Predictors of healthy aging in men with high life expectancies

Prevalence, Awareness, Treatment, and Control of Hypertension Among Older Adults in the Philippines

BACKGROUND

Little is known about the current prevalence and management of hypertension among older Filipinos. To address this gap, we examined the prevalence, awareness, treatment, and control of hypertension, as well as their correlates, among older Filipinos.

METHODS

We analyzed a nationally representative survey of Filipinos aged 60 years and older (N = 5 985) in the Philippines. Blood pressure (BP) measurements were taken using a digital BP apparatus. People with hypertension included those with a systolic BP ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg, or those who reported current use of antihypertensive medication. People with undiagnosed hypertension were those who had measured hypertension but had not been diagnosed by a doctor as having hypertension, while people with untreated hypertension were those who had measured hypertension but not taking medication. Among those who were taking antihypertensive medication, respondents with measured hypertension were considered to have uncontrolled BP.

RESULTS

Results showed that 69.1% of older Filipinos had hypertension, but only 61.6% of people with hypertension were aware of their hypertension and 51.5% were untreated. Sociodemographic factors, such as age, sex, education, and living arrangements, were significantly associated with hypertension prevalence, hypertension awareness, lack of treatment for hypertension, and/or suboptimal BP control.

CONCLUSION

We observed a high prevalence of hypertension among older Filipinos and a relatively low level of awareness and treatment of hypertension among them. While there are government efforts to address the growing prevalence of hypertension in the country, more efforts should be made to bring these government programs to older Filipinos.

Exploring the Relationships Between Four Aging Ideals: A Bibliometric Study

When examining research articles on the aging strategies, four ideals (i.e., successful aging, healthy aging, productive aging and active aging) could be explored by conducting bibliometric analyses. For the literature analysis, general information on the four aging ideals was understood through visualization analysis; the intellectual base and research hotspots were intuitively observed. CiteSpace was used as the method to conduct the co-occurrence analysis of keywords in order to obtain research trends and cutting-edge knowledge in the field of aging-related policies. Subsequently, the study revealed the nature of the link between these four aging ideals and disclosed the connection between their fundamental principles. The study ultimately enhanced the understanding of the diverse contexts that have impacted the way in which these ideals influence policy, which has caused dissimilar strategies for policy development. The study also extended the discussion of the definitions of and relationships between these four ideals with the goal of identifying new directions for aging-related practice and providing innovative insights and references for investigators.

Development of an elderly lifestyle profile: A Delphi survey of multidisciplinary health-care experts

OBJECTIVE

Lifestyle is considered as a key factor that affects one's health and quality of life, and it has become the focus of increasing research interest worldwide. Research has shown that lifestyle is an important health determinant in preventive health care. However, lifestyle is a multifaceted construct and there is limited evidence regarding lifestyle assessment, which evaluates individuals' multi-domain lifestyle factors. This study developed evaluation items for measuring the multifaceted lifestyle profile of community-dwelling older adult to prevent chronic disease and improve their health and quality of life.

METHODS

Opinions from 21 experts with experience in older adults and lifestyle research were collected from December 2019 to January 2020. Three Delphi surveys were carried out, based on previous research. The first survey gathered opinions using a mix of open- and closed-ended questions regarding items of the older adults' multifaceted lifestyle profile. The second was conducted after adding and modifying several items based on the first Delphi survey. In the third survey, after the results of the second one were presented to the expert panels, final opinions from the experts were converged.

RESULTS

In total, 59 items were selected as the first Delphi results; 62 items were selected as the second results after adding and modifying the values below a content validity ratio of .42; and 62 items were selected as the third Delphi results. The average content validity ratio of the final Delphi survey was .92, the stability was .18, and the consensus was .80, which were all high.

CONCLUSIONS

This study verified the content validity of the evaluation items for community-dwelling older adults' multifaceted lifestyle profile. In the future, it is expected that after verifying the validity and reliability, this will be used as a standardized assessment tool in clinical environments.

Age-related disease burden in Indian population

OBJECTIVES

Aging is not just a consequence of wear-and-tear, but it is the inappropriate regenerative mechanism of the stem cells. Aging is directly proportional to increase in health-problems involving all organs and physiological systems - more of non-communicable types. On the other hand, medical advancement and awareness about health-care are increasing the life expectancy, which could outnumber the young generation or the mainstream of work-force gradually. Hence, understanding of disease-prevalence is essential with a view to making necessary medical, environmental and economic arrangements and offering holistic care to the older population.

STUDY DESIGN

Records of medical consultancies of outpatient departments (OPD) were retrieved from the hospital database and considered for understanding the disease-prevalence in the geriatric population.

METHODS

Over 47000 subjects of 60 years and above were categorized into eight age-groups and analyzed for age-related disease-prevalence in both males and females.

RESULTS

Approximately 25% were affected with cardiovascular system followed by 20% with general complication of cold/cough/fever and GI-disorientation. A uniform damage was observed in systems such as gastro-/neuro-/nephro-/ophthalmic and urology in both genders. Males were more prone to cardiac, nephorologic and urologic problems whereas females were more affected with musculo-skeletal problems than men. In general, men were more affected with geriatric diseases.

CONCLUSION

Cardiovascular disorder after 60 years onwards could be related to stress for transition from 'income-to-no-income' state and lack of financial and other preparedness. Significant osteoarthritis problem in females is undoubtedly associated with ageing of ovaries. An intensive medical intervention following hospital-admission and outcome will guide for building age-friendly, long-stay and isolated accommodation, which could be considered for low- and middle-income countries as a model for handling geriatric disease burden.

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

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

Physical Activity as a Determinant of Successful Aging over Ten Years

We aimed to examine the temporal association between physical activity and successful aging. The analyses involved 1,584 adults aged 49 + years living west of Sydney (Australia), who did not have cancer, coronary artery disease and stroke at baseline and who were followed over 10 years. Participants provided information on the performance of moderate or vigorous activities and walking exercise and this was used to determine total metabolic equivalents (METs) minutes of activity per week. Successful aging status was determined through interviewer-administered questionnaire and was classified as the absence of: depressive symptoms, disability, cognitive impairment, respiratory symptoms and systemic conditions (e.g. cancer, coronary artery disease). 249 (15.7%) participants (mean age 59.9 ± 6.1) had aged successfully 10 years later. After multivariable adjustment; older adults in the highest level of total physical activity (≥5000 MET minutes/week; n = 71) compared to those in the lowest level of total physical activity (<1000 MET minutes/week; n = 934) had 2-fold greater odds of aging successfully than normal aging, odds ratio, OR, 2.08 (95% confidence intervals, CI, 1.12–3.88). Older adults who engaged in high levels of total physical activity, well above the current recommended minimum level had a greater likelihood of aging successfully 10 years later.

Cardiovascular Risk Factors and the Risk of Disability in Older Adults: Variation by Age and Functional Status

OBJECTIVES

We aimed to quantify the increased risk of disability associated with cardiovascular risk factors among older adults, and to verify whether this risk may vary by age and functional status.

DESIGN

Longitudinal population-based cohort study.

SETTING

Urban area of Stockholm, Sweden.

PARTICIPANTS

Community-dwelling and institutionalized adults ≥60 years in the Swedish National study on Aging and Care in Kungsholmen free of cardiovascular diseases and disability (n = 1756) at baseline (2001-2004).

MEASURES

Incident disability in activities of daily living (ADL) was ascertained over 9 years. Cardiovascular risk factors (physical inactivity, alcohol consumption, smoking, high blood pressure, diabetes, high body mass index, high levels of total cholesterol, and high C-reactive protein) and walking speed were assessed at baseline. Data were analyzed using Cox proportional hazards models, stratifying by younger-old (age 60-72 years) and older-old (≥78 years).

RESULTS

During the follow-up, 23 and 148 persons developed ADL-disability among the younger- and older-old, respectively. In the younger-old, the adjusted hazard ratio (HR) of developing ADL-disability was 4.10 (95% confidence interval [CI] 1.22-13.76) for physical inactivity and 5.61 (95% CI 1.17-26.82) for diabetes. In the older-old, physical inactivity was associated with incident ADL-disability (HR 1.99, 95% CI 1.36-2.93), and there was a significant interaction between physical inactivity and walking speed limitation (<0.8 m/s), showing a 6-fold higher risk of ADL-disability in those who were both physically inactive and had walking speed limitation than being active with no limitation, accounting for a population-attributable risk of 42.7%.

CONCLUSIONS/IMPLICATIONS

Interventions targeting cardiovascular risk factors may be more important for the younger-old in decreasing the risk of disability, whereas improving physical function and maintaining physical activity may be more beneficial for the older-old.

The Mediating Role of Overweight and Obesity in the Prospective Association between Overall Dietary Quality and Healthy Aging

BACKGROUND

Our objective was to quantify to what extent the association between adherence to the French nutritional recommendations at midlife, measured by the Programme National Nutrition Santé-Guideline Score (PNNS-GS), and healthy aging (HA) is mediated by body mass index (BMI) status.

METHODS

We analyzed data from 2249 participants of the French 'Supplementation with Vitamins and Mineral Antioxidants' (SU.VI.MAX-'SUpplémentation en VItamines et Minéraux AntioXydants') cohort. At baseline (1994⁻1995), data on BMI status (<25 vs. ≥25 and <30 vs. ≥30) and diet were collected. At follow-up (2007⁻2009), HA status (yes/no) was evaluated via a multidimensional concept focusing on chronic disease incidence, physical and cognitive functioning, mental and social health, pain, and perceived health. Relative risks (RR) were estimated by extensively adjusted robust-error-variance Poisson regression, and counterfactual-based mediation analysis was performed.

RESULTS

Our HA criteria were met by 39% of participants. We identified a positive direct relation of a greater adherence to the French nutritional recommendations, with the probability of HA (RR_Quartile ₄ _vsquartile ₁ = 1.31 (95% confidence interval (CI) = 1.13, 1.53)), and an indirect relation mediated by BMI status (1.01 (95% CI: 1.01, 1.02)), accounting for 5% of the total relation.

CONCLUSION

These results indicate that high dietary quality may contribute to the preservation of overall health during aging, partly via obesity prevention and partly via other mechanisms.

Associations of smoking and alcohol consumption with healthy ageing: a systematic review and meta-analysis of longitudinal studies

OBJECTIVES

The number of older people is growing across the world; however, quantitative synthesis of studies examining the impact of lifestyle factors on the ageing process is rare. We conducted a systematic review and meta-analysis of longitudinal studies to synthesise the associations of smoking and alcohol consumption with healthy ageing (HA).

METHODS

Major electronic databases were searched from inception to March 2017 (prospectively registered systematic reviews registration number CRD42016038130). Studies were assessed for methodological quality. Random-effect meta-analysis was performed to calculate pooled ORs and 95% CI.

RESULTS

In total, we identified 28 studies (n=184 543); 27 studies reported results on smoking, 22 on alcohol consumption. 23 studies reported a significant positive association of never or former smoking with HA and 4 non-significant. 12 studies reported a significant positive association of alcohol consumption with HA, 9 no association and 1 negative. Meta-analysis revealed increased pooled OR of HA for never smokers compared with current smokers (2.36, 95% CI 2.03 to 2.75), never smokers compared with former smokers (1.32, 95% CI 1.23 to 1.41), former or never smokers compared with current smokers (1.72, 95% CI 1.20 to 2.47), never smokers compared with past or current smokers (1.29, 95% CI 1.16 to 1.43); drinkers compared with non-drinkers (1.28, 95% CI 1.08 to 1.52), light drinkers compared with non-drinkers (1.12, 95% CI 1.03 to 1.22), moderate drinkers compared with non-drinkers (1.35, 95% CI 0.93 to 1.97) and high drinkers compared with non-drinkers (1.25, 95% CI 1.09 to 1.44). There was considerable heterogeneity in the definition and measurement of HA and alcohol consumption.

CONCLUSIONS

There is consistent evidence from longitudinal studies that smoking is negatively associated with HA. The associations of alcohol consumption with HA are equivocal. Future research should focus on the implementation of a single metric of HA, on the use of consistent drinking assessment among studies and on a full-range of confounding adjustment. Our research also highlighted the limited research on ageing in low-and-middle-income countries.

Adversity in childhood and measures of aging in midlife: Findings from a cohort of british women

Very few studies have assessed whether socioeconomic and psychosocial adversity during childhood are associated with objective measures of aging later in life. We assessed associations of socioeconomic position (SEP) and total psychosocial adversity during childhood, with objectively measured cognitive and physical capability in women during midlife. Adverse childhood experiences were retrospectively reported at mean ages 28-30 years in women from the Avon Longitudinal Study of Parents And Children (N = 2,221). We investigated associations of childhood SEP and total psychosocial adversity, with composite measures of cognitive and physical capability at mean age 51 years. There was evidence that, compared with participants whose fathers had professional occupations, participants whose fathers had managerial/technical, skilled nonmanual, skilled manual, and partly or unskilled manual occupations had, on average, lower physical and cognitive capability. There was a clear trend for increasing magnitudes of association with lowering childhood SEP. There was also evidence that greater total psychosocial adversity in childhood was associated with lower physical capability. Total psychosocial adversity in childhood was not associated with cognitive capability. Lower SEP in childhood is detrimental to cognitive and physical capability in midlife, at least in part, independently of subsequent SEP in adulthood. Greater psychosocial adversity in childhood is associated with poorer physical capability, independently of social disadvantage in childhood. Our findings highlight the need for interventions to both identify and support children experiencing socioeconomic or psychosocial of adversity as early as possible. (PsycINFO Database Record

Prospective association between body mass index at midlife and healthy aging among French adults

OBJECTIVE

To assess the association between midlife body mass index (BMI) and healthy aging (HA) in the French SU.VI.MAX cohort.

METHODS

HA was assessed in 2007 to 2009 among 2,733 individuals, aged 45 to 60 years and free of diabetes, cardiovascular disease and cancer at baseline (1994-1995). HA was defined as not developing any major chronic disease, good physical and cognitive functioning, no limitations in instrumental activities of daily living, no depressive symptoms, no health-related limitations in social life, good overall self-perceived health, and no function-limiting pain. Associations between anthropometric indicators (measured in 1995-1996) and HA were assessed using robust-error-variance Poisson regression.

RESULTS

After adjustment for potential confounders, BMI (continuous) was negatively associated with HA: relative risk (RR) = 0.97 (95% confidence interval = 0.96-0.99). Moreover, the detrimental role of obesity (RR_{obesity vs. normal weight}  = 0.67 [0.51-0.88]) was substantially stronger than that of overweight (RR_{overweight vs. normal weight}  = 0.91 [0.81-1.01]). Furthermore, while metabolically healthy individuals with overweight had a similar HA probability as metabolically healthy individuals with normal weight, metabolically unhealthy overweight individuals had a substantially lowered HA probability.

CONCLUSIONS

This study provides novel evidence that an elevated BMI at midlife may jeopardize the preservation of health during aging. Our results also highlight the importance of maintaining a healthy metabolic profile during midlife.

Community Nurses’ Experiences Regarding the Meaning and Promotion of Healthy Aging in Northeastern Thailand

Purpose: Describe community nurses’ experiences regarding the meaning and promotion of healthy aging in northeastern Thailand. Method: Data were collected through five focus group interviews with 36 community nurses in northeastern Thailand. Latent content analysis was conducted to analyze the data. Findings: Healthy aging was characterized by the interconnection of older persons, older persons’ family members, and the community. Healthy aging was associated with two themes: “being strong” and “being a supporter and feeling supported.” The nurses’ experiences in promoting healthy aging were described by the themes “providing health assessment,” “sharing knowledge,” and “having limited resources.” Conclusions: The findings of this study provide a deeper understanding of the meaning of healthy aging from a holistic viewpoint. Community nurses must pay attention to older persons and their surroundings when planning how to promote healthy aging. Person-centeredness should be applied in practice to promote healthy aging. The current findings contribute useful information that should help policy makers develop healthy aging strategies in Thailand.

Optimal Levels of All Major Cardiovascular Risk Factors in Younger Age and Functional Disability in Older Age: The Chicago Heart Association Detection Project in Industry 32-Year Follow-Up Health Survey

BACKGROUND

The associations of optimal levels of all major cardiovascular disease risk factors, that is, low risk, in younger age with subsequent cardiovascular disease morbidity and mortality have been well documented. However, little is known about associations of low-risk profiles in younger age with functional disability in older age.

METHODS AND RESULTS

The sample included 6014 participants from the Chicago Heart Association Detection Project in Industry Study. Low-risk status, defined as untreated systolic/diastolic blood pressure ≤120/≤80 mm Hg, untreated serum total cholesterol <5.18 mmol/l, not smoking, body mass index < 25 kg/m(2), and no diabetes mellitus, was assessed at baseline (1967 to 1973). Functional disability, categorized as (1) any disability in activities of daily living (ADLs), (2) any disability in instrumental ADLs but not in ADL, or (3) no disability, was assessed from the 2003 health survey. There were 39% women, 4% Black, with a mean age of 43 years and 6% low-risk status at baseline. After 32 years, 7% reported having limitations in performing any ADL and 11% in any instrumental ADL only. The prevalence of any ADL limitation was lowest in low-risk people and increased in a graded fashion with less-favorable risk factor groups (P trend <0.001). Compared with those with 2+ high-risk factors, the multivariable-adjusted odds of having any disability in ADLs versus no disability in people with low risk, any moderate risk, and 1 high-risk factor at baseline were lower by 58%, 48%, and 37%, respectively. Results were similar for instrumental ADLs, in both men and women.

CONCLUSIONS

Having an optimal cardiovascular disease risk factor profile at younger age is associated with the lowest rate of functional disability in older age.

Effects of Improved Morbidity Rates on Active Life Expectancy and Eligibility for Long-Term Care Services

This study examines effects of better health on active life expectancy and eligibility for long-term care services, using data from the 1984-1990 Longitudinal Study of Aging and microsimulation techniques. Results show that better health increases total life expectancy (TLE), the proportion of life spent unimpaired, and the amount of time spent unimpaired. Women experience larger proportional increases in active life expectancy under assumptions of better health. Better health also reduces the proportion of men and women who would be eligible for long-term care services. However, better health decreases the proportion of men eligible for long-term care services more than it decreases the eligible proportion of women. The results reinforce the importance of focusing on policies designed to promote healthy lifestyles and to reduce the prevalence of chronic conditions.

Adherence to Dietary Guidelines and Successful Aging Over 10 Years

BACKGROUND

We aimed to prospectively examine the relationship between overall diet quality (reflecting adherence to dietary guidelines) and successful aging in a population-based cohort of older adults.

METHODS

In this population-based cohort study, we analyzed 10-year follow-up data from 1,609 adults aged 49 years and older, who were free of cancer, coronary artery disease, and stroke at the baseline and who had complete dietary data. Dietary data were collected using a semiquantitative food frequency questionnaire. Total diet scores (TDS) were allocated for intake of selected food groups and nutrients for each participant as described in the national dietary guidelines. Higher scores indicated closer adherence to dietary guidelines. Successful aging was defined as the absence of disability, depressive symptoms, cognitive impairment, respiratory symptoms, and chronic diseases (cancer, coronary artery disease, and stroke).

RESULTS

At 10-year follow-up, 610 (37.9%) participants had died and 249 (15.5%) participants aged successfully. After multivariable adjustment, each 1-unit increase in TDS at baseline was associated with a 8% increased odds of successful aging 10 years later, odds ratio 1.08 (95% confidence interval 1.00-1.15). Participants in the highest (high adherence to dietary guidelines) versus lowest quartile (poor adherence to guidelines) of TDS at baseline had 58% higher odds of successful aging after 10 years, odds ratio 1.58 (95% confidence interval 1.02-2.46).

CONCLUSIONS

Greater compliance with recommended national dietary guidelines (higher diet quality) was associated with an increased likelihood of successful aging, as determined through a multidomain approach.

Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial

Background

Both aging and obesity are related to dysregulated immune function, which may be responsible for increased risk of infection and also chronic non-infectious diseases. Dietary lipids have been shown to impact immune and inflammatory responses and cardio-metabolic risk factors. No information on the impact of olive oil on immune responses of overweight and obese older adults is available.

Objective

We aimed to determine the effect of replacing oils used in a typical American diet with extra virgin olive oil for 3 months on immune responses and cardio-metabolic risk factors in overweight and obese older adults.

Methods

This was a randomized, single-blinded and placebo-controlled trial in 41 overweight or obese participants (aged ≥ 65) who consumed a typical American diet. Participants in the control (CON, n = 21) group were provided with a mixture of corn, soybean oil and butter, and those in the olive oil (OO, n = 20) group, with extra virgin olive oil, to replace substitutable oils in their diet. At baseline and 3 months, we measured blood pressure, biochemical and immunological parameters using fasting blood, and delayed-type hypersensitivity (DTH) skin response.

Results

Compared to the CON group, the OO group showed decreased systolic blood pressure (P < 0.05), a strong trend toward increased plasma HDL-C concentrations (P = 0.06), and increased anti-CD3/anti-CD28 -stimulated T cell proliferation (P < 0.05). No differences were found in T cell phenotype, cytokine production, and DTH response between the two groups.

Conclusions

Our results indicate that substitution of oils used in a typical American diet with extra virgin olive oil in overweight and obese older adults may have cardio-metabolic and immunological health benefits. This trial was registered at clinicaltrials.gov as NCT01903304.

The burden of disease in older people and implications for health policy and practice

23% of the total global burden of disease is attributable to disorders in people aged 60 years and older. Although the proportion of the burden arising from older people (≥60 years) is highest in high-income regions, disability-adjusted life years (DALYs) per head are 40% higher in low-income and middle-income regions, accounted for by the increased burden per head of population arising from cardiovascular diseases, and sensory, respiratory, and infectious disorders. The leading contributors to disease burden in older people are cardiovascular diseases (30·3% of the total burden in people aged 60 years and older), malignant neoplasms (15·1%), chronic respiratory diseases (9·5%), musculoskeletal diseases (7·5%), and neurological and mental disorders (6·6%). A substantial and increased proportion of morbidity and mortality due to chronic disease occurs in older people. Primary prevention in adults aged younger than 60 years will improve health in successive cohorts of older people, but much of the potential to reduce disease burden will come from more effective primary, secondary, and tertiary prevention targeting older people. Obstacles include misplaced global health priorities, ageism, the poor preparedness of health systems to deliver age-appropriate care for chronic diseases, and the complexity of integrating care for complex multimorbidities. Although population ageing is driving the worldwide epidemic of chronic diseases, substantial untapped potential exists to modify the relation between chronological age and health. This objective is especially important for the most age-dependent disorders (ie, dementia, stroke, chronic obstructive pulmonary disease, and vision impairment), for which the burden of disease arises more from disability than from mortality, and for which long-term care costs outweigh health expenditure. The societal cost of these disorders is enormous.

Shorter men live longer: association of height with longevity and FOXO3 genotype in American men of Japanese ancestry

Objectives

To determine the relation between height, FOXO3 genotype and age of death in humans.

Methods

Observational study of 8,003 American men of Japanese ancestry from the Honolulu Heart Program/Honolulu-Asia Aging Study (HHP/HAAS), a genetically and culturally homogeneous cohort followed for over 40 years. A Cox regression model with age as the time scale, stratified by year of birth, was used to estimate the effect of baseline height on mortality during follow-up. An analysis of height and longevity-associated variants of the key regulatory gene in the insulin/IGF-1 signaling (IIS) pathway, FOXO3, was performed in a HHP-HAAS subpopulation. A study of fasting insulin level and height was conducted in another HHP-HAAS subpopulation.

Results

A positive association was found between baseline height and all-cause mortality (RR = 1.007; 95% CI 1.003–1.011; P = 0.002) over the follow-up period. Adjustments for possible confounding variables reduced this association only slightly (RR = 1.006; 95% CI 1.002–1.010; P = 0.007). In addition, height was positively associated with all cancer mortality and mortality from cancer unrelated to smoking. A Cox regression model with time-dependent covariates showed that relative risk for baseline height on mortality increased as the population aged. Comparison of genotypes of a longevity-associated single nucleotide polymorphism in FOXO3 showed that the longevity allele was inversely associated with height. This finding was consistent with prior findings in model organisms of aging. Height was also positively associated with fasting blood insulin level, a risk factor for mortality. Regression analysis of fasting insulin level (mIU/L) on height (cm) adjusting for the age both data were collected yielded a regression coefficient of 0.26 (95% CI 0.10–0.42; P = 0.001).

Conclusion

Height in mid-life is positively associated with mortality, with shorter stature predicting longer lifespan. Height was, moreover, associated with fasting insulin level and the longevity genotype of FOXO3, consistent with a mechanistic role for the IIS pathway.

Obesity and late-age survival without major disease or disability in older women

IMPORTANCE

The effect of obesity on late-age survival in women without disease or disability is unknown.

OBJECTIVE

To investigate whether higher baseline body mass index and waist circumference affect women's survival to 85 years of age without major chronic disease (coronary disease, stroke, cancer, diabetes mellitus, or hip fracture) and mobility disability.

DESIGN, SETTING, AND PARTICIPANTS

Examination of 36,611 women from the Women's Health Initiative observational study and clinical trial programs who could have reached 85 years or older if they survived to the last outcomes evaluation on September 17, 2012. Recruitment was from 40 US clinical centers from October 1993 through December 1998. Multinomial logistic regression models were used to estimate odds ratios and 95% CIs for the association of baseline body mass index and waist circumference with the outcomes, adjusting for demographic, behavioral, and health characteristics.

MAIN OUTCOMES AND MEASURES

Mutually exclusive classifications: (1) survived without major chronic disease and without mobility disability (healthy); (2) survived with 1 or more major chronic disease at baseline but without new disease or disability (prevalent diseased); (3) survived and developed 1 or more major chronic disease but not disability during study follow-up (incident diseased); (4) survived and developed mobility disability with or without disease (disabled); and (5) did not survive (died).

RESULTS

Mean (SD) baseline age was 72.4 (3.0) years (range, 66-81 years). The distribution of women classified as healthy, prevalent diseased, incident diseased, disabled, and died was 19.0%, 14.7%, 23.2%, 18.3%, and 24.8%, respectively. Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. Relative to healthy-weight women, adjusted odds ratios (95% CIs) of mobility disability were 1.6 (1.5-1.8) for overweight women and 3.2 (2.9-3.6), 6.6 (5.4-8.1), and 6.7 (4.8-9.2) for class I, II, and III obesity, respectively. Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability.

CONCLUSIONS AND RELEVANCE

Overall and abdominal obesity were important and potentially modifiable factors associated with dying or developing mobility disability and major chronic disease before 85 years of age in older women.

The epidemiology of longevity and exceptional survival

The field of the "epidemiology of longevity" has been expanding rapidly in recent years. Several long-term cohort studies have followed older adults long enough to identify the most long-lived and to define many factors that lead to a long life span. Very long-lived people such as centenarians have been examined using case-control study designs. Both cohort and case-control studies have been the subject of genome-wide association studies that have identified genetic variants associated with longevity. With growing recognition of the importance of rare variations, family studies of longevity will be useful. Most recently, exome and whole-genome sequencing, gene expression, and epigenetic studies have been undertaken to better define functional variation and regulation of the genome. In this review, we consider how these studies are leading to a deeper understanding of the underlying biologic pathways to longevity.

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.

Hypertension prevalence, awareness, treatment and control among older people in Latin America, India and China: a 10/66 cross-sectional population-based survey

OBJECTIVES

To estimate the prevalence, social patterning, treatment and control of hypertension among older people in the 10/66 Dementia Research Group developing country sites.

METHODS

Cross-sectional surveys of SBP, hypertension, and hypertension awareness, treatment and control among 17 014 people aged 65 years and over in eight urban and four rural sites in Latin America, India and China.

RESULTS

Hypertension prevalence was higher in urban (range 52.6-79.8%) than rural sites (range 42.6-56.9%), and lower in men than women [pooled prevalence ratio 0.89, 95% confidence interval (CI) 0.85-0.93]. Educational attainment was positively associated with hypertension in rural and least-developed sites. Age-standardized morbidity ratios, compared to USA (100), were higher in urban sites in Cuba (105), Dominican Republic (109), and Venezuela (107), similar in Puerto Rico (105), urban Mexico (99) and urban India (101), and lower in urban (75) and rural (61) Peru, rural Mexico (81), urban (91) and rural (84) China and rural India (65). In most Latin American centres, and urban China just over one-third of those with hypertension were controlled (BP < 140/90). Control was poor in rural China (2%), urban India (12%) and rural India (9%). The proportion controlled, not compositional factors (age, sex, education and obesity), explained most of the between-site variation in SBP.

CONCLUSION

Uncontrolled hypertension is common among older people in developing countries, and may rise further during the demographic and health transitions. It is a major determinant of population SBP level. Strengthening primary care to improve hypertension management is necessary for primary prevention.

Lifecourse socioeconomic circumstances and multimorbidity among older adults

BACKGROUND

Many older adults manage multiple chronic conditions (i.e. multimorbidity); and many of these chronic conditions share common risk factors such as low socioeconomic status (SES) in adulthood and low SES across the lifecourse. To better capture socioeconomic condition in childhood, recent research in lifecourse epidemiology has broadened the notion of SES to include the experience of specific hardships. In this study we investigate the association among childhood financial hardship, lifetime earnings, and multimorbidity.

METHODS

Cross-sectional analysis of 7,305 participants age 50 and older from the 2004 Health and Retirement Study (HRS) who also gave permission for their HRS records to be linked to their Social Security Records in the United States. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions.

RESULTS

Childhood financial hardship and lifetime earnings were not associated with the absence of morbidity. However, childhood financial hardship was associated with an 8% higher number of chronic conditions; and, an increase in lifetime earnings, operationalized as average annual earnings during young and middle adulthood, was associated with a 5% lower number of chronic conditions reported. We also found a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity.

CONCLUSIONS

This study shows that childhood financial hardship and lifetime earnings are associated with multimorbidity, but not associated with the absence of morbidity. Lifetime earnings modified the association between childhood financial hardship and multimorbidity suggesting that this association is differentially influential depending on earnings across young and middle adulthood. Further research is needed to elucidate lifecourse socioeconomic pathways associated with the absence of morbidity and the presence of multimorbidity among older adults.

Personality and health, subjective well-being, and longevity

Personality traits can be employed to guide understanding of trajectories to health and longevity, but long-term longitudinal study and multifaceted assessment of healthy aging are crucial. Following up on the life span study initiated by Lewis Terman, we assessed 4 validated factors of personality in young adulthood in 1940, constructed a multifactor measure of participants' healthy aging in 1986, and collected death certificates through 2007 (to determine longevity) on a sample of 1,312 Terman participants (732 men). Neuroticism predicted worse physical health and subjective well-being in old age and, for women, higher mortality risk, but for men, neuroticism predicted decreased mortality risk. For both sexes, extraversion predicted old-age social competence, whereas conscientiousness predicted men's old-age productivity. Differential patterns of association between personality traits and healthy aging components are informative about individual personality characteristics and long-term health outcomes.

Cross-cultural comparison between academic and lay views of healthy ageing: a literature review

The aim of this study is to specify the concept of ‘healthy ageing’ from both western and non-western cultural perspectives, and to compare the views of academics and lay older people. Thirty-four published peer-reviewed full papers in English and Chinese (traditional characters) were identified using electronic database searches. The key components of their definitions of healthy ageing were extracted and categorised into 12 domains. The results show that, in general, lay definitions (as described in 11 studies) included more domains (independency, family, adaptation, financial security, personal growth, and spirituality) and more diversity in the healthy ageing concept than academic views (which tend to focus more on physical and mental health and social functioning in later life). Certain domains were valued differently across cultures. As shown in previous studies, the findings affirm that healthy ageing is a multi-dimensional and complex concept and that there are substantial differences in different cultures. Moreover, we found that there are pronounced variations in the conceptualisation of healthy ageing as between academic and older lay people. Generally, older lay people perceive healthy ageing more broadly than the maintenance of physical, mental and social functioning. We suggest that academic researchers should integrate the more holistic perspectives of older lay people and cultural diversity into the classical ‘physical–mental–social’ healthy ageing concept.

Health-Related Variables and Functional Fitness among Older Adults

This study assesses the functional fitness of a convenient sample of older adults (>70 years), to examine correlations between functional fitness and several other health-related variables and to compare with criterion performance data as established by Rikli and Jones (2001). One hundred and seven community-dwelling older adults with an average age of 78.36 ± 5.60 years performed the Senior Fitness Test (SFT) and responded to several health-related questionnaires. The SFT scores were similar to the scores in the low-active group data published by Rikli and Jones (1999b). There was a strong correlation between the 30-second arm curl and the 2-minute step-in-place ( r = .54, p < .01). More than one-half of the participants performed in the normal range or above normal range, according to the criterion performance data. This demonstrates a high level of functional fitness.

Physical activity at midlife in relation to successful survival in women at age 70 years or older

BACKGROUND

Physical activity is associated with reduced risks of chronic diseases and premature death. Whether physical activity is also associated with improved overall health among those who survive to older ages is unclear.

METHODS

A total of 13,535 Nurses' Health Study participants who were free of major chronic diseases at baseline in 1986 and had survived to age 70 years or older as of the 1995-2001 period made up the study population. We defined successful survival as no history of 10 major chronic diseases or coronary artery bypass graft surgery and no cognitive impairment, physical impairment, or mental health limitations.

RESULTS

After multivariate adjustment for covariates, higher physical activity levels at midlife, as measured by metabolic-equivalent tasks, were significantly associated with better odds of successful survival. Significant increases in successful survival were observed beginning at the third quintile of activity: odds ratios (ORs) (95% confidence intervals [CIs]) in the lowest to highest quintiles were 1 [Reference], 0.98 (0.80-1.20), 1.37 (1.13-1.65), 1.34 (1.11-1.61), and 1.99 (1.66-2.38) (P < .001 for trend). Increasing energy expenditure from walking was associated with a similar elevation in odds of successful survival: the ORs (95% CIs) of successful survival across quintiles of walking were 1 [Reference], 0.99 (0.80-1.21), 1.19 (0.97-1.45), 1.50 (1.24-1.82), and 1.47 (1.22-1.79) (P < .001 for trend).

CONCLUSION

These data provide evidence that higher levels of midlife physical activity are associated with exceptional health status among women who survive to older ages and corroborate the potential role of physical activity in improving overall health.

Adiposity and weight change in mid-life in relation to healthy survival after age 70 in women: prospective cohort study

OBJECTIVE

To examine the hypothesis that mid-life adiposity is associated with a reduced probability of maintaining an optimal health status among those who survive to older ages.

DESIGN

Prospective cohort study.

SETTING

The Nurses' Health Study, United States.

PARTICIPANTS

17,065 women who survived until at least the age of 70, provided information on occurrence of chronic disease, cognitive function, physical function, and mental health at older ages, and were free from major chronic diseases at mid-life (mean age was 50 at baseline in 1976).

MAIN OUTCOME MEASURES

Healthy survival to age 70 and over was defined as having no history of 11 major chronic diseases and having no substantial cognitive, physical, or mental limitations.

RESULTS

Of the women who survived until at least age 70, 1686 (9.9%) met our criteria for healthy survival. Increased body mass index (BMI) at baseline was significantly associated with linearly reduced odds of healthy survival compared with usual survival, after adjustment for various lifestyle and dietary variables (P<0.001 for trend). Compared with lean women (BMI 18.5-22.9), obese women (BMI >or=30) had 79% lower odds of healthy survival (odds ratio 0.21, 95% confidence interval 0.15 to 0.29). In addition, the more weight gained from age 18 until mid-life, the less likely was healthy survival after the age of 70. The lowest odds of healthy survival were among women who were overweight (BMI >or=25) at age 18 and gained >or=10 kg weight (0.18, 0.09 to 0.36), relative to women who were lean (BMI 18.5-22.9) and maintained a stable weight.

CONCLUSIONS

These data provide evidence that adiposity in mid-life is strongly related to a reduced probability of healthy survival among women who live to older ages, and emphasise the importance of maintaining a healthy weight from early adulthood.

Validation of a novel successful aging construct

PURPOSE

Assess the validity of our previously published multidimensional concept of Successful Aging that integrates physiological, psychological, and sociological domains of health.

DESIGN

Three distinctly different populations were used to assess the discriminant and predictive validity.

METHODS

Data included 1438 women age 65 and older who participated in the Women's Health and Aging Studies I and II (WHAS-I and WHAS-II) and 302 participants in a continuing care retirement community (CCRC) study. Outcome measures included ADL and IADL function, self-reported health status, and number of hospitalizations.

RESULTS

Within the CCRC, the Successful Aging construct discriminated participants with regard to ADL and IADL function and self-reported health status. In both WHAS-I and WHAS- II samples, the construct predicted functional ADL and IADL change over time, and in WHAS-I, it predicted hospitalizations.

IMPLICATIONS

The Successful Aging construct appears valid and warrants further research and refinement among the general population.

Relation of smoking, physical activity and living residence to body fat and fat distribution in elderly men in Greece

It is well-documented that body fat and body fat distribution are related to increased risk for cardiovascular disease, hyperinsulinaemia, and diabetes mellitus. The purpose of this study was to investigate the impact of smoking status, physical activity and place of living on body fat and fat distribution of Greek elderly men. The participants were 144 elderly men of mean age 71.78 +/- 6.39 years, who were free-living individuals, in Thessaloniki (104 subjects) and in the suburbs (40 subjects). According to our results, 23.9% of men who participated in the study were smokers. No association was found between skinfolds, skinfold ratio and physical activity or smoking. It is worth to mention that a triple percentage of younger elders (60-75 years) smoked, compared to the older ones. This finding could possible explain the absence in anthropometric differences between elderly smokers and non-smokers. Intervention programs aiming to yield information about changing the various modifiable risk factors in the elderly are needed.

Can successful aging and chronic illness coexist in the same individual? A multidimensional concept of successful aging

For the past 4 decades, many studies seeking to develop a definition and identify critical determinants of successful aging have been published. To date, there is still no consensus on a standard definition or measure of "successful aging." Most constructs have been one dimensional; although a few have been multidimensional, none has emerged as standard. The most serious limitation of contemporary successful aging constructs is the undue focus on physiologic aspects of aging. To move beyond this limited perspective that stresses disease and impairment, we postulate that successful aging may coexist with diseases and functional limitations if compensatory psychological and/or social mechanisms are used. With this premise, this article presents a new definition and conceptual framework of successful aging, together with an operational definition (measurement) that delineates our successful aging concept. We discuss how the proposed multidimensional measurement may be used as a screening tool, and address its relevance for health services research and health care delivery.

Long-term function in an older cohort--the cardiovascular health study all stars study

OBJECTIVES

To evaluate shared and unique risk factors for maintaining physical and cognitive function into the ninth decade and beyond.

DESIGN

Longitudinal cohort study.

SETTING

Four U.S. communities.

PARTICIPANTS

One thousand six hundred seventy-seven participants in the Cardiovascular Health Study All Stars Study, assessed in 2005/06. Median age was 85 (range 77-102), 66.5% were women, and 16.6% were black.

MEASUREMENTS

Intact function was defined as no difficulty with any activities of daily living and a score of 80 or higher on the Modified Mini-Mental State Examination. Baseline characteristics assessed in 1992/93 included demographics, behavioral health factors, chronic disease history, subclinical disease markers, cardiovascular risk factors, and inflammatory markers. Multinomial logistic regression was used to compare risk for physical disability, cognitive impairment,and combined impairments with no functional impairment.

RESULTS

Of the 1,677 participants evaluated in both domains, 891 (53%) were functionally intact. Continuous measures of function, including the Digit Symbol Substitution Test and gait speed, showed that all groups, including the most functional, had declined over time. The functional group had less decline but also tended to have higher starting values. Functional individuals had a higher baseline health profile than those with either or cognitive impairment or both impairments combined. Women and individuals with greater weight had higher rates of physical impairment but not cognitive impairment. Risk factors common to both types of impairment included cardiovascular disease and hypertension.

CONCLUSION

Intact function was found in only approximately half of these older adults in the ninth decade and beyond. High baseline function and low vascular disease risk characterized functional aging.

High blood pressure in middle age is associated with a future decline in activities of daily living. NIPPON DATA80

Although several studies have reported on the relation between high blood pressure (BP) and impaired activities of daily living (ADL), only a few studies have reported on the relation of high BP in middle-aged subjects with future impaired ADL. Furthermore, no studies reported an excess impaired ADL due to non-normal BP. Using ADL 1999 data, we compared data from NIPPON DATA80 survivors without impaired ADL (N=1816) with those with impaired ADL (N=75) using baseline BP information collected in 1980. We analysed participants who were aged 47-59 years at baseline. Multiple adjusted logistic regression analyses were used to estimate the risk of impaired ADL, according to baseline BP categories using Joint National Committee 7 guidelines (normal BP, prehypertension, stage 1 hypertension (HT) and stage 2 HT). Subjects who used antihypertensive medications were classified as having stage 2 HT. We calculated excess impaired ADL due to non-normal BP. Compared with normal BP categories, the adjusted odds ratio (OR) and 95% confidence interval (CI) of having impaired ADL was higher in subjects with prehypertension (OR=1.50, 95% CI: 0.55-4.09), stage 1 HT (OR=1.56, 95% CI: 0.56-4.32) and stage 2 HT (OR=2.96, 95% CI: 1.09-8.05). Non-normal BP explained 45% (33.7/75) of impaired ADL. A positive relation of BP categories with the composite end point of mortality and impaired ADL was also observed. In conclusion, controlling BP in middle age may prevent deaths and future ADL decline.

Cardiovascular risk profile and subsequent disability and mental well-being: the Zutphen Elderly Study

OBJECTIVES

It is insufficiently known whether "classic" cardiovascular risk factors are associated with subsequent functional disability and mental well-being in elderly men.

DESIGN

A population-based cohort study with 15 years of follow-up from 1985 onward.

SETTING

The Zutphen Study started as the Dutch contribution to the Seven Countries Study.

PARTICIPANTS

Five hundred forty-five (59.2%) of 887 men (aged 64-84 years) who were free of preexisting cardiovascular disease and cancer.

MEASUREMENTS

High cardiovascular risk was defined as having >/=2 "classic" risk factors: body mass index >/=30.0 kg/m(2), presently smoking, hypertension (systolic blood pressure >/=160 mm Hg, diastolic blood pressure >/=95 mm Hg, or antihypertensive medication), serum cholesterol >/=6.5 mmol/L, and diabetes mellitus. Self-rated health and dispositional optimism were assessed in 1985, 1990, 1995, and 2000. Disability and depressive symptoms (by the Zung self-rating depression scale) were assessed from 1990 onward.

RESULTS

The high-risk (N = 230) versus low-risk group (N = 315) had higher multivariate adjusted risks of all-cause and cardiovascular mortality (hazard ratios: 1.43; confidence interval[CI]: 1.15, 1.76; and 1.61; CI: 1.20, 2.18, respectively). High-risk status was also associated with more functional disability at 5, 10, and 15 years (odds ratios of 2.00, 95% CI: 1.25-3.20; 2.51, 95% CI: 1.36-4.65; and 2.45, 95% CI: 0.91-6.61, respectively), adjusted for baseline age, self-rated health, and dispositional optimism. Risk status was not associated with self-rated health, dispositional optimism, or depressive symptoms at follow-up.

CONCLUSION

Combined "classic" cardiovascular risk factors are not associated with impaired self-rated health or mental well-being in elderly men, but are predictive of functional disability.

Lifestyle and Successful Aging: An Overview

Since the 1950s, the phrase successful aging has been used increasingly to represent the factors and conditions underlying healthy aging and is often attributed to the healthy elderly. In this short review, the authors discuss the transformation in the social theories of aging that allowed for the evolution of successful aging as a construct and ultimately a theoretical basis for investigation. Because of the multifactorial nature of the psychosocial and biomedical domains, there is no clear consensus on the definition of successful aging or its determinants. What is clear, however, is that successful aging is related to the human health span, or healthy life expectancy. Moreover, the accumulating information from multidimensional studies suggests that many age-associated changes in physiological and cognitive functioning can be explained by such modifiable lifestyle factors as smoking, physical activity, and nutrition choice. The evidence presented supports the promotion of a healthy lifestyle as an effective strategy for successful aging.

Successful aging: the contribution of early-life and midlife risk factors

OBJECTIVES

To test whether early-life factors (education, height, father's social position) and midlife social, behavioral, and psychosocial factors were associated with entering older age without disease and with good functioning.

DESIGN

A longitudinal, British civil service-based cohort study. Participants were followed for 17 years to assess successful aging. This was defined as being free of major disease and in the top tertile of physical and cognitive functioning measured in 2002 to 2004.

SETTING

Twenty London-based Civil Service departments.

PARTICIPANTS

Four thousand, one hundred forty men and 1,823 women, free of major disease at baseline in 1985 to 1988 (mean age 44, range 35-55).

MEASUREMENTS

Behavioral, biological, and psychosocial risk factors; physical and cognitive functioning; and disease outcomes.

RESULTS

Five hundred forty eight (12.8%) men and 246 (14.6%) women were successfully aging at follow-up. Midlife socioeconomic position strongly predicted this (age-adjusted odds ratio, highest vs lowest=7.1, 95% CI=3.4-14.6, for men and 7.7, 95% CI=4.9-12.1, for women). Height, education (in men), not smoking, diet, exercise, moderate alcohol (in women), and work support (in men) were related to a favorable older life after adjustment for age and socioeconomic position.

CONCLUSION

Interventions to promote healthy adult behavior may attenuate harmful effects of less-modifiable risk factors and reduce social inequalities.

Cystatin C and aging success

BACKGROUND

To our knowledge, the effect of kidney function on successful aging has not been examined.

METHODS

We evaluated the relationship between cystatin C and aging success during a 6-year follow-up in the Cardiovascular Health Study, a community-based cohort of older adults (aged >or= 65 years). Successful aging was defined as remaining free of cardiovascular disease, cancer, and chronic obstructive pulmonary disease and having intact physical and cognitive functioning. In adjusted analysis, an accelerated failure time model was used to evaluate the percentage reduction in successful years by level of cystatin C. A separate Cox proportional hazards model evaluated whether cystatin C was related to incident physical and cognitive disability.

RESULTS

A total of 2140 participants had cystatin C measured and were free of the previously mentioned conditions at baseline. Their mean age was 74 years. The mean cystatin C level, creatinine level, and estimated glomerular filtration rate were 1.06 mg/L, 0.93 mg/dL, and 78 mL/min/1.73 m(2), respectively (to convert cystatin C to nanomoles per liter, multiply by 75; and to convert creatinine to micromoles per liter, multiply by 88.4). A total of 873 participants reached a first event in follow-up, 138 because of cognitive disability, 238 because of physical disability, 34 because of chronic obstructive pulmonary disease, 146 because of cancer, and 317 because of cardiovascular disease. The adjusted percentage reduction in successful life years in the highest vs the lowest quartile of cystatin C was 27% (95% confidence interval, 11%-39%). The highest vs lowest quartile of cystatin C also was independently associated with incident cognitive or physical disability (hazard ratio, 1.39; 95% confidence interval, 1.00-1.98).

CONCLUSION

A higher cystatin C level, even within a range of relatively normal kidney function, was associated with unsuccessful aging.

The Health Trade-off of Rural Residence for Impaired Older Adults: Longer Life, More Impairment

CONTEXT

Years lived with and without physical impairment are central measures of public health.

PURPOSE

We sought to determine whether these measures differed between rural and urban residents who were impaired at the time of a baseline measurement. We examined 16 subgroups defined by rural/urban residence, gender, race, and education.

METHODS

This is a 20-year retrospective cohort study, following 2,939 Americans who were aged 65-69 in 1982 and physically impaired at the time of the baseline measurement, with data from the National Long-Term Care Survey. Interpolated Markov chain analysis and microsimulation estimated life expectancy at age 65 and expected number of years with physical impairment. Impairment was defined as requiring help in 1 or more activities of daily living.

FINDINGS

Among older individuals with physical impairments at baseline, rural residents lived notably longer than urban residents. In all but 1 group, rural residents lived more years with physical impairment, and they also had a notably larger proportion of remaining life impaired.

CONCLUSIONS

Results suggest a notable public health impact of rural residence for impaired individuals, a longer expected period of impairment. Needs for services for people with impairments may be greater in rural areas.

Weight increase and overweight are associated with DNA oxidative damage in skeletal muscle

BACKGROUND AND AIMS

Weight maintenance within normal standards is recommended for prevention of conditions associated with oxidative injury. To compare oxidative damage in a post mitotic tissue, between adults differing in long-term energy balance.

METHODS

During hernia surgery, a sample of skeletal muscle was obtained in 17 non-obese adults. Subjects were divided into two groups according to their self-reported weight change: weight maintainers (WM) reported <4kg increase, and weight gainers (WG) reported >5kg increment. Muscle immunohistochemistry for 8-hydroxy-deoxyguanosine (8OHdG), 4-Hydroxy-2-nonenal (4HNE), and TNF-alpha, as markers of oxidative injury and inflammation, were performed. As known positive controls for oxidative injury, we included 10 elderly subjects (66-101yr). Anthropometric measures and blood samples for clinical laboratory and serum cytokines (TNF-alpha and IL-6) were obtained.

RESULTS

8OHdG was higher in WG compared with WM (149.1+/-16.2 versus 117.8+/-29.5, P=0.03), and was associated with anthropometric indicators of fat accumulation. 4HNE was similar in WG compared with WM (10.9+/-7.6 versus 9.8+/-6.3) but noticeably higher in elderly subjects (21.5+/-15.3, P=0.059). TNF-alpha protein in WG was higher compared with WM (114.0+/-41.7 versus 70.1+/-23.3, P=0.025), and was associated with weight increase.

CONCLUSIONS

Moderate self-reported weight increase, and body fat accumulation, suggesting long-term positive energy balance is associated with muscle DNA oxidative injury and inflammation.

Combinations of biomarkers predictive of later life mortality

A wide range of biomarkers, reflecting activity in a number of biological systems (e.g., neuroendocrine, immune, cardiovascular, and metabolic), have been found to prospectively predict disability, morbidity, and mortality outcomes in older adult populations. Levels of these biomarkers, singly or in combination, may serve as an early warning system of risk for future adverse health outcomes. In the current investigation, 13 biomarkers were examined as predictors of mortality occurrence over a 12-year period in a sample of men and women (n = 1,189) 70-79 years of age at enrollment into the study. Biomarkers examined in analyses included markers of neuroendocrine functioning (epinephrine, norepinephrine, cortisol, and dehydroepiandrosterone), immune activity (C-reactive protein, fibrinogen, IL-6, and albumin), cardiovascular functioning (systolic and diastolic blood pressure), and metabolic activity [high-density lipoprotein (HDL) cholesterol, total to HDL cholesterol ratio, and glycosylated hemoglobin]. Recursive partitioning techniques were used to identify a set of pathways, composed of combinations of different biomarkers, that were associated with a high-risk of mortality over the 12-year period. Of the 13 biomarkers examined, almost all entered into one or more high-risk pathways although combinations of neuroendocrine and immune markers appeared frequently in high-risk male pathways, and systolic blood pressure was present in combination with other biomarkers in all high-risk female pathways. These findings illustrate the utility of recursive partitioning techniques in identifying biomarker combinations predictive of mortal outcomes in older adults, as well as the multiplicity of biological pathways to mortality in elderly populations.

Successful aging: measuring the years lived with functional loss

Current research of risk factors potentially associated with successful aging faces the difficulty of taking into consideration two distinct outcome measures: survival and functioning. Previous studies either used successful aging measures restricted to survivors or presented more than one outcome measure to handle the dual outcome. This article illustrates the utility of health expectancy measures, based on life tables, to integrate the effects of survival and functioning across all ages. It is shown that three hypothetical successful aging strategies, considered equally successful according to the traditional measures restricted to survivors, are associated with vastly different changes in the years lived with and without disability. Furthermore, the intervention considered most successful when considering multiple successful aging measures, was associated with the largest increase in the time lived with disability. It is recommended that research on successful aging should be based on summary measures of population health that reflect both survival and functioning throughout life. These will provide more relevant information than is currently available for individuals and societies to evaluate and choose between successful aging strategies.

Ten dimensions of health and their relationships with overall self-reported health and survival in a predominately religiously active elderly population: the cache county memory study

OBJECTIVES

To document the extent of healthy aging along 10 different dimensions in a population known for its longevity.

DESIGN

A cohort study with baseline measures of overall self-reported health and health along 10 specific dimensions; analyses investigated the 10 dimensions as predictors of self-reported health and 10-year mortality.

SETTING

Cache County, Utah, which is among the areas with the highest conditional life expectancy at age 65 in the United States.

PARTICIPANTS

Inhabitants of Cache County aged 65 and older (January 1, 1995).

MEASUREMENTS

Self-reported overall health and 10 specific dimensions of healthy aging: independent living, vision, hearing, activities of daily living, instrumental activities of daily living, absence of physical illness, cognition, healthy mood, social support and participation, and religious participation and spirituality.

RESULTS

This elderly population was healthy overall. With few exceptions, 80% to 90% of persons aged 65 to 75 were healthy according to each measure used. Prevalence of excellent and good self-reported health decreased with age, to approximately 60% in those aged 85 and older. Even in the oldest old, the majority of respondents were independent in activities of daily living. Although vision, hearing, and mood were significant predictors of overall self-reported health in the final models, age, sex, and cognition were significant only in the final survival models.

CONCLUSION

This population has a high prevalence of most factors representing healthy aging. The predictors of overall self-reported health are distinct from the predictors of survival in this age group and, being potentially modifiable, are amenable to clinical and public health efforts.

Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies

OBJECTIVE

There is no consensual definition of "successful aging." Our aim was to review the literature on proportions of subjects meeting criteria and individual components of definitions of successful aging as well as correlates of these definitions.

METHODS

We conducted a literature search for published English-language peer-reviewed reports of data-based studies of adults over age 60 that included an operationalized definition of successful aging. The authors categorized the components of these definitions and independent variables examined in relation to successful aging (e.g., gender, education, and social contacts).

RESULTS

The authors identified 28 studies with 29 different definitions that met our criteria. Most investigations used large samples of community-dwelling older adults. The mean reported proportion of successful agers was 35.8% (standard deviation: 19.8) but varied widely (interquartile range: 31%). Multiple components of these definitions were identified, although 26 of 29 included disability/physical functioning. The most frequent significant correlates of the various definitions of successful aging were age (young-old), nonsmoking, and absence of disability, arthritis, and diabetes. Moderate support was found for greater physical activity, more social contacts, better self-rated health, absence of depression and cognitive impairment, and fewer medical conditions. Gender, income, education, and marital status generally did not relate to successful aging.

CONCLUSION

Despite variability among definitions, approximately one-third of elderly individuals were classified as aging successfully. The majority of these definitions were based on the absence of disability with lesser inclusion of psychosocial variables. Predictors of successful aging varied yet point to several potentially modifiable targets for increasing the likelihood of successful aging.

Cardiovascular Risk Factors Predictive for Survival and Morbidity-Free Survival in the Oldest-Old Framingham Heart Study Participants

OBJECTIVES

To examine whether midlife cardiovascular risk factors predict survival and survival free of major comorbidities to the age of 85.

DESIGN

Prospective community-based cohort study.

SETTING

Framingham Heart Study, Massachusetts.

PARTICIPANTS

Two thousand five hundred thirty-one individuals (1,422 women) who attended at least two examinations between the ages of 40 and 50.

MEASUREMENTS

Risk factors were classified at routine examinations performed between the ages of 40 and 50. Stepwise sex-adjusted logistic regression models predicting the outcomes of survival and survival free of morbidity to age 85 were selected from the following risk factors: systolic and diastolic blood pressure, total serum cholesterol, glucose intolerance, cigarette smoking, education, body mass index, physical activity index, pulse pressure, antihypertensive medication, and electrocardiographic left ventricular hypertrophy.

RESULTS

More than one-third of the study sample survived to age 85, and 22% of the original study sample survived free of morbidity. Lower midlife blood pressure and total cholesterol levels, absence of glucose intolerance, nonsmoking status, higher educational attainment, and female sex predicted overall and morbidity-free survival. The predicted probability of survival to age 85 fell in the presence of accumulating risk factors: 37% for men with no risk factors to 2% with all five risk factors and 65% for women with no risk factors to 14% with all five risk factors.

CONCLUSION

Lower levels of key cardiovascular risk factors in middle age predicted overall survival and major morbidity-free survival to age 85. Recognizing and modifying these factors may delay, if not prevent, age-related morbidity and mortality.

William M. Feinberg Lecture: Cognitive Vitality and the Role of Stroke and Cardiovascular Disease Risk Factors

BACKGROUND AND PURPOSE

Vascular risk factors are common in the elderly, and some such as hypertension may be important predictors of cognitive impairment.

SUMMARY OF REVIEW

In this article, the role that vascular risk factors may play in the prevention of vascular and nonvascular forms of cognitive impairment is reviewed.

CONCLUSIONS

Because vascular risk factors may have negative effects on brain structure and cognitive function, and because vascular risk factors may be present in midlife or possibly earlier, we may need to develop long-term intervention strategies to control or prevent vascular risk factors in an effort to preserve cognitive vitality as we age.