Ageing

BACKGROUND: Depression independently increases the risk of falls in older people, but the mechanism for this relationship, as well as the specific falls type involved, remains unclear. Accidental falls (AFs) are due to slips or trips, while the cause of unexplained falls (UFs) is not immediately apparent and can include unrecognised syncope.

In this review, we survey the economic literature on the health–retirement link in developed countries.

We use the best available longitudinal data set, the Health and Retirement Study, and a battery of causal inference methods to provide both central estimates and bounds for the long-term effect of health insurance on health and mortality among the near-elderly (initial age 50–61) over a 20-year period.

Background: social isolation is defined as a lack of meaningful and sustained communication or interactions with social networks. There is limited understanding on the prevalence of social isolation and loneliness in people following hip fracture and no previous understanding of how this changes over time.

Background: Reliable estimation of future trends in life expectancy and the burden of disability is crucial for ageing societies. Previous forecasts have not considered the potential impact of trends in disease incidence. The present prediction model combines population trends in cardiovascular disease, dementia, disability, and mortality to forecast trends in life expectancy and the burden of disability in England and Wales up to 2025.

The authors use detailed health care data for the period 2009–11 from nine countries to measure the composition and magnitude of medical spending in the three years before death.

Objective To forecast dementia prevalence with a dynamic modelling approach that integrates calendar trends in dementia incidence with those for mortality and cardiovascular disease.

Older adults' negative beliefs about ageing are related to their health and functioning, but little is known about how perceptions of ageing (POA) relate to frailty status. This study aimed to explore the relationship between POA and frailty. Secondary analysis of data used were from the English Longitudinal Study of Ageing Waves 2 and 5. A POA score was based on participants' responses to 12 statements using a five-point Likert scale at baseline, and a Frailty Index (FI) score was calculated for each participant for both waves. Multiple linear regression models were conducted to assess the relationship between POA and frailty cross-sectionally and longitudinally in models controlled for age, gender, depression symptoms, and socioeconomic status. Older adults with more negative POA had greater frailty (β = .12, p < .001). Negative POA predicted greater frailty 6 years later (β = .03, p < .05). Future work regarding the mechanisms of this relationship is needed to identify ways of intervening to improve health.

Changes over time in the health and functioning of older people moving into care homes: analysis of data from the English Longitudinal Study of Ageing

Loneliness, social integration and incident dementia over 6 years: prospective findings from the English Longitudinal Study of Ageing

Insulin-like Growth Factor 1 (IGF-1) is associated with cardiovascular disease, itself a risk factor for hearing impairment, and, in animal studies, molecular evidence suggests a role for IGF-1 in hearing function. However, the link between IGF-1 and the occurrence of hearing impairment is untested in population-based studies of humans. A total of 4390 participants aged ≥50 y (mean [SD] age 64.2 [8.0] years at baseline, 55% women) from the English Longitudinal Study of Ageing provided serum levels of IGF-1 in 2008 and again in 2012. Hearing acuity was assessed by an objective hearing test (HearCheck handheld device) in 2014 when the prevalence was 38.2%. In the full cohort, IGF-1 was not associated with subsequent hearing impairment (OR5nmol/L increase; 95% CI: 1.01; 0.94, 1.09). However, this relationship appeared to differ by age (p-value for interaction = 0.03). Thus, in younger participants (aged 50-60 y, n = 1400), IGF-1 was associated with lower odds of hearing impairment (0.86; 0.73, 1.00) after adjustment for a range of potential confounders. Among people ≥60 y (n = 2990) there was a non-significant 'J'-shaped association. Our observational evidence that higher levels of IGF-1 appeared to confer some protection against hearing impairment in some older adults warrants replication in other prospective cohort studies.

Background: A possible role of vitamin D in depression has received considerable attention, especially given the significant disability, mortality, and healthcare costs associated to depression and the high prevalence of vitamin D deficiency.

In elderly populations, frailty is associated with higher mortality risk. Although many frailty scores (FS) have been proposed, no single score is considered the gold standard. We aimed to evaluate the agreement between a wide range of FS in the English Longitudinal Study of Ageing (ELSA). Through a literature search, we identified 35 FS that could be calculated in ELSA wave 2 (2004-2005). We examined agreement between each frailty score and the mean of 35 FS, using a modified Bland-Altman model and Cohen's kappa (κ). Missing data were imputed. Data from 5,377 participants (ages ≥60 years) were analyzed (44.7% men, 55.3% women). FS showed widely differing degrees of agreement with the mean of all scores and between each pair of scores. Frailty classification also showed a very wide range of agreement (Cohen's κ = 0.10-0.83). Agreement was highest among "accumulation of deficits"-type FS, while accuracy was highest for multidimensional FS. There is marked heterogeneity in the degree to which various FS estimate frailty and in the identification of particular individuals as frail. Different FS are based on different concepts of frailty, and most pairs cannot be assumed to be interchangeable. Research results based on different FS cannot be compared or pooled.

Mental and physical aspects are both integral to health but little is known about the dynamic relationship between them. We consider the dynamic relationship between mental and physical health using a sample of 11,203 individuals in six waves (2002-2013) of the English Longitudinal Study of Ageing (ELSA). We estimate conditional linear and non-linear random-effects regression models to identify the effects of past physical health, measured by Activities of Daily Living (ADL), and past mental health, measured by the Centre for Epidemiological Studies Depression (CES-D) scale, on both present physical and mental health. We find that both mental and physical health are moderately state-dependent. Better past mental health increases present physical health significantly. Better past physical health has a larger effect on present mental health. Past mental health has stronger effects on present physical health than physical activity or education. It explains 2.0% of the unobserved heterogeneity in physical health. Past physical health has stronger effects on present mental health than health investments, income or education. It explains 0.4% of the unobserved heterogeneity in mental health. These cross-effects suggest that health policies aimed at specific aspects of health should consider potential spill-over effects.

The role of sports clubs in helping older people stay active and prevent frailty: a longitudinal mediation analysis

OBJECTIVE: This study aims to investigate the implications of the heterogeneous cohort composition on depression trajectories of older adults in the United States and England.

Objective Moderate to severe chronic pain affects one in five adults. Pain may increase the risk of mortality but the relationship is unclear. This study investigated whether mortality risk was influenced by pain phenotype, characterised by pain extent or pain impact on daily life. Methods The study population was drawn from two large population cohorts of adults aged ≥50 years; the English Longitudinal Study of Ageing (ELSA) (n=6324) and the North Staffordshire Osteoarthritis Project (NorStOP) (n=10985). Survival analyses (Cox's proportional hazard models) estimated the risk of mortality in participants reporting "any pain" and then separately according to the extent of pain (total number of pain sites; widespread pain according to American College of Rheumatology (ACR) criteria; widespread pain according to Manchester criteria) and pain impact on daily life (pain interference; and often troubled with pain). Models were cumulatively adjusted for age, sex, education and wealth/adequacy of income. Results After adjustments, the report of any pain (MRR 1.06, 95% CI (0.95, 1.19)) or having widespread pain (ACR 1.07 (0.92, 1.23) or Manchester 1.16 (0.99, 1.36)) was not associated with an increased risk of mortality. Participants who were often troubled with pain (1.29 (1.12, 1.49)) and those that reported "quite a bit" (1.38 (1.20,1.59)) and "extreme" (1.88 (1.54, 2.29)) pain interference had an increased risk of all-cause mortality. Conclusion Pain that interferes with daily life, rather than pain per se was associated with an increased risk of mortality. Future studies should investigate the mechanisms through which pain increases mortality risk. This article is protected by copyright. All rights reserved.

Perceived life expectancy is associated with colorectal cancer screening in England

Oral health-related quality of life and loneliness among older adults