Functional impairment and disability become increasingly common with aging. As more people are reaching old age, the number of people needing care will rise, creating a crisis of need for care. ...Population studies and clinical trials have demonstrated the importance of the detection of early loss of strength and walking speed in predicting disability and in designing interventions to prevent functional decline. There is a large societal burden linked to age-related disorders. Physical activity is to date the only intervention that has prevented disability in a long-term clinical trial, but is difficult to sustain. Novel interventions are needed to maintain function in late life.
Research highlights ► Markers of inflammation are elevated in older adults. ► Visceral abdominal fat and lower sex steroid hormones are associated with higher levels of inflammatory markers. ► Of the ...markers assessed, IL-6 most robustly predicts disease, disability and mortality in old age.
Newman introduces her friend and colleague Dr. Linda P. Fried as the 2022 recipient of the Association of American Physicians (AAP) George M. Kober Medal. Dr. Fried is Dean of Columbia University's ...Mailman School of Public Health, Professor of Epidemiology and DeLamar Professor of Public Health Practice at the Mailman School, Professor of Medicine at the Vagelos College of Physicians and Surgeons, and Senior Vice President of Columbia University Irving Medical Center. Dr. Fried is also a past president of the AAP. In fact, she understands that she is only the second AAP president who is a dean of a school of public health, the first being William Henry Welch. In her AAP presidential address in 2017, she noted that one of the founders of the AAP was William Henry Welch.
Cardiovascular disease (CVD) in older Americans imposes a huge burden in mortality, morbidity, disability, functional decline, and health care costs. In light of the projected growth of the ...population of older adults over the next several decades, the societal burden attributable to CVD will continue to rise. There is thus an enormous opportunity to foster successful aging and to increase functional life years through expanded efforts aimed at CVD prevention. This article provides an overview of the epidemiology of CVD in older adults, including an assessment of the impact of CVD on mortality, morbidity, and health care costs.
Sleep-disordered breathing is a common condition associated with adverse health outcomes including hypertension and cardiovascular disease. The overall objective of this study was to determine ...whether sleep-disordered breathing and its sequelae of intermittent hypoxemia and recurrent arousals are associated with mortality in a community sample of adults aged 40 years or older.
We prospectively examined whether sleep-disordered breathing was associated with an increased risk of death from any cause in 6,441 men and women participating in the Sleep Heart Health Study. Sleep-disordered breathing was assessed with the apnea-hypopnea index (AHI) based on an in-home polysomnogram. Survival analysis and proportional hazards regression models were used to calculate hazard ratios for mortality after adjusting for age, sex, race, smoking status, body mass index, and prevalent medical conditions. The average follow-up period for the cohort was 8.2 y during which 1,047 participants (587 men and 460 women) died. Compared to those without sleep-disordered breathing (AHI: <5 events/h), the fully adjusted hazard ratios for all-cause mortality in those with mild (AHI: 5.0-14.9 events/h), moderate (AHI: 15.0-29.9 events/h), and severe (AHI: >or=30.0 events/h) sleep-disordered breathing were 0.93 (95% CI: 0.80-1.08), 1.17 (95% CI: 0.97-1.42), and 1.46 (95% CI: 1.14-1.86), respectively. Stratified analyses by sex and age showed that the increased risk of death associated with severe sleep-disordered breathing was statistically significant in men aged 40-70 y (hazard ratio: 2.09; 95% CI: 1.31-3.33). Measures of sleep-related intermittent hypoxemia, but not sleep fragmentation, were independently associated with all-cause mortality. Coronary artery disease-related mortality associated with sleep-disordered breathing showed a pattern of association similar to all-cause mortality.
Sleep-disordered breathing is associated with all-cause mortality and specifically that due to coronary artery disease, particularly in men aged 40-70 y with severe sleep-disordered breathing. Please see later in the article for the Editors' Summary.
Telomeres are nucleoprotein caps flanking DNA. They are shortened by cell division and oxidative stress and are lengthened by the enzyme telomerase and DNA exchange during mitosis. Short telomeres ...induce cellular senescence. As an indicator of oxidative stress and senescence (2 processes thought to be fundamental to aging), telomere length is hypothesized to be a biomarker of aging. This hypothesis has been tested for more than a decade with epidemiologic study methods. In cross-sectional studies, researchers have investigated whether leukocyte telomere length (LTL) is associated with demographic, behavioral, and health variables. In prospective studies, baseline LTL has been used to predict mortality and occasionally other adverse health outcomes. Conflicting data have generated heated debate about the value of LTL as a biomarker of overall aging. In this review, we address the epidemiologic data on LTL and demonstrate that shorter LTL is associated with older age, male gender, Caucasian race, and possibly atherosclerosis; associations with other markers of health are equivocal. We discuss the reasons for discrepancy across studies, including a detailed review of methods for measuring telomere length as they apply to epidemiology. Finally, we conclude with questions about LTL as a biomarker of aging and how epidemiology can be used to answer these questions.
COVID-19 Through the Lens of Gerontology Le Couteur, David G; Anderson, Rozalyn M; Newman, Anne B
The journals of gerontology. Series A, Biological sciences and medical sciences,
09/2020, Volume:
75, Issue:
9
Journal Article
Peer reviewed
Open access
The case-fatality rate for COVID-19 increases dramatically with age from 3% to 5% between 65 and 74 years, 4% to 11% between 75 and 84 years, and 10% to 27% above 85 years and people aged 65 years ...and older account for 4.5% of hospitalizations, 53% of intensive care unit admissions, and 80% of deaths. The first infections with the coronavirus, SARS-C0V-2, were recognized in December 2019 in Wuhan, China and since then, over 80,000 people in China contracted COVID-19, with more than 3,000 deaths. The US has seen an exponential increase in the number of cases with the vast majority of deaths also occurring in people aged 65 years or older. Here, Le Couteur et al discuss COVID-19 through the lens of gerontology.
Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disability-free life in healthy ...seniors is unclear.
From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally. The primary end point was a composite of death, dementia, or persistent physical disability. Secondary end points reported in this article included the individual components of the primary end point and major hemorrhage.
A total of 19,114 persons with a median age of 74 years were enrolled, of whom 9525 were randomly assigned to receive aspirin and 9589 to receive placebo. A total of 56.4% of the participants were women, 8.7% were nonwhite, and 11.0% reported previous regular aspirin use. The trial was terminated at a median of 4.7 years of follow-up after a determination was made that there would be no benefit with continued aspirin use with regard to the primary end point. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95% confidence interval CI, 0.92 to 1.11; P=0.79). The rate of adherence to the assigned intervention was 62.1% in the aspirin group and 64.1% in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%; hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001).
Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo. (Funded by the National Institute on Aging and others; ASPREE ClinicalTrials.gov number, NCT01038583 .).
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