To examine relationships between modifiable midlife factors, aging, and physical and cognitive function (independent aging) and survival in very old age.
Uppsala Longitudinal Study of Adult Men, Uppsala, Sweden.
Swedish men investigated in 1970-74 (aged 48.6-51.1) and followed up for four decades (N=2,293).
Conventional cardiovascular risk factors, body mass index (BMI), and dietary biomarkers were measured, and a questionnaire was used to gather information on lifestyle variables at age 50. Four hundred seventy-two men were reinvestigated in 2008-09 (aged 84.8-88.9). Independent aging was defined as survival to age 85, Mini-Mental State Examination score of 25 or greater, not living in an institution, independent in personal care and hygiene, able to walk outdoors without personal help, and no diagnosis of dementia. The National Swedish Death Registry provided survival data.
Thirty-eight percent of the cohort survived to age 85. Seventy-four percent of the participants in 2008-09 were aging independently. In univariable analyses, high leisure-time physical activity predicted survival but not independent aging. Low work-time physical activity was associated more strongly with independent aging (odds ratio (OR)=1.84, 95% confidence interval (CI)=1.18-2.88) than with survival (OR=1.27, 95% CI=1.05-1.52). In multivariable analyses, midlife BMI was negatively associated (OR=0.80/SD, 95% CI=0.65-0.99/SD), and never or former smoking was positively associated (OR=1.66, 95% CI=1.07-2.59), with independent aging. As expected, conventional cardiovascular and lifestyle risk factors were associated with mortality.
A normal midlife BMI and not smoking were associated with independent aging close to four decades later, indicating that normal weight at midlife has the potential not only to increase survival, but also to preserve independence with aging.
How older people spend their time in different occupations could contribute to our understanding of everyday life in healthy ageing. This study adopted a time-geographic method and occupational perspective to explore the occupational engagement of community dwelling older people. The term occupational engagement encompasses what people do, where and with whom they spend their time and the perceived level of competence and meaningfulness of their time use. Nineteen volunteers born between 1932 and 1933, living alone in an urban area in northern Sweden and receiving no home care services, completed open time-geographic diaries for 5 days in May 2010. The diary data were analyzed using Daily Life software program. The study revealed the complexity and the diversity of the older people's occupational engagement and that most of their time was spent alone in their home. The older people reported they were very good at doing almost half of the occupations in which they engaged and that their occupations were primarily either very meaningful or meaningful. While some methodological limitations were identified, time-geographic studies of community dwelling older people living independently are considered to have potential to contribute to community and social planning for older people as they can provide interesting insights to older persons' time use and occupational needs.
Prepared meals distributed by municipalities is a service to elderly people, or persons with health related impairments, who live in their own home, have difficulties preparing their own food and cannot meet their food requirements in any other way. This study aimed to provide a brief picture of how elderly people living at home perceive the food they receive through their municipal food service and what is important to them. The data was collected using questionnaires. 274 out of 276 participants answered the questionnaire (n=173 women 62% and n=101 man 37%). The data was analyzed using Principal Component Analysis (PCA). The results showed that the elderly persons receiving meals through the service were often satisfied, especially with the size of the portions and the delivery time. Those who had been using the food delivery service for a longer time were not satisfied with the alternative dishes they were been offered. There was no significant difference between the views of either gender. Further, those who were receiving special food were, in general, unsatisfied with the meals delivered. Development of the food distribution service by systematic quality insurance and interactive knowledge exchange between the producers and consumers seems to be a way to promote a more holistic and individual adjusted service. Evaluation of the municipal FD service is a powerful tool that can contribute to the development of this service. The food service can be improved and consequently even the quality of life and health of its receivers. The present survey should be revisited and developed in order to detect differences between genders.
The purpose of this study is to assess short- and long-distance walking performance in indoor and outdoor environments of slow and fast walkers' subjects living in the community in the later stage post-stroke. Thirty-six subjects with at least 6 months post-stroke were included and divided into two groups based on their walking speed in the clinical setting. Thirty-meter walk tests (30?mWT) at self-selected and maximum speeds were assessed in three environments: (1) clinical setting; (2) basement setting; and (3) outdoor setting. Six-minute walk test (6?MWT) distance was assessed in the clinical and outdoor settings. The differences between the 30?mWT and the 6?MWT, as measured by the actual distance obtained in the 6?MWT and the predicted distance calculated for the 30?mWT, were also investigated. There was no difference in walking speed when subjects performed short-distance walking in different environments. However, a difference was found in performance of long-distance walking. Subjects who walked 0.8?m/s or faster also walked further in the outdoor setting. The findings of our study demonstrate that in those who scored below 0.8?m/s, performance of short- and long-distance walking evaluated in an indoor environment reflects the results obtained in an outdoor environment. However, for subjects post-stroke who score 0.8?m/s or faster, distance was increased in the outdoor environments during long-distance walking. Walking speed obtained over a short distance seemed to overestimate long-distance walking capacity for the slow walkers, despite the environment.
Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls.
Community-dwelling individuals 75-93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, =2 non-injurious falls, and =1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls.
During the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40-5.50) compared to those with no falls. No other group showed an increased risk.
In community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall.
Cites: Med Clin North Am. 2006 Sep;90(5):807-2416962843
objectively measured population physical activity (PA) data from older persons is lacking. The aim of this study was to describe free-living PA patterns and sedentary behaviours in Icelandic older men and women using accelerometer.
from April 2009 to June 2010, 579 AGESII-study participants aged 73-98 years wore an accelerometer (Actigraph GT3X) at the right hip for one complete week in the free-living settings.
in all subjects, sedentary time was the largest component of the total wear time, 75%, followed by low-light PA, 21%. Moderate-vigorous PA (MVPA) was
Cites: Am J Epidemiol. 2008 Apr 1;167(7):875-8118303006
This research uses four nationally representative samples of time diary data, spanning almost 30 yr, that are fused with energy expenditure information to enumerate the median daily duration of moderate or vigorous effort activity, quantify the prevalence of Canadians age 65 yr and older who are meeting recommended daily levels of physical activity, and explore the factors affecting rates of active living. Results indicate that 41.1% of older Canadians met recommended levels of physical activity in 1992, 40.6% in 1998, 43.5% in 2005, and 39.6% in 2010. Both rates of active living and daily duration of aerobic activity exhibit significant differences among sociodemographic groups, with age, sex, activity limitation, urban-rural, and season exhibiting the most significant influences. This study illustrates the potential for time diary data to provide detailed surveillance of physical activity patterns, active aging research, and program development, as well.
To study how long antidepressants initiated after diagnoses of Alzheimer's disease (AD) were used and factors associated with discontinuation of use among persons with Alzheimer's disease (AD). In addition, differences in duration of use between the antidepressants groups were compared.
Register-based Medication use and Alzheimer's disease (MEDALZ) cohort included 70,718 community-dwelling people with AD who were diagnosed during the years 2005-2011. For this study, the new antidepressant users were included after 1-year washout period (N?=?16,501; 68.6% females, mean age 80.9). The duration of antidepressant use was modeled with the PRE2DUP method. Factors associated with treatment discontinuation were assessed with Cox proportional hazard models and included age, gender, comorbid conditions and concomitant medications.
Median duration of the new antidepressant use period was 309 days (IQR 93-830). For selective serotonin reuptake inhibitor (SSRI) use, the median duration was 331 days (IQR 101-829), for mirtazapine 202 days (IQR 52-635), and for serotonin and norepinephrine reuptake inhibitors (SNRIs) 134 days (IQR 37-522). After 1-year follow-up, 40.8% had discontinued antidepressant use, 54.6% after 2 years and 64.1% after 3 years. Factors associated with treatment discontinuation were age over 85, male gender, diabetes, and use of memantine, opioids, and antiepileptics whereas benzodiazepines and related drugs and antipsychotic use were inversely associated with discontinuation.
Antidepressants are used for long-term among people with AD. Need and indication for antidepressant use should be assessed regularly as evidence on their efficacy for behavioral and psychological symptoms of dementia is limited.
This paper is a report of a study of the meaning of living alone from the perspective of older people with dementia.
Risks and problems experienced by older women living alone have been investigated mostly through quantitative research. Balancing their safety and autonomy is a serious international community care dilemma. Older people's perspectives have been muted in qualitative research on living alone with dementia.
Using an interpretive phenomenological approach and van Manen's method, 14 interviews were conducted in Ontario, Canada from January 2004 to April 2005 with eight older women diagnosed with Alzheimer disease or a related dementia.
The theme holding back time expressed the temporal meaning of living alone. Pharmacological treatments represented stored time, offering the opportunity to hold back future dreaded time. Past experience with others with dementia was a context for holding on to now and facing some risks of living alone with memory loss. The women acknowledged the limited time remaining for, and identified endpoints to, living alone.
Insight into the impact of past experience with others with dementia could inform nursing assessment and advocacy for health/social services that are sensitive to the potential emotional impact of mixing people with varied levels of dementia in the same programme.