Objectives
To describe the natural history of frailty transitions in a large cohort of community‐dwelling older men and identify predictors associated with progression to or improvement from states ...of greater frailty.
Design
Prospective cohort study.
Setting
Six U.S. sites.
Participants
Community‐dwelling men aged 65 and older (N = 5,086).
Measurements
Frailty was measured at baseline and an average of 4.6 years later. Frailty was defined as having three or more of the following components (low lean mass, weakness, self‐reported exhaustion, low activity level, and slow walking speed); prefrailty was defined as having one or two components. Separate multivariable logistic regression models were analyzed for progression and improvement in frailty status.
Results
Of the 5,086 men, 8% were frail, 46% were prefrail, and 46% were robust at baseline. Between baseline and follow‐up, 35% progressed in frailty status or died, 56% had no change in frailty status, and 15% of prefrail or frail participants improved, although only 0.5% improved across two levels, from frail to robust. In multivariable models, factors associated with improvement in frailty status included greater leg power, being married, and good or excellent self‐reported health, whereas presence of any instrumental activity of daily living (IADL) limitations, low albumin levels, high interleukin‐6 levels, and presence of chronic obstructive pulmonary disease or diabetes mellitus were associated with lower likelihood of improvement in frailty status.
Conclusion
Improvement in frailty status was possible in this cohort of community‐dwelling older men, but improvement from frail to robust was rare. Several predictors were identified as possible targets for intervention, including prevention and management of comorbid medical conditions, prevention of IADL disability, physical exercise, and nutritional and social support.
See related editorial by Bandeen‐Roche et al.
Objectives
To evaluate the relationship between life‐space (the extent, frequency, and independence of an individual's movement) and mortality in older men.
Design
Prospective cohort study.
Setting
...Six U.S. clinical sites.
Participants
Men aged 71 to 98 followed from 2007 to 2011 (N = 3,892).
Measurements
Life‐space during the past month was assessed as 0 (daily restriction to one's bedroom) to 120 (daily trips outside one's town without assistance) and categorized into 20‐point intervals. The primary outcome was noncancer mortality, and secondary outcomes were all‐cause, cardiovascular, cancer, and noncardiovascular noncancer mortality.
Results
Over 2.7 years (2007–2011), 373 (9.6%) men died, 230 from noncancer causes. Unadjusted risk of noncancer mortality was 41.2% in men with the lowest level of life‐space (0–20 points, n = 34) and 2.4% in men with the highest level of life‐space (101–120 points, n = 868), a 17 times difference. In multivariable‐adjusted models, there was a strong linear trend between decreasing life‐space and increasing risk of noncancer mortality (P = .005). Risk of noncancer mortality was 3.8 times higher (95% confidence interval (CI)=1.3,11.5) in men with the lowest life‐space than in those with the highest life‐space. Risk of noncancer mortality was 1.3 times higher (95% CI=1.1–1.5) for each standard‐deviation (24 point) decrease in life‐space. Risk of noncancer mortality was 1.5 times higher (95% CI=1.0–2.3) in men who did not travel beyond their neighborhood without assistance (n = 471). Results were similar for all‐cause mortality and did not change after control for chronic disease burden.
Conclusion
Life‐space predicted a variety of mortality endpoints in older men; scores of 40 or less were associated with mortality independent of other risk factors.
Objective
To examine rest–activity circadian rhythm (RAR) and cognitive decline in older men.
Design
Longitudinal.
Setting
Osteoporotic Fractures in Men (MrOS) and ancillary Outcomes of Sleep ...Disorders in Men (MrOS Sleep) studies.
Participants
MrOS and MrOS Sleep participants (N=2,754; mean age 76.0 ± 5.3).
Measurements
The Modified Mini‐Mental State examination (3MS) was used to assess cognition at baseline (2003–05) and follow‐up examinations (2005–06 and 2007–09). Wrist actigraphy was used to measure 24‐hour activity counts at baseline. RAR variables included amplitude (strength of activity rhythm), mesor (mean activity level), pseudo F‐statistic (overall circadian rhythm robustness), and acrophase (time of daily peak activity).
Results
After an average of 3.4 ± 0.5 years, men with lower amplitudes, mesors, and pseudo F‐statistics had greater decline in 3MS performance (amplitude: –0.7 points Q1 vs –0.5 points Q4, p<.001; mesor: –0.5 points Q1 vs –0.2 points Q4, p=.01; pseudo F‐statistic: –0.5 points Q1 vs –0.3 points Q4, p<.001). Lower amplitudes and pseudo‐F statistics were associated with greater odds of clinically significant cognitive decline (≥5‐point decrease) (amplitude Q1 vs. Q4: odds ratio (OR)=1.4, 95% confidence interval (CI)=1.0–1.9; pseudo‐F statistic Q1 vs Q4: OR=1.4, 95% CI=1.0–1.9). Men with phase‐advanced acrophase had greater odds of clinically significant cognitive decline (OR=1.8, 95% CI=1.2–2.8). Results were adjusted for multiple confounders.
Conclusion
Several parameters of disrupted RAR (lower amplitude, pseudo F‐statistic, mesor, phase‐advanced acrophase) were associated with greater cognitive decline in older community‐dwelling men. These findings contribute to a growing body of evidence suggesting that altered RARs are associated with cognitive decline in older adults. J Am Geriatr Soc 66:2136–2143, 2018.
Objective
To evaluate the associations between definitions of sarcopenia and clinical outcomes and the ability of the definitions to discriminate those with a high likelihood of having these outcomes ...from those with a low likelihood.
Design
Osteoporotic Fractures in Men Study.
Setting
Six clinical centers.
Participants
Community‐dwelling men aged 65 and older (N = 5,934).
Measurements
Sarcopenia definitions from the International Working Group, European Working Group on Sarcopenia in Older Persons, Foundation for the National Institutes of Health Sarcopenia Project, Baumgartner, and Newman were evaluated. Recurrent falls were defined as two or more self‐reported falls in the year after baseline (n = 694, 11.9%). Incident hip fractures (n = 207, 3.5%) and deaths (n = 2,003, 34.1%) were confirmed according to central review of medical records over 9.8 years. Self‐reported functional limitations were assessed at baseline and 4.6 years later. Logistic regression or proportional hazards models were used to estimate associations between sarcopenia and falls, hip fractures, and death. The discriminative ability of the sarcopenia definitions (vs reference models) for these outcomes was evaluated using area under the receiver operating characteristic curve or C‐statistics. Referent models included age alone for falls, functional limitations and mortality, and age and bone mineral density for hip fractures.
Results
The association between sarcopenia according to the various definitions and risk of falls, functional limitations, and hip fractures was variable; all definitions were associated with greater risk of death, but none of the definitions materially changed discrimination based on the AUC and C‐statistic when compared with reference models (change ≤1% in all models).
Conclusion
Sarcopenia definitions as currently constructed did not consistently improve prediction of clinical outcomes in relatively healthy older men.
This study investigated how cognitive function changes with age and whether rates of decline vary by sex or education in a large, homogenous longitudinal cohort characterized by high participation ...rates, long duration of follow-up, and minimal loss to follow-up.
Between 1988 and 2016, 2,225 community-dwelling participants of the Rancho Bernardo Study, aged 31 to 99 years at their initial cognitive assessment, completed neuropsychological testing approximately every 4 years, over a maximum 27-year follow-up.
Linear mixed effects regression models defined sex-specific cognitive trajectories, adjusting for education and retest effects.
Significant decline across all cognitive domains began around age 65 years and accelerated after age 80 years. Patterns of decline were generally similar between sexes, although men declined more rapidly than women on the global function test. Higher education was associated with slower decline on the tests of executive and global functions. After excluding 517 participants with evidence of cognitive impairment, accelerating decline with age remained for all tests, and women declined more rapidly than men on the executive function test.
Accelerating decline with advancing age occurs across multiple cognitive domains in community-dwelling older adults, with few differences in rates of decline between men and women. Higher education may provide some protection against executive and global function decline with age. These findings better characterize normal cognitive aging, a critical prerequisite for identifying individuals at risk for cognitive impairment, and lay the groundwork for future studies of health and behavioral factors that affect age-related decline in this cohort.
Highlights ► Only total and LDL cholesterol and apolipoprotein B changed within one year of the last menstrual period. ► Increasing importance of testosterone instead of estrogen to explain harmful ...effect of oophorectomy on cardiovascular risk. ► In adjusted analyses incident AF did not differ between early menopausal (<45 years) versus late menopausal (>53 years) age. ► Methodologically challenging but critical to separate out the influences of chronologic aging and menopause.
OBJECTIVES: To examine the associations between insulin resistance and changes in body composition in older men without diabetes mellitus.
DESIGN: Longitudinal cohort study of older men participating ...in the Osteoporotic Fractures in Men (MrOS) study.
SETTING: Six U.S. clinical centers.
PARTICIPANTS: Three thousand one hundred thirty‐two ambulatory men aged 65 and older at baseline.
MEASUREMENTS: Baseline insulin resistance was calculated for men without diabetes mellitus using the homeostasis model assessment of insulin resistance (HOMA‐IR). Total lean, appendicular lean, total fat, and truncal fat mass were measured using dual energy X‐ray absorptiometry scans at baseline and 4.6 ± 0.3 years later in 3,132 men with HOMA‐IR measurements.
RESULTS: There was greater loss of weight, total lean mass, and appendicular lean mass and less gain in total fat mass and truncal fat mass with increasing quartiles of HOMA‐IR (P<.001 for trend). Insulin‐resistant men in the highest quartile had higher odds of 5% or more loss of weight (odds ratio (OR)=1.88, 95% confidence interval (CI)=1.46–2.43), total lean mass (OR=2.09, 95% CI=1.60–2.73) and appendicular lean mass (OR=1.57, 95% CI=1.27–1.95) and lower odds of 5% or more gain in total fat mass (OR=0.56, 95% CI=0.45–0.68) and truncal fat mass (OR=0.52, 95% CI=0.42–0.64) than those in the lowest quartile. These findings remained significant after accounting for age, site, baseline weight, physical activity, and change in physical activity. These associations were also independent of other metabolic syndrome features and medications.
CONCLUSION: Greater lean mass loss and lower fat mass gain occurred in insulin‐resistant men without diabetes mellitus than in insulin‐sensitive men. Insulin resistance may accelerate age‐related sarcopenia.
Objectives
To examine associations between objective measures of activity level and mortality risk in older men.
Design
Prospective cohort study.
Setting
Six U.S. sites.
Participants
Men aged 71 and ...older followed an average of 4.5 years (N = 2,918).
Measurements
Time awake spent in sedentary behavior (metabolic equivalent (MET) level ≤1.50), light activity (MET level 1.51–2.99), and at least moderate activity (MET level ≥3.00) measured using an activity monitor worn for 5 days or longer and expressed as quartiles. Deaths were confirmed with death certificates; cause of death was adjudicated by review of certificates and records.
Results
During follow‐up, 409 (14%) men died. After multivariable adjustment, comparing Q4 with Q1, more time spent in sedentary behavior (Q4 vs Q1, hazard ratio (HR) = 1.51, 95% confidence interval (CI) = 1.10–2.08), less time spent in light activity (Q1 vs Q4, HR = 1.54, 95% CI = 1.06–2.24), and less time spent in at least moderate activity (Q1 vs Q4, HR = 1.56, 95% CI = 1.09–2.25) were similarly associated with greater mortality risk primarily due to higher risks of cardiovascular and noncardiovascular, noncancer death. The association between time spent in sedentary behavior and mortality varied according to time spent at higher activity level. More time spent in sedentary behavior was associated with greater risk of death in men spending 1.2 (median) h/d or more in at least moderate activity (Q4 vs Q1, HR = 2.09, 95% CI = 1.26–3.49) but not in those spending less time (Q4 vs Q1, HR = 1.02, 95% CI = 0.62–1.66) (P = .005 for interaction).
Conclusion
In older men exceeding current guidelines on physical activity, more time spent in sedentary behavior is associated with greater mortality risk.
OBJECTIVE
To evaluate the association of lower urinary tract symptoms (LUTS) with the risk of falls in elderly community‐dwelling men.
SUBJECTS AND METHODS
We evaluated 5872 participants in the ...Osteoporotic Fractures in Men, a prospective cohort study of risk factors for falls and osteoporotic fractures among community‐dwelling men aged ≥65 years. The primary outcome was the 1‐year cumulative incidence of falls in men with moderate or severe, vs mild LUTS at baseline, as measured by the American Urological Association Symptom Index. We used Poisson regression models and considered multiple variables as potential confounders.
RESULTS
At baseline, 3188 (54%) reported mild, 2301 (39%) moderate, and 383 (7%) severe LUTS. Compared with men who had mild symptoms, the adjusted 1‐year cumulative incidence of falls was significantly higher among men with moderate or severe LUTS. The risk of at least one fall was increased by 11% among those with moderate (relative risk 1.11, 95% confidence interval, CI, 1.01–1.22; P = 0.02) and by 33% among those with severe LUTS (1.33, 1.15–1.53; P < 0.001). Further, those with moderate LUTS had a 21% (1.21, 1.05–1.40; P = 0.01) and those with severe LUTS a 63% (1.63, 1.31–2.02; P < 0.001) greater risk of at least two falls. LUTS most strongly associated with falls were urinary urgency, difficulty initiating urination, and nocturia.
CONCLUSIONS
Moderate and severe LUTS independently increase the 1‐year risk of falls, particularly recurrent falls, in community‐dwelling older men. Because of the serious consequences of falls, these results might justify the routine assessment of LUTS with a validated questionnaire in the primary care of this population.
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