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.
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 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.
Objective: To compare ethnic differences in visceral adipose tissue (VAT), assessed by computed tomography, and type 2 diabetes risk among 55‐ to 80‐year‐old Filipino, African‐American, and white ...women without known cardiovascular disease.
Research Methods and Procedures: Subjects were participants in the Rancho Bernardo Study (n = 196), the Filipino Women's Health Study (n = 181), and the Health Assessment Study of African‐American Women (n = 193). Glucose and anthropometric measurements were assessed between 1995 and 2002.
Results: African‐American women had significantly higher age‐adjusted BMI (29.7 kg/m2) and waist girth (88.1 cm) compared with Filipino (BMI, 25.5 kg/m2; waist girth, 81.9 cm) or white (BMI: 26.0 kg/m2; waist girth: 80.7 cm) women. However, VAT was significantly higher among Filipino (69.1 cm3) compared with white (62.3 cm3; p = 0.037) or African‐American (57.5 cm3, p < 0.001) women. VAT correlated better with BMI (r = 0.69) and waist (r = 0.77) in whites, compared with Filipino (r = 0.42; r = 0.59) or African‐American (r = 0.50; r = 0.56) women. Age‐adjusted type 2 diabetes prevalence was significantly higher in Filipinas (32.1%) than in white (5.8%) or African‐American (12.1%) women. Filipinas had higher type 2 diabetes risk compared with African Americans adjusted odds ratio, 2.30; 95% confidence interval (CI), 1.09 to 4.86 or whites (adjusted odds ratio, 7.51; 95% CI, 2.51 to 22.5) after adjusting for age, VAT, exercise, education, and alcohol intake.
Discussion: VAT was highest among Filipinas despite similar BMI and waist circumference as whites. BMI and waist circumference were weaker estimates of VAT in Filipino and African‐American women than in whites. Type 2 diabetes prevalence was highest among Filipino women at every level of VAT, but VAT did not explain their elevated type 2 diabetes risk.
This overview is primarily concerned with large recent prospective cohort studies of adult populations, not patients, because the latter studies are confounded by differences in medical and surgical ...management for men vs. women. When early papers are uniquely informative they are also included. Because the focus is on epidemiology, details of age, sex, sample size, and source as well as study methods are provided. Usually the primary outcomes were all-cause or coronary heart disease (CHD) mortality using baseline data from midlife or older adults. Fifty years ago few prospective cohort studies of all-cause or CHD mortality included women. Most epidemiologic studies that included community-dwelling adults did not include both sexes and still do not report men and women separately. Few studies consider both sex (biology) and gender (behavior and environment) differences. Lifespan studies describing survival after live birth are not considered here. The important effects of prenatal and early childhood biologic and behavioral factors on adult mortality are beyond the scope of this review. Clinical trials are not discussed. Overall, presumptive evidence for causality was equivalent for psychosocial and biological exposures, and these attributes were often associated with each other. Inconsistencies or gaps were particularly obvious for studies of sex or gender differences in age and optimal measures of body size for CHD outcomes, and in the striking interface of diabetes and people with the metabolic syndrome, most of whom have unrecognized diabetes.
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.
Abstract Background Female sexual dysfunction is a focus of medical research, but few studies describe the prevalence and covariates of recent sexual activity and satisfaction in older ...community-dwelling women. Methods A total of 1303 older women from the Rancho Bernardo Study were mailed a questionnaire on general health, recent sexual activity, sexual satisfaction, and the Female Sexual Function Index. Results A total of 806 of 921 respondents (87.5%) aged 40 years or more answered questions about recent sexual activity. Their median age was 67 years; mean years since menopause was 25; most were upper-middle class; 57% had attended at least 1 year of college; and 90% reported good to excellent health. Half (49.8%) reported sexual activity within the past month with or without a partner, the majority of whom reported arousal (64.5%), lubrication (69%), and orgasm (67.1%) at least most of the time, although one third reported low, very low, or no sexual desire. Although frequency of arousal, lubrication, and orgasm decreased with age, the youngest (<55 years) and oldest (>80 years) women reported a higher frequency of orgasm satisfaction. Emotional closeness during sex was associated with more frequent arousal, lubrication, and orgasm; estrogen therapy was not. Overall, two thirds of sexually active women were moderately or very satisfied with their sex life, as were almost half of sexually inactive women. Conclusion Half these women were sexually active, with arousal, lubrication, and orgasm maintained into old age, despite low libido in one third. Sexual satisfaction increased with age and did not require sexual activity.
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