FACTORS ASSOCIATED WITH FRID USE IN OLDER BLACK AND WHITE MEN AND WOMEN: THE HEALTH ABC STUDY

Medications that increase falls, fall-risk increasing drugs (FRIDs), are common in older adults. Two FRID definitions, the CDC Steadi-Rx and Swedish National Board of Health and Welfare, are widely accepted. We hypothesized that FRID use risk factors vary by definition in 1,352 community-dwelling older adults in the Health, Aging, and Body Composition Study (Health ABC; 2007–2008 clinic visit; 83.4±2.8 years; 54.1% women; 34.9% Black). FRID use by either definition was associated with chronic health conditions, medical care including non-FRID use, higher BMI and depression scores, and less walking exercise (all p < 0.05). Steadi-Rx FRID use was also associated with more falls, ADL difficulty, and better cognitive scores. Using stepwise multivariate Poisson regression adjusting for demographics, lifestyle/behavior factors, and comorbidity, a 1-unit increase in BMI and depression score was associated with an approximately 2% mean FRID count increase for both definitions and 7% mean FRID count increase per 1-unit increase in non-FRID count. Both definitions had a 40% and 15% lower mean FRID count, respectively, with hypertension and cardiovascular disease (CVD) history. Better cognitive scores were associated with 1% mean increase in Steadi-Rx FRID count and a mean decrease of 13% and 33% FRID count, respectively, with cancer history and having primary healthcare. In identically adjusted logistic regression, FRID use (yes/no) was associated in a consistent direction with BMI, depression score, non-FRID count, hypertension, CVD, having primary healthcare, and also less likely with low-vs-high income (OR=0.18[0.06–0.50]). Risk factors differ by FRID definition, with Steadi-Rx identifying more predictors than the Swedish definition.

TOUCH SENSATION IS AN UNDERSTUDIED PREDICTOR OF DEMENTIA RISK IN OLDER ADULTS

Few studies have focused on touch sensation as risk factor or marker of dementia, although other sensory impairments are associated with cognitive decline. We studied touch sensation as measured by peripheral sensory nerve function; impairment was defined as insensitivity to 10-g monofilament or vibration detection threshold >130μm of the toe, in 2,174 Black and White participants (52% women; 35% black, aged 70-79 years) from Health, Aging, and Body Composition Study who were ambulatory and without dementia at enrollment. Incident dementia over the following 11 years was determined based on medical records, cognitive scores, and medications. Impaired touch sensation was associated with a 1.63-fold higher risk of dementia (95% CI 1.21, 2.19) after adjustment for demographics, health behaviors, and health conditions. Associations persisted even after additional adjustment for hearing, vision, and smell (HR: 1.45; 95%CI 1.09, 2.03). These findings highlight the underappreciated association between poor touch sensation and risk of dementia.

PHYSICAL FUNCTIONING AND BODY SIZE IN MID-LIFE WOMEN: THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION

To evaluate patterns of age-related changes in physical functioning (PF) and associations with body size, we utilized data from the longitudinal Study of Women’s Health Across the Nation (SWAN). Participants (n=1,793) with self-reported SF-36 PF data at visit 4 (2000-01; mean age:50.0 years ±2.7), visit 15 (2016-17), plus one additional visit were included. Body weight and waist circumference were measured at each visit; change from visits 4 to 15 was calculated. Five PF trajectories were identified using latent class growth modeling (% of women): (1) persistently low (4.1%); (2) start moderate and improve slightly (5.4%); (3) start high and decline slightly (24.0%); (4) persistently high (59.5%); and (5) start high and decline substantially (7.0%). Participants with persistently low PF (Group 1) lost weight during follow-up (mean change: -3.2% body weight) whereas there was little change in all other groups (ANOVA p< 0.0001). Women with persistently low PF (Group 1) had < 2% increase in waist circumference over follow-up; all other groups had more than double that increase (range: 4.1%-6.1%; ANOVA p=0.002). No statistically significant differences in anthropometry changes across the PF groups were observed after adjustment for sociodemographic and time-variant health characteristics. PF trajectories may be associated with changes in body weight or waist circumference during midlife and transition to older adulthood; however, these associations may be explained by other major health-related variables. Future research is needed to understand the complex interplay between PF and body size, particularly for women at-risk for late-life disability that may benefit from preventive efforts in mid-life.

OUTDOOR ENVIRONMENTAL RISK FACTORS FOR FALLS AND FEAR OF FALLING: A SYSTEMATIC REVIEW

The purpose of this systematic review was to identify outdoor environmental risk factors associated with falls and/or fear of falling among older adults. PubMed, EMBASE, and CINAHL were searched through February 19, 2021. Studies were included if they measured outdoor environment, falls or fear of falling as an outcome, and included adults aged ≥ 45 years. Excluded studies were not published in English and/or did not include original results. Two study-team members completed abstract screening. For full text reviews, a third reviewer resolved conflicts. A total of 5,727 abstracts were screened and 462 full texts were reviewed. After full-text review, approximately 25 studies will be assessed for risk of bias and data extracted by two independent reviewers. Based on the initial review, uneven outdoor surfaces, busy traffic areas, and neighborhood disorder were associated with falls/fear of falling among older adults. Modifiable outdoor environmental factors may be targets for fall prevention.

STAIR CLIMB TIME AND FUNCTIONAL POWER ASSOCIATIONS TO MUSCLE FUNCTION AND PHYSICAL PERFORMANCE

Repeated stair climbing assesses sustained performance and neuromuscular components of movement, including functional muscle power (force*velocity). However, repeated stair climb associations to standard muscle and physical function measures are not established in older adults. We hypothesized that stair climb time (sec), and ascend power (peak and average; Watts=W) over 3 stair climb laps were associated with standard muscle function, physical function and risk factors in the Study of Muscle, Mobility and Aging (SOMMA; preliminary baseline N=455; 76.9+/-5.3 years; 58.0% women; 85.7% White). Adjusting for age, sex, race, and BMI using multivariate linear regression, stair climb time, peak power and average power were significantly associated with all standard muscle (Keiser leg press 1-RM strength and power; grip strength) and physical function (400m walk speed, SPPB and components) measures. Women had worse stair climb performance vs. men (all p< 0.01) including: longer total time (29.6+/-8.1 vs. 27.4+/-6.7 sec), lower peak power (121.9+/-34.5 vs. 161.4+/-39.0 W), and lower average power (94.9+/-24.3 vs. 124.1+/-28.4 W). Adjusting for age, sex, race, BMI, CHAMPS total physical activity/week, CES-D depressive symptoms, and comorbidity count using multivariate linear regression, older age was related to slower stair climb time and lower peak/average power. Other known risk factors were also associated with worse stair climb performance: non-White race (average power only), lower physical activity (peak/average power only), BMI, depressive symptoms, and higher comorbidity (time only). Repeated stair climb time and power may capture unique aspects of functional decline with aging and are associated with standard muscle and physical function measures.

PHYSICAL ACTIVITY AND SEDENTARY TIME ASSOCIATIONS WITH NON-FRACTURE FALL INJURY (NFFI) AND FRACTURE

Understanding fall injury risk factors and circumstances may lead to better prevention. However, many fall injury studies focus on fractures from hospitalizations or emergency events, rather than non-fracture fall injuries (NFFI), which comprise &gt;50% of fall injuries in older adults. We hypothesized that risk factors were differently associated with NFFI vs. fracture fall injuries in a community-based cohort of ambulatory women with fall injuries in the Objective Physical Activity and Cardiovascular Disease Health in Older Women (OPACH) ancillary of the Women’s Health Initiative Long Life Study. Women with daily fall calendars over 1-year follow-up completed telephone interviews regarding fall injury circumstances (Nf662; mean 79.6 + 6.7 years; 73.3% White). Risk factors and fall circumstances were assessed with first reported fall injury (NFFI vs. fracture) using univariate and multivariate logistic regression. Participants with NFFI vs. fracture were more likely to be non-white, less likely to seek clinical treatment or need help up from fall (all p &lt; 0.05). Adjusting for age, race, and BMI, NFFI vs. fracture were more likely to report &gt;=6 hours sitting (OR=1.72, 95% CI=1.07–2.73) and less likely to report weekly moderate exercise (OR=0.61, 95% CI=0.38–0.96), though total accelerometer-measured sedentary time and physical activity (PA) were not significant. Self-reported PA level at the time of fall (OR=1.31, 95% CI=0.82–2.09) and walking outside for &gt;10 minutes &gt;= 1/week (OR=1.24, 95% CI=0.77–1.98) were not different for NFFI vs. fractures. Older women with NFFI vs. fracture had more sedentary time and less moderate exercise, which may have implications for fall injury severity.

Hearing loss and risk of depressive symptoms in older adults in the Health ABC study

Objective

Hearing loss (HL) is highly prevalent among older adults and may lead to increased risk of depressive symptoms. In both cross-sectional and longitudinal analysis, we quantified the association between HL and depressive symptoms, incorporating the variable nature of depressive symptoms and characterizing by race and gender.

Methods

Data were from the Health, Aging, and Body Composition study. Depressive symptoms were measured using the Center for Epidemiologic Study Depression Scale short form (CES-D 10), defined as CES-D 10 score ≥10 or treatment for depression. Hearing was defined via four-frequency pure-tone average (PTA) decibel hearing level (dB HL), categorized as normal hearing (PTA ≤25 dB HL), mild HL (PTA26-40 dB HL), and ≥moderate HL (PTA > 40 dB HL). Associations at baseline were quantified using logistic regression, incident depressive symptoms using Cox proportional hazard models, and change in depressive symptoms over time using growth mixture models and multinomial logistic regression.

Results

Among 2,089 older adults (1,082 women, 793 Black; mean age 74.0 SD: 2.8), moderate or greater HL was associated with greater odds of concurrent [Odds Ratio (OR):2.45, 95% CI:1.33, 4.51] and incident depressive symptoms [Hazard Ratio (HR):1.26, 95% CI:1.00, 1.58]. Three depressive symptom trajectory patterns were identified from growth mixture models: low, moderate increasing, and borderline high depressive symptom levels. Those with moderate or greater HL were more likely to be in the borderline high depressive-symptom trajectory class than the low trajectory class [Relative Risk Ratio (RRR):1.16, 95% CI:1.01, 1.32].

Conclusions

HL was associated with greater depressive symptoms. Although findings were not statistically significantly different by gender and race, estimates were generally stronger for women and Black participants. Investigation of psychosocial factors and amelioration by hearing aid use could have significant benefit for older adults' quality of life.

Muscle Quality Revisited: Biopsy Energetics, MR Spectroscopy, and Muscle Power and Strength

With age, strength may decline faster than muscle mass pointing to a deterioration in muscle quality. Aspects of muscle quality and function are being measured in SOMMA; we hypothesized that in vitro and in vivo bioenergetics capacity of muscle would be related to muscle strength and power. Associations differed between men and women. In men (n=48, ATPMAX, 70, max OXPHOS and max ETS) but not women (n=68, ATPMAX, n=103, max OXPHOS and max ETS), muscle ATP regeneration by 31P MR spectroscopy was correlated with leg power (r = 0.27, p= 0.05). Energy production in tissue was similarly more strongly correlated with power in men than women, though not statistically significant. Correlations between the tissue measures and strength were also stronger in men than women. In ongoing follow-up, we will be able to determine what role that muscle tissue energetics plays in explaining the loss of strength and power with aging.

Metabolic Syndrome and Objective Physical Performance Measures in Mid-to-Early Late Life Women: SWAN

Metabolic syndrome (MetS) is a cluster of factors (hypertension, abdominal obesity, impaired fasting glucose, low high-density lipoprotein, hypertriglyceridemia). How midlife MetS impacts future physical functioning is uncertain. We hypothesized that higher midlife MetS components are associated with poorer physical performance in early late life for multi-ethnic women. MetS status from 1996-2011 (8 visits) and objective physical performance (2015/16; short physical performance battery (SPPB; 0-12), 40-foot walk (m/s), 4-meter gait speed (m/s), chair stands (sec), stair climb (sec)) were assessed in the Study of Women’s Health Across the Nation (SWAN; n=1722; age 65.4±2.7 years; 26.9% Black, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified trajectory groups distinguishable by number of MetS components: none (23.9%), 1=low-MetS (28.7%), 2=mid-MetS (30.9%), &gt;3=high-MetS (16.5%). High-MetS versus none had higher body mass index, pain, financial strain, and lower physical activity and self-reported health (p &lt; 0.0001). Black and Hispanic women were more likely to be in high-MetS and had worse physical functioning, along with Chinese women, versus White (all p&lt;0.05, except gait speed in Hispanic). Adjusted linear regression related MetS groups to physical performance. High-MetS versus none demonstrated adjusted worse 40-ft walk (β:-0.08; 95% CI:-0.13, -0.03), gait speed (β:-0.09; 95% CI:-0.15, -0.02), SPPB (β:-0.79; 95% CI: -1.15, -0.44), and chair stands (β:0.69; 95% CI: 0.09, 1.28), but not stair climb, with race significantly related to all except 40-ft walk. Midlife MetS trajectories related to poor physical performance in early late life multi-ethnic women. Managing midlife metabolic function may improve physical performance in late life.

Joseph T. Freeman and Excellence in Rehabilitation Award Lecture

The Joseph T. Freeman Award lecture will feature an address by the 2021 Freeman Award recipient Pamela Cacchione, PhD, CRNP, BC, FGSA, FAAN, of the University of Pennsylvania. The Joseph T. Freeman Award is a lectureship in geriatrics awarded to a prominent clinician in the field of aging, both in research and practice. The award was established in 1977 through a bequest from a patient's estate as a tribute to Dr. Joseph T. Freeman. The Excellence in Rehabilitation of Aging Persons Award lecture will feature an address by the 2021 Excellence in Rehabilitation Award recipient Gregory Hicks, MPT, PhD of the University of Delaware. The Excellence in Rehabilitation of Aging Persons Award is designed to acknowledge outstanding contributions in the field of the rehabilitation of aging individuals.

Understanding Racial/Ethnic Disparities in Physical Performance in Midlife Women: Findings From SWAN (Study of Women's Health Across the Nation)

OBJECTIVES

Evaluate degree to which racial/ethnic differences in physical performance are mediated by sociodemographic, health, behavioral, and psychosocial factors.

METHODS

Physical performance was evaluated using a decile score derived from grip strength, timed 4 m walk, and timed repeat chair stand in 1,855 African American, Caucasian, Chinese, Hispanic, and Japanese women, mean age = 61.8 (SD = 2.7) in the Study of Women's Health Across the Nation. Mediators included education, financial strain, comorbidities, pain, body mass index (BMI), physical activity, and perceived stress. Structural equation models provided estimates of the total difference in physical performance between Caucasians and each race/ethnic groups and differences due to direct effects of race/ethnicity and indirect effects through mediators.

RESULTS

The mean decile score for Caucasian women was 16.9 (SD = 5.6), 1.8, 2.6, and 2.1 points higher than the model-estimated scores in African Americans, Hispanics and Chinese, respectively, and 1.3 points lower than the Japanese. Differences between Caucasians and the Chinese and Japanese were direct effects of race/ethnicity whereas in African Americans and Hispanics 75% or more of that disparity was through mediators, particularly education, financial strain, BMI, physical activity, and pain.

DISCUSSION

Addressing issues of poverty, racial inequality, pain, and obesity could reduce some racial/ethnic disparity in functional limitations as women age.

Hearing Impairment and Risk of Depression in Older Adults in Health ABC

Whether hearing impairment (HI) is associated with depressive symptoms remains disputed for older adults, in part due to varying definition employed, use of subjective hearing measures, or cross-sectional analysis. We studied 1936 men and women (mean age 74.1 years, 41.7% black race) enrolled in the prospective Health, Aging and Body Composition study Hearing thresholds at 500-4000 Hz were averaged to create a pure tone average (PTA) and HI was defined using clinical cutpoints in the better-hearing ear. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D) or the CES-D 10, a revised 10 question scale depending on visit. Linear mixed effects models with random intercepts and slopes were used to estimate difference in rates of change in depressive symptomatology by hearing status over nine years. Cox proportional hazard models were used to examine the association between HI and incident depression defined as change in CES-D score >=10 points. In models adjusted for demographic and clinical covariates, participants with HI demonstrated a higher baseline prevalence of depressive symptoms compared to those with normal hearing (20.7% vs. 8.4%).Rates of change did not differ by HI status. Participants with moderate or greater HI had an increased risk of 9-year incident depression (HR=1.28, 95% CI: 1.00-1.62) compared to participants with normal hearing. HI is associated with increased risk of incident depression and a greater overall prevalence of depression compared to normal hearing, underscoring the importance of further research on whether rehabilitative therapies can mitigate this association.

Impact of Age on Community Diabetes Prevention Program Attendance and Weight Loss Goals

The Diabetes Prevention Program (DPP) lifestyle intervention demonstrated that meeting the weight loss (WL) and activity goals prevents/delays type 2 diabetes. Older DPP participants, 60-85 years, reduced the risk of developing diabetes by 71% versus 58% in those <60 years. Currently, community translated DPP-based lifestyle interventions including Group Lifestyle Balance (DPP-GLB), are reimbursed by Medicare for overweight/obese older adults with prediabetes. This effort examined the impact of age group (60-65: reference, 66-70, ≥71 years) on both DPP-GLB maintenance session attendance (months 7-12) and achieving the 5% WL goals at 6- and 12-months. Data were combined from two identical 12-month DPP-GLB intervention trials involving overweight/obese adults with prediabetes and/or metabolic syndrome. Participants ≥60 years attending ≥4 sessions (months 0-6), with complete data on session attendance and WL were included (n=145; age=68.7 + 5.8 years, range 60-88; 79% women). Participants aged 66-70 years (N=46) were more likely to meet the 6-month 5% WL goal (67.4%) vs. 60-65 years (N=51; 45.1%; p=0.03). Participants aged 66-70 (69.6%) and ≥71 years (N=48; 60.4%) were more likely to meet the 12-month WL goal vs. 60-65 years (35.3%; 66-70: p=0.0007; ≥71: p=0.01). Maintenance attendance did not vary by age group with approximately 30% of each group attending ≥4 of 6 maintenance sessions (p=0.55). In conclusion, adults 66+ vs. 60-65 years more successfully met the clinically meaningful 5% WL goals at 6 and 12 months. With nationwide implementation of community-based “real-world” DPP-GLB lifestyle interventions, better understanding of program success across older adult age groups will enhance program reach and effectiveness.

SAT-616 Associations Of Body Mass Index And Waist Circumference In Young Adulthood With Later Life Incident Diabetes

Background: Overweight and obesity are known risk factors for incident diabetes, but it remains unclear if exposures during young adulthood (age 18 to 39 years) contribute to mid and late-life (age ≥40 years, collectively labeled here as “later-life”) risk of incident diabetes independent of later-life risk factor exposures.

Objective: We sought to assess the independent associations between young adult exposures to overweight and obesity, as assessed by body mass index (BMI) and waist circumference (WC), with later-life incident diabetes, accounting for later-life exposures.

Methods: We pooled data from six US cohorts (ARIC, CARDIA, CHS, Framingham Offspring, Health ABC, and MESA), and imputed life-course risk factor trajectories for BMI and WC, as well as for multiple cardiometabolic risk factors, annually from age 18 years to end of follow-up for each participant. Incident diabetes was defined by observed fasting blood glucose ≥126 mg/dL, non-fasting glucose ≥200, or use of diabetes medications. We used Cox proportional hazards models to examine the independent associations between time-weighted average exposures to BMI and WC during young adulthood and incident diabetes. We also performed mediation analyses to assess whether these associations were mediated by young adult exposures to other cardiometabolic risk factors (blood pressure, lipids, insulin resistance).

Results: 30,780 participants were included (mean age at first in-person visit 53.1±16.2 years; 56.1% female). Over a 9-year median follow-up, 4,323 participants had incident diabetes. Both young adult BMI and WC were associated with diabetes risk in a dose-dependent manner, independent of later-life BMI and WC. Compared to BMI 18.5–24.9 kg/m², hazard ratios (HR) for incident diabetes were 1.27 (95%CI: 1.14–1.41) and 1.99 (95%CI: 1.67–2.37) for BMI 25–29 kg/m² and ≥30 kg/m², respectively. Similarly, compared to normal WC (≤80 cm women; ≤94 cm men), the HRs were 1.42 (95%CI: 1.26–1.59) for WC 81-88cm (women)/95-102cm (men) and 2.13 (95%CI: 1.87–2.43) for WC >88cm (women)/>102cm (men). Young adult homeostatic model of insulin resistance (HOMA-IR) mediated 49% (95%CI: 23–76) and 44% (95%CI: 26–62) of the association between young adult BMI and WC with later-life incident diabetes, respectively.

Conclusions: Elevated BMI or WC during young adulthood were independently associated with later-life incident diabetes, after accounting for later-life BMI and WC, with insulin resistance suggested as a key mediator.

MULTIPLE MEDICATION USE AND RISK OF TREATED FALL INJURY: THE HEALTH ABC STUDY

Multiple medication use within one year is associated with increased fall injury risk in older adults. However, chronically using multiple medications and treated fall injury have rarely been explored, particularly in cohort studies linked with claims data. We examined using >5 medications in 2 or more consecutive years (chronic medication use) as a risk factor for treated fall injury in 1,898 community-dwelling adults (age 73.6±2.9 years; 53% women; 37% black) with linked Medicare Fee-For-Service (FFS) claims from the Health, Aging and Body Composition Study since 1997/98 clinic visit. Incident fall injury (N=546) was the first claim from 1998/99 clinic visit to 12/31/08 with an ICD-9 fall code and non-fracture injury code, or fracture code with/without a fall code. Stepwise Cox models with a time-varying predictor of chronic medication use before fall injury or censoring (N=414) vs. not using >5 medications at the same time (N=1008) were adjusted for baseline demographics, lifestyle factors, fall history, quadriceps strength, cardiovascular disease (CVD), diabetes, sensory nerve impairment, and kidney function. Fall injury risk increased for chronic medication users (37%) vs. non-users (29%) (HR=1.25[1.00-1.57]), though was attenuated after adjustment for CVD and diabetes (HR=1.18[0.93-1.51]). Sensitivity analyses excluding fall-risk-increasing drugs (FRIDs) from medication counts (HR=1.32[0.54-3.20]), or including those using >5 medications non-chronically (N=365) in referent groups (HR=1.22[0.96-1.55]) had consistent findings. Unmeasured comorbidity differences may confound associations of chronic medication use and treated fall injury risk in older adults with Medicare FFS. Considering both chronic diseases and medication use in fall risk assessments is needed.

STAIR CLIMB TIME AND FUNCTIONAL POWER ASSOCIATIONS IN EARLY OLD AGE: SWAN

Stair climbing assesses neuromuscular components of movement, including muscle power (force*velocity) which may decline earlier in aging vs. strength. We hypothesized age and age-related factor (N=1370; 65.5±2.7 years) associations to stair climb total time (sec), ascend lap time degradation (lap 1 minus 3), power (W/kg body weight) and power degradation (lap 1 minus 3). Adjusting for demographic, lifestyle and age-related comorbidity factors using multivariate linear regression, older age independently related to slower total time and lower power. Non-white ethnicity had slower total time (Black, Hispanic), higher ascend time degradation (Hispanic), and lower power (Hispanic, Chinese, Japanese) vs. Whites. Higher 36-Item Short Form Health Survey (SF-36) and Modified Baecke physical activity scores indicated better performance: lower total time, higher power (SF-36 only), and less degradation in ascend time and power. Stair climb time and power in early old age may capture initial functional loss targets for interventions to prevent late-life disability.

IMPACT OF MULTIPLE CHRONIC CONDITIONS ON CHANGE IN PHYSICAL FUNCTION FROM MID- TO EARLY LATE LIFE

Chronic conditions emerging in midlife may be modifiable to prevent progression ultimately preserve physical function (PF) in late life. We quantified change in perceived PF in relation to several common chronic conditions known to impact PF in late life (osteoarthritis, diabetes, stroke, hypertension, heart disease, cancer, osteoporosis, and depression). Physical function (PF) was assessed using the Physical Functioning Scale of the SF-36 among 2,283 women in SWAN from an average age of 50.0±2.7 to 64.0±3.7 years. In covariate-adjusted Poisson models, each additional condition was associated with 3% worse PF (p<0.001), and an additional 0.4% annual worsening (p<0.001). Thus, holding demographic, lifestyle, socioeconomic, and other health factors constant, a woman a decade later entering old age with no chronic conditions would have 8.1%, 15.5%, and 17.0% better PF vs. having one, two, or three conditions, respectively. Preventing or delaying chronic disease progression in midlife may improve PF trajectories into late life.

A LIFE COURSE PERSPECTIVE OF LATE-LIFE FUNCTIONING: THE STUDY OF WOMEN’S HEALTH ACROSS THE NATION

Early late-life deficits in physical functioning are highly relevant among women, who experience a more rapid decline in physical functioning vs. age-matched men. Trends showing an increasing prevalence of disability among mid-life adults, with an evolving understanding that late life health and functioning is the product of exposures accumulated across ones life, suggests an urgent need to understand the causes and consequences of functional limitations at the transition between mid- to late-life. The Study of Women’s Health Across the Nation (SWAN) is an observational multi-racial/ethnic (White, Black, Chinese, Japanese, Hispanic) longitudinal study of 3,302 women recruited in 1996 from 7 U.S. clinical sites; Boston, Chicago, Detroit-area, Los Angeles, Newark (NJ), Oakland (CA), and Pittsburgh. Over the past 23 years, women have participated in up to 16 near-annual study visits, spanning from mid-life (age 42-52 years at baseline) to late life (age 65-73 years at follow-up visit 15). Retention at the most recently completed in-person visit (2015) was 74%. This symposium identifies mid-life risk factors for poor late-life performance-based physical functioning among women, including race/ethnicity (Sternfeld) and chronic health conditions (Lange-Maia). Further, early late-life decrements in stair climb time and muscle power (Strotmeyer) and falls and fall injuries (Ylitalo) were observed with key factors identified. The Discussant will examine implications for life course epidemiology in advancing our understanding of predictors of late-life physical functioning. Consideration of functioning during the transition from mid-life to late life is critical to target interventions that are most efficacious in promoting late life health and function.

Prevalence and correlates of self-reported medication non-adherence among older adults with coronary heart disease, diabetes mellitus, and/or hypertension

BACKGROUND

Information about the prevalence and correlates of self-reported medication nonadherence using multiple measures in older adults with chronic cardiovascular conditions is needed.

OBJECTIVE

To examine the prevalence and correlates of self-reported medication nonadherence among community-dwelling elders with chronic cardiovascular conditions.

METHODS

Participants (n = 897) included members from the Health, Aging and Body Composition Study with coronary heart disease, diabetes mellitus, and/or hypertension at Year 10. Self-reported nonadherence was measured by the 4-item Morisky Medication Adherence Scale (MMAS-4) and 2-item cost-related nonadherence (CRN-2) scale at Year 11. Factors (demographic, health status, and access to care) were examined for association with the MMAS-4 and then for association with the CRN-2 scale.

RESULTS

Nonadherence per the MMAS-4 and CRN-2 scale was reported by 40.7% and 7.7% of participants, respectively, with little overlap (3.7%). Multivariable logistic regression analyses found that black race was significantly associated with nonadherence per the MMAS-4 (P = 0.002) and the CRN-2 scale (P = 0.005). Other correlates of nonadherence per the MMAS-4 (with independent associations) included having cancer (P = 0.04), a history of falls (P = 0.02), sleep disturbances (P = 0.04) and having a hospitalization in the previous 6 months (P = 0.005). Conversely, being unmarried (P = 0.049), having worse self-reported health (P = 0.04) and needs being poorly met by income (P = 0.02) showed significant independent associations with nonadherence per the CRN-2 scale.

CONCLUSIONS

Self-reported medication nonadherence was common in older adults with chronic cardiovascular conditions and only one factor - race - was associated with both types. The research implication of this finding is that it highlights the need to measure both types of self-reported nonadherence in older adults. Moreover, the administration of these quick measures in the clinical setting should help identify specific actions such as patient education or greater use of generic medications or pill boxes that may address barriers to medication nonadherence.

Association of spinal muscle composition and prevalence of hyperkyphosis in healthy community-dwelling older men and women

BACKGROUND

Older adults with hyperkyphosis are at increased risk of falls, fractures, and functional decline. Modifiable risk factors for hyperkyphosis have not been well studied. Our objective was to determine whether spinal muscle area and density are associated with hyperkyphosis, independent of age, race, sex, bone mineral density, and trunk fat.

METHODS

Using data from the Pittsburgh site of the Health, Aging, and Body Composition study, we performed a baseline cross-sectional analysis. Participants were black and white men and women 70-79 years old (N = 1172), independent in activities of daily living and able to walk &frac14; mile and up 10 steps without resting. We measured Cobb's angle of kyphosis from supine lateral scout computed tomography scans, and categorized hyperkyphosis as Cobb's angle >40°. Axial images from lateral scout computed tomography scans assessed spinal extensor muscle cross-sectional area and density (proxy for fat infiltration).

RESULTS

In our sample, 21% had hyperkyphosis. Prevalence in black men was 11%; in white men, 17%; in black women, 26%; and in white women, 30%. In multivariate analysis, each standard deviation increase in muscle density was associated with a 29% reduction in the odds of hyperkyphosis, independent of covariates. Muscle area was not significantly associated with hyperkyphosis.

CONCLUSIONS

Lower spinal muscle density is associated with hyperkyphosis in healthy community-dwelling older adults. This potentially modifiable risk factor could be targeted in exercise interventions. Randomized trials are needed to determine whether an exercise program targeting spinal muscle density reduces hyperkyphosis and in turn improves health outcomes.

The assessment of clinical distal symmetric polyneuropathy in type 1 diabetes: a comparison of methodologies from the Pittsburgh Epidemiology of Diabetes Complications Cohort

Distal symmetrical polyneuropathy (DSP) is the most common type of diabetic neuropathy, but often difficult to diagnose reliably. We evaluated the cross-sectional association between three point-of-care devices, Vibratron II, NC-stat(®), and Neurometer(®), and two clinical protocols, MNSI and monofilament, in identifying those with DSP, and/or amputation/ulcer/neuropathic pain (AUP), the two outcomes of major concern. This report presents data from 195 type 1 diabetic participants of the Epidemiology of Diabetes Complications (EDC) Study attending the 18-year examination (2004-2006). Participants with physician-diagnosed DSP, AUP or who were abnormal on the NC-stat, and the Vibratron II, MNSI, and monofilament were older (p<0.05) and had a longer duration of diabetes (p < 0.05). There was no difference by sex for DSP, AUP, or any testing modality, with the exception of NCstat (motor). The Vibratron II and MNSI showed the highest sensitivity for DSP (>87%) and AUP (>80%), whereas the monofilament had the highest specificity (98% DSP, 94% AUP) and positive predictive value (89% DSP, 47% AUP), but lowest sensitivity (20% DSP, 30% AUP). The MNSI also had the highest negative predictive value (83%) and Youden's Index (37%) and currently presents the single best combination of sensitivity and specificity of DSP in type 1 diabetes.

Correlates of insulin resistance in older individuals with and without kidney disease

BACKGROUND

Chronic kidney disease (CKD) is associated with insulin resistance (IR). Prior studies have found that in individuals with CKD, leptin is associated with fat mass but resistin is not and the associations with adiponectin are conflicting. This suggests that the mechanism and factors associated with IR in CKD may differ.

METHODS

Of the 2418 individuals without reported diabetes at baseline, participating in the Health, Aging and Body Composition study, a study in older individuals aged 70-79 years, 15.6% had CKD defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) based on cystatin C. IR was defined as the upper quartile of the homeostasis model assessment. The association of visceral and subcutaneous abdominal fat, percent body fat, muscle fat, lipids, inflammatory markers and adiponectin were tested with logistic regression. Interactions were checked to assess whether the factors associated with IR were different in those with and without CKD.

RESULTS

Individuals with IR had a lower eGFR (80.7 ± 20.9 versus 75.6 ± 19.6, P < 0.001). After multivariable adjustment, eGFR (odds ratio per 10 mL/min/1.73 m(2) 0.92, 95% confidence interval 0.87-0.98) and CKD (1.41, 1.04-1.92) remained independently associated with IR. In individuals with and without CKD, the significant predictors of IR were male sex, black race, higher visceral fat, abdominal subcutaneous fat and triglycerides. In individuals without CKD, IR was associated with lower high-density lipoprotein and current nonsmoking status in multivariate analysis. In contrast, among individuals with CKD, interleukin-6 (IL-6) was independently associated with IR. There was a significant interaction of eGFR with race and IL-6 with a trend for adionectin but no significant interactions with CKD (P > 0.1). In the fully adjusted model, there was a trend for an interaction with adiponectin for eGFR (P = 0.08) and significant for CKD (P = 0.04 ), where adiponectin was associated with IR in those without CKD but not in those with CKD.

CONCLUSIONS

In mainly Stage 3 CKD, kidney function is associated with IR; except for adiponectin, the correlates of IR are similar in those with and without CKD.

Risk factor associations with clinical distal symmetrical polyneuropathy and various neuropathy screening instruments and protocols in type 1 diabetes

OBJECTIVE

To determine whether DSP and neuropathy-assessment instruments used by non-physicians have similar risk factors.

RESEARCH DESIGN AND METHODS

analyses were cross-sectional (n=176).

RESULTS

risk factors were similar for DSP and screening devices.

CONCLUSIONS

these data support the clinical utility of neuropathy screening devices used by non-physician personnel.

Greater adipose tissue infiltration in skeletal muscle among older men of African ancestry

CONTEXT

There is substantial variability across ethnic groups in the predisposition to obesity and associated metabolic abnormalities. Skeletal muscle fat has been identified as an important depot that increases with aging and may contribute to the development of diabetes.

OBJECTIVE

We tested whether men of African ancestry have greater calf intermuscular adipose tissue (IMAT), compared to Caucasian men, and whether IMAT is associated with type 2 diabetes (T2D).

DESIGN

We measured fasting serum glucose, body mass index, total body fat by dual-energy x-ray absorptiometry, and calf skeletal muscle composition by quantitative computed tomography in 1105 Caucasian and 518 Afro-Caribbean men aged 65+.

RESULTS

Compared to Caucasian men, we found greater IMAT and lower sc adipose tissue in Afro-Caribbean men at all levels of total adiposity (P < 0.0001), including the subset of men matched on age and dual-energy x-ray absorptiometry total body fat percentage (P < 0.001). In addition, IMAT was 29 and 23% greater, whereas sc adipose tissue was 6 and 8% lower among Caucasian and Afro-Caribbean men with T2D, respectively, compared to men without T2D (P < 0.01). Observed differences in intermuscular and sc fat, both ethnic and between men with and without T2D, were independent of age, height, calf skeletal muscle and total adipose tissue, and lifestyle factors.

CONCLUSIONS

Our analyses suggest that despite lower total adiposity, skeletal muscle fat infiltration is greater among African than among Caucasian ancestry men and is associated with T2D in both ethnic groups. Additional studies are needed to determine the mechanisms contributing to ethnic differences in skeletal muscle adiposity and to define the metabolic and health implications of this fat depot.

Glycemic status and incident heart failure in elderly without history of diabetes mellitus: the health, aging, and body composition study

BACKGROUND

It is unclear whether measures of glycemic status beyond fasting glucose (FG) levels improve incident heart failure (HF) prediction in patients without history of diabetes mellitus (DM).

METHODS AND RESULTS

The association of measures of glycemic status at baseline (including FG, oral glucose tolerance testing [OGTT], fasting insulin, hemoglobin A(1c) [HbA(1c)] levels, and homeostasis model assessment of insulin resistance [HOMA-IR] and insulin secretion [HOMA-B]) with incident HF, defined as hospitalization for new-onset HF, was evaluated in 2386 elderly participants without history of DM enrolled in the Health, Aging, and Body Composition Study (median age, 73 years; 47.6% men; 62.5% white, 37.5% black) using Cox models. After a median follow-up of 7.2 years, 185 (7.8%) participants developed HF. Incident HF rate was 10.7 cases per 1000 person-years with FG <100mg/dL, 13.1 with FG 100-125 mg/dL, and 26.6 with FG >or=126 mg/dL (P=.002; P=.003 for trend). In adjusted models (for body mass index, age, history of coronary artery disease and smoking, left ventricular hypertrophy, systolic blood pressure and heart rate [HR], and creatinine and albumin levels), FG was the strongest predictor of incident HF (adjusted HR per 10mg/dL, 1.10; 95% CI, 1.02-1.18; P=.009); the addition of OGTT, fasting insulin, HbA(1c), HOMA-IR, or HOMA-B did not improve HF prediction. Results were similar across race and gender. When only HF with left ventricular ejection fraction (LVEF) <or=40% was considered (n=69), FG showed a strong association in adjusted models (HR per 10mg/dL, 1.15; 95% CI, 1.03-1.29; P=.01). In comparison, when only HF with LVEF >40%, was considered (n=71), the association was weaker (HR per 10mg/dL, 1.05; 95% CI; 0.94-1.18; P=.41).

CONCLUSIONS

Fasting glucose is a strong predictor of HF risk in elderly without history of DM. Other glycemic measures provide no incremental prediction information.