Category Archive for: ‘Disease outcomes’

Cardiovascular risk factors and long-term all-cause mortality

Many cardiovascular risk factors related to all-cause mortality

In the Seven Countries Study age, systolic blood pressure, smoking and serum cholesterol predicted 25-year all-cause mortality in most cohorts. These risk factors were also predictive of 40-year all-cause mortality in the US railroad and the Cretan cohort.

An analysis of the European cohorts showed that systolic blood pressure remained a strong predictor of excess relative risk of all-cause mortality during 35 years of follow-up. The strength of the association declined with increasing follow-up years (ageing) while absolute risk increased greatly with age.

In the rural Italian cohorts other risk factors were also related to 40-year all-cause mortality, namely: mortality of father and mother before age 60, job-related physical activity (inversely related), body mass index (inverse J-shaped), mid-arm circumference (inversely related), lung function (inversely related) and the presence of corneal arcus, xanthalasmata and of any catagory of clinical CVD, diabetes or cancer at entry.


Cognitive decline and all-cause mortality

Cognitive decline associated with mortality

Elderly men from Finland, The Netherlands and Italy (the FINE study) whose cognition declined in the preceding 5 years, had a 2-fold greater risk of dying in the subsequent 5 years. The mortality risk of the men whose cognition improved between 1990 and 1995 was not different from those whose cognition remained stable.

Many factors predict survival

At the start of the mortality follow-up in 1995, the survivors in 2000 were younger, had a better cognitive function, were more physically active and were less disabled. They also had a lower prevalence of heart attacks and cancer than those who died during the 5-year mortality follow-up period.


Self-rated health, disability, depression and all-cause mortality

Disability and depressive symptoms related to all-cause mortality

Self-rated health, disability and depressive symptoms were independent from each other, and were associated with all-cause mortality in elderly men from Finland, The Netherlands and Italy (the FINE study). After adjustment for the prevalence of chronic diseases severity of disability and depressive symptoms remained related to all-cause mortality.

Combinations of measures also associated with all-cause mortality


Self-rated health, depression, disability and all-cause mortality

For the combination of disability and self-rated health a 3-fold greater mortality risk was observed for men who had severe disability and a poor self-rated health compared to the reference group. Men with severe disability in the two highest categories of depressive symptoms had also a 3-fold higher mortality risk.

These results suggest that for adequate prognosis of mortality and for developing intervention strategies information is needed on other and different health outcomes.


Self-rated health, physician-rated health and mortality

Self-rated and physician-rated health associated with mortality


Self-rated health and 5-year survival

Self-rated health was strongly related to all-cause mortality after 5 and 15 years of follow-up. Physician-rated health was an independent predictor of 15-year all-cause mortality. Self-rated health predicted cancer mortality and physician-rated health predicted cardiovascular mortality. Self-rated health provided information beyond physican-rated health and may help clinicians to optimize the decision-making surrounding treatment, hospital referral and follow-up visits to achieve “patient-centered care”.

Measuring self-rated and physician-rated health

Self-rated health has been identified by the American Institute of Medicine as one of the 20 key indicators valuable in measuring health of populations. In 1985, self-rated health was measured on a four-point scale in the Zutphen Elderly Study. Physician-rated health was evaluated with a five-point scale.


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Studies in the elderly

The Zutphen Elderly, HALE and FINE studies researched the indicators of healthy ageing.

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Widowhood and disability

Widowhood associated with disability

Elderly men from Finland, The Netherlands and Italy who became widowed during 10 years of observation had a 2-fold greater risk of disabilities related to instumental activities or mobility than those who did not lose their wives. Widowed men living alone had 75% fewer mobility-related disabilities and 98% fewer basic activities-related disability than those living with other adults. The associations among countries did not differ.

Observations among widowed men

In elderly men of the FINE study, duration of widowhood more or less than 5 years was studied according to household composition: living alone, with family, or in an institution. Standardized questionnaires were used for measuring different Activities of Daily Living.


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Studies in the elderly

The Zutphen Elderly, HALE and FINE studies researched the indicators of healthy ageing.

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Physical activity and disability

Physical activity relates to lower risk of disability

Elderly European men with a high level of physical activity at entry had a 54% lower risk of subsequent disability compared to men with a low activity level. This was related to the length of time the physical activities were caried out and not to their intensity.

The results suggest that even in old age among relatively healthy men, a physically active lifestyle protects against disability and the duration of such activities appeared more important than their intensity.

Measuring physical activity and disability

Different aspects of physical activity and disability were investigated in the FINE study of elderly men from Finland, Italy and The Netherlands, with 10 years of follow-up. Information on self-reported physical activity was based on a validated questionnaire on activities such as walking, biking and gardening. Self-reported disabilities were evaluated with the WHO-questionnaire on Activities of Daily Living.


Cardiovascular risk factors and disability

Cardiovascular risk factors associated with disability.

Elderly men from Zutphen were divided at baseline in those with a high cardiovascular risk, defined as 2 or more of the following traditional cardiovascular risk factors: obesity, smoking, hypertension, hypercholesterolemia and diabetes and a low-risk group with less than 2 risk factors. Men at baseline with a high cardiovascular risk had compared to those with a low risk a 2-fold or greater risk of functional disabilities after 5, 10 or 15 years. These results suggest that elevated cardiovascular risk factor might prevent or postpone disability.

Design of the study

In the Zutphen Elderly Study, traditional cardiovascular risk factors measured in 1985 were evaluated in relation to information on self-reported disabilities collected in 1990, 1995 and 2000.


Measuring functional status

Quality of self-reported measures of functional status.

In the Zutphen Elderly Study, self-reported functional status was measured with the self-administered 13-item WHO-questionnaire on Activities of Daily Living. A hierarchic disability-scale was constructed based on basic activities of daily living (e.g. walking indoors), mobility-related (e.g. moving outdoors) and instrumental activities of daily living (e.g. preparing meals). The reproducibility of the self-reported disabilities was fair to good.

Quality of the performance-based measures of functional status

Performance-based measures of functional status are more objective than self-reported measures. A score from performance-based limitations was based on the results of four tests: standing balance, walking speed, ability to rise from a chair, and external shoulder rotation. Three of the four performance tests were highly reproducible, the shoulder rotation test was not.


Disability and depressive symptoms

Disability associated with depressive symptoms

An increasing severity of disability from entry to 5 year follow-up was positively associated with depressive symptoms. Men with no disability scored lower on depressive symptoms than those with disability in any of three domains (see below). The associations were stronger in Finland and Italy than in the Netherlands.

Among men with mild disability, whose disability status worsened over 5 years, scored higher on depressive symptoms than those whose status improved.

Investigating disability

In elderly men from Finland, Italy and the Nethelands, self-reported information on disability and depressive symptoms was collected on 2 surveys, in 1990 and 1995. Three domains of disability were distinguished: instrumental, mobility-related and basic activities using the WHO questionnaire on Activities of Daily Living.


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Studies in the elderly

The Zutphen Elderly, HALE and FINE studies researched the indicators of healthy ageing.

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Lifestyle, diet and optimism

A healthy lifestyle and diet associated with a higher level of optimism

Moderate physical activity, refraining from smoking and moderate alcohol consumption were associated with an high level of optimism.

Eating more fruit, vegetables, and whole grain bread was also related to a higher level of optimism.

Optimistic through healthy living?

Optimism was associated with a lower risk of cardiovascular death, but the underlying mechanisms for this association are unknown. Therefore, the associations of diet and lifestyle with optimism were investigated in the Zutphen Elderly Study. Information on lifestyle, diet and optimism was collected every 5 years in the period 1985-2000.


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