Association of Physical Activity and Cognitive Activity With Disability: A 2-Year Prospective Cohort Study

Abstract Objective Engaging in physical activity (PA) and/or cognitive activity (CA) retains function in older adults, but whether the combination of these activities is associated with disability onset is still unknown. This study aimed to examine the prospective association of PA and/or CA with disability onset in older adults. Methods This was an ongoing prospective community-based cohort study. Data collection was conducted through a health check. An analyzable sample of 2668 participants (mean age = 75.5 years; 51.6% female) were categorized into 4 groups based on quartile 1 (low) and 2 to 4 (high) values of accelerometer-measured moderate-to-vigorous PA and CA scale scores based on the frequency of 6 activities including reading, writing for pleasure, doing crossword puzzles, and playing board games or cards. Disability onset was monitored through long-term care insurance certification for at least 2 years. Results A log-rank test showed significantly lower incidence of disability in the high PA and low CA group and the high PA and high CA group compared with the low PA and low CA group. Cox-proportional hazards models (referring to the low PA and low CA group) showed that only the high PA and high CA group was significantly associated with a lowered hazard ratio for disability onset (0.51; 95% CI = 0.29–0.90) after adjusting for covariates. Conclusions Engaging in both PA and CA is effective for reducing risk of disability onset, but engaging in either PA or CA is not effective. Impact Physical therapists can be guided by this research to design intervention strategies for people at risk of disability.

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Pre-Existing Disability and Its Risk of Fragility Hip Fracture in Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16071237 ◽

2019 ◽

Vol 16 (7) ◽

pp. 1237

Author(s):

Jayeun Kim ◽

Soong-Nang Jang ◽

Jae-Young Lim

Keyword(s):

Older Adults ◽

Hip Fracture ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Mental Disabilities ◽

Term Care ◽

Fragility Hip Fracture

Background: Hip fracture is one of the significant public concerns in terms of long-term care in aging society. We aimed to investigate the risk for the incidence of hip fracture focusing on disability among older adults. Methods: This was a population-based retrospective cohort study, focusing on adults aged 65 years or over who were included in the Korean National Health Insurance Service–National Sample from 2004 to 2013 (N = 90,802). Hazard ratios with 95% confidence interval (CIs) were calculated using the Cox proportional hazards model according to disability adjusted for age, household income, underlying chronic diseases, and comorbidity index. Results: The incidence of hip fracture was higher among older adults with brain disability (6.3%) and mental disability (7.5%) than among those with other types of disability, as observed during the follow-up period. Risk of hip fracture was higher among those who were mildly to severely disabled (hazard ratio for severe disability = 1.59; 95% CI, 1.33–1.89; mild = 1.68; 95% CI, 1.49–1.88) compared to those who were not disabled. Older men with mental disabilities experienced an incidence of hip fracture that was almost five times higher (hazard ratio, 4.98; 95% CI, 1.86–13.31) versus those that were not disabled. Conclusions: Older adults with mental disabilities and brain disability should be closely monitored and assessed for risk of hip fracture.

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A Nomogram Prediction of Length of Hospital Stay in Patients with COVID-19 Pneumonia: A Retrospective Cohort Study

Disease Markers ◽

10.1155/2021/5598824 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Kang Li ◽

Chi Zhang ◽

Ling Qin ◽

Chaoran Zang ◽

Ang Li ◽

...

Keyword(s):

Cohort Study ◽

Hospital Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Characteristic Curve ◽

Length Of Hospital Stay ◽

Cox Proportional Hazards ◽

Brier Score ◽

Rank Test

Assessing the length of hospital stay (LOS) in patients with coronavirus disease 2019 (COVID-19) pneumonia is helpful in optimizing the use efficiency of hospital beds and medical resources and relieving medical resource shortages. This retrospective cohort study of 97 patients was conducted at Beijing You’An Hospital between January 21, 2020, and March 21, 2020. A multivariate Cox proportional hazards regression based on the smallest Akaike information criterion value was used to select demographic and clinical variables to construct a nomogram. Discrimination, area under the receiver operating characteristic curve (AUC), calibration, and Kaplan–Meier curves with the log-rank test were used to assess the nomogram model. The median LOS was 13 days (interquartile range [IQR]: 10–18). Age, alanine aminotransferase, pneumonia, platelet count, and PF ratio (PaO2/FiO2) were included in the final model. The C-index of the nomogram was 0.76 ( 95 % confidence interval CI = 0.69 – 0.83 ), and the AUC was 0.88 ( 95 % CI = 0.82 – 0.95 ). The adjusted C-index was 0.75 ( 95 % CI = 0.67 – 0.82 ) and adjusted AUC 0.86 ( 95 % CI = 0.73 – 0.95 ), both after 1000 bootstrap cross internal validations. A Brier score of 0.11 ( 95 % CI = 0.07 – 0.15 ) and adjusted Brier score of 0.130 ( 95 % CI = 0.07 – 0.20 ) for the calibration curve showed good agreement. The AUC values for the nomogram at LOS of 10, 20, and 30 days were 0.79 ( 95 % CI = 0.69 – 0.89 ), 0.89 ( 95 % CI = 0.83 – 0.96 ), and 0.96 ( 95 % CI = 0.92 – 1.00 ), respectively, and the high fit score of the nomogram model indicated a high probability of hospital stay. These results confirmed that the nomogram model accurately predicted the LOS of patients with COVID-19. We developed and validated a nomogram that incorporated five independent predictors of LOS. If validated in a future large cohort study, the model may help to optimize discharge strategies and, thus, shorten LOS in patients with COVID-19.

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High blood uric acid is associated with reduced risks of mild cognitive impairment among older adults in China: a 9-year prospective cohort study

10.1101/2021.07.24.21261062 ◽

2021 ◽

Author(s):

Chen Chen ◽

Xueqin Li ◽

Yuebin Lv ◽

Zhaoxue Yin ◽

Feng Zhao ◽

...

Keyword(s):

Older Adults ◽

Uric Acid ◽

Cohort Study ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Healthy Aging ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Blood Uric Acid ◽

Quartile Group

Abstract Background: It remains unsolved that whether blood uric acid (UA) is a neuroprotective or neurotoxic agent. This study aimed to evaluate the longitudinal association of blood UA with mild cognitive impairment (MCI) among older adults in China. Methods: A total of 3103 older adults (aged 65+ years) free of MCI at baseline were included from the Healthy Aging and Biomarkers Cohort Study (HABCS). Blood UA level was determined by the uricase colorimetry assay and analyzed as categorical (by quartile) variables. Global cognition was assessed using the Mini-Mental State Examination four times between 2008 and 2017, with a score below 24 being considered as MCI. Cox proportional hazards models were used to examine the associations. Results: During a 9-year follow-up, 486 (15.7%) participants developed MCI. After adjustment for all covariates, higher UA had a dose-response association with a lower risk of MCI (all P for trend< 0.05). Participants in the highest UA quartile group had a reduced risk (hazard ratio [HR], 0.73; 95% [CI]: 0.55-0.96) of MCI, compared with those in the lowest quartile group. The associations were still robust even when considering death as a competing risk. Subgroup analyses revealed that these associations were statistically significant in younger older adults (65-79 years) and those without hyperuricemia. Conclusions: High blood UA level is associated with reduced risks of MCI among Chinese older adults, highlighting the potential of managing UA in daily life for maintaining late-life cognition.

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Combination of diabetes mellitus and lack of habitual physical activity is a risk factor for functional disability in Japanese

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000901 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000901

Author(s):

Kazuya Fujihara ◽

Yasuhiro Matsubayashi ◽

Mayuko Harada Yamada ◽

Masaru Kitazawa ◽

Masahiko Yamamoto ◽

...

Keyword(s):

Physical Activity ◽

Functional Disability ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Habitual Physical Activity ◽

Term Care ◽

Patients With Diabetes ◽

The Impact

ObjectiveDeclining healthy life expectancy due to functional disability is relevant and urgent because of its association with decreased quality of life and also for its enormous socioeconomic impact. The aim of this study is to examine the impact of diabetes, hypertension, dyslipidemia and physical activity habits on functional disability among community-dwelling Japanese adults.Research design and methodsThis is a population-based retrospective cohort study including 9673 people aged 39–98 years in Japan (4420, men). Functional disability was defined as a condition meeting Japan’s new long-term care insurance certification requirements for the need of assistance in the activities of daily living whether by caregivers or assistive devices. Cox proportional-hazards regression model identified variables related to functional disability.ResultsMedian follow-up was 3.7 years. During the study period, 165 disabilities occurred in the overall study population. Multivariate analysis showed that diabetes (HR 1.74 (95% CI 1.12 to 2.68)) and no physical activity habit (HR 1.83 (1.27 to 2.65)) presented increased risks for disability. HR for disability increased with the number of risk factors (HR of individuals with four conditions, 3.96 (1.59 to 9.99) vs individuals with none of those conditions as a reference). HR for disability among patients with diabetes with and without a physical activity habit was 1.68 (0.70 to 4.04) and 3.19 (1.79 to 5.70), respectively, compared with individuals without diabetes with a physical activity habit.ConclusionsThe combination of diabetes and lack of habitual physical activity is predictive of functional disability in Japanese. Habitual physical activity attenuates the risk of functional disability in patients with diabetes.

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Anxiety and Unmet Needs for Assistance With Daily Activities Among Older Adults

Journal of Aging and Health ◽

10.1177/0898264319830805 ◽

2019 ◽

Vol 32 (5-6) ◽

pp. 491-500

Author(s):

Ashley Zuverink ◽

Xiaoling Xiang

Keyword(s):

Older Adults ◽

Unmet Needs ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Anxiety Symptoms ◽

Daily Activities ◽

Medicare Beneficiaries ◽

Term Care ◽

Care Services ◽

Bidirectional Relationship

Objective: To examine the potentially bidirectional relationship between anxiety symptoms and unmet needs for assistance with daily activities among older adults. Method: Data came from the National Health and Aging Trends Study, 2011 through 2016 surveys. The study sample consisted of 3,936 Medicare beneficiaries with activity limitations at baseline, aged 65 or older. Cox proportional hazards regression was used to test the proposed relationship between anxiety symptoms and unmet needs for assistance with daily activities. Result: Having unmet needs increased the risk of the onset of anxiety symptoms, and elevated anxiety symptoms increased the risk of incident unmet needs for assistance with daily activities. Conclusion: Anxiety symptoms and unmet needs form a bidirectional relationship. Integrated mental health and community-based long-term care services may help reduce the burden of late-life anxiety disorders and stressful life incidents contributing to disability.

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Systemic Sclerosis is Linked to Psoriasis and May Impact on Patients’ Survival: A Large Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm8040521 ◽

2019 ◽

Vol 8 (4) ◽

pp. 521 ◽

Cited By ~ 13

Author(s):

Watad ◽

Bragazzi ◽

McGonagle ◽

Damiani ◽

Comaneshter ◽

...

Keyword(s):

Cohort Study ◽

Systemic Sclerosis ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Rank Test ◽

Medical Database ◽

Log Rank Test ◽

Kaplan Meier ◽

Large Cohort Study ◽

And Gender

Although skin manifestations are quite common in systemic sclerosis (SSc), a link between SSc and psoriasis (PsO) has been poorly investigated. We assessed the Clalit medical database in a cohort study to compare the prevalence of PsO between SSc-patients and SSc-free controls. We also evaluated the SSc-related autoantibodies’ role in the co-existence of the two conditions. Survival analysis was performed using both univariate (Kaplan–Meier, log-rank test) and multivariate (Cox proportional-hazards technique) analyses. Our cohort of 2,431 SSc-patients was age- and gender-matched with 12,710 controls (case-control match 1:5.2). There were 150 (1.2%) cases of PsO among controls and 47 (1.9%) among SSc-patients (p = 0.0027). A SSc diagnosis was an independent risk factor for PsO with an odds ratio (OR) of 2.16 (95%CI 1.38–3.39, p = 0.0008). Among SSc-patients, 98.6% with PsO were antinuclear antibodies (ANA)-negative. In terms of survival, the mortality rate in SSc-patients with PsO was lower than SSc without PsO (14.9% vs. 26%, p < 0.0001). At the multivariate-analysis, SSc-patients with PsO compared to SSc-patients without PsO had an OR for death of 0.44 (95%CI 0.19–0.99, p < 0.05). SSc is independently associated with PsO. The cases with concurrent PsO and SSc are almost exclusively ANA-negative and may exhibit a better survival.

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Independent effects of waist circumference and physical activity on all-cause mortality in Canadian women

Applied Physiology Nutrition and Metabolism ◽

10.1139/h05-038 ◽

2006 ◽

Vol 31 (3) ◽

pp. 271-276 ◽

Cited By ~ 24

Author(s):

Peter T Katzmarzyk ◽

Cora L Craig

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Waist Circumference ◽

Physical Inactivity ◽

Proportional Hazards ◽

Leisure Time Physical Activity ◽

Smoking Status ◽

Cox Proportional Hazards ◽

Independent Effects

The purpose of this study was to determine the independent effects of waist circumference (WC) and physical inactivity on the risk of mortality in women. This prospective cohort study included 5421 female participants 20-69 years of age in the 1981 Canada Fitness Survey. WC was measured with an anthropometric tape and leisure-time physical activity levels over the previous 12 months were assessed with a questionnaire. Mortality surveillance was conducted by data linkage with the Canadian Mortality Database through 31 December, 1993. The hazard ratios (HR) of mortality were estimated using Cox proportional hazards regression with age, smoking status, and alcohol con sumption included as covariates in all models. A total of 225 deaths occurred over an average of 12.4 years of follow up (67 500 person-years of follow up). Physical activity (HR = 0.78; 95% C.I.: 0.64-0.95) and WC (HR = 1.17; 95% C.I.: 1.05-1.31) were associated with mortality when included in separate regression models. When included in the same model, both physical activity (HR = 0.79; 95% CI: 0.65-0.96) and WC (HR = 1.16; 95% C.I.: 1.04-1.30) remained independent significant predictors of mortality. In conclusion, physical inactivity and high WC have significant independent risks of premature mortality among women.Key words: death, obesity, cohort study, Canada Fitness Survey.

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Effect of Financial Literacy on Starting a New Business: Using Survival Analysis to Examine Differences between Older and Younger Entrepreneurs

ESIC MARKET Economic and Business Journal ◽

10.7200/esicm.169.0522.2 ◽

2020 ◽

pp. 343-372

Author(s):

Felichism W. Kabo

Keyword(s):

United States ◽

Older Adults ◽

Financial Literacy ◽

Proportional Hazards ◽

The United States ◽

Study Data ◽

Cox Proportional Hazards ◽

Wide Range ◽

New Business ◽

Nationally Representative

Objective: This paper focuses on financial literacy as an antecedent to entrepreneurial involvement in order to examine and better understand differences between older and younger entrepreneurs. Financial literacy is the ability to apply the knowledge and skills needed to effectively manage financial resources over the life-course and is related to a wide range of economic outcomes. Methodology: The antecedence of financial literacy with respect to entrepreneurial engagement is examined using novel entrepreneurship data the United States. The study uses three waves (2014, 2016, and 2019) of complex survey data the Understanding America Study (UAS), a nationally representative and probability-based internet panel of households representing roughly 8,500 respondents ages 18 and older, and active since 2014. The data are used to generate survival curves using the Kaplan-Meier method, and to run survey linear and Cox proportional hazards regression models outcomes are starting a new business with respect to two time frames: over one’s lifetime, and since 2014. Results: The results show that there are associations between financial literacy and the rate of starting a new business both over one’s lifetime and since 2014, but only among older adults. Limitations: The study data were collected using a sample of adults in the United States which may limit the generalizability of the study findings to countries and regions other than the United States. Practical implications: This paper presents evidence that indicates that financial literacy is correlated with business start-up activities among older adults. This implies that financial literacy programs targeted at older adults may have an appreciable and significant multiplier effect.

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FAMILY CAREGIVER FACTORS AND HOSPITALIZATION IN DISABLED OLDER ADULTS WITH AND WITHOUT DEMENTIA

Innovation in Aging ◽

10.1093/geroni/igz038.2708 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S739-S739

Author(s):

Halima Amjad ◽

John Mulcahy ◽

Judith D Kasper ◽

Julia Burgdorf ◽

David L Roth ◽

...

Keyword(s):

Older Adults ◽

Family Caregiver ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Term Care ◽

Adults With Disabilities ◽

Hospitalization Rates ◽

Cox Proportional Hazards Models ◽

Care Survey ◽

One Year

Abstract Older adults with disabilities commonly rely on family caregivers’ help, yet effects of caregiver factors on patient outcomes are poorly understood. Within this population, dementia is common. Our objective was to evaluate the association between caregiver factors and risk of hospitalization in disabled older adults with and without dementia. We examined 2,589 community-living older adults with mobility/self-care disability and their primary family caregiver in four waves of the National Long-Term Care Survey and National Health and Aging Trends Study. We used Cox proportional hazards models to examine risk of one-year, Medicare claims-derived, all-cause hospitalization as a function of caregiver factors, adjusting for older adult characteristics (sociodemographics, comorbidities, healthcare utilization) and survey year, considering dementia a characteristic of interest. Among disabled older adults, 38% were hospitalized over one year, and 31% had probable dementia. Hospitalization rates were similar for older adults with and without dementia (39.5% and 37.3% respectively); dementia was not associated with hospitalization risk (HR 1.09, 95% CI 0.95-1.26). Older adults demonstrated greater risk of hospitalization if their caregiver was male (HR 1.31, 95% CI 1.10-1.56), new to caregiving (HR 1.61, 95% CI 1.27-2.04 for < 1 year versus ≥ 4 years), or helped with healthcare tasks (HR 1.21, 95% CI 1.04-1.41). The association between most caregiving factors and hospitalization risk did not differ by dementia status. Results suggest that strategies to reduce hospitalization in older adults with disabilities could target select caregivers using similar strategies in populations with and without dementia.

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Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older Adults: A Population-Based Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211017408 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110174

Author(s):

Sriram Sriperumbuduri ◽

Eric McArthur ◽

Gregory L. Hundemer ◽

Mark Canney ◽

Navdeep Tangri ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Proportional Hazards ◽

Event Rate ◽

Population Based ◽

Cox Proportional Hazards ◽

Older Individuals ◽

Raas Blockade ◽

Adjusted Risk ◽

Urine Albumin

Background: The risk of hyperkalemia is elevated in chronic kidney disease (CKD); however, the initial and recurrent risk among older individuals is less clear. Objectives: We set out to examine the initial and 1-year recurrent risk of hyperkalemia by level of kidney function (estimated glomerular filtration rate, eGFR) in older adults (≥66 years old). Design: Population-based, retrospective cohort study Settings: Ontario, Canada Participants: 905 167 individuals (≥66 years old) from 2008 to 2015. Measurements: Serum potassium values Methods: Individuals were stratified by eGFR (≥90, 60-89, 30-59, 15-29 mL/min/1.73 m2) and examined for the risk of incident hyperkalemia (K ≥ 5.5 mEq/L) using adjusted Cox proportional hazards models. The 1-year risk of recurrent hyperkalemia was examined using multivariable Andersen-Gill models. Results: Among a population of 905 167 individuals (15% eGFR ≥ 90, 58% eGFR 60-89, 25% eGFR 30-59, 3% eGFR 15-29) with a potassium measurement, there were a total of 18 979 (2.1%) individuals with hyperkalemia identified. The event rate (per 1000 person-years) and adjusted hazard ratio (HR) of hyperkalemia was inversely associated with eGFR (mL/min; eGFR >90 mL/min: 8.8, referent, 60-89 mL/min: 11.8 HR 1.41; eGFR 30-59: 39.8, HR 4.37; eGFR 15-29: 133.6, 13.65) and with an increasing urine albumin-to-creatinine ratio (ACR, mg/mmol; ACR< 3: 14, referent, ACR 3-30: 35.1, HR 1.98; ACR >30: 93.7, 4.71). The 1-year event rate and adjusted risk of recurrent hyperkalemia was similarly inversely associated with eGFR (eGFR ≥ 90: 10.1, referent, eGFR 60-89: 14.4, HR 1.47; eGFR 30-59: 54.8, HR 4.90; eGFR 15-29: 208.0, HR 12.98). Among individuals with a baseline eGFR of 30 to 59 and 15 to 29, 0.9 and 3.8% had greater than 2 hyperkalemia events. The relative risk of initial and recurrent hyperkalemia was marginally higher with RAAS blockade. Roughly 1 in 4 individuals with hyperkalemia required hospitalization the day of or within 30 days after their hyperkalemia event. Limitations: Limited to individuals aged 66 years and above. Conclusions: Patients with low eGFR are at a high risk of initial and recurrent hyperkalemia. Trial registration: N/A

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