. Approximately 20 years earlier, a subset of them had assessments for cardiometabolic risk factors (n=522) and lung function (n=143). Results: Forced Expiratory Volume at one second (FEV1) and six seconds (FEV6) were higher among men than women. Women had higher immediate and delayed recall scores compared to men. Multivariate models indicated that those with lower FEV1 (lts) and FEV1/FEV6 ratio in late life had lower composite cognitive score (SD, standard deviation), independent of growth and environment in early life and childhood, attained education, socioeconomic position, cardiometabolic disorders in mid-and late life and lifestyle factors (0.29 SD per litre 95% confidence interval [CI] (0.10, 0.50) p=0.006 for FEV1 and 1.32 SD (0.20, 2.50) p=0.02 for FEV1/FEV6 ratio). Lung function in midlife was unrelated to cognitive outcomes in late life. Conclusions: Causality cannot be inferred from cross sectional associations. Therefore, causality is best explored in longitudinal studies with serial, but contemporaneous measurements of both lung and cognitive function. Mechanistic studies that examine the role of shared risk factors like environmental pollutants and biomass exposure on this relationship are urgently required in LMICs.

Life-course socioeconomic disadvantage and lung function: a multicohort study of 70 496 individuals

BACKGROUND

Lung function is an important predictor of health and a marker of physical functioning at older ages. This study aimed to quantify the years of lung function lost according to disadvantaged socioeconomic conditions across the life-course.

METHODS

This multicohort study used harmonised individual-level data from six European cohorts with information on life-course socioeconomic disadvantage and lung function assessed by forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). 70 496 participants (51% female) aged 18-93 years were included. Socioeconomic disadvantage was measured in early life (low paternal occupational position), early adulthood (low educational level) and adulthood (low occupational position). Risk factors for poor lung function (e.g. smoking, obesity, sedentary behaviour, cardiovascular and respiratory diseases) were included as potential mediators. The years of lung function lost due to socioeconomic disadvantage were computed at each life stage.

RESULTS

Socioeconomic disadvantage during the life-course was associated with a lower FEV1. By the age of 45 years, individuals experiencing disadvantaged socioeconomic conditions had lost 4-5 years of healthy lung function versus their more advantaged counterparts (low educational level -4.36 (95% CI -7.33--2.37) for males and -5.14 (-10.32--2.71) for females; low occupational position -5.62 (-7.98--4.90) for males and -4.32 (-13.31--2.27) for females), after accounting for the risk factors for lung function. By the ages of 65 years and 85 years, the years of lung function lost due to socioeconomic disadvantage decreased by 2-4 years, depending on the socioeconomic indicator. Sensitivity analysis using FVC yielded similar results to those using FEV1.

CONCLUSION

Life-course socioeconomic disadvantage is associated with lower lung function and predicts a significant number of years of lung function loss in adulthood and at older ages.

Systematic Review of Pulmonary Function and Cognition in Aging

BACKGROUND

Substantial research is dedicated to understanding the aging-related dynamics among individual differences in level, change, and variation across physical and cognitive abilities. Evaluating replicability and synthesizing findings has been limited by differences in measurements, samples, study design, and statistical analyses that confound between-person differences with within-person changes. Here, we systematically reviewed longitudinal results on the aging-related dynamics linking pulmonary function and cognitive performance.

METHODS

Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were used to systematically review longitudinal studies of pulmonary function and cognition.

RESULTS

Only four studies thoroughly investigating cognitive and pulmonary longitudinal associations (three or more measurement occasions) were identified. Expanded review criteria identified three studies reporting two measurement occasions, and seven studies reporting one measurement of pulmonary function or cognition and two or more measurements of the other. We identified numerous methodological quality and risk for bias issues across studies.

CONCLUSIONS

Despite documented correlational associations between pulmonary function and cognition, these results show there is very limited research thoroughly investigating their longitudinal associations. This highlights the need for longitudinal data, rigorous methodological design including key covariates, and clear communication of methods and analyses to facilitate replication across an array of samples. We recommend systematic study of outcome measures and covariates, inclusion of multiple measures (e.g., peak expiratory flow, forced expiratory volume in 1 s, and forced vital capacity), as well as application of the same analytic approach across multiple datasets.

Black Older Adults in the Age of Biomarkers, Physical Functioning, and Genomics: Heterogeneity, Community Engagement, and Bioethics

There are persistent disparities in all-cause mortality between Blacks and Whites in the United States. Black Americans also carry the greatest burden of morbidity from different diseases of aging including heart disease, stroke, hypertension, type 2 diabetes, and certain types of cancer. Health disparities research, and particularly race/ethnic comparison studies of physical health and aging, have consistently positioned Black health in frameworks of disadvantage, suggesting that regardless of the outcome, Black people are in worse states of health and well-being relative to Whites. Yet, extensive evidence suggests that there is significant within-group variability in the aging process among Black older adults. The use of biological, physical performance, and genomic data in survey settings offer new tools and insights to interrogate heterogeneity in Black health. This chapter examines indicators of biological, physical performance, and genetic markers of aging among a national sample of Black Americans ages 54+ years with the aim of addressing two questions about heterogeneity among Black older adults: (a) How do these measures vary by age and gender among Black older adults? (b) Which indicators predict health and mortality among Black older adults? The results indicate that biological, physical performance, and genomic measures of health, generally, have more variation than simple yes or no measures of a disease, condition, or diagnosis among Black older adults, providing counternarratives to the disadvantage frameworks that dominate characterizations of Black health and aging. However, bioethical challenges limit the utility of biomarkers, physical performance, and genomics measures for Black populations.

Role of motor function and lung function in pathways to ageing and decline

Background

Extensive research has investigated the association between age changes in various domains, including lung function and motor function. However, a few analyses have tested models that incorporate bidirectional longitudinal influences between lung and motor function to test the temporal chain of events in the disability process. Dual change score models (DCSM) assist with identification of leading indicators of change by leveraging longitudinal data to examine the extent to which changes in one variable influence subsequent changes in a second variable, and vice versa.

Aims

The purpose of the current-analysis study was to apply DCSM to data from the Swedish Adoption/Twin Study of ageing to examine the nature of the longitudinal relationship between motor functioning and lung function.

Methods

Three motor functioning factors were created from 20 performance measures, including measures of balance, flexibility, and fine motor skills. Peak expiratory flow measured lung function. Participants were 829 adults aged 50–88 at the first of 9 waves of testing covering a 27-year follow-up period; 80% participated in at least three waves.

Results

Model comparisons indicated that decline in lung function preceded and contributed to subsequent decline in motor function.

Discussion

Combined with previous results, these results suggest that declining lung function results in increasing difficulties in motor function, which contribute to subsequent declines in multiple domains.

Conclusion

Understanding the cascade of events that can lead to dependence can help in the development of interventions targeted early in the disablement process.

Electronic supplementary material

The online version of this article (10.1007/s40520-020-01494-3) contains supplementary material, which is available to authorized users.

Long-Term Running Exercise Delays Age-Related Changes in White Matter in Rats

Running exercise, one of the strategies to protect brain function, has positive effects on neurons and synapses in the cortex and hippocampus. However, white matter, as an important structure of the brain, is often overlooked, and the effects of long-term running exercise on white matter are unknown. Here, 14-month-old male Sprague–Dawley (SD) rats were divided into a middle-aged control group (18-month-old control group), an old control group (28-month-old control group), and a long-term runner group (28-month-old runner group). The rats in the runner group underwent a 14-month running exercise regime. Spatial learning ability was tested using the Morris water maze, and white matter volume, myelinated fiber parameters, total mature oligodendrocyte number, and white matter capillary parameters were investigated using stereological methods. The levels of growth factors related to nerve growth and vascular growth in peripheral blood and the level of neurite outgrowth inhibitor-A (Nogo-A) in white matter were measured using an enzyme-linked immunosorbent assay (ELISA). The present results indicated that long-term running exercise effectively delayed the age-related decline in spatial learning ability and the atrophy of white matter by protecting against age-related changes in myelinated fibers and oligodendrocytes in the white matter. Moreover, long-term running exercise prevented age-related changes in capillaries within white matter, which might be related to the protective effects of long-term exercise on aged white matter.

Biomarkers of aging and lung function in the normative aging study

Elderly individuals who are never smokers but have the same height and chronological age can have substantial differences in lung function. The underlying biological mechanisms are unclear. To evaluate the associations of different biomarkers of aging (BoA) and lung function, we performed a repeated-measures analysis in the Normative Aging Study using linear mixed-effect models. We generated GrimAgeAccel, PhenoAgeAccel, extrinsic and intrinsic epigenetic age acceleration using a publically available online calculator. We calculated Zhang's DNAmRiskScore based on 10 CpGs. We measured telomere length (TL) and mitochondrial DNA copy number (mtDNA-CN) using quantitative real-time polymerase chain reaction. A pulmonary function test was performed measuring forced expiratory volume in 1 second / forced vital capacity (FEV₁/FVC), FEV₁, and maximum mid-expiratory flow (MMEF). Epigenetic-based BoA were associated with lower lung function. For example, a one-year increase in GrimAgeAccel was associated with a 13.64 mL [95% confidence interval (CI), 5.11 to 22.16] decline in FEV₁; a 0.2 increase in Zhang's DNAmRiskScore was associated with a 0.009 L/s (0.005 to 0.013) reduction in MMEF. No association was found between TL/mtDNA-CN and lung function. Overall, this paper shows that epigenetics might be a potential mechanism underlying pulmonary dysfunction in the elderly.

Height shrinkage, health and mortality among older adults: Evidence from Indonesia

In this paper, we analyze the correlates of height shrinkage and the association of height shrinkage and late-life health among mid-aged and older adults from the Indonesian Family Life Survey. We first document the extent of height shrinkage based on measured height over 17 years. Height shrinkage is higher among older age groups, taller individuals, and women. Socioeconomic and initial health correlates of shrinkage are found to be different for men and women. Higher education, marital status, household consumption, urban birth and poor self-reported health in adulthood and childhood are found to be significant correlates for men. Ethnicity, working in the agricultural sector and availability of local health infrastructure are key correlates of height shrinkage for women. Height shrinkage of 1 cm is associated with a 0.02 s.d. decrease in cognition scores for Indonesian men and a 0.01 s.d. decrease for women, and 4% increase in index of mobility difficulties for both men and women. Extreme height loss, defined as height loss greater than 3 cm is associated with 8-10 percent lower lung function and grip strength among both men and women. Extreme height loss among Indonesian older women is also associated with a 7-percentage-point increase in the likelihood of death in the most recent wave. Our results emphasize the importance of taking into account age related height loss as a significant covariate for health and mortality of older adults, independent of baseline height and health.

Improvements in functional and cognitive status following short-term pulmonary rehabilitation in COPD lung transplant recipients: a pilot study

BACKGROUND

Pulmonary rehabilitation (PR) following lung transplantation (LTx) is considered part of the optimal treatment in chronic obstructive pulmonary disease (COPD) for favourable post-operative outcomes. We investigated the effects of a PR intervention in the post-transplant phase with regard to lung function, exercise responses and cognitive function in COPD LTx recipients.

METHODS

24 COPD LTx recipients (mean±sd forced expiratory volume in 1 s 75±22% predicted) were assigned to a comprehensive 3-week inpatient PR programme. Changes from PR admission to discharge in lung function variables, 6-min walk test-derived outcomes and cognitive function were assessed and examined for several factors. The magnitude of changes was interpreted by effect size (ES).

RESULTS

In response to the PR intervention, LTx recipients had improved lung function with regard to diffusing capacity of the lung for carbon monoxide (+4.3%; p=0.012) and static hyperinflation (residual volume/total lung capacity -2.3%; p=0.017), increased exercise capacity (6-min walk test +86 m; p<0.001), and had small to large improvements (ES range 0.23-1.00; all p≤0.34) in 50% of the administered cognitive tests. Learning skills and memory ability presented the greatest benefits (ES composite scores 0.62 and 0.31, respectively), which remained similar after stratification by single or bilateral LTx and sex.

CONCLUSIONS

PR is an effective treatment for LTx recipients in the post-transplant phase, improving lung function, exercise responses, and domains of cognitive function of learning, memory and psychomotor speed. PR may facilitate the course of post-operative treatment and should be recommended in LTx.

Association between choice of cooking fuel and peak expiratory flow rate among rural women in the Niger Delta, Nigeria

Background: Long-term exposure to indoor air pollution from biomass fuel combustion is a risk factor for respiratory disease, which is an increasingly prevalent contributor to morbidity and mortality in low- and middle-income countries. This study evaluated the association between household fuel use and the peak expiratory flow rate (PEFR) of rural-dwelling women in selected communities of the Niger Delta. Methods: This was a cross-sectional study including 321 non-smoking women aged 18 years and older. Questionnaires were used to obtain data on predominant fuel used and a brief medical history. Women with current respiratory symptoms were excluded. Fuel use was classified into three categories: biomass fuels (BMF), such as wood, animal dung and coal, kerosene and liquefied petroleum gas (LPG). The PEFR was measured with an Omron peak flow meter using standard protocols and was abnormal if it was less than 80% of predicted value based on age and height. Results: The mean age of the 321 women was 38.5±14.2 years. The biomass fuel users had significantly lower PEFR (353.9±104.4) compared to kerosene users (376.2±70.1) and LPG users (393.6± 93.3) (p=0.030). The overall prevalence of abnormal PEFR was 22.4%. The PEFR was abnormal in more BMF users (28%) than kerosene users (13.4%) and LPG users (9.4%) (p=0.005). The PEFR of women who used LPG was 20.8 l/min higher than BMF users (p=0.012). The users of BMF were 5.8 times more likely to have abnormal PEFR than LPG users (OR 5.8, 95% CI 1.62, 20.52, p=0.007). Conclusion: In this population, the use of biomass fuel was significantly associated with abnormal PEFR. This needs to be further explored in this population with a larger study using more objective measures, such as spirometry testing, to guide policies for the implementation of preventive strategies to protect vulnerable women from chronic obstructive airway disease.

Green and blue spaces and physical functioning in older adults: Longitudinal analyses of the Whitehall II study

There is increasing evidence of the health benefits of exposure to natural environments, including green and blue spaces. The association with physical functioning and its decline at older age remains to be explored. The aim of the present study was to investigate the longitudinal association between the natural environment and the decline in physical functioning in older adults. We based our analyses on three follow-ups (2002-2013) of the Whitehall II study, including 5759 participants (aged 50 to 74 years at baseline) in the UK. Exposure to natural environments was assessed at each follow-up as (1) residential surrounding greenness across buffers of 500 and 1000 m around the participants' address using satellite-based indices of greenness (Enhanced Vegetation Index (EVI) and Normalized Difference Vegetation Index (NDVI)) and (2) the distance from home to the nearest natural environment, separately for green and blue spaces, using a land cover map. Physical functioning was characterized by walking speed, measured three times, and grip strength, measured twice. Linear mixed effects models were used to quantify the impact of green and blue space on physical functioning trajectories, controlled for relevant covariates. We found higher residential surrounding greenness (EVI and NDVI) to be associated with slower 10-year decline in walking speed. Furthermore, proximity to natural environments (green and blue spaces combined) was associated with slower decline in walking speed and grip strength. We observed stronger associations between distance to natural environments and decline in physical functioning in areas with higher compared to lower area-level deprivation. However, no association was observed with distance to green or blue spaces separately. The associations with decline in physical functioning were partially mediated by social functioning and mental health. Our results suggest that higher residential surrounding greenness and living closer to natural environments contribute to better physical functioning at older ages.

Prognostic value of short-term decline of forced expiratory volume in 1 s over height cubed (FEV1/Ht3) in a cohort of adults aged 80 and over

BACKGROUND

Forced expiratory volume in 1 s over height cubed (FEV₁/Ht³) is an FEV₁ expression that uses no reference values and is independently associated with adverse outcomes in older adults. No studies have reported on the prognostic value of its decline over time in adults aged 80 and over.

AIM

To investigate the prognostic value of FEV₁/Ht³ decline for adverse outcomes in a cohort of adults aged 80 and over.

METHODS

328 community-dwelling adults aged 80 and over of the BELFRAIL prospective cohort had two valid FEV₁ measurements as part of their comprehensive geriatric assessment at baseline and follow-up (after 1.7 ± 0.21 years). Kaplan-Meier survival curves, Cox and logistic multivariable regression, assessed association of excessive decline of FEV₁/Ht³ (lowest quintile of percentage change) with all-cause mortality (3 years after follow-up assessment), time to first hospitalization (1 year), and new/ worsened disability in activities of daily living (ADL) at the follow-up assessment.

RESULTS

Participants with excessive FEV₁/Ht³ decline had increased adjusted hazard ratio for all-cause death 1.61 (95% CI 1.01-2.55) and first hospitalization 1.71 (1.08-2.71) and increased odds ratio for new/worsened ADL disability at follow-up 2.02 (1.10-3.68) compared to the rest of the study population.

CONCLUSIONS

Excessive, short-term decline in FEV₁/Ht³ was independently associated with all-cause mortality, time to first, unplanned hospitalization, and ADL disability in a cohort of adults aged 80 and over. This FEV₁ expression should be further investigated in studies of longitudinal FEV₁ change in older adults.

Association of generic health-related quality of life (EQ-5D dimensions) and inactivity with lung function in lung-healthy German adults: results from the KORA studies F4L and Age

PURPOSE

Among patients with lung disease, decreased lung function is associated with lower health-related quality of life. However, whether this association is detectable within the physiological variability of respiratory function in lung-healthy populations is unknown. We analyzed the association of each EQ-5D-3L dimension (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) and self-reported physical inactivity with spirometric indices in lung-healthy adults. Modulating effects between inactivity and EQ-5D dimensions were considered.

METHODS

1132 non-smoking, apparently lung-healthy participants (48% male, aged 64 ± 12 years) from the population-based KORA F4L and Age surveys in Southern Germany were analyzed. Associations of each EQ-5D dimension and inactivity with spirometric indices serving as outcomes (forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), FEV₁/FVC, and mid-expiratory flow) were examined by linear regression, considering possible confounders. Interactions between EQ-5D dimensions (no problems/any problems) and inactivity (four categories of time spent engaging in exercise: inactive to most active) were assessed.

RESULTS

Among all participants 42% reported no problems in any EQ-5D dimension, 24% were inactive and 32% exercised > 2 h/week. After adjustment, FEV₁ was - 99 ml (95% CI - 166; - 32) and FVC was - 109 ml (95% CI - 195; - 24) lower among subjects with mobility problems. Comparable estimates were observed for usual activities. Inactivity was negatively associated with FVC (β-coefficient: - 83 ml, 95% CI - 166; 0), but showed no interactions with EQ-5D.

CONCLUSIONS

Problems with mobility or usual activities, and inactivity were associated with slightly lower spirometric parameters in lung-healthy adults, suggesting a relationship between perceived physical functioning and volumetric lung function.

Lung function discordance in monozygotic twins and associated differences in blood DNA methylation

Background

Lung function is an important predictor of morbidity and mortality, with accelerated lung function decline reported to have immense consequences for the world's healthcare systems. The lung function decline across individual's lifetime is a consequence of age-related changes in lung anatomical structure and combination of various environmental factors; however, the exact molecular mechanisms contributing to this decline are not fully understood. DNA methylation is an epigenetic modification that changes across individual's lifetime, as well as allows for interplay between environmental and genetic factors. DNA methylation plays a crucial role in regulation of gene expression, with increasing evidence linking aberrant DNA methylation levels with a number of common human diseases. In this study, we investigated possible associations between genome-wide DNA methylation levels and lung function in 169 pairs of middle-aged monozygotic twins (86 male pairs: mean age (min-max) = 66 years (57-79); 83 female pairs: mean age (min-max) = 66 years (56-78)). The twins were collected from the Danish Twin Registry and were examined at baseline (1998-1999) and follow-up (2008-2011) visits. Using the twin design, we correlated intra-pair differences in cross-sectional and longitudinal lung function with intra-pair blood DNA methylation differences at follow-up by linear regression analyses adjusted for sex, age, BMI, smoking, and blood cell composition measured for each individual with the use of flow cytometry.

Results

We identified several differentially methylated CpG sites associated with forced expiratory volume the first second (FEV1) and forced vital capacity (FVC). Three probes identified for level of FVC were located in GLIPR1L2 gene (lowest p value = 7.14 × 10-8), involved in innate immunity and tumour-suppressor/pro-oncogenic mechanisms. Change in FEV1 during the 11-year follow-up period was associated with blood DNA methylation level in TRIM27 gene (p value = 1.55 × 10-6), a negative regulator of CD4 T cells, and also involved in cancer development. Several enriched pathways were identified, especially for FEV1, with one being "TGFBR" (Benjamini-Hochbergadjp value = 0.045), the receptor for TGFβ, a growth factor involved in normal lung tissue repair through pro-fibrotic effects.

Conclusions

Our findings suggest that epigenetic regulation of immunological- and cancer-related genes, as well as TGF-β-receptor-related genes, may be involved in the cross-sectional level and longitudinal change in lung function in middle-aged monozygotic twins.

Functional Limitations Among Responders to the World Trade Center Attacks 14 Years After the Disaster: Implications of Chronic Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is associated with self-reported difficulties navigating the social and physical world and may also be associated with risk of functional limitations. The Short Physical Performance Battery (SPPB), an objective functional assessment, was administered during monitoring exams between January and December 2015 to a consecutive sample of 1,268 rescue workers, volunteers, and other responders who had aided in response, recovery, and cleanup efforts at the World Trade Center (WTC) in New York after the September 11, 2011 attacks. Data were linked with diagnostic and longitudinal data from the WTC monitoring study. Multivariable analyses were used to examine predictors of functional limitations. Prevalence estimates weighted to the general responder population revealed a relatively high prevalence of functional limitations, SPPB ≤ 9; 16.0%, 95% CI [13.7, 18.4]. Current PTSD was associated with a twofold increased risk of functional limitations after controlling for predisposing factors, trauma severity, behavioral factors, and WTC-related medical conditions, adjusted risk ratio (aRR) = 2.11, 95% CI [1.48, 3.01]. Exposure to ergonomic risk factors at the WTC also increased the risk of functional impairments, aRR = 1.34 95% CI [1.05, 1.70]. Longitudinal results suggest that individuals with current functional limitations experienced high baseline PTSD severity, B = 2.94, SE = 1.33, and increasing PTSD symptom severity, B = 0.29, SE = 0.10, since September 11, 2001. This study identified a cross-sectional relationship between functional limitations and PTSD and a worsening of PTSD symptoms in persons who eventually demonstrated functional limitations. Results highlight the potential role of chronic PTSD in functional limitations.

The effect of organic dust exposure on long-term change in lung function: a systematic review and meta-analysis

Lung function is a predictor of morbidity and mortality, and the chronic nature of lung function decline allows for preventive initiatives. Proinflammatory constituents of organic dust are considered a possible cause of compromised respiratory health. The aim of this systematic review was to reveal the impact of organic dust exposure on long-term change in lung function. The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Predefined criteria concerned study design: longitudinal, ≥1 year follow-up, ≥50 exposed; exposure measures: organic dust, measured or estimated, in different occupational settings; and outcome measures: change in lung function measured by spirometry. Based on these criteria, 1580 potentially relevant publications were narrowed down to 20 included publications. Quality was evaluated and discussed based on six objectively defined criteria. Overall, 14 studies found some type of association between exposure to organic dust and long-term change in lung function. However, the results were inconsistent and no specific work exposure showed more clear associations to change in lung function. Meta-analysis revealed an overall small significant excess loss in forced expiratory volume in the 1st s for exposed compared with controls of 4.92 mL/year (95% CI 0.14 to 9.69). No significant association was seen overall for forced vital capacity. 12 studies revealed a significant exposure-response relation between organic dust and change in lung function. The results were inconsistent across varying study design and different exposure measures and outcomes. We therefore conclude that there is limited evidence of a causal association between general exposure to organic dust and long-term excess decline in lung function.

Genetic Influences on Functional Capacities in Aging

PURPOSE

Older populations are characterized by great heterogeneity in functional capacities and understanding the factors underlying these differences has been a major area of research for some decades. Genetic differences arguably play an important role in the heterogeneity observed for many outcomes among older individuals. However, the role of genes in the variation and trajectories of functional capacities in older age is poorly understood. This review was conducted to explore the evidence for genetic influences on physical functional capacities in aging.

DESIGN AND METHODS

This rapid review was conducted using the following criteria: journal articles retrieved from the PubMed, Embase, AgeLine, Scopus, and Web of Science electronic databases including the key words: genetics, genotype, polymorphism, physical or functional performance, functional capacity, activities of daily living, older, and elderly. In total, 118 articles were included for initial review.

RESULTS

The heritability of objective measures of physical function ranges from 30% to 60% in studies of older twins. There is a paucity of evidence about genetic influences on functional capacities, but some candidate genes related to functional capacity have been identified.

IMPLICATIONS

No strong candidate genes exist for functional capacities. Current methodologies are beginning to generate new evidence about genetic influences on overall physical function at older ages, but the variety of measures of functional capacity makes evidence difficult to compare.

I forgot when I lost my grip-strong associations between cognition and grip strength in level of performance and change across time in relation to impending death

An association between level of cognitive function and grip strength is well established, whereas evidence for longitudinal associations of change in the 2 functions is still unclear. We examined associations between cognition and grip strength in levels of performance and in longitudinal change in late life in a population-based sample, aged ≥80 years at baseline, followed until death. The sample consisted of 449 nondemented individuals drawn from the OCTO-Twin Study. A test battery assessing 6 cognitive domains and grip strength was administered at 5 occasions with measurements intervals of 2 years. We fitted time to death bivariate growth curve models, adjusted for age, education, and sex which resulted in associations between grip strength and cognition in both levels of performance (across all cognitive domains) and rates of change (in 4 of 6 domains). These results show that cognition and grip strength change conjointly in later life and that the association between cognition and grip strength is stronger before death than earlier in life.

Associations of Pulmonary Function with Dementia and Depression in an Older Korean Population

OBJECTIVE

Previous studies reported an association between pulmonary function and cognitive function. However, not much has been investigated in this regard concerning dementia in a community population, taking depression into account. We aimed to examine the associations of pulmonary function with dementia and depression in a community-dwelling elderly population.

METHODS

A total of 1,038 participants were evaluated for dementia and depression using the Korean version of the Geriatric Mental State Schedule B3 (GMS B3-K), the Community Screening Interview for Dementia-Korean version (CSID-K) and a modified 10-item Word List Learning from the Consortium to Establish a Registry of Alzheimer's Disease (CERAD). Pulmonary function was measured as forced expiratory volume in 1 s (FEV1) from a forced expiratory maneuver.

RESULTS

Prevalence rates of dementia and depression were 11.0% and 10.4%, respectively. Individuals who were diagnosed with dementia manifested a lower mean FEV1, as compared to those without dementia after adjusting for potential confounders, including disability and depression [OR=1.34 (1.05-1.72)]. Following gender-stratified analysis, the association was only statistically significant in women [OR=1.40 (1.04-1.89)]. The association between depression and mean FEV1 was less significant compared to dementia [OR=1.32 (1.10-1.58)]. However, the association was no longer significant after adjusting for age and years of education. No association was significant in the gender-stratified analysis.

CONCLUSION

Decreased pulmonary function was associated with dementia status only in an older female Korean population. Pulmonary function and depression were not significantly associated in either gender.

A proposed panel of biomarkers of healthy ageing

BACKGROUND

There is no criterion reference for assessing healthy ageing and this creates difficulties when conducting and comparing research on ageing across studies. A cardinal feature of ageing is loss of function which translates into wide-ranging consequences for the individual and for family, carers and society. We undertook comprehensive reviews of the literature searching for biomarkers of ageing on five ageing-related domains including physical capability and cognitive, physiological and musculoskeletal, endocrine and immune functions. Where available, we used existing systematic reviews, meta-analyses and other authoritative reports such as the recently launched NIH Toolbox for assessment of neurological and behavioural function, which includes test batteries for cognitive and motor function (the latter described here as physical capability). We invited international experts to comment on our draft recommendations. In addition, we hosted an experts workshop in Newcastle, UK, on 22-23 October 2012, aiming to help capture the state-of-the-art in this complex area and to provide an opportunity for the wider ageing research community to critique the proposed panel of biomarkers.

DISCUSSION

Here we have identified important biomarkers of healthy ageing classified as subdomains of the main areas proposed. Cardiovascular and lung function, glucose metabolism and musculoskeletal function are key subdomains of physiological function. Strength, locomotion, balance and dexterity are key physical capability subdomains. Memory, processing speed and executive function emerged as key subdomains of cognitive function. Markers of the HPA-axis, sex hormones and growth hormones were important biomarkers of endocrine function. Finally, inflammatory factors were identified as important biomarkers of immune function. We present recommendations for a panel of biomarkers that address these major areas of function which decline during ageing. This biomarker panel may have utility in epidemiological studies of human ageing, in health surveys of older people and as outcomes in intervention studies that aim to promote healthy ageing. Further, the inclusion of the same common panel of measures of healthy ageing in diverse study designs and populations may enhance the value of those studies by allowing the harmonisation of surrogate endpoints or outcome measures, thus facilitating less equivocal comparisons between studies and the pooling of data across studies.

A proposed panel of biomarkers of healthy ageing

BACKGROUND

There is no criterion reference for assessing healthy ageing and this creates difficulties when conducting and comparing research on ageing across studies. A cardinal feature of ageing is loss of function which translates into wide-ranging consequences for the individual and for family, carers and society. We undertook comprehensive reviews of the literature searching for biomarkers of ageing on five ageing-related domains including physical capability and cognitive, physiological and musculoskeletal, endocrine and immune functions. Where available, we used existing systematic reviews, meta-analyses and other authoritative reports such as the recently launched NIH Toolbox for assessment of neurological and behavioural function, which includes test batteries for cognitive and motor function (the latter described here as physical capability). We invited international experts to comment on our draft recommendations. In addition, we hosted an experts workshop in Newcastle, UK, on 22-23 October 2012, aiming to help capture the state-of-the-art in this complex area and to provide an opportunity for the wider ageing research community to critique the proposed panel of biomarkers.

DISCUSSION

Here we have identified important biomarkers of healthy ageing classified as subdomains of the main areas proposed. Cardiovascular and lung function, glucose metabolism and musculoskeletal function are key subdomains of physiological function. Strength, locomotion, balance and dexterity are key physical capability subdomains. Memory, processing speed and executive function emerged as key subdomains of cognitive function. Markers of the HPA-axis, sex hormones and growth hormones were important biomarkers of endocrine function. Finally, inflammatory factors were identified as important biomarkers of immune function. We present recommendations for a panel of biomarkers that address these major areas of function which decline during ageing. This biomarker panel may have utility in epidemiological studies of human ageing, in health surveys of older people and as outcomes in intervention studies that aim to promote healthy ageing. Further, the inclusion of the same common panel of measures of healthy ageing in diverse study designs and populations may enhance the value of those studies by allowing the harmonisation of surrogate endpoints or outcome measures, thus facilitating less equivocal comparisons between studies and the pooling of data across studies.

Predictors of poor-quality spirometry in two cohorts of older adults in Russia and Belgium: a cross-sectional study

BACKGROUND

Spirometry is an important test for the diagnosis of respiratory diseases, yet it is underused especially in older adults. Several predictors of good-quality spirometry in this age group have been reported, based mainly on in/outpatients of geriatric and/or respiratory units.

AIMS

This study aims to assess predictors of poor-quality spirometry in community-dwelling older adults from two primary care cohorts in Russia and Belgium.

METHODS

Spirograms from two population-based cohort studies in Russia (CRYSTAL) and Belgium (BELFRAIL) were assessed in accordance with the American Thoracic Society/European Respiratory Society (ATS/ERS) acceptability and repeatability criteria and grouped into good and poor quality. Multivariable analysis assessed the association of poor-quality spirometry with socio-demographics, functional dependency, physical and mental functioning and co-morbidities.

RESULTS

In all, 43.3% of the 522 BELFRAIL participants (84.71 ± 3.67 years old) and 57.7% of the 605 CRYSTAL participants (75.11 ± 5.97 years old) achieved all ATS/ERS acceptability and repeatability criteria. In both cohorts, those with poor-quality spirometry had lower cognitive function (mini-mental state examination (MMSE) ⩽ 24). After adjustment in multivariable analysis, MMSE ⩽ 24 had an odds ratio for poor-quality spirometry of 1.33 (95% CI = 0.78-2.28) in the BELFRAIL and 1.30 (95% CI = 0.88-1.91) in the CRYSTAL cohort.

CONCLUSIONS

In community-dwelling older adults, including those over 80 years old, impaired cognition measured by the MMSE may not be an independent predictor of poor-quality spirometry. Further research is needed in this area, and spirometry should be used more often in older adults in primary care.

Vascular burden and cognitive function in late-life depression

OBJECTIVE

To evaluate the relation of vascular risk factors, subclinical, and manifest vascular disease with four domains of cognitive functioning in a large sample of clinically depressed older persons.

METHODS

A cross-sectional analysis was used, and depressed patients were recruited from general practices and mental healthcare institutes. Presence of a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depressive episode was established with the Composite International Diagnostic Interview. Framingham Risk Score (FRS) was used as a measure for vascular risk profile, ankle-brachial index for subclinical vascular disease, and history of a cardiovascular event as a measure for manifest vascular disease. Three neurocognitive tasks evaluated processing speed, working memory, verbal memory, and interference control.

RESULTS

In 378 participants, linear regression analysis showed that FRS was related to poorer interference control (t = -2.353; df = 377; p <0.05) but to no other cognitive domain after adjustment for age, sex, education level, and depressive symptom severity. Lower ankle-brachial index and history of cardiovascular event were related to slower processing speed (t = 2.659; df = 377; p <0.05 and t = -3.328; df = 377; p <0.01, respectively) but to no other cognitive domain. In 267 participants without manifest vascular disease, higher FRS was related to slower processing speed (t = -2.425; df = 266; p <0.05) and poorer interference control (t = -2.423; df = 266; p <0.05), and lower ankle brachial index was related to slower processing speed (t = 2.171; df = 266; p <0.05).

CONCLUSION

In depressed older persons, vascular burden is related to slower processing speed also in the absence of manifest vascular disease. Poorer interference control was only related to vascular risk factors but not to subclinical or manifest vascular disease.

Respiratory training as strategy to prevent cognitive decline in aging: a randomized controlled trial

Background

Inadequate oxygenation may cause lesions and brain atrophy during aging. Studies show a positive association between pulmonary function and the cognitive performance of individuals from middle age on.

Objective

To investigate the effect of aerobic physical exercises and respiratory training on the blood oxygenation, pulmonary functions, and cognition of the elderly.

Design

This was a randomized and controlled trial with three parallel groups. A total of 195 community-dwelling elderly were assessed for eligibility; only n=102 were included and allocated into the three groups, but after 6 months, n=68 were analyzed in the final sample. Participants were randomized into a social interaction group (the control group), an aerobic exercise group (the “walking” group), or a respiratory training group (the “breathing” group). The main outcome measures were the Wechsler Adult Intelligence Scale, Wechsler Memory Scale, Wisconsin Card Sorting Test, respiratory muscular strength, cirtometry (thoracic–abdominal circumference); oxygen saturation in arterial blood (SpO₂), and hemogram.

Results

No differences were observed for any of the blood parameters. Aerobic exercise and respiratory training were effective in improving the pulmonary parameters. Better cognitive performance was observed for the breathing group as regards abstraction and mental flexibility. The walking group remained stable in the cognitive performance of most of the tests, except attention. The control group presented worst performance in mental manipulation of information, abstraction, mental flexibility, and attention.

Conclusion

Our results showed that both the walking and breathing groups presented improvement of pulmonary function. However, only the breathing group showed improved cognitive function (abstraction, mental flexibility). The improvement in cognitive functions cannot be explained by blood parameters, such as SpO₂, erythrocytes, hemoglobin, and hematocrit.

Cognition and health in African American men

OBJECTIVE

Despite high rates of poor health outcomes, little attention has been focused on associations between prominent health factors and cognitive function in African American men, exclusively. The objective was to examine relationships between cardiovascular and pulmonary health, and cognitive function in African American men.

METHOD

Data from 257 men were pooled from two studies of African American aging. The mean age of participants was 58.15 and mean educational attainment was 11.78 years. Participants provided self-reported health and demographic information, completed cognitive measures, and had their blood pressure and peak expiratory flow assessed.

RESULTS

After adjustment, significant relationships were found between average peak expiratory flow rate (APEFR) and cognitive performance measures.

DISCUSSION

Results suggest that lung function is important to consider when examining cognitive function in African American men. Understanding the role of health in cognition and implications for quality of life in this population will be critical as life expectancies increase.

Short-term prognostic value of forced expiratory volume in 1 second divided by height cubed in a prospective cohort of people 80 years and older

Background

Spirometry-based parameters of pulmonary function such as forced expiratory volume in 1 second (FEV₁) have prognostic value beyond respiratory morbidity and mortality. FEV₁ divided by height cubed (FEV₁/Ht³) has been found to be better at predicting all-cause mortality than the usual standardization as percentage of predicted "normal values" (FEV₁%) and its use is independent of reference equations. Yet, limited data are available on the very old adults (80 years and older) and in association to other adverse health outcomes relevant for this age group. This study aims to investigate the short-term prognostic value of FEV₁/Ht³ for all-cause mortality, hospitalization, physical and mental decline in a cohort of very old adults.

Methods

In a population-based prospective cohort study of 501 very old adults in Belgium, comprehensive geriatric assessment and spirometry were performed at baseline and after 1.7 ± 0.21 years. Kaplan-Meier curves for 3-year all-cause mortality and hospitalization rates and multivariable analysis adjusted for age, sex, smoking status, co-morbidities, anemia, high C reactive protein and creatinine levels examined the association of FEV₁/Ht³ with all-cause mortality, unplanned hospitalization and decline in mental and physical functioning. Physical functioning was assessed by activities of daily living, a battery of physical performance tests and grip strength. Mental functioning was assessed with mini mental state examination and 15 items geriatric depression scale.

Results

Individuals in the lowest quartile of FEV₁/Ht³ had a statistically significant increased adjusted risk for all-cause mortality (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.10-2.60) and unplanned hospitalization (HR 1.65, 95% CI 1.21-2.25), as well as decline in physical (odds ratio [OR] 1.89, 95% CI 1.05-3.39) and mental functioning (OR 2.39, 95% CI 1.30-4.40) compared to the rest of the study population.

Conclusions

In a cohort of very old adults, low FEV₁ expressed as FEV₁/Ht³ was found to be a short-term predictor of all-cause mortality, hospitalization and decline in physical and mental functioning independently of age, smoking status, chronic lung disease and other co-morbidities. Further research is needed on FEV₁/Ht³ as a potential risk marker for frailty and adverse health outcomes in this age group.

Non-consent to a wrist-worn accelerometer in older adults: the role of socio-demographic, behavioural and health factors

Background

Accelerometers, initially waist-worn but increasingly wrist-worn, are used to assess physical activity free from reporting-bias. However, its acceptability by study participants is unclear. Our objective is to assess factors associated with non-consent to a wrist-mounted accelerometer in older adults.

Methods

Data are from 4880 Whitehall II study participants (1328 women, age range = 60–83), requested to wear a wrist-worn accelerometer 24 h every day for 9 days in 2012/13. Sociodemographic, behavioral, and health-related factors were assessed by questionnaire and weight, height, blood pressure, cognitive and motor function were measured during a clinical examination.

Results

210 participants had contraindications and 388 (8.3%) of the remaining 4670 participants did not consent. Women, participants reporting less physical activity and less favorable general health were more likely not to consent. Among the clinical measures, cognitive impairment (Odds Ratio = 2.21, 95% confidence interval: 1.22–4.00) and slow walking speed (Odds Ratio = 1.38, 95% confidence interval: 1.02–1.86) were associated with higher odds of non-consent.

Conclusions

The rate of non-consent in our study of older adults was low. However, key markers of poor health at older ages were associated with non-consent, suggesting some selection bias in the accelerometer data.

Cumulative associations between midlife health behaviors and physical functioning in early old age: a 17-year prospective cohort study

Objectives

To examine cumulative associations between midlife health behaviors and walking speed and upper-limb strength in early old age.

Design

Prospective cohort study.

Setting

Whitehall II Study.

Participants

Individuals (mean age 49.1 ± 5.9 in 1991–93) with health behavior data for at least two of the three assessments (1991–93, 1997–99, 2002–04) and physical functioning measures in 2007–09 (mean age 65.9 ± 5.9) (N = 5,671).

Measurements

A trained nurse assessed walking speed and upper-limb strength. Unhealthy behaviors were defined as current or recent smoking, nonmoderate alcohol consumption (abstinence or heavy drinking), fruit and vegetable consumption less than twice per day, and physical inactivity (<1 h/wk of moderate and <1 h/wk of vigorous physical activity). For each unhealthy behavior, a cumulative score was calculated as the number of times a person reported the behavior over the three assessments divided by 3. The score ranged between 0 (never) and 1 (all three times).

Results

In linear regression models adjusted for age, sex, education, marital status, and height, all unhealthy behaviors in 1991–93 were associated with slower walking speed in 2007–09, with differences ranging from 0.10 (nonmoderate alcohol consumption) to 0.25 (physical inactivity) of a standard deviation between participants with and without the unhealthy behavior (P_t-test<.001). For walking speed, the accumulation-of-risk model provided the best fit for unhealthy diet (β for a 1-point increment in the low fruit and vegetable consumption score = −0.29, 95% confidence interval (CI) = −0.36 to −0.22) and physical inactivity (β = −0.37, 95% CI = −0.45 to −0.29). For smoking and nonmoderate alcohol consumption, a cumulative effect was also observed, but partial F-tests did not suggest that it provided a better fit than models with behaviors in 1991–93, 1997–99, or 2002–04. All behavioral scores except smoking were associated with grip strength, but F-tests supported the accumulation-of-risk hypothesis only for physical inactivity.

Conclusion

These findings highlight the importance of duration of unhealthy behaviors, particularly for diet and physical activity, when examining associations with physical functioning.

Cumulative associations between midlife health behaviors and physical functioning in early old age: a 17-year prospective cohort study

OBJECTIVES

To examine cumulative associations between midlife health behaviors and walking speed and upper-limb strength in early old age.

DESIGN

Prospective cohort study.

SETTING

Whitehall II Study.

PARTICIPANTS

Individuals (mean age 49.1 ± 5.9 in 1991-93) with health behavior data for at least two of the three assessments (1991-93, 1997-99, 2002-04) and physical functioning measures in 2007-09 (mean age 65.9 ± 5.9) (N = 5,671).

MEASUREMENTS

A trained nurse assessed walking speed and upper-limb strength. Unhealthy behaviors were defined as current or recent smoking, nonmoderate alcohol consumption (abstinence or heavy drinking), fruit and vegetable consumption less than twice per day, and physical inactivity (<1 h/wk of moderate and <1 h/wk of vigorous physical activity). For each unhealthy behavior, a cumulative score was calculated as the number of times a person reported the behavior over the three assessments divided by 3. The score ranged between 0 (never) and 1 (all three times).

RESULTS

In linear regression models adjusted for age, sex, education, marital status, and height, all unhealthy behaviors in 1991-93 were associated with slower walking speed in 2007-09, with differences ranging from 0.10 (nonmoderate alcohol consumption) to 0.25 (physical inactivity) of a standard deviation between participants with and without the unhealthy behavior (Pt-test <.001). For walking speed, the accumulation-of-risk model provided the best fit for unhealthy diet (β for a 1-point increment in the low fruit and vegetable consumption score = -0.29, 95% confidence interval (CI) = -0.36 to -0.22) and physical inactivity (β = -0.37, 95% CI = -0.45 to -0.29). For smoking and nonmoderate alcohol consumption, a cumulative effect was also observed, but partial F-tests did not suggest that it provided a better fit than models with behaviors in 1991-93, 1997-99, or 2002-04. All behavioral scores except smoking were associated with grip strength, but F-tests supported the accumulation-of-risk hypothesis only for physical inactivity.

CONCLUSION

These findings highlight the importance of duration of unhealthy behaviors, particularly for diet and physical activity, when examining associations with physical functioning.

Peak flow as a predictor of cause-specific mortality in China: results from a 15-year prospective study of ∼170 000 men

Background Forced expiratory volume in one second (FEV1) is inversely associated with mortality in Western populations, but few studies have assessed the associations of peak expiratory flow (PEF) with subsequent cause-specific mortality, or have used populations in developing countries, including China, for such assessments.

Methods A prospective cohort study followed ∼170 000 Chinese men ranging in age from 40–69 years at baseline (1990–1991) for 15 years. In the study, height-adjusted PEF (h-PEF), which was uncorrelated with height, was calculated by dividing PEF by height. Hazard ratios (HR) for cause-specific mortality and h-PEF, adjusted for age, area of residence, smoking, and education, were calculated through Cox regression analyses.

Results Of the original study population, 7068 men died from respiratory causes (non-neoplastic) and 22 490 died from other causes (including 1591 from lung cancer, 5469 from other cancers, and 10 460 from cardiovascular disease) before reaching the age of 85 years. Respiratory mortality was strongly and inversely associated with h-PEF. For h-PEF ≥ 250 L/min, the association was log-linear, with a hazard ratio (HR) of 1.29 (95% CI: 1.25–1.34) per 100 L/min reduction in h-PEF. The association was stronger but not log-linear for lower values of h-PEF. Mortality from combined other causes was also inversely associated with h-PEF, and the association was log-linear for all values of h-PEF, declining with follow-up, with HRs per 100 L/min reduction in h-PEF of 1.13 (1.10–1.15), 1.08 (1.06–1.11), and 1.06 (1.03–1.08) in three consecutive 5-year follow-up periods. Specifically, lower values of h-PEF were associated with higher mortality from cardiovascular disease and lung cancer, but not from other cancers.

Conclusions A lower value of h-PEF was associated with increased mortality from respiratory and other causes, including lung cancer and cardiovascular disease, but its associations with the other causes of death declined across the follow-up period.

Influence of individual and combined healthy behaviours on successful aging

BACKGROUND

Increases in life expectancy make it important to remain healthy for as long as possible. Our objective was to examine the extent to which healthy behaviours in midlife, separately and in combination, predict successful aging.

METHODS

We used a prospective cohort design involving 5100 men and women aged 42-63 years. Participants were free of cancer, coronary artery disease and stroke when their health behaviours were assessed in 1991-1994 as part of the Whitehall II study. We defined healthy behaviours as never smoking, moderate alcohol consumption, physical activity (≥ 2.5 h/wk moderate physical activity or ≥ 1 h/wk vigorous physical activity), and eating fruits and vegetables daily. We defined successful aging, measured over a median 16.3-year follow-up, as good cognitive, physical, respiratory and cardiovascular functioning, in addition to the absence of disability, mental health problems and chronic disease (coronary artery disease, stroke, cancer and diabetes).

RESULTS

At the end of follow-up, 549 participants had died and 953 qualified as aging successfully. Compared with participants who engaged in no healthy behaviours, participants engaging in all 4 healthy behaviours had 3.3 times greater odds of successful aging (95% confidence interval [CI] 2.1-5.1). The association with successful aging was linear, with the odds ratio (OR) per increment of healthy behaviour being 1.3 (95% CI 1.2-1.4; population-attributable risk for 1-4 v. 0 healthy behaviours 47%). When missing data were considered in the analysis, the results were similar to those of our main analysis.

INTERPRETATION

Although individual healthy behaviours are moderately associated with successful aging, their combined impact is substantial. We did not investigate the mechanisms underlying these associations, but we saw clear evidence of the importance of healthy behaviours for successful aging.

Impact of smoking on cognitive decline in early old age: the Whitehall II cohort study

CONTEXT

Smoking is a possible risk factor for dementia, although its impact may have been underestimated in elderly populations because of the shorter life span of smokers.

OBJECTIVE

To examine the association between smoking history and cognitive decline in the transition from midlife to old age.

DESIGN

Cohort study.

SETTING

The Whitehall II study. The first cognitive assessment was in 1997 to 1999, repeated over 2002 to 2004 and 2007 to 2009.

PARTICIPANTS

Data are from 5099 men and 2137 women in the Whitehall II study, mean age 56 years (range, 44-69 years) at the first cognitive assessment.

MAIN OUTCOME MEASURES

The cognitive test battery was composed of tests of memory, vocabulary, executive function (composed of 1 reasoning and 2 fluency tests), and a global cognitive score summarizing performance across all 5 tests. Smoking status was assessed over the entire study period. Linear mixed models were used to assess the association between smoking history and 10-year cognitive decline, expressed as z scores.

RESULTS

In men, 10-year cognitive decline in all tests except vocabulary among never smokers ranged from a quarter to a third of the baseline standard deviation. Faster cognitive decline was observed among current smokers compared with never smokers in men (mean difference in 10-year decline in global cognition=-0.09 [95% CI, -0.15 to -0.03] and executive function=-0.11 [95% CI, -0.17 to -0.05]). Recent ex-smokers had greater decline in executive function (-0.08 [95% CI, -0.14 to -0.02]), while the decline in long-term ex-smokers was similar to that among never smokers. In analyses that additionally took dropout and death into account, these differences were 1.2 to 1.5 times larger. In women, cognitive decline did not vary as a function of smoking status.

CONCLUSIONS

Compared with never smokers, middle-aged male smokers experienced faster cognitive decline in global cognition and executive function. In ex-smokers with at least a 10-year cessation, there were no adverse effects on cognitive decline.

Neuroticism and cardiovascular disease mortality: socioeconomic status modifies the risk in women (UK Health and Lifestyle Survey)

OBJECTIVE

The association between personality traits and mortality might differ as a function of socioeconomic status (SES). Our aim was to evaluate the all-cause, cardiovascular disease (CVD), and cancer mortality risk associated with neuroticism or extraversion and their interactions with SES in a representative sample of the UK adult population.

METHODS

A total of 5450 participants (2505 men) from the Health and Lifestyle Survey completed the Eysenck Personality Inventory at baseline and were monitored for vital status over 25 years. SES was defined as a latent variable comprising occupational social class, educational attainment, and income.

RESULTS

A significant neuroticism-by-SES-by-sex interaction (p = .04) for CVD mortality revealed a neuroticism-by-SES interaction specific to women. Compared to women with average SES, those with both high neuroticism and low SES were at an increased risk for CVD mortality (hazard ratio = 2.02, 95% confidence interval = 1.45-2.80), whereas those with high neuroticism and high SES combined were at a decreased risk for CVD mortality (hazard ratio = 0.61, 95% confidence interval = 0.38-0.97, p for interaction = 0.003). The interaction term was not explained by health behaviors (10% attenuation) and physiological variables (11% attenuation). This interaction was not observed for all-cause and cancer mortality risks or among men for CVD mortality.

CONCLUSIONS

High neuroticism is a risk factor for cardiovascular mortality in women with low SES, whereas in women with higher SES, it is protective. Further research is needed to replicate this finding and identify the mechanisms behind the modifying effect of SES on neuroticism.

Forced expiratory volume in 1 second and cognitive aging in men

OBJECTIVES

To evaluate forced expiratory volume in 1 second (FEV(1) , a measure of overall lung function), long-term average FEV(1) , and rate of decline in FEV(1) in relation to cognition and cognitive decline in older men.

DESIGN

Prospective observational study.

SETTING

Community-based population.

PARTICIPANTS

Eight hundred sixty-four older men from the Normative Aging Study.

MEASUREMENTS

Starting in 1984, participants underwent triennial clinical evaluations. Lung function assessments provided estimates of FEV(1) . Cognitive assessments entailing tests of several cognitive abilities began in 1993. FEV(1) measured approximately 12 years before baseline cognitive testing, average FEV(1) over the 12-year period, and rate of change in FEV(1) were all evaluated in relation to baseline and change in performance on the cognitive tests.

RESULTS

In multivariable-adjusted analyses, associations between FEV(1) and baseline cognitive scores were mixed, although average FEV(1) predicted significantly better performance on tests of visuospatial ability (P=.04) and general cognition (P=.03). Higher FEV(1) was more consistently associated with slower cognitive decline, but only the association between historical FEV(1) and attention was significant (difference per standard deviation in FEV(1) =0.056, P=.05). Rate of FEV(1) decline was not consistently associated with cognitive function or decline. Findings were generally similar or stronger in men who had never smoked. To account for potential bias due to selective attrition, inverse probability of censoring weights were applied to the cognitive decline analyses, yielding slightly larger estimates; the inadequate prognostic power of the censoring models limited this approach.

CONCLUSION

Overall, the data provide limited evidence of an inverse association between FEV(1) and cognitive aging.