scholarly journals Body size throughout the life-course and incident benign prostatic hyperplasia-related outcomes and nocturia

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saira Khan ◽  
K. Y. Wolin ◽  
R. Pakpahan ◽  
R. L. Grubb ◽  
G. A. Colditz ◽  
...  
Keyword(s):  
Body Size ◽  
Benign Prostatic Hyperplasia ◽  
Life Course ◽  
Early Life ◽  
Prostate Volume ◽  
Late Life ◽  
Later Life ◽  
Normal Weight ◽  
Prostatic Hyperplasia ◽  
The Life Course

Abstract Background Existing evidence suggests that there is an association between body size and prevalent Benign Prostatic Hyperplasia (BPH)-related outcomes and nocturia. However, there is limited evidence on the association between body size throughout the life-course and incident BPH-related outcomes. Methods Our study population consisted of men without histories of prostate cancer, BPH-related outcomes, or nocturia in the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) (n = 4710). Associations for body size in early- (age 20), mid- (age 50) and late-life (age ≥ 55, mean age 60.7 years) and weight change with incident BPH-related outcomes (including self-reported nocturia and physician diagnosis of BPH, digital rectal examination-estimated prostate volume ≥ 30 cc, and prostate-specific antigen [PSA] concentration > 1.4 ng/mL) were examined using Poisson regression with robust variance estimation. Results Men who were obese in late-life were 25% more likely to report nocturia (Relative Risk (RR): 1.25, 95% Confidence Interval (CI): 1.11–1.40; p-trendfor continuous BMI < 0.0001) and men who were either overweight or obese in late-life were more likely to report a prostate volume ≥ 30 cc (RRoverweight: 1.13, 95% CI 1.07–1.21; RRobese: 1.10, 95% CI 1.02–1.19; p-trendfor continuous BMI = 0.017) as compared to normal weight men. Obesity at ages 20 and 50 was similarly associated with both nocturia and prostate volume ≥ 30 cc. Considering trajectories of body size, men who were normal weight at age 20 and became overweight or obese by later-life had increased risks of nocturia (RRnormal to overweight: 1.09, 95% CI 0.98–1.22; RRnormal to obese: 1.28, 95% CI 1.10–1.47) and a prostate volume ≥ 30 cc (RRnormal to overweight: 1.12, 95% CI 1.05–1.20). Too few men were obese early in life to examine the independent effect of early-life body size. Later-life body size modified the association between physical activity and nocturia. Conclusions We found that later-life body size, independent of early-life body size, was associated with adverse BPH outcomes, suggesting that interventions to reduce body size even late in life can potentially reduce the burden of BPH-related outcomes and nocturia.

scholarly journals Early-life circumstances and the risk of function-limiting long-term conditions in later life

2020 ◽  
Vol 11 (2) ◽  
pp. 157-180
Author(s):  
Matthew H. Iveson ◽  
Chris Dibben ◽  
Ian J. Deary
Keyword(s):  
Life Course ◽  
Cognitive Ability ◽  
Early Life ◽  
Economic Status ◽  
Functional Limitation ◽  
Later Life ◽  
Socio Economic Status ◽  
Childhood Cognitive Ability ◽  
The Life Course

Older adults are particularly prone to function-limiting health issues that adversely affect their well-being. Previous work has identified factors from across the life course –childhood socio-economic status, childhood cognitive ability and education – that predict later-life functional outcomes. However, the independence of these contributions is unclear as later-in-the-life-course predictors are themselves affected by earlier ones. The present study capitalised on the recent linkage of the Scottish Mental Survey 1947 with the Scottish Longitudinal Study, using path analyses to examine the direct and indirect associations between life-course predictors and the risk of functional limitation at ages 55 (N = 2,374), 65 (N = 1,971) and 75 (N = 1,534). The odds of reporting a function-limiting long-term condition increased across later life. At age 55, reporting a functional limitation was significantly less likely in those with higher childhood socio-economic status, higher childhood cognitive ability and higher educational attainment; these associations were only partly mediated by other predictors. At age 65, adult socio-economic status emerged as a mediator of several associations, although direct associations with childhood socio-economic status and childhood cognitive ability were still observed. At age 75, only childhood socio-economic status and adult socio-economic status directly predicted the risk of a functional limitation, particularly those associated with disease or illness. A consistent pattern and direction of associations was observed with self-rated health more generally. These results demonstrate that early-life and adult circumstances are associated with functional limitations later in life, but that these associations are partly a product of complex mediation between life-course factors.

scholarly journals Rural and Urban Dwelling Across the Life-Course and Late-Life Cognitive Ability in Mexico

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 574-574
Author(s):  
Joseph Saenz
Keyword(s):  
Life Course ◽  
Cognitive Ability ◽  
Rural Areas ◽  
Early Life ◽  
Healthcare Access ◽  
Late Life ◽  
Urban Migration ◽  
Rural And Urban ◽  
And Migration ◽  
The Life Course

Abstract BACKGROUND: Research has consistently suggested urban dwelling in late adulthood is associated with better cognitive ability. Whether early life rural/urban dwelling and its interaction with late-life rural/urban dwelling relate with late-life cognitive ability in the context of Mexico is not well understood. METHOD: Data comes from the 2003 Mexican Health and Aging Study. Early life rural/urban was assessed as respondents’ reports of growing up in an urban/rural area. Current rural/urban was assessed by locality size (greater/fewer than 100,000 residents). RESULTS: Both early life and current rural residence were associated with poorer cognitive ability independent of education, literacy, early life SES and health, income/wealth, healthcare access, health, and health behaviors. Compared to individuals who always lived in rural areas, rural to urban migration was associated with better cognitive ability. DISCUSSION: In addition to current rural/urban dwelling, researchers should consider where individuals lived in early life and migration across the life-course.

A life of relationships

2017 ◽  
Author(s):  
Torbjörn Bildtgård ◽  
Peter Öberg
Keyword(s):  
Older People ◽  
Life Course ◽  
Late Life ◽  
Later Life ◽  
Older Individuals ◽  
Relationship Experiences ◽  
The Life Course ◽  
Historical Transition ◽  
Experiences Of Women ◽  
Prior Relationship

This chapter bridges the macro–micro gap by showing how the historical transformation of intimacy is reflected in older individuals’ relationship careers. The chapter challenges the idea that current generations of older people have normally lived their lives in single lifelong marriages ending in widowhood and shows the complexity of their relationship careers. It discusses the consequences of prior relationship experiences on interest in, and preferences for, late-life intimacy. It discusses the different implications of being widowed versus divorced for interest in repartnering. Finally, it focuses on the different biographical relationship experiences of women and men and how they impact on the interest for repartnering in later life. The chapter concludes with a discussion of the presented findings in relation to the deinstitutionalisation of the life course. Extensive biographical case descriptions are used to give the reader an understanding of what it means to have lived one’s life during the historical transition to divorce culture.

scholarly journals Life Course Socioeconomic Status and Later Life Alzheimer’s Disease-Related Neuropathological Lesions

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 164-164
Author(s):  
Sarah Tom ◽  
Amol Mehta ◽  
Stepanie Izard ◽  
Paul Crane ◽  
David Bennett ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Socioeconomic Status ◽  
Life Course ◽  
Early Life ◽  
Parental Education ◽  
Brain Aging ◽  
Late Life ◽  
Later Life ◽  
Braak Stage

Abstract While higher life course socioeconomic status (SES) is associated with lower Alzheimer’s Disease (AD) risk, relationships with AD-related neuropathological lesions are unclear. We hypothesize that high SES in early, mid and late life will be associated with lower frequency of AD-related pathological lesions. The Rush Memory and Aging Project is a cohort of 2025 people age ≥ 65 years from Northeastern Illinois recruited 1997 – 2018; 972 participants died. We created binary variables for Braak stage (0-II versus III-VI), NIA-Reagan score (low likelihood/no AD pathology versus high/intermediate likelihood), presence of microinfarcts and, separately, macroinfarcts, and life course SES based on median for late life (baseline income), midlife (income at age 40 years), and early life (composite of parental education and number of siblings). Logistic regression models adjusted for ages at baseline and death, sex, presence of APOE-Ɛ4 alleles, and separately, vascular factors and education. Of 761 participants with relevant data, 69% were women, and mean ages at baseline and death were 83 + 6 years and 90 + 6 years, respectively. High early life SES was related to lower frequency of AD pathology (OR= 0.69, 95% CI 0.50, 0.96) and macroinfarcts (OR= 0.69, 95% CI 0.51, 0.94). Results were similar when adjusting for vascular factors; adjustment for education modestly attenuated these associations. Mid-life and late life SES were not associated with AD-related neuropathological lesions. High early life SES was related to lower frequency of AD pathology and macroinfarct presence. Environment during early development may influence later life brain aging.

The Early-Life Origins of Later-Life Networks

2020 ◽  
Author(s):  
Alyssa W Goldman
Keyword(s):  
Social Networks ◽  
Life Course ◽  
Network Structure ◽  
Social Life ◽  
Early Life ◽  
Later Life ◽  
Well Being ◽  
Wide Range ◽  
The Life Course ◽  
Personal Social Networks

Abstract Personal social networks profoundly influence a wide range of outcomes throughout the life course. But little research has considered how some features of individuals’ social networks may be shaped by experiences in early life. This study uses nationally representative data from the National Social Life, Health, and Aging Project to examine how childhood circumstances may shape the structure of older adults’ personal social networks. The analyses show that higher childhood socioeconomic status is associated with larger network size and a more expansive, less kin-based network structure. At the same time, higher levels of family happiness in childhood are associated with greater network density and more kin-centric network composition, which may reflect greater access to social support and overall network intimacy across the life course. The results suggest that studies of the relative advantages of social network structure may benefit from contextualizing individuals’ social networks in terms of their social origins. The article discusses the need for additional research on the life-course bases of the link between childhood circumstances and later-life network properties, and what role this connection plays in shaping later-life well-being.

Associations between life-course frailty and later-life heart size and function in the 1946 NSHD British birth cohort-an epidemiological study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C.C Topriceanu ◽  
J.C Moon ◽  
R Hardy ◽  
A.D Hughes ◽  
N Chaturvedi ◽  
...  
Keyword(s):  
Life Course ◽  
Birth Cohort ◽  
Frailty Index ◽  
Later Life ◽  
Left Ventricular ◽  
Step Change ◽  
Deficit Accumulation ◽  
Heart Size ◽  
And Function ◽  
The Life Course

Abstract Background Cardiovascular diseases are an important component of the multi-morbidity syndrome which is associated with negative health outcomes resulting in a major societal economic burden. An objective way to assess multi-morbidity is to calculate a frailty index based on medical deficit accumulation. Late-life frailty has been validated to predict mortality, but little is known about the association between life-course frailty and cardiovascular health in later-life. Purpose To study the association between life-course frailty and later-life heart size and function using data from the world's longest running birth cohort with continuous follow-up. Methods A 45-deficit frailty index (FI) was calculated at 4 age-intervals across the life-course (0 to 16 years old, 19 to 44 years old, 45 to 54 years old and 60 to 64 years old) in participants from the UK 1946 Medical Research Council (MRC) National Survey of Heath and Development (NSHD) birth cohort. The life-course frailty indices (FI0_16, FI19_44, FI45_54 and FI60_64) reflect the cumulative medical deficits at the corresponding age-intervals. They were used to derive FImean and FIsum reflecting overall-life frailty. The step change in deficit accumulation between age-intervals was also calculated (FI2-1, FI3-1, FI4-1, FI3-2, FI4-2, FI4-3). Echocardiographic data at 60–64 years provided: E/e' ratio, ejection fraction (EF), myocardial contraction fraction index (MCFi) and left ventricular mass index (LVmassi). Generalized linear mixed models with gamma distribution and log link assessed the association between FIs and echo parameters after adjustment for sex, socio-economic position and body mass index. Results 1.805 NSHD participants were included (834 male). Accumulation of a single deficit had a significant impact (p&lt;0.0001 to p&lt;0.049) on LVmassi and MCFi in all the life-course FIs and overall FIs. LVmassi increased by 0.89% to 1.42% for the life-course FIs and by 0.36%/1.82% for FIsum and FImean respectively. MCFi decreased by 0.62% to 1.02% for the life-course FIs and by 0.33%/ 1.04%. for FIsum and FImean respectively. One accumulated deficit translated into higher multiplicative odds (13.2 for FI60-64, 2.1 for FI4-1, 75.4 for FI4-2 and 78.5 for FI4-3) of elevated filling pressure (defined as E/e' ratio &gt;13, p&lt;0.0.005 to p&lt;0.02).A unit increase in frailty decreased LV EF (%) by 11%/12% for FI45-54 and FI60-64 respectively, by 10% to 12% for FI2-1, FI3-1, FI4-1 and FI4-2, and 4%/15% for FIsum and FImean respectively (p&lt;0.0014 to p&lt;0.044). Conclusion Frailty during the life-course, overall life-frailty and the step change in deficit accumulation is associated with later-life cardiac dysfunction. Frailty strain appears to have its greatest impact on pathological myocardial hypertrophy (high LVmassi and low MCFi) potentially paving the way to later-life systolic or diastolic dysfunction in susceptible individuals. Funding Acknowledgement Type of funding source: None

scholarly journals Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098628
Author(s):  
Chen Xu ◽  
Gang Zhang ◽  
Jin-jin Wang ◽  
Chun-xian Zhou ◽  
Min-jun Jiang
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Elderly Patients ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Urine Volume ◽  
Prostatic Hyperplasia ◽  
Antigen Level ◽  
Residual Urine Volume ◽  
Safety And Efficacy ◽  
Total Prostate Specific Antigen

Objective To assess the safety and efficacy of prostatic arterial embolization (PAE) for elderly patients with lower urinary tract symptoms secondary to large benign prostatic hyperplasia. Methods Twenty-eight patients (>80 years of age) with prostate volume >80 mL were enrolled from October 2016 to October 2019. PAE was performed using microspheres and functional results were evaluated at 1, 3, 6, and 12 months postoperatively. The following data were recorded: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Qmax), post-void residual urine volume, prostate volume and total prostate-specific antigen level. Results Selective prostatic arterial catheterization and embolization were achieved in 27 of 28 patients. Follow-up data were available for those 27 patients until 12 months postoperatively. Significant improvements were found at all postoperative time points in terms of the mean IPSS, mean QoL score, mean Qmax, mean post-void residual urine volume, mean total prostate-specific antigen level, and mean prostate volume. The overall complication rate was 46.4%. Conclusions PAE is an efficacious and safe treatment for elderly patients with large prostate volume; it may offer an effective approach for patients who are not candidates for open or endoscopic surgical procedures because of comorbidities.

scholarly journals Efficacy and safety of Finasteride (5 alpha-reductase inhibitor) monotherapy in patients with benign prostatic hyperplasia: A critical review of the literature

2020 ◽  
Vol 91 (4) ◽  
pp. 205-210
Author(s):  
Gian Maria Busetto ◽  
Francesco Del Giudice ◽  
Daniele D'Agostino ◽  
Daniele Romagnoli ◽  
Andrea Minervini ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Benign Prostatic Hyperplasia ◽  
Adverse Events ◽  
Clinical Efficacy ◽  
Critical Review ◽  
Reductase Inhibitor ◽  
Prostate Volume ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Efficacy And Safety

Background: Combination therapy with 5 alpha-reductase inhibitor (5-ARI) and alpha-blocker can be considered as a gold standard intervention for medical management of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH). On the other hand, 5-ARI monotherapy and in particular Finasteride alone is currently getting focus of attention especially due to lack of systematic reviews investigating efficacy outcomes and/or adverse events associated. Objectives: Aim of the present critical review was to analyze current knowledge of clinical efficacy and incidence of adverse events associated with 5-ARI treatment for LUTS/BPH. Materials and methods: A systematic review of clinical trials of the literature of the past 20 years was performed using database from PubMed, Cochrane Collaboration and Embase. A total of 8821 patients were included in this study and inclusion criteria for studies selection were: data from randomized clinical trials (RCTs) focusing their attention on the clinical role of Finasteride monotherapy for symptomatic BPH. Parameters of research included prostate specific antigen (PSA), prostate volume (PV), International Prostate Symptom Score (IPPS), postvoid residual urine (PVR), voiding symptoms of IPSS (voiding IPSS), maximum urinary flow rate (Qmax), and adverse events (AEs). Results: Overall 12 original articles were included and critically evaluated. Sample sizes of patient actively treated with finasteride varied from 13 to 1524 cases analyzed in a single study. Follow-up after treatments ranged from 3 to 54 months. The effect of finasteride in reducing prostate volume (PV) was moderate (standardized mean difference (SMD) effect between 0.5 to 0.8 for all trials evaluable) while the effect on IPSS score and Qmax was considered significant (SMD in the 0.2 to 0.5 variation range). No severe AEs and/or psychiatric disorders were retrieved among the studies. Sexual health dysfunctions were significantly influenced by finasteride therapy when compared with placebo treated patients. Conclusions: Although significant clinical benefits of finasteride monotherapy were demonstrated, the effective size of the available reports included in the analysis is limited. Additional head-to-head studies would be needed to re-evaluate clinical efficacy and safety of 5-ARI in combination or not with alpha blockers.

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