Alcohol consumption and physical functioning among middle-aged and older adults in Central and Eastern Europe: results from the HAPIEE study

The relationship between physical performance and alcohol consumption levels in Russian adults

Investigating the relationship between alcohol consumption and physical performance, we used data from the 2015-2018 Know Your Heart study on 4215 adults aged 35-69 from Arkhangelsk and Novosibirsk, Russia. We classified participants' drinking status into non-drinking, non-problem drinking, hazardous drinking, and harmful drinking based on their self-reported drinking behaviors. To evaluate physical performance, we developed a Composite Physical Performance Scale (CPPS), which combined the results of three functional tests: grip strength (GS), closed-eyes balance, and chair rises (CR). We applied multivariable linear regression to assess the relationship between alcohol consumption and CPPS score, and ordinal logistic regression to explore the associations between alcohol consumption and the three functional tests separately. The results showed that harmful drinking was associated with lower CPPS scores compared to non-problem drinking. Among harmful drinking men, the decrease in CPPS scores was explained by all three tests equally and exceptionally by GS among women. Non-drinking was also associated with decreased CPPS, linked to lower GS and CR scores in men, and only lower GS scores in women. The study revealed a reduced physical performance in the non-drinking and harmful drinking groups compared to non-problem drinking.

Multidimensional health heterogeneity of Chinese older adults and its determinants

Background

Nowadays, the "Healthy China" and "Actively Addressing Population Aging" are two important national strategies in China. Promoting high-quality development of demand-driven older adults health services is an important way to achieve these strategies. From the perspective of active ageing, assessing the health status of older adults from multiple dimensions becomes crucial as it helps identify their specific health service needs, intervention measures, and health policies tailored to this population.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) wave 4 (2018). A total of 4190 older adults (aged ≥60 years) were included as the analysis sample. Latent class analysis was performed to categorize older adults based on 6 health indicators, including Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), doctor diagnosed chronic diseases, depressive symptoms, cognitive function, and social participation. Multinomial logistic model was used to explore determinants associated with the various patterns of multidimensional health of older adults.

Results

The multidimensional health of older people was classified into three latent classes: Relatively Healthy (Class 1, n = 2806, 66.97%), Highly Depressed and Relatively Health Risk (Class 2, n = 1189, 28.38%), and Functional Impairment (Class 3, n = 195, 4.65%). Gender, age, education, marital status, number of children, alcohol consumption, physical activity, savings, residence, air quality satisfaction, and medical service satisfaction had significant effects on the attribution of all multidimensional health latent classes.

Conclusion

Heterogeneous and multidimensional health classes exist in China's older population, and these classes are influenced by a variety of factors and to varying degrees. Policymakers and healthcare providers can use these evidence to further address the diverse needs of older adults and improve older-care health services, ultimately achieving the goal of Active Ageing and Healthy China.

Lifestyle risk factors of self-reported fibromyalgia in the Norwegian Women and Cancer (NOWAC) study

BACKGROUND

While the aetiology of fibromyalgia syndrome (FM) remains unknown, lifestyle factors have been linked to the disorder. However, there are few studies on the association between lifestyle factors and FM, thus we examine the risk of self-reported fibromyalgia given selected lifestyle factors.

METHODS

We used data from 75,485 participants in the Norwegian Women and Cancer study. Information on FM and the lifestyle factors body mass index (BMI), physical activity level, smoking status/intensity, and alcohol consumption were obtained from baseline and follow-up questionnaires. We used Cox proportional hazards model to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

After a median follow-up time of 10 years, we observed 2,248 cases of self-reported fibromyalgia. Overweight (BMI 25-29.9 kg/m2) and obese (BMI ≥ 30 kg/m2) women had a relative risk of 1.34 (95% CI 1.21-1.47) and 1.62 (95% CI 1.41-1.87), respectively, compared to women with normal weight (BMI 18.5-24.9 kg/m2). Very low physical activity level (1-2) was associated with a 31% higher risk of self-reported fibromyalgia (HR 1.31, 95% CI 1.09-1.57) when compared to moderate physical activity level (5-6). There was a strong dose-response relationship between smoking status/intensity and self-reported fibromyalgia (p for trend < 0.001). Compared with moderate alcohol consumption (4.0-10 g/day), the risk of self-reported FM was 72% (HR 1.72; 95% CI 1.45-2.03) higher among teetotallers, and 38% (HR 1.38, 95% CI 1.23-1.54) higher among those with low consumption (0.1-3.9 g/day).

CONCLUSIONS

Overweight and obesity, very low physical activity level, smoking, and alcohol consumption were associated with an increased risk of self-reported FM.

Mortality Risk in Older People Who Drank Alcohol in the Past by Varying Duration of Alcohol Abstention

INTRODUCTION

This study aims to explore the mortality risk in older people who drank alcohol in the past by varying the duration of alcohol abstention.

METHODS

In total, 31,999 participants aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey (Waves 1998, 2000, 2002, 2005, 2008, 2011, 2014) were included. Duration of alcohol abstention was assessed by designed questions, and the study outcome was all-cause mortality. Cox proportional hazard models were used to examine the association. Analyses occurred from 2022 to 2023.

RESULTS

During a follow-up of 140,974.8 person-years, all-cause mortality occurred in 24,257 participants. Mortality significantly increased by 23% (adjusted hazard ratio=1.23, 95% CI=1.14, 1.33, p<0.001), by 17% (adjusted hazard ratio=1.17, 95% CI=1.06, 1.31, p=0.003), and by 17% (adjusted hazard ratio=1.17, 95% CI=1.07, 1.28, p=0.001) in people who drank alcohol in the past with ≤5 years, 5-10 years, 10-20 years of alcohol abstention, respectively, compared with that among those who drink alcohol at present. After 20 years of alcohol abstention, the increased mortality risk disappeared (adjusted hazard ratio=1.06, 95% CI=0.97, 1.15, p=0.204). Stratified and sensitivity analysis revealed similar results. In addition, compared with the risk of all-cause mortality among people who never drink alcohol, the risk of all-cause mortality in those who drank alcohol in the past also significantly increased in the following 20 years after they stop drinking, and then the increased risk disappeared afterward.

CONCLUSIONS

An increased risk of all-cause mortality in older people who drank alcohol in the past was observed, which disappeared after 20 years of alcohol abstention.

Trajectories in physical functioning at older age in relation to childhood and adulthood SES and social mobility: a population-based cohort study

Introduction

Older age is associated with the deterioration of physical functioning (PF), and low PF is strongly related to poor quality of life among older people. We conducted a study to examine the trajectories of PF between middle and old age, considering sex differences as well as the association between socioeconomic status (SES) at different life stages and changes in PF.

Methods

We analyzed data from the Polish arm of the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study, including 1,116 men and 1,178 women aged 45-64 years at baseline. Adult and childhood SES and social mobility were assessed using a retrospectively focused questionnaire. PF was assessed using the 10-question SF-36 scale at baseline examination, face-to-face re-examination, and three postal surveys, covering up to 20 years (on average, 18 years). We employed Generalized Estimating Equations models to assess changes in PF scores over time and compare PF trajectories across different SES categories.

Results

After adjusting for age and other covariates, we found that, in both sexes, participants with always middle or high SES, as well as those who reported upward mobility, had higher PF scores at baseline compared to those with always low SES. A decline in PF between middle and old age was observed in all SES groups; however, the decline was slower in participants with always middle or high SES compared to those with always low SES.

Conclusion

This cohort study revealed that lower SES and downward social mobility were cross-sectionally associated with poorer PF, while upward social mobility seemed to largely reverse the effect of low childhood SES. In addition to the cross-sectional associations observed at baseline, advantaged SES was also significantly associated with a slower decline in PF over an 18-year follow-up period.

Alcohol Drinking and Health in Ageing: A Global Scale Analysis of Older Individual Data through the Harmonised Dataset of ATHLOS

We investigated the relation between alcohol drinking and healthy ageing by means of a validated health status metric, using individual data from the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project. For the purposes of this study, the ATHLOS harmonised dataset, which includes information from individuals aged 65+ in 38 countries, was analysed (n = 135,440). Alcohol drinking was reflected by means of three harmonised variables: alcohol drinking frequency, current and past alcohol drinker. A set of 41 self-reported health items and measured tests were used to generate a specific health metric. In the harmonised dataset, the prevalence of current drinking was 47.5% while of past drinking was 26.5%. In the pooled sample, current alcohol drinking was positively associated with better health status among older adults ((b-coef (95% CI): 1.32(0.45 to 2.19)) and past alcohol drinking was inversely related (b-coef (95% CI): -0.83 (-1.51 to -0.16)) with health status. Often alcohol consumption appeared to be beneficial only for females in all super-regions except Africa, both age group categories (65-80 years old and 80+), both age group categories, as well as among all the financial status categories (all p < 0.05). Regional analysis pictured diverse patterns in the association for current and past alcohol drinkers. Our results report the need for specific alcohol intake recommendations among older adults that will help them maintain a better health status throughout the ageing process.

The Benefit of Moderate Alcohol Use on Mood and Functional Ability in Later Life: Due to Beers or Frequent Cheers?

BACKGROUND AND OBJECTIVES

Evidence relates moderate alcohol consumption in later life to fewer depressive symptoms and greater functional ability. This study evaluated social interaction as a mediator of these outcomes.

RESEARCH DESIGN AND METHODS

Data included older adults in the Health and Retirement Study. In Study 1, cross-sectional mediation analyses evaluated social interaction as a mechanism through which moderate alcohol use was related to decreased depressive symptomatology (Model 1; N = 2,294) and less functional limitation (Model 2; N = 2,357). In Study 2, longitudinal cross-lagged path analyses further evaluated the impact of moderate alcohol use and social interaction on future depressive symptoms and functional limitation.

RESULTS

In Study 1, results from Model 1 indicated that moderate alcohol use was associated with decreased depressive symptomatology indirectly via greater social interaction. In Model 2, moderate alcohol use was associated with less functional limitation indirectly via greater social interaction. In Study 2, significant indirect effects corroborated findings from Study 1. In Model 3, moderate alcohol use in 2012 inversely predicted depressive symptomatology in 2014 via greater levels of social interaction in 2012. In Model 4, moderate alcohol use in 2012 predicted less functional limitation in 2014 via greater social interaction in 2012.

DISCUSSION AND IMPLICATIONS

Social interaction is essential to the seemingly beneficial effect of moderate alcohol use on depressive symptomatology and functional ability. Clinically, this suggests caution in attributing health benefits to consumption of alcohol itself and identifies social interaction as a treatment target for improved health outcomes in later life.

Epidemiology of at-risk alcohol use and associated comorbidities of interest among community-dwelling older adults: a protocol for a systematic review

INTRODUCTION

There is little epidemiological evidence and knowledge about at-risk alcohol use among community-dwelling older adults and their chronic and acute alcohol-related comorbidities of interest. This systematic review will summarise and examine relevant studies about the epidemiology of at-risk alcohol use and associated comorbidities of interest in this population.

METHODS

We will search the following databases, without language or date restrictions, from inception to 31 August 2019: Embase.com, Medline Ovid SP, Pubmed (NOT medline[sb]), CINAHL EBSCO, PsycINFO Ovid SP, Central-Cochrane Library Wiley and Web of Science (Core Collection). Search strategies will be developed in collaboration with a librarian. We will use predefined search terms for alcoholism, epidemiology, the elderly, living place and comorbidities of interest, as well as terms related to the identification of "measurements", "tools" or "instruments" for measuring harm from alcohol use. At-risk status will be determined by the amount of alcohol consumed and any comorbidities of interest associated with at-risk alcohol use, with the latter being documented separately or using an assessment tool for at-risk drinking. We will also examine the bibliographies of all the relevant articles found and search for unpublished studies. We will consider publications in all languages.

ETHICS AND DISSEMINATION

No ethical approval is necessary. Results will be presented in national and international conferences on addiction and published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42018099965.

Alcohol Consumption and Functional Limitations in Older Men: Does Muscle Strength Mediate Them?

OBJECTIVES

To evaluate the dose-response relationships between alcohol consumption and functional limitations in older European men, and explore the role of muscle strength as a mediator of these relationships.

DESIGN

Cross-sectional study of older men participating in the Survey of Health, Aging and Retirement in Europe (SHARE).

SETTING

Urban and rural households in 17 European countries and Israel.

PARTICIPANTS

A total of 17 870 men aged 65 years and older from the SHARE (Wave 6, 2015) were included in this study.

MEASUREMENTS

Outcome variables were functional limitations: mobility limitation, arm function limitation, and fine motor limitation. Main exposure variable was alcohol consumption. Mediating factor was grip strength. Basic demographics, life habits, and health status were considered as potential confounders. Dose-response analyses with restricted cubic splines and the Karlson/Holm/Breen method were conducted.

RESULTS

A total of 17 870 participants were included in this study. Dose-response analyses revealed that moderate alcohol consumption was related to the lower odds of reporting mobility limitation (≤35 units/wk) and arm function limitation (≤41 units/wk), with a minimum odds ratio (OR) occurring at 10 units/week drinks for mobility limitation (OR = .71; 95% confidence interval [CI] = .62-.81) and arm function limitation (OR = .66; 95% CI = .59-.75). The odds of reporting the fine motor limitation monotonically increased with alcohol consumption when alcohol consumption was beyond 15 units/week. No significant mediating effect of grip strength on the relationships between alcohol consumption and mobility limitation and arm function limitation was found.

CONCLUSION

Moderate alcohol consumption has a protective role in mobility and arm function limitation in older European men. Grip strength is not the main mediator of these associations, suggesting that the protective effect is independent of muscle strength. Alcohol consumption is associated with higher odds of reporting fine motor limitation in older European men. J Am Geriatr Soc 67:2331-2337, 2019.

Factors associated with elevated consumption of alcohol in older adults-comparison between China and Norway: the CLHLS and the HUNT Study

OBJECTIVES

The primary objective was to investigate the prevalence and factors associated with elevated alcohol consumption among older adults 65 years and above in China and Norway. The secondary objective was to compare the prevalence and factors in the two countries.

DESIGN

A secondary data analysis was conducted using two large cross-sectional studies (Chinese Longitudinal Healthy Longevity Survey data in 2008-2009 and Nord-Trøndelag Health Study data in 2006-2008).

PARTICIPANTS

A total of 3223 (weighted) Chinese older adults and 6210 Norwegian older adults who responded drinking alcohol were included in the analysis.

OUTCOME MEASURES

The dependent variable was elevated alcohol consumption, which was calculated as a ratio of those with elevated drinking among current drinkers. Multivariable logistic regression was used to test the dependent variable.

RESULTS

The prevalence of elevated alcohol consumption among current drinkers for the Chinese and Norwegian samples were 78.3% (weighted) and 5.1%, respectively. Being male was related to a higher likelihood of elevated alcohol consumption in both Chinese and Norwegian samples (OR=2.729, 95% CI 2.124 to 3.506, OR=2.638, 95% CI 1.942 to 3.585). Being older, with higher levels of education and a living spouse or partner were less likely to have elevated drinking in the Chinese sample (OR=0.497, 95% CI 0.312 to 0.794, OR=0.411, 95% CI 0.260 to 0.649, OR=0.533, 95% CI 0.417 to 0.682, respectively). Among Norwegian older adults, a higher level of education was related to higher likelihood of elevated drinking (OR=1.503, 95% CI 1.092 to 2.069, OR=3.020, 95% CI 2.185 to 4.175). Living in rural areas and higher life satisfaction were related to lower likelihood of elevated drinking in the Norwegian sample (OR=0.739, 95% CI 0.554 to 0.984, OR=0.844, 95% CI 0.729 to 0.977, respectively).

CONCLUSIONS

The elevated alcohol consumption patterns were strikingly different between China and Norway in regards to prevalence and socioeconomic distribution. To develop and implement culturally appropriate public health policies regarding alcohol in the future, public health policy makers and professionals need to be aware of the cultural differences and consider the demographic, social and economic characteristics of their intended population.

Congruent relations between perceived neighbourhood social cohesion and depressive symptoms among older European adults: An East-West analysis

Rationale

Two gaps in the literature arise on the relationship between social cohesion and depressive disorders. Firstly, there is a lack of studies comparing countries with diverse communal bonds and population-level differences in depression. Secondly, most work on explanatory mechanisms has overwhelmingly focussed on social network and social support pathways.

Objectives

We compared the prospective association between perceived neighbourhood social cohesion and depressive symptoms among older adults in England, the Czech Republic, Poland and Russia; and examined whether psychological and health behavioural pathways mediated this association.

Methods

Harmonized data on 26,081 adults from the English Longitudinal Study of Ageing (ELSA), and the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) studies were analysed. Prospective associations between perceived neighbourhood social cohesion at baseline and depressive symptoms at follow-up were assessed using multivariable negative binomial regression. The psychological (through control of life, and control at home) and health behavioural (through smoking and drinking) pathways were tested using path analysis.

Results

Low cohesion predicted a higher number of depressive symptoms at follow-up among English (b = 0.106, p = 0.001), Czech (b=0.203, p < 0.001), Polish (0.115, p < 0.001) and Russian adults (b = 0.087, p < 0.001). Indirect effects via psychological mechanisms were strong and explained 64% (Poland), 82% (Russia), 84% (England) and 95% (Czech Republic) of the total indirect effects from low cohesion to elevated symptoms in these populations. Indirect effects via health behaviours were much weaker by comparison.

Conclusions

Prospective associations between low social cohesion and increased depressive symptoms were largely congruent among older adults from England and three Central and Eastern European countries. These associations operated via a psychological, but not a health behavioural, pathway among ageing adults living in diverse parts of Europe.

•

Social cohesion protects against depressive symptoms in older European adults.

•

The association operates via psychological, but not health behavioural, mechanisms.

•

Findings were highly consistent between English, Czech, Polish and Russian adults.

Associations of Lifestyle Behaviour and Healthy Ageing in Five Latin American and the Caribbean Countries-A 10/66 Population-Based Cohort Study

Latin American and the Caribbean countries exhibit high life expectancy and projections show that they will experience the fastest growth of older people in the following years. As people live longer, it is important to maximise the opportunity to age healthily. We aimed to examine the associations of lifestyle behaviours with healthy ageing in Cuba, Dominican Republic, Peru, Mexico and Puerto Rico, part of the 10/66 study. Residents 65 years old and over (n = 10,900) were interviewed between 2003 and 2010. In the baseline survey, we measured four healthy behaviours: Physical activity, non-smoking, moderate drinking and fruits or vegetables consumption. Healthy ageing was conceptualised within the functional ability framework over a median of 4 years follow-up. Logistic models were calculated per country and then pooled together with fixed-effects meta-analysis. People engaging in physical activity and consuming fruits or vegetables had increased odds of healthy ageing in the follow-up (OR: 2.59, 95% CI: 2.20–3.03; OR: 1.24, 95% CI: 1.06–1.44, respectively). Compared with participants engaging in none or one healthy behaviour, the ORs of participants engaging in two, three or four healthy behaviours increased in a linear way (OR: 1.60, 95% CI: 1.40–1.84; OR: 2.29, 95% CI: 1.94–2.69; OR: 2.46, 95% CI: 1.54–3.92, respectively). Our findings highlight the importance of awareness of a healthy lifestyle behaviour among older people.

Alcohol use, abuse and dependence in an older European population: Results from the MentDis_ICF65+ study

BACKGROUND

Alcohol use disorders (AUD) in older people have been the subject of increasing interest in Europe and worldwide. However, thus far, no reliable data exist regarding the prevalence of AUD in people over the age of 65 years in Europe.

OBJECTIVE

To assess the current (past month), 12-month and lifetime prevalence of alcohol use, abuse and dependence in people aged 65-84 years.

STUDY DESIGN

The MentDis_ICF65+ study was a representative stepwise cross-sectional survey that was conducted in six European and associated cities (Hamburg, Germany; Ferrara, Italy; London/Canterbury, England; Madrid, Spain; Geneva, Switzerland and Jerusalem, Israel).

METHOD

In total, 3,142 community-dwelling people aged between 65 and 84 years who lived in participating cities were assessed with an age-sensitive diagnostic interview (CIDI65+).

RESULTS

The prevalence of lifetime alcohol use was 81% for the overall sample. The observed AUD (DSM-IV-TR) prevalence was as follows: current, 1.1%; 12-month, 5.3% and lifetime, 8.8%. Alcohol consumption and AUD were more prevalent in males, and a significant interaction between gender and city was observed; greater gender differences in the prevalence of these disorders were observed in Hamburg, London/Canterbury and Geneva in comparison to the other cities. The prevalence of lifetime alcohol consumption and 12-month AUD tended to be lower in older persons.

CONCLUSION

The results highlight the appropriateness of using age-adjusted diagnostic tools (CIDI65+) to identify alcohol use and AUD in older people. Different alcohol use patterns were observed in males and females. The results seem to indicate the presence of different alcohol use patterns between northern and southern European countries. Specialized services are proposed, including brief and/or more intensive interventions framed intensive and more simple interventions framed in stepped care strategies, to improve the social and health resources available for older people across Europe.

Differences between Slovak and Dutch patients scheduled for coronary artery bypass graft surgery regarding clinical and psychosocial predictors of physical and mental health-related quality of life

BACKGROUND

Differences in health-related quality of life in coronary artery disease patients and associated factors between patients of central and western European descent are rarely investigated. We aim to test differences between Dutch and Slovak health-related quality of life, whether nationality predicted health-related quality of life and if standardised beta weights of health-related quality of life determinants differ across countries.

DESIGN

An observational multicentre study at university cardiac centres in the Netherlands and Slovakia.

METHODS

In 226 coronary artery disease patients, health-related quality of life was measured by the Short Form Health Survey 36, anxiety and depression were measured using the Hospital Anxiety and Depression Scale, and type D personality was assessed with the 14-item Type D Scale. Multivariate analysis was used to explore the effect of patient characteristics on the physical and mental component summaries. Estimates of each predictor's beta value of the physical and mental component summaries in the Slovak and Dutch patient sample were separately calculated using the Cummings criterion for comparison of two independent betas.

RESULTS

Stronger predictors of physical health-related quality of life in Slovak patients were educational level, current smoking, poor functional status, history of diabetes and amount of social support. In Dutch patients, only more symptoms of depression was a stronger predictor ( P<0.05). Regarding Slovak mental health-related quality of life, stronger predictors were educational level, current smoking and amount of social support. Female gender, history of myocardial infarction and more symptoms of depression were stronger predictors in Dutch patients ( P<0.05).

CONCLUSION

Descent and differences between both populations in determinants of health-related quality of life should be considered while planning care, follow-up, health education and rehabilitation.

Effect of Temporal Changes in Therapeutic Exposure on Self-reported Health Status in Childhood Cancer Survivors

BACKGROUND

The effect of temporal changes in cancer therapy on health status among childhood cancer survivors has not been evaluated.

OBJECTIVE

To compare proportions of self-reported adverse health status outcomes among childhood cancer survivors across 3 decades.

DESIGN

Cross-sectional. (ClinicalTrials.gov: NCT01120353).

SETTING

27 North American institutions.

PARTICIPANTS

14 566 adults, who survived for 5 or more years after initial diagnosis (median age, 27 years; range, 18 to 48 years), treated from 1970 to 1999.

MEASUREMENTS

Patient report of poor general or mental health, functional impairment, activity limitation, or cancer-related anxiety or pain was evaluated as a function of treatment decade, cancer treatment exposure, chronic health conditions, demographic characteristics, and health habits.

RESULTS

Despite reductions in late mortality and the proportions of survivors with severe, disabling, or life-threatening chronic health conditions (33.4% among those treated from 1970 to 1979 and 21.0% among those treated from 1990 to 1999), those reporting adverse health status did not decrease by treatment decade. Compared with survivors diagnosed in 1970 to 1979, those diagnosed in 1990 to 1999 were more likely to report poor general health (11.2% vs. 13.7%; P < 0.001) and cancer-related anxiety (13.3% vs. 15.0%; P < 0.001). From 1970 to 1979 and 1990 to 1999, the proportions of survivors reporting adverse outcomes were higher (P < 0.001) among those with leukemia (poor general health, 9.5% and 13.9%) and osteosarcoma (pain, 23.9% and 36.6%). Temporal changes in treatment exposures were not associated with changes in the proportions of survivors reporting adverse health status. Smoking, not meeting physical activity guidelines, and being either underweight or obese were associated with poor health status.

LIMITATION

Considerable improvement in survival among children diagnosed with cancer in the 1990s compared with those diagnosed in the 1970s makes it difficult to definitively determine the effect of risk factors on later self-reported health status without considering their effect on mortality.

CONCLUSION

Because survival rates after a diagnosis of childhood cancer have improved substantially over the past 30 years, the population of survivors now includes those who would have died in earlier decades. Self-reported health status among survivors has not improved despite evolution of treatment designed to reduce toxicities.

PRIMARY FUNDING SOURCE

The National Cancer Institute.

The Relationship between Body Mass Index and 10-Year Trajectories of Physical Functioning in Middle-Aged and Older Russians: Prospective Results of the Russian HAPIEE Study

OBJECTIVE

To investigate the associations of overweight and obesity with longitudinal decline in physical functioning (PF) among middle-aged and older Russians.

DESIGN

Prospective cohort study.

SETTING

Four rounds of data collection in the Russian Health, Alcohol and Psychosocial factors In Eastern Europe study with up to 10 years of follow-up.

PARTICIPANTS

9,222 men and women aged 45-69 years randomly selected from the population of two districts of Novosibirsk, Russia.

MEASUREMENTS

PF score (range 0-100) was measured by the Physical Functioning Subscale (PF-10) of the 36-item Short Form Health Survey (SF-36) at baseline and three subsequent occasions. Body mass index (BMI), derived from objectively measured body height and weight at baseline, was classified into normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obesity class I (BMI 30.0-34.9), and obesity class II+ (BMI≥35.0).

RESULTS

The mean annual decline in the PF score during the follow-up was -1.92 (95% confidence interval -2.17; -1.68) in men and -1.91 (-2.13; -1.68) in women. At baseline, compared with normal weight, obesity classes I and II+ (but not overweight) were associated with significantly lower PF in both sexes. In prospective analyses, the decline in PF was faster in overweight men (difference from normal weight subjects -0.38 [-0.63; -0.14]), class I obese men and women (-0.49 [-0.82; -0.17] and -0.44 [-0.73; -0.15] respectively) and class II+ obese men and women (-1.13 [-1.73; -0.53] and -0.43 [-0.77; -0.09] respectively). Adjustment for physical activity and other covariates did not materially change the results.

CONCLUSIONS

PF decreased more rapidly in obese men and women than among those with normal weight. The adverse effect of high BMI on PF trajectories appeared to be more pronounced in men than in women, making more extremely obese Russian men an important target population to prevent/slow down the process of decline in PF.

Alcohol drinking patterns and risk of functional limitations in two cohorts of older adults

BACKGROUND & AIMS

Several studies have found that moderate alcohol intake is associated with lower risk of functional limitations in older adults. However, no previous investigation has assessed this association in older adults from Mediterranean countries, who show characteristic drinking patterns.

METHODS

Data were taken from the UAM and the Seniors-ENRICA cohorts in Spain, comprising community-dwelling people aged ≥60 years. At baseline, participants in both cohorts were classified as non-drinkers, ex-drinkers, moderate drinkers and heavy drinkers (the threshold between moderate and heavy intake was ≥40 g/day in men and ≥24 g/day in women). The Seniors-ENRICA cohort allowed assessment of a Mediterranean Drinking Pattern (MDP), defined as moderate alcohol intake, with wine preference (≥80% of alcohol consumed as wine) and drinking only with meals. The incidence of limitation in mobility, agility, and instrumental activities of daily living (IADL) was ascertained in each cohort at the end of a 3.5-year follow-up. Analyses were adjusted for sex, age, education, lifestyle, BMI, chronic conditions, and functional limitations at baseline others than the studied limitation.

RESULTS

Compared with non-drinkers, ex-drinkers showed a higher risk of IADL limitation (pooled adjusted odds ratio [paOR]: 1.63; 95% confidence interval [CI]: 1.04-2.21). By contrast, moderate drinkers had a lower risk of limitations in mobility (paOR: 0.80; 95% CI: 0.63-0.97), agility (paOR: 0.82; 95% CI: 0.65-0.99) and IADL (paOR: 0.54; 95% CI: 0.39-0.69). Among individuals reporting poor or fair health, the MDP was associated with lower risk of mobility limitation (aOR: 0.51; 95% CI: 0.27-0.97).

CONCLUSION

In older adults, moderate alcohol consumption, as well as the MDP in specific subgroups, is associated with lower risk of functional limitation. These results should not serve to promote alcohol intake, because older adults are particularly vulnerable to its harmful effects.

Trajectories of Unhealthy Behaviors in Midlife and Risk of Disability at Older Ages in the Whitehall II Cohort Study

BACKGROUND

Most of the evidence on the association between unhealthy behaviors and disability comes from studies in the elderly, where reverse causation and selection bias may distort associations; thus, studies based on midlife trajectories of health behaviors are needed. We examined the association of trajectories of four health behaviors (physical activity, fruit and vegetable consumption, smoking, alcohol), starting in midlife and over 20 years, with subsequent disability risk in early old age (range = 54-84 years) in the Whitehall II cohort study.

METHODS

Disability was assessed three times over 3 years. A hierarchical disability indicator was constructed; participants were considered disabled if they reported difficulties with mobility and instrumental activities of daily living or with mobility and instrumental and basic activities of daily living. Behavior trajectories were defined using group-based trajectory models. Multivariable generalized estimating equations logistic models were used to examine their independent associations with disability.

RESULTS

Of 6,825 participants, 19.2% reported being disabled at least once. In mutually adjusted models, participants with persistent inactivity or declining physical activity, recent ex- or current smokers, and persistent/recent abstainers or persistent heavy drinkers had a higher disability risk, whereas fruit and vegetable consumption was not associated with disability. Disability risk increased progressively with the number of unhealthy behavior trajectories: the odds ratio of disability for 2-3 unhealthy trajectories was 2.69 (95% confidence interval = 2.26-3.19); these associations remained after adjustment for a wide range of covariates.

CONCLUSIONS

Unhealthy behavior trajectories in midlife are associated with greater disability risk later in life.

Alcohol Consumption and Longitudinal Trajectories of Physical Functioning in Central and Eastern Europe: A 10-Year Follow-up of HAPIEE Study

Background:

Physical functioning (PF) is an essential domain of older persons’ health and quality of life. Health behaviors are the main modifiable determinants of PF. Cross-sectionally, alcohol consumption appears to be linked to better PF, but longitudinal evidence is mixed and very little is known about alcohol consumption and longitudinal PF trajectories.

Methods:

We conducted longitudinal analyses of 28,783 men and women aged 45–69 years from Novosibirsk (Russia), Krakow (Poland), and seven towns of the Czech Republic. At baseline, alcohol consumption was measured by a graduated frequency questionnaire and problem drinking was evaluated using the CAGE questionnaire. PF was assessed using the Physical Functioning Subscale of the SF-36 instrument at baseline and three subsequent occasions. Growth curve modeling was used to estimate the associations between alcohol consumption and PF trajectories over 10-year follow-up.

Results:

PF scores declined during follow-up in all three cohorts. Faster decline in PF over time was found in Russian female frequent drinkers, Polish female moderate drinkers, and Polish male regular heavy drinkers, in comparison with regular and/or light-to-moderate drinkers. Nondrinking was associated with a faster decline compared with light drinking only in Russian men. Problem drinking and past drinking were not related to the decline rate of PF.

Conclusions:

This large longitudinal study in Central and Eastern European populations with relatively high alcohol intake does not strongly support the existence of a protective effect of alcohol on PF trajectories; if anything, it suggests that alcohol consumption is associated with greater deterioration in PF over time.

Drinking pattern, abstention and problem drinking as risk factors for depressive symptoms: evidence from three urban Eastern European populations

Purpose

To examine whether the frequency and amount of alcohol consumed in binge drinking sessions, total annual volume of alcohol consumed, problem drinking and abstaining from alcohol are associated with depressive symptoms in Eastern Europe.

Subjects and Methods

Cross-sectional data from a total of 24,381 participants from general population samples of the Czech Republic (N = 7,601), Russia (N = 6,908) and Poland (N = 9,872) aged 45–69 years in 2002–2005. Depressive symptoms were defined as ≥16 points on the Centre for Epidemiological Studies – Depression (CES-D) scale. Several alcohol related measures were derived using responses from the graduated frequency questionnaire. Binge drinking was defined at several sex-specific thresholds (ranging from 60+ to 140+ g of ethanol) and two frequencies (at least monthly or weekly). Total annual alcohol intake in grams was also extracted. Problem drinking was defined as ≥2 positive answers on the CAGE questionnaire.

Results

Problem drinking was consistently associated with approximately a 2-fold increase in odds of depressive symptoms across all countries and in both sexes. Abstaining from alcohol was typically associated with increased odds of depressive symptoms. Analyses separating lifelong abstainers and former drinkers in the Russian cohort revealed that this increased odds was driven by former drinkers. Amongst men, heavy frequent binge drinking was associated with increased odds of depressive symptoms in the Czech Republic and Poland. In women, heavy infrequent binge drinking was associated with increased odds of depressive symptoms in Russia and Poland. Only in Polish men was higher annual volume of alcohol intake associated with increased odds of depressive symptoms.

Conclusion

Abstaining from alcohol and problem drinking were associated with increased odds of depressive symptoms in these Eastern European populations. Annual volume of alcohol intake as well as frequency and amount of alcohol consumed in a binge drinking session were less consistently associated with depressive symptoms.