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.

Genetic priming of a proinflammatory profile predicts low IQ in octogenarians.

The purpose of the study was to test the hypothesis that single nucleotide polymorphisms (SNPs) within interleukin (IL)-18, TNF-alpha, IL-6 and IL-10 gene promoter regions are risk factors for cognitive decline in healthy octogenarians, and to isolate the strongest inflammatory biomarkers of cognitive function in the peripheral blood. The Wechsler Adult Intelligence Scale was administered to 112 individuals at ages 80 and 85. An IL-18 haplotype was an independent risk factor of poor Performance IQ. The TNF-308GA genotype was related to individual declines in Verbal IQ, and the IL-10-592 CC genotype was related to better Verbal IQ at the age of 80. Circulating levels of TNF-alpha, sTNFRs, and IL-6 were negatively correlated with IQ at age 85 and less strongly to IQ at age 80 with activation of the TNF system as the strongest biomarker. In conclusion, SNPs related to high proinflammatory or low anti-inflammatory activity are independent risk factors of reduced cognitive function in octogenarians. Only the IL-18 haplotype was associated with inflammation in the peripheral blood and only with regard to circulating TNF-alpha.

Unintended weight loss in the elderly living at home: the aged in Home Care Project (AdHOC).

OBJECTIVE: To describe associations between unintended weight loss (UWL) and characteristics of nutritional status. DESIGN: A comparative cross-sectional assessment study at 11 sites in Europe. The target population was a stratified random sample of 4,455 recipients of home care (405 in each random sample from 11 urban areas) aged 65 years and older. MEASUREMENTS: the Resident Assessment Instrument for Home Care, version 2.0. Epidemiological and medical characteristics of clients and service utilisation were recorded in a standardized, comparative manner. UWL was defined as information of 5% or more weight loss in the last 30 days (or 10% or more in the last 180 days). RESULTS: The final sample consisted of 4,010 persons; 74% were female. The mean ages were 80.9 +/- 7.5 years (males) and 82.8 +/- 7.3 years (females). No associations were found between single diagnoses and UWL, except for cancer. Cancer patients were excluded from further analyses. Persons with a Cognitive Performance Scale value (CPS) superior 3 (impaired) had increased risk of UWL (OR = 2.0) compared with those scoring inferior or egal 3 (less impaired). Only in the oldest group did we find a significant association between UWL and reduction in ADL and IADL functions, comparing those who scored 3 or less with those who scored more than 3 (disabled). A binary logistic regression model explained 26% of UWL: less than one meal/day, reduced appetite, malnutrition, reduced social activity, experiencing a flare-up of a recurrent or chronic problem, and hospitalisation were important indicators. CONCLUSION: We recommend a regular comprehensive assessment in home care to identify clients with potential risk factors for weight loss and malnutrition, in particular those discharged from hospital, and those with physical dependency or cognitive problems. This study may provide incentives to create tailored preventive strategies.

High serum YKL-40 level in a cohort of octogenarians is associated with increased risk of all-cause mortality.

YKL-40 is secreted by macrophages, neutrophils, chondrocytes, endothelial-, vascular smooth muscle- and cancer cells. Interleukin (IL)-6 stimulates YKL-40 production in human in vivo studies. High serum YKL-40 is associated with poor prognosis in patients with inflammatory diseases and cancer. We studied whether serum YKL-40 was associated with systemic low-level inflammation, an immune risk phenotype, and mortality in relatively healthy 80-year old humans. Serum YKL-40, IL-6 and tumour necrosis factor (TNF)-alpha were measured by enzyme-linked immunosorbent assays (ELISAs) in octogenarians (n = 151) and serum YKL-40 in 18-30-year-olds (n = 89). Fifty-one of the octogenarians died during the 6-year follow-up. Serum YKL-40 in octogenarians was higher compared to the level in young people (median 116 versus 31 microg/l, P < 0.0005). Serum YKL-40 correlated with serum IL-6 in elderly women (Spearman's rho = 0.30, P = 0.009) and men (rho = 0.25, P = 0.003), but only with serum TNF-alpha (rho = 0.23, P = 0.05) and C-reactive protein (CRP) (rho = 0.57, P < 0.0005) among the elderly women. In addition, high serum level of YKL-40 was associated with a low CD4 : CD8 cell ratio. Univariate analysis of serum YKL-40 (logarithmically transformed and divided by tertiles) showed significant association with all-cause mortality [tertile 3: hazard ratio (HR) = 2.38, 95% confidence interval (CI): 1.19-4.78, P = 0.02]. The effect persisted after adjusting for potential confounders (sex, smoking, body mass index, chronic disease and anti-inflammatory medicine). These results suggest that serum YKL-40 is a prognostic and sensitive biomarker of all-cause mortality in octogenarians.

PIV validation of blood-heart valve leaflet interaction modelling.

The aim of this study was to validate the 2D computational fluid dynamics (CFD) results of a moving heart valve based on a fluid-structure interaction (FSI) algorithm with experimental measurements. Firstly, a pulsatile laminar flow through a monoleaflet valve model with a stiff leaflet was visualized by means of Particle Image Velocimetry (PIV). The inflow data sets were applied to a CFD simulation including blood-leaflet interaction. The measurement section with a fixed leaflet was enclosed into a standard mock loop in series with a Harvard Apparatus Pulsatile Blood Pump, a compliance chamber and a reservoir. Standard 2D PIV measurements were made at a frequency of 60 bpm. Average velocity magnitude results of 36 phase-locked measurements were evaluated at every 10 degrees of the pump cycle. For the CFD flow simulation, a commercially available package from Fluent Inc. was used in combination with inhouse developed FSI code based on the Arbitrary Lagrangian-Eulerian (ALE) method. Then the CFD code was applied to the leaflet to quantify the shear stress on it. Generally, the CFD results are in agreement with the PIV evaluated data in major flow regions, thereby validating the FSI simulation of a monoleaflet valve with a flexible leaflet. The applicability of the new CFD code for quantifying the shear stress on a flexible leaflet is thus demonstrated.

Home care needs of extremely obese elderly European women.

OBJECTIVE: To examine the health and needs of extremely obese women aged over 65 years receiving home care in Europe. STUDY DESIGN: A cross-sectional assessment study based on the Aged in Home Care (AdHOC) project recruited 2974 women aged 65 or over who were receiving home care at 11 sites in European countries. Extreme obesity was defined as 'Obesity of such a degree as to interfere with normal activities, including respiration'. MAIN OUTCOME MEASURES: Resident Assessment Instrument for Home Care (RAI-HC version 2.0); Activity of Daily Living Scale; Instrumental Activity of Daily Living Scale; the Minimum Data Set Cognitive Performance Scale; and a health profile. RESULTS: One hundred and twenty women (4.0%) were extremely obese. They were younger than their thinner counterparts, with a median age of 78.3 versus 83.3 years, and they more often had multiple health complaints and needed more help with mobility outside the home. The extremely obese had received home care longer than the non-extremely obese (median 28.7 versus 36.6 months). Extremely obese women also needed more help with personal care than the other group and, due to lower age, they were less cognitively impaired. CONCLUSIONS: Extreme obesity is a problem that increasingly affects home care of elderly women.

Functional ability at age 75: is there an impact of physical inactivity from middle age to early old age?

The aim of this study is to analyze the impact of physical inactivity from middle age to early old age on functional ability at age 75. Physical activity is measured both as cumulated activity from age 50 to 60 to 70 and at three separate points in time. Three hundred eighty-seven men and women born in 1914 and living in seven municipalities in the western part of the County of Copenhagen were followed for 25 years with examinations in 1964, 1974, 1984 and 1989. Analyses were conducted with physical inactivity as an independent variable (accumulated and separately for each point in time) and smoking, sex, school education, household composition, chronic disease at baseline and functional ability at age 70 as possible confounders. There was a strong association between physical inactivity at age 70 and disability at age 75. However, the analyses showed no effect of cumulated physical inactivity from age 50 to 60 to 70 on disability at age 75 when adjusting for functional ability at age 70. Physical inactivity is a risk factor for disability among old people. Thus, old people should be encouraged to take up and maintain physical training throughout the aging process.

Postoperative physical training following colorectal surgery: a randomised, placebo-controlled study.

BACKGROUND AND AIMS: Major surgery is often followed by fatigue and reduced physical function. We wished to study if postoperative physical training reduced fatigue and improved physical function. MATERIAL AND METHODS: Randomised, placebo-controlled, single-blinded study. Participants were unselected patients > or = 60 years undergoing elective colorectal surgery without disseminated cancer or inflammatory bowel disease. Group A trained muscular strength and work capacity. Group B performed relaxation exercises and received hot wrappings and massage. Main outcome measures were: fatigue (visual analogue scale), muscular strength, walking speed, physical performance test, and physical function questions (SF-36). RESULTS: Preoperatively the two groups were similar except that A was more fatigued than B. By postoperative day seven fatigue had increased compared to preoperatively, more in B than A, but by day 30 and 90 there were no significant differences between groups. All indices of physical function decreased postoperative day seven and were at the preoperative level day 90 with no significant differences between groups in change in function. Day seven the change in knee extension strength tended to be lower in B than A but by day 30 changes were similar in both groups. CONCLUSION: Postoperative training did not improve physical function, but reduced fatigue in hospital.

Nutritional status and associated factors on geriatric admission.

INTRODUCTION: The proportion of elderly patients who are undernourished is high and undernutrition has serious health implications. No consensus exists regarding nutritional screening measurements suitable for elderly patients. There is a need to identify risk factors for undernutrition in elderly patients to enable prevention and treatment. AIM: To identify clinically identifiable risk factors for undernutrition in geriatric patients on admission. METHODS: Newly admitted patients (n=196, mean age 83.7 years) were examined for nutritional risk factors by the nursing staff. Analyses of variance and multiple regression analyses were used to identify risk factors for undernutrition. RESULTS: Undernutrition was present in 41% of the patients using a Body Mass Index cut-off < 22 (kg/m2) as definition of undernutrition. Poor appetite, oral cavity problems, constipation and nausea or vomiting were frequent problems; the patients also used a high number of medical preparations, including preparations that induced nausea. No help with cooking before admission, poor appetite, oral cavity problems and high age were all significantly associated with undernutrition. CONCLUSION: To improve nursing care and to prevent undernutrition, it is recommended to routinely examine the patient's mouth and teeth on admission and to assess patients not only for their physical condition (appetite, oral health and nutritional status), but also for their living conditions e.g. help with cooking.

Secular trends in acute myocardial infarction in relation to physical activity in the general Danish population.

Secular trends in AMI rates were analyzed in relation to physical activity levels. The population attributable risk of physical inactivity was calculated. Participants were randomly selected subjects from a suburb of Copenhagen, Denmark, screened during the years 1964-1991. Occupational physical activity and in leisure time were assessed 1964, 1974, 1976, 1982, 1987 and 1991 by self-administered questionnaire along with smoking habits and alcohol consumption. Blood pressure, weight, height and serum lipids were measured according to WHO-standards. Mortality data were obtained from death certificates, from hospital records or autopsies. Acute myocardial infarctions (AMI) 1964-1994 were included. 13.925 men and women aged 30, 40, 50 and 60 years, were drawn as random samples from a background population of 300.000 inhabitants. A cohort born in 1914 was examined in 1964 and 1974, a cohort born in 1936, was examined in 1976 and 1987; Monica (Monitoring trends and determinants in cardiovascular diseases) I cohort were examined in 1982 and 1987; MONICA II in 1986, and MONICA III in 1991. Mean physical activity level at leisure adjusted for age and sex increased over time (P < 0001). 25% of the men were sedentary, and more women reported a sedentary lifestyle than men. The overall trend was from 1964 to 1992 a decline in physical activity at work (P < 0001) in both gender and all age groups. The difference in AMI incidence rates between leisure time physical activity (LTPA) levels increased over time. No change was found in AMI rates comparing sedentary in different time periods. A remarkable decrease over time in the AMI incidence rate was found in physically active during leisure time. Population attributable risk (PAR) exceeded 40% in both genders in the late 1980s. In conclusion the difference in AMI rates between LTPA subgroups has increased over time. The low AMI rates observed among the most physically active reveal a substantial potential for the prevention of AMI through physical activity. A population attributable risk of more than 40% for physical inactivity suggests a potential for primary prevention through increased physical activity.

Inactivity and weight loss: effective criteria to identify frailty.

The effectiveness was examined of inactivity and weight loss as criteria to identify a frail subgroup within independently living elderly persons participating in the SENECA study (Survey in Europe on Nutrition and the Elderly, a Concerted Action). Eight-hundred-forty-nine participants (aged 75 to 80) from nine countries were classified in four subgroups: 1) inactive elderly (lowest tertile activity score: n = 204); 2) weight losing elderly (lowest quintile: * 6.3% weight loss over 4-5 years: n = 108); 3) both inactive and weight losing (n = 54); 4) neither inactive nor weight losing: reference (n = 483). Differences in health, physical functioning and nutritional characteristics between groups 1, 2 and 3 respectively, and the reference group were evaluated. Compared to the weight-stable, active reference group, both inactive, weight losing (group 3) and inactive subjects (group 1) reported significantly more chronic diseases (2.2 and 1.8 vs. 1.1), disabilities (81 and 80 vs. 43%), use of medications (both 2.3 vs. 1.1) and care services (26 and 21 vs. 6%), and a lower self-rated health (2.8 and 3.1 vs. 3.8), relative health (1.9 and 2.1 vs. 2.6), and physical performance score (17 and 18 vs. 22). In addition, inadequate micronutrient intake and biochemical deficiencies were more prevalent. Weight-losing elderly were not significantly different from the reference group with respect to these characteristics. Therefore, physical inactivity alone or in combination with weight loss seems to be a practical and inexpensive screening criterion for identifying a subgroup of elderly with less favourable health and nutritional characteristics and poorer physical functioning among non-institutionalised elderly.

Predicting death from tumour necrosis factor-alpha and interleukin-6 in 80-year-old people.

Ageing is associated with low-grade inflammation and markers such as IL-6 possess prognostic value. Tumour necrosis-alpha (TNF-alpha) initiates the inflammatory cascade and has been linked to several age-associated disorders. It remains, however, unknown if TNF-alpha is associated with mortality in old populations. The aim of the present study was to investigate if serum levels of TNF-alpha were associated with all-cause mortality independently of interleukin (IL)-6 in a prospective study of 333 relatively healthy 80-year-old people. A Cox regression model was used to explore effects of TNF-alpha and IL-6 on survival in the following 6 years. A total of 133 participants died during this follow-up period. TNF-alpha was associated with mortality in men, but not in women, whereas low-grade elevations in IL-6 were associated strongly with mortality in both sexes. TNF-alpha explained only 7% of the variability in IL-6 and effects of the two cytokines were independent of each other as well as of other traditional risk factors for death [smoking, blood pressure, physical exercise, total cholesterol, co-morbidity, body mass index (BMI) and intake of anti-inflammatory drugs]. These findings indicate that at least in old populations chronic elevated levels of TNF-alpha and IL-6 have different biological functions that trigger age-associated pathology and cause mortality.

Physical activity in an ageing population.

UNLABELLED: This review over previously published articles, describes physical activity changes during ageing from age 50-85 in the 1914-cohort in Glostrup, Denmark, and analyses the association between physical activity and mortality, myocardial infarction, hip fractures and functional ability. The 1914-cohort in Glostrup was examined at age 50 in 1964 and re-examined 1974, 1984, 1989, 1994 and 1999. Some analyses were based on pooled data (CCPPS: Copenhagen Centre for Prospective Population Studies) from three longitudinal population studies conducted in Copenhagen, Denmark: The Copenhagen County Centre for Preventive Medicine in Glostrup, The Copenhagen City Heart Study and The Copenhagen Male Study. Physical activity of work and leisure time was classified into four levels based on questions originally constructed by Saltin and Grimby. MAIN OUTCOME MEASURES: all-cause mortality, fatal and non-fatal myocardial infarction, hip fracture and functional ability (Avlund mobility index of dependency). The lifetime risk from a sedentary leisure time was analysed in multivariate regression analyses controlling for covariates describing gender, age, life style, education and chronic diseases. Less than one third of the population had a sedentary leisure time. Physical activity definitely influenced health and quality of life over the life course in a positive way: compared to the group of inactive men and women, the mortality was about 60%, the incidence of myocardial infarction 70% and the incidence of hip fractures 75% in the moderate active groups. On top the physically active persons gained independency in activities of daily living.

Body composition of 80-years old men and women and its relation to muscle strength, physical activity and functional ability.

OBJECTIVE: To measure body composition and analyse the relation to muscle strength, physical activity and functional ability in healthy, old subjects, and to relate the results to an optimal BMI level for the elderly. SETTING: Subjects aged 80 years living at home from the 1914-population in Glostrup, Denmark. SUBJECTS AND METHOD: 121 men and 113 women had their height and weight measured. Body fat mass and fat-free mass were assessed by bioelectrical impedance. Muscle strength was measured as handgrip, elbow flexion, knee extension, body flexion and body extension. Physical activity was self reported and functional ability was assessed by the Physical Performance Test (PPT) and self reported mobility including information about tiredness and help. RESULTS: After dividing BMI into three groups: BMI < 24, BMI 24-29 and BMI > 29 no relationship was seen between a BMI interval of 24-29 kg/m2, and physical activity and functional ability. BMI was related to body fat mass, and FFM was related to muscle strength. Muscle strength was related to mobility and PPT. Mobility and PPT were mutually related and were related to physical activity. CONCLUSION: Our cross sectional study did not support newly proposed guidelines for the elderly of an optimal BMI interval of 24-29 kg/m2. We found relations between body composition, muscle strength, physical activity and functional ability.

Food intake patterns and risk of coronary heart disease: a prospective cohort study examining the use of traditional scoring techniques.

OBJECTIVE: This study analyses the risk of coronary heart disease (CHD) associated with food intake patterns. DESIGN: A cohort study with follow-up in 1996 for first admission to hospital for a CHD diagnosis or death caused by CHD (280 cases). Three food patterns were identified from a food frequency questionnaire: (1) a predefined healthy food index; (2) a prudent diet (reflecting frequent intakes of wholemeal cereals, fruit and vegetables); and (3) a Western food pattern (reflecting frequent intakes of meat products, butter and white bread) derived by factor analysis. Both factor scores had a mean of zero and a standard deviation of 1. SETTING: Copenhagen County, Denmark. SUBJECTS: A random sample of 7316 adults participated in health examinations conducted either in 1982-1984, 1987, or 1991-1992. RESULTS: The healthy food index and the Western pattern were not associated with CHD. The prudent pattern was associated with a decreased risk of CHD (Hazard ratio (HR per score unit increase)=0.85; 95% confidence intervals (CI), 0.75, 0.96), but the association vanished (HR=1.06; 95% CI, 0.93, 1.21) after controlling for confounding. Body mass index (BMI) modified the effect of the prudent and the Western patterns on CHD risk, suggesting an inverse association between both patterns and CHD in persons with low BMI, while the risk of CHD seemed to be positively related to the prudent and the Western pattern in those with high BMIs. CONCLUSIONS: This study showed no association between dietary patterns and CHD risk, but suggests that BMI modifies the relation between diet and CHD risk.

Trends in lifestyle coronary risk factors in the Danish MONICA population 1982-1992.

Myocardial infarction incidence rate declined 3-5% per year during 1982-1992 in the Danish study population of the WHO MONICA Project. We examined whether smoking habits, alcohol intake, dietary habits and physical activity levels changed in the population during the same period. Data from 6695 men and women of ages 30, 40, 50 and 60 y, examined in 1982-4, in 1986-7, and in 1991-2, were analysed to estimate trends. A summary healthy eating index and six scores derived by factor analysis were used to analyse food frequency data. The percentage of smokers declined 1.6% per year in men, and 1.0% per year in 30-, 40- and 50-y-old women, but increased 0.9% per year in 60-y-old women. The percentages of heavy cigarette smoking men and women nevertheless remained constant and close to 30%. Total alcohol intake declined among 30-y-olds, but appeared constant in other age groups. However, among 60-y-old men and among women over 30, the percentage of wine-drinkers rose from 6-11% in 1982-4 to 9-18% in 1991-2. Only 60-y-old men became more physically active at work and only 30-y-old women more so in leisure times. The percentage of individuals with a low healthy eating index decreased and the percentage with a high index increased. More importantly, dietary factor scores showed trends suggesting that very profound and potentially beneficial changes in dietary habits occurred. Lifestyle in the DAN-MONICA population changed in several ways that may have contributed to the declining incidence of myocardial infarction during the 1980s.

Assessment of habitual energy and macronutrient intake in adults: comparison of a seven day food record with a dietary history interview.

OBJECTIVE: To examine the quantitative agreement between a 7 day food record and a diet history interview when these are conducted under the same conditions and to evaluate whether the two methods assess habitual diet intake differently among subgroups of age and body mass index (BMI). DESIGN: Cross-sectional study. SETTING: Population study, Denmark. SUBJECTS: A total of 175 men and 173 women aged 30-60 y, selected randomly from a larger population sample of Danish adults. INTERVENTIONS: All subjects had habitual diet intake assessed by a diet history interview and completed a 7 day food record within 3 weeks following the interview. The diet history interview and coding of records were performed by the same trained dietician. MAIN OUTCOME MEASURE: Median between-method difference in assessment of total energy intake, absolute intake of macronutrients, and nutrient energy percentages. Difference between reported energy intake from both methods and estimated energy expenditure in different subgroups. RESULTS: Energy and macronutrient intake was assessed slightly higher by the 7 day food record than by the diet history interview, but in absolute terms the differences were negligible. The between-method difference in assessment of total energy intake appeared to be stable over the range of age and BMI in both sexes. As compared to estimated total energy expenditure, both diet assessment methods underestimated energy intake by approximately 20%. For both methods the under-reporting increased by BMI in both sexes and by age in men. CONCLUSIONS: Energy and macronutrient intake data collected under even conditions by either a 7 day food record or a diet history interview may be collapsed and analysed independent of the underlying diet method. Both diet methods, however, appear to underestimate energy intake dependent on age and BMI. SPONSORSHIP: Danish Medical Research Council, the FREJA programme.

Ten-year changes in anthropometric characteristics of elderly Europeans.

OBJECTIVE: Assess longitudinal (10-y) changes in height, body weight and circumferences in elderly Europeans. DESIGN: Longitudinal assessments including baseline measurements taken in 1988/1989 which were repeated in 1993 (follow-up) and in 1999 (Finale). SETTING: Longitudinal data were collected in nine European research towns: Hamme/Belgium (H/B), Roskilde/Denmark (R/DK), Haguenau/France (H/F), Romans/France (R/F), Padua/Italy (P/I), Culemborg/the Netherlands (C/NL), Vila Franca de Xira/Portugal (V/P), Betanzos/Spain (B/E), Yverdon/Switzerland (Y/CH). SUBJECTS: Using standardised methodologies data were collected from a random stratified sample of elderly men and women born between 1913 and 1918 including a total of 662 subjects in 1999. RESULTS: On average stature had decreased by 1,5-2 cm. Mean weight changed by -2.6 kg to - 4.2 kg in only three towns. An increase of at least 5 kg of body weight had taken place in 13 % of both men and women whereas 23 % of men and 27 % women had lost at least 5 kg of their baseline weight. Such weight loss over the first 4 years of follow-up was associated with higher mortality rates in men (crude RR 2.2, p<0.0001). Serial changes in arm circumference were small but waist circumference had increased by 3-4 cm. CONCLUSIONS: Whilst small-to-modest average changes in height, body weight and circumferences emerged over SENECA's 10-year follow-up period, considerable gains and losses of body weight had occurred in a significant proportion of the SENECA populations, whereby early weight loss might be predictive of subsequent survival.

Health related quality of life and physical performance. SENECA 1999.

UNLABELLED: This paper describes health related quality of life in 81-85 year old participants of the SENECA study and relates outcome to health and physical performance. DESIGN: SENECA is a mixed-longitudinal study in birth-cohorts, 1913-1918, with baseline measurements in 1988/1989 repeated in 1993 and 1999. Nine towns collected data in 1999. The study population consisted of 445 survivors. METHODS: Health related quality of Life was measured by The Nottingham Health Profile (NHP). Percentages of answers (yes/no) to 38 items were used for scoring different dimensions. Self-perceived health was measured by a global question with five answer categories and chronic diseases as presence or absence of any chronic reported disease. For functional ability, a standardised Activity of Daily Living (ADL) questionnaire was used with 16 questions on a 4-point scale. Functional limitations were measured by a sum-score of objective simple functions tests (PPT). RESULTS: Average scores in the different sections were: Energy:46, pain:55, emotional reactions:58, sleep:64, social integration:47 and physical mobility:70 11% had no problems in any of the sections. All health and physical performance measures were significantly associated with, not only physical mobility, but also affective and social components of quality of life, age 81-85. CONCLUSION: The Nottingham Health Profile was a useful instrument to measure health related quality of life in physical, affective and social dimensions across birth cohorts, gender and culturally different towns in Europe. The answers apparently mirrored the subjective disadvantage of impairment-related functional limitations and may therefore be used as end point for further analyses of SENECA data.

Decreased natural killer cell activity is associated with atherosclerosis in elderly humans.

Well-preserved natural killer cell (NK) activity has been associated with successful aging. The aim of the present study was to perform detailed analyses of NK cell function and to investigate the clinical significance of the NK cell number and function in relationship to health in a large cohort of elderly humans. It was tested if the potential of natural cytotoxicity in the blood (evaluated as an index including cytotoxicity per NK cell and the number of circulating NK cells) was preserved in 174 81-year-old humans versus 91 young controls and if NK cell mediated immunity was associated with age-related inflammatory diseases such as atherosclerosis. Elderly people had decreased cytotoxicity per NK cell in short-term but not in long-term assays. Ca(2+) independent cytotoxicity was unaltered, and NK cells maintained their cytotoxic responses to interleukin-2 and interferon-alpha signals. The decreased cytotoxicity per NK cell was not completely counteracted by increased circulating numbers of NK cells in the blood. Elderly people with severe medical disorders had low numbers of circulating NK cells. Furthermore, elderly people with atherosclerosis had low cytotoxicity per NK cell and a high number of circulating neutrophils.