Category Archive for: ‘Disease outcomes’
Need for help increases with age but is lower in later generations
In the HALE project, in elderly European men and women disability and need for help increased with advancing age but at the same time decreased over time among more recent generations. Prospective analysis showed a favorable time trend in self care abilities for men and women and in need for self care help in men.
Mobility varies across cultures
Mobility-related disability among men and self care disability among women decreased overall but more in cohorts from the south than from the north of Europe. This suggests that the proportion of elderly people with disability is decreasing and that physical function differs across cultures.
Measuring physical function
Physical function was measured with the self-administered WHO-questionnaire on Activities of Daily Living.
Disabilities differ among countries
Elderly men from Italy and The Netherlands had approximately 50% more self-reported disabilities than those from Finland. The performance-based limitation score was highest in Italy and lowest in The Netherlands. The number of self-reported disabilities was positively related to the performance-based limitations score and that relation did not differ among countries.
Self-reported disability score relates to performance-based limitation score
Cross-sectional analysis showed that the mean self-reported disability score had a graded relation to the performance-based limitation score in the FINE study. This was confirmed in prosprective data analysis carried out in the Zutphen Elderly Study.
- Hoeymans et al. J Clin Epidemiol 1996;49:1103-10
- Van den Brink et al. J Am Geriatr Soc 2003;51:782-8
Optimism associated with a lower risk of depression
In the Zutphen Elderly Study a high level of optimism in 1985 was associated with a 77% lower risk of depressive symptoms in either 1990, 1995 or 2000. Men free of depressive symptoms in 1990 had a 63% lower cumulative 10-year incidence of depressive symptoms. These results suggest that optimistic elderly men are at a lower risk to develop depressive symptoms.
Measuring optimism and depression
Dispositional optimism was assessed with a 4-item questionnaire of the Central Bureau of Statistics in The Netherlands and depressive symptoms with the 20-items validated Zung self-rating depression scale.
Omega-3 fatty acids associated with lower risk of depressive symptoms
A cross-sectional analysis of the Zutphen Elderly Study showed that men with an average daily intake of the fish fatty acids EPA-DHA (407 mg per day), followed for 10 years, had a 54% lower risk of depressive symptoms compared to those with an average daily intake of 21 mg/d. An explanation for this association might be that low levels of EPA-DHA are associated with low levels of neurotransmitters and with markers of inflammation and endothelial dysfunction.
B-vitamins not related to depressive symptoms
Major depression is associated with with lower blood levels of B-vitamins. The B-vitamins folate, vitamin B6 and B12 are involved in the production of neurotransmitters and low levels are associated with depression. However, in a cross-sectional analysis the intake of B-vitamins was not related to depressive symptoms in the Zutphen Elderly Study.
Depression and physical inactivity, two sides of the same coin?
The relationship between depressive symptoms and CVD risk may be the consequence of a more sedentary lifestyle of depressed persons. Thus, physical inactivity may be the intermediate factor in the relation between depressive symptoms and CVD. The independent and combined effects of depressive symptoms and physical activity on CVD mortality were investigated prospectively in elderly men from the FINE study cohorts of Finland, the Netherlands and Italy.
Physical inactivity and depression both related to cardiovascular risk.
A 30 min/d lower level of physical activity at entry was associated with a 9% excess CVD mortality after 10 years. A one-standard deviation greater score for depressive symptoms was related to a 37% higher CVD mortality, after adjustment for physical activity. The excess risk of CVD mortality attributable to the combined effect of depressive symptoms with inactivity was 47%. The greater risk of CVD due to depressive symptoms cannot be explained by physical inactivity. However, depressive symptoms and physical inactivity may interact to increase CVD risk.
Moderate physical activity inversely associated with depression
At least mild physical activities (2 kcal/kg/hour, so f.i. for a 70 kg person that would be 140 kcal/hour) were inversely related to depressive symptoms in the baseline survey of the Finland, Italy, Netherlands Elderly study. One unit of moderate physical activity (30 min per day of walking, cycling, gardening and sports) at baseline was associated with a 3% lower risk of depressive symptoms 5 years later.
Moderate alcohol intake inversely related to depression but not to smoking
Moderate alcohol intake (less than 31 gram per day, equal to 3 glasses/d) entry was related to a 65% lower risk of depressive symptoms 5 years later, but the prevalence of smoking did not predict depressive symptoms.
- Kamphuis et al. Med Sci Sports Exerc 2007;39:1693-9
- Bots et al. Int J Geriatr Psychiatry 2008;23:478-84
Poor lung function associated with depression
Data from the Finnish and Italian cohorts showed that poor lung function in men aged 50-69 was associated with subsequent depressive symptoms 15-30 years later. This association was stronger in men with chronic diseases than in those without.
Decline in serum cholesterol predictor of depression
Among elderly men from Finland, The Netherlands and Italy, a 5-year decline in total serum cholesterol level was a predictor of depressive symptoms 5 years later. Men with two or more cardiovascular risk factors at entry (obesity, smoking, hypertension, hypercholesterolaemia, or diabetes) had no higher future risk of depression in the Zutphen Elderly Study.
- Giltay et al Am J Geriatr Psychiatry 2008;16:874-82
- Bots et al. Int J Geriatr Psychiatry 2008;23:478-84
- Giltay et al. Psychosomatic Med 2010;72:53-60
Living together associated with lower cognitive decline
In elderly men from Finland, The Netherlands and Italy information was collected on marital status and living situation in 1985 and again in 1990. This was related to cognitive decline during the next 10 years. Men who were married or who lived with others (with spouse, children, others or in a nursing home) in both 1985 and 1990, had the smallest subsequent 10-year cognitive decline.
The influence of marriage
Elderly men who lost a partner and those who were unmarried in the two examination rounds had a 2 times greater cognitive decline compared with those who were married in both years. Men who started to live alone between 1985 and 1990, had a cognitive decline 2 times greater and those who lived alone in both years had a cognitive decline 3.5 times greater than that of men who lived with others in both years.
Fish consumption related to lower cognitive decline.
In the Zutphen Elderly Study fish consumers had significantly less cognitive decline after 5 years than non-users. Similar results were obtained for the intake of the omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).
Fish consumption related to lower cognitive decline
In the Zutphen Elderly Study fish consumers had less cognitive decline than non-users after 3 years of follow-up. However, this association was not statistically significant. After extending the follow-up period to 5 years this association became statistically significant.
Moderate intake fatty acids EPA-DHA associated with lower cognitive decline
An average difference in consumption of 380 mg of EPA-DHA per day was associated with a significant difference in cognitive decline after 5 years of follow-up. These results suggest that a moderate intake of EPA-DHA may postpone cognitive decline.
Coffee may promote cognitive function in contrast to alcohol and smoking
In elderly men of the FINE study, moderate coffee drinking was associated with less cognitive decline, while alcohol consumption and tobacco-smoking were not related to cognition.
Coffee associated with less cognitive decline
The least cognitive decline was observed for elderly men who consumed 3 cups of coffee/day. It was 4 times less than the decline among non-consumers. The association between coffee consumption and cognitive decline over a 10-year period was investigated in the FINE study. In Finland, 90% of the elderly men drank coffee, while 95% did so in The Netherlands and 50% in Italy.
Alcohol and smoking not related to cognitive decline
Alcohol consumption was not related to cognitive decline in men without CVD or diabetes at entry. About 80% of the elderly men in Zutphen used alcohol while only 5% drank as many as 3 drinks per day. There was also no association between cigarette smoking and cognitive decline in men without CVD or diabetes at entry. In Zutphen, only 23% of men aged 70-89 smoked cigarettes.