Risk Factors of Walking While Talking Decline in Older Adults: Central Control of Mobility and Aging Study

Abstract Background Slow gait speed during walking while talking (WWT-speed) is associated with an increased risk of falls and dementia. Age-related changes in WWT-speed and associated risk factors, however, are poorly understood. This study examined 1) change in WWT-speed over time 2) factors associated with change in WWT-speed. Methods A total of 431 older participants (M Age=76.8±6.4 years; M follow-up 4.5±2.3 years) enrolled in the Central Control of Mobility in Aging study were examined. WWT-speed was measured with a computerized walkway while participants recited alternate letters of the alphabet while walking. The following baseline measures were examined as risk factors: demographic [age, sex, education], medical [hypertension, diabetes, cardiac arrhythmias, history of stroke, Parkinson’s disease, kidney disease, arthritis, depression], cognitive [global cognition, executive function, processing speed], sensorimotor [balance, grip strength, vision], falls and frailty. Linear mixed effect models were used to examine 1) change in WWT-speed over time 2) risk factors of WWT-speed change. Results WWT-speed declined over time (b -1.06, 95%CI -1.45, -.68) independent of baseline age, sex and education. Rate of WWT-decline was modified by age (b -.10, 95%CI -.17, -.03) and poorer balance (b -1.12, 95%CI -1.95, -.28). Lower scores in tests of global cognition and processing speed and, kidney disease predicted slow WWT-speed on average. Conclusion Greater age and poorer balance accelerate WWT-speed decline while poorer global cognition, slow processing speed and kidney disease predicts slow WWT-speed. These factors may provide potential targets for future interventions to prevent decline in WWT-speed and associated adverse health outcomes.

Download Full-text

Prevalence of Impaired Kidney Function in the German Elderly: Results from the Berlin Aging Study II (BASE-II)

Gerontology ◽

10.1159/000454831 ◽

2017 ◽

Vol 63 (3) ◽

pp. 201-209 ◽

Cited By ~ 4

Author(s):

Maximilian König ◽

Maik Gollasch ◽

Ilja Demuth ◽

Elisabeth Steinhagen-Thiessen

Keyword(s):

Risk Factors ◽

Older Adults ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

The Elderly ◽

Community Dwelling ◽

Structured Interviews ◽

Cross Sectional ◽

Increased Risk ◽

Aging Study

Background: In aging populations with an ever-growing burden of risk factors such as obesity, diabetes, and hypertension, chronic kidney disease (CKD) is on the rise. However, little is known about its exact prevalence among elderly adults, and often albuminuria is not included in the definition of CKD. Moreover, novel equations for the estimated glomerular filtration rate (eGFR) have recently emerged, which have not been applied comprehensively to older adults. Data on CKD awareness among the elderly are sparse. Objectives: To determine the prevalence of CKD among older adults by eGFR and albumin/creatinine ratio (ACR), compare the performance of 6 established and novel eGFR formulas, explore risk factors, and determine the awareness of CKD in a large cohort of community-dwelling elderly from Germany. Methods: A total of 1,628 subjects from the Berlin Aging Study II (BASE-II) were included in this analysis (mean age 68.7 years; 51.2% female). Extensive cross-sectional data on sociodemographics, lifestyle, medication, and diagnoses were inquired during structured interviews and a medical examination, and blood and urine parameters were measured. Results: In all, 77.1% of the subjects had hypertension, 12.4% had diabetes, and 18.3% were obese. The prevalence of CKD strongly depended on the eGFR equations used: 25.4% (full age spectrum [FAS] equation), 24.6% (Berlin Initiative Study), 23.1% (Lund-Malmö revised), 19.3% (Cockcroft-Gault), 16.4% (Chronic Kidney Disease-Epidemiology Collaboration [CKD-EPI]), and 14.7% (Modification of Diet in Renal Disease [MDRD]). Of the subjects with an eGFRFAS <60 mL/min/1.73 m2 and/or an ACR >30 mg/g, only 3.9% were aware of having CKD. Polypharmacy, age, BMI, coronary artery disease, non-HDL cholesterol, and female sex were independently associated with CKD. Conclusions: CKD is prevalent among older adults in Germany, but awareness is low. The FAS equation detects higher rates of CKD than MDRD and CKD-EPI, which are most widely used at present. Also, when CKD is defined based on eGFR and albuminuria, considerably more people are identified than by eGFR alone. Finally, polypharmacy is associated with an increased risk for CKD in the elderly.

Download Full-text

Stroke in chronic renal failure

Orvosi Hetilap ◽

10.1556/oh.2008.28292 ◽

2008 ◽

Vol 149 (15) ◽

pp. 691-696

Author(s):

Dániel Bereczki

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Chronic Renal Disease ◽

Kidney Diseases ◽

Cerebrovascular Diseases ◽

Lipid Lowering ◽

Increased Risk ◽

Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

Download Full-text

The Role of Vascular Aging in Atherosclerotic Plaque Development and Vulnerability

Current Pharmaceutical Design ◽

10.2174/1381612825666190830175424 ◽

2019 ◽

Vol 25 (29) ◽

pp. 3098-3111 ◽

Cited By ~ 6

Author(s):

Luca Liberale ◽

Giovanni G. Camici

Keyword(s):

Atherosclerotic Plaque ◽

Molecular Mechanisms ◽

Driving Forces ◽

Plaque Burden ◽

Vascular Aging ◽

Age Related ◽

Plaque Development ◽

Increased Risk ◽

The Impact ◽

Over Time

Background: The ongoing demographical shift is leading to an unprecedented aging of the population. As a consequence, the prevalence of age-related diseases, such as atherosclerosis and its thrombotic complications is set to increase in the near future. Endothelial dysfunction and vascular stiffening characterize arterial aging and set the stage for the development of cardiovascular diseases. Atherosclerotic plaques evolve over time, the extent to which these changes might affect their stability and predispose to sudden complications remains to be determined. Recent advances in imaging technology will allow for longitudinal prospective studies following the progression of plaque burden aimed at better characterizing changes over time associated with plaque stability or rupture. Oxidative stress and inflammation, firmly established driving forces of age-related CV dysfunction, also play an important role in atherosclerotic plaque destabilization and rupture. Several genes involved in lifespan determination are known regulator of redox cellular balance and pre-clinical evidence underlines their pathophysiological roles in age-related cardiovascular dysfunction and atherosclerosis. Objective: The aim of this narrative review is to examine the impact of aging on arterial function and atherosclerotic plaque development. Furthermore, we report how molecular mechanisms of vascular aging might regulate age-related plaque modifications and how this may help to identify novel therapeutic targets to attenuate the increased risk of CV disease in elderly people.

Download Full-text

Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends

Reproductive Health ◽

10.1186/s12978-020-00990-z ◽

2020 ◽

Vol 17 (S3) ◽

Author(s):

Melissa Bauserman ◽

Vanessa R. Thorsten ◽

Tracy L. Nolen ◽

Jackie Patterson ◽

Adrien Lokangaka ◽

...

Keyword(s):

Risk Factors ◽

Maternal Mortality ◽

Maternal Deaths ◽

Middle Income ◽

Maternal Risk ◽

Live Births ◽

Middle Income Countries ◽

Risk Of Death ◽

Increased Risk ◽

Over Time

Abstract Background Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. Conclusions The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. Trial registration The MNHR is registered at NCT01073475.

Download Full-text

Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽

10.1161/str.45.suppl_1.tp136 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

George Howard ◽

Mary Cushman ◽

Maciej Banach ◽

Brett M Kissela ◽

David C Goff ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Multivariable Analysis ◽

The Elderly ◽

Stroke Risk Factors ◽

Age Related ◽

Increased Risk ◽

The Impact ◽

Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

Download Full-text

Abstract MP74: Long Term Risk-Factor Profiles for Chronic Kidney Disease in the Framingham Heart Study

Circulation ◽

10.1161/circ.127.suppl_12.amp74 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Gearoid M McMahon ◽

Sarah R Preis ◽

Shih-Jen Hwang ◽

Caroline S Fox

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Risk Factor ◽

Kidney Disease ◽

Framingham Heart Study ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Standard Deviation Increase ◽

Heart Study ◽

Increased Risk

Background: Chronic Kidney Disease (CKD) is an important public health issue and is associated with an increased risk of cardiovascular disease. Risk factors for CKD are well established, but most are typically assessed at or near the time of CKD diagnosis. Our hypothesis was that risk factors for CKD are present earlier in the course of the disease. We compared the prevalence of risk factors between CKD cases and controls at time points up to 30 years prior to CKD diagnosis. Methods: Participants were drawn from the Framingham Heart Study Offspring cohort. CKD was defined as an estimated glomerular filtration rate of ≤60ml/min/1.73m2. Incident CKD cases occurring at examination cycles 6, 7, and 8 were age- and sex-matched 1:2 to controls. Risk factors including systolic blood pressure (SBP), hypertension, lipids, diabetes, smoking status, body mass index (BMI) and dipstick proteinuria were measured at the time of CKD diagnosis and 10, 20 and 30 years prior. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls Results: During follow-up, 441 new cases of CKD were identified and these were matched to 882 controls (mean age 69.2 years, 52.4% women). Up to 30 years prior to CKD diagnosis, those who ultimately developed CKD were more likely to have hypertension (OR 1.74, CI 1.21-2.49), be obese (OR 1.74, CI 1.15-2.63) and have higher triglycerides (OR 1.43, CI 1.12-1.84, p=0.005 per 1 standard deviation increase). Each 10mmHg increase in SBP was associated with an OR of 1.22 for future CKD (95% CI 1.10-1.35) Additionally, cases were more likely to have diabetes (OR 2.90, CI 1.59-5.29) and be on antihypertensive therapy (OR 1.65, CI 1.14-2.40, p=0.009) up to 20 years prior to diagnosis. Increasing HDLc was associated with a lower risk of CKD (OR 0.84, CI 0.81-0.97 per 10mg/dl). Conclusions: As many as 30 years prior to diagnosis, risk factors for CKD are identifiable. In particular, modifiable risk factors such as obesity, hypertension and dyslipidemia are present early in the course of the disease. These findings demonstrate the importance of early identification of risk factors in patients at risk of CKD through a life-course approach.

Download Full-text

Community prevalence of SARS-CoV-2 in England: Results from the ONS Coronavirus Infection Survey Pilot

10.1101/2020.07.06.20147348 ◽

2020 ◽

Cited By ~ 4

Author(s):

Koen B Pouwels ◽

Thomas House ◽

Julie V Robotham ◽

Paul Birrell ◽

Andrew B Gelman ◽

...

Keyword(s):

Risk Factors ◽

Credible Interval ◽

Control Measures ◽

Cross Sectional ◽

Direct Patient Contact ◽

Increased Risk ◽

Potential Risk Factors ◽

Coronavirus Infection ◽

Over Time

Objective: To estimate the percentage of individuals infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) over time in the community in England and to quantify risk factors. Design: Repeated cross-sectional surveys of population-representative households with longitudinal follow-up if consent given. Setting: England. Participants: 34,992 Individuals aged 2 years and over from 16,722 private residential households. Data were collected in a pilot phase of the survey between 26 April and 28 June 2020. Main outcome measures: Percentage of individuals in the community testing positive for SARS-CoV-2 RNA using throat and nose swabs. Individuals were asked about any symptoms and potential risk factors. Results: The percentage of people in private-residential households testing positive for SARS-CoV-2 reduced from 0.32% (95% credible interval (CrI) 0.19% to 0.52%) on 26 April to 0.08% (95% CrI 0.05% to 0.12%) on 28 June, although the prevalence stabilised near the end of the pilot. Factors associated with an increased risk of testing positive included having a job with direct patient contact (relative exposure (RE) 4.06, 95% CrI 2.42 to 6.77)), working outside the home (RE 2.49, 95% CrI 1.39 to 4.45), and having had contact with a hospital (RE 2.20, 95% CrI 1.09 to 4.16 for having been to a hospital individually and RE 1.95, 95% CrI 0.81 to 4.09 for a household member having been to a hospital). In 133 visits where individuals tested positive, 82 (61%, 95% CrI 53% to 69%) reported no symptoms, stably over time. Conclusion: The percentage of SARS-CoV-2 positive individuals declined between 26 April and 28 June 2020. Positive tests commonly occurred without symptoms being reported. Working outside your home was an important risk factor, indicating that continued monitoring for SARS-CoV-2 in the community will be essential for early detection of increases in infections following return to work and other relaxations of control measures.

Download Full-text

Special conditions: kidney disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0223 ◽

2018 ◽

pp. 947-950

Author(s):

Drazenka Pongrac Barlovic ◽

Per-Henrik Groop

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Kidney Disease ◽

Life Expectancy ◽

Renal Disease ◽

Beneficial Effect ◽

Cardiovascular Events ◽

Treatment Strategies ◽

Microvascular Damage ◽

Increased Risk

Kidney disease is one of the most common and important consequences of microvascular damage in diabetes. Its occurrence largely determines the increased risk of cardiovascular events and remarkably shortens life expectancy. Therefore, protecting the kidney is one of the main aims of patient care in diabetes and should be based on implementation of the intensive treatment of risk factors that promote its progression to prevent renal failure, and even more importantly, cardiovascular events. Very recently, some new therapies with a beneficial effect on renal disease have emerged; however, there is still plenty of room for additional innovative treatment strategies to prevent, arrest, treat, and reverse kidney disease caused by diabetes and its devastating consequences.

Download Full-text

Longitudinal Changes in Resting Metabolic Rates with Aging Are Accelerated by Diseases

Nutrients ◽

10.3390/nu12103061 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3061

Author(s):

Marta Zampino ◽

Majd AlGhatrif ◽

Pei-Lun Kuo ◽

Eleanor Marie Simonsick ◽

Luigi Ferrucci

Keyword(s):

Chronic Diseases ◽

Resting Metabolic Rate ◽

Disease Status ◽

Linear Regression Models ◽

Two Phase ◽

Cross Sectional ◽

Mixed Effect ◽

Age Related ◽

Baltimore Longitudinal Study ◽

Over Time

Resting metabolic rate (RMR) declines with aging and is related to changes in health status, but how specific health impairments impact basal metabolism over time has been largely unexplored. We analyzed the association of RMR with 15 common age-related chronic diseases for up to 13 years of follow-up in a population of 997 participants to the Baltimore Longitudinal Study of Aging. At each visit, participants underwent measurements of RMR by indirect calorimetry and body composition by DEXA. Linear regression models and linear mixed effect models were used to test cross-sectional and longitudinal associations of RMR and changes in disease status. Cancer and diabetes were associated with higher RMR at baseline. Independent of covariates, prevalent COPD and cancer, as well as incident diabetes, heart failure, and CKD were associated with a steeper decline in RMR over time. Chronic diseases seem to have a two-phase association with RMR. Initially, RMR may increase because of the high cost of resiliency homeostatic mechanisms. However, as the reserve capacity becomes exhausted, a catabolic cascade becomes unavoidable, resulting in loss of total and metabolically active mass and consequent RMR decline.

Download Full-text

Trends in factors indicating increased risk for STI among key subpopulations in the United States, 2002–2015

Sexually Transmitted Infections ◽

10.1136/sextrans-2019-054045 ◽

2019 ◽

Vol 96 (2) ◽

pp. 121-123 ◽

Cited By ~ 3

Author(s):

Jami S Leichliter ◽

Patricia J Dittus ◽

Casey E Copen ◽

Sevgi O Aral

Keyword(s):

Risk Factors ◽

National Survey ◽

Temporal Trends ◽

Male Partner ◽

The United States ◽

High Risk Factors ◽

Increased Risk ◽

The Usa ◽

Sex With Men ◽

Over Time

ObjectivesWithin the context of rising rates of reportable STIs in the USA, we used national survey data to examine temporal trends in high-risk factors that indicate need for STI/HIV preventive services among key subpopulations with disproportionate STI rates.MethodsWe used data from the 2002 (n=12 571), 2006–2010 (n=22 682) and 2011–2015 (n=20 621) National Survey of Family Growth (NSFG). NSFG is a national probability survey of 15–44 year olds living in US households. We examined STI risk factors among sexually active men who have sex with men (MSM) and Hispanic, non-Hispanic black, 15–19 year old, 20–24 year old, and 25–29 year old women who have sex with men (WSM) and men who have sex with women (MSW). Risk behaviours included: received money or drugs for sex, gave money or drugs for sex, partner who injected drugs, partner who has HIV, non-monogamous partner (WSM, MSW only) and male partner who had sex with other men (WSM only). Endorsement of any of these behaviours was recoded into a composite variable focusing on factors indicating increased STI risk (yes/no). We used chi-squares and logistic regression (calculating predicted marginals to estimate adjusted prevalence ratios (aPRs)) to examine STI risk factors over time among the key subpopulations.ResultsFrom 2002 to 2011–2015, reported STI risk factors did not change or declined over time among key subpopulations in the USA. In adjusted analyses comparing 2002 to 2011–2015, we identified significant declines among WSM: Hispanics (aPR=0.84 (0.68–1.04), non-Hispanic blacks (aPR=0.69 (0.58–0.82), adolescents (aPR=0.71 (0.55–0.91) and 25–29 year olds (aPR=0.76 (0.58–0.98); among MSW: Hispanics (aPR=0.53 (0.40–0.70), non-Hispanic blacks (aPR=0.74 (0.59–0.94) and adolescents (aPR=0.63 (0.49–0.82); and among MSM (aPR=0.53 (0.34–0.84).ConclusionsWhile reported STIs have increased, STI risk factors among key subpopulations were stable or declined. Condom use related to these risk factors, sexual mixing patterns and STI testing should be examined.

Download Full-text