Survival and its predictors from age 75 to 85 in men and women belonging to cohorts with marked survival differences to age 75: a comparative study in three Nordic populations.

BACKGROUND AND AIMS: While predictors of survival in older people have been examined in depth in a large number of studies, a literature search revealed no cross-national comparative prospective cohort studies on this issue. This study investigated survival and its predictors from age 75 to 85 among three local Nordic populations using survival data on national cohorts as background information. METHODS: The data were derived from national registers and from samples of 75-year old living in Denmark, Sweden, and Finland. The subjects were invited to take part in interviews and examinations focusing on different domains of health, functional capacity, and physical and social activities. RESULTS: The proportion of survivors to age 75 was markedly smaller among the Finnish men and women than Danish or Swedish subjects. In the local population no marked differences in survival from age 75 to 85 were observed between the groups of men, while women survived longer than men and longer in Göteborg than in Glostrup or Jyväskylä. Univariate models revealed 12 predictors of survival. In the multivariate models, the significant predictors among men related to physical fitness, whereas among women they pertained to social activities and morbidity. CONCLUSIONS: Despite great differences in the proportions of survivors to age 75, and excepting the survival advantage of women, only minor differences were present in the subjects' further survival to age 85. In the univariate analyses, many of the factors predictive of survival from age 75 to 85 were the same in the examined populations, whereas in the multivariate analyses differences between the sexes emerged.

Factors affecting the increased risk of physical inactivity among older people with depressive symptoms.

The purpose of this study was to investigate the association between depressive symptoms and physical inactivity, and whether motives for and barriers to exercise explain the potential association between depressive symptoms and physical inactivity in older people. The design of the study was cross-sectional. The study population comprised 645 people born between 1922 and 1928 who were residents in a city-center area of Jyväskylä in central Finland. Depressive symptoms were assessed using Center for the Epidemiologic Studies Depression Scale, physical activity using Grimby's (1986) validated scale, and motives for and barriers to exercise using a questionnaire and mobility limitation with a test of walking time over 10 m. The results demonstrated that the risk of physical inactivity was more than twofold among persons with depressive symptoms compared with non-depressed people. A higher prevalence of perceived barriers to physical activity, such as poor health, fear and negative experiences, together with lack of knowledge, explained part of the increased risk of physical inactivity among those with depressive symptoms while differences in motives for physical activity did not have a material effect. Adjustment for walking time over 10 m attenuated the increased risk of inactivity further. When planning exercise promotion programs, finding ways to overcome fear and negative experiences and providing information may help to increase physical activity among people with depressive symptoms. Additionally, difficulties caused by poor mobility should not be ignored.

Genetic effects in common on maximal walking speed and muscle performance in older women.

The purpose was to examine whether maximal walking speed, maximal isometric knee extensor strength, and leg extensor power share genetic or environmental effects in common. The data was collected from 103 monozygotic and 114 dizygotic female twin pairs aged 63-76 years. Maximal walking speed over 10 m was measured in the laboratory corridor using photocells for timing. Isometric knee extensor strength and leg extensor power were measured using an adjustable dynamometer. The genetic models showed that strength, power, and walking speed had a genetic effect in common which accounted for 52% of the variance in strength, 36% in power, and 34% in walking speed. Strength and power had a non-shared environmental effect in common explaining 13% of variation in strength and 14% in power. The remaining variance was accounted for by trait-specific effects. Some people may be more prone to functional limitation in old age due to their genetic disposition, but this does not rule out that changes in the lifestyle of predisposed subjects may also have a major effect. Approximately half of the variation in each trait was explained by environmental effects, which suggests the importance of the physical activity to improve performance and prevent functional limitation.

Customer-oriented counseling for physical activity in older people: study protocol and selected baseline results of a randomized-controlled trial (ISRCTN 07330512).

The objective of this study is to describe the rationale, design and selected baseline results of a 2-year randomized-controlled trial (RCT) on the effects of physical activity counseling in community-living older people. After a four-phase screening and data-collection process targeting all independently living people in the city center of Jyväskylä, Finland, six hundred and thirty-two 75-81-year-old cognitively intact, sedentary persons who were able to move independently outdoors at least minimally and willing to take part in the RCT were randomized into intervention and control groups. At baseline, over half of the subjects exercised less than two to three times a month and two-thirds were willing to increase their physical activity level. The desire to increase physical activity was more common (86%) among subjects with mobility limitation compared with those without (60%, P=0.004). The intervention group received an individualized face-to-face counseling session, followed by phone contacts every 3 months throughout the intervention. The study outcomes include physical activity level, mobility limitation, functional impairments, disability, mood, quality of life, use of services, institutionalization and mortality. The screening and recruitment process was feasible and succeeded well, and showed that unmet physical activity needs are common in older people.

Physical activity compensates for increased mortality risk among older people with poor muscle strength.

The aim of the study was to determine whether habitual physical activity can compensate for the increased mortality risk among older people with poor muscle strength. Mortality was followed up for 10 years after laboratory examination in 558 community dwelling 75- and 80-year-old men and women. Maximal isometric strength of five muscle groups was measured and tertile cut-off points were used to categorize participants. Participants, who reported moderate physical activity for at least 4 h a week, were categorized as physically active and the others as sedentary. High muscle strength and physical activity both protected from mortality, but their effect was not additive. Within each muscle strength tertile, physically active people had a lower mortality risk than sedentary people, the effect being most pronounced among those with lower strength in all muscle groups. A high level of physical activity may thus compensate for the increased mortality associated with low muscle strength.

Low-field MR imaging of meningiomas including dynamic contrast enhancement study: evaluation of surgical and histopathologic characteristics.

BACKGROUND AND PURPOSE: Risks associated with surgery of meningiomas, especially those located in the skull base, are influenced by tumor consistency and vascularity. The purpose of this study was to find out if vascularity, consistency, and histologic characteristics of meningioma can be predicted preoperatively by using low-field MR imaging, including dynamic imaging of contrast enhancement. MATERIALS AND METHODS: Twenty-one patients (mean age, 56; range, 34-73 years; 16 women, 5 men) with meningioma requiring first surgery were imaged by a 0.23T scanner. Time to maximum enhancement, maximum enhancement, and maximum intensity increase were noted from the enhancement curve of dynamic imaging. Relative intensity of tumor in fluid-attenuated inversion recovery (FLAIR) and T2-weighted images was calculated. The neurosurgeon evaluated surgical bleeding and hardness of tumor on a visual analog scale. Histopathologic analysis included subtype, World Health Organization grade, mitotic activity, grades of progesterone receptor expression and collagen content, proliferation activity by Ki-67 (MIB-1), and microvessel density by CD34. Correlations were studied with Kendall tau statistics. RESULTS: The most powerful association was found between time to maximum enhancement and microvessel density (tau = -0.60, P < .001). Surgical bleeding (tau = 0.49, P = .002), blood loss during surgery (tau = 0.49, P = .002), progesterone receptor expression (tau = 0.59, P < .001), and collagen content (tau = -0.54, P < .001) were statistically best correlated with the relative intensity of meningioma on FLAIR images. Tissue hardness correlated best with relative intensity on T2-weighted images (tau = 0.40, P = .012). CONCLUSION: Assessment of microvessel density, collagen content, and progesterone receptor expression of meningioma may be clinically feasible by using low-field MR imaging.

The predictive value of exercise testing for survival among 75-year-old men and women.

All 75-year-olds born in 1914 and living in the city of Jyväskylä, central Finland (n=388) were invited to study the predictive value of exercise test for mortality. Subjects who entered the laboratory (n=295) were to have a standard pre-test evaluation and perform a cycle ergometer exercise test. Subjects with complete background, exercise-test status and mortality data (n=282) were divided into three groups according to exercise-test status: a non-exercise test group (n=79), an exercise-test termination group (n=95), and an exercise-test completion group (n=108). Mortality was followed up for 9 years. The multivariate hazard ratio (HR) for death among the non-exercise test group compared with exercise-test completion group was 1.87 (CI 1.19-2.94). The multivariate HR for death among the exercise-test termination group compared with the exercise-test completion group was 0.95 (CI 0.58-1.54). High cycling power (W/kg body weight) in the exercise-test completion group was associated with a decreased risk for death with a multivariate HR 0.14 (CI 0.05-0.38). Performing an exercise test serves information on the risk of death that is incremental to clinical data and traditional risk factors of death in elderly people.

Activity as a predictor of mental well-being among older adults.

This eight-year follow-up study examines the roles of physical and leisure activity as predictors of mental well-being among older adults born in 1904-1923. As part of the Evergreen project, 1224 (80%) persons aged 65-84 years were interviewed at baseline (1988), and 663 (90%) persons in the follow-up (1996). Mental well-being factors including depressive symptoms, anxiety, loneliness, self-rated mental vigour and meaning in life were constructed using factor analysis. The predictors of mental well-being included physical and leisure activity, mobility status and number of chronic illnesses. We used a path analysis model to examine the predictors of mental well-being. At baseline, low number of chronic illnesses, better mobility status and leisure activity were associated with mental well-being. Baseline mental well-being, better mobility status and younger age predicted mental well-being in the follow-up. Explanatory power of the path analysis model for the mental well-being factor at baseline was 19% and 35% in the follow-up. These findings suggest that mental well-being in later life is associated with activity, better health and mobility status, which should become targets for preventive measures.

Efficacy of bilateral subthalamic nucleus (STN) stimulation in Parkinson's disease.

BACKGROUND: Deep brain stimulation (DBS) has, for the most part, replaced irreversible stereotactic coagulations in the surgical treatment of advanced Parkinson's disease. This study was undertaken to evaluate the benefits of bilateral STN stimulation related to its potential risks and side effects. METHOD: Twenty-nine consecutive Parkinsonian patients treated with STN-DBS were prospectively followed-up. Effects on Parkinsonian symptoms were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS). The evaluation was performed preoperatively and included postoperative follow-up evaluations at one and twelve months. All evaluations were made during the patient's best on-medication phase and postoperative follow-ups were conducted under both stimulator-on and stimulator-off conditions by a blinded neurologist. A neuropsychologist also evaluated the patients at every visit. FINDINGS: Two patients were excluded from the analysis because of severe surgical complications and three for an infection demanding the removal of the stimulator material. Other complications and side effects were clearly milder and temporary. At twelve months after surgery dyskinesia scores in the UPDRS were 53% lower than preoperative values. The results of the UPDRS motor scores improved 31.4% and activities of daily living (ADL) scores increased 19% compared with the preoperative situation. Also, the daily levodopa dose was 22% lower. Neuropsychological changes were minor, except for some deterioration in verbal fluency. CONCLUSION: The majority of Parkinsonian patients experienced significant and long lasting relief from their motor symptoms and an improvement in ADL functions due to DBS-STN therapy when evaluated at the best on-medication phase.

Recommendations for and warnings against physical activity given to older people by health care professionals.

BACKGROUND: Little is known about how health care professionals advice older people with chronic conditions about physical exercise. This study investigated exercise counseling in the context of health care as perceived by older people, and factors associated with perceived advice. DESIGN AND METHODS: Participants were 580 non-institutional 73- to 92-year-old people who reported at least one contact with health care during the previous 12 months. RESULTS: Of all the participants, 23% recalled solely recommendations to exercise, and 9% solely warnings against exercise. Additionally, 34% recalled receiving both recommendations for and warnings against physical activity, and 34% did not recall exercise-related advice at all. Recalling solely recommendations to exercise was associated with having musculoskeletal diseases and impaired mobility. Reporting solely warnings against physical activity was more common among those having heart conditions. Recalling both recommendations for and warnings against exercise was associated with being physically active despite of having heart conditions, musculoskeletal diseases, and impaired mobility. Recalling no exercise-related advice was most common among people who were sedentary and older, had fewer chronic conditions and reported no mobility limitation. CONCLUSIONS: A substantial proportion of older people recalled negative, no, or contradicting advice about exercise. As warnings against physical activity may outweigh recommendations to exercise, special attention should be paid to the content of advice in order to avoid discouraging older people from being active.

The effect of advice by health care professionals on increasing physical activity of older people.

The aim of this study was to investigate whether advice by health care professionals is associated with increased exercise activity in older people. As part of the Evergreen follow-up study, self-report data on exercise related advice were collected in 1996 and physical activity in 1988 and 1996 among 611 non-institutional people initially aged 65-84 years. Logistic regression analyses were used to study the association of recollection of having received exercise counseling with increased activity. Of all the subjects, 92% reported having been in contact with health care professionals during the follow-up period, and 58% of them recalled having been advised to exercise. Those men and women who recalled having received advice, started to participate in supervised exercise classes 5-6 times more often than those who did not recall being advised. The odds ratio (95% confidence interval) in men was 6.27 (1.19-32.9), and in women 5.27 (1.97-14.1). For calisthenics at home, the corresponding figure was 12.5 (3.52-44.4) in men. We concluded that initiating new physical activities in old age is strongly connected to encouragement to exercise by health care professionals. Health care professionals should be supported to promote exercise among older patients.

Muscle strength before and mortality after a bone fracture in older people.

We studied whether muscle strength measured before a bone fracture predicts mortality following the fracture. The participants were a sub-cohort of 82 people of a total of 493 Evergreen project participants initially aged 75- and 80 years, who had participated in knee extension strength tests as part of the baseline examinations, and who subsequently suffered at least one bone fracture. Maximal isometric knee extension strength was measured at baseline using an adjustable dynamometer chair. Fracture surveillance was carried out from patient records for 5 years, and mortality surveillance from population register for 10 years after baseline examinations. Average time till a fracture occurred after the baseline was 878 days (SD 576). Subsequent to the fracture, 32 deaths occurred. Using gender-specific cut-offs, three equal distribution-based groups were formed. A gradient risk of mortality was found according to baseline strength. The crude mortality rate per 1000 person-months was 15.2 in the lowest 4.9 in the middle and 1.7 in the highest third of baseline knee extension strength. The adjusted relative risk (RR) of death was 4.40 (95% confidence interval, CI 1.40-13.80) in the lowest and 2.39 (95% CI 0.68-8.4) in the middle tertile vs the highest tertile of muscle strength. Poor muscle strength measured before a fracture occurred was a powerful predictor of increased mortality after the fracture. Poor muscle strength may be a good indicator of overall vulnerability and frailty in old age, and strength testing could be helpful in targeting older people for preventive interventions.

Coping with activities of daily living in different care settings.

OBJECTIVE: To measure the functional capacity of elderly people cared for in different health and welfare care settings, with functional capacity defined in terms of activities of daily living. SUBJECTS AND METHODS: We assessed all people aged > or =65 in health-centre hospitals or nursing homes or receiving home nursing and home help services in Central Finland (n=5652) using the Evergreen activities of daily living index, which comprises nine physical and nine instrumental activities of daily living. RESULTS: Assessments of functional capacity were obtained for nearly all subjects: only 33 forms (0.6%) were returned with incomplete data. The mean activities of daily living sum score (range 0-54) was lowest for women receiving home nursing (17.3), and highest for women in long-term care at health-centre hospitals (48.4). Low scores described good and high scores poor functional capacity. Age showed no association with the mean activities of daily living sum score in any of the care settings. CONCLUSION: The Evergreen activities of daily living index was easy to use and successfully distinguishes between people in different care settings. Policies of assigning older people to different settings appear to be sound and sensible as the main defining criterion is level of functional capacity rather than age.

Rapid induction of meningeal collagen synthesis in the cerebral cisternal and ventricular compartments after subarachnoid hemorrhage.

Procollagen propeptides in the lumbar CSF increase after subarachnoid hemorrhage (SAH), and elevated concentrations have been detected as early as on day 8. We studied here the timing and localization of the induction of meningeal collagen synthesis during the first week after SAH by analysing cisternal and ventricular CSF samples. We obtained 29 cisternal and 10 ventricular CSF samples at operation from patients with SAH between days 1 and 9 after onset. The carboxyterminal propeptide of type I procollagen (PICP) and the aminoterminal propeptide of type III procollagen (PIIINP) were measured using radio-immunoassays. The concentrations of PICP and PIIINP in the cisternal CSF were elevated as early as on day 2 after SAH. PICP increased in a sigmoidal fashion (R2 = 0.39, p < 0.001), while PIIINP increased linearly (R2 = 0.28, p = 0.003) and was approximately 3-fold higher on day 9 than initially. PICP was twice as high (p = 0.02) in the cisternal than in the ventricular CSF after SAH and PIIINP was 4-times higher (p = 0.007). Interestingly, the concentrations were similar in a patient with intraventricular bleeding. The cisternal compartment contributed to the propeptides in the CSF more than did the ventricular compartment, but the latter also appeared to have a definite potential for fibroproliferative reaction. Meningeal collagen synthesis was induced rapidly within the first few days after SAH suggesting that therapeutic attempts to inhibit the fibroproliferative reaction should be started as early as possible.

Predictors of decline in self-assessments of health among older people--a 5-year longitudinal study.

Within the framework of the Evergreen project we examined how changes in several indicators of health and functioning and physical activity predicted a decline in self-assessments of health evaluated over a 5-year period in older people by two different measurements: self-rated health (SRH) and self-assessed change in health (SACH). The study group comprised all 75-year-old persons born in 1914 (N = 382) and living in Jyväskylä, a town in central Finland. At baseline in 1989, 91.6%, and at follow-up 5 years later in 1994, 87.3% of those eligible participated in the interview and 77.2 and 71.3%, respectively, in the examinations in the study centre, focusing on different domains of health and functional capacity. One-fifth of the subjects reported a deterioration in and one-fifth an improvement in SRH over the 5 years. The rest gave identical self-assessments of their health at baseline and at follow-up in response to the same question. Decline in SRH was associated with a decrease in physical activity and cognitive capacity. When asked directly about changes in their health (SACH), however, half the subjects said their health had declined. Negative SACH over the 5-year period was related to an increased number of chronic conditions, deterioration in functional performance and physical activity, and to the number of chronic conditions at baseline. We suggest that ageing people adapt to changes in their objective health and functional performance: the majority tend to assess their health as similar to or even better with increasing age despite an increase in chronic diseases and decline in functional performance. However, a negative SACH indicates that older people are realistic about these negative changes. These results support the assumption that the two subjective measurements of change in health are based on different criteria: assessment of current general health status tends to be based on inter-individual comparison, whereas assessment of change in health over a given time period may be based on intra-individual comparison. Physical activity seems to be an important factor when older people assess their health.

The association of socio-economic factors with physical and mental capacity in elderly men and women.

The association of socio-economic factors with functional capacity has received less research attention than their association with diseases and mortality. However, functional capacity is an important measure of health and independence in the elderly. This study explores the associations of socio-economic factors with physical and mental capacity as measured in laboratory tests and on the basis of self-report. The data were drawn from the Evergreen project, comprising all persons aged 75 (N=388) and 80 (N=291) in Jyväskylä, central Finland. Women with a higher level of education showed better functional capacity on all indicators, among men higher education was only associated with better vital capacity and cognitive capacity. Better perceived financial situation was associated with better functional capacity in both men and women. The association between socio-economic factors and functional capacity remained even when the number of chronic diseases was controlled for. The results lend support to the assumption that socio-economic factors are associated with physical and mental capacity in elderly people.

A pattern of long-term predictors of health ratings among older people.

The aim of our study was to examine the predictors of health ratings by applying a path analysis model to a set of data from 75-year-old men and women in a 5-year follow-up study. The study was part of the Evergreen project with the study group comprising all the eligible inhabitants of Jyväskylä, central Finland (N=382). The data were based on an interview and study center examinations focusing on different domains of health and functional capacity. Among the women, better health ratings at baseline, better functional ability and maximal working capacity, and a higher number of social contacts were important direct predictors of better health ratings at follow-up. Among the men, better health ratings at baseline, and depending on the model, higher physical activity or a lower number of chronic conditions and better functional ability were the most important direct predictors. The explanatory power of the path analysis models was 31-39% for men and 32% for women. In conclusion, health ratings reflect multiple dimensions of health and functioning. In addition to significant direct effects on health ratings, the predictors also have sequential effects running from life-style through functional performance and the activities of daily living to health ratings. The factors associated with health ratings differ to some extent by gender.

Linkage disequilibria and the site frequency spectra in the su(s) and su(w(a)) regions of the Drosophila melanogaster X chromosome.

Over the last decade, surveys of DNA sequence variation in natural populations of several Drosophila species and other taxa have established that polymorphism is reduced in genomic regions characterized by low rates of crossing over per physical length. Parallel studies have also established that divergence between species is not reduced in these same genomic regions, thus eliminating explanations that rely on a correlation between the rates of mutation and crossing over. Several theoretical models (directional hitchhiking, background selection, and random environment) have been proposed as population genetic explanations. In this study samples from an African population (n = 50) and a European population (n = 51) were surveyed at the su(s) (1955 bp) and su(w(a)) (3213 bp) loci for DNA sequence polymorphism, utilizing a stratified SSCP/DNA sequencing protocol. These loci are located near the telomere of the X chromosome, in a region of reduced crossing over per physical length, and exhibit a significant reduction in DNA sequence polymorphism. Unlike most previously surveyed, these loci reveal substantial skews toward rare site frequencies, consistent with the predictions of directional hitchhiking and random environment models and inconsistent with the general predictions of the background selection model (or neutral theory). No evidence for excess geographic differentiation at these loci is observed. Although linkage disequilibrium is observed between closely linked sites within these loci, many recombination events in the genealogy of the sampled alleles can be inferred and the genomic scale of linkage disequilibrium, measured in base pairs between sites, is the same as that observed for loci in regions of normal crossing over. We conclude that gene conversion must be high in these regions of low crossing over.