3-D health trajectories and related childhood predictors among older adults in China.
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ABSTRACT:
SUBMITTER: Pan C
PROVIDER: S-EPMC8110566 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background and objectivesThe individual heterogeneity in the progression of frailty has not been fully disclosed. Studies on frailty trajectories in Chinese older adults are rare and lack evidence suggesting that the frailty trajectories follow similar patterns to those in other countries. This study aims to identify distinct frailty trajectories in a nationwide cohort of community-dwelling older adults in China and explore the relationship between demographic, socioeconomic, and behavioral factors, and frailty trajectories.Research design and methodsWe included an analytical sample of 8,993 individuals aged 50 and older from the China Health and Retirement Longitudinal Study. We used group-based trajectory models to identify patterns of frailty trajectories over time. Multinomial logistic regression was used to estimate the relationship between demographic, socioeconomic, and behavioral factors, and group membership.ResultsThree frailty trajectories were identified: "Low and stable trajectory" (56.8% of the respondents), "Moderate and increasing trajectory" (34.4%), and "High and increasing trajectory" (8.8%). Older age (odds ratio [OR] = 7.37, 95% confidence interval [CI]: 5.90-9.20), being female (OR = 1.79, 95% CI: 1.42-2.27), no formal education (OR = 4.91, 95% CI: 2.33-10.36), living in rural areas (OR = 1.22, 95% CI: 1.01-1.47), low level of physical activity (OR = 2.65, 95% CI: 1.94-3.62), and residing in Northeast China (OR = 3.53, 95% CI: 2.56-4.88) were associated with the rapid progression of frailty, whereas moderate alcohol consumption appears to be associated with low and stable frailty trajectory (OR = 0.45, 95% CI: 0.35-0.58).Discussion and implicationsThe findings of the study emphasize a significant number of older adults with moderate and increasing as well as high and increasing frailty trajectories in China, which is cause for concern.
| S-EPMC10798827 | biostudies-literature
Project description:Despite the increasing health burden of chronic hepatitis B (CHB) in aging populations, little is known about the course of health-related quality of life (HRQoL) changes. We aimed to assess individual-level longitudinal HRQoL changes in elderly patients with CHB and to examine their correlates. A prospective 5.1 years-cohort study was conducted in community-dwelling adults aged 55 years with hepatitis B surface antigen-positive. Participants underwent serial measurement of HRQoL using the short-form (12) health survey version 2. Of 503 participants, 82.7% remained in good physical health throughout the study period, whereas 9.1% had declining physical health and 8.2% were in poor physical health. We likewise identified three trajectories of mental health changes ("good mental health" [86.9%], "declining mental health" [6.8%], and "poor mental health" [6.4%]). Three baseline characteristics were independently associated with a lower likelihood of remaining physically or mentally healthy: sarcopenic obesity (odds ratio [OR] with 95% confidence interval [95% CI] of 7.5 [2.8-20.5] for poor physical health, 3.1 [1.1-8.4] for declining physical health, 4.3 [1.4-13.0] for poor mental health), a higher number of metabolic abnormalities (OR [95% CI] of 3.6 [1.6-8.0] for poor physical health) and depressed mood (OR [95% CI] of 21.7 [5.8-81.0] for poor physical health, 5.3 [1.4-19.9] for declining physical health, 83.1 [19.7-350.2] for poor mental health, 13.6 [2.9-64.8] for declining mental health). In conclusion, in a cohort of elderly patients with CHB, we demonstrated the heterogeneity and nonlinearity of HRQoL changes and their associations with variations in specific extrahepatic organs/systems.
| S-EPMC8193133 | biostudies-literature
Project description:Stigma and discrimination toward individuals experiencing homelessness and mental disorders remain pervasive across societies. However, there are few longitudinal studies of stigma and discrimination among homeless adults with mental illness. This study aimed to identify the two-year group trajectories of stigma and discrimination and examine the predictive role of mental health characteristics among 414 homeless adults with mental illness participating in the extended follow-up phase of the Toronto At Home/Chez Soi (AH/CS) randomized trial site. Mental health-related perceived stigma and discrimination were measured at baseline, one, and two years using validated scales. Group-based-trajectory modelling was used to identify stigma and discrimination group trajectory memberships and the effect of the Housing First treatment (rent supplements and mental health support services) vs treatment as usual on these trajectories. The associations between mental health-related characteristics and trajectory group memberships were also assessed using multinomial logistic regression. Over two-years, three group trajectories of stigma and discrimination were identified. For discrimination, participants followed a low, moderate, or increasingly high discrimination group trajectory, while for stigma, participants followed a low, moderate or high stigma group trajectory. The Housing First treatment had no significant effect on discrimination or stigma trajectories groups. For the discrimination trajectories, major depressive episode, mood disorder with psychotic features, alcohol abuse, suicidality, severity of mental health symptoms, and substance use severity in the previous year were predictors of moderate and increasingly high discrimination trajectories. History of discrimination within healthcare setting was also positively associated with following a moderate or high discrimination trajectory. For the stigma trajectories, substance dependence, high mental health symptoms severity, substance use severity, and discrimination experiences within healthcare settings were the main predictors for the moderate trajectory group; while substance dependence, suicidality, mental health symptom severity, substance use severity and discrimination experiences within health care setting were also positive predictors for the high stigma trajectory group. Ethno-racial status modified the association between having a major depression episode, alcohol dependence, and the likelihood of being a member of the high stigma trajectory group. This study showed that adults experiencing mental illness and homelessness followed distinct stigma and discrimination group trajectories based on their mental health-problems. There is an urgent need to increase focus on strategies and policies to reduce stigma and discrimination in this population.
| S-EPMC7046214 | biostudies-literature
Project description:BackgroundHealth-related quality of life (HRQoL) is an important outcome measure when considering medical treatment; however, the impact of polypharmacy on trajectories of HRQoL over time is unknown. This study aimed to investigate the association between polypharmacy status and trajectories of HRQoL in older adults.MethodsA longitudinal cohort study of 2181 community-dwelling adults, 65 years and older, who participated in the 2013 to 2017 waves of the Household Income and Labour Dynamics in Australia (HILDA) Survey. Polypharmacy was defined as the regular use of ≥ 5 prescription medications. Polypharmacy status was categorised into no polypharmacy, in 2013 only (baseline only polypharmacy), in 2017 only (incident polypharmacy) or at both time points (persistent polypharmacy). HRQoL was assessed through the SF-36 questionnaire generating two summary scores: physical component summary (PCS) and mental component summary (MCS). Linear mixed-effects models stratified according to polypharmacy status and change in comorbidities were used to assess trajectories of HRQoL.ResultsOlder adults with persistent polypharmacy had lowest scores for HRQoL measures from 2013 to 2017. After adjusting for all covariates, those with incident polypharmacy had the steepest annual decline in both the PCS and MCS: - 0.86 in PCS and - 0.76 in MCS for those with decreasing or stable comorbidities, and - 1.20 in PCS and - 0.75 in MCS for those with increasing comorbidities.ConclusionsPolypharmacy was associated with poorer HRQoL, even after adjusting for confounders. Incident polypharmacy was found to be associated with a clinically important decline in HRQoL and this should be considered when prescribing additional medication to older adults.
| S-EPMC9356923 | biostudies-literature
Project description:BackgroundPeople age differently, challenging the identification of those more at risk of rapid health deterioration. This study aimed to explore the heterogeneity in the health of older adults by using five clinical indicators to detect age-related variation and individual health trajectories over time.MethodsHealth of 3,363 people aged 60+ from the Swedish National study on Aging and Care-Kungsholmen (SNAC-K) assessed at baseline and at 3- and 6-year follow-ups. Number of chronic diseases, physical and cognitive performance, personal and instrumental activities of daily living were integrated in a health assessment tool (HAT). Interindividual health differences at baseline and follow-ups were assessed with logistic quantile regression. Intraindividual health trajectories were traced with quantile mixed-effect models.ResultsThe HAT score ranges from 0 (poor health) to 10 (good health); each score corresponds to a specific clinical profile. HAT was reliable over time and accurately predicted adverse health outcomes (receiver-operating characteristic areas: hospitalization = 0.78; 95% confidence interval = 0.74-0.81; mortality = 0.85; 95% confidence interval = 0.83-0.87; similar areas obtained for gait speed). Before age 85, at least 90% of participants were free of severe disability, and at least 50% were functionally independent despite chronic disorders. Age- and sex-related variation and high heterogeneity in health were detected at baseline and confirmed by intraindividual health trajectories.ConclusionsThis study provides a positive picture of the health status of people 60+. Despite the complexity and heterogeneity of health in this age group, we could identify age- and sex-specific health trajectories using an integrated HAT. HAT is potentially useful in clinical practice and public health interventions.
| S-EPMC5861965 | biostudies-literature
Project description:ObjectivesFamily structure in childhood influences early brain development and cognitive performance in adulthood. Much less is known about its long-term impact on later-life cognitive functioning. We extend the two-generation family structure approach to investigate the potential contribution of living with grandparents in multigenerational households to differences in cognitive functioning at older ages.MethodsData were drawn from 9 waves of the Health and Retirement Study (1998-2014) merged with newly collected childhood family history data. Five types of family structure were assessed: two-parent households, two-parent households with grandparents, single-parent households, single-parent households with grandparents, and grandparent-headed households. Growth curve models were used to estimate trajectories of cognitive functioning over time.ResultsChildhood family structure was significantly associated with level of cognitive functioning, but not to rate of cognitive decline. Relative to those from two-parent households, individuals who grew up in multigenerational households showed higher levels of cognitive functioning, including those living with a single parent and grandparents. Those who lived with a single parent alone were the most disadvantaged. The effects of these multigenerational households persisted net of childhood and adulthood socioeconomic status and health outcomes.DiscussionGrandparent coresidence may cultivate a socially enriched home environment, providing resources and protection for early cognitive development that could persist throughout life. Multigenerational living arrangements are likely to increase as the contemporary population ages. More research needs to be done to understand the impact of these living arrangements on future generations' brain health and cognitive aging.
| S-EPMC8200351 | biostudies-literature
Project description:Emerging evidence suggests that olfactory function is closely linked to memory function. The aims of this study were to assess whether olfactory and episodic memory functions follow similar age-related decline trajectories, to identify different patterns of decline, as well as predictors of the patterns. 1023 participants from the Memory and Aging Project were followed for up to 8 years with annual episodic memory and odor identification assessments. Trajectories were modelled using growth mixture models. Multivariate logistic regression was used to identify pattern predictors. Three patterns of joint trajectories were identified; Class 1- stable average performance in both functions (n=690, 67.4%); Class 2- stable average episodic memory and declining odor identification (n=231, 22.6%); and Class 3- decline in both functions (n= 102, 10.0%). Class predictors included age, sex, APOE ε4 status, cognitive activity level and BMI. Participants in Class 3 were most likely to develop dementia. Episodic memory and olfactory function show similar trajectories in aging. Such classification can contribute to a better understanding of the factors related to cognitive decline and dementia.
| S-EPMC8312450 | biostudies-literature
Project description:ObjectiveTo determine the prevalence, incidence, and predictors of epilepsy among older adults in the Cardiovascular Health Study (CHS).MethodsWe analyzed data prospectively collected in CHS and merged with data from outpatient Medicare administrative claims. We identified cases with epilepsy using self-report, antiepileptic medication, hospitalization discharge ICD-9 codes, and outpatient Medicare ICD-9 codes. We used Cox proportional hazards regression to identify factors independently associated with incident epilepsy.ResultsAt baseline, 42% of the 5,888 participants were men and 84% were white. At enrollment, 3.7% (215 of 5,888) met the criteria for prevalent epilepsy. During 14 years of follow-up totaling 48,651 person-years, 120 participants met the criteria for incident epilepsy, yielding an incidence rate of 2.47 per 1,000 person-years. The period prevalence of epilepsy by the end of follow-up was 5.7% (335 of 5,888). Epilepsy incidence rates were significantly higher among blacks than nonblacks: 4.44 vs 2.17 per 1,000 person-years (p < 0.001). In multivariable analyses, risk of incident epilepsy was significantly higher among blacks compared to nonblacks (hazard ratio [HR] 4.04, 95% confidence interval [CI] 1.99-8.17), those 75 to 79 compared to those 65 to 69 years of age (HR 2.07, 95% CI 1.21-3.55), and those with history of stroke (HR 3.49, 95% CI 1.37-8.88).ConclusionsEpilepsy in older adults in the United States was common. Blacks, the very old, and those with history of stroke have a higher risk of incident epilepsy. The association with race remains unexplained.
| S-EPMC5331867 | biostudies-literature
Project description:BackgroundIdentifying patients at high risk of drug-related hospital admission (DRA) may help to efficiently target preventive interventions. We developed a score to predict DRAs in older patients with multimorbidity and polypharmacy.MethodsWe used participants from the multicenter European OPERAM trial ("Optimising PharmacothERapy in the Mutlimorbid Elderly"). We assessed the association between easily identifiable predictors and 1-year DRAs by univariable logistic regression. Variables with p-value< 0.20 were taken forward to backward regression. We retained all variables with p < 0.05 in the model. We assessed the C-statistic, calibration (observed/predicted proportions), and overall accuracy (scaled Brier score, <0.25 indicating a useful model) of the score, and internally validated it by tenfold cross-validation.ResultsWithin 1 year, 435/1879 (23.2%) patients (mean age 79.4 years) had a DRA. The score included seven variables: previous hospitalizations, non-elective admission, hypertension, cirrhosis with portal hypertension, chronic kidney disease, diuretic, oral corticosteroid. The C-statistic was 0.64 (95% CI 0.61-0.67). Patients with <1 point had a 12.4% predicted and observed risk of DRA, while those with >3 points had a 40.4% predicted and 38.9% observed risk of DRA. The scaled Brier score was 0.05. Calibration showed an adequate match between predicted and observed proportions.ConclusionComorbidities related to drug metabolism, specific medications, non-elective admission, and a history of hospitalization, were associated with a higher risk of DRA. Awareness of these associations and the score we developed may help identify patients most likely to benefit from preventive interventions.
| S-EPMC9305949 | biostudies-literature
Project description:BackgroundMidlife represents an important time to evaluate health status and health behaviors that may affect health-related quality of life (HRQL) in later years. This study examines change in women's HRQL over 11 years from ages 47-59 to 57-69 and identifies midlife characteristics that predict HRQL at older ages.MethodsPhysical (PCS) and mental component summaries (MCS) of the SF-36 were used to assess HRQL from 2002 to 2013 in 2,614 women from the Study of Women's Health Across the Nation (SWAN), a multiethnic/racial cohort study. We used locally weighted scatterplot smoothing (LOESS) models to obtain unadjusted predicted mean trajectories of PCS and MCS as a function of age.ResultsLOESS predicted PCS declined from 51.6 to 47.1, whereas MCS increased from 49.2 to 53.1. In multivariable models, controlling for baseline PCS, higher baseline physical activity (p = .002) and increase in physical activity from baseline (p < .0001) predicted better PCS. Time since baseline (ie, aging; p < .001), higher baseline body mass index (p < .0001), increased body mass index over time (p < .0001), smoking (p < .05), two or more medical conditions (p < .0001), sleep problems (p < .0001), and urinary incontinence (p < .0001) were related to lower PCS. Early (p = .004) and late postmenopause (p = .001; vs. premenopause) and aging (p = .05) predicted higher MCS. Predictors of lower MCS were less than very good health (p < .0001), sleep problems (p < .0001), stressful life events (p < .0001), higher perceived stress (p < .0001), and higher trait anxiety (p = .004). Race/ethnicity was related to MCS, but not PCS.ConclusionsSeveral potentially modifiable midlife factors, such as improved sleep hygiene, physical activity, and body mass index, might improve HRQL for older women.
| S-EPMC6175022 | biostudies-literature