Dataset Information

The contribution of diseases to the male-female disability-survival paradox in the very old: results from the Newcastle 85+ study.

ABSTRACT:

Background

Explanations for the male-female disability-survival paradox - that woman live longer than men but with more disability - include sex differences in diseases and their impact on disability and death. Less is known about the paradox in the very old. We examine sex differences in the presence and impact of disabling and fatal diseases accounting for the male-female disability-survival paradox in very late life.

Methods

We use data from the Newcastle 85+ Study, a cohort of people born in 1921 and all recruited at age 85 in 2006. Participants underwent a health assessment (HA) at baseline, 18 months, 36 months, 60 months, and a review of their GP records (GPRR) at baseline and 36 months. We used multi-state modelling to assess the impact of specific diseases on disability and death. Disability (measured via ADLs/IADLs) was categorised as no disability (difficulty with 0 activities), or disabled (difficulty with one or more activities). Diseases were ascertained from review of general practice records and cognitive impairment which was defined as an sMMSE of 21 or less (from health assessment).

Results

In participants who had complete HA and GPRR, women had more arthritis (RR?=?1.2, 95% CI: 1.1-1.3) and hypertension (RR?=?1.2, 95%CI 1.0-1.3), more disability, and were more likely disabled at all follow-ups. From multistate models, women with cerebrovascular disease (HR: 2.6, 95% CI: 2.1-3.4) or respiratory disease (HR: 2.0, 95% CI: 1.4-3.0) were more likely to become disabled than those without but this did not hold for men (sex difference p<0.01). Men were more likely to die from respiratory disease (HR: 2.2, 95% CI: 1.8-2.8) but this did not hold for women (p?=?0.002).

Conclusion

The disability-survival paradox was still evident at age 85 and appears due to sex differences in the types of diseases and their impact on the disability pathway.

SUBMITTER: Kingston A

PROVIDER: S-EPMC3917849 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

The contribution of diseases to the male-female disability-survival paradox in the very old: results from the Newcastle 85+ study.

Kingston Andrew A Davies Karen K Collerton Joanna J Robinson Louise L Duncan Rachel R Bond John J Kirkwood Thomas B L TB Jagger Carol C

PloS one 20140207 2

<h4>Background</h4>Explanations for the male-female disability-survival paradox - that woman live longer than men but with more disability - include sex differences in diseases and their impact on disability and death. Less is known about the paradox in the very old. We examine sex differences in the presence and impact of disabling and fatal diseases accounting for the male-female disability-survival paradox in very late life.<h4>Methods</h4>We use data from the Newcastle 85+ Study, a cohort of ...[more]

PMID: 24516578

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Project description:ObjectivesAlthough the biological rationale for the association between folate, vitamin B12, and homocysteine with cognitive function seems plausible, conflicting results have been reported. This study aimed to determine the associations between 1-carbon (1-C) metabolism biomarkers (folate, vitamin B12, and homocysteine), and cognitive impairment at baseline and the rate of cognitive decline over 5 years in the very old.DesignThe Newcastle 85+ Study was a prospective longitudinal study of people 85 years old and followed over 5 years in Northeast England.SettingCommunity-dwelling and institutionalized.ParticipantsThe analytical sample included 765 very old participants with 1-C metabolism biomarkers and cognitive measures.MeasurementsGlobal cognition was measured by the Standardized Mini-Mental State Examination (SMMSE) at baseline, and at 3 and 5 years of follow-up and, attention-specific cognition with the Cognitive Drug Research (CDR) System at baseline, and at 1.5 and 3.0 years of follow-up. Baseline red blood cell folate (RBC folate), plasma vitamin B12, and total homocysteine (tHcy) concentrations were determined by immunoassay. Linear mixed models were used to estimate the associations between quartiles of 1-C metabolism biomarkers and cognition over 3 (CDR) and 5 years (SMMSE).ResultsCompared with participants in the lowest quartile of RBC folate concentrations (<612 nmol/L), those in the highest quartile of RBC folate concentrations (>1280 nmol/L) had 1 more point on the SMMSE at baseline (β = +1.02, SE = 0.43, P = .02). Those in quartile 4 of tHcy (>21.4 μmol/L) had 1 point less in the SMMSE at baseline than those in the lowest quartile (<13.5 μmol/L) (β = -1.05, SE = 0.46, P = .02). Plasma vitamin B12 was not predictive of global or attention-specific cognition at baseline and at follow-up. None of the 1-C metabolism biomarkers except tHcy was associated with the rate of decline in attention scores over 3 years.ConclusionRBC folate and tHcy, but not plasma vitamin B12, were associated with better global cognition in the very old at baseline but were not predictive of rate of decline over 5 years.

Dataset Information

The contribution of diseases to the male-female disability-survival paradox in the very old: results from the Newcastle 85+ study.

Background

Methods

Results

Conclusion

Publications

The contribution of diseases to the male-female disability-survival paradox in the very old: results from the Newcastle 85+ study.

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