Cognitive, physical and disability trajectories in community-dwelling elderly people

Trajectories of cognitive function and frailty in older adults in China: a longitudinal study

Background

Cognitive impairment and frailty are common issues in older adults. Understanding the co-development trajectories of these conditions can provide valuable sights for early detection and intervention in high-risk individuals.

Objectives

This study aims to identify the co-development of cognitive function and frailty and explore the associated characteristics.

Methods

We analyzed data from 8,418 individuals aged 55 years and above who participated in the China Health and Retirement Longitudinal Survey between 2011 and 2018. Group-based dual trajectory modeling and logistic regression were used to identify trajectory groups and assess associations with risk factors.

Results

Two distinct dual trajectories were identified: "Consistently Robust" group (76.12%) and "Consistently Severe" group (23.88%). Factors such as being female, older age, lower levels of education, residing in rural areas, being unmarried, and having comorbidities such as hypertension, diabetes, complete tooth loss, vision impairment, or hearing impairment were associated with a higher likelihood of being assigned to the "Consistently Severe" group.

Conclusion

Our findings suggest a co-development pattern between cognitive function and frailty in Chinese older adults aged 55 years and above. While cognitive impairment may be irreversible, frailty is a condition that can be potentially reversed. Early detecting is crucial in preventing cognitive decline, considering the shared trajectory of these conditions.

Community-dwelling older adults' perspectives on health risks: a qualitative study exploring anxieties, priorities, and expectations in ageing

BACKGROUND

With the conflict between the promise of ageing in health and longevity and the limited availability of health resources and social support, older adults in China inevitably experience anxieties surrounding health risks. This study aims to investigate how older adults perceive the health risks that come with getting older, explore the degree to which health risks affect older adults, and advocate for active engagement in practices for managing health risks.

METHODS

Using purposive sampling, three districts of Beijing (Xicheng District, Fengtai District, and Daxing District, respectively) were selected for the research. Qualitative semi-structured and in-depth interviews were conducted with 70 community-dwelling older adults who participated in the study. Data were extracted and analyzed based on a thematic framework approach.

RESULTS

Three main themes were identified: (i) the anxieties of older adults concerning health risks in ageing; (ii) the priorities of older adults for health risk management in ageing; (iii) the expectations of older adults for health risk management in ageing. The primary health concerns among older adults included disease incidence and function decline. It was found that basic health management emerged as a critical need for older adults to mitigate health risks. Moreover, it was observed that healthcare support for older adults from familial, institutional, and governmental levels exhibited varying degrees of inadequacy.

CONCLUSIONS

The primary source of anxieties among older adults regarding health risks predominantly stems from a perceived sense of health deprivation. It is often compounded by persistent barriers to primary care of priorities in managing health risks among older adults. In addition, the expectations of older adults for health risk management emphasize the necessity for integrated care approaches. Therefore, further research should give priority to the prevention and management of health risks, aim to reduce anxieties, provide integrated care to meet the primary needs and expectations of older adults, and ultimately strive toward the overarching goal of promoting health and longevity.

Identifying and predicting physical limitation and cognitive decline trajectory group of older adults in China: A data-driven machine learning analysis

OBJECTIVE

This study aimed to utilize data-driven machine learning methods to identify and predict potential physical and cognitive function trajectory groups of older adults and determine their crucial factors for promoting active ageing in China.

METHODS

Longitudinal data on 3026 older adults from the Chinese Longitudinal Healthy Longevity and Happy Family Survey was used to identify potential physical and cognitive function trajectory groups using a group-based multi-trajectory model (GBMTM). Predictors were selected from sociodemographic characteristics, lifestyle factors, and physical and mental conditions. The trajectory groups were predicted using data-driven machine learning models and dynamic nomogram. Model performance was evaluated by area under the receiver operating characteristics curve (AUROC), area under the precision-recall curve (PRAUC), and confusion matrix.

RESULTS

Two physical and cognitive function trajectory groups were determined, including a trajectory group with physical limitation and cognitive decline (14.18 %) and a normal trajectory group (85.82 %). Logistic regression performed well in predicting trajectory groups (AUROC = 0.881, PRAUC = 0.649). Older adults with lower baseline score of activities of daily living, older age, less frequent housework, and fewer actual teeth were more likely to experience physical limitation and cognitive decline trajectory group.

LIMITATION

This study didn't carry out external validation.

CONCLUSIONS

This study shows that GBMTM and machine learning models effectively identify and predict physical limitation and cognitive decline trajectory group. The identified predictors might be essential for developing targeted interventions to promote healthy ageing.

Pilot testing of a simplified dance intervention for cardiorespiratory fitness and blood lipids in obese older women

INTRODUCTION

Dance interventions require long learning periods and exert high joint loading. Therefore, a simple dance intervention is required.

AIMS

To examine the effects of simplified dance on body composition, cardiorespiratory fitness, and blood lipid levels in obese older women.

METHOD

Twenty-six obese older women were randomly assigned to exercise and control groups. The dance exercise involved pelvic tilt and rotation with basic breathing techniques. Anthropometry, cardiorespiratory fitness, and blood lipid levels were measured at baseline and after the 12-week training.

RESULTS

The exercise group had lower total cholesterol and low-density lipoprotein cholesterol levels and improved VO₂max after the 12-week training than at baseline; however, no significant difference was observed for the control group. Additionally, the exercise group had lower triglycerides and higher high-density lipoprotein cholesterol than the control group.

CONCLUSIONS

Simplified dance interventions have the potential to improve blood composition and aerobic fitness in obese older women.

Trajectories of Social Participation and Its Predictors in Older Adults: Based on the CLHLS Cohorts from 2002 to 2018

Social participation is a key factor in achieving active aging. This study aimed to explore the trajectories and predictors of social participation changes among older adults in China. The data used in this study are from the ongoing national longitudinal study CLHLS. A total of 2492 older adults from the cohort study were included. Group-based trajectory models (GBTM) were used to identify potential heterogeneity in longitudinal changes over time and investigate associations between baseline predictors and trajectories for different cohort members using logistic regression. Four different trajectories of social participation were reported in older adults, namely, stable (8.9%), slow decline (15.7%), lower score with decline (42.2%), and higher score with decline (9.5%). On multivariate analyses, age, years of schooling, pension, mental health, cognitive function, instrumental activities of daily living, and initial social participation scores significantly impact the rate of change in social participation over time. Four trajectories of social participation were identified in the Chinese elderly population. Management of mental health, physical function, and cognitive function appear to be important in maintaining the long-term social participation of older people in the community. Early identification of factors influencing the rapid decline in social participation and timely interventions can maintain or improve social participation levels in older adults.

Developmental Trajectories and Predictors of Incident Dementia among Elderly Taiwanese People: A 14-Year Longitudinal Study

The aim of this study was to identify dementia trajectories and their associated predictors among elderly Taiwanese people over a 14-year period using a nationwide representative longitudinal study. This retrospective cohort study was performed using the National Health Insurance Research Database. Group-based trajectory modeling (GBTM) was used to distinguish the specific trajectory groups of incident dementia during 2000-2013. All 42,407 patients were classified by GBTM to identify the trajectory of incident dementia, which included high- (n = 11,637, 29.0%), moderate- (n = 19,036, 44.9%), and low-incidence (n = 11,734, 26.1%) groups. Those diagnosed with hypertension (adjusted odds ratio [aOR] = 1.43; 95% confidence interval [CI] = 1.35-1.52), stroke (aOR = 1.45, 95% CI = 1.31-1.60), coronary heart disease (aOR = 1.29, 95% CI = 1.19-1.39), heart failure (aOR = 1.62, 95% CI = 1.36-1.93), and chronic obstructive pulmonary disease (aOR = 1.10, 95% CI = 1.02-1.18) at baseline revealed tendencies to be classified into high-incidence groups in dementia risk. The results from a 14-year longitudinal study identified three distinct trajectories of incident dementia among elderly Taiwanese people: patients with cardiovascular disease risk factors and cardiovascular disease events tended to be classified into high-incidence dementia groups. Early detection and management of these associated risk factors in the elderly may prevent or delay the deterioration of cognitive decline.

Psychological Distress, Cognition, and Functional Disability Trajectory Profiles of Aging in Primary Care Older Adults

OBJECTIVES

To identify profiles of aging by combining psychological distress, cognition and functional disability, and their associated factors.

METHODS

Data were drawn from the Étude sur la Santé des Aînés-Services study and included 1585 older adults. Sociodemographic, psychosocial, lifestyle and health factors were informed from structured interviews. Group-based multi-trajectory modeling and multinomial logistic regression were used to identify aging profiles and correlates. Sampling weights were applied to account for the sampling plan.

RESULTS

The weighted sample size was 1591. Three trajectories were identified: a favorable (79.0%), intermediate (14.5%), and severe scenario (6.5%). Factors associated with the severe scenario were older age, male gender, lower education, the presence of anxiety disorders, low physical activity, and smoking. Membership in the intermediate scenario was associated with daily hassles, physical disorders, anxiety and depression, antidepressant/psychotherapy use, low physical activity, and no alcohol use. High social support was protective against less favorable profiles.

CONCLUSIONS

Symptoms of anxiety and depression and high burden of physical disorders were associated with less favorable trajectories. Modifiable lifestyle factors have a significant effect on healthy aging.

CLINICAL IMPLICATIONS

Assessment and management of anxio-depressive symptoms are important in older adults. Clinical interventions including access to psychotherapy and promotion of healthier lifestyles should be considered.

Objectively Assessed Weight Change and All-Cause Mortality among Community-Dwelling Older People

Later life changes in body weight may be associated with an increased risk of mortality in older adults. The objective of this study was to examine whether weight change over four years was associated with a 17-year mortality risk in older adults. Participants were 1664 community-dwelling adults aged ≥65 years in the longitudinal Enquete de Sante’ Psychologique-Risques, Incidence et Traitement (ESPRIT) study. Outcomes were all-cause mortality, cardiovascular disease (CVD) and cancer mortality. Weight change was defined as difference between weight at baseline and 4 years, categorised into: weight stable (±<5% weight change), weight loss (≥5%) and weight gain (≥5%). Association between weight change and mortality risk was evaluated using Cox proportional hazards models. Over 17 years of follow-up (median 15 years), 565 participants died. Compared to stable weight participants, those with ≥ 5% weight loss had an increased risk of all-cause mortality (HR: 1.24, 95% CI: 1.00−1.56, p = 0.05) and CVD mortality (HR: 1.53, 95% CI: 1.10−2.14, p = 0.01), but not cancer mortality (HR: 0.83, 95% CI: 0.50−1.39, p = 0.49). Weight gain of ≥5% was not associated with increased mortality (HR: 1.05, 95% CI: 0.76−1.45, p = 0.74). Weight monitoring in older adults could help identify weight loss at its early stages to better target interventions to maintain nutritional reserve and prevent premature mortality.

Co-occurring Hearing Loss and Cognitive Decline in Older Adults: A Dual Group-Based Trajectory Modeling Approach

Hearing loss and cognitive impairments are both highly prevalent neurological complications for older adults. While there is growing evidence to suggest that these two conditions are interrelated, little research has been conducted that directly examines the progression and developmental trajectories of these complications contemporaneously. The aim of the study is to identify the distinct trajectory profiles for hearing loss and cognitive function in an older population over a 10-year period. Through dual trajectory modeling, the interrelationship, co-occurring movements, and overlaps between these two complications were examined. We also investigated the influence of hearing aid ownership on cognitive function trajectories. We utilized longitudinal data from 1,445 participants in the Blue Mountains Hearing Study (aged 55+ years) involving repeated measures from a population-based survey with audiometric hearing assessments. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). The group-based trajectory modeling (GBTM) identified three trajectory profiles for both hearing loss and cognitive function in two older age groups (55-69 years and 70+ years). The outputs from the dual trajectories models showed the conditional probability for "no hearing loss" trajectories to be around 90% more likely to have "high-normal" cognitive function, demonstrating co-occurring overlap. In contrast, for "moderate to severe hearing loss" trajectories, the conditional probability drops to 65% and 79% for the 55-69 age group and 70+ age group respectively. There was also an increasing probability for "cognitive decline" conditional on the severity of hearing loss with 6.7%, 7.5%, and 8.7% for no hearing loss, mild hearing loss, and moderate to severe hearing loss trajectory groups. While we did not find any statistically significant difference in the influence of hearing aid use in the cognitive function trajectories, there was a consistent greater representation of non-hearing aid users in the trajectories with poorer cognitive function. This study found GBTM to identify trajectories that were in agreement with our current understanding of hearing loss and cognitive impairment in older adults. This study also adds to the existing evidence-base as dual trajectories demonstrated co-occurrence in developmental changes in these two common neurological complications for the older population.

Determinants of Processing Speed Trajectories among Middle Aged or Older Adults, and Their Association with Chronic Illnesses: The English Longitudinal Study of Aging

The aim of this study was to identify latent groups of similar trajectories in processing speed through aging, as well as factors that are associated with these trajectories. In the context of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project, data from the English Longitudinal Study of Aging (ELSA) (n = 12099) were analyzed. Latent groups of similar trajectories in the processing scores as well as their predictors and covariates were investigated, using group-based trajectory models (GBTM). The coefficient estimates for potential group predictors correspond to parameters of multinomial logit functions that are integrated in the model. Potential predictors included sex, level of education, marital status, level of household wealth, level of physical activity, and history of smoking, while time-varying covariates included incidence of cardiovascular disease (CVD), diabetes mellitus, depressive symptoms, and sleep disturbances. Four trajectories were identified and named after their baseline scores and shapes: High (4.4%), Middle/Stable (31.5%), Low/Stable (44.5%), and Low Decline (19.6%). Female sex, higher levels of education, mild level of physical activity, having been married, and higher level of wealth were associated with a higher probability of belonging to any of the higher groups compared to the Low/Decline that was set as reference, while presence of CVD, diabetes mellitus, and depressive symptoms were associated with lower processing speed scores within most trajectories. All the aforementioned factors might be valid targets for interventions to reduce the burden of age-related cognitive impairment.