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1.  Exploring psychosocial pathways between neighbourhood characteristics and stroke in older adults: the cardiovascular health study 
Age and Ageing  2012;42(3):391-397.
Objectives: to investigate whether psychosocial pathways mediate the association between neighbourhood socioeconomic disadvantage and stroke.
Methods: prospective cohort study with a follow-up of 11.5 years.
Setting: the Cardiovascular Health Study, a longitudinal population-based cohort study of older adults ≥65 years.
Measurements: the primary outcome was adjudicated incident ischaemic stroke. Neighbourhood socioeconomic status (NSES) was measured using a composite of six census-tract variables. Psychosocial factors were assessed with standard measures for depression, social support and social networks.
Results: of the 3,834 white participants with no prior stroke, 548 had an incident ischaemic stroke over the 11.5-year follow-up. Among whites, the incident stroke hazard ratio (HR) associated with living in the lowest relative to highest NSES quartile was 1.32 (95% CI = 1.01–1.73), in models adjusted for individual SES. Additional adjustment for psychosocial factors had a minimal effect on hazard of incident stroke (HR = 1.31, CI = 1.00–1.71). Associations between NSES and stroke incidence were not found among African-Americans (n = 785) in either partially or fully adjusted models.
Conclusions: psychosocial factors played a minimal role in mediating the effect of NSES on stroke incidence among white older adults.
doi:10.1093/ageing/afs179
PMCID: PMC3633364  PMID: 23264005
neighbourhood; psychosocial factors; stroke; older adults
2.  Objective measurements of daily physical activity patterns and sedentary behaviour in older adults: Age, Gene/Environment Susceptibility-Reykjavik Study 
Age and Ageing  2012;42(2):222-229.
Background: 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.
Methods: 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.
Results: 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 <1%. Men had slightly higher average total PA (counts × day−1) than women. The women spent more time in low-light PA but less time in sedentary PA and MVPA compared with men (P < 0.001). In persons <75 years of age, 60% of men and 34% of women had at least one bout ≥10 min of MVPA, which decreased with age, with only 25% of men and 9% of women 85 years and older reaching this.
Conclusion: sedentary time is high in this Icelandic cohort, which has high life-expectancy and is living north of 60° northern latitude.
doi:10.1093/ageing/afs160
PMCID: PMC3575120  PMID: 23117467
physical activity; accelerometry; sedentary behaviour; older adults; BMI; AGES-Reykjavik; older people
3.  Association of age at diagnosis and Crohn's disease phenotype 
Age and Ageing  2012;42(1):102-106.
Background: fifteen percent of patients with Crohn’s disease (CD) are elderly; they are less likely to have complications and more likely to have colonic disease.
Objective: to compare disease behaviour in patients with CD based on age at diagnosis.
Design: cross-sectional study.
Setting: tertiary referral centre.
Subjects: patients with confirmed CD.
Methods: behaviour was characterised according to the Montreal classification. Patients with either stricturing or penetrating disease were classified as having complicated disease. Age at diagnosis was categorised as <17, 17–40, 41–59 and ≥60 years. Logistic regression analysis was performed to examine the association between advanced age ≥60 and complicated disease.
Results: a total of 467 patients were evaluated between 2004 and 2010. Increasing age of diagnosis was negatively associated with complicated disease and positively associated with colonic disease. As age of diagnosis increased, disease duration (P < 0.001), family history of Inflammatory bowel disease (IBD) (P = 0.015) and perianal disease decreased (P < 0.0015). After adjustment for confounding variables, the association between age at diagnosis and complicated disease was no longer significant (OR: 0.60, 95% CI: 0.21–1.65).
Conclusions: patients diagnosed with CD ≥60 were more likely to have colonic disease and non-complicated disease. However, the association between age at diagnosis and complicated disease did not persist after adjustment for confounding variables.
doi:10.1093/ageing/afs107
PMCID: PMC3518904  PMID: 22918090
Crohn's disease; aged; phenotype; inflammatory bowel disease; older people
4.  Cognitive screening in the acute stroke setting 
Age and Ageing  2012;42(1):113-116.
Background: current literature suggests that two-thirds of patients will have cognitive impairment at 3 months post-stroke. Post-stroke cognitive impairment is associated with impaired function and increased mortality. UK guidelines recommend all patients with stroke have a cognitive assessment within 6 weeks. There is no ‘gold standard’ cognitive screening tool. The Montreal cognitive assessment (MoCA) is more sensitive than the Mini-Mental State Examination (MMSE) in mild cognitive impairment and for cognitive impairment in the non-acute post-stroke setting and in a Chinese-speaking acute stroke setting.
Methods: a convenience sample of 50 patients, admitted with stroke or transient ischaemic attack (TIA), were screened within 14 days, using the MoCA and the MMSE.
Results: the mean MoCA was 21.80 versus a mean MMSE of 26.98; 70% were impaired on the MoCA (cut-off <26) versus 26% on MMSE (cut-off <27). The MoCA could be completed in <10 min in 90% of cases.
Conclusion: the MoCA is easy and quick to use in the acute stroke setting. Further work is required to determine whether a low score on the MoCA in the acute stroke setting will predict the cognitive and functional status and to explore what the best cut-off should be in an acute post-stroke setting.
doi:10.1093/ageing/afs116
PMCID: PMC3518905  PMID: 22923608
stroke; cognitive impairment; post-stroke dementia; older people
5.  An investigation into which individual instrumental activities of daily living are affected by a home visiting nurse intervention 
Age and Ageing  2012;42(1):27-33.
Background: to our knowledge no research has investigated the effect of home visiting nurse (HVN) interventions on individual instrumental activities of daily living (IADL).
Objective: to investigate the effects of an HVN intervention on the difficulty or dependence in six individual IADLs.
Design: a secondary analysis of a randomised controlled study comparing an HVN intervention (n = 237) with usual care (n = 262) at 22 months after study entry.
Setting: home care linked to primary care.
Subjects: a total of 499 Medicare patients needing or receiving help with at least three IADLs or two ADLs, who had recent significant health-care use.
Methods: the intervention consisted of monthly home visits by trained nursing staff. Unadjusted and adjusted (binary and multinomial logistic regression) analyses were performed.
Results: unadjusted analyses found less difficulty or dependence for the HVN group for meal preparation, telephone use, shopping and ordinary housework, and more difficulty or dependence for medication management. After adjustment, in addition to an effect through health-care services use, the HVN group had less difficulty or dependence for meal preparation and shopping and more difficulty or dependence for medication management.
Conclusions: an HVN intervention had mixed results for individual IADLs. The negative effect on medication management questions the validity of a total IADL score as an outcome measure, and implies that other medication management measures should be considered for outcome evaluation. Future research is needed to confirm and better understand these findings.
doi:10.1093/ageing/afs151
PMCID: PMC3577044  PMID: 23034558
instrumental activities of daily living; homecare; nursing; aged; older people
6.  Childhood milk consumption is associated with better physical performance in old age 
Age and Ageing  2012;41(6):776-784.
Background: studies have shown that milk and dairy consumption in adulthood have beneficial effects on health.
Methods: we examined the impact of childhood and adult diet on physical performance at age 63–86 years. The Boyd Orr cohort (n = 405) is a 65-year prospective study of children who took part in a 1930's survey; the Caerphilly Prospective Study (CaPS; n = 1,195) provides data from mid-life to old age. We hypothesised that higher intakes of childhood and adult milk, calcium, protein, fat and energy would be associated with a better performance.
Results: in fully adjusted models, a standard deviation (SD) increase in natural log-transformed childhood milk intake was associated with 5% faster walking times from the get-up and go test in Boyd Orr (95% CI: 1 to 9) and 25% lower odds of poor balance (OR: 0.75; 0.55 to 1.02). Childhood calcium intake was positively associated with walking times (4% faster per SD; 0 to 8) and a higher protein intake was associated with lower odds of poor balance (OR: 0.71; 0.54 to 0.92). In adulthood, protein intake was positively associated with walking times (2% faster per SD; 1 to 3; Boyd Orr and CaPS pooled data).
Conclusion: this is the first study to show positive associations of childhood milk intake with physical performance in old age.
doi:10.1093/ageing/afs052
PMCID: PMC3476828  PMID: 22542496
diet; physical performance; walking speed; standing balance; older people
7.  Inferior physical performance tests in 10,998 men in the MrOS study is associated with recurrent falls 
Age and Ageing  2012;41(6):740-746.
Background: recurrent fallers are at especially high risk for injuries.
Objective: to study whether tests of physical performance are associated with recurrent falls.
Subjects: a total of 10,998 men aged 65 years or above.
Methods: questionnaires evaluated falls sustained 12 months preceding testing of grip strength, timed stand, 6-m walk and 20-cm narrow walk test. Means with 95% confidence interval (95% CI) are reported. P < 0.01 is a statistically significant difference.
Results: in comparison to both occasional fallers and non-fallers, recurrent fallers performed more poorly on all the physical ability tests (all P < 0.001). A score below −2 standard deviations (SDs) in the right-hand grip strength test was associated with an odds ratio of 2.4 (95% CI 1.7, 3.4) for having had recurrent falls compared with having had no fall and of 2.0 (95% CI 1.3, 3.4) for having had recurrent falls compared with having had an occasional fall.
Conclusion: low performance in physical ability tests are in elderly men associated with recurrent falls.
doi:10.1093/ageing/afs104
PMCID: PMC3476829  PMID: 22923607
falls; men; muscle; older people; physical performance tests; recurrent
8.  The role of physical activity and diabetes status as a moderator: functional disability among older Mexican Americans 
Age and Ageing  2012;41(6):752-758.
Purpose: we investigate the temporal association between the rate of change in physical function and the rate of change in disability across four comparison groups: Those with and without diabetes who report >30 min of physical activity per day, and those who report <30 min of physical activity per day.
Methods: six waves of longitudinal data from the Hispanic Established Population for Epidemiologic Studies of the Elderly were utilised. At baseline, there were a total of 3,050 elder participants aged 65 years old or greater. The longitudinal rates of change in disability and physical function were compared by the diabetes status (ever versus none) and the physical activity status (less than or greater than or equal to 30 min per day).
Results: disability and physical function data were analysed using a latent growth curve modelling approach adjusted for relevant demographic/health-related covariates. There were statistically significant longitudinal declines in physical function and disability (P < 0.001) in all groups. Most notable, the physical activity status was an important moderator. Those with >30 min of activity demonstrated better baseline function and less disability as well as better temporal trajectories than those reporting <30 min of physical activity per day. Comparisons between diabetes statuses within the same physical activity groups showed worse disability trajectories among those with diabetes.
Conclusions: a longitudinal decline in physical function and disability is moderated most notably by physical activity. The diabetes status further moderates decline in function and disability over time. Increased physical activity appears to be protective of disability in general and may lessen the influence of diabetes-related disability in older Mexican Americans, particularly at the end of life.
doi:10.1093/ageing/afs106
PMCID: PMC3577043  PMID: 23052844
physical activity; diabetes; disability; Mexican Americans; ageing populations
9.  The frailty index in Europeans: association with age and mortality 
Age and Ageing  2012;41(5):684-689.
Background: the frailty index (FI) is an approach to the operationalisation of frailty based on accumulation of deficits. It has been less studied in Europeans.
Objective: to construct sex-specific FIs from a large sample of Europeans and study their associations with age and mortality.
Design: longitudinal population-based survey.
Setting: the Survey of Health, Ageing and Retirement in Europe (SHARE, http://share-dev.mpisoc.mpg.de/).
Subjects: a total of 16,217 females and 13,688 males aged ≥50 from wave 1 (2004–05). Mortality data were collected between 2005 and 2006 (mean follow-up: 2.4 years).
Methods: regression curve estimations between age and an FI constructed as per the standard procedure. Logistic regressions were used to assess the relative effects of age and the FI towards mortality.
Results: in both sexes, there was a significant non-linear association between age and the FI (females: quadratic R2 = 0.20, P < 0.001; males: quadratic R2 = 0.14, P < 0.001). Overall, the FI was a much stronger predictor of mortality than age, even after adjusting for the latter (females: age-adjusted OR 100.5, 95% confidence interval (CI): 46.3–218.2, P < 0.001; males: age-adjusted OR 221.1, 95% CI: 106.7–458.4, P < 0.001).
Conclusion: the FI had the expected properties in this large sample of Europeans.
doi:10.1093/ageing/afs051
PMCID: PMC3424051  PMID: 22522775
frail elderly; health status index; mortality; frailty index; sex differences; elderly
10.  Community falls prevention for people who call an emergency ambulance after a fall: an economic evaluation alongside a randomised controlled trial 
Age and Ageing  2012;41(5):635-641.
Objective: we estimated the cost-effectiveness of a community falls prevention service compared with usual care from a National Health Service and personal social services perspective over the 12 month trial period.
Design: a cost-effectiveness and cost utility analysis alongside a randomised controlled trial
Setting: community.
Participants: people over 60 years of age living at home or in residential care who had fallen and called an emergency ambulance but were not taken to hospital.
Interventions: referral to community fall prevention services or usual health and social care.
Measurements: incremental cost per fall prevented and incremental cost per Quality-Adjusted Life Years (QALYs)
Results: a total of 157 participants (82 interventions and 75 controls) were used to perform the economic evaluation. The mean difference in NHS and personal social service costs between the groups was £-1,551 per patient over 1 year (95% CI: £-5,932 to £2,829) comparing the intervention and control groups. The intervention patients experienced on average 5.34 fewer falls over 12 months (95% CI: −7.06 to −3.62). The mean difference in QALYs was 0.070 (95% CI: −0.010 to 0.150) in favour of the intervention group.
Conclusion: the community falls prevention service was estimated to be cost-effective in this high-risk group. Current Controlled Trials ISRCTN67535605. (controlled-trials.com)
doi:10.1093/ageing/afs071
PMCID: PMC3424053  PMID: 22695789
economic evaluation; falls prevention; older people
11.  High normal plasma triglycerides are associated with preserved cognitive function in Chinese oldest-old 
Age and Ageing  2012;41(5):600-606.
Objective: to explore the relationship between blood lipids/lipoproteins and cognitive function in the Chinese oldest-old.
Design: multivariate statistical analysis using cross-sectional data.
Setting: community-based setting in longevity areas in China.
Subjects: eight hundred and thirty-six subjects aged 80 and older were included in the sample.
Methods: plasma total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, blood pressure and fasting plasma glucose were measured and information about demographics and lifestyle was collected. Cognitive status was assessed using the Mini-Mental State Examination (MMSE).
Results: cumulative logit model analysis showed that triglyceride was significantly negatively associated with cognitive impairment. By general linear modelling, there was a significant linear trend of MMSE scores with the level of triglyceride, but not with levels of cholesterol after adjustment. The odds ratio (OR) of cognitive impairment (MMSE score < 18) was significantly reduced for the highest quartile of plasma triglyceride concentration (OR: 0.52, 95% CI: 0.33–0.84), but not for the second or third quartile, compared with the lowest quartile (adjusted models). There were no significant associations between cognitive impairment and cholesterol.
Conclusion: we concluded that high normal plasma triglyceride was associated with preservation of cognitive function while lower concentrations were not in the Chinese oldest-old.
doi:10.1093/ageing/afs033
PMCID: PMC3500861  PMID: 22447910
triglycerides; cognitive function; lipids; oldest-old; elderly
12.  Interpreting and evaluating the CASP-19 quality of life measure in older people 
Age and Ageing  2012;41(5):612-617.
Objective: to investigate how to interpret changes on the CASP-19 quality of life scale for older people, and whether it discriminates between, and is responsive to, relevant differences or changes in participants' circumstances.
Methods: analysis of data from the English Longitudinal Study of Ageing for those completing CASP-19 in both Wave 1 and Wave 2 (n = 6,482). Cross-sectional and longitudinal comparisons, using multiple linear regression, of CASP-19 scores with respect to eight anchor variables.
Results: cross-sectional comparisons found differences in mean CASP-19 scores at Wave 1 between categories of anchor variables varied from 1.9 for living alone to 8.0 for being able to walk ¼ mile with difficulty. Longitudinal comparisons of changes in CASP-19 found that subjects that had moved between categories of the anchor variables over 28 months, had changed their mean CASP-19 score by about 1 unit in the expected direction, compared with the unchanged category. These changes were statistically significant for six of the eight anchors.
Conclusions: the cross-sectional comparisons help interpret differences and indicate CASP-19 has discriminatory power. The longitudinal changes show that CASP-19 is responsive to changes in most anchor variables that reflect some aspects of quality of life.
doi:10.1093/ageing/afs023
PMCID: PMC3693476  PMID: 22391614
quality of life; older persons; responsiveness; discriminatory power; anchor-based methods; longitudinal studies; elderly
13.  Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes 
Age and Ageing  2012;41(4):488-495.
Background: worldwide, the frequency of tuberculosis among older people almost triples that observed among young adults.
Objective: to describe clinical and epidemiological consequences of pulmonary tuberculosis among older people.
Methods: we screened persons with a cough lasting more than 2 weeks in Southern Mexico from March 1995 to February 2007. We collected clinical and mycobacteriological information (isolation, identification, drug-susceptibility testing and IS6110-based genotyping and spoligotyping) from individuals with bacteriologically confirmed pulmonary tuberculosis. Patients were treated in accordance with official norms and followed to ascertain treatment outcomes, retreatment, and vital status.
Results: eight hundred ninety-three tuberculosis patients were older than 15 years of age; of these, 147 (16.5%) were 65 years of age or older. Individuals ≥65 years had significantly higher rates of recently transmitted and reactivated tuberculosis. Older age was associated with treatment failure (OR = 5.37; 95% CI: 1.06–27.23; P = 0.042), and death due to tuberculosis (HR = 3.52; 95% CI: 1.78–6.96; P < 0.001) adjusting for sociodemographic and clinical variables.
Conclusions: community-dwelling older individuals participate in chains of transmission indicating that tuberculosis is not solely due to the reactivation of latent disease. Untimely and difficult diagnosis and a higher risk of poor outcomes even after treatment completion emphasise the need for specific strategies for this vulnerable group.
doi:10.1093/ageing/afs028
PMCID: PMC3377131  PMID: 22431155
tuberculosis; older; ageing; epidemiology; incidence rates; mortality rates; diagnosis; elderly
14.  The impact of visual impairment on Mini-Mental State Examination Scores in the Newcastle 85+ study 
Age and Ageing  2012;41(4):565-568.
Background: cognitive test scores and visual acuity are strongly associated in older people. This may be due to poor vision limiting performance on cognitive tasks specifically requiring vision, or an association between visual and neurodegenerative disorders.
Objective: to explore, using data from the Newcastle 85+ cohort study, the impact of sight impairment (SI) on Mini-Mental State Examination (MMSE) scores and whether reduced scores among SI participants are limited to tasks requiring vision.
Results: of 839 participants aged 85 years, 44 (5.2%) were registered SI. Median (inter-quartile range) sMMSE scores were 25 (22–29) for SI and 28 (25–29) for non-SI participants (P = 0.006). SI participants had lower subscale scores on tasks requiring vision (P < 0.001 for each) but also for some subscale scores not obviously requiring vision: orientation (P = 0.018) and repetition (P = 0.030). Excluding visual items, there was no significant difference in MMSE scores between those with/without SI.
Conclusion: SI may be an obstacle to older people completing cognitive assessments including tasks requiring vision. People with SI also scored lower on some tasks not obviously requiring vision. An association between cognitive impairment and SI may exist beyond simply being unable to see the test material in cognitive tests.
doi:10.1093/ageing/afs042
PMCID: PMC3377132  PMID: 22431154
visually impaired persons; memory disorders; cognition; elderly
15.  High-sensitivity C-reactive protein and mobility disability in older adults 
Age and Ageing  2012;41(4):541-545.
Objective: to determine the association of high sensitivity C-reactive protein (HsCRP) levels with a risk of mobility disability and decline in older adults with and without vascular disease.
Design: prospective cohort.
Setting: community-residing population.
Subjects: six hundred and twenty-four adults age 70 and older (62% women) with gait and HsCRP assessments.
Main outcome measures: incident mobility disability (velocity <70 cm/s) and annual rates of decline on gait velocity.
Results: elevated HsCRP levels (≥3 mg/l) at baseline present in 224 of the 624 eligible subjects was associated with a faster annual decline in gait velocity of 0.91 cm/s (P = 0.02). Subjects with elevated HsCRP levels had increased risk of mobility disability (hazard ratio: 1.85, 95% CI: 1.09–3.14). Each one-unit increase in log HsCRP levels in the 406 subjects without prevalent mobility disability was associated with increased risk of mobility disability (hazard ratio: 1.33, 95% CI: 1.05–1.68). The association of baseline HsCRP levels with mobility disability and decline was stronger in the 224 individuals without vascular disease. The associations were not significant in the 400 subjects with vascular disease.
Conclusions: HsCRP levels predict mobility disability and accelerated decline in walking speed in older adults. These associations were stronger in those without vascular disease.
doi:10.1093/ageing/afs038
PMCID: PMC3500856  PMID: 22417984
cohort study; epidemiology; gait; inflammation elderly
16.  Effect of vertebral fractures on function, quality of life and hospitalisation the AGES-Reykjavik study 
Age and Ageing  2012;41(3):351-357.
Background: understanding the determinants of health burden after a fracture in ageing populations is important.
Objective: assess the effect of clinical vertebral and other osteoporotic fractures on function and the subsequent risk of hospitalisation.
Design: individuals from the prospective population-based cohort study Age, Gene/Environment Susceptibility (AGES)-Reykjavik study were examined between 2002 and 2006 and followed up for 5.4 years.
Subjects: a total of 5,764 individuals, 57.7% women, born 1907–35, mean age 77.
Method: four groups with a verified fracture status were used; vertebral fractures, other osteoporotic fractures excluding vertebral, non-osteoporotic fractures and not-fractured were compared and analysed for the effect on mobility, strength, QoL, ADL, co-morbidity and hospitalisation.
Results: worst performance on functional tests was in the vertebral fracture group for women (P < 0.0001) and the other osteoporotic fractures group for men (P < 0.05). Both vertebral and other osteoporotic fractures, showed an increased risk of hospitalisation, HR = 1.4 (95% CI: 1.3–1.7) and 1.2 (95% CI: 1.1–1.2) respectively (P < 0.0001). Individuals with vertebral fractures had 50% (P < 0.0001) longer hospitalisation than not-fractured and 33% (P < 0.002) longer than the other osteoporotic fractures group.
Conclusion: individuals with a history of clinical vertebral fracture seem to carry the greatest health burden compared with other fracture groups, emphasising the attention which should be given to those individuals.
doi:10.1093/ageing/afs003
PMCID: PMC3335370  PMID: 22367357
vertebral fracture; health burden; osteoporotic fracture; strength; ADL; quality of life; mobility; elderly
17.  Validation and diagnostic accuracy of the Alzheimer's questionnaire 
Age and Ageing  2012;41(3):396-399.
Background: accurately identifying individuals with cognitive impairment is difficult. Given the time constraints that many clinicians face, assessment of cognitive status is often not undertaken. The intent of this study is to determine the diagnostic accuracy of the Alzheimer's questionnaire (AQ) in identifying individuals with mild cognitive impairment (MCI) and AD.
Methods: utilising a case–control design, 300 [100 AD, 100 MCI, 100 cognitively normal (CN)] older adults between the ages of 53 and 93 from a neurology practice and a brain donation programme had the AQ administered to an informant. Diagnostic accuracy was assessed through receiver-operating characteristic analysis, which yielded sensitivity, specificity and area under the curve (AUC).
Results: the AQ demonstrated high sensitivity and specificity for detecting MCI [89.00 (81.20–94.40)]; [91.00 (83.60–65.80)] and AD [99.00 (94.60–100.00)]; [96.00 (90.10–98.90)]. AUC values also indicated high diagnostic accuracy for both MCI [0.95 (0.91–0.97)] and AD [0.99 (0.96–1.00)]. Internal consistency of the AQ was also high (Cronbach's alpha = 0.89).
Conclusion: the AQ is a valid informant-based instrument for identifying cognitive impairment, which could be easily implemented in a clinician's practice. It has high sensitivity and specificity in detecting both MCI and AD and allows clinicians to quickly and accurately assess individuals with reported cognitive problems.
doi:10.1093/ageing/afs008
PMCID: PMC3335371  PMID: 22367356
mild cognitive impairment; Alzheimer's disease; cognitive screening; informant-based assessment
18.  Inferior physical performance test results of 10,998 men in the MrOS Study is associated with high fracture risk 
Age and Ageing  2012;41(3):339-344.
Background: most fractures are preceded by falls.
Objective: the aim of this study was to determine whether tests of physical performance are associated with fractures.
Subjects: a total of 10,998 men aged 65 years or above were recruited.
Methods: questionnaires evaluated falls sustained 12 months before administration of the grip strength test, the timed stand test, the six-metre walk test and the twenty-centimetre narrow walk test. Means with 95% confidence interval (95% CI) are reported. P < 0.05 is a statistically significant difference.
Results: fallers with a fracture performed worse than non-fallers on all tests (all P < 0.001). Fallers with a fracture performed worse than fallers with no fractures both on the right-hand-grip strength test and on the six-metre walk test (P < 0.001). A score below –2 standard deviations in the right-hand-grip strength test was associated with an odds ratio of 3.9 (95% CI: 2.1–7.4) for having had a fall with a fracture compared with having had no fall and with an odds ratio of 2.6 (95% CI: 1.3–5.2) for having had a fall with a fracture compared with having had a fall with no fracture.
Conclusion: the right-hand-grip strength test and the six-metre walk test performed by old men help discriminate fallers with a fracture from both fallers with no fracture and non-fallers.
doi:10.1093/ageing/afs010
PMCID: PMC3335372  PMID: 22314696
falls; fractures; men; old; physical performance tests; elderly
19.  Patterns and correlates of grip strength change with age in Afro-Caribbean men 
Age and Ageing  2012;41(3):326-332.
Background: muscle strength is essential for physical functions and an indicator of morbidity and mortality in older adults. Among the factors associated with muscle strength loss with age, ethnicity has been shown to play an important role.
Objective: to examine the patterns and correlates of muscle strength change with age in a population-based cohort of middle-aged and older Afro-Caribbean men.
Methods: handgrip strength and body composition were measured in 1,710 Afro-Caribbean men. Data were also collected for demographic variables, medical history and lifestyle behaviours.
Results: the age range of the study population was 29–89 years. Grip strength increased below age 50 years, and decreased after age 50 years over 4.5-year follow-up. The average loss in grip strength was 2.2% (0.49% per year) for ages 50 years or older and 3.8% (0.64% per year) for ages 65 years or older. The significant independent predictors of grip strength loss included older age, a greater body mass index, lower initial arm lean mass and greater loss of arm lean mass.
Conclusion: Afro-Caribbean men experience a significant decline in muscle strength with advanced age. The major independent factors associated with strength loss were similar to other ethnic groups, including age, body weight and lean mass.
doi:10.1093/ageing/afs030
PMCID: PMC3335373  PMID: 22465797
male; population-based study; muscle strength; strength loss; ageing; elderly
20.  Brief Memory and Executive Test: evaluation of a new screening test for cognitive impairment due to small vessel disease 
Age and Ageing  2012;41(2):212-218.
Background: cerebral small vessel disease (SVD) is the most common cause of vascular cognitive impairment (VCI). Despite this, there is a paucity of rapid simple screening tools to identify cognitive impairment in SVD and differentiate it from other common dementia types.
Objective: to validate a new screening test for cognitive impairment in SVD, the Brief Memory and Executive Test (BMET) battery, and examine its ability to detect SVD and differentiate it from Alzheimer's disease (AD).
Subjects: 45 patients with SVD, 27 patients with AD and 80 normal controls.
Methods: the BMET includes brief tests of executive functioning and processing speed, with comparative tests of memory and orientation. Group discrimination was calculated using discriminant function analysis.
Results: the BMET took an average of 10 min to administer. It showed high sensitivity (91%) and specificity (85%) in differentiating SVD patients with cognitive impairment from AD patients. As a comparison the mini-mental state examination had lower sensitivity (63%) and specificity (62%).
Conclusions: the BMET is a simple and quick to administer clinical tool for the detection of VCI in SVD and its differentiation from AD impairment. Further multicentre studies are required to evaluate and compare it with other existing screening tests.
doi:10.1093/ageing/afr172
PMCID: PMC3280679  PMID: 22267862
vascular cognitive impairment; small vessel disease; stroke; lacunar; rapid screening; elderly
21.  Older adults with higher income or marriage have longer telomeres 
Age and Ageing  2012;42(2):234-239.
Background: telomere length has been used to represent biological ageing and is found to be associated with various physiological, psychological and social factors.
Objective: to explore the effects of income and marriage on leucocyte telomere length in a representative sample of older adults.
Design and subjects: cross-sectional analysis among 298 adults, aged 65–74, randomly selected from the community by census.
Methods: telomere length was measured by quantitative PCR. Participants provided information on sociodemographics, physical illness and completed questionnaires rating mental state and perceived neighbourhood experience.
Results: telomere length was negatively associated with lower income [coefficient −0.141 (95% CI: −0.244 to −0.020), P = 0.021] and positively associated with the marital status [coefficient 0.111 (95% CI: −0.008 to 0.234), P = 0.067] when controlling for gender, age, educational level, physical diseases (including diabetes, hypertension, cardiovascular diseases, cerebrovascular disease and Parkinson's disease), depressive symptoms, minor mental symptoms, cognitive impairment and perceived neighbourhood experience (including social support, perceived security and public facilities).
Conclusions: these results indicate that older adults with higher income or being married have longer telomeres when other sociodemographics, physical diseases, mental status and neighbourhood experience are adjusted.
doi:10.1093/ageing/afs122
PMCID: PMC3575119  PMID: 22951603
telomere; income; marital status; neighbourhood; stress; older people
22.  Socioeconomic circumstances, health behaviours and functional limitations in older persons in four Central and Eastern European populations 
Age and Ageing  2012;41(6):728-735.
Objectives: to investigate functional limitations and their association with socioeconomic factors in four Central and Eastern European populations.
Methods: a cross-sectional study of random population samples in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns participating in the HAPIEE study. Functional limitations (classified into tertiles of the SF-36 physical functioning subscale), socioeconomic circumstances and health behaviours were available for 34,431 subjects aged 45–69 years.
Results: the proportion of subjects in the worst tertile of the functional limitations score (≤80% of the maximum score) ranged from 21% of the men in Kaunas to 48% in Krakow women. In multivariate ordered logistic regression, functional limitations were strongly inversely associated with education and positively with material deprivation and with being economically inactive. Functional limitations were more common in male smokers and less common in alcohol drinkers. Socioeconomic characteristics explained some of the differences in functional limitations between populations. Health behaviours explained some of the differences between social groups in both genders and between populations in women.
Conclusion: unexpectedly, functional limitations were not most common in the sample from Russia, the country with the highest mortality rates. All socioeconomic measures were strongly associated with functional limitations and made some contribution towards explaining differences in limitations between populations.
doi:10.1093/ageing/afs114
PMCID: PMC3476830  PMID: 22923605
disability; physical functioning; socioeconomic factors; Eastern Europe; older people
23.  Adult macronutrient intake and physical capability in the MRC National Survey of Health and Development 
Age and Ageing  2012;42(1):81-87.
Background: poor physical capability is associated with higher subsequent risk of disability and mortality in older people. Energy and macronutrient intakes may play a role in the maintenance of physical capability. This analysis aimed to examine the role of intakes of energy and the macronutrients, protein, carbohydrate and fat in early and mid-adulthood on objective measures of physical capability in later adulthood in the MRC National Survey of Health and Development (1946 British birth cohort).
Methods: adult diet assessed by a 5-day diary at 36 years (1982) and 43 years (1989). Physical capability was assessed at 53 years. Objective measures were height, weight and three measures of physical capability: grip strength, standing balance time and chair rises.
Results: using multiple linear regression analysis, modest positive associations were found between energy intake at 36 and 43 years and grip strength at 53 years. Results for macronutrients were mixed although there was some indication of relationships of protein intake with grip strength and standing balance time.
Conclusions: higher energy intake in midlife may play a role in the prevention of muscle weakness in later life. Higher protein intakes may also be related to physical capability but further research is needed.
doi:10.1093/ageing/afs101
PMCID: PMC3518903  PMID: 22923606
physical capability; diet; energy; macronutrients; longitudinal
24.  Comparison of the quick mild cognitive impairment (Qmci) screen and the SMMSE in screening for mild cognitive impairment 
Age and Ageing  2012;41(5):624-629.
Introduction: differentiating mild cognitive impairment (MCI) from normal cognition (NC) is difficult. The AB Cognitive Screen (ABCS) 135, sensitive in differentiating MCI from dementia, was modified to improve sensitivity and specificity, producing the quick mild cognitive impairment (Qmci) screen.
Objective: this study compared the sensitivity and specificity of the Qmci with the Standardised MMSE and ABCS 135, to differentiate NC, MCI and dementia.
Methods: weightings and subtests of the ABCS 135 were changed and a new section ‘logical memory’ added, creating the Qmci. From four memory clinics in Ontario, Canada, 335 subjects (154 with MCI, 181 with dementia) were recruited and underwent comprehensive assessment. Caregivers, attending with the subjects, without cognitive symptoms, were recruited as controls (n = 630).
Results: the Qmci was more sensitive than the SMMSE and ABCS 135, in differentiating MCI from NC, with an area under the curve (AUC) of 0.86 compared with 0.67 and 0.83, respectively, and in differentiating MCI from mild dementia, AUC of 0.92 versus 0.91 and 0.91. The ability of the Qmci to identify MCI was better for those over 75 years.
Conclusion: the Qmci is more sensitive than the SMMSE in differentiating MCI and NC, making it a useful test, for MCI in clinical practice, especially for older adults.
doi:10.1093/ageing/afs059
PMCID: PMC3424052  PMID: 22610464
quick mild cognitive impairment screen; mild cognitive impairment; standardised mini-mental state examination; AB cognitive screen 135; sensitivity
25.  Older people's preferences regarding programme formats for managing concerns about falls 
Age and Ageing  2012;41(4):474-481.
Objective: to explore the preferences of community-dwelling older persons regarding different programme formats for managing concerns about falls.
Subjects and design: cross-sectional study of 5,755 community-dwelling people aged ≥70 years in the Netherlands.
Methods: a questionnaire assessed people's willingness to participate per programme format (n = 6), i.e. a programme at home, via telephone, via home visits and telephone consultations, via television or via Internet.
Results: of the 2,498 responders, 62.7% indicated no interest in any of the formats. The willingness to participate per programme format varied between 21.5 (at home) and 9.4% (via Internet). Among people interested in at least one of the formats (n = 931), higher levels of fall-related concerns were associated with increased preference for a programme with home visits. Poor perceived health and age ≥80 years were associated with less preference for a group programme. Higher educated people were more in favour of a programme via Internet compared with their lower educated counterparts.
Conclusion: the majority of community-dwelling older people are not likely to participate in any of the six proposed programme formats for managing concerns about falls. However, when diverse formats of effective programmes will be made available, uptake and adherence may be increased since programme preferences are associated to specific population characteristics.
doi:10.1093/ageing/afs007
PMCID: PMC3377130  PMID: 22367355
aged; fear of falling; programme formats; patient preference; accidental falls; elderly

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