Background. We examined the association between extremely low-frequency magnetic fields (EMF) and the risk of dementia and Alzheimer’s disease using all 9,508 individuals from the Study of Dementia in Swedish Twins (HARMONY) with valid occupational and diagnostic data.

Methods. Dementia diagnoses were based on telephone screening followed by in-person clinical workup. Main lifetime occupation was coded according to an established EMF exposure matrix. Covariates were age, gender, education, vascular risk factors, and complexity of work. Based on previous research, data were also analyzed separately for cases with disease onset by age 75 years versus later, men versus women, and those with manual versus nonmanual main occupation. We used generalized estimating equations with the entire sample (to adjust for the inclusion of complete twin pairs) and conditional logistic regression with complete twin pairs only.

Results. Level of EMF exposure was not significantly associated with dementia or Alzheimer’s disease. However, in stratified analyses, medium and high levels of EMF exposure were associated with increased dementia risk compared with low level in cases with onset by age 75 years (odds ratio: 1.94, 95% confidence interval: 1.07–3.65 for medium, odds ratio: 2.01, 95% confidence interval: 1.10–3.65 for high) and in participants with manual occupations (odds ratio: 1.81, 95% confidence interval: 1.06–3.09 for medium, odds ratio: 1.75, 95% confidence interval: 1.00–3.05 for high). Results with 42 twin pairs discordant for dementia did not reach statistical significance.

Conclusions. Occupational EMF exposure appears relevant primarily to dementia with an earlier onset and among former manual workers.

Many mutations that dramatically extend life span in model organisms come with substantial fitness costs. Although these genetic manipulations provide valuable insight into molecular modulators of life span, it is currently unclear whether life-span extension is unavoidably linked to fitness costs. To examine this relationship, we evolved a genetically heterogeneous population of Caenorhabditis elegans for 47 generations, selecting for early fecundity. We asked whether an increase in early fecundity would necessitate a decrease in longevity or late fecundity (antagonistic pleiotropy). Caenorhabditis elegans experimentally evolved for increased early reproduction and decreased late reproduction but suffered no total fitness or life-span costs. Given that antagonistic pleiotropy among these traits has been previously demonstrated in some cases, we conclude that the genetic constraint is not absolute, that is, it is possible to uncouple longevity from early fecundity using genetic variation segregating within and among natural populations.

BACKGROUND: Declines in functional dependence among older adults were observed before the 1990s, but there is uncertainty about subsequent trends. Our study aimed to verify the temporal trends in disability during 1991-2010 in an older Swedish population and to estimate the associated changes in survival.

METHODS: Functional status in octogenarians and nonagenarians was assessed at seven occasions with intervals of 2-3 years. Sample size varied at each assessment with an average of 646 (range 212-1096). Disability was defined as difficulty in one or more of personal activities of daily living. We compared prevalence and incidence, as well as mortality, and survival associated with disability over the 20-year period.

RESULTS: Sex-standardized prevalence of disability remained steady over time with a tendency toward a gradual decline, and a statistically significant decrease was present among nonagenarians. Sex-standardized cumulative incidence also remained steady. The proportion of people with prevalent disability who died <3 years remained stable, as did the survival time of people with incident disability. In contrast, among nondisabled persons, 3-year mortality decreased significantly, and for octogenarians median survival time was 1.3 years longer at the more recent assessment than a decade earlier.

CONCLUSIONS: Both prevalence and incidence of disability remained stable over the last two decades in this urban Swedish population, with a trend toward a slow decline. Mortality remained steady among disabled persons but decreased among persons without disability, suggesting that increased life expectancy during the last two decades may be essentially driven by longer lives of functionally independent people.

Background. Declines in functional dependence among older adults were observed before the 1990s, but there is uncertainty about subsequent trends. Our study aimed to verify the temporal trends in disability during 1991-2010 in an older Swedish population and to estimate the associated changes in survival. Methods. Functional status in octogenarians and nonagenarians was assessed at seven occasions with intervals of 2-3 years. Sample size varied at each assessment with an average of 646 (range 212-1096). Disability was defined as difficulty in one or more of personal activities of daily living. We compared prevalence and incidence, as well as mortality, and survival associated with disability over the 20-year period. Results. Sex-standardized prevalence of disability remained steady over time with a tendency toward a gradual decline, and a statistically significant decrease was present among nonagenarians. Sex-standardized cumulative incidence also remained steady. The proportion of people with prevalent disability who died <3 years remained stable, as did the survival time of people with incident disability. In contrast, among nondisabled persons, 3-year mortality decreased significantly, and for octogenarians median survival time was 1.3 years longer at the more recent assessment than a decade earlier. Conclusions. Both prevalence and incidence of disability remained stable over the last two decades in this urban Swedish population, with a trend toward a slow decline. Mortality remained steady among disabled persons but decreased among persons without disability, suggesting that increased life expectancy during the last two decades may be essentially driven by longer lives of functionally independent people.

Dietary Restriction extends lifespan in a diverse range of animals, but this often comes at a cost to reproduction. While a number of molecular pathways integral to these relationships have been characterised, we still do not fully understand whether restriction of specific nutrients or calories is responsible. Two recent studies on insects have offered novel insights into this longstanding issue via the application of Nutritional Geometry. This technique promises to significantly advance our understanding of how nutrition influences reproduction and longevity.

Background. Hearing deterioration at advanced ages is associated with environmental exposures (eg, to noise and solvents) and genetic influences may also be important. Little is known about the role of genetic influences on hearing when evaluated longitudinally. We sought to investigate longitudinal hearing loss in a cohort of adult male twins to evaluate the importance of genetic and environmental factors for hearing deterioration over time. Methods. Hearing using conventional clinical audiometry was assessed in 583 male twins (128 monozygotic twin pairs and 111 dizygotic twin pairs) aged 34-79 at baseline and again two decades later. The hearing thresholds at two time points were compared at each frequency and in two different frequency regions. Genetic analyses were based on structural equation models. Bivariate Cholesky decomposition was used for longitudinal analysis. Results. The prevalence of hearing loss increased over time in better and worse ear. The hearing threshold shift was more pronounced in the high-frequency region, especially at 8000 Hz. Genetic influences were moderate (heritability: 53%-65%) for pure-tone averages at both lower and higher frequencies, and were of equal magnitude at baseline and follow-up. In contrast, environmental influences were of substantial importance (55%-88%) for rate of change of the hearing threshold over the 18-year period. Conclusions. Genetic factors are of considerable importance for level of hearing acuity, but environmental factors are more important for rate of change over an 18-year period.

Background: While research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

Methods: Screening Across the Lifespan Twin Study (SALT) participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios (HR) for dementia.

Results: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤ 6 hours) and extended (> 9 hours) time-in-bed (TIB) compared to the middle reference group (HR=1.40, 95% CI=1.06-1.85, HR=1.11, 95% CI=1.00-1.24, respectively) and rising at 8:00AM or later compared to earlier rising (HR=1.12, 95% CI=1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

Conclusions: Short and extended TIB as well as delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

BACKGROUND: Although research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

METHODS: Screening Across the Lifespan Twin (SALT) study participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios for dementia.

RESULTS: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤6 hours) and extended (>9 hours) time in bed (TIB) compared to the middle reference group (hazard ratio = 1.40, 95% confidence interval = 1.06-1.85; hazard ratio = 1.11, 95% confidence interval = 1.00-1.24, respectively) and rising at 8:00 AM or later compared to earlier rising (hazard ratio = 1.12, 95% confidence interval = 1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

CONCLUSIONS: Short and extended TIB and delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

Background: While research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

Methods: Screening Across the Lifespan Twin Study (SALT) participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios (HR) for dementia.

Results: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤ 6 hours) and extended (> 9 hours) time-in-bed (TIB) compared to the middle reference group (HR=1.40, 95% CI=1.06-1.85, HR=1.11, 95% CI=1.00-1.24, respectively) and rising at 8:00AM or later compared to earlier rising (HR=1.12, 95% CI=1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

Conclusions: Short and extended TIB as well as delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

OBJECTIVE: This paper documents the applicability of the Older Americans Resources and Services (OARS) Social Resources Scale in six European Countries (the Netherlands, Luxembourg, Italy, Austria, the United Kingdom and Sweden). METHOD: A questionnaire was administered through face-to-face interviews in five countries, and postal interview in the sixth, to representative populations of adults aged 50-90 living independently (N=12478). The paper examines the missing values and distribution of the items in the social resources scale, and the consistency of skew and kurtosis across the countries. Item-total correlations are performed. Confirmatory factor analyses (CFA) are run to test a three factor model which was obtained in USA and Spanish analyses. Cronbach’s Alpha determines the reliability of the social resources sub-scales. RESULTS: Relatively large proportion of missing data is observed for one item (have someone who would help you). All items correlate with a score equal to or greater than 0.20. Although the CFA generally support the acceptability of the three factor structure in the European data, the reliability of two of the sub-scales (dependability and affective) is unacceptably low. DISCUSSION: Differences across countries makes it unlikely a single social resources scale can be developed that would have item equivalence in multiple countries.

Background

Although the definition of multimorbidity as the simultaneous presence of two or more chronic diseases is well established, its operationalization is not yet agreed. This study aims to provide a clinically driven comprehensive list of chronic conditions to be included when measuring multimorbidity.

Methods

Based on a consensus definition of chronic disease, all four-digit level codes from the International Classification of Diseases, 10th revision (ICD-10) were classified as chronic or not by an international and multidisciplinary team. Chronic ICD-10 codes were subsequently grouped into broader categories according to clinical criteria. Last, we showed proof of concept by applying the classification to older adults from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) using also inpatient data from the Swedish National Patient Register.

Results

A disease or condition was considered to be chronic if it had a prolonged duration and either (a) left residual disability or worsening quality of life or (b) required a long period of care, treatment, or rehabilitation. After applying this definition in relation to populations of older adults, 918 chronic ICD-10 codes were identified and grouped into 60 chronic disease categories. In SNAC-K, 88.6% had >= 2 of these 60 disease categories, 73.2% had >= 3, and 55.8% had >= 4.

Conclusions

This operational measure of multimorbidity, which can be implemented using either or both clinical and administrative data, may facilitate its monitoring and international comparison. Once validated, it may enable the advancement and evolution of conceptual and theoretical aspects of multimorbidity that will eventually lead to better care.

Background: Cut-points to define slow walking speed have largely been derived from expert opinion. Methods: Study participants (13 589 men and 5043 women aged >= 65years) had walking speed (m/s) measured over 4-6 m (mean +/- SD: 1.20 +/- 0.27 m/s in men and 0.94 +/- 0.24 m/s in women.) Mobility limitation was defined as any self-reported difficulty with walking approximately 1/4 mile (prevalence: 12.6% men, 26.4% women). Sex-stratified classification and regression tree (CART) models with 10-fold cross-validation identified walking speed cut-points that optimally discriminated those who reported mobility limitation from those who did not. Results: Among 5043 women, CART analysis identified 2 cut-points, classifying 4144 (82.2%) with walking speed >= 0.75 m/s, which we labeled as "fast"; 478 (9.5%) as "intermediate" (walking speed >= 0.62 m/s but <0.75 m/s); and 421 (8.3%) as "slow" (walking speed <0.62 m/s). Among 13 589 men, CART analysis identified 3 cut-points, classifying 10 001 (73.6%) with walking speed >= 1.00m/s ("very fast"); 2901 (21.3%) as "fast" (walking speed >= 0.74 m/s but <1.00 m/s); 497 (3.7%) as "intermediate" (walking speed >= 0.57 m/s but <0.74 m/s); and 190 (1.4%) as "slow" (walking speed <0.57 m/s). Prevalence of self-reported mobility limitation was lowest in the "fast" or "very fast" (11% for men and 19% for women) and highest in the "slow" (60.5% in men and 71.0% in women). Rounding the 2 slower cut-points to 0.60 m/s and 0.75 m/s reclassified very few participants. Conclusions: Cut-points in walking speed of approximately 0.60 m/s and 0.75 m/s discriminate those with self-reported mobility limitation from those without.

Background: Body weight variability (BWV) refers to intraindividual weight loss and gain over a period. The association of long-term BWV with dementia remains unclear and whether this association is beyond body weight change is undetermined.

Methods: In the Health and Retirement Study, a total of 5 547 dementia-free participants (56.7% women; mean [SD] age, 71.1 [3.2] years) at baseline (2008) were followed up to 8 years (mean = 6.8 years) to detect incident dementia. Body weight was self-reported biennially from 1992 to 2008. BWV was measured as the coefficient of variation utilizing the body weight reported 9 times across 16 years before baseline. Cox-proportional hazard model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).

Results: Among the 5 547 participants, a total of 427 incident dementia cases were identified during follow-up. Greater long-term BWV was significantly associated with a higher risk of dementia (HR comparing extreme quartiles: 2.01, 95% CI: 1.48-2.72; HR of each SD increment: 1.21, 95% CI: 1.10-1.32; p-trend < .001) independent of mean body weight and body weight change. This significant association was even observed for BWV estimated approximately 15 years preceding dementia diagnosis (HR of each SD increment: 1.13, 95% CI: 1.03-1.23) and was more pronounced for that closer to diagnosis.

Conclusion: Our prospective study suggested that greater BWV may be a novel risk factor for dementia.

Background: Subjective and social well-being, avoiding sedentary behavior (SB), and engaging in physical activity (PA) are important factors for health in older adults, but the extent to which they are related to each other remains unclear. We aimed to investigate these correlations, and whether they differ by age.

Method: A cross-sectional study was carried out in 595 people aged 66 years and older, from the Swedish National study on Aging and Care in Kungsholmen. Subjective and social well-being (life satisfaction, positive and negative affect, social connections, social support, and social participation) were assessed through validated questionnaires and activPAL3 accelerometers provided information on SB and PA. Data were analyzed using multi-adjusted quantile regression models.

Results: Higher positive affect was significantly associated with less daily sitting time (β = −27.08, 95% confidence interval [CI]: −47.77, −6.39) and higher levels of light PA (LPA) (β = 40.67, 95% CI: 21.06, 60.28). Higher levels of social support and social participation were associated with less daily sitting time (β = −22.79, 95% CI: −39.97, −5.62; and β = −21.22, 95% CI: −39.99, −2.44) and more time in LPA (β = 23.86, 95% CI: 4.91, 42.81; and β = 25.37, 95% CI: 6.27, 44.47). Stratified analyses suggested that the associations of positive affect and social participation were strongest for individuals aged 80 years and older.

Conclusions: Our results suggest that older adults with higher levels of subjective and social well-being spend less time sitting and engage more in PA. This was especially evident among the oldest-old individuals. Future research should longitudinally investigate the directionality of these correlations.

Background: Many studies have been conducted to investigate risk factors of falls in older people, but little is known about falls among centenarians. We analyzed the cross-sectional data from the Five-Country Oldest Old Project (5-COOP) to investigate the prevalence and correlates of falls among centenarians. Methods: Data collection was carried out in 2011-2014 in Japan, France, Switzerland, Sweden, and Denmark. The sample consisted of 1,165 centenarians who were at least 100 years old in 2011. The outcome variable was falls in the past 6 months. Demographics, chronic conditions, pain, visual impairment, global cognitive function, dizziness and syncope, number of medications, functional limitation (ie, dressing, bathing, toileting, transferring, incontinence, and feeding), mobility difficulty, poor strength, and assistive device usage were included in the analysis. Results: The prevalence of falls within the last 6 months was 33.7%, ranging from 21.6% (Japan) to 40.9% (France). Being male, experiencing dizziness, syncope, incontinence, and using assistive devices indoors were associated with an increased risk of falls among centenarians. Significant cross-country differences in the relationships between some risk factors (ie, gender, difficulty with bathing, toileting, transferring, and feeding, and using assistive devices for walking indoors and outdoors) and falls were observed. Subsample analysis using data from each country also showed that factors related to falls were different. Conclusions: The prevalence of falls among centenarians is high and fall-related factors may be different than those for their younger counterparts. Given that centenarians is an emerging population, more studies investigating risk factors are needed to better understand falls among centenarians.

BACKGROUND: Although an increasing body of evidence links being overweight in midlife with an increased risk for dementia in late life, no studies have examined the association between being overweight in midlife and cognitive ability in late life. Our aim was to examine the association between being overweight in midlife as measured by body mass index (BMI) and cognitive ability assessed over time. METHODS: Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample. The participants completed baseline surveys in 1963 or 1973 (mean age 41.6 years, range 25-63 years). The surveys included questions about height, weight, diseases, and lifestyle factors. Beginning in 1986, the same individuals were assessed on neuropsychological tests every 3 years (except in 1995) until 2002. During the study period, 781 individuals who were 50 years and older (60% women) had at least one complete neuropsychological assessment. A composite score of general cognitive ability was derived from the cognitive test battery for each measurement occasion. RESULTS: Latent growth curve models adjusted for twinness showed that persons with higher midlife BMI scores had significantly lower general cognitive ability and significantly steeper longitudinal decline than their thinner counterparts. The association did not change substantially when persons who developed dementia during the study period were excluded from the analysis. CONCLUSIONS: Higher midlife BMI scores precede lower general cognitive ability and steeper cognitive decline in both men and women. The association does not seem to be mediated by an increased risk for dementia

BACKGROUND: Although an increasing body of evidence links being overweight in midlife with an increased risk for dementia in late life, no studies have examined the association between being overweight in midlife and cognitive ability in late life. Our aim was to examine the association between being overweight in midlife as measured by body mass index (BMI) and cognitive ability assessed over time. METHODS: Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample. The participants completed baseline surveys in 1963 or 1973 (mean age 41.6 years, range 25-63 years). The surveys included questions about height, weight, diseases, and lifestyle factors. Beginning in 1986, the same individuals were assessed on neuropsychological tests every 3 years (except in 1995) until 2002. During the study period, 781 individuals who were 50 years and older (60% women) had at least one complete neuropsychological assessment. A composite score of general cognitive ability was derived from the cognitive test battery for each measurement occasion. RESULTS: Latent growth curve models adjusted for twinness showed that persons with higher midlife BMI scores had significantly lower general cognitive ability and significantly steeper longitudinal decline than their thinner counterparts. The association did not change substantially when persons who developed dementia during the study period were excluded from the analysis. CONCLUSIONS: Higher midlife BMI scores precede lower general cognitive ability and steeper cognitive decline in both men and women. The association does not seem to be mediated by an increased risk for dementia

BACKGROUND: To study the effects of exercise on falls, fractures, hospitalizations, and death in people with dementia.

METHOD: We conducted an individual-level patient data meta-analysis of 7 randomized controlled trials (RCTs). We looked for studies from the reference list of previous systematic reviews and undertook an electronic search for articles published between 2013 and 2019 in Ageline, CENTRAL, PsycINFO, PubMed, and SportsDiscus. Main (binary) outcome measures were the risk of mortality, hospitalization, faller, multiple faller, injurious faller, and fractures. Secondary (count) outcomes were the incident rates of hospitalizations, falls, and injurious falls.

RESULTS: From the 1314 participants, 771 were allocated to the exercise group and 543 to the control group. The number of cases regarding the main outcome measures in exercisers and controls were, respectively: 45 (5.8%) and 31 (5.7%) deaths; 102 (14.4%) and 65 (13.4%) participants hospitalized; 221 (34.4%) and 175 (41.3%) had at least 1 fall; 128 (20.2%) and 92 (21.7%) had multiple falls; 78 (24.8%) and 92 (29.3%) had injurious falls; and 19 (2.9%) and 15 (3.5%) had suffered a fracture. Two-step meta-analysis found no effects of exercise on any outcome. One-step meta-analysis found exercise reduced the risk of falls (odds ratio 0.75; 95% CI: 0.57-0.99). Exploratory analysis showed exercise decreased the rate of incident falls in participants with the lowest functional ability (incident rate ratio 0.48; 95% CI: 0.30-0.79).

CONCLUSIONS: Although the 2-step meta-analysis suggests exercise does not have an effect on the outcomes, 1-step meta-analysis suggested that exercise may reduce fall risk. Data from further high-quality RCTs are still needed.

BACKGROUND: Substantial research is dedicated to understanding the aging-related dynamics among individual differences in level, change, and variation across physical and cognitive abilities. Evaluating replicability and synthesizing these findings has been limited by differences in measurements and samples, and by study design and statistical analyses confounding between-person differences with within-person changes. In this paper, we conducted a coordinated analysis and summary meta-analysis of new results on the aging-related dynamics linking pulmonary function and cognitive performance.

METHODS: We performed coordinated analysis of bivariate growth models in data from 20,586 participants across eight longitudinal studies to examine individual differences in baseline level, rate of change, and occasion-specific variability in pulmonary and cognitive functioning. Results were summarized using meta-analysis.

RESULTS: We found consistent but weak baseline and longitudinal associations in levels of pulmonary and cognitive functioning, but no associations in occasion-specific variability.

CONCLUSIONS: Results provide limited evidence for a consistent link between simultaneous changes in pulmonary and cognitive function in a normal aging population. Further research is required to understand patterns of onset of decline and differences in rates of change within and across physical and cognitive functioning domains, both within-individuals and across countries and birth cohorts. Coordinated analysis provides an efficient and rigorous approach for replicating and comparing results across independent longitudinal studies.

Background: Although falls in older adults are related to multiple risk factors, these factors have commonly been studied individually. We aimed to identify risk profiles for injurious falls in older adults by detecting clusters of established risk factors and quantifying their impact on fall risk. Methods: Participants were 2,566 people, aged 60 years and older, from the population-based Swedish National Study on Aging and Care in Kungsholmen. Injurious falls was defined as hospitalization for or receipt of outpatient care because a fall. Cluster analysis was used to identify aggregation of possible risk factors including chronic diseases, fall-risk increasing drugs (FRIDs), physical and cognitive impairments, and lifestyle-related factors. Associations between the clusters and injurious falls over 3, 5, and 10 years were estimated using flexible parametric survival models. Results: Five clusters were identified including: a healthy, a well-functioning with multimorbidity, a well-functioning, with multimorbidity and high FRID consumption, a physically and cognitively impaired, and a disabled cluster. The risk of injurious falls for all groups was significantly higher than for the first cluster of healthy individuals in the reference category. Hazard ratios (95% confidence intervals) ranged from 1.71 (1.02-2.66) for the second cluster to 12.67 (7.38-21.75) for the last cluster over 3 years of follow-up. The highest risk was observed in the last two clusters with high burden of physical and cognitive impairments. Conclusion: Risk factors for injurious fall tend to aggregate, representing different levels of risk for falls. Our findings can be useful to tailor and prioritize clinical and public health interventions.

Background: Olfactory dysfunction is common in aging and associated with dementia and mortality. However, longitudinal studies tracking change in olfactory ability are scarce. We sought to identify predictors of interindividual differences in rate of olfactory identification change in aging.

Method: Participants were 1780 individuals, without dementia at baseline and with at least 2 olfactory assessments over 12 years of follow-up (mean age = 70.5 years; 61.9% female), from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Odor identification was assessed with the Sniffin’ Sticks. We estimated the impact of demographic, health, and genetic factors on rate of olfactory change with linear mixed effect models.

Results: Advancing age, manufacturing profession, history of cerebrovascular disease, higher cardiovascular disease burden, diabetes, slower walking speed, higher number of medications, and the APOE ε4 allele were associated with accelerated odor identification decline (ps < .014). Multi-adjusted analyses showed unique associations of age, diabetes, and ε4 to olfactory decline (ps < .017). In 1531 participants who remained free of dementia (DSM IV criteria) during follow-up, age, cardiovascular disease burden, and diabetes were associated with accelerated decline (ps < .011). Of these, age and diabetes remained statistically significant in the multi-adjusted model (ps < .001).

Conclusion: Demographic, vascular, and genetic factors are linked to rate of decline in odor identification in aging. Although some olfactory loss may be an inevitable part of aging, our results highlight the importance of vascular factors for the integrity of the olfactory system, even in the absence of dementia.

Background: Nutritional supplementation and physical activity have been shown to positively influence muscle mass and strength in older adults. The efficacy of long-term nutritional supplementation in combination with physical activity in older adults remains unclear.

Methods: Mobility-limited (short physical performance battery [SPPB] ≤9) and vitamin D insufficient (serum 25(OH) D 9–24 ng/mL) older adults were recruited for this study. All subjects participated in a physical activity program. Subjects were randomized to consume a daily nutritional supplement (150 kcal, 20 g whey protein, 800 IU vitamin D, 119 mL beverage) or placebo (30 kcal, nonnutritive, 119 mL). In a prespecified secondary analysis, we examined total-body composition (dual energy X-ray absorptiometry), thigh composition (computed tomography), and muscle strength, power, and quality before and after the 6-month intervention.

Results: One hundred and forty-nine subjects were randomized into the study [mean (standard deviation, SD) age 78.5 (5.4) years; 46.3% female; mean (SD) short physical performance battery 7.9 (1.2); mean (SD) vitamin D 18.7 (6.4) ng/mL]. After the intervention period both groups demonstrated improvements in muscle strength, body composition, and thigh composition. Nutritional supplementation lead to further losses of intermuscular fat (p = .049) and increased normal muscle density (p = .018).

Conclusions: Six months of physical activity resulted in improvements in body composition, subcutaneous fat, intermuscular fat, and strength measures. The addition of nutritional supplementation resulted in further declines in intermuscular fat and improved muscle density compared to placebo. These results suggest nutritional supplementation provides additional benefits to mobility-limited older adults undergoing exercise training.

Background. Because of the possible implications for intervention and thus successful aging, researchers have striven to determine whether the age changes in physical and cognitive functioning are coincident or does functioning in one domain change before, and possibly contribute to, functioning in the other.

Methods. Bivariate dual change score models were applied to four cognitive factors and three motor functioning factors available from 813 adults who participated in the Swedish Adoption/Twin Study of Aging. Participants were aged 50–88 at the first of six waves of testing covering a 19-year follow-up period; 68% participated in at least three waves.

Results. Model comparisons indicated dynamic coupling relationships between Balance and Fine Motor factors and the Speed cognitive factor. Decline in motor function precedes decline in performance on processing speed tasks, even though the motor function tasks were not timed. Results indicated possible bidirectional coupling between Fine Motor and Speed.

Conclusions. Combined with other dual change score model analyses of cognition and physical function, a picture is beginning to emerge of the cascade of events that may lead to cognitive aging.

BACKGROUND: The aim was to develop a functional aging index (FAI) that taps four body systems: sensory (vision and hearing), pulmonary, strength (grip strength), and movement/balance (gait speed) and to test the predictive value of FAI for entry into care and mortality.

METHOD: Growth curve models and cox regression models were applied to data from 1695 individuals from three Swedish longitudinal studies of aging. Participants were aged 45 to 93 at intake and data from up to 8 follow-up waves were available.

RESULTS: The rate of change in FAI was twice as fast after age 75 as before, women demonstrated higher mean FAI, but no sex differences in rates of change with chronological age were identified. FAI predicted entry into care and mortality, even when chronological age and a frailty index were included in the models. Hazard ratios indicated FAI was a more important predictor of entry into care for men than women; whereas it was a stronger predictor of mortality for men than women.

CONCLUSIONS: Measures of biological aging and functional aging differ in their predictive value for entry into care and mortality for men and women, suggesting that both are necessary for a complete picture of the aging process across genders.

BACKGROUND: The aim was to develop a functional aging index (FAI) that taps four body systems: sensory (vision and hearing), pulmonary, strength (grip strength), and movement/balance (gait speed) and to test the predictive value of FAI for entry into care and mortality.

METHOD: Growth curve models and cox regression models were applied to data from 1695 individuals from three Swedish longitudinal studies of aging. Participants were aged 45 to 93 at intake and data from up to 8 follow-up waves were available.

RESULTS: The rate of change in FAI was twice as fast after age 75 as before, women demonstrated higher mean FAI, but no sex differences in rates of change with chronological age were identified. FAI predicted entry into care and mortality, even when chronological age and a frailty index were included in the models. Hazard ratios indicated FAI was a more important predictor of entry into care for men than women; whereas it was a stronger predictor of mortality for men than women.

CONCLUSIONS: Measures of biological aging and functional aging differ in their predictive value for entry into care and mortality for men and women, suggesting that both are necessary for a complete picture of the aging process across genders.

The aim of this study was to compare apolipoprotein A1 (ApoA1) and B (ApoB) with high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) as markers for cardiovascular mortality and morbidity in elderly men. We analyzed serum ApoA1, ApoB, total cholesterol, HDL-C, and LDL-C in a group of 77-year-old men (n = 785). The results were correlated with data from the Swedish cause of death registry. Receiver-operating characteristic curves showed that, of the studied serum markers, ApoA1 was the best predictor for ischemic heart disease mortality (area under the curve = 0.724, 95% confidence interval, 0.691-0.755). There were also significant correlations between the apolipoproteins and other known risk markers for cardiovascular disease such as triglycerides, high-sensitivity C-reactive protein (hsCRP), and cystatin C. Serum ApoA1 is a better risk marker than are ApoB, ApoB/ApoA1 ratio, HDL-C, and LDL-C for cardiovascular disease and mortality in elderly men.

Background: Understanding how depression is associated with chronic conditions and sociodemographic characteristics can inform the design and effective targeting of depression screening and care interventions. In this study, we present some of the first evidence from sub-Saharan Africa on the association between depressive symptoms and a range of chronic conditions (diabetes, HIV, hypertension, and obesity) as well as sociodemographic characteristics. Methods: A questionnaire was administered to a population-based simple random sample of 5,059 adults aged 40 years and older in Agincourt, South Africa. Depressive symptoms were measured using a modified version of the eight-item Center for Epidemiological Studies-Depression screening tool. Diabetes was assessed using a capillary blood glucose measurement and HIV using a dried blood spot. Results: 17.0% (95% confidence interval: 15.9%-18.1%) of participants had at least three depressive symptoms. None of the chronic conditions were significantly associated with depressive symptoms in multivariable regressions. Older age was the strongest correlate of depressive symptoms with those aged 80 years and older having on average 0.63 (95% confidence interval: 0.40-0.86; p<.001) more depressive symptoms than those aged 40-49 years. Household wealth quintile and education were not significant correlates. Conclusions: This study provides some evidence that the positive associations of depression with diabetes, HIV, hypertension, and obesity that are commonly reported in high-income settings might not exist in rural South Africa. Our finding that increasing age is strongly associated with depressive symptoms suggests that there is a particularly high need for depression screening and treatment among the elderly adults in rural South Africa.

Statins are widely used for cardiovascular disease prevention but their effects on cognition remain unclear. Statins reduce cholesterol concentration and have been suggested to provide both beneficial and detrimental effects. Our aim was to investigate the cross-sectional and longitudinal association between statin use and cognitive performance, and whether blood low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, glucose, C-Reactive Protein (CRP), and vitamin D biomarkers mediated this association. We used participants from the UK biobank aged 40 to 69 without neurological and psychiatric disorders (n = 147,502 and n = 24,355, respectively). We performed linear regression to evaluate the association between statin use and cognitive performance and, mediation analysis to quantify the total, direct, indirect effects and the proportion meditated by blood biomarkers. Statin use was associated with lower cognitive performance at baseline (β = -0.40 [-0.53, -0.28], P = <.0001) and this association was mediated by LDL (Proportion mediated = 51.4%, P = 0.002), CRP (Proportion mediated = -11%, P = 0.006) and blood glucose (Proportion mediated = 2.6%, P = 0.018) concentrations. However, statin use was not associated with cognitive performance, measured 8 years later (β = -0.003 [-0.11, 0.10], P = 0.96). Our findings suggest that statins are associated with lower short-term cognitive performance by lowering LDL and raising blood glucose concentrations, and better performance by lowering CRP concentrations. In contrast, statins have no effect on long-term cognition and remain beneficial in reducing cardiovascular risk factors.

Background. Complaints of disturbed or dissatisfied sleep are common among older people. This study aimed to evaluate the prevalence of sleep problems in very old persons and its relation to physical and mental health and drug use.

Methods. This is a cross-sectional analysis of sleep problems in a population of old persons living in Stockholm, Sweden. There were 641 subjects aged 81+ years; 77.8% were women, 91.4% were noninstitutionalized, and 68.6% lived alone. All persons underwent a comprehensive medical and psychiatric interview and examination. Sleep problems were assessed using the Clinical Psychopathological Rating Scale (CPRS). Covariates included chronic medical conditions, depression, dementia, pain, self-rated health, activities of daily living, use of hypnotics-sedatives, use of other psychotropic drugs, and use of nonpsychotropic drugs.

Results. More than one third of subjects were identified with sleep problems. They were more common among women and persons using a higher number of drugs. Poor self-rated health, depression, and pain were related to the presence of sleep problems. Among persons with sleep problems and depression, only 19.2% used antidepressants, and 46.2% used hypnotics-sedatives. Among persons with sleep problems and pain, 63.2% used analgesics, and 47.0% used hypnotics-sedatives. One or more chronic diseases, use of hypnotics-sedatives, use of other psychotropic drugs, and use of nonpsychotropic drugs were also related to sleep problems. After multivariate analysis, factors significantly related to sleep problems were female gender, depression, pain, and hypnotic-sedative use.

Conclusions. Sleep problems were common in this very old population. These results suggest the importance of carefully assessing an older person's complaints to accurately diagnose and effectively treat sleep problems.

Background: To identify brain magnetic resonance imaging (MRI) signatures characterizing people with different patterns of decline in cognition and motor function.

Methods: In the Swedish National Study on Aging and Care in Kungsholmen, Stockholm, 385 participants had available repeated brain MRI examinations, where markers of brain volumes and white matter integrity were assessed. The speed of cognitive and motor decline was estimated as the rate of a Mini-Mental State Examination and gait speed decline over 12 years (linear mixed models), and further dichotomized into the upper (25% fastest rate of decline) versus the lower quartiles. Participants were grouped in slow/no decliners (reference), isolated motor decliners, isolated cognitive decliners, and cognitive and motor decliners. We estimated the associations between changes in brain markers (linear mixed models) and baseline diffusion tensor imaging measures (linear regression model) and the 4 decline patterns.

Results: Individuals with concurrent cognitive and motor decline (n = 51) experienced the greatest loss in the total brain (β: −12.3; 95% confidence interval [CI]: −18.2; −6.38) and hippocampal (β: −0.25; 95% CI: −0.34; −0.16) volumes, the steepest accumulation of white matter hyperintensities (β: 1.61; 95% CI: 0.54; 2.68), and the greatest ventricular enlargement (β: 2.07; 95% CI: 0.67; 3.47). Compared to the reference, those only experiencing cognitive decline presented with steeper hippocampal volume loss, whereas those exhibiting only motor decline displayed a greater white matter hyperintensities burden. Lower microstructural white matter integrity was associated with concurrent cognitive and motor decline.

Conclusion: Concurrent cognitive and motor decline is accompanied by rapidly evolving and complex brain pathology involving both gray and white matter. Isolated cognitive and motor declines seem to exhibit brain damage with different qualitative features.

Background: The impact of late-life weight changes on incident dementia is unclear. We aimed to investigate the associations of body mass index (BMI) and weight changes with dementia and to explore the role of APOE ɛ4 in these associations.

Methods: A total of 1 673 dementia-free participants aged ≥60 and older were followed for an initial 6 years to detect changes in BMI/weight and then for an additional 6 years to detect incident dementia. BMI change ([BMI_{first 6-year follow-up} - BMI_baseline]/BMI_baseline) was categorized as stable (≤5%), and moderate (5%-10%) or large (>10%) gain or loss. Weight change (weight_{first 6-year follow-up} - weight_baseline) was categorized as stable (≤2.5 kg), and moderate (2.5-7.5 kg) or large (>7.5 kg) gain or loss. Dementia was diagnosed following standard criteria. Data were analyzed using Cox regression models.

Results: Over the second 6-year follow-up period, 102 incident dementia cases were identified. Compared with stable BMI, the hazard ratios (95% CI) of dementia were 2.61 (1.09-5.54) and 2.93 (1.72-4.91) for BMI gain or loss >10%, respectively. The risk of dementia was higher among APOE ɛ4 carriers experiencing a large BMI gain (9.93 [3.49-24.6]) or loss (6.66 [2.83-14.4]) than APOE ɛ4 noncarriers with stable BMI. Similar results were observed for weight change and dementia associations.

Conclusions: BMI and weight changes showed U-shaped associations with dementia risk. Large bodyweight gain and loss alike are associated with an almost 3-fold higher risk of dementia, which may be amplified by APOE ɛ4.

Background: A series of studies have explored the health effects of long-term exposure to ambient PM_2.5 among older adults. However, few studies have investigated the adverse effect of long-term exposure to ambient PM_2.5 on frailty, and the results are inconclusive. This study sought to investigate the associations between long-term exposure to ambient PM_2.5 and frailty in 6 low- and middle-income countries.

Methods: We included an analytical sample of 34 138 individuals aged 50 and older from the Study on global AGEing and adult health Wave 1 (2007/2010). Air pollution estimates were generated using a standard methodology derived from Moderate Resolution Imaging Spectroradiometer observations and Multiangle Imaging Spectroradiometer instruments from the Terra satellite, along with simulations from the GEOS-Chem chemical transport model. A 3-level hierarchical logistic model was used to evaluate the association between frailty index and long-term PM_2.5 exposure at 3 levels (individual, province, and country).

Results: In rural areas, each 10 μg/m3 increase in ambient PM_2.5 was associated with a 30% increase in the odds of frailty (OR = 1.30, 95% CI: 1.21-1.39) after adjusting for various potential confounding factors. The gender-stratified analysis showed that the association seemed to be slightly stronger in men (OR = 1.31, 95% CI: 1.18-1.46) than in women (OR = 1.21, 95% CI: 1.07-1.36) in rural areas.

Conclusion: In a large sample of community-based older adults from 6 middle-income countries, we found evidence that long-term PM_2.5 exposure was associated with frailty in rural areas.

Background: Increasing evidence shows that cognition and gait speed are associated and are important measures of health among older adults. However, previous studies have used different methods to assess these 2 outcomes and lack sufficient sample size to examine heterogeneity among subgroups. This study examined how the relationship between global cognitive function and gait speed are influenced by age, gender, and race utilizing an integrated data analysis approach.

Method: Data on cognition (Montreal Cognitive Assessment [MoCA], Mini-Mental Status Examination [MMSE], and Modified Mini-Mental State Examination [3MSE]) and gait speed (range: 4–400 m) were acquired and harmonized from 25 research studies (n = 2802) of adults aged 50+ from the Wake Forest Older American Independence Center. Multilevel regression models examined the relationship between predicted values of global cognitive function (MoCA) and gait speed (4-m walk), including heterogeneity by age, race, and gender.

Results: Global cognitive function and gait speed exhibited a consistent positive relationship among whites with increasing age, while this was less consistent for African Americans. That is, there was a low correlation between global cognitive function and gait speed among African Americans aged 50–59, a positive correlation in their 60s and 70s, then a negative correlation thereafter.

Conclusion: Global cognition and gait speed exhibited a curvilinear U-shaped relationship among whites; however, the association becomes inverse in African Americans. More research is needed to understand this racial divergence and could aid in identifying interventions to maintain cognitive and gait abilities across subgroups.

Background: Acute clinical events, such as pneumonia, may impact physical functionality but their effect on cognition and the possible duration of this effect remains to be quantified. This study investigated the impact of pneumonia on cognitive trajectories and dementia development in older people.

Methods: Data were obtained from 60+ years old individuals, who were assessed from 2001 to 2018 in the population-based SNAC-K study (Sweden). Participants were eligible if they were not institutionalized, had no dementia, and did not experience pneumonia 5 years prior to baseline (N = 2 063). A propensity score was derived to match 1:3 participants hospitalized with a diagnosis of pneumonia (N = 178), to nonexposed participants (N = 534). Mixed linear models were used to model cognitive decline. The hazard of dementia, clinically diagnosed by physicians following Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV, was estimated using Cox regression models.

Results: We found a transient impact of pneumonia on cognitive decline in the first 2.5 years (B = −0.94, 95% confidence interval [CI] −1.75, −0.15). The hazard ratio (HR) for dementia was not statistically significantly increased in pneumonia participants (HR = 1.17, 95%CI 0.82, 1.66).

Conclusions: The transient impact of pneumonia on cognitive function suggests an increased need of health care for patients after a pneumonia-related hospitalization and reinforces the relevance of pneumonia prevention.

Background. Low vitamin D status is associated with poorer cognitive function in older adults, but little is known about the potential impact on cerebrospinal fluid (CSF) biomarkers and brain volumes. The objective of this study was to examine the relations between plasma 25-hydroxyvitamin D (25(OH)D) and cognitive impairment, CSF biomarkers of Alzheimer's disease (AD), and structural brain tissue volumes. Methods. A total of 75 patients (29 with subjective cognitive impairment, 28 with mild cognitive impairment, 18 with AD) referred to the Memory Clinic at Karolinska University Hospital, Huddinge, Sweden were recruited. Plasma 25(OH)D, CSF levels of amyloid beta (A beta(1-42)), total-tau, and phosphorylated tau, and brain tissue volumes have been measured. Results. After adjustment for several potential confounders, the odds ratios (95% confidence interval) for cognitive impairment were as follows: 0.969 (0.948-0.990) per increase of 1 nmol/L of 25(OH) D and 4.19 (1.30-13.52) for 24(OH) D values less than 50 nmol/L compared with values greater than or equal to 50 nmol/L. Adjusting for CSF A beta(1-42) attenuated the 25(OH) D-cognition link. In a multiple linear regression analysis, higher 25(OH)D levels were related to higher concentrations of CSF A beta(1-42) and greater brain volumes (eg, white matter, structures belonging to medial temporal lobe). The associations between 25(OH)D and tau variables were not significant. Conclusions. This study suggests that vitamin D may be associated with cognitive status, CSF A beta(1-42) levels, and brain tissue volumes.

Telomere length has been associated with longevity. As telomere length is partly determined by the human telomerase reverse transcriptase (hTERT), we investigated the association between an hTERT polymorphism located in its promoter region ((-) (1327)T/C) and longevity in two cohorts of older adults. Participants from the Kungsholmen project (KP; n = 1,205) and the Swedish National study of Aging and Care in Kungsholmen (SNAC-K; n = 2,764) were followed for an average period of 7.5 years. The main outcomes were hazard ratios (HR) of mortality and median age at death. In both cohorts, mortality was lower in female T/T carriers, aged 75+ years in KP (HR = 0.8, 95% CI: 0.5-0.9) and 78+ years in SNAC-K (HR = 0.6, 95% CI: 0.4-0.8) compared with female C/C carriers. T/T carriers died 1.8-3 years later than the C/C carriers. This effect was not present in men, neither in SNAC-K women aged 60-72 years. The association was not modified by presence of cancer, cardiovascular diseases, number of chronic diseases, or markers of inflammation, and did not interact with APOE genotype or estrogen replacement therapy. The gender-specific increased survival in T/T carriers can be due to a synergistic effect between genetic background and the life-long exposure to endogenous estrogen.

Background: Sarcopenia, or the loss of muscle mass and strength, is known to increase the risk for falls and (hip) fractures in older people. The objective of this study was to assess the skeletal muscle fiber characteristics in elderly female hip fracture patients.

Method: Percutaneous needle biopsies were collected from the vastus lateralis muscle in 15 healthy young women (20 +/- 0.4 years), 15 healthy elderly women (79 +/- 1.7 years), and 15 elderly women with a fall-related hip fracture (82 +/- 1.5 years). Immunohistochemical analyses were performed to assess Type I and Type II muscle fiber size, and myonuclear and satellite cell content.

Results: Type II muscle fiber size was significantly different between all groups (p <.05), with smaller Type II muscle fibers in the hip fracture patients (2,609 +/- 185 mu m(2)) compared with healthy elderly group (3,723 +/- 322 mu m(2)) and the largest Type II muscle fibers in the healthy young group (4,755 +/- 335 mu m(2)). Furthermore, Type I muscle fiber size was significantly lower in the hip fracture patients (4,684 +/- 211 mu m(2)) compared with the healthy elderly group (5,842 +/- 316 mu m(2), p =.02). The number of myonuclei per Type II muscle fiber was significantly lower in the healthy elderly and hip fracture group compared with the healthy young group (p =.011 and p =.002, respectively). Muscle fiber satellite cell content did not differ between groups.

Conclusion: Elderly female hip fracture patients show extensive Type II muscle fiber atrophy when compared with healthy young or agematched healthy elderly controls. Type II muscle fiber atrophy is an important hallmark of sarcopenia and may predispose to falls and (hip) fractures in the older population.

To assess the age-related loss of muscle mass and to determine the mechanisms behind this aging atrophy, the muscle structure and fiber type composition have been estimated, using invasive and noninvasive techniques. Limb muscles from older men and women are 25-35% smaller and have significantly more fat and connective tissue than limb muscles from younger individuals. Comparisons of muscle biopsies from younger and older individuals reveal that type 2 (fast-twitch) fibers are smaller in the old, while the size of type 1 (slow-twitch) fibers is much less affected. Studies of whole muscle cross sections also show a significantly smaller number of muscle fibers, a significantly lower relative type 2 fiber area, and a significant increase in fiber type grouping with increasing age. These results indicate a gradual decrease in size/volume with advancing age, accompanied by a replacement by fat and connective tissue. This aging atrophy seems to be due to a reduction in both number and size of muscle fibers, mainly of type 2, and is to some extent caused by a slowly progressive neurogenic process

Background. A decline in prevalence of late-life disability in activities of daily living (ADLs) has been reported in Western countries. We investigate the time trend of disability in basic ADLs among Chinese older people in 1997-2006, and explore the potential contribution of cardiometabolic diseases to the trend. Methods. The study included 7,845 participants (age >= 60 years) in the China Health and Nutrition Survey who were examined in 1997, 2000, 2004, and 2006. Data on ADLs were collected through interviews. Disability in basic ADLs was defined as need of assistance or inability to perform at least one of the five self-care activities of bathing, dressing, toileting, feeding, and transferring. Generalized estimating equation models were used to test the time trend in ADL disability and its association with cardiometabolic diseases. Results. Prevalence of ADL disability decreased from 13.2% in 1997 to 9.9% in 2006; the trend was statistically evident among people aged 60-69 years, women, and rural residents (p(trend) <.05). From 1997 to 2006, the prevalence of ADL disability decreased at a relative annual rate of 3.1% in total sample; the decline was statistically more evident in young-olds than older-olds, in men than women, and in rural than urban residents. The disabling effect decreased over time for stroke (p(trend) = .032) and multiple cardiometabolic diseases (p(trend) = .014). Conclusions. The prevalence of disability in basic ADLs among Chinese older adults decreased from 1997 to 2006. Stroke and multiple cardiometabolic diseases appear to become less disabling over time, which may partly contribute to the favorable trend in ADL disability.

Rapamycin inhibits the nutrient-sensing TOR pathway and extends life span in a wide range of organisms. Although life-span extension usually differs between the sexes, the reason for this is poorly understood. Because TOR influences growth, rapamycin likely affects life-history traits such as growth and reproduction. Sexes have different life-history strategies, and theory predicts that they will resolve the tradeoffs between growth, reproduction, and life span differently. Specifically, in taxa with female-biased sexual size dimorphism, reduced growth may have smaller effects on male fitness. We investigated the effects of juvenile, adult, or life-long rapamycin treatment on growth, reproduction, life span, and individual fitness in the outcrossing nematode Caenorhabditis remanei. Life-long exposure to rapamycin always resulted in the strongest response, whereas postreproductive exposure did not affect life span. Although rapamycin resulted in longer life span and smaller size in males, male individual fitness was not affected. In contrast, size and fitness were negatively affected in females, whereas life span was only extended under high rapamycin concentrations. Our results support the hypothesis that rapamycin affects key life-history traits in a sex-specific manner. We argue that the fitness cost of life-span extension will be sex specific and propose that the smaller sex generally pay less while enjoying stronger life-span increase.

The effects of increasing age on skeletal muscle fatigue and endurance were assessed in 22 healthy young (14 men and 8 women; mean age, 28 +/- 6 years) and 16 healthy old (8 men and 8 women; mean age, 73 +/- 3 years) individuals. All subjects performed 100 repeated maximum dynamic knee extensions at 90 degrees.s-1 (1.57 rad.s-1) using an isokinetic dynamometer (Cybex II). Peak torque was recorded during every contraction, and for each individual the maximal voluntary contraction (MVC), the fatigue rate, the endurance level, and the relative reduction in muscle force were determined. MVC and endurance level were significantly lower in old men and women, but there was no discernible difference in relative muscle force reduction and fatigue rate between young and old individuals. We conclude that thigh muscles of older individuals are weaker than those of younger individuals, but relative to their strength, older individuals have similar properties as younger individuals with respect to muscle fatigue and endurance.

BACKGROUND: Current consensus is to combine a functional measure with muscle quantity to assess/confirm sarcopenia. However, the proper body size adjustment for muscle quantity is debated and sarcopenia in obesity is not well described. Further, functional measures are not muscle-specific or sensitive to etiology, and can be confounded by, for example, fitness/pain. For effective detection/treatment/follow-up, muscle-specific biomarkers linked to function are needed.

METHODS: Nine thousand six hundred and fifteen participants were included and current sarcopenia thresholds (EWGSOP2: DXA, hand grip strength) applied to investigate prevalence. Fat-tissue free muscle volume (FFMV) and muscle fat infiltration (MFI) were quantified through magnetic resonance imaging (MRI) and sex-and-body mass index (BMI)-matched virtual control groups (VCGs) were used to extract each participant's FFMV/height2 z-score (FFMVVCG). The value of combining FFMVVCG and MFI was investigated through hospital nights, hand grip strength, stair climbing, walking pace, and falls.

RESULTS: Current thresholds showed decreased sarcopenia prevalence with increased BMI (underweight 8.5%/normal weight 4.3%/overweight 1.1%/obesity 0.1%). Contrary, the prevalence of low function increased with increasing BMI. Previously proposed body size adjustments (division by height2/weight/BMI) introduced body size correlations of larger/similar magnitude than before. VCG adjustment achieved normalization and strengthened associations with hospitalization/function. Hospital nights, low hand grip strength, slow walking pace, and no stair climbing were positively associated with MFI (p < .05) and negatively associated with FFMVVCG (p < .01). Only MFI was associated with falls (p < .01). FFMVVCG and MFI combined resulted in highest diagnostic performance detecting low function.

CONCLUSIONS: VCG-adjusted FFMV enables proper sarcopenia assessment across BMI classes and strengthened the link to function. MFI and FFMV combined provides a more complete, muscle-specific description linked to function enabling objective sarcopenia detection.

The fruit fly, Drosophila melanogaster is a broadly used model for gerontological research. Many studies are dedicated to understanding nutritional effects on ageing; however, the influence of dietary carbohydrate type and dosage is still poorly understood. We show that among three carbohydrates tested, fructose, glucose, and sucrose, the latter decreased life span by 13%-27%, being present in concentrations of 2%-20% in the diet. Life-span shortening by sucrose was accompanied by an increase in age-independent mortality. Sucrose also dramatically decreased the fecundity of the flies. The differences in life span and fecundity were determined to be unrelated to differential carbohydrate ingestion. The highest mitochondrial protein density was observed in flies fed sucrose-containing diet. However, this parameter was not affected by carbohydrate amount in the diet. Fly sensitivity to oxidative stress, induced by menadione, was increased in aged flies and was slightly affected by type and concentration of carbohydrate. In general, it has been demonstrated that sucrose, commonly used in recipes of Drosophila laboratory food, may shorten life span and lower egg-laying capability on the diets with very low protein content.

Background Frailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its association with adverse outcomes in hospitalized older adults. Methods EHRs were extracted for 18 225 patients with unplanned admissions between 1 March 2020 and 17 June 2021 from 9 geriatric clinics in Stockholm, Sweden. A 48-item eFI was constructed using diagnostic codes, functioning and other health indicators, and laboratory data. The CFS, Hospital Frailty Risk Score, and Charlson Comorbidity Index were used for comparative assessment of the eFI. We modeled in-hospital mortality and 30-day readmission using logistic regression; 30-day and 6-month mortality using Cox regression; and length of stay using linear regression. Results Thirteen thousand one hundred and eighty-eight patients were included in analyses (mean age 83.1 years). A 0.03 increment in the eFI was associated with higher risks of in-hospital (odds ratio: 1.65; 95% confidence interval: 1.54-1.78), 30-day (hazard ratio [HR]: 1.43; 1.38-1.48), and 6-month mortality (HR: 1.34; 1.31-1.37) adjusted for age and sex. Of the frailty and comorbidity measures, the eFI had the highest area under receiver operating characteristic curve for in-hospital mortality of 0.813. Higher eFI was associated with longer length of stay, but had a rather poor discrimination for 30-day readmission. Conclusions An EHR-based eFI has robust associations with adverse outcomes, suggesting that it can be used in risk stratification in hospitalized older adults.

Background: The aim of this study is to identify clusters of older persons based on their multimorbidity patterns and to analyze differences among clusters according to sociodemographic, lifestyle, clinical, and functional characteristics. Methods: We analyzed data from the Swedish National Study on Aging and Care in Kungsholmen on 2,931 participants aged 60 years and older who had at least two chronic diseases. Participants were clustered by the fuzzy c-means cluster algorithm. A disease was considered to be associated with a given cluster when the observed/expected ratio was >= 2 or the exclusivity was >= 25%. Results: Around half of the participants could be classified into five clinically meaningful clusters: respiratory and musculoskeletal diseases (RESP-MSK) 15.7%, eye diseases and cancer (EYE-CANCER) 10.7%, cognitive and sensory impairment (CNS-IMP) 10.6%, heart diseases (HEART) 9.3%, and psychiatric and respiratory diseases (PSY-RESP) 5.4%. Individuals in the CNS-IMP cluster were the oldest, with the worst function and more likely to live in a nursing home; those in the HEART cluster had the highest number of co-occurring diseases and drugs, and they exhibited the highest mean values of serum creatinine and C-reactive protein. The PSY-RESP cluster was associated with higher levels of alcoholism and neuroticism. The other half of the cohort was grouped in an unspecific cluster, which was characterized by gathering the youngest individuals, with the lowest number of co-occurring diseases, and the best functional and cognitive status. Conclusions: The identified multimorbidity patterns provide insight for setting targets for secondary and tertiary preventative interventions and for designing care pathways for multimorbid older people.

Background: We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age.

Method: A total of 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Predisease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of >= 2 diseases in the same patient. The hazard ratio (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated.

Results: Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units, and 42 died. Patients who died were older (81.0 vs 65.2 years, p < .001), more frequently multimorbid (97.6 vs 52.8%; p < .001), and more likely frail (37.5 vs 4.1%; p < .001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only, and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR = 1.3; 95% CI = 1.05-1.62) and in patients aged 70+ years (HR = 1.29; 95% CI = 1.04-1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years.

Conclusions: Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence.