Predictors of all-cause mortality between ages 70 and 80: the Koganei study

Multiple cardiometabolic diseases enhance the adverse effects of hypoalbuminemia on mortality among centenarians in China: a cohort study

BACKGROUND

Although hypoalbuminemia was associated with high risk of mortality in community-dwelling older adults, as well as in the hospitalized older adults, little is known among centenarians. And there are limited data on whether having cardiometabolic diseases (CMDs) is associated with additive effects.

METHODS

Baseline examinations including a determination of albumin levels were performed in 1002 Chinese centenarians from January 2014 through to December 2016, and the survival status was subsequently ascertained until 31 May 2021. Cox proportional risk model was performed to assess the risk of all-cause mortality associated with albumin levels and hypoalbuminemia combined with CMDs.

RESULTS

Of 1002 participants included in the analysis, the mean level of albumin was 38.5 g/L (± standard deviation, 4.0 g/L), and 174 (17.4%) had hypoalbuminemia (albumin < 35 g/L). The multivariable analyses showed that albumin level was negatively associated with all-cause mortality (Ptrend < 0.05). Compared to normoalbuminemia, hypoalbuminemia was associated with an increased mortality risk in the overall participants (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.22-1.97). Furthermore, the HR (95% CI) of hypoalbuminemia combined with multiple CMDs was 2.15 (1.14-4.07). There was evidence of an additive deleterious dose effect of an increasing number of CMDs (Ptrend = 0.001).

CONCLUSIONS

Hypoalbuminemia is associated with an increased risk of all-cause mortality in Chinese centenarians, and this risk is more pronounced among centenarians with multiple cardiometabolic diseases. Our findings suggest that older adults with hypoalbuminemia, especially comorbid multiple CMDs warrant early identification and management.

Physical Function and Survival in Older Adults: A longitudinal study accounting for time-varying effects

PURPOSE OF THE STUDY

Variation in physical function in older adults over time raises several methodological challenges in the study of its association with survival, many of which have largely been overlooked in previous studies. The objective of this study is to examine the relationship between time-varying measures of physical function and survival in men and women aged 70 years and over, while accounting for the time-varying effects of health and lifestyle characteristics.

METHODS

1,846 women and 1,245 men in the Cardiovascular Health Study followed annually for up to 10 years beginning at age 70-74 years were included. We estimated the effect of gait speed and grip strength on survival over the subsequent year, using age as the timescale.

RESULTS

A 0.1m/s higher gait speed was associated with a 12% decrease in the likelihood of death in the subsequent year among women (HR 0.88, 95% CI 0.82-0.94). There was no statistically significant effect of gait speed on survival among men (HR 0.97, 95% CI 0.91 to 1.03), or of grip strength on survival among women (HR 0.97, 95% CI 0.95-1.00) or men (HR 0.99, 95% CI 0.97-1.01), over one year.

CONCLUSIONS

Upon using time-varying measures of physical function while accounting for time-varying effects of health and lifestyle characteristics, higher gait speed was associated with increased survival among the women in our study. We found no evidence of an association between gait speed and one-year survival in men, or between grip strength and one-year survival in women or men.

Associations Between Handgrip Strength and Disease-Specific Mortality Including Cancer, Cardiovascular, and Respiratory Diseases in Older Adults: A Meta-Analysis

Several controversial studies linking handgrip strength and health have suggested that low handgrip strength in older adults may be related to health problems and have investigated whether there is a minimum handgrip strength level associated with reduced mortality. Thus, by meta-analysis, the authors identified an association between handgrip strength in older adults and disease-specific mortality and all-cause mortality. Thirty studies with a total of 194,767 older adult participants were included in this meta-analysis. Higher handgrip strength was associated with an 18% decrease in all-cause mortality. Lower handgrip strength was associated with increased all-cause mortality. The minimum handgrip strength in older women that did not increase all-cause mortality was 18.21 kg. Increased handgrip strength showed a decreased all-cause mortality, whereas decreased handgrip strength was associated with increased all-cause mortality. Strengthening the handgrip may help improve disease-specific mortality in older adults.

Heritability estimates of muscle strength-related phenotypes: A systematic review and meta-analysis

The purpose of this study was to clarify the heritability estimates of human muscle strength-related phenotypes (H² -msp). A systematic literature search was conducted using PubMed (through August 22, 2016). Studies reporting the H² -msp for healthy subjects in a sedentary state were included. Random-effects models were used to calculate the weighted mean heritability estimates. Moreover, subgroup analyses were performed based on phenotypic categories (eg, grip strength, isotonic strength, jumping ability). Sensitivity analyses were also conducted to investigate potential sources of heterogeneity of H² -msp, which included age and sex. Twenty-four articles including 58 measurements were included in the meta-analysis. The weighted mean H² -msp for all 58 measurements was 0.52 (95% confidence intervals [CI]: 0.48-0.56), with high heterogeneity (I² =91.0%, P<.001). Subgroup analysis showed that the heritability of isometric grip strength, other isometric strength, isotonic strength, isokinetic strength, jumping ability, and other power measurements was 0.56 (95% CI: 0.46-0.67), 0.49 (0.47-0.52), 0.49 (0.32-0.67), 0.49 (0.37-0.61), 0.55 (0.45-0.65), and 0.51 (0.31-0.70), respectively. The H² -msp decreased with age (P<.05). In conclusion, our results indicate that the influence of genetic and environmental factors on muscle strength-related phenotypes is comparable. Moreover, the role of environmental factors increased with age. These findings may contribute toward an understanding of muscle strength-related phenotypes.

Physical Performance Measures Associated With Locomotive Syndrome in Middle-Aged and Older Japanese Women

BACKGROUND

The Japanese Orthopaedic Association proposed a concept called locomotive syndrome (LS) to identify middle-aged and older adults at high risk of requiring health care services because of problems with locomotion. It is important to identify factors associated with the development of LS. Physical performance measures such as walking speed and standing balance are highly predictive of subsequent disability and mortality in older adults. However, there is little evidence about the relationship between physical performance measures and LS.

PURPOSE

To determine the physical performance measures associated with LS, the threshold values for discriminating individuals with and without LS, and the odds ratio of LS according to performance greater than or less than these thresholds in middle-aged and older Japanese women.

METHODS

Participants were 126 Japanese women (mean age = 61.8 years). Locomotive syndrome was defined as a score of 16 or more on the 25-question Geriatric Locomotive Function Scale. Physical performance was evaluated using grip strength, unipedal stance time with eyes open, seated toe-touch, and normal and fast 6-m walk time (6 MWT). Variables were compared between LS and non-LS groups.

RESULTS

Fourteen participants (11.1%) were classed as having LS. Unipedal stance time, normal 6 MWT, and fast 6 MWT were significantly different between the 2 groups. The LS group had a shorter unipedal stance time and a longer normal and fast 6 MWT than the non-LS group. For these 3 variables, the area under the receiver operating characteristic curve was greater than 0.7, and the threshold for discriminating the non-LS and LS groups was 15 s for unipedal stance time, 4.8 s for normal 6 MWT and 3.6 s for fast 6 MWT. These variables were entered into a multiple logistic regression analysis, which indicated that unipedal stance time less than 15 s was significantly related to LS (odds ratio = 8.46; P < .01).

CONCLUSION

Unipedal stance time was the physical performance measure that was most strongly associated with LS. This measure may be useful for early detection of LS.

Serum Albumin Levels and Economic Status in Japanese Older Adults

BACKGROUND

Low serum albumin levels are associated with aging and medical conditions such as cancer, liver dysfunction, inflammation, and malnutrition and might be an independent predictor of long-term mortality in healthy older populations. We tested the hypothesis that economic status is associated with serum albumin levels and explained by nutritional and health status in Japanese older adults.

DESIGN

We performed a cross-sectional analysis using data from the Japan Gerontological Evaluation study (JAGES). The study participants were 6528 functionally independent residents (3189 men and 3339 women) aged ≥65 years living in four municipalities in Aichi prefecture. We used household income as an indicator of economic status. Multiple linear regression was used to compare serum albumin levels in relation to household income, which was classified as low, middle, and high. Additionally, mediation by nutritional and health-related factors was analyzed in multivariable models.

RESULTS

With the middle-income group as reference, participants with low incomes had a significantly lower serum albumin level, even after adjustment for sex, age, residential area, education, marital status, and household structure. The estimated mean difference was -0.17 g/L (95% confidence interval, -0.33 to -0.01 g/L). The relation between serum albumin level and low income became statistically insignificant when "body mass index", "consumption of meat or fish", "self-rated health", "presence of medical conditions", "hyperlipidemia", or "respiratory disease "was included in the model.

CONCLUSION

Serum albumin levels were lower in Japanese older adults with low economic status. The decrease in albumin levels appears to be mediated by nutrition and health-related factors with low household incomes. Future studies are needed to reveal the existence of other pathways.

Midlife and late-life handgrip strength and risk of cause-specific death in a general Japanese population: the Hisayama Study

BACKGROUND

Decreased handgrip strength has been reported to be a risk factor for all-cause death among the elderly. However, it is unclear whether handgrip strength measured in midlife is associated with risk of all-cause and cause-specific death in the general population.

METHODS

We followed, prospectively, a total of 2527 community-dwelling Japanese (1064 men and 1463 women) aged ≥40 years for 19 years. Participants were divided into three groups according to the age-specific and sex-specific tertiles of handgrip strength (T1, lowest; T3, highest).

RESULTS

During the follow-up period, 783 participants died, of whom 235 died of cardiovascular disease, 249 of cancer, 154 of respiratory disease and 145 of other causes. In the middle-aged group (40-64 years), multivariable-adjusted HRs (95% CIs) for all-cause death were 0.75 (0.56 to 0.99) in T2 and 0.49 (0.35 to 0.68) in T3 compared with T1 as a reference. Corresponding HRs (95% CI) in the elderly group (≥65 years) were 0.50 (0.40 to 0.62) and 0.41 (0.32 to 0.51), respectively. As regards the cause of death, higher levels of handgrip strength were significantly associated with decreased risks of cardiovascular death, respiratory death and death from other causes, but not of cancer, in the middle-aged and the elderly.

CONCLUSIONS

Our findings suggest that handgrip strength levels in midlife and late life are inversely associated with the risks of all-cause and non-cancer death in the general Japanese population.

Association between activities of daily living and mortality among institutionalized elderly adults in Japan

Background

We assessed the association between activities of daily living (ADL) and mortality among nursing home residents in Japan.

Methods

This 1-year prospective cohort study investigated 8902 elderly adults in 140 nursing homes. Baseline measurements included age, sex, height, weight, body mass index (BMI), ADL, and dementia level. ADL levels were obtained by caregivers, using the Barthel Index (BI), after which total BI scores were calculated (higher scores indicate less dependence). Information on dates of discharge and mortality was also obtained to calculate person-years. The Cox proportional hazards model was used to estimate hazard ratios (HRs).

Results

Mean age was 84.3 years, and mean total BI score was 38.5. The HRs of mortality adjusted for sex, age, BMI, and type of nursing home were 7.6 (95% CI: 3.3–17.8) for those with a BI score of 0 (totally dependent), 3.9 (1.7–9.0) for those with a score of 1 to 10, 3.5 (1.4–8.7) for those with a score of 11 to 40, 2.7 (1.4–5.1) for those with a score of 41 to 70, and 1.3 (0.7–2.4) for those with a score of 71 to 99 (P for trend <0.001), as compared with those with a score of 100. Multivariate analysis revealed that BI, sex, age, and BMI were significantly associated with mortality rate.

Conclusions

There was a clear inverse association between ADL level and mortality. In conjunction with other risk factors, ADL level might effectively predict short-term mortality in institutionalized elderly adults.

[Relationships between nutritional status and the effects of exercise training in frail elderly people]

AIM

The objectives of this study were to examine the relationship between nutritional status indicators such as body mass index (BMI) and serum albumin, and the effects of exercise intervention in community-dwelling frail elderly people.

METHODS

We enrolled 44 subjects aged 65 years and older (average age 73.9±5.1 years) in this study. The subjects participated in exercise intervention, including muscle strength training twice a week for 3 months. We evaluated various functional performance measures at the start and end of the intervention, and calculated the measurement differences. We then evaluated any relationships between nutritional status and the amount of changes.

RESULTS

Some physical functions improved after exercise intervention, even in participants with under-nutritional status. There were no significant differences or relationships found between nutritional status and improvements in physical function.

CONCLUSIONS

These results suggest that the physical functions of frail elderly people can improve regardless of their nutritional status. Further study is necessary to evaluate the influence of nutritional status on exercise effects, and the optimal method of applying exercise interventions, primarily for community-dwelling frail older people.

Objectively measured physical capability levels and mortality: systematic review and meta-analysis

OBJECTIVE

To do a quantitative systematic review, including published and unpublished data, examining the associations between individual objective measures of physical capability (grip strength, walking speed, chair rising, and standing balance times) and mortality in community dwelling populations.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Relevant studies published by May 2009 identified through literature searches using Embase (from 1980) and Medline (from 1950) and manual searching of reference lists; unpublished results were obtained from study investigators.

STUDY SELECTION

Eligible observational studies were those done in community dwelling people of any age that examined the association of at least one of the specified measures of physical capability (grip strength, walking speed, chair rises, or standing balance) with mortality.

DATA SYNTHESIS

Effect estimates obtained were pooled by using random effects meta-analysis models with heterogeneity between studies investigated.

RESULTS

Although heterogeneity was detected, consistent evidence was found of associations between all four measures of physical capability and mortality; those people who performed less well in these tests were found to be at higher risk of all cause mortality. For example, the summary hazard ratio for mortality comparing the weakest with the strongest quarter of grip strength (14 studies, 53 476 participants) was 1.67 (95% confidence interval 1.45 to 1.93) after adjustment for age, sex, and body size (I(2)=84.0%, 95% confidence interval 74% to 90%; P from Q statistic <0.001). The summary hazard ratio for mortality comparing the slowest with the fastest quarter of walking speed (five studies, 14 692 participants) was 2.87 (2.22 to 3.72) (I(2)=25.2%, 0% to 70%; P=0.25) after similar adjustments. Whereas studies of the associations of walking speed, chair rising, and standing balance with mortality have only been done in older populations (average age over 70 years), the association of grip strength with mortality was also found in younger populations (five studies had an average age under 60 years).

CONCLUSIONS

Objective measures of physical capability are predictors of all cause mortality in older community dwelling populations. Such measures may therefore provide useful tools for identifying older people at higher risk of death.

Serum albumin levels as an independent predictor of 4-year mortality in a community-dwelling 80-year-old population

BACKGROUND AND AIMS

Although serum albumin levels are associated with mortality in non-institutionalized elderly people under 80 years old, as well as in the institutionalized very elderly, little is known about the relationship in community-dwelling very elderly people. We, therefore, examined the association in a Japanese population of 80-year-old community residents.

METHODS

Serum albumin levels were measured in 672 (267 men, 405 women) out of 1282 80-year-old individuals. Over the following 4 years, the dates and causes of death were recorded from resident registration cards and official death certificates.

RESULTS

Of the above individuals, 107 subjects died (58 men, 49 women: 27 due to cancer, 27 cardiovascular disease, and 22 pneumonia). Survival rates were compared among 4 groups (highest >or=45 g/L, higher than 43-44 g/L, lower than 41-42 g/L, lowest <or=40 g/L). After adjustment for confounding factors, total death or cardiovascular death in the lowest albumin group was 3.1 times and 10.7 times more incident than in the highest albumin group, but there were no differences among groups as regards deaths due to cancer or pneumonia.

CONCLUSION

Serum albumin levels are an independent predictor of mortality due to all-cause or cardiovascular disease, but not of mortality due to cancer or pneumonia in very elderly Japanese community residents.

Oral care help to maintain nutritional status in frail older people

The purpose of this study was to evaluate the effect of continuous oral care on the nutritional status of older people who require care using a 1-year randomized, controlled study. Fifty-three residents of a nursing home in Japan participated in this study. Subjects were randomly divided into two groups, an oral care intervention group and control group. The subjects in the oral care intervention group received professional oral care from a dentist three times a week over the course of 1 year. Body weight, body mass index (BMI), serum albumin, and high-density lipoprotein cholesterol (HDL-C) were measured as objective indicators of nutritional status at baseline and after 1 year, and compared between the groups. In the oral care group, no significant decline was seen in all indicators from the start to the end of the intervention, but in the control group there was a statistically significant decline in all indicators at the end of the year. These results suggest that the intervention of oral care alone can serve to maintain the nutritional status of older people who require care. Implementation of continuous oral care is an important task from the viewpoint of maintaining nutritional status in older people.

[Anthropometric measurements as a predictor of mortality of community-dwelling Japanese elderly: the Nagoya Longitudinal Study of Frail Elderly (NLS-FE)]

AIM

This study aimed to evaluate the relationship between anthropometric measurements and mortality among community-dwelling frail elderly.

METHODS

This study was a prospective cohort analysis of 520 community-dwelling elderly registered in the Nagoya Longitudinal Study for Frail Elderly (NLS-FE). Data included the participants' demographic characteristics, body mass index (BMI), mid-arm circumference (MAC), triceps skinfold (TSF), and arm muscle area (AMA), basic activities of daily living, comorbidity. BMI and TSF values were categorized into three groups, respectively, according to above the 75th percentile, the 25-75th percentile, and below the 25th percentile of Japanese Anthropometric Reference Data (JARD 2001). Survival analysis of 21-month mortality was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models.

RESULTS

BMI and TSF were independent risk factors for 21-month mortality in the study participants. Significant higher risk of 21-month mortality was observed in participants below the 75th percentile of BMI or below the 25th percentile of TSF set in JARD 2001. A striking increase in the risk of 21-month mortality, adjusting for potential confounding factors, was observed in the below 75th percentile of the BMI group with a below 25th percentile TSF of JARD 2001, compared with the 75th or above percentile BMI group with the 25th or above percentile TSF.

CONCLUSION

The combination of BMI and TSF is a predictor of 21-month mortality among older people with ADL dysfunction.

Association of health behavior and social role with total mortality among Japanese elders in Okinawa, Japan

BACKGROUND AND AIMS

Longitudinal studies on the relationship of life-style factors and social networking with mortality have been only slightly conducted in a comprehensive manner among the Japanese elderly. This study aims at examining associations of health behavior and social role with total mortality among Japanese elders in Okinawa.

METHODS

All residents aged 65 years or older were recruited in 1987 from the village of Ohgimi, and 724 subjects were followed for 12 years. A comprehensive health assessment questionnaire was used, and the resulting data were analyzed by the Cox proportional hazards model.

RESULTS

The number of deaths during the study period was 139 (55.4%) for men and 166 (35.1%) for women. The standardized mortality rates of malignancy, cerebrovascular disease, heart disease and pneumonia were higher for men. In the final model of multivariate analysis for women, less than 6 hours of sleep [Hazard ratio (HR)=2.62] and lower social role (HR=1.88) significantly increased the risk of mortality. As for men, neither health behavioral items nor social role showed a significant association with mortality.

CONCLUSIONS

Our study results suggest that having sufficient hours of sleep and enhancing social role could greatly help elderly women in Okinawa to maintain good health. Moreover, our study provides direction for future research to explore the difference in adequate health promotion measures between women and men.

Physical factors affecting daily walking activities among elderly female residents of a care house

To understand the physical and other factors related to walking among the elderly residents of a Care House for the aged, the total number of steps walked were measured over a period of 1 week (Nov. 6-12. 1994) for 67 female residents (mean age 79 ± 1 years). In addition, walking speed, stride length, and the time to climb 15 steps (stair-climbing time) were measured. To understand the indirect factors such as balance and agility that may control walking, tests were conducted on the subjects' ability to stand on one leg with eyes open and closed, and jumping reaction time. Results showed a negative correlation between total number of steps and age (r=-0.543, P< 0.01), jumping reaction time (r=-0.258, p<0.05) and stair-climbing time (r=-0.501, P< 0.01).However, a positive correlation was found between total number of steps and stride length (r=0.408, P< 0.01), walking speed (r=0.419, P< 0.01), self-rated health (r= 0.390, P< 0.05) and standing on one leg with eyes closed (r=0.258, P< 0.05). The total number of steps walked and physical factors, particularly physique and balance, were also closely related. The above suggests that a walking habit among elderly persons helps to slow the decline in physical strength, which is necessary to prevent falls. It is also reflected in the person's awareness of health and may increase the opportunities for leading an active daily life.

Subjective evaluation of chewing ability and self-rated general health status in elderly residents of Japan

The purpose of the present study was to statistically analyse the relationship between subjective evaluation of chewing ability and self-rated general health status in elderly Japanese residents. Interviews were conducted with 1,544 respondents over 65 years of age in Yamanashi Prefecture, Japan. The interviews included questions concerning age, sex, health status, capacity to understand conversation, chewing ability, and ADL status. First, the age-adjusted odds ratio between subjective evaluation of chewing ability and self-rated health status was 2.242 (p < or = 0.01). Second, the age-adjusted odds ratio between respondentive evaluation of chewing ability and ADL status was 2.572 (p < or = 0.01). Third, the age-adjusted odds ratio between self-assessment of chewing ability and the degree of understanding conversations was 5.290 (p < or = 0.01). These results suggest that chewing ability is related to self-rated general health, ADL status, and the degree of understanding conversation among the elderly.

Indicators of quality medical care for the terminally ill in nursing homes

PURPOSE

To identify medical care indicators for nursing home terminal care.

DATA SOURCES

Studies examining care of terminally ill patients were identified using computer, bibliography, and expert searches; input from nursing home medical directors in Maryland; and input from expert geriatricians.

STUDY SELECTION

More than 900 articles, books, and abstracts from meetings covering medical care for terminally ill patients were reviewed. Information from more than 100 publications is included.

DATA EXTRACTION

Indicators of medical care for terminally ill patients, which can be used to quantify performance with respect to standards, guidelines, and options, were identified initially through review of the literature.

DATA SYNTHESIS

Indicators were refined by input from medical directors of Maryland long-term care facilities and subsequent review by expert geriatricians.

CONCLUSIONS

Minimum standards for which 100% performance is expected are communication of advance directives, attention to pain control, and attention to relief of dyspnea. Performance indicators for medical care guidelines and options in terminal care of nursing home patients are also described.

Lung function level as a valuable predictor of survival among the elderly. A 5-year community-based mortality study in Cracow

The objective of the study undertaken among the elderly was to assess the strength and importance of health variable predictors (ventilatory lung function, blood pressure) in comparison with that of sociodemographic variables (age, sex, education), smoking habit, obesity and health self-assessment. The study covered a sample of elderly inhabitants of Cracow (698 males and 1211 females) who attended the mass screening X-ray clinic. The sample examined did not include patients of old people's homes or geriatric wards. Statistical analysis of the relation between mortality over a 5-year period and chosen predictors was carried out with Cox proportional hazards model. It was found that besides age, forced expiratory volume in 1 s (FEV(1)) level is the strongest survival predictor among the elderly. Subjects who had better FEV(1) by 500 ml showed significantly lower death risk, by 18% in males and 27% in females after allowing for age and height. The results obtained confirmed the expectation that ventilatory lung function is one of the strongest predictors of survival in the elderly. In the sample studied, the impact of education, smoking habit, obesity, health self-assessment on mortality was not significant. The effect of hypertension appeared to be relevant only in the female group.