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.

Contrasting preferences of arbuscular mycorrhizal and dark septate fungi colonizing boreal and subarctic Avenella flexuosa.

Arbuscular mycorrhizal (AM) and dark septate endophytic (DSE) fungi are ubiquitous in grass roots, but their colonizations may vary according to latitudinal gradient and site conditions. We investigated how vegetation zone (boreal vs. subarctic), humus thickness, and site openness affect root fungal colonizations of the grass Avenella flexuosa. More precisely, we hypothesized that AM and DSE fungal colonizations would have different responses to environmental conditions such that AM fungi could be more common in boreal zone, whereas we expected DSE fungi to be more affected by the amount of humus. We found site openness to affect AM and DSE fungi in a contrasting manner, in interaction with the vegetation zone. AM colonization was high at open coastal dunes, whereas DSE fungi were more common at forested sites, in the boreal zone. Humus thickness affected AM fungi negatively and DSE fungi positively. To conclude, the observed AM and DSE fungal colonization patterns were largely contrasting. AM fungi were favored in seashore conditions characterized by thin humus layer, whereas DSE fungi were favored in conditions of higher humus availability.

Walking ability and all-cause mortality in older women.

In this study self-reported ability to walk 2 km and six-minute walking test (6MWT) performance were examined as predictors of all-cause mortality in 434 women, aged 63-76 years. The primary outcome measure was all-cause mortality (follow-up: 8 years). Predictors were self-reported difficulties in walking 2 km and 6-min walking distance tertiles of ≤495, 496-560 and ≥561 m, and no test result due to refusal by the physician to grant permission to perform the test or participant's inability or unwillingness to perform the test. During the follow-up, 39 participants died. Participants reporting minor (age- and body mass index-adjusted hazard ratio 2.53, 95% confidence interval 1.12-5.69) or major (7.93, 3.49-18.05) difficulties in walking 2 km had increased risk of death compared with those reporting no difficulties. Participants with no 6MWT result (6.99, 2.46-19.86) were at an increased risk of death when compared with participants who walked ≥561 m. A similar trend (2.47, 0.81-7.56) was found for participants with walking distance of ≤495 m during the 6MWT. The trends remained similar after adjustments for other confounders. In conclusion, self-reported difficulties in walking 2 km are associated with an increased risk of death in older community-dwelling women. Objectively measured walking ability gives similar results.

Genetic contribution to the relationship between personality and depressive symptoms among older women.

BACKGROUND: Prior studies suggest that certain types of personality are at higher risk for developing depressive disorders. This study examined the relationship between old age depressive symptoms and two middle-age personality dimensions, neuroticism and extraversion. METHOD: The present study is part of the Finnish Twin Study on Aging, where altogether 409 female twins who had completed the Eysenck Personality Inventory at the age of 38-51 years were studied for depressive symptoms 28 years later using Center for the Epidemiologic Studies Depression Scale. Logistic regression analysis suitable for dependent data and univariate and Cholesky models for decomposing the genetic and environmental factor were used. RESULTS: Middle age extraversion protected from later depressive symptoms while neuroticism increased the risk. Twin modeling indicated that the association between neuroticism and depressive symptoms resulted from shared genetic risk factors common to both traits. However, a substantial proportion of the genetic vulnerability was specific to old age depressive symptoms and was not shared with neuroticism. Middle age extraversion had no genetic relationship with old age depressive symptoms. CONCLUSIONS: The relationship between middle age neuroticism and old age depressive symptoms is strong but only partly the result of genetic factors that predispose to both neuroticism and depressive symptoms. Extraversion, by contrast, has no genetic relationship with depressive symptoms experienced in old age.

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.

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.

Health and functional capacity as predictors of community dwelling among elderly people.

The aim of this study was to identify factors that predict community dwelling (i.e., nonuse of institutional bed-days) among elderly people. This was a longitudinal study of institution use including both short-term and long-term use of hospitals and nursing homes. The impact of health, functional performance, and carrying out the activities of daily living on community dwelling was studied using the method of path analysis. The participants were all the 75-year-old (N = 388) and 80-year-old (N = 291) men and women resident in the City of Jyväskylä, Finland. Predictor variables included disease severity, symptoms of illness, cognitive capacity, walking speed, muscle strength, hearing, and ability to carry out the activities of daily living. The outcome variable was community dwelling. Over 70% of the elderly people had received institutional care during the 5-year follow-up. The path analysis models showed that disease severity and symptoms of illness had an effect on community dwelling: those with a more severe disease or more symptoms needed more institutional care. The effect was also mediated through limitations in physical performance and cognitive capacity and need for assistance in activities of daily living. The explanatory power of these models varied from 23% to 36%. The results of this study suggest that prevention, treatment, and rehabilitation programs aimed at the promotion of community dwelling in elderly people should focus on the severity of diseases, functional performance, and the ability to carry out the activities of daily living.

A comparative study of factors related to carrying out physical activities of daily living (PADL) among 75-year-old-men and women in two Nordic localities.

The aim of this cross-sectional and cross-national study was to describe and compare the ability to carry out physical activities of daily living (PADL) and examine factors that might explain variation in this ability in two Nordic populations. Seven hundred and six men and women aged 75 from two populations (Glostrup, Denmark, and Jyväskylä, Finland) were interviewed and given a laboratory examination in 1989-90. The ability to carry out the PADL activities was studied by interview. Tests were given to determine depressive symptoms, cognitive capacity, and selected physical and sensory performance domains. Four different regression models (men and women in Jyväskylä and Glostrup) were used to analyze a number of variables describing physical and psychological health and performance related to the PADL. Knee extension strength and stair mounting height in three models (men and women in Jyväskylä and women in Glostrup), and walking speed in one model (men in Glostrup) emerged as explanatory factors on the basis of the physical performance tests done. Sight, except in the women in Glostrup, hearing in the men in Jyväskylä, and balance in the women in Glostrup also explained PADL functioning. In addition, symptoms of depression in the men in Glostrup, and symptoms of illness, except in the men in Jyväskylä, and cognitive capacity in the men in Jyväskylä emerged as explanatory factors in the regression models. There were, however, no major differences in the determinants of PADL functioning in the two Nordic populations of elderly people. Physical, psychological and sensory tests provide useful information, complementary to self-reports regarding declining PADL functional capacity.

Morbidity and disability in 75- and 80-year-old men and women. A five-year follow-up.

Purpose of this report is to describe the changes that occurred in morbidity, symptoms of illness and disability of 75- and 80-year-old residents of Jyväskylä, Finland, over a five-year period. The study population consisted of the elderly residents of the city of Jyväskylä in central Finland who were born in 1914 and 1910. At baseline (in 1989 and 1990), 355 (92.9%) persons from the younger age group and 262 (91.9%) from the older age group were interviewed and 311 (81.4%) and 230 (80.7%), respectively, took part in the physical examination. At follow-up (in 1994 and 1995), the corresponding numbers were 250 (93.3%) and 148 (88.6%) for the interviews and 217 (81.0%) and 127 (76.0%) for the physical examinations. The prevalence of chronic conditions was determined in connection with the medical examinations on the basis of self-report and the respondent's prescriptions and medical information cards. To measure the occurrence of symptoms, the respondents were asked whether during the past 14 days they had suffered from any of 17 listed symptoms. Functional capacity was assessed in connection with the interview carried out at the respondent's home in terms of needing help in activities of daily living (ADL). In the baseline examinations, subjects were found to have on average 2-3 diseases. During the follow-up the number of diseases and the proportion of people with co-morbidity increased in both age groups. Both men and women had on average 1-2 symptoms that caused them much trouble, and the number of such symptoms increased to some extent during the follow-up. The proportions of those needing help increased during the follow-up in all groups and the increase was most prominent among the women of the older age group. Of those who managed independently with physical ADL (PADL) at baseline, 14.9%-44.9% reported need of help in at least one task at follow-up. The need for help in PADL was greatest with cutting toe-nails, negotiating stairs, moving outdoors, washing the upper body and in instrumental ADL (IADL) with vacuuming, shopping, handling finances and in the use of public transport. Successful prevention and postponement of functional disabilities in the elderly population depends not only on the early diagnosis of illness but also on identifying even minor signs and symptoms of disease and functional limitations, and to focus health care interventions accordingly.

Roentgenographic findings of pneumonia caused by Chlamydia pneumoniae. A comparison with streptococcus pneumonia.

BACKGROUND: Pneumonia caused by Chlamydia pneumoniae or Streptococcus pneumoniae cannot be reliably differentiated by clinical signs or symptoms. OBJECTIVE: To find differences in the roentgenographic patterns of community-acquired pneumonia caused by C pneumoniae, S pneumoniae, or both in hospitalized patients during a C pneumoniae epidemic in Finland. METHODS: The patients were divided into 3 groups: 24 patients with serologic evidence of C pneumoniae only; 8 patients with combined C pneumoniae and S pneumoniae infection; and 13 patients with infection caused by S pneumoniae only. The chest roentgenograms obtained on admission to the hospital, during the hospital stay, and at follow-up visits were reevaluated by one of us (S.L.) who was unaware of the causative organism. In the final study groups, other causes of community-acquired pneumonia were excluded by a large pattern of microbiological methods. RESULTS: Bronchopneumonia was observed in 21 (88%) of the group with C pneumoniae and 10 (77%) of the group with S pneumoniae (P = .67). Lobar or sublobar (air space) pneumonia was seen in 7 (29%) of the patients with C pneumoniae compared with 7 (54%) with pneumonia caused by S pneumoniae. In the combined group, bronchopneumonia was seen as frequently as in the group with C pneumoniae, and air-space involvement was seen as frequently as in the group with S pneumoniae. The pneumonic shadowing was usually unilateral and in the lower lobes in all groups. Of the patients in the C pneumoniae group, 17% had residual abnormalities at follow-up visits. CONCLUSIONS: Roentgenographic changes cannot be used to differentiate pneumonia caused by C pneumoniae from that caused by S pneumoniae. Thus, initial antibiotic treatment should be directed at the pathogens that commonly cause community-acquired pneumonia.

Clinical picture of community-acquired Chlamydia pneumoniae pneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia.

BACKGROUND: The importance of Chlamydia pneumoniae as a cause of pneumonia has remained controversial. The clinical picture of C pneumoniae and Streptococcus pneumoniae in patients admitted to hospital with community-acquired pneumonia was compared during a C pneumoniae epidemic in Finland. METHODS: Group I consisted of 24 patients in whom serological testing and bacterial culture indicated an association with C pneumoniae only, group II comprised nine patients with both C pneumoniae and S pneumoniae, and group III consisted of 13 patients with S pneumoniae only. RESULTS: The patients with C pneumoniae suffered from headache more frequently than the other patients (group I, 46%; group II, 11%; and group III, 15%) and had received antimicrobial treatment more often before admission to hospital (group I, 54%; groups II and III, 0%). The patients with C pneumoniae produced few good sputum samples and had suffered from respiratory symptoms longer than those with S pneumoniae (group I, 10 days; groups II and III, 4 days). C reactive protein values on admission were lowest in group I and highest in group II. The antimicrobial treatment provided in hospital covered C pneumoniae in 36% of cases in group I and 0% in group II, while S pneumoniae was covered in all patients. C pneumoniae and S pneumoniae together were associated with more severe disease and a longer stay in hospital. CONCLUSIONS: Pneumonia caused by C pneumoniae was milder but clinically resembled that caused by S pneumoniae, and required hospital treatment even among young patients. Mixed infections were common and should be taken into account when planning antimicrobial treatment for community-acquired pneumonia. Further studies with more patients are needed to evaluate the severity of C pneumoniae pneumonia.

Pneumonia due to Chlamydia pneumoniae: prevalence, clinical features, diagnosis, and treatment.

The association of Chlamydia pneumoniae with pneumonia was first reported in 1985. This review summarizes the data collected during the subsequent 10 years on the prevalence, clinical features, diagnosis, and treatment of this disease, which is now associated with approximately 10% of all cases of pneumonia worldwide. Primary infections are documented most often in schoolchildren and young adults, while reinfections are prominent among the elderly. C. pneumoniae pneumonia is difficult to diagnose; its onset is often insidious, with nonpurulent sputum and without leukocytosis. The microbiological diagnosis is based on the results of serological tests, polymerase chain reaction, and culture. Tetracyclines and macrolides are effective in the treatment of C. pneumoniae pneumonia, as are new quinolones.

The etiology of community-acquired pneumonia among hospitalized patients during a Chlamydia pneumoniae epidemic in Finland.

The etiology of community-acquired pneumonia during a Chlamydia pneumoniae epidemic was studied among 125 hospitalized patients. Etiologic investigations included blood and sputum cultures, pneumococcal antigen detection, and serologic investigations for common respiratory viruses and for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumococcal antigen detection, and serologic investigations for common and for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, and Chlamydia species. A specific microbial agent was identified in 110 patients (88%). Some 48% of the patients had mixed infections. S. pneumoniae was the most common pathogen (55%), followed by C. pneumoniae (43%). C. pneumoniae was found both as a single etiologic agent and as a mixed infection, most often with S. pneumoniae. In conclusion, S. pneumoniae is the most common cause of community-acquired pneumonia, even during a C. pneumoniae epidemic. The organism, alone or with other pathogens (especially S. pneumoniae), may cause community-acquired pneumonia that requires hospital treatment.

Muscle strength and mobility as predictors of survival in 75-84-year-old people.

The purpose of the study was to examine the association of physical capacity, as determined on the basis of self-report and physical measurements, with survival in three groups of elderly people aged 75, 80 and 75-84 years. The main aspects of physical capacity were mobility, walking speed, hand grip strength and knee extension strength. Although 1142 persons participated in mobility interview, of whom 466 also took part in the walking speed test, and 463 in the strength tests. The follow-up periods ranged from 48 to 58 months. Risk of death was significantly related to difficulties in indoor mobility among the 75-84-year-olds (odds ratio = 1.99, 95% confidence interval = 1.27-3.13) and 75- and 80- year-olds (OR = 1.60, CI = 1.07-2.38) and outdoor mobility among the 75-84-year-olds (OR = 2.44, CI = 1.63-3.67) and 75- and 80-year-olds (OR =2.75, CI = 1.72-4.40). The odds ratios for hand grip strength (OR = 1.86, CI=1.13-3.07), knee extension strength (OR =2.52, CI = 1.50-4.42) and walking time over 10 meters (OR = 1.98, CI = 1.18-3.34) for the 75- and 80-year-olds were also significant. Since these variables can be easily measured and provide valuable information about functional capacity and risk of death they merit inclusion in medical examination of elderly clients.

Adhesion molecules in the nickel allergic reaction.

Nickel is the major cause of allergic contact dermatitis, and to increase our understanding of this immune reaction we studied changes in the expression of adhesion molecules on mononuclear cells during nickel stimulation in vivo and in vitro. Nickel-induced lymphocyte cultures were used in vitro, the cells being examined with monoclonal antibodies (Mabs) and by flow cytometry. Mononuclear cells from skin biopsies of in vivo cutaneous nickel reactions were studied with Mabs and immunohistochemistry. The expression of adhesion molecules in vitro was differential: the number of cells carrying CD11c, CD29, CDw49b, CDw49d, CDw49e, CDw49f, CD54, CD56 and ELAM-1 being significantly overrepresented among the nickel-induced lymphoblasts whereas the number of blasts carrying CD44 was underrepresented and those of CD11a, CD18, CD58 and LAM-1 remained unchanged. CD4+ cells gained adhesion molecules during nickel-induced blast transformation whereas CD8+ cells lost most of their adhesion molecules. The in vivo results were in agreement with the in vitro ones except that CDw49b, CDw49f, CD56 and ELAM-1 could not be detected in a 96-hour nickel reaction in vivo. In conclusion, the nickel allergic reaction favors the expression of certain adhesion molecules, and this expression is induced on CD4+ cells while CD8+ cells tend to lose such molecules. The changes were more sensitively detected with the in vitro method.

Factors related to carrying out everyday activities among elderly people aged 80.

The study was based on an epidemiological model in which performing activities of daily living (ADL) was the dependent variable. Variation in performing was explained by physical and mental health, and by physical performance. The population consisted of all 80-year-old residents (N = 291) of the city of Jyväskylä in central Finland; 90% of them agreed to take part in the interviews at home, while 72% took part in the laboratory examinations to determine health status and functional capacity. Difficulties in at least some PADL (Physical Activities of Daily Living) tasks were reported by 86.5% of the men, and 87.2% of the women; none said they could perform all IADL (Instrumental Activities of Daily Living) tasks without difficulty. Physical performance (grip strength and stair mounting test in men, and stair mounting test, balance, and upper extremity function test in women) and visual acuity showed a significant association with ADL performance both in men and in women. In addition, depressive symptoms in women, and cognitive capacity in men were associated with both PADL and IADL, and ADL performance, respectively. In the search for pathways to reduced ADL performance, it is important to look not only at chronic diseases but also at the aging processes as well as the disabilities caused by inactivity. Tests of cognitive capacity, psychological well-being and physical performance provide valuable information on the factors that underlie the aged individual's reduced functional capacity.

Use of drugs by non-institutionalized urban Finns born in 1904-1923 and the association of drug use with mood and self-rated health.

The purpose of this study was to examine the use of drugs by elderly people and to investigate its associations with various other factors. Random sampling was used to select 800 interviewees born in 1904-13 and a further 800 born in 1914-23. The average number of prescribed drugs per person was 2.2. Women used a greater number of prescribed drugs than did men; and this difference increased with age. The use of vitamins and trace elements seemed to decline with increasing age. Among women a significant association between the use of prescribed drugs and depressive symptoms was found. Women in the older age group used prescribed drugs more often than women in the younger age group. One fifth of the subjects had a greater number of drugs in simultaneous use than is generally recommended. It seems that, especially among elderly women, depression often remains undiagnosed and treatments are chiefly provided for the associated symptoms.

Mononuclear cell subsets in the nickel-allergic reaction in vitro and in vivo.

Nickel is the major cause of metal-induced contact allergy. To understand the mechanism of its immune reaction, we studied changes in lymphocyte surface markers during nickel challenge in both allergic and healthy subjects using an in vitro nickel reaction in which the lymphocytes of allergic subjects divide when they are stimulated with nickel sulfate. The lymphocytes were labeled with monoclonal antibodies (MAbs) to cell-surface antigens and studied by flow cytometry. Mononuclear cells from the nickel reaction in vivo were studied from skin biopsy specimens using MAbs and avidin-biotin immunohistochemistry. Nickel-induced lymphoblast transformation occurred in vitro only in cells from nickel-allergic subjects. CD4+ cells and CD45RO+ cells were overrepresented among the lymphoblasts of nickel-sensitive subjects, whereas CD8+ and CD8+CD11b+ and CD4+CD45R+ cells were underrepresented. The lymphoblasts contained T cells with the following activation markers: CD25, HLA-DR, CD26, CD71, Ki-67, and activation-associated antigen detected by the MAb, M21C5, but they were CD30-. CD16+ cells were overrepresented among the lymphoblasts. Nickel-reacting T cells used predominantly the T cell receptor, alpha beta-heterodimer, but no preferential selection of either V beta 5, V beta 6, or V beta 8 was observed. The phenotypes of nickel-reacting cells from cutaneous biopsy specimens were in agreement with the in vitro results.