Prevalence and socioeconomic predictors of diagnosed and undiagnosed diabetes in oldest-old and younger Caucasian seniors: results from the PolSenior study.

INTRODUCTION: Type 2 diabetes is one of the most common diseases in the aging population; however, data concerning correlates of diabetes in age-advanced individuals are limited. The study aimed to identify the socioeconomic correlates of diabetes in representative groups of oldest-old (≥ 85 years) and younger (65 to 84 years) Polish Caucasian seniors. MATERIAL AND METHODS: PolSenior is a multicentre, population-based study conducted in Poland. Fasting plasma glucose levels and data from detailed medical questionnaires were obtained from 2128 male and 1961 female study participants aged ≥ 65 years. Multivariate logistic regression was used to identify significant socioeconomic risk factors for diabetes and undiagnosed diabetes. RESULTS: The overall prevalence of diabetes in the study group was 21.9% (24.0% in women vs. 19.9% in men, p = 0.002), with an estimated weighted prevalence for all older Poles of 23.1%. Nearly one-fifth of cases were previously undiagnosed. Diabetes was more common in the younger elderly (65-84 years) than in the oldest-old (≥ 85 years) (23.4% vs. 18.6%, p < 0.001). The frequency of diabetes was higher in women than in men (24.0% vs. 19.9%, p < 0.002); however, men remained undiagnosed more commonly than women (4.7% vs. 3.3%, p = 0.029). The frequency of diabetes was higher among urban than rural dwellers (23% vs. 20.4%, p = 0.048). It was also related to marital status in women (p = 0.036) and occupation in men (p = 0.015). Multivariate logistic regression analysis revealed that the independent risk factors for diabetes were body mass index (BMI) and marital status in women, while in men it was solely BMI. Undiagnosed diabetes was more frequent among rural than city dwellers (4.8% vs. 3.5%, p = 0.03). In multivariate logistic regression analysis, only BMI and place of residence remained significant risk factors for being undiagnosed. CONCLUSIONS: The prevalence of diabetes in the ≥ 65-year-old population exceeds 20% but is lower in the oldest-old than in the younger elderly and is modified by socioeconomic factors. Many elderly individuals remain undiagnosed and do not benefit from the currently available therapy.

Blood Lipids and Cognitive Performance of Aging Polish Adults: A Case-Control Study Based on the PolSenior Project.

Background: The demand for effective strategies for maintaining cognitive capableness and establishing early dementia diagnosis has been tremendous, especially in the context of population aging. However, studies on the elderly population and neurocognitive impairment had provided ambiguous results throughout, while potential blood biomarkers of cognitive decline are yet to be clearly understood. Objectives: The present study is aimed at assessing the relationship between blood lipids-especially in the context of their usefulness as biomarkers of an early cognitive decline-and cognitive functioning of aging adults. Materials and Methods: The study sample consisted of 230 participants-(109 women, 121 men) aged 65+ years. Plasma 24(S)-hydroxycholesterol [24(S)-OHC], serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL) were assessed. The analyses were conducted in three groups of cognitive performance: cognitively normal, mild cognitive impairment (MCI), and mild dementia, of which the subjects were divided with the Mini-Mental State Examination (MMSE). Results: No significant differences in 24(S)-OHC plasma concentrations for different levels of cognitive performance were found. Significant differences were found in serum TC (p = 0.026) and LDL (p = 0.007) concentrations for different levels of cognitive performance. Concentrations of both parameters were highest in the MCI group and lowest in mild dementia and cognitive norm, respectively. No significant differences between serum HDL concentrations and cognitive performance were found. Conclusions: To fully assess the potential of research on blood lipids in regards to a cognitive decline, cross-sectional or epidemiological studies aimed at further exploring blood lipid roles in both the early and advanced MCI and dementia, are needed.

CA125 as a Marker of Heart Failure in the Older Women: Population-Based Analysis.

(1) Background: Cancer antigen 125 (CA125) is a glycoprotein that is expressed by tissue derived from coelomic epithelium in the pleura, peritoneum, pericardium. It has been shown that CA125 concentrations are correlated with NT-proBNP in older with congestive heart failure (HF). We conducted a study on the association between concentrations of CA125 and NT-proBNP in a population-based cohort of older Polish women. (2) Methods: The current research is sub-study of a large, cross-sectional research project (PolSenior). The study group consisted of 1565 Caucasian women aged 65-102 years. To assess the relationship between CA125 and other variables a stepwise backward multivariate normal and skew-t regression analyses were performed. (3) Results: The median of CA125 concentration was 13.0 U/mL and values over the upper normal range limit (35 U/mL) were observed in 5.1% (n = 79) of the study cohort. The concentration of CA125 was positively related to age, hospitalization for HF and history of atrial fibrillation and chronic obstructive pulmonary disease, levels of NT-proBNP, IL-6, hs-CRP and triglycerides. We found, in multivariate analyses, that increased CA125 levels were independently associated with log10 (IL-6) (ß = 11.022), history of hospitalization for HF (ß = 4.619), log10 (NT-proBNP) (ß = 4.416) and age (ß = 3.93 for 10 years). (4) Conclusion: Despite the association between CA125 and NT-proBNP, the usefulness of CA125 for the detection of HF in older women is limited by factors such as inflammatory status and age.

Clinical examination of peripheral arterial disease and ankle-brachial index in a nationwide cohort of older subjects: practical implications.

BACKGROUND: Prevalence of peripheral arterial disease increases with age and is related to increased morbidity and mortality. The clinical diagnosis includes the measurement of ankle-brachial index (ABI). AIMS: To check the prevalence of abnormal ABI, and the value of physical examination of arterial system in detection of ABI < 0.9. METHODS: We performed subgroup analysis of patients included in the PolSenior survey. We measured ABI, performed physical examination of arterial system, assessed laboratory and questionnaire factors related to atherosclerosis. Participants were divided according to ABI strata of < 0.9, 0.9-1.4 and > 1.4. Clinical score of abnormalities on physical examination was proposed. Using logistic regression, we obtained areas under the curve (AUC). RESULTS: The mean age of 844 participants (53.3% men) was 74.7 (10.6) years. ABI < 0.9 was found in 20.3% participants and it was linked to history of myocardial infarction, hypertension and renal failure. In the entire group, 72.4% of subjects declared, that they were able to walk a distance of 200 m without interruption. Higher clinical score was associated with lower ABI. Full physical examination (AUC = 0.67) followed by examination of lower extremities (AUC = 0.65) showed strongest diagnostic value for PAD based on ABI. Neither ABI nor clinical examination was a good predictor of the inability to walk 200 meters without difficulties. DISCUSSION/CONCLUSIONS: Full clinical examination, only moderately, adds to detection of PAD. The ability to walk 200 m is not a good measure of PAD in older subjects.

Utilization of medical rehabilitation services among older Poles: results of the PolSenior study.

BACKGROUND: Rehabilitation tailored to older adults' needs might improve their functional performance and quality of life, as well as increase social participation. The aim of the study was to evaluate the use of medical rehabilitation services among older Poles in relation to socio-economic and health-related determinants. MATERIALS AND METHODS: Data regarding medical rehabilitation were obtained from the nationwide, multidisciplinary PolSenior project (2007-2012) conducted on representative sample of 4813 respondents (48.3% women) aged 65+ years. Socio-economic status, physical functioning, falls, chronic pain, and formal disability occurrence, as well as self-rated health were accounted for. RESULTS: One in six respondents (18.9% women vs. 15.8% men, p < 0.005) underwent medical rehabilitation during 12 months prior to the survey. Respondents mostly received electrotherapy or light radiation therapy (61.3%). Multivariate logistic regression analysis revealed that women aged 80+ years and men aged 90+ years had a significantly lower chance of using rehabilitation services compared to the youngest study participants (65-69 y.o.). City dwellers used rehabilitation services nearly twice as frequently as rural dwellers. Respondents with university education level were most likely to take part in these services. Dependence in IADL decreased participation in medical rehabilitation, while formal disability and chronic pain promoted utilization of rehabilitation services. CONCLUSIONS: Younger age, city dwelling, higher education, functional independence, formal disability certificate, and chronic pain increased participation in medical rehabilitation. Such results of the study should be considered in planning actions towards reducing health inequalities at the national level and promoting health and well-being among older adults.

Self-rated health and its association with all-cause mortality of older adults in Poland: The PolSenior project.

OBJECTIVES: Predictive effect of self-rated health (SRH) on mortality in older adults has been observed. The purpose of the study was to analyze this association in Poles aged 65+. METHODS: Data were obtained from the nationwide, multidisciplinary PolSenior project, conducted in a representative sample of older population. The study group comprised 4049 respondents (48.0% women) without significant cognitive deficit. SRH was measured using Visual Analog Scale. The analysis included selected socio-economic, health status and life-style factors. Mortality data were retrieved from the state registry. RESULTS: During 5-year period, 414 women (21.4%) and 672 men (31.8%) have died, including 17.5% of women and 26.6% of men with good, 21.6% and 32.9% with fair, 36.2% and 55.3% with poor SRH, respectively. Kaplan-Meier survival curves for SRH revealed significant differences for both genders. Univariate Cox regression analysis revealed significant hazard ratios (HRs) for mortality among women and men with poor compared to good SRH [2.48 (1.83-3.37); 2.62 (2.04-3.36), respectively] and those with fair compared to good SRH [1.29 (1.03-1.60); 1.29 (1.10-1.52), respectively]. Age-adjusted HRs for mortality were significant between groups with poor and good SRH [women: 1.98 (1.46-2.68), men: 2.06 (1.60-2.64)]. Multivariate Cox proportional hazard regression model including revealed significant HRs for mortality between women with poor and good SRH [1.67 (1.06-2.64)]. CONCLUSIONS: SRH was associated with mortality in both genders. After adjustment for age, this relationship was maintained in respondents with poor compared to good SRH. Inclusion of potential confounders demonstrated that SRH was an independent predictor of mortality only in women.

Dental status in the Polish senior population and its correlates-Results of the national survey PolSenior.

OBJECTIVE: The aim of the study was to assess dental status of Polish seniors having and wearing dentures in relation to demographic, socioeconomic and lifestyle factors. BACKGROUND: Tooth loss is associated with deterioration of general health status. The epidemiological data on dental status in Poland, including Polish seniors, are fragmented. MATERIALS AND METHODS: The study cohort consisted of 4524 randomly selected participants, aged 65 years and over, representative for Polish seniors. Demographic, socioeconomic, lifestyle factors and dental status were collected using standardised questionnaires. RESULTS: The prevalence of partial and complete edentulism in the Polish senior population was estimated at 45.7% and 47.1%, respectively. Fourteen point four per cent (14.4%) of complete edentulous participants and 31.1% with partial edentulism (1-19 natural teeth) did not have dentures, and one-twelfth of respondents having dentures were not wearing them. The independent correlates of complete edentulism were: female sex, advanced age, rural dwelling, lower education level, physical work in the past, smoking and diabetes. Male sex, age 90+, rural dwelling, type of work, dependence in activities of daily living and partial edentulism were independent correlates of not having dentures and denture disuse. Lower than average personal income was only significant for not having dentures. CONCLUSIONS: Complete edentulism is frequent among older Poles and affects almost 50% of them. It is associated with female sex, age, rural dwelling, poor economic status, smoking and diabetes. Rural dwelling and dependence of daily living are significant correlates of not having dentures and denture disuse.

Plasma Level of Retinol-Binding Protein 4, N-Terminal proBNP and Renal Function in Older Patients Hospitalized for Heart Failure.

BACKGROUND/AIM: Elevated plasma concentration of retinol-binding protein 4 (RBP4) has recently emerged as a potential new risk factor for cardiovascular diseases, including hypertension (HT) and coronary artery disease (CAD). Limited data suggest that RBP4 promotes inflammatory damage to cardiomyocytes and participates in the development of heart failure (HF). This study aimed to analyze the relationship between concentrations of plasma RBP4 and serum N-terminal proBNP (NT-proBNP), a powerful biomarker of left ventricle dysfunction, in the older Polish population. METHODS: The study sample consisted of 2,826 (1,487 men) participants of the PolSenior study, aged 65 years and older, including a subgroup hospitalized for HF (n = 282). In all subjects, plasma concentrations of RBP4, interleukin-6 (IL-6), serum level of NT-proBNP, and hs-CRP were measured. Additionally, BMI, estimated glomerular filtration rate (eGFR), and HOMA-IR were calculated. The prevalence of HT, CAD, atrial fibrillation (AF), and medication were considered as potential confounders. RESULTS: Similar RBP4 levels were found in subjects with NT-proBNP < 125 and ≥125 ng/mL, with and without AF, and in the subgroups hospitalized for HF with and without AF. Regression analysis revealed no association between log10(NT-proBNP) and log10(RBP4). Plasma levels of RBP4 were increased by HT occurrence and diuretic therapy, while diminished with regard to female gender, age, eGFR values, AF, and IL-6 levels. CONCLUSION: Our results show that RBP4 is affected by GFR but cannot be considered as an independent biomarker of heart muscle dysfunction.

Possible association of the TERT promoter polymorphisms rs2735940, rs7712562 and rs2853669 with diabetes mellitus in obese elderly Polish population: results from the national PolSenior study.

One of the markers of aging is lymphocyte telomere length (LTL), which is affected by genetic constitution of the organism and environmental conditions, such as development and diseases, including diabetes. The relationship of the later seems to be bilateral. The enzyme responsible for the maintenance of telomere length is a subunit of telomerase-telomerase reverse transcriptase (TERT). The aims of the present study were to (1) determine the influence of the TERT promoter sequence SNP variants on relative telomere length (RTL) in an elderly Polish population and (2) explore the potential associations of the SNPs with the type 2 diabetes mellitus (T2DM) in the obese individuals. Two highly homogenous subgroups of PolSenior participants were investigated, the first constituted 70 relatively healthy respondents and the second 70 individuals with T2DM. Telomere length ratio (T/S value) was measured; 1.5 kb part upstream of the transcription start site of the TERT promoter was sequenced, and the frequencies of polymorphisms were calculated and compared against analysed data. Low-frequency SNPs were evaluated but excluded from further comparative analyses to RTL and glucose metabolism markers. No significant difference in telomere length was found between the two studied subgroups. Univariate statistical analyses showed only a weak association of environmental or genetic factors altering this marker of aging. Approximate frequency of four SNPs in TERT promoter sequence was assessed in Polish population aged 65-95 years, but three of them (rs2735940, rs7712562 and rs2853669) were selected for further analyses. The SNP selection was based on their minor allele frequencies in general population and on published data. The univariate analysis has revealed that carriers of CC SNP (rs2853669) have had the shortest RTL in the T2DM group. Multivariate analysis has also revealed that the genetic effect of TERT promoter CC SNP was strengthened by the incidence of T2DM. The additional variation in RTL in paired groups indicates that in addition to T2DM and genetics, there are other factors contributing to development of the age-related diseases.

Socio-economic determinants of vitamin D deficiency in the older Polish population: results from the PolSenior study.

OBJECTIVE: Numerous studies have reported an association between vitamin D (25-hydroxyvitamin D; 25(OH)D) deficiency and low economic status, lower educational level, drugs exposure, smoking and reduced physical activity. Our study analysed the association between sociodemographic factors and 25(OH)D status in Polish (Caucasian) seniors. DESIGN: Cross-sectional study (part of the PolSenior study). Serum 25(OH)D concentration was measured by a solid-phase ELISA method; a standardized questionnaire evaluated educational level, economic status, alcohol consumption, current or past cigarette smoking, physical activity, activities of daily living (ADL) and instrumental activities of daily living. SETTING: Community-dwelling randomly selected individuals aged 65 years or older, selected using three-stage stratified, proportional draw. SUBJECTS: Seniors (n 3472; 1658 women and 1814 men). RESULTS: Mean serum 25(OH)D concentration was 20·5 (sd 9·6) ng/ml. Values below the recommended level (30 ng/ml) were detected in 82·8 % of men and 90·4 % of women. Regression analysis revealed that the difference between sexes was associated with decreased walking activity in women, probably resulting in less sunlight exposure. There was a positive association between any disability in ADL and the presence of vitamin D deficiency/insufficiency. In the sex-adjusted analysis, older age, alcohol abstinence and lack of cycling and long-distance walking were explanatory variables for vitamin D deficiency. CONCLUSIONS: Vitamin D deficiency/insufficiency is frequent in the older Polish population and associated with functional disability and impaired mobility of seniors.

Prevalence of chronic pain in the elderly Polish population - results of the PolSenior study.

INTRODUCTION: Pain is the most common complaint of elderly people. In Poland, no large studies on the prevalence of chronic pain in the elderly were conducted until recently. MATERIAL AND METHODS: The study was a part of the PolSenior project, a cross-sectional multidisciplinary study on ageing of the Polish population, and included a randomly selected group of 716 people aged 55-59 years, and 4979 people over 65 years. The survey was conducted through a standardized questionnaire. An evaluation of pain occurrence, location, intensity and coexistence of pains in relation to gender, age and use of health care was performed. RESULTS: Chronic pain affected 42.0% of respondents aged 65 years and over (48.6% of women and 35.8% of men) as compared to 35.2% of the pre-elderly. The most common pain locations were the lumbar region (51.6%) and knees (41.0%). The average number of pain sites was 3.1 ±2.3. Average intensity of pain was 6.2 points on the VAS scale in people over 65 years and 6.0 points in the pre-elderly (NS). Average pain intensity increased significantly from 5.7 points in patients reporting pain in one place to 7.2 points in those reporting six pain sites. Elderly respondents with pain compared to those without pain more frequently reported physician visits performed at least once a month (54.6% vs. 48.4%, p < 0.001). CONCLUSIONS: Polish elderly most frequently complained of low back and lower limb pain. In respondents reporting many sites of pain, an increase in the intensity of pain was observed. Elderly patients with chronic pain often use medical care.

Clustering of geriatric deficits emerges to be an essential feature of ageing - results of a cross-sectional study in Poland.

The majority of old people suffer from various clinical conditions that affect health, functioning and quality of life. This research is a part of a cross-sectional, nationwide PolSenior Study that provides a comprehensive assessment of eight geriatric impairments and their co-occurrence in a representative sample (3471 participant aged 65-104 years, mean age 78.3 years) of the old adults living in the community in Poland. The participants were recruited randomly from all administrative regions of Poland by a three-stage, proportional, stratified-by-age group selection process. Eight geriatric conditions were assessed: falls, incontinences, cognitive impairment, mood disorders, vision and hearing impairments, malnutrition, and functional dependence. We showed that the most common deficits causing disability were vision and hearing impairments, and mood disorders, with more than two thirds of the participants presented at least one geriatric deficit. We showed that presence any of the analyzed conditions significantly increased the risk for co-occurrence of other examined weaknesses. The highest prevalence odds ratios were for functional dependence and, respectively: malnutrition (8.61, 95%CI:4.70-15.80), incontinences (8.0, 95%CI:5.93-10.70), and cognitive impairment (7.22; 95%CI:5.91-8.83). We concluded that the majority of the old people living in the community present various clinical conditions that prompt disability.

Socioeconomic determinants of prostate-specific antigen testing and estimation of the prevalence of undiagnosed prostate cancer in an elderly Polish population based on the PolSenior study.

INTRODUCTION: Socioeconomic determinants of prostate-specific antigen (PSA) testing and prevalence of undiagnosed prostate cancer (PCa) in the Polish population are poorly understood. The aim of this study was to identify factors associated with PSA testing in elderly Polish men, and estimate the size of the population at risk of PCa related to PSA non-testing. MATERIAL AND METHODS: We analyzed questionnaire-derived data concerning PSA testing, obtained in 2567 elderly and 332 younger (age: 55-59) participants of the population-based PolSenior study. Additionally, PSA was measured in 2414 subjects. RESULTS: The PSA had previously been tested in 41.2% of elderly and in 24.8% of younger participants. Non-smoking status (OR = 2.06, p < 0.001), higher personal income (OR = 1.56, p < 0.001), better education (OR = 1.49, p = 0.001), previous white-collar work (OR = 1.37, p = 0.005), alcohol abstinence (OR = 1.28, p = 0.02), married status (OR = 1.24, p = 0.04), dependence in Instrumental Activities of Daily Living (IADL) but not in Activities of Daily Living (ADL) (OR = 0.65, p < 0.001), and dependence in ADL (OR = 0.55, p < 0.001) were independent predictors of previous PSA testing in elderly participants. There were 31 elderly previously treated for PCa (calculated standardized prevalence: 935 per 100,000 elderly population). The PSA levels > 4 ng/ml were found in 12.8% of 65-74-year-old and 4.5% of 55-59-year-old previously non-tested participants. We calculated the standardized prevalence rate of undiagnosed PCa as approximately 1370 and 2352 cases per 100,000 population aged 55-59 and 65-74 years, respectively. CONCLUSIONS: In Poland, 58.8% of elderly men have never had PSA tested. These were less likely to be functionally independent, married, better educated, non-smokers or to have previous office employment or higher than average personal income. Our data suggest substantial underdiagnosis of prostate cancer among Polish men.

Dietary intakes of iron and zinc assessed in a selected group of the elderly: are they adequate?

BACKGROUND: Many studies demonstrate that the elderly consume a nutritionally inadequate diet that includes deficiencies in macro- and microelements; iron and zinc being significant examples of the former. OBJECTIVES: To assess the adequacy of dietary iron and zinc intakes in the elderly. MATERIAL AND METHODS: The study was conducted on n = 102 elderly persons, participating in the PolSenior Project, aged over 65, of which 44 were women and 58 men. Consumption data were collected by using 3 day dietary record from which a usual intakes of energy, macroelements (iron and zinc) were calculated. The Estimated Average Requirement (EAR) cut point and z-scores methods were used to determine probabilities of whether iron and zinc uptake was adequate per subject. RESULTS: By using the EAR cut-point method it was stated that iron intake was inadequate for 5% of respondents, whereas 44% showed deficits in zinc (34% women and 52% men). The z-scores demonstrated that 3% of subjects had high probabilities of deficiencies in iron and 52% in zinc. Indeed, very high zinc deficiencies were observed in 20% of cases. CONCLUSIONS: The insufficient energy intake observed among respondents contributes to a high risk of zinc deficiency necessary to ensure health in the elderly. In most cases, the low risk of iron deficiency shows that there is no need to increase this nutrient uptake in the examined group of elderly. The study highlights the need for educating the elderly, especially focused on improving zinc intake without changing iron intake. It can be done through appropriate dietary choices so as to include products such as dairy products, wheat bran, pumpkin and sunflower seeds, beans, lentils and nuts.

Medical, psychological and socioeconomic aspects of aging in Poland: assumptions and objectives of the PolSenior project.

Both descriptive and longitudinal studies of aging are nowadays a subject of growing interest in different countries worldwide. However, in Poland and other Central-Eastern European countries, such comprehensive, nationally representative, multidimensional studies were never performed in the past in elderly population. The present paper describes the PolSenior project including its objectives, sample selection and structure, methods, fieldwork procedures and study flow. The aim of the project was to examine medical, psychological and socioeconomic aspects of aging in Poland. The research sample included 5695 respondents (2899 males and 2796 females) split into six equally sized age groups of elderly individuals (65-69 years, 70-74 years, 75-79 years, 80-84 years, 85-89 years, 90+years) and one group of subjects just about to enter old age (55-59 years). Subjects were recruited using three stage stratified, proportional draw. The response rate was 42% and ranged from 32% to 61% between provinces. The study consisted of three visits performed by trained nurses including questionnaire survey, comprehensive geriatric assessment and blood and urine sampling. The questionnaire consisted of medical and specific socioeconomic questions. The comprehensive geriatric assessment included blood pressure and anthropometric measurements, as well as selected scales and tests routinely used in the examination of elderly subjects. Blood and urine samples were collected from 4737 and 4526 individuals, respectively. More than 50 biochemical parameters were measured, and DNA was isolated and banked. In a selected group of 1018 subjects, a medical examination by a physician was performed. The self-rated health was lower in females than in males in age groups 70-84, but similar in individuals of both sexes aged 65-69 and 85 years. Besides providing data on health and functioning of elderly population, the PolSenior project aims to analyze interrelationships between different elements of health and social status, and between genetics and health status in advanced age. The results of the PolSenior project will facilitate prioritizing the state's public health and social policies in elderly population. Such a program provides also an excellent starting point for longitudinal studies and a basis for comparative analysis between Poland and other European countries or regions.