Seasonal and meteorological associations with depressive symptoms in older adults:a geo-epidemiological study

Background Given increased social and physiological vulnerabilities, older adults may be particularly susceptible to environmental influences on mood. Whereas the impact of season on mood is well described for adults, studies rarely extend to elders or include objective weather data. We investigated the impact of seasonality and meteorological factors on risk of current depressive symptoms in older adults. Methods We used data on 8027 participants from the first wave of The Irish Longitudinal Study of Ageing, a population-representative cohort of adults aged 50+. Depressive symptoms were recorded using the Centre for Epidemiological Studies Depression Scale. Season was defined according to the World Meteorological Organisation. Data on climate over the preceding thirty years, and temperature and rain over the preceding month, were provided by the Irish Meteorological Service and linked using Geographic Information Systems techniques to participant's geo-coded locations at a resolution of one kilometre. Results The highest levels of depressive symptoms were reported in winter and the lowest in spring (mean 6.56 [CI95% 6.09, 7.04] vs. 5.81 [CI95%: 5.40, 6.22]). In fully adjusted linear regression models, participants living in areas with higher levels of rainfall in the preceding and/or current calendar month had greater depressive symptoms (0.04 SE 0.02; p=0.039 per 10 mm additional rainfall per month) while those living in areas with sunnier climates had fewer depressive symptoms (−2.67 SE 0.88; p=0.003 for every additional hour of average annual daily sunshine). Limitations This was a cross-sectional analysis thus causality cannot be inferred; monthly rain and temperature averages were available only on a calendar month basis while monthly local levels of sunshine data were not available. Conclusions Environmental cues may influence mood in older adults and thus have relevance for the recognition and treatment of depression in this age group

Autonomic dysfunction in patients with advanced cancer; prevalence, clinical correlates and challenges in assessment

<p>Abstract</p> <p>Background</p> <p>The results of a small number of studies of autonomic function in patients with advanced cancer suggest that autonomic dysfunction (AD) is common. In other disease-specific groups this is associated with decreased survival, falls and symptoms such as postural hypotension, nausea, early satiety and fatigue. The contribution of AD to symptoms in advanced cancer is unknown.</p> <p>Methods</p> <p>We conducted a prospective cohort study designed to identify the risk factors for falls in patients with advanced cancer. Ambulant adult patients admitted consecutively to palliative care services were invited to participate. Participants underwent an assessment at baseline which included standard clinical tests of autonomic function, assessment of symptom severity, muscle strength, anthropometric measurements, walking speed, medication use, comorbidities and demographics. Information regarding survival was recorded ten months following cessation of recruitment. The clinical correlates of AD, defined as definite or severe dysfunction using Ewing's classification, were examined by univariate and multivariate logistic regression analysis. Survival analysis was conducted using Kaplan-Meier plots and the log rank test.</p> <p>Results</p> <p>Of 185 patients recruited, 45% were unable to complete all of the clinical tests of autonomic function. Non-completion was associated with scoring high on clinical indicators of frailty. It was possible to accurately classify 138/185 (74.6%) of participants as having either definite or severe versus normal, early or atypical AD: 110 (80%) had definite/severe AD. In logistic regression analysis, age (OR = 1.07 [95% CI; 1.03-1.1] <it>P </it>= 0.001) and increased severity of fatigue (OR = 1.26 [95% CI; 1.05-1.5] <it>p </it>= 0.016) were associated with having definite/severe AD. In analysis adjusted for age, median survival of participants with definite/severe AD was shorter than in those with normal/early/atypical classification (χ²= 4.3, <it>p </it>= 0.038).</p> <p>Conclusions</p> <p>Autonomic dysfunction is highly prevalent in patients with advanced cancer and is associated with increased severity of fatigue and reduced survival. Due to frailty, up to 45% of participants were unable to complete standard clinical tests of autonomic function. In order to further investigate the impact of AD and the therapeutic potential of treatment of AD in patients with advanced cancer, the validity of alternative novel methods of assessing autonomic function must be appraised.</p

Examining the gap between evidence based guidelines and clinical practice in lipid modification in adults at high risk of cardiovascular disease mortality: evidence from an Irish cohort

The role of statins in the secondary prevention of cardiovascular disease (CVD) is well established. Statin therapy is also recommended as part of the management strategy for diabetics. In asymptomatic individuals, statins are recommended if their Systematic Coronary Risk Estimation (SCORE) of 10 year CVD mortality is high (≥5% and ≤10%) or very high (≥10%) and Low-Density Lipoprotein (LDL-C) levels are above defined intervention thresholds

Hypertension prevalence and awareness in older Irish adults: Evidence from the Irish Longitudinal Study on Ageing (TILDA)

Introduction: Hypertension prevalence is increasing worldwide: population ageing and an increase in the prevalence of obesity are contributing to this rise. Hypertension is a major modifiable risk factor for stroke, coronary heart disease, end stage renal disease and has been associated with cognitive impairment. The aim of this study is to determine the prevalence of hypertension and to identify determinants of awareness of hypertension in older Irish adults. Methods: The Irish Longitudinal Study on Ageing (TILDA) is a population based prospective cohort study representative of community living adults. Each member of the Irish population aged 50 years and older had an equal probability of participation in the study. Face to face interviews and objective health assessments were conducted between Oct 2009 and July 2011. Descriptive statistics and logistic regression analysis were used to calculate prevalence and determinants of awareness of hypertension. Survey weights were applied to the estimates to adjust for selection and non-response bias in the survey. Results: The household response rate was 62%. Of the 8,175 respondents who took part in the study 5857 (71.6%) completed a comprehensive health assessment including blood pressure measurement. Hypertension was defined as a mean systolic blood pressure (SBP) ≥140mmHg and/or a mean diastolic blood pressure (DBP) ≥90mmHg and/or currently taking antihypertensive medications. The overall prevalence of hypertension was 64% (95% CI 62-65%) in those aged 50 years and older. Hypertension prevalence was higher in men than in women (69% vs 59%, p<.007) and prevalence increased with age to 87% (95% CI 84-89%) in those aged 75 years and older. Of those classified as hypertensive 55% (95% CI 53-57%) self-reported a previous doctor’s diagnosis of hypertension. Strong determinants of awareness included older age, female sex, overweight and obesity. Conclusions: This study documents a high prevalence of hypertension in adults aged 50 years and older in Ireland and identifies a low level of awareness of hypertension in this group. Raising awareness of hypertension is a major public health challenge. These findings provide reliable information which can contribute to practice and policy aimed at decreasing the prevalence of hypertension

Investigation of Surrogate Biomarkers Associated with Macular Pigment Status in a Group of Older Irish Adults

SIGNIFICANCE: Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula; however, its optical density in the eye is not routinely measured in clinical practice. PURPOSE: This study explored a range of surrogate biomarkers including anthropometric, clinical, and plasma measures that may be associated with lower MP optical density (MPOD). METHODS: Two thousand five hundred ninety-four subjects completed a full MP assessment as part of wave 1 of The Irish Longitudinal Study of Aging. Macular pigment optical density was measured using customized heterochromatic flicker photometry. Clinical (blood pressure), plasma (lipoproteins, inflammatory markers), and anthropometric (waist, hip, height, weight) biomarkers were measured for each participant. RESULTS: Mean (standard deviation) MPOD for the study group was 0.223 (0.161), with a range of 0 to 1.08. One-way ANOVA revealed that MPOD was significantly lower among participants with low plasma high-density lipoprotein (HDL; P = .04), raised plasma triglyceride-to-HDL ratio (P = .003), and raised total cholesterol–to–HDL ratio (P = .03). Subjects with an elevated waist circumference (WC) had a significantly lower MPOD (mean, 0.216 [0.159]) compared with those with an ideal WC (mean, 0.229 [0.162]; P = .03). Significant correlates of MPOD on mixed linear model analysis included education, smoking status, and WC. CONCLUSIONS: Higher abdominal fat is associated with lower MPOD in this representative sample of older Irish adults. Although altered lipoprotein profiles (low HDL, raised triglyceride-to-HDL ratio, raised total cholesterol–to–HDL ratio) may affect the transport, uptake, and stabilization of carotenoids in the retina, these plasma biomarkers were not predictive of low MPOD after adjustment for abdominal circumference. Although WC emerged as a viable anthropometric predictor of lower MPOD, its effect size seems to be small

Frailty index transitions over eight years were frequent in The Irish Longitudinal Study on Ageing.

Background: The frailty index (FI) is based on accumulation of health deficits. FI cut-offs define non-frail, prefrail and frail states. We described transitions of FI states in The Irish Longitudinal Study on Ageing (TILDA). Methods: Participants aged ≥50 years with information for a 31-deficit FI at wave 1 (2010) were followed-up over four waves (2012, 2014, 2016, 2018). Transitions were visualized with alluvial plots and probabilities estimated with multi-state Markov models, investigating the effects of age, sex and education. Results: 8174 wave 1 participants were included (3744 men and 4430 women; mean age 63.8 years). Probabilities from non-frail to prefrail, and non-frail to frail were 18% and 2%, respectively. Prefrail had a 19% probability of reversal to non-frail, and a 15% risk of progression to frail. Frail had a 21% probability of reversal to prefrail and 14% risk of death. Being older and female increased the risk of adverse FI state transitions, but being female reduced the risk of transition from frail to death. Higher level of education was associated with improvement from prefrail to non-frail. Conclusions: FI states are characterized by dynamic longitudinal transitions and frequent improvement. Opportunities exist for reducing the probability of adverse transitions

Impairments in Hemodynamic Responses to Orthostasis Associated with Frailty: Results from TILDA

Background: Dysregulated homeostatic response to stressors may underlie frailty in older adults. Orthostatic hypotension results from impairments in cardiovascular homeostasis and is implicated in falls and other adverse outcomes. This study aimed to characterise the relationships between orthostatic BP and heart rate recovery and frailty in an older population. Design: Cross-sectional study. Setting: Two health centres in the Republic of Ireland. Participants: 4334 adults aged 50 and older enrolled in The Irish Longitudinal Study on Ageing. Measurements: Continuous non-invasive blood pressure (BP) responses during active standing were captured by Finometer®. Frailty was assessed using the Cardiovascular Health Study criteria. Linear mixed models (random intercept) with piecewise splines were used to model differences in the rate of BP and heart rate recovery. Results: 93 (2.2%) participants were frail and 1366 (31.5%) were prefrail. Adjusting for age and sex, frailty was associated with a reduced rate of systolic BP recovery between 10-20 seconds post stand (frailty*time = -4.12 95%CI: -5.53 - -2.72) and with subsequent deficits in BP between 20-50 seconds. Similar results were seen for diastolic BP and heart rate. Further adjustment for health behaviours, morbidities, and medications reduced, but did not attenuate these associations. Of the 5 frailty criteria, only slow gait speed was consistently related to impaired BP and heart rate responses in the full models. Conclusions: Frailty, and particularly slow gait speed, was associated with reduced rate of recovery in BP and heart rate recovery following active standing. Impaired BP recovery may represent a marker of physiological frailty