Relationships between non-communicable disease, social isolation and frailty in community dwelling adults in later life: findings from the Hertfordshire Cohort Study

Background Social relationships play a fundamental role in individuals’ lives and health, and social isolation is prevalent among older people. Chronic non-communicable diseases (NCDs) and frailty are also common in older adults. Aims To examine the association between number of NCDs and social isolation in a cohort of community-dwelling older adults in the UK, and to consider whether any potential association is mediated by frailty. Methods NCDs were self-reported by 176 older community-dwelling UK adults via questionnaire. Social isolation was assessed using the six-item Lubben Social Network Scale. Frailty was assessed by the Fried phenotype of physical frailty. Results The median (IQR) age of participants in this study was 83.1 (81.5–85.5) years for men and 83.8 (81.5–85.9) years for women. The proportion of socially isolated individuals was 19% in men and 20% in women. More women (18%) than men (13%) were identified as frail. The number of NCDs was associated with higher odds of being isolated in women (unadjusted odds ratio per additional NCD: 1.65, 95% CI 1.08, 2.52, p = 0.021), but not in men, and the association remained robust to adjustment, even when accounting for frailty (OR 1.85, 95% CI 1.06, 3.22, p = 0.031). Discussion Number of self-reported NCDs was associated with higher odds of social isolation in women but not in men, and the association remained after considering frailty status. Conclusions Our observations may be considered by healthcare professionals caring for community-dwelling older adults with multiple NCDs, where enquiring about social isolation as part of a comprehensive assessment may be important.

P111 Osteoporosis is a significant predictor of frailty in older community dwelling adults: findings from the Hertfordshire Cohort Study

Background/Aims Frailty is associated with a range of adverse health outcomes, including falls and fractures. Previous work in a Japanese cohort found that the presence of both osteoporosis (OP) and sarcopenia (SP) increased the risk of frailty compared to the presence of OP or SP alone. We examined these relationships in a comparable cohort of community dwelling older people in the UK. Methods Our study comprised of 432 participants (216 men and 216 women) of the UK the Hertfordshire Cohort Study (HCS). Participants were assessed at baseline and followed up 5 years later with questionnaires, clinical examination, measures of physical performance and grip strength. Proximal femur bone mineral density (BMD) values were determined using dual-energy X-ray absorptiometry. OP was defined at BMD T- scores < = -2.5 at the femoral neck or use of anti-osteoporosis medication. Cut-offs for low grip strength; <30kg for men and <20kg for women and ALM index < =7.23kg/m2 for men, < =5.67kg/m2 for women, were used to define SP. Frailty was defined using the Fried definition. Logistic regressions were performed to analyse associations of OP/SP as explanatory variables for frailty. Results The mean (SD) age of participants was 75.7 (2.6) years. At baseline, the prevalence of frailty and pre-frailty was 12.2% (men, 8%, women, 16.3 %), and 57% (men, 55.7%; women, 58.2%) respectively. Individuals living with frailty were older, tended to drink less alcohol, have lower physical activity, lower walking speed and grip strength (P < 0.001). They were more likely to be female compared to non-frail subjects (P = 0.007). Co-existence of SP, OP and frailty was observed in 0.6% of the population; 0.6% had SP and frailty; 1.6% had OP and frailty and 1.6% of the study population had SP and OP. 71.8% did not have SP, OP or frailty at baseline. SP was significantly associated with frailty at baseline (p < 0.001). The cumulative incidence of frailty during the 5-year period was 2.47% /year (2.13%/year in men, 2.89%/year in women) and that of SP was 2.14%/year (2.84% in men, 1.35%/year in women). The presence of OP at baseline was a significant predictive factor for the occurrence of frailty at follow-up (odds ratio [OR], 3.04; 95% confidence interval [95% CI], 1.11,8.38; P = 0.031), while the risk of developing frailty was also increased in those participants who were both osteoporotic and sarcopenic at baseline; though this was not significant (OR; 10.08, 95% CI,0.55,186.08; P = 0.12). Conclusion Our findings demonstrate that the presence of OP is a significant predictive factor for developing frailty and might be used as a trigger for appropriate interventions to reduce or reverse its development in older adults. Our findings are in accordance with the previous reports in Asian populations and warrant further investigation in other national cohorts. Disclosure F. Laskou: None. K. Jameson: None. E. Dennison: None.

The association between social isolation and musculoskeletal health in older community-dwelling adults: findings from the Hertfordshire Cohort Study

Purpose Social isolation has been associated with both physical and psychological adverse outcomes and is prevalent in older adults. We investigated the impact of social isolation on bone mineral density (BMD) and physical capability in community-dwelling older adults. Methods Data were collected in 2011 and 2017 from the Hertfordshire Cohort Study. In 2011, we assessed social isolation using the six-item Lubben Social Network Scale (LSNS-6) and the Maastricht Social Participation Profile (MSSP) and depressive and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS). Physical capability was assessed by performing tests of gait speed, chair stands, timed up and go and balance at both time points. BMD was assessed using dual X-ray absorptiometry (DXA) at both time points. Results Data were available from 369 participants in 2011 and 184 in 2017. Forty percent of men and 42.4% of women were socially isolated. Isolated participants had higher odds of depressive disorder (OR 3.01, 95% CI 1.27–7.11, p < 0.02). Social isolation at baseline was associated with poor physical capability scores at follow-up (OR 5.53, 95% CI 1.09–27.99, p < 0.04). No associations were found between social isolation and BMD at either time point. Conclusions Social isolation was associated with higher odds of having depressive symptoms and predicted the development of poor physical capability 6 years later. Further longitudinal studies that include loneliness as a covariate are warranted.

O05 How does radiographic knee OA impact musculoskeletal aging in midlife? Findings from the Hertfordshire Cohort study

Background With an aging population, the burden of musculoskeletal aging in joints, bones and muscles carries with it significant morbidity. Osteoarthritis (OA) is the most common joint condition, and can be defined clinically or radiologically. Musculoskeletal aging in bone and muscle can be assessed through change in body composition, grip strength and physical performance. The aim of this study was to investigate whether a diagnosis of radiological knee OA impacted involution in muscle or bone in the midlife in a group of community-dwelling older adults in the UK. Methods Our study comprised 220 members of the Hertfordshire Cohort Study (118 males and 102 females), a group of community dwelling older adults in the United Kingdom. Knee radiographs were performed at baseline (1999-2003), with osteoarthritis defined as a Kellgren and Lawrence score ≥2. At baseline and follow-up (2017) questionnaires assessed physical activity and lifestyle factors; JAMAR dynamometry was performed to assess grip strength; 8 foot walk test was performed to assess gait speed and DXA was performed to assess bone mineral density at the hips and body composition. Linear regression was performed to analyse associations in males and females, before and after adjustment for follow-up time, lifestyle factors (including smoking, alcohol consumption, social class, calcium intake and physical activity), anthropometric measures (BMI) and HRT use and age at menopause in women. The development of hand osteoarthritis was adjusted for grip strength outcomes. Results The mean age of participants at baseline was 65.0 years. Median follow-up was 16.7 years (range 15.0-18.4 years). Knee osteoarthritis was present in 75 (34%) participants. Radiographic knee osteoarthritis status at baseline was significantly associated with grip strength (β=-3.2kg, -5.3 to -1.1, p &lt; 0.01) at follow-up in females but not in males (β=-2.9, -5.8 to 0.1, p = 0.06). No significant associations between radiographic osteoarthritis status at baseline and other measures of sarcopenia (gait speed or lean mass) or bone mineral density were found in either sex. Conclusion Our findings demonstrate that the presence of knee osteoarthritis in midlife can have a substantial bearing on grip strength in women over 15 years later independent of the presence of hand osteoarthritis. Grip strength has been shown to correlate closely with lower limb strength and so the demonstrated association between grip strength and knee osteoarthritis is representative of a global weakness resulting from the disease. Reduction in grip strength has been associated with an increased risk of morbidity including falls and fractures. Thus, in order to countermand this association, it may be that concerted interventions (including physical therapy, strengthening and surgical intervention) should be recommended for those with knee osteoarthritis at this stage in the lifecourse. Of course, these findings require replication and validation in other cohorts. Disclosures N.R. Fuggle None. M. Clynes None. F. Laskou None. K. Jameson None. C. Cooper None. E. Dennison None.

P68 Age-related muscle strength decline in mid-late life varies in men and women and is associated with diet and physical activity: observations from the Hertfordshire Cohort Study

Background In the context of an aging population, age-related decline in muscle strength is well recognised, and is associated with functional limitation and increased mortality. However, scarce epidemiological data are available regarding its prevalence, or lifestyle associations at a time when intervention is still possible to retard or prevent loss. We considered these issues in the Hertfordshire Cohort Study, a cohort of late-middle aged community dwelling adults. Methods 2,987 participants were seen in 1999-2004, 1,572 men and 1,415 women. A lifestyle questionnaire was administered that asked about social class, physical activity, diet, co-morbidities and cigarette and alcohol consumption. Grip strength was measured with a Jamar dynamometer, three times on each side with the highest value used. Age related muscle strength decline was defined, according to current convention, as a grip strength &lt;30kg in men and &lt;20 kg in women. Results The mean age of participants was 65.8 (IQR 63.5-67.8) years for men and 66.5 (IQR 64.5-68.7) years for women. Muscle strength decline was more common in women (10.3%) than men (3%); the odds ratio (OR) for age-related muscle strength decline was 3.73 (95%CI 2.66-5.23) in women relative to men (p &lt; 0.001). Factors that appeared protective included higher physical activity scores in men (OR 0.97, 95%CI 0.96-0.99, p = 0.003) and in women (OR 0.97, 95%CI 0.96-0.98, p &lt; 0.001) and a higher prudent diet score in women (OR: 0.74, 95%CI 0.60-0.90 p = 0.003). Muscle strength decline was strongly associated with quality of life in women (p ≤ 0.001) as assessed by SF36 and EuroQoL EQ-5D for all domains, although EuroQOL anxiety/depression and SF36 role emotional were less strongly associated (p-value=0.042, p-value=0.006, respectively). Table 1 shows self-reported impaired ability to move, self-care, perform usual activities and increased pain were associated with higher risk of age-related muscle strength decline in women. Conclusion Age related muscle strength decline was more common in community dwelling women than men, and diet and physical activity were predictors of such decline. Research into effective preventative interventions is now warranted. Disclosures J. Zhang None. F. Laskou None. K. Jameson None. C. Cooper None. E.M. Dennison None.