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1.  Prevalence and correlates of frailty among community-dwelling older men and women: findings from the Hertfordshire Cohort Study 
Age and ageing  2009;39(2):197-203.
Background
frailty, a multi-dimensional geriatric syndrome, confers a high risk for falls, disability, hospitalisation and mortality. The prevalence and correlates of frailty in the UK are unknown.
Methods
frailty, defined by Fried, was examined among community-dwelling young-old (64-74 years) men (n = 320) and women (n = 318) who participated in the Hertfordshire Cohort Study, UK.
Results
the prevalence of frailty was 8.5% among women and 4.1% among men (P = 0.02). Among men, older age (P = 0.009), younger age of leaving education (P = 0.05), not owning/mortgaging one’s home (odds ratio [OR] for frailty 3.45 [95% confidence interval {CI} 1.01-11.81], P = 0.05, in comparison with owner/mortgage occupiers) and reduced car availability (OR for frailty 3.57 per unit decrease in number of cars available [95% CI 1.32, 10.0], P = 0.01) were associated with increased odds of frailty. Among women, not owning/mortgaging one’s home (P = 0.02) was associated with frailty. With the exception of car availability among men (P = 0.03), all associations were non-significant (P > 0.05) after adjustment for co-morbidity.
Conclusions
frailty is not uncommon even among community-dwelling young-old men and women in the UK. There are social inequalities in frailty which appear to be mediated by co-morbidity.
doi:10.1093/ageing/afp204
PMCID: PMC3546311  PMID: 20007127
frailty; prevalence; older people; social inequalities; co-morbidity; elderly
2.  Grip strength and cardiovascular drug use in older people: findings from the Hertfordshire Cohort Study 
Age and ageing  2009;39(2):185-191.
Background
reduced grip strength is associated with adverse health consequences, and there is interest in identifying modifiable influences. Cardiovascular drugs are commonly used by older people, but their effect on muscle strength is unclear.
Methods
we investigated associations between cardiovascular drug use and grip strength among 1,572 men and 1,415 women, aged 59-73, who participated in the Hertfordshire Cohort Study.
Results
Forty-five percent of participants were taking a cardiovascular drug. Furosemide was associated with average decreases in grip strength of 3.15 kg (95% confidence interval [CI] 0.90, 5.39, P<0.01) among men and 2.35 kg (95% CI 0.93, 3.77, P<0.01) among women after adjustment for age and height. Corresponding differences for nitrates were 1.84 kg (95% CI 0.29, 3.39, P=0.02) among men and 3.66 kg (95% CI 1.99, 5.33, P<0.01) among women. Calcium channel blockers and fibrates were associated with reduced grip among women. Statins were not associated with grip. The associations between grip strength and nitrate use in men and nitrate and fibrate use in women were robust to additional adjustment for comorbidity.
Conclusions
use of some cardiovascular drugs is associated with reduced grip strength in older people. These findings have potential implications for the functional ability of older people treated with these drugs.
doi:10.1093/ageing/afp203
PMCID: PMC3546312  PMID: 20019032
grip strength; sarcopenia; cardiovascular drugs; ageing; elderly
3.  Coronary heart disease risk factors and regional deprivation in England: does age matter? 
Age and Ageing  2009;39(2):253-256.
doi:10.1093/ageing/afp205
PMCID: PMC2842111  PMID: 19923164
regional deprivation; older population; CHD risk factors; social position; elderly
4.  Interaction of HDL cholesterol concentrations on the relationship between physical function and inflammation in community-dwelling older persons 
Age and Ageing  2009;39(1):74-80.
Background: the existence of a relationship among inflammation, high-density lipoprotein cholesterol (HDL-C) and physical function has been suggested.
Objective: the aim of the study is to investigate the possible interaction of HDL-C on inflammation and physical function.
Design: cross-sectional study.
Setting: town of Tuscania (Italy).
Subjects: all the 329 community-dwelling older persons aged ≥75 years (mean age 79.8 ± 5.2 years, women 56.2%).
Methods: HDL-C, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and interleukin-6 (IL-6) were measured. Activities of daily living (ADL), instrumental ADL (IADL) and 4-m walking speed were assessed. Linear regression models were performed.
Results: given the multiple significant interactions, models were stratified according to HDL-C concentrations. In participants with normal HDL-C concentrations, only IL-6 showed a significant association with IADL (β = −0.439, SE = 0.176, P = 0.01). In participants with low HDL-C concentrations, all three inflammatory biomarkers were significantly associated with 4-m walking speed and IADL. IL-6 was also significantly associated with ADL (β = −0.755, SE = 0.259, P = 0.006), whereas borderline significances were reported for CRP and ESR.
Conclusions: the association between inflammation and physical function is particularly enhanced in elders with low HDL-C concentrations. Though HDL-C may merely act as a wellbeing index, HDL-C concentrations should be considered in studies evaluating inflammation and physical function.
doi:10.1093/ageing/afp194
PMCID: PMC2800252  PMID: 19892744
HDL cholesterol; physical function; inflammation; older persons; elderly
5.  Risk factors for disability in older persons over 3-year follow-up 
Age and Ageing  2009;39(1):92-98.
Background: the identification of modifiable risk factors for preventing disability in older individuals is essential for planning preventive strategies.
Purpose: to identify cross-sectional correlates of disability and risk factors for the development activities of daily living (ADL) and instrumental ADL (IADL) disability in community-dwelling older adults.
Methods: the study population consisted of 897 subjects aged 65–102 years from the InCHIANTI study, a population-based cohort in Tuscany (Italy). Factors potentially associated with high risk of disability were measured at baseline (1998–2000), and disability in ADLs and IADLs were assessed both at baseline and at the 3-year follow-up (2001–03).
Results: the baseline prevalence of ADL disability and IADL disability were, respectively, 5.5% (49/897) and 22.2% (199/897). Of 848 participants free of ADL disability at baseline, 72 developed ADL disability and 25 of the 49 who were already disabled had a worsening in ADL disability over a 3-year follow-up. Of 698 participants without IADL disability at baseline, 100 developed IADL disability and 104 of the 199 who already had IADL disability had a worsening disability in IADL over 3 years. In a fully adjusted model, high level of physical activity compared to sedentary state was significantly associated with lower incidence rates of both ADL and IADL disability at the 3-year follow-up visit (odds ratio (OR): 0.30; 95% confidence intervals (CI) 0.12–0.76 for ADL disability and OR: 0.18; 95% CI 0.09–0.36 for IADL disability). After adjusting for multiple confounders, higher energy intake (OR for difference in 100 kcal/day: 1.09; 95% CI 1.02–1.15) and hypertension (OR: 1.91; 95% CI 1.06–3.43) were significant risk factors for incident or worsening ADL disability.
Conclusions: higher level of physical activity and lower energy intake may be protective against the development in ADL and IADL disability in older persons.
doi:10.1093/ageing/afp209
PMCID: PMC2800253  PMID: 19933449
prevention; disability; physical activity; energy; ageing; elderly
6.  Cognitive performance in community-dwelling English- and Spanish-speaking seniors 
Age and Ageing  2009;38(6):669-675.
Objectives: to examine the association of language (English vs Spanish), and commonly used measures of memory and word fluency among older adults.
Design: cross-sectional.
Setting: community-based settings in New York City, including senior centres and residential complexes.
Subjects: four hundred and twenty independently living adults aged 60 or older (mean 73.8 years).
Methods: participants completed the Mini-Mental State Exam (MMSE), animal naming test (ANT) and Wechsler Memory Scale III (WMS) Story A immediate and delayed subtests. Scores were examined by strata of language, age or education and for different thresholds of the MMSE. We tested the association of language and cognitive test performance using multivariable linear regression.
Results: twenty-one per cent of subjects were interviewed in Spanish and 16.2% reported poor-fair English proficiency. The mean WMS scores were not statistically different between English and Spanish groups (immediate recall, 9.9 vs 9.5, P = 0.44; delayed recall, 8.0 vs 7.6, P = 0.36, respectively), whereas ANT scores did differ (16.6 vs 14.3, P < 0.0001). These associations were consistent across MMSE thresholds. The association of language and ANT score was not significant after accounting for education.
Conclusions: we found little difference in performance on the Story A subtests from the WMS suggesting that this test may be used for both English- and Spanish-speaking populations. Results suggest that variations in ANT performance may be accounted for by adjusting for the level of education. These results have important implications for the generalisability of test scores among diverse older populations.
doi:10.1093/ageing/afp127
PMCID: PMC2763288  PMID: 19651699
elderly; cognition; language; Spanish
7.  Gait speed under varied challenges and cognitive decline in older persons: a prospective study 
Age and Ageing  2009;38(5):509-514.
Objective: to examine whether usual gait speed, fast gait speed or speed while walking with a cognitive or neuromuscular challenge predicts evolving cognitive decline over 3 years.
Design: prospective study.
Setting: population-based sample of community-dwelling older persons.
Participants: 660 older participants (age ≥65 years).
Measurements: usual gait speed, fastest gait speed, gait speed during ‘walking-while-talking’, depression, comorbidities, education, smoking and demographics were assessed at baseline. Cognition was evaluated at baseline and follow-up. A decline in MMSE score by ≥3 points was considered as significant cognitive decline (SCD).
Results: adjusting for confounders, only fast speed was associated with cognitive performance at 3-year follow-up. One hundred thirty-five participants had SCD over 3 years. Participants in the lowest quartile of usual speed or walking-while-talking speed were more likely to develop SCD. Conversely, participants in the third and fourth quartiles of fast speed were more likely to develop SCD. J-test showed that the model including fast speed quartiles as a regressor was significantly more predictive of SCD than the models with usual speed or walking-while-talking speed quartiles.
Conclusion: measuring fast gait speed in older persons may assist in identifying those at high risk of cognitive decline.
doi:10.1093/ageing/afp093
PMCID: PMC2729240  PMID: 19549981
Elderly; cognition; gait speed; ageing; significant cognitive decline
8.  Older men with higher self-rated socioeconomic status have shorter telomeres 
Age and Ageing  2009;38(5):553-558.
Background: previous studies examining the relationship between socioeconomic status and telomere length showed conflicting results, one study finding shorter telomere length in subjects with lower socioeconomic status and one showing no relationship.
Design: cross-sectional study.
Setting: community-living elderly Chinese in Hong Kong.
Objective: this study examines the relationship between self-rated social economic status and telomere length in Hong Kong Chinese men and women aged 65 years and over living in the community.
Subjects and method: information was collected from 958 men and 978 women regarding possible confounding factors such as the presence of chronic diseases, smoking, physical activity level, dietary intake and body mass index. Telomere length was measured by quantitative PCR.
Result: in men only, after adjustment for age and other confounding factors, a higher ranking in community standing was associated with shorter telomere length.
Conclusion: men with higher self-rated socioeconomic status have shorter telomeres, possibly mediated through psychosocial rather than lifestyle factors or the presence of chronic disease. There may be cultural ethnic and age-related differences in social determinants of health.
doi:10.1093/ageing/afp098
PMCID: PMC2729241  PMID: 19556325
telomere length; socioeconomic status; elderly Chinese; elderly
9.  Repeat falls and the recovery of social participation in the year post-hip fracture 
Age and Ageing  2009;38(5):570-575.
Background: although the majority of hip fractures are the result of a fall, whether repeated falls in the year post-fracture adversely influence recovery of social participation is not known.
Design: analysis of data from a longitudinal cohort study.
Subjects: community-dwelling women aged ≥65 years, admitted to one of two hospitals in Baltimore with a new, non-pathological fracture of the proximal femur between 1992 and 1995.
Methods: information on falls was collected from a falls diary. At the baseline, 6- and 12-month evaluations, subjects were asked about the number of times in the 2 weeks prior to the evaluation they had participated in 10 categories of social activities. We examined the association of repeated falls with social participation using generalized estimating equations. The effect of physical and psychological functions was examined by including measures of lower extremity functional performance and depressive symptoms into the model.
Results: the analyses included 196 women, mean age = 80.2 years. Eighty-one subjects fell. The subjects with >1 fall between evaluations participated in a mean (95% CI) of 3.5 (0.12, 6.9) and 4.3 (0.9, 7.7) fewer social activities at 6 and 12 months post-fracture, respectively, compared to those who did not fall (P = 0.0003). These results were attenuated by adjustment for depressive symptoms, but not by lower extremity functional performance.
Conclusions: in the year post-fracture, repeated falls in women were associated with decreased social participation independent of lower extremity function. Depressive symptoms in repeated fallers may partly explain this association.
doi:10.1093/ageing/afp107
PMCID: PMC2981467  PMID: 19586976
accidental falls,; hip fracture; social activities; aged; elderly
10.  The association between dehydroepiandosterone and frailty in older men and women 
Age and Ageing  2009;38(4):401-406.
Objectives: to evaluate the association between dehydroepiandosterone (DHEA) and physical frailty in older adults.
Design: cross-sectional analysis of baseline information from three separate studies in healthy older men, women and residents of assisted living.
Setting: academic health centre in greater Hartford, CT, USA.
Participants: eight hundred and ninety-eight adults residing in the community or assisted living facility.
Measurements: participants had measurement of frailty (weight loss, grip strength, sense of exhaustion, walking speed and physical activity) and serum DHEAS levels.
Results: overall, 6% of the individuals in the study were classified as frail, 58% intermediate frail and 35% were not frail. In the bivariate analysis, there were differences between categories of frailty across age, gender and by DHEAS levels. In an ordinal logistic regression model, with frailty as a dependent measure, we found that age, DHEAS and interactions of age and BMI and DHEAS and BMI were predictive of more frailty characteristics.
Conclusion: we found an association between frailty and DHEAS levels. Whether the association is due to similar conditions resulting in lower DHEA levels and more susceptibility to frailty or whether lower DHEA levels have an impact on increasing frailty cannot be addressed by cross-sectional analysis. Gender did not impact the association between DHEAS and frailty, but obesity (BMI > 30 kg/m2) attenuated the association between higher DHEA levels and lower frailty status.
doi:10.1093/ageing/afp015
PMCID: PMC2720687  PMID: 19276095
dehydroepiandosterone; frailty; ageing; elderly
11.  Elevated serum advanced glycation end products and their circulating receptors are associated with anaemia in older community-dwelling women 
Age and Ageing  2009;38(3):283-289.
Objective: to determine whether serum carboxymethyl-lysine, a dominant advanced glycation end product (AGE), and circulating total receptor for AGEs (sRAGE) and endogenous secretory receptor for AGEs (esRAGE) are associated with anaemia.
Design: cross-sectional analysis.
Setting: moderately severely disabled women, ≥65 years, living in the community in Baltimore, MD (the Women's Health and Aging Study I).
Participants: 519 women with and without anaemia.
Main outcome measure: haemoglobin and anaemia (haemoglobin <12 g/dL).
Results: of 519 women, 128 (24.7%) had anaemia. All odds ratios (OR) were expressed per one standard deviation. Serum CML was associated with anaemia [OR 1.47, 95% confidence interval (CI) 1.11–1.95, P = 0.008] in a multivariate logistic regression model adjusting for age, race, smoking, education and chronic diseases. Serum sRAGE (ng/mL) and esRAGE (ng/mL) were associated with anaemia (OR 1.52, 95% CI 1.21–1.92, P = 0.0004; OR 1.49, 95% CI 1.18–1.87, P = 0.0006, respectively) in separate multivariate logistic regression models, adjusting for the same covariates mentioned above. Serum CML (P = 0.004), sRAGE (P < 0.0001) and esRAGE (P < 0.0001) were inversely and independently associated with haemoglobin concentrations.
Conclusion: AGEs and circulating RAGE are independently associated with haemoglobin and anaemia in older women. AGEs are amenable to interventions, as serum AGEs can be lowered by a change in dietary pattern and pharmacological treatment.
doi:10.1093/ageing/afp011
PMCID: PMC2724885  PMID: 19252206
advanced glycation end products; anaemia; haemoglobin; women; elderly
13.  Heart rate variability and its changes over 5 years in older adults 
Age and Ageing  2009;38(2):212-218.
Purpose: to characterise the association between age, ageing and heart rate variability (HRV) in older individuals, 585 adults age >65 years with two 24-h Holter recordings in the Cardiovascular Health Study were studied.
Methods: heart rate (HR), ventricular premature contractions (VPCs), atrial premature contractions (APCs), frequency-domain, ratio-based and non-linear HRV and heart rate turbulence (HRT) were examined cross-sectionally by 5-year age groups and prospectively over 5 years. Analyses adjusted for gender, lower versus elevated cardiovascular (CV) risk and for the change in CV risk.
Results: HR declined, and VPCs and APCs increased per 5-year increase in age. Frequency-domain HRV decreased more at 65–69, less at 70–74 and minimally at ≥75 years, independent of CVD risk or change in CVD risk. Ratio and non-linear HRV continued to decline to ≥75 years old. Ratio HRV and HRT slope were more strongly related to CVD risk than frequency-domain HRV.
Conclusions: cardiac autonomic function, assessed by frequency-domain HRV, declines most at 65–70 and levels off at age >75. The decline is independent of CVD risk or change in CVD risk. Ratio-based and non-linear HRV and HRT slope continued to change with increasing age and were more closely related to CVD risk than frequency-domain HRV.
doi:10.1093/ageing/afn292
PMCID: PMC2724889  PMID: 19147739
ageing; autonomic nervous system; heart rate variability; ambulatory ECG; elderly
15.  APOE and ACE polymorphisms and dementia risk in the older population over prolonged follow-up: 10 years of incidence in the MRC CFA Study 
Age and Ageing  2009;39(1):104-111.
Background: dementia risk conferred by apolipoprotein-E (APOE) and angiotensin-1-converting enzyme (ACE) polymorphisms have been reported for the MRC Cognitive Function and Ageing Study (CFAS) at 6-year follow-up. We concentrate on incident dementia risk over 10 years.
Methods: participants come from MRC CFAS, a multi-centre longitudinal population-based study of ageing in England and Wales. Three follow-up waves of data collection were used: 2, 6 and 10 years. Logistic regressions were undertaken to investigate associations between APOE (n = 955) and ACE (n = 856) alleles/genotypes and incident dementia. Two types of control groups were used: non-demented and highly functioning non-demented. Results were back-weighted.
Results: compared to APOE ε3, ε2 conferred protection of odds ratio (OR) = 0.3 (95% confidence interval, CI = 0.1–0.6) and ε4 risk of OR = 2.9 (95% CI = 1.7–4.9) for incident dementia. Compared to ε3/ε3, the ε3/ε4 and ε4/ε4 genotypes conferred risks of OR = 3.6 (95% CI = 1.8–7.3) and OR = 7.9 (95% CI = 1.6–39.2), respectively. The ε3/ε2 genotype protected against dementia (OR = 0.2, 95% CI = 0.1–0.7), and ε2/ε2 had a similar protective effect but with wide CIs (OR = 0.3, 95% CI = 0.1–1.7). Restricting the control group accentuated these differentials. The effects of ACE alleles/genotypes on incident dementia risk were small.
Conclusions: APOE but not ACE is associated with late-onset incident dementia in the population. Using longer term follow-up with proper adjustment for attrition and incident cases increases estimates of risk.
doi:10.1093/ageing/afp210
PMCID: PMC2794361  PMID: 19939808
apolipoprotein-E; angiotensin-1-converting enzyme; population; dementia; old
16.  Perceptions of active ageing in Britain: divergences between minority ethnic and whole population samples 
Age and Ageing  2009;38(6):703-710.
Objective: to identify perceptions of, and associations with, active ageing among ethnically diverse and homogeneous samples of older people in Britain.
Design and setting: cross-sectional and longitudinal surveys of older people living at home in Britain.
Measures: active ageing, health, psych-social, socio-economic circumstances, and indicators of quality of life.
Results: respondents defined active ageing as having health, fitness, and exercise; psychological factors; social roles and activities; independence, neighbourhood and enablers. The ethnically diverse sample respondents were less likely to define active ageing as having physical health and fitness, and were less likely to rate themselves as ageing actively, than more homogeneous sample respondents. The lay-based measure of quality of life used was independently and consistently associated with self-rated active ageing in each sample
Conclusion: Policy models of active ageing were reflected in lay views, although the latter had a more multidimensional focus. Lay definitions of active ageing were also more dynamic, compared with definitions of quality of life and successful ageing. Differences in self-rated active ageing and perceptions of this concept by ethnic group need further exploration.
doi:10.1093/ageing/afp175
PMCID: PMC2763289  PMID: 19779054
active ageing; ethnicity; old age; quality of life; successful ageing; elderly
18.  SGS: a structured treatment and teaching programme for older patients with diabetes mellitus—a prospective randomised controlled multi-centre trial 
Age and Ageing  2009;38(4):390-396.
Objectives: evaluation of the effectiveness of a new structured diabetes teaching and treatment programme (DTTP) with specific didactical approaches and topics for geriatric patients with diabetes mellitus.
Design: a prospective randomised controlled multi-centre trial.
Setting and participants: a total of 155 geriatric patients were randomly admitted to either the new DTTP SGS (n = 83) or the standard DTTP (n = 72) for insulin-treated patients with type 2 diabetes mellitus (HbA1c 8.0 ± 1.4%, age 76.2 ± 6.3 years).
Measurements: biometrical data, metabolic control, acute complications, diabetes knowledge, self-management.
Results: SGS participants showed improved levels of HbA1c 6 months after the DTTP, and less acute complications than the standard group (P<0.009). Both groups demonstrated a good capacity for diabetes self-management and improvement in diabetes knowledge after the DTTP (P<0.01).
Conclusion: the new SGS diabetes education programme, focusing on the learning capabilities and the particular needs of older persons, is effective in improving metabolic control and in maintaining auto-sufficiency in geriatric patients with diabetes mellitus.
doi:10.1093/ageing/afp056
PMCID: PMC2699189  PMID: 19454403
diabetes mellitus type 2; patient education; treatment and teaching programme; insulin therapy; randomised controlled trial; elderly

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