Is The Association Between Cognitive Decline And Mortality Modified By High Blood Pressure Among The Oldest Old?

Few studies have systematically explored the association between cognitive decline and mortality among the aged (above 80 years old) and also have limited evidence of the potential effect modifiers between them. Therefore, this study included 14,891 aged (mean age: 90.3±7.5 years) and 10,904 aged deaths with 34,486 person-years were observed. Cognitive decline was continuous and stratified into ten categories. Potential effect modifiers were identified as age, sex, blood pressure (BP) and high BP related diseases, including hypertension and cardiovascular disease (CVD) mortality. Cox proportional hazards model was used to evaluate the relationship between them after adjusting for demographic characteristics, socioeconomic status, lifestyle factors, leisure activities and health conditions. Compared to those with maintained high normal cognitive function, participants who have declined to severe cognitive impairment from a high normal cognitive function, low normal cognitive function and mild cognitive impairment have 55%, 56% and 63% mortality risks respectively. The multivariable-adjusted model indicated that the aged with decreasing one more point in MMSE score per year, had around 4% higher risk of mortality. There was a significant association of interaction of cognitive decline-mortality and sex (P=0.013) as well as hypertension (P=0.004) but with no significant association among age (P=0.277), high BP (P=0.082), and CVD mortality (P=0.058). Our findings suggest that periodic screen cognitive decline and strengthen BP control may be necessary for public health.

Associations of Wellbeing Levels, Changes, and Within-Person Variability With Late-Life All-Cause Mortality Across 12 Years: Contrasting Hedonic vs. Eudaimonic Wellbeing Among Very Old Adults

Advanced old age has been characterized as a biologically highly vulnerable life phase. Biological, morbidity-, and cognitive impairment-related factors play an important role as mortality predictors among very old adults. However, it is largely unknown whether previous findings confirming the role of different wellbeing domains for mortality translate to survival among the oldest-old individuals. Moreover, the distinction established in the wellbeing literature between hedonic and eudaimonic wellbeing as well as the consideration of within-person variability of potentially relevant mortality predictors has not sufficiently been addressed in prior mortality research. In this study, we examined a broad set of hedonic and eudaimonic wellbeing indicators, including their levels, their changes, as well as their within-person variability, as predictors of all-cause mortality in a sample of very old individuals. We used data from the LateLine study, a 7-year longitudinal study based on a sample of n = 124 individuals who were living alone and who were aged 87–97 years (M = 90.6, SD = 2.9) at baseline. Study participants provided up to 16 measurement occasions (mean number of measurement occasions per individual = 5.50, SD = 4.79) between 2009 and 2016. Dates of death were available for 118 individuals (95.2%) who had deceased between 2009 and 2021. We ran longitudinal multilevel structural equation models and specified between-person level differences, within-person long-term linear change trends, as well as the “detrended” within-person variability in three indicators of hedonic (i.e., life satisfaction and positive and negative affect) and four indicators of eudaimonic wellbeing (i.e., purpose in life, autonomy, environmental mastery, and self-acceptance) as all-cause mortality predictors. Controlling for age, gender, education, and physical condition and testing our sets of hedonic and eudaimonic indictors separately in terms of their mortality impact, solely one eudaimonic wellbeing indicator, namely, autonomy, showed significant effects on survival. Surprisingly, autonomy appeared “paradoxically” related with mortality, with high individual levels and intraindividual highly stable perceptions of autonomy being associated with a shorter residual lifetime. Thus, it seems plausible that accepting dependency and changing perceptions of autonomy over time in accordance with objectively remaining capabilities might become adaptive for survival in very old age.

Octogenarian Motor Vehicle Collisions: Injury Patterns Matter

Introduction. Motor vehicle collision (MVC) is the second most common mechanism of injury among octogenarians and is on the rise. These “oldest old” trauma patients have much higher mortality rates than expected. This study examined potential factors influencing this increased mortality including comorbidities, medications, injury patterns, and hospital interventions. Methods. A 10-year retrospective review was conducted of patients aged 80 and over who were injured in a MVC. Data collected included patient demographics, comorbidities, medication use prior to injury, collision details, injury severity and patterns, hospitalization details, outcomes, and discharge disposition. Results. We identified 239 octogenarian patients involved in a MVC. Overall mortality was 18.8%. We recognized an increased mortality for specific injury patterns, patients injured in a rural setting, and those who were transfused, intubated, or admitted to the ICU. We found no correlation between mortality and medications or comorbidities. Conclusions. The high mortality rate for octogenarian patients involved in a MVC is related to injury severity, type of injury, and in-hospital complications, and not due to comorbidities and prior medications.

The shift from old age to very old age: an analysis of the perception of aging among older people

Background The oldest-old (individuals over 90 years) are a fast-growing population. Understanding the perceptions of older people about very old age is the first step towards developing optimal geriatric care for an aging population. This study aimed to explore the potential shift from old age to very old age through the exploration of older people’s perception of aging. Methods Qualitative study conducted through individual interviews in the homes of older people. We voluntarily chose to include persons a decade under and above 90 years old to explore other factors than age that could participate in the shift from old age to very old age. The sampling was theoretical. We carried out the analyses using an inductive approach based on the phases of grounded theory. The researchers used triangulation. Collection was concluded when theoretical saturation was reached. Results Fourteen participants were interviewed. The shift from old age to very old age was not based on age but occurred when participants became conscious of the irreversibility of aging and its effects, and when they started living day-by-day, renouncing to any plan in a near future. The transition to very old age seemed to be preceded by a progressive disengagement from non-essentials activities. Participants reported a sensation of progressive social exclusion due to the loss of contemporaries or spouse, the difficulty to connect with younger generations or the absence of relationships in their neighborhood. The last step of life was feared, not because of the idea of death itself but because of the associated suffering and loss of autonomy. Conclusion Precipitating and slowing factors of the shift to very old age were identified to help general practitioners support older patients throughout their life trajectories.

Physical and Mental Health Differences Reported by Three Age Groups of Older Adults With Diabetes

Most studies have classified older adults with diabetes into one group despite substantial variation in health status across different stages of late adulthood. In this study, we examined difference in self-reported physical and mental health among three age groups of older adults with diabetes. Using data from the 2016 National Social Life, Health and Aging Project, Wave 3, we classified 424 individuals diagnosed with diabetes into three age groups, young-old (YO): 50–64 years; middle-old (MO): 65–74; and oldest old (OO): 75+ years. A one-way multivariate analysis of covariance was used to assess group differences, followed by univariate analyses. The results indicate that the YO group reported significantly lower physical health and higher depression than the MO group and higher levels of loneliness than the MO and OO groups. These findings indicate that physical and mental health may differ among different age groups of older adults with diabetes and suggest that the YO might be more vulnerable to diminished physical and mental health than the other age groups.

Personal Social Networks of Community-Dwelling Oldest Old During the Covid-19 Pandemic—A Qualitative Study

The COVID-19 pandemic and its related restrictions have affected the everyday life of older people. Advanced age is a significant predisposing factor for a more severe COVID-19 infection, increasing the risk for hospitalization and mortality. Even though restrictions have been, thus, well-grounded, they may also have had detrimental effects on the social well-being of older people. Personal networks and social activity are known protective factors against the premature decline in health and functioning, and it is widely acknowledged that social isolation increases feelings of loneliness, poor quality of life, and even the risk for diseases and disabilities among older adults. This qualitative study investigated changes in personal networks among community-dwelling oldest-old individuals (persons aged 80 and over) during the first and second waves of the COVID-19 pandemic in Finland. The data is part of the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE85+) study, which is an ongoing large longitudinal population-based study in Finland. In this qualitative sub-study, we analyzed fifteen in-depth telephone interviews using directed content analyses and identified five types of changes in personal social networks during the pandemic. In type 1, all social contacts were significantly reduced due to official recommendations and fear of the virus. Type 2 included modified ways of being socially active i.e., by deploying new technology, and in type 3, social contacts increased during the lockdown. In type 4, personal social networks were changed unexpectedly or dramatically due to a death of a spouse, for example. In type 5, we observed stable social networks, which had not been affected by the pandemic. At an individual level, one person could have had different types of changes during the pandemic. These results highlight the heterogeneity of the oldest olds' personal social networks and changes related to them during the exceptional times of the COVID-19 pandemic. Social activity and personal networks play an important role in the well-being of the oldest old, but individual situations, needs, and preferences toward personal social networks should be taken into account when planning social activities, policies, and interventions.

Who is Included in Digital Health Technologies to Support Hospital to Home Transitions for Older Adults?: Secondary analysis of a rapid review and equity-informed recommendations (Preprint)

BACKGROUND Digital health technologies have been proposed to support hospital to home transitions for older adults. The COVID-19 pandemic and associated physical distancing guidelines propelled a shift to digital health technologies. However, the characteristics of older adults who participated in digital health interventions to support hospital to home transitions remain unclear. This information is needed to assess whether current digital health technologies are generalizable to the needs of broader older adult populations. OBJECTIVE We conducted a rapid review of the existing literature to: i) identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions that are designed to support hospital to home transitions, ii) identify the characteristics of the samples included within studies testing digital health interventions used to support hospital to home transitions, and iii) create recommendations for enhancing the diversity of samples within future digital health interventions. METHODS A rapid review methodology informed by Arksey and O’Malley’s (2005) scoping review guidelines was conducted. A search for peer-reviewed literature published between (2010-2021) on digital health solutions that support hospital to home transitions for older adults was conducted through MEDLINE, EMBASE and CINAHL. Data were analyzed using descriptive statistics and qualitative content analysis. The Sex-and Gender-Based Analysis Plus (SGBA+) lens theoretically guided the study design, analysis and interpretation. RESULTS 34 papers met inclusion criteria. Our findings indicate that many groups of older adults were excluded from these interventions and remain understudied. Specifically, the “oldest old” and those living with cognitive impairments were excluded from studies included in this review. In addition, very few studies described characteristics related to gender diversity, education, race, ethnicity and culture. No study commented on the sexual orientation of participants. CONCLUSIONS This is the first review, to our knowledge, that has mapped the literature focusing on the inclusion of older adults in digital hospital to home interventions. Findings suggest that the literature on digital health interventions tends to operationalize older adults as a homogenous group, ignoring the heterogeneity in older age definitions. Inconsistency in the literature surrounding the characteristics of included participants suggests a need for further study to understand better how digital technologies to support hospital to home transitions can be inclusive. CLINICALTRIAL N/A

Social support and health-related quality of life among the oldest old — longitudinal evidence from the multicenter prospective AgeCoDe-AgeQualiDe study

Purpose The aim of this study was to examine the longitudinal within-association between social support and health-related quality of life among the oldest old. Methods Longitudinal data (follow-up waves 7 to 9) were used from the multicenter prospective cohort study “Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85 +)” (AgeQualiDe). n = 648 individuals were included in the analytical sample. At FU wave 7, mean age was 88.8 years (SD: 2.9 years, from 85 to 99 years). Social support was quantified using the Lubben Social Network Scale (6-item version). Health-related quality of life was assessed using the EQ-5D-3L including problems in five health dimensions, and its visual analogue scale (EQ VAS). It was adjusted for several covariates in conditional logistic and linear fixed effects regressions. Results Intraindividual decreases in social support were associated with an increased likelihood of developing problems in ‘self-care’, ‘usual activities’, ‘pain/discomfort’ and ‘anxiety/depression’ (within individuals over time). In contrast, intraindividual changes in social support were not associated with intraindividual changes in the EQ VAS score. Conclusion Findings indicate a longitudinal intraindividual association between social support and problems, but only in some health dimensions. Further research in this area based on longitudinal studies among the oldest old (from different countries) is required.

The Effects of Greenness Exposure on Hypertension Incidence Among Chinese Oldest Old: A 10-Year Prospective Cohort Study

Background Present studies showed greenness affected hypertension incidence. While population-based epidemiologic studies are limited in the oldest-old population (aged 80+). Methods This was a 10-year prospective cohort study that included oldest old (80 years +) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Participants were free of hypertension at baseline (2008) and were followed up at 2011/2012, 2014, and 2018 waves. The 1-year average of the Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI) at 16-Day 500 m buffer before the year of hypertension event occurrence or last interview (for censoring) was estimated at 652 counties/districts units level of the participants resided and as exposure indicator. The non-linear association between greenness and hypertension incidence was performed by the Cox proportional hazards model with the penalized spline. The links between greenness and hypertension incidence were performed by the random-effects Cox proportional hazards model adjusted for potential confounding variables. We also examined the causal mediation effects of BMI, leisure activity, and PM2.5 on the association between greenness exposure and hypertension. Results Among 5432 participants, the incidence of hypertension was 7.25 (95% CI: 6.83 to 7.67) per 100 person-years. We found a non-liner association existed between greenness exposure and hypertension risk. In the fully adjusted model, the third tertile of NDVI value presenting protective effects on hypertension incidence compared with the first tertile (hazard ratios (HRs): 0.51; 95% confidence interval: 0.40-0.64). The third tertile of EVI value had a significant protective effect on hypertension incidence, compared with participants in the first tertile (HRs:0.44, 95%CI: 0.34-0.55). The effect of greenness exposure on hypertension was more pronounced in participants living in central/western China. We observed there were 41.63% and 17.01% of the association between NDVI/EVI exposure and hypertension was mediated by PM2.5, respectively. Conclusions Greenness could decrease approximate 50% risk induced by hypertension among oldest-old people, that is, expanding greenness is a recommended approach to hypertension prevention for the them. In particular, implementing plans to expanding green space construction in central/western China is needed. It is also emphasized the the importance of improve air quality when greenness exposure is existing.