Linking early life risk factors to frailty in old age: evidence from the China Health and Retirement Longitudinal Study

Abstract Background exposures in childhood and adolescence may impact the development of diseases and symptoms in late life. However, evidence from low- and middle-income countries is scarce. In this cross-sectional study, we examined the association of early life risk factors with frailty amongst older adults using a large, nationally representative cohort of community-dwelling Chinese sample. Methods we included 6,806 participants aged $\ge$60 years from the China Health and Retirement Longitudinal Study. We measured 13 risk factors in childhood or adolescence through self-reports, encompassing six dimensions (education, family economic status, nutritional status, domestic violence, neighbourhood and health). We used multinomial regression models to examine the association between risk factors and frailty. We further calculated the absolute risk difference for the statistically significant factors. Results persons with higher personal and paternal education attainment, better childhood neighbourhood quality and better childhood health status had lower risk of being frail in old age. Severe starvation in childhood was associated with higher risk of prefrailty. The risk differences of being frail were 5.6% lower for persons with a high school or above education, 1.5% lower for those whose fathers were literate, 4.8% lower for the highest neighbourhood quality and 2.9% higher for worse childhood health status compared to their counterparts. Conclusions unfavorable socioeconomic status and worse health condition in childhood and adolescence may increase the risk of late-life frailty amongst Chinese older adults.

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Childhood infectious diseases and old age cognitive functioning: a nationally representative sample of community-dwelling older adults

International Psychogeriatrics ◽

10.1017/s1041610220001404 ◽

2020 ◽

pp. 1-8

Author(s):

A. Rotstein ◽

S. Z. Levine

Keyword(s):

Risk Factors ◽

Older Adults ◽

Infectious Diseases ◽

Cognitive Functioning ◽

Old Age ◽

Early Life ◽

Representative Sample ◽

Community Dwelling ◽

Sensitivity Analyses ◽

Nationally Representative

ABSTRACT Background: Cumulative evidence suggests that health-related risk factors during midlife and old-age are associated with cognitive impairment. However, studies are needed to clarify the association between early-life risk factors and impaired cognitive functioning to increment existing knowledge. Objective: To examine the association between childhood infectious diseases and late-life cognitive functioning in a nationally representative sample of older adults. Participants: Eligible respondents were 2994 community-dwelling individuals aged 65–85. Measurements: Cognitive functioning was assessed using the Mini-Mental State Examination (MMSE). Childhood infectious diseases (i.e. chicken pox, measles, and mumps) were self-reported. The study covariates were age, sex, highest educational level achieved, smoking status, body mass index, and depression. The primary statistical analysis examined the association between the number of childhood infectious diseases and total MMSE scores, accounting for all study covariates. Regression models of progressive complexity were examined for parsimony. The robustness of the primary results was tested in 17 sensitivity analyses. Results: The most parsimonious model was a linear adjusted model (Bayesian Information Criterion = 12646.09). Late-life cognitive functioning significantly improved as the number of childhood infectious diseases increased (β = 0.18; 95% CI = 0.11, 0.26; p < 0.001). This effect was not significantly attenuated in all sensitivity analyses. Conclusion: The current study results are consistent with prior ecological findings indicating that some childhood infectious diseases are associated with better cognitive functioning in old-age. This points to an early-life modifiable risk factor associated with older-life cognitive functioning. Our results may reflect selective mortality and/or beneficial effects via hormetic processes.

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Association of Early-Life Family and Nieghborhood Circumstances With Depressive Symptoms in Chinese Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.1707 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 441-442

Author(s):

Yan Chen ◽

Jie Tan

Keyword(s):

Risk Factors ◽

Older Adults ◽

Depressive Symptoms ◽

Old Age ◽

Early Life ◽

Strong Association ◽

Community Dwelling ◽

Bivariate Analysis ◽

Life Circumstances ◽

Community Dwelling Older Adults

Abstract A growing body of literature suggests that early life circumstances can influence mental health throughout the lifespan. However, how these early life circumstances cumulatively contribute to depression in old age is not completely understood. The present study examined the associations of eight factors representing multifaceted early life experience at individual, family, and community levels with depression among community-dwelling older adults. Data were from the China Health and Retirement Longitudinal Study. We included 8,239 community-dwelling individuals who were ≥60 years, completed the life history questionnaire, and had assessment of depression. Chi-square test was used to examine the unadjusted associations between each of the eight early life risk factors and depression. An early life disadvantage index was established using risk factors that were significantly associated with depression. Logistic regression was used to examine the association of each early life risk factor and the index with depression. Of 8,239 individuals included, 2,055 (24.9%) had depression. In bivariate analysis, each of eight early life risk factors was significantly associated with depression. Except for maternal and paternal education, all risk factors persisted to be associated with depression after multivariable adjustment. In the multivariable-adjusted model, a one-point higher in the early life disadvantage index (range: 0-6) was associated with a 45% (95% CI: 37%, 53%) higher odds of depression. There was a strong association between early life environments and depressive symptoms among Chinese community-dwelling older adults. Adverse early life circumstances could contribute cumulatively to depression in old age.

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Risk factors for future falls among community-dwelling older adults without a fall in the previous year: A prospective one-year longitudinal study

Archives of Gerontology and Geriatrics ◽

10.1016/j.archger.2020.104161 ◽

2020 ◽

Vol 91 ◽

pp. 104161 ◽

Cited By ~ 1

Author(s):

Jaqueline Mello Porto ◽

Natália Camargo Rodrigues Iosimuta ◽

Renato Campos Freire Júnior ◽

Roberta de Matos Brunelli Braghin ◽

Érika Leitner ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Longitudinal Study ◽

Community Dwelling ◽

One Year ◽

Community Dwelling Older Adults

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Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults

International Journal of Geriatric Psychiatry ◽

10.1002/gps.2438 ◽

2009 ◽

Vol 25 (10) ◽

pp. 981-987 ◽

Cited By ~ 30

Author(s):

Damien Gallagher ◽

Aine Ni Mhaolain ◽

Elaine Greene ◽

Cathal Walsh ◽

Aisling Denihan ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Age Of Onset ◽

Late Life ◽

Community Dwelling ◽

Late Life Depression ◽

Community Dwelling Older Adults

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Subjective Technology Adaptivity Predicts Technology Use in Old Age

Gerontology ◽

10.1159/000471802 ◽

2017 ◽

Vol 63 (4) ◽

pp. 385-392 ◽

Cited By ~ 6

Author(s):

Stefan T. Kamin ◽

Frieder R. Lang ◽

Anja Beyer

Keyword(s):

Older Adults ◽

Personality Traits ◽

Old Age ◽

Technology Use ◽

Behavioral Plasticity ◽

Functional Limitations ◽

Late Life ◽

Community Dwelling ◽

Innovative Technology ◽

Interindividual Differences

Background: To date, not much is known about the psychological and motivational factors underlying technology use in late life. What are the interindividual determinants that lead older adults to invest in using technological innovations despite the age-related physiological changes that impose challenges on behavioral plasticity in everyday life? Objective: This research explores interindividual differences in subjective technology adaptivity - a general technology-related motivational resource that accounts for technology use in late life. More specifically, we investigate the influence of this factor relative to demographic characteristics, personality traits, and functional limitations in a longitudinal sample of community-dwelling older adults. Methods: We report results from a paper-and-pencil survey with 136 older adults between 59 and 92 years of age (mean = 71.4, SD = 7.4). Of those participants, 77 participated in a 2-year follow-up. We assessed self-reports of technology use, subjective technology adaptivity, functional limitations, and the personality traits openness to new experiences and neuroticism. Results: Higher levels of subjective technology adaptivity were associated with technology use at the first measurement as well as increased use over the course of 2 years. Conclusions: Subjective technology adaptivity is a significant predictor of technology use in old age. Our findings contribute to improving the understanding of interindividual differences when using technological innovation in late life. Moreover, our findings have implications in the context of user involvement and may contribute to the successful development of innovative technology for older adults.

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Incidence and risk factors of depressive symptoms in 4 years of follow-up among mid-aged and elderly community-dwelling Chinese adults: findings from the China Health and Retirement Longitudinal Study

BMJ Open ◽

10.1136/bmjopen-2019-029529 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029529 ◽

Cited By ~ 4

Author(s):

Yue Wen ◽

Chunjuan Liu ◽

Jing Liao ◽

Yiqiong Yin ◽

Dongmei Wu

Keyword(s):

Risk Factors ◽

Depressive Symptoms ◽

Longitudinal Study ◽

Health Status ◽

Representative Sample ◽

Lower Risk ◽

Community Dwelling ◽

Chinese Adults ◽

Nationally Representative

ObjectivesThe purpose of this study was to examine the incidence of depressive symptoms, and determine if baseline risk factors conferred a risk for incident depressive symptoms in nationally representative sample of mid-aged and elderly Chinese adults.DesignThis study was a secondary analysis of a prospective cohort from a nationally representative sample.SettingCommunity samples were recruited from the baseline survey of the China Health and Retirement Longitudinal Study. A four-stage, stratified, cluster probability sampling strategy was used, which included 10 257 households with members aged 45 years or older and their spouse.ParticipantsA total of 11 533 participants free of depressive symptoms at baseline were identified, and 10 288 were re-examined in either the first and/or the second follow-up surveys. The current analysis was conducted among the 10 288 participants.Primary and secondary outcome measuresDepressive symptoms were measured by the Center for Epidemiological Studies Depression Scale short form.ResultsThe findings showed that the incidence of depressive symptoms in a 4-year follow-up was as high as 22.3%. The incidence was much higher in rural areas (25.7%) and in women (27.9%). Furthermore, participants with 1 hour longer of night-time sleep had a 10% lower risk of developing depressive symptoms. Compared with individuals who perceived their health status as poor, those who perceived their health status as excellent had a 62% lower risk of developing depressive symptoms. In addition, having diabetes (OR=1.19), chronic kidney disease (OR=1.32), chronic digestive disorders (OR=1.15) and arthritis (OR=1.43) at baseline increased the risk of depressive symptoms. However, baseline body mass index was not associated with the subsequent depressive symptoms in this population.ConclusionsThis study highlights the importance of developing an appropriate screening test to identify depressive symptoms for those who are vulnerable and ensure these individuals can receive early interventions for depressive symptoms.

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Haemoglobin A1c, fasting glucose and future risk of elevated depressive symptoms over 2 years of follow-up in the English Longitudinal Study of Ageing

Psychological Medicine ◽

10.1017/s0033291711000079 ◽

2011 ◽

Vol 41 (9) ◽

pp. 1889-1896 ◽

Cited By ~ 20

Author(s):

M. Hamer ◽

G. D. Batty ◽

M. Kivimaki

Keyword(s):

Risk Factors ◽

Older Adults ◽

Depressive Symptoms ◽

Longitudinal Study ◽

Glucose Metabolism ◽

Fasting Glucose ◽

Community Dwelling ◽

English Longitudinal Study ◽

Hba1c Levels

BackgroundThe cross-sectional association between impaired glucose/diabetes and depression is inconsistent. We examined the longitudinal associations between diabetes, indicators of glucose metabolism and depressive symptoms over 2 years of follow-up.MethodParticipants were 4338 men and women from the English Longitudinal Study of Ageing, a prospective study of community-dwelling older adults [aged 62.9 (s.d.=9.0) years, 45.2% men]. Depressive symptoms were assessed at baseline and after 2 years of follow-up using the eight-item Centre of Epidemiological Studies – Depression (CES-D) scale. Glycated haemoglobin (HbA1c) levels, fasting glucose and other biological and behavioural risk factors were also assessed at baseline.ResultsApproximately 11.5% of the sample were categorized with elevated depressive symptoms at follow-up (a score ⩾4 on the CES-D). There was an association between HbA1c and depressive symptoms at follow-up [per unit increase, odds ratio (OR) 1.17, 95% confidence interval (CI) 1.03–1.33] after adjustment for age and baseline CES-D. Cross-sectionally, the probability of depressive symptoms increased with increasing HbA1c levels until the value of 8.0% after which there was a plateau [p(curve)=0.03]. Compared with those with normal fasting glucose, participants with diabetes (confirmed through self-report or elevated fasting blood glucose) at baseline had an elevated risk of depressive symptoms at follow-up (OR 1.52, 95% CI 1.01–2.30) after adjusting for depressive symptoms at baseline, behavioural and sociodemographic variables, adiposity and inflammation.ConclusionsThese data suggest that poor glucose metabolism and diabetes are risk factors for future depression in older adults. There was no evidence of a U-shaped association.

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Self-compassion as predictor of daily physical symptoms and chronic illness across older adulthood

Journal of Health Psychology ◽

10.1177/13591053211002326 ◽

2021 ◽

pp. 135910532110023

Author(s):

Heather Herriot ◽

Carsten Wrosch

Keyword(s):

Older Adults ◽

Longitudinal Study ◽

Chronic Illness ◽

End Of Life ◽

Old Age ◽

Physical Symptoms ◽

Older Adulthood ◽

Self Compassion ◽

Early Old Age

This study examined whether self-compassion could benefit daily physical symptoms and chronic illness in early and advanced old age. The hypotheses were evaluated in a 4-year longitudinal study of 264 older adults. Results showed that self-compassion predicted lower levels of daily physical symptoms across the study period in advanced, but not early, old age ( T-ratio = −1.93, p = 0.05). In addition, self-compassion was associated with fewer increases in chronic illness in advanced, but not early, old age ( T-ratio = − 2.45, p < 0.02). The results of this study suggest that self-compassion may be particularly adaptive towards the end of life.

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Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001122 ◽

2021 ◽

Vol 30 ◽

Author(s):

Shiyu Lu ◽

Tianyin Liu ◽

Gloria H. Y. Wong ◽

Dara K. Y. Leung ◽

Lesley C. Y. Sze ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Symptom Severity ◽

Social Care ◽

Late Life ◽

Community Dwelling ◽

Service Utilisation ◽

Late Life Depression ◽

Social Care Service ◽

Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

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Diagnostic Power of Circulatory Metabolic Biomarkers as Metabolic Syndrome Risk Predictors in Community-Dwelling Older Adults in Northwest of England (A Feasibility Study)

Nutrients ◽

10.3390/nu13072275 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2275

Author(s):

Razieh Hassannejad ◽

Hamsa Sharrouf ◽

Fahimeh Haghighatdoost ◽

Ben Kirk ◽

Farzad Amirabdollahian

Keyword(s):

Risk Factors ◽

Older Adults ◽

Metabolic Syndrome ◽

Roc Analysis ◽

Cross Validation ◽

Community Dwelling ◽

Tnf Α ◽

Diagnostic Power ◽

Metabolic Biomarkers ◽

Community Dwelling Older Adults

Background: Metabolic Syndrome (MetS) is a cluster of risk factors for diabetes and cardiovascular diseases with pathophysiology strongly linked to aging. A range of circulatory metabolic biomarkers such as inflammatory adipokines have been associated with MetS; however, the diagnostic power of these markers as MetS risk correlates in elderly has yet to be elucidated. This cross-sectional study investigated the diagnostic power of circulatory metabolic biomarkers as MetS risk correlates in older adults. Methods: Hundred community dwelling older adults (mean age: 68.7 years) were recruited in a study, where their blood pressure, body composition and Pulse Wave Velocity (PWV) were measured; and their fasting capillary and venous blood were collected. The components of the MetS; and the serum concentrations of Interleukin-6 (IL-6), Tumor Necrosis Factor-α (TNF-α), Plasminogen Activator Inhibitor-I (PAI-I), Leptin, Adiponectin, Resistin, Cystatin-C, C-Reactive Protein (CRP), insulin and ferritin were measured within the laboratory, and the HOMA1-IR and Atherogenic Index of Plasma (AIP) were calculated. Results: Apart from other markers which were related with some cardiometabolic (CM) risk, after Bonferroni correction insulin had significant association with all components of Mets and AIP. These associations also remained significant in multivariate regression. The multivariate odds ratio (OR with 95% confidence interval (CI)) showed a statistically significant association between IL-6 (OR: 1.32 (1.06–1.64)), TNF-α (OR: 1.37 (1.02–1.84)), Resistin (OR: 1.27 (1.04–1.54)) and CRP (OR: 1.29 (1.09–1.54)) with MetS risk; however, these associations were not found when the model was adjusted for age, dietary intake and adiposity. In unadjusted models, insulin was consistently statistically associated with at least two CM risk factors (OR: 1.33 (1.16–1.53)) and MetS risk (OR: 1.24 (1.12–1.37)) and in adjusted models it was found to be associated with at least two CM risk factors and MetS risk (OR: 1.87 (1.24–2.83) and OR: 1.25 (1.09–1.43)) respectively. Area under curve (AUC) for receiver operating characteristics (ROC) demonstrated a good discriminatory diagnostics power of insulin with AUC: 0.775 (0.683–0.866) and 0.785 by cross validation and bootstrapping samples for at least two CM risk factors and AUC: 0.773 (0.653–0.893) and 0.783 by cross validation and bootstrapping samples for MetS risk. This was superior to all other AUC reported from the ROC analysis of other biomarkers. Area under precision-recall curve for insulin was also superior to all other markers (0.839 and 0.586 for at least two CM risk factors and MetS, respectively). Conclusion: Fasting serum insulin concentration was statistically linked with MetS and its risk, and this link is stronger than all other biomarkers. Our ROC analysis confirmed the discriminatory diagnostic power of insulin as CM and MetS risk correlate in older adults.

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