Abstract
Background
Frailty is an age-related clinical syndrome of decreased resilience to stressors and is associated with numerous adverse outcomes. Although there is preponderance of literature on ...frailty in developed countries, limited investigations have been conducted in less developed regions including China—a country that has the world’s largest aging population. We examined frailty prevalence in China by sociodemographics and geographic region, and investigated correlates of frailty.
Methods
Participants were 5,301 adults aged ≥60 years from the China Health and Retirement Longitudinal Study. Frailty was identified by the validated physical frailty phenotype (PFP) scale. We estimated frailty prevalence in the overall sample and by sociodemographics. We identified age-adjusted frailty prevalence by geographical region. Bivariate associations of frailty with health and function measures were evaluated by chi-squared test and analysis of variance.
Results
We found 7.0% of adults aged 60 years or older were frail. Frailty is more prevalent at advanced ages, among women, and persons with low education. Age-adjusted frailty prevalence ranged from 3.3% in the Southeast and the Northeast to 9.1% in the Northwest, and was more than 1.5 times higher in rural versus urban areas. Frail versus nonfrail persons had higher prevalence of comorbidities, falls, disability, and functional limitation.
Conclusions
We demonstrated the utility of the PFP scale in identifying frail Chinese elders, and found substantial sociodemographic and regional disparities in frailty prevalence. The PFP scale may be incorporated into clinical practice in China to identify the most vulnerable elders to reduce morbidity, prevent disability, and enable more efficient use of health care resources.
Older adults frequently have several chronic health conditions which require multiple medications. We illustrated trends in prescription medication use over 20 years in the United States, and ...described characteristics of older adults using multiple medications in 2009-2010.
Participants included 13,869 adults aged 65 years and older in the National Health & Nutrition Examination Survey (1988-2010). Prescription medication use was verified by medication containers. Potentially inappropriate medications were defined by the 2003 Beers Criteria.
Between 1988 and 2010 the median number of prescription medications used among adults aged 65 and older doubled from 2 to 4, and the proportion taking ≥5 medications tripled from 12.8% (95% confidence interval: 11.1, 14.8) to 39.0% (35.8, 42.3).These increases were driven, in part, by rising use of cardioprotective and antidepressant medications. Use of potentially inappropriate medications decreased from 28.2% (25.5, 31.0) to 15.1% (13.2, 17.3) between 1988 and 2010. Higher medication use was associated with higher prevalence of functional limitation, activities of daily living limitation, and confusion/memory problems in 2009-2010, although these associations did not remain after adjustment for covariates. In multivariable models, older age, number of chronic conditions, and annual health care visits were associated with increased odds of using both 1-4 and ≥5 medications. Additionally, body mass index, higher income-poverty ratio, former smoking, and non-black non-white race were associated with use of ≥5 medications.
Prescription medication use increased dramatically among older adults between 1988 and 2010. Contemporary older adults on multiple medications have worse health status compared with those on less medications, and appear to be a vulnerable population.
Background Chronic kidney disease (CKD) and hyperuricemia often coexist, and both conditions are increasing in prevalence in the United States. However, their shared role in cardiovascular risk ...remains highly debated. Study Design Cross-sectional and longitudinal. Setting & Participants Participants in the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2002 (n = 10,956); data were linked to mortality data from the National Death Index through December 31, 2006. Predictors Serum uric acid concentration, categorized as the sex-specific lowest (<25th), middle (25th-<75th), and highest (≥75th) percentiles; and kidney function assessed by estimated glomerular filtration rate (eGFR) based on the CKD-EPI (CKD Epidemiology Collaboration) creatinine-cystatin C equation and urinary albumin-creatinine ratio (ACR). Outcomes Cardiovascular death and all-cause mortality. Results Uric acid levels were correlated with eGFRcr-cys ( r = −0.29; P < 0.001) and were correlated only slightly with ACR ( r = 0.04; P < 0.001). There were 2,203 deaths up until December 31, 2006, of which 981 were due to cardiovascular causes. Overall, there was a U-shaped association between uric acid levels and cardiovascular mortality in both women and men, although the lowest risk of cardiovascular mortality occurred at a lower level of uric acid for women compared with men. There was an association between the highest quartile of uric acid level and cardiovascular mortality even after adjustment for potential confounders (HR, 1.48; 95% CI, 1.13-1.96), although this association was attenuated after adjustment for ACR and eGFRcr-cys (HR, 1.25; 95% CI, 0.89-1.75). The pattern of association between uric acid levels and all-cause mortality was similar. Limitations GFR not measured; mediating events were not observed. Conclusions High uric acid level is associated with cardiovascular and all-cause mortality, although this relationship was no longer statistically significant after accounting for kidney function.
Recent evidence suggests potential clinical benefits of statin in cancer chemoprevention and treatment. Nonalcoholic fatty liver disease (NAFLD) is expected to become the leading cause of ...hepatocellular carcinoma (HCC). We aimed to investigate the association between statin initiation and the risk of HCC among patients with NAFLD.
In this study using the Optum de-identified Clinformatics database, Cox proportional hazards regression model was performed to determine the risk of HCC in statin initiators versus nonusers. We incorporated inverse probability of treatment weighting (IPTW) to minimize potential confounding.
Among 272,431 adults with NAFLD diagnosis, IPTW model shows that statin initiators had 53% less risk of developing HCC compared with nonusers (hazard ratio HR, 0.47; 95% confidence interval, 0.36-0.60). In the subcohort with fibrosis-4 index data available, statin initiation was associated with 56% hazard reduction of developing HCC in NAFLD after adjusting for fibrosis-4 index score (HR, 0.44; 0.30-0.65). The association between statin initiation and lower risk of HCC development was observed for both lipophilic statin (HR, 0.49; 0.37-0.65) and hydrophilic statin (HR, 0.40; 0.21-0.76). Moreover, we observed greater hazards reduction as the dose and duration of statin use increased. NAFLD patients with more than 600 cumulative defined daily doses of statin had 70% reduction in hazards of developing HCC (HR, 0.30; 0.20-0.43).
Our study provides strong evidence for the association between statin initiation and reduced risk of HCC development in NAFLD patients. These findings imply that statin can be used as a protective medication for NAFLD patients to reduce the risk of HCC.
Machine Learning in Aging Research Odden, Michelle C; Melzer, David
The journals of gerontology. Series A, Biological sciences and medical sciences,
11/2019, Letnik:
74, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Machine learning has revolutionized the technology sector with day-to-day applications ranging from prompting our choice of movies to check processing at ATMs. With the U.S. Food and Drug ...Administration approval of a retinal image processor (1), interest in health care applications is high. This raises the question of whether machine learning will be a powerful tool for enhancing gerontological research. In this issue, Wallace and colleagues (2) report its application to predict mortality from sleep measures. How should we evaluate this and future outputs of machine learning research?
Frailty and multimorbidity are independent prognostic factors for mortality, but their interaction has not been fully explored. We investigated the importance of multimorbidity patterns in older ...adults with the same level of frailty phenotype.
In a cohort of 7,197 community-dwelling adults aged 65 years and older, physical frailty status (robust, pre-frail, frail) was defined using shrinking, exhaustion, inactivity, slowness, and weakness. Latent class analysis was used to identify individuals with multimorbidity patterns based on 10 self-reported chronic conditions. We estimated hazard ratios (HR) and incidence rate differences (IRDs) for mortality comparing multimorbidity patterns within each frailty state.
Five multimorbidity classes were identified: minimal disease (24.7%), cardiovascular disease (29.0%), osteoarticular disease (27.3%), neuropsychiatric disease (8.9%), and high multisystem morbidity (10.0%). Within each frailty state, the mortality rate per 1,000 person-years over 4 years was greatest in the neuropsychiatric class and lowest in the minimal disease class: robust (56.3 vs 15.7; HR, 2.11 95% CI: 1.05, 4.21; IRD, 24.1 95% CI: -11.2, 59.3), pre-frail (85.3 vs 40.4; HR, 1.74 95% CI: 1.28, 2.37; IRD, 27.1 95% CI: 7.6, 46.7), and frail (218.1 vs 96.4; HR, 2.05 95% CI: 1.36, 3.10; IRD, 108.4 95% CI: 65.0, 151.9). Although HRs did not vary widely by frailty, the excess number of deaths, as reflected by IRDs, increased with greater frailty level.
Considering both multimorbidity patterns and frailty is important for identifying older adults at greater risk of mortality. Of the five patterns identified, the neuropsychiatric class was associated with lower survival across all frailty levels.
Abstract
Background
exposures in childhood and adolescence may impact the development of diseases and symptoms in late life. However, evidence from low- and middle-income countries is scarce. In this ...cross-sectional study, we examined the association of early life risk factors with frailty amongst older adults using a large, nationally representative cohort of community-dwelling Chinese sample.
Methods
we included 6,806 participants aged $\ge$60 years from the China Health and Retirement Longitudinal Study. We measured 13 risk factors in childhood or adolescence through self-reports, encompassing six dimensions (education, family economic status, nutritional status, domestic violence, neighbourhood and health). We used multinomial regression models to examine the association between risk factors and frailty. We further calculated the absolute risk difference for the statistically significant factors.
Results
persons with higher personal and paternal education attainment, better childhood neighbourhood quality and better childhood health status had lower risk of being frail in old age. Severe starvation in childhood was associated with higher risk of prefrailty. The risk differences of being frail were 5.6% lower for persons with a high school or above education, 1.5% lower for those whose fathers were literate, 4.8% lower for the highest neighbourhood quality and 2.9% higher for worse childhood health status compared to their counterparts.
Conclusions
unfavorable socioeconomic status and worse health condition in childhood and adolescence may increase the risk of late-life frailty amongst Chinese older adults.
BACKGROUND:Statins are effective in the primary prevention of atherosclerotic cardiovascular disease. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline expands ...recommended statin use, but its cost-effectiveness has not been compared with other guidelines.
METHODS:We used the Cardiovascular Disease Policy Model to estimate the cost-effectiveness of the ACC/AHA guideline relative to current use, Adult Treatment Panel III guidelines, and universal statin use in all men 45 to 74 years of age and women 55 to 74 years of age over a 10-year horizon from 2016 to 2025. Sensitivity analyses varied costs, risks, and benefits. Main outcomes were incremental cost-effectiveness ratios and numbers needed to treat for 10 years per quality-adjusted life-year gained.
RESULTS:Each approach produces substantial benefits and net cost savings relative to the status quo. Full adherence to the Adult Treatment Panel III guideline would result in 8.8 million more statin users than the status quo, at a number needed to treat for 10 years per quality-adjusted life-year gained of 35. The ACC/AHA guideline would potentially result in up to 12.3 million more statin users than the Adult Treatment Panel III guideline, with a marginal number needed to treat for 10 years per quality-adjusted life-year gained of 68. Moderate-intensity statin use in all men 45 to 74 years of age and women 55 to 74 years of age would result in 28.9 million more statin users than the ACC/AHA guideline, with a marginal number needed to treat for 10 years per quality-adjusted life-year gained of 108. In all cases, benefits would be greater in men than women. Results vary moderately with different risk thresholds for instituting statins and statin toxicity estimates but depend greatly on the disutility caused by daily medication use (pill burden).
CONCLUSIONS:At a population level, the ACC/AHA guideline for expanded statin use for primary prevention is projected to treat more people, to save more lives, and to cost less compared with Adult Treatment Panel III in both men and women. Whether individuals benefit from long-term statin use for primary prevention depends more on the disutility associated with pill burden than their degree of cardiovascular risk.
IMPORTANCE: Neighborhood-level residential segregation is implicated as a determinant for poor health outcomes in black individuals, but it is unclear whether this association extends to cognitive ...aging, especially in midlife. OBJECTIVE: To examine the association between cumulative exposure to residential segregation during 25 years of young adulthood among black individuals and cognitive performance in midlife. DESIGN, SETTING, AND PARTICIPANTS: The ongoing prospective cohort Coronary Artery Risk Development in Young Adults (CARDIA) Study recruited 5115 black and white participants aged 18 to 30 years from 4 field centers at the University of Alabama, Birmingham; University of Minnesota, Minneapolis; Northwestern University, Chicago, Illinois; and Kaiser Permanente, Oakland, California. Data were acquired from February 1985 to May 2011. Among the surviving CARDIA cohort, 3671 (71.8%) attended examination year 25 of the study in 2010, when cognition was measured, and 3008 (81.9%) of those completed the cognitive assessments. To account for time-varying confounding and differential censoring, marginal structural models using inverse probability weighting were applied. Data were analyzed from April 16 to July 20, 2019. MAIN OUTCOMES AND MEASURES: Racial residential segregation was measured using the Getis-Ord Gi* statistic, and the mean cumulative exposure to segregation was calculated across 6 follow-up visits from baseline to year 25 of the study, then categorized into high, medium, and low segregation. Cognitive function was measured at year 25 of the study, using the Digit Symbol Substitution Test (DSST), Stroop color test (reverse coded), and Rey Auditory Verbal Learning Test. To facilitate comparison of estimates, z scores were calculated for all cognitive tests. RESULTS: A total of 1568 black participants with available cognition data were included in the analysis. At baseline, participants had a mean (SD) age of 25 (4) years and consisted of 936 women (59.7%). Greater cumulative exposure to segregated neighborhoods was associated with a worse DSST z score (for high segregation, β = −0.37 95% CI, −0.61 to −0.13; for medium segregation, β = −0.25 95% CI, −0.51 to 0.0002) relative to exposure to low segregation. CONCLUSIONS AND RELEVANCE: In this cohort study, exposure to residential segregation throughout young adulthood was associated with worse processing speed among black participants as early as in midlife. This association may potentially explain black-white disparities in dementia risk at older age.
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