Publications by authors named "Anda Botoseneanu"

32 Publications

Metabolic syndrome and the benefit of a physical activity intervention on lower-extremity function: Results from a randomized clinical trial.

Exp Gerontol 2021 Apr 10:111343. Epub 2021 Apr 10.

Department of Internal Medicine/Geriatrics, Yale School of Medicine, New Haven, CT, USA. Electronic address:

Background: In older adults, increases in physical activity may prevent decline in lower-extremity function, but whether the benefit differs according to metabolic syndrome (MetS) status is uncertain. We aim to investigate whether structured physical activity is associated with less decline in lower-extremity function among older adults with versus without MetS.

Methods: We used data from the multicenter Lifestyle Interventions and Independence for Elders (LIFE) study to analyze 1535 sedentary functionally-vulnerable women and men, aged 70 to 89 years old, assessed every 6 months (February 2010-December 2013) for an average of 2.7 years. Participants were randomized to a structured, moderate-intensity physical activity intervention (PA; n = 766) or health education program (HE; n = 769). MetS was defined according to the 2009 multi-agency harmonized criteria. Lower-extremity function was assessed by 400-m walking speed and the Short Physical Performance Battery (SPPB) score.

Results: 763 (49.7%) participants met criteria for MetS at baseline. Relative to HE, PA was associated with faster 400-m walking speed among participants with MetS (P < 0.001) but not among those without MetS (P = 0.91), although the test for statistical interaction was marginally non-significant (P = 0.07). In contrast, no benefit of PA versus HE was observed on the SPPB score in either MetS subgroup.

Conclusions: Among older adults at high risk for mobility disability, moderate-intensity physical activity conveys significant benefits in 400-m walking speed but not SPPB in those with, but not without, MetS. The LIFE physical activity program may be an effective strategy for maintaining or improving walking speed among vulnerable older adults with MetS.

Trial Registration: clinicaltrials.gov Identifier: NCT01072500.
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http://dx.doi.org/10.1016/j.exger.2021.111343DOI Listing
April 2021

Racial and Ethnic Differences in Multimorbidity Changes Over Time.

Med Care 2021 May;59(5):402-409

Department of Health & Human Services, University of Michigan, Dearborn.

Background: Our understanding of how multimorbidity progresses and changes is nascent.

Objectives: Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults.

Design, Setting, And Participants: Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297).

Measures: Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms.

Results: Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014.

Conclusions And Relevance: Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.
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http://dx.doi.org/10.1097/MLR.0000000000001527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024615PMC
May 2021

Short-, medium-, and long-term weight changes and all-cause mortality in old age: Findings from the National Survey of the Japanese Elderly.

J Gerontol A Biol Sci Med Sci 2021 Feb 24. Epub 2021 Feb 24.

Tokyo Metropolitan Institute of Gerontology, Sakae-cho, Itabashi-ku, Tokyo, Japan.

Background: Recent studies, predominantly in Western populations, suggest that both weight loss and weight gain are associated with an increased mortality risk in old age. However, evidence of this association in older Asian populations remains sparse. This study aimed to examine the association between weight change and all-cause mortality in a nationally representative sample of community-dwelling older Japanese people.

Methods: Data were obtained from the National Survey of the Japanese Elderly, which included 4,869 adults aged ≥60 years. Participants were followed for up to 30 years. We considered three indicators of weight change according to the follow-up interval: short-term (3 years), medium-term (6-7 years), and long-term (12-13 years). Weight change was classified as loss ≥5%, loss 2.5-4.9%, stable (±2.4%), gain 2.5-4.9%, and gain ≥5%. Cox proportional hazards models were used to calculate the relative mortality risk of each weight change category.

Results: Weight loss ≥5% for all intervals was associated with higher mortality than stable weight and the effects were largely similar across all three intervals (hazard ratio [95% confidence interval]: 1.36 [1.22-1.51] for short-term, 1.36 [1.22-1.51] for medium-term, and 1.31 [1.11-1.54] for long-term). A similar pattern of results was observed among the young-old and old-old, and among men and women. The effect of weight loss on higher mortality was greater among those with a lower body mass index at baseline.

Conclusions: These findings could inform clinical and public health approaches to body-weight management aimed at improving the health and survival of older adults, particularly in Asian populations.
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http://dx.doi.org/10.1093/gerona/glab052DOI Listing
February 2021

An Agenda for Addressing Multimorbidity and Racial and Ethnic Disparities in Alzheimer's Disease and Related Dementia.

Am J Alzheimers Dis Other Demen 2020 Jan-Dec;35:1533317520960874

Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.

Advancements in Alzheimer's disease and related dementias (ADRD) research on the U.S. population acknowledge the importance of the high burden of ADRD on segments of the population and yet-to-be characterized risks attributable to the burden of multiple chronic diseases (multimorbidity). These realizations suggest successful strategies in caring for people with ADRD and their caregivers will rely not only on clinical treatments but also on more refined and comprehensive models of ADRD that take its broad effects on the whole-person and the whole of society into consideration. To this end, it is critical to characterize and address the relationship between ADRD and multimorbidity combinations that complicate care and lead to poor outcomes, particularly with regard to racial and ethnic disparities in the occurrence, course, and effects of ADRD. Several research and policy recommendations are presented to address the intersection of ADRD, multimorbidity, and underrepresented populations most at risk for adverse outcomes.
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http://dx.doi.org/10.1177/1533317520960874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984095PMC
February 2021

Socioeconomic Differences in Trajectories of Functional Capacity Among Older Japanese: A 25-Year Longitudinal Study.

J Am Med Dir Assoc 2020 06 18;21(6):734-739.e1. Epub 2020 Apr 18.

Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan.

Objectives: There is limited research on long-term changes in functional capacity among older Japanese, who differ significantly from their counterparts in Western, developed nations. This study aimed to identify distinct trajectories of functional capacity over a 25-year period and to explore socioeconomic differences in trajectory-group membership probabilities, using a national sample of older Japanese.

Design: Longitudinal panel study with 8 observation points from 1987 to 2012.

Setting And Participants: The data came from the National Survey of the Japanese Elderly, which consisted of 6193 samples of community-dwelling Japanese aged 60 years and older at baseline.

Methods: Functional capacity measure included basic and instrumental activities of daily living. Group-based mixture models were used for data analysis.

Results: Among participants aged 60 to 74 years at baseline, 4 trajectories were identified: minimal disability (80.3%), late-onset disability (11.6%), early-onset disability (6.2%), and moderate disability (1.9%). Those aged ≥75 years at baseline experienced higher levels of disability but somewhat parallel trajectories, including minimal disability (73.3%), early-onset disability (11.2%), moderate disability (11.3%), and severe and worsening disability (4.2%). Lower socioeconomic status, including education and household income, was associated with a higher risk of experiencing trajectories of poorer functional capacity among those aged 60 to 74 years, but no such association existed among those aged ≥75 years.

Conclusions And Implications: We found that approximately 70% to 80% of older Japanese maintained healthy functional capacity over time. Although we could not follow those who dropped out during the observation period, this study provided useful evidence that socioeconomic disparities in functional health converge with age. Our findings inform the design of health policies and interventions aiming to maintain functional health among older adults with diverse socioeconomic backgrounds. In particular, public policies aiming to reduce socioeconomic disparities should be emphasized to promote healthy aging.
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http://dx.doi.org/10.1016/j.jamda.2020.02.012DOI Listing
June 2020

Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults.

PLoS One 2019 17;14(6):e0218462. Epub 2019 Jun 17.

Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, United States of America.

Background: Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.

Methods And Findings: We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.

Conclusions: Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218462PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6576751PMC
February 2020

Diabetes-Multimorbidity Combinations and Disability Among Middle-aged and Older Adults.

J Gen Intern Med 2019 06 27;34(6):944-951. Epub 2019 Feb 27.

Department of Health & Human Services, University of Michigan, Dearborn, MI, USA.

Background: Older adults with diabetes rarely have only one chronic disease. As a result, there is a need to re-conceptualize research and clinical practice to address the growing number of older Americans with diabetes and concurrent chronic diseases (diabetes-multimorbidity).

Objective: To identify prevalent multimorbidity combinations and examine their association with poor functional status among a nationally representative sample of middle-aged and older adults with diabetes.

Design: A prospective cohort study of the 2012-2014 Health and Retirement Study (HRS) data. We identified the most prevalent diabetes-multimorbidity combinations and estimated negative binomial models of diabetes-multimorbidity on prospective disability.

Participants: Analytic sample included 3841 HRS participants with diabetes, aged 51 years and older.

Main Measures: The main outcome measure was the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index (range 0-11; higher index denotes higher disability). The main independent variables were diabetes-multimorbidity combination groups, defined as the co-occurrence of diabetes and at least one of six somatic chronic diseases (hypertension, cardiovascular disease, lung disease, cancer, arthritis, and stroke) and/or two mental chronic conditions (cognitive impairment and high depressive symptoms (CESD score ≥ 4).

Key Results: The three most prevalent multimorbidity combinations were, in rank-order diabetes-arthritis-hypertension (n = 694, 18.1%); diabetes-hypertension (n = 481, 12.5%); and diabetes-arthritis-hypertension-heart disease (n = 383, 10%). Diabetes-multimorbidity combinations that included high depressive symptoms or stroke had significantly higher counts of ADL-IADL limitations compared with diabetes-only. In head-to-head comparisons of diabetes-multimorbidity combinations, high depressive symptoms or stroke added to somatic multimorbidity combinations was associated with a higher count of ADL-IADL limitations (diabetes-arthritis-hypertension-high depressive symptoms vs. diabetes-arthritis-hypertension: IRR = 1.95 [1.13, 3.38]; diabetes-arthritis-hypertension-stroke vs. diabetes-arthritis-hypertension: IRR = 2.09 [1.15, 3.82]) even after adjusting for age, gender, education, race/ethnicity, BMI, baseline ADL-IADL, and diabetes duration. Coefficients were robust to further adjustment for diabetes treatment.

Conclusions: Depressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.
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http://dx.doi.org/10.1007/s11606-019-04896-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544693PMC
June 2019

Tracking Multimorbidity Changes in Diverse Racial/Ethnic Populations Over Time: Issues and Considerations.

J Gerontol A Biol Sci Med Sci 2020 01;75(2):297-300

Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.

Multimorbidity is widely recognized as having adverse effects on health and wellbeing and may threaten the ability of older adults to live independently. Much of what is known about multimorbidity rests on research that has largely focused on one point in time, or from a static perspective. Given that there remains a lack of agreement in the field on how to standardize multimorbidity definitions and measurement, it is not surprising that analyzing and predicting multimorbidity development, progression over time, and its impact are still largely unaddressed. As a result, there are important gaps and challenges to measuring and studying multimorbidity in a longitudinal context. This Research Practice perspective summarizes pressing challenges and offers practical steps to move the field forward.
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http://dx.doi.org/10.1093/gerona/glz028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176055PMC
January 2020

Age and gender differences in the association between body mass index and all-cause mortality among older Japanese.

Ethn Health 2020 08 4;25(6):874-887. Epub 2018 May 4.

Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Increasing evidence suggests a reverse J-shaped association between body mass index (BMI) and all-cause mortality among the older population. However, findings from non-Western societies including Japan are still sparse. Furthermore, little evidence regarding variation by age and gender in the BMI-mortality relationship in old age exists. This study aimed to examine age and gender variations in the relationship between BMI and all-cause mortality among older Japanese. Data came from a national representative sample of community-dwelling Japanese aged 60 years and older at baseline ( = 4,869). Participants were followed for up to 25 years. We categorized BMI into seven categories: < 18.5, 18.5-19.9, 20.0-21.4, 21.5-22.9, 23.0-24.9, 25.0-26.9, and ≥ 27.0. Cox proportional hazards models were used to assess the relative mortality risk associated with BMI categories. Lower BMI (< 18.5 and 18.5-19.9) was associated with higher mortality, compared to the mid-normal weight category (BMI: 21.5-22.9), after adjusting for covariates. In contrast, high-normal weight (BMI: 23.0-24.9) and overweight (BMI: 25.0-26.9 and ≥ 27.0) were not associated with mortality. Relative to old-old (aged ≥ 75 years), the higher mortality risk associated with lower BMI (< 20) appeared to be more prominent among young-old (aged 60-74 years). A moderately increased mortality risk associated with low BMI (18.5-19.9) was identified among men but not among women. Among older Japanese, low BMI (< 20.0) was associated with higher mortality, while high BMI (≥ 27.0) was not. The increased mortality risk associated with low BMI is more apparent among young-old and men. These age and gender differences need to be considered in assessing healthy body weight in old age.
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http://dx.doi.org/10.1080/13557858.2018.1469737DOI Listing
August 2020

Exercise's effect on mobility disability in older adults with and without obesity: The LIFE study randomized clinical trial.

Obesity (Silver Spring) 2017 07;25(7):1199-1205

Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville, Florida, USA.

Objective: Some data suggest that obesity blunts the benefits of exercise on mobility in older adults. This study tested the homogeneity of the effect of a physical activity intervention on major mobility disability (MMD) across baseline obesity classifications in the Lifestyle Interventions and Independence for Elders (LIFE) Study. LIFE randomized 1,635 sedentary men and women aged 70 to 89 years to a moderate-intensity physical activity (PA) or health education program.

Methods: MMD, defined as the inability to walk 400 m, was determined over an average follow-up of 2.6 years. Participants were divided into four subgroups: (1) nonobese (BMI < 30 kg/m ; n = 437); (2) nonobese with high waist circumference (WC > 102 cm [men], > 88 cm [women]; n = 434); (3) class 1 obesity (30 kg/m  ≤ BMI < 35 kg/m ; n = 430); and (4) class 2 + obesity (BMI ≥ 35 kg/m ; n = 312). Cox proportional hazard modeling was used to test an obesity by intervention interaction.

Results: The PA intervention had the largest benefit in participants with class 2 + obesity (hazard ratio 0.69, 95% confidence interval 0.48, 0.98). However, there was no statistically significant difference in benefit across obesity categories.

Conclusions: A structured PA program reduced the risk of MMD even in older adults with extreme obesity.
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http://dx.doi.org/10.1002/oby.21860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567861PMC
July 2017

Prospective Disability in Different Combinations of Somatic and Mental Multimorbidity.

J Gerontol A Biol Sci Med Sci 2018 01;73(2):204-210

University of Michigan-Dearborn, Health Policy Studies.

Background: Multimorbidity (multiple co-occurring chronic conditions) may be an important contributor to disability and poor health-related quality of life. The functional consequences of specific combinations of somatic and mental health conditions are unclear.

Methods: Nationally representative prospective cohort study using the National Health and Aging Trends Study data of Medicare beneficiaries. We included 4,017 participants aged 65 years or older interviewed in 2013 and 2014. The primary outcome was prospective activities of daily living (ADL)-instrumental ADL (IADL) index (range = 0-11) assessed in 2014. All other measures were assessed in 2013. Chronic conditions included heart disease, hypertension, stroke, diabetes, arthritis, lung disease, osteoporosis, cancer, depression, and cognitive impairment. Analyses were adjusted for age, sex, education, race/ethnicity, body mass index, and baseline ADL-IADL.

Results: Thirty-four percent of multimorbidity combinations included depression, cognitive impairment, or both. Relative to multimorbidity combinations of exclusively somatic conditions, combinations that included both depression and cognitive impairment were associated with 1.34 times greater ADL-IADL in adjusted models (95% confidence interval [CI]: 1.09, 1.64). Relative to combinations of both depression and cognitive impairment, combinations of cognitive impairment and somatic conditions were associated with 0.84 times lower ADL-IADL in adjusted models (95% CI: 0.74, 0.96); combinations of depression and somatic conditions were associated with 0.72 times lower ADL-IADL in adjusted models (95% CI: 0.62, 0.85).

Conclusions: Depression and/or cognitive impairment was identified in one-third of older adults with multimorbidity, and these combinations were associated with substantially greater prospective disability than combinations comprised exclusively of somatic conditions. This argues for identifying and managing mental health conditions that co-occur with somatic conditions.
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http://dx.doi.org/10.1093/gerona/glx100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279134PMC
January 2018

Effect of Metabolic Syndrome on the Mobility Benefit of a Structured Physical Activity Intervention-The Lifestyle Interventions and Independence for Elders Randomized Clinical Trial.

J Am Geriatr Soc 2017 Jun 28;65(6):1244-1250. Epub 2017 Mar 28.

Division of Geriatrics, Department of Internal Medicine, Yale University, New Haven, Connecticut.

Objectives: To test whether structured physical activity (PA) is associated with a greater reduction in major mobility disability (MMD) in older persons with metabolic syndrome (MetS) than in those without.

Design: Data from the Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter randomized trial of 1,635 persons with assessments every 6 months (average 2.7 years).

Setting: Eight U.S. centers.

Participants: Sedentary men and women aged 70 to 89 with functional limitations (N = 1,535); 100 participants were excluded because of missing MetS data.

Intervention: Participants were randomized to a moderate-intensity PA program (n = 766) or a health education program (n = 769).

Measurements: MetS was defined according to the 2009 multiagency harmonized criteria. Outcomes included incident MMD (loss of ability to walk 400 m) and persistent MMD (two consecutive MMD diagnoses or one MMD diagnosis followed by death).

Results: Seven hundred sixty-three (49.7%) participants met criteria for MetS. PA reduced incident MMD more than health education did in participants with MetS (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.57-0.91, P = .007) but not in those without MetS (HR = 0.96, 95% CI = 0.73-1.25, P = .75); the test for statistical interaction was not significant (P = .13). PA reduced the risk of persistent MMD in participants with MetS (HR = 0.57, 95% CI = 0.41-0.79, P < .001) but not in those without MetS (HR = 0.97, 95% CI = 0.67-1.41, P = .87). The test for statistical interaction was significant (P = .04).

Conclusion: Moderate-intensity PA substantially reduces the risk of persistent MMD in older persons with functional limitations with MetS but not in those without MetS. Comparable results were observed for incident MMD. The LIFE PA program may be an effective strategy for reducing mobility disability in vulnerable older persons with MetS.
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http://dx.doi.org/10.1111/jgs.14793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478451PMC
June 2017

Changes in health behaviors and the trajectory of body mass index among older Japanese: A 19-year longitudinal study.

Geriatr Gerontol Int 2017 Nov 9;17(11):2008-2016. Epub 2017 Mar 9.

Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Aim: Although the modification of lifestyle factors might facilitate weight control, the effects of health behaviors on the trajectory of bodyweight among older adults have been understudied. We examined the effect of changes in smoking, alcohol use and physical activity on the long-term trajectory of body mass index (BMI) among older Japanese adults.

Methods: Data came from a national sample of 4869 Japanese adults aged 60 years and older at baseline, with up to seven repeated observations over a period of 19 years (1987-2006). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in BMI trajectory.

Results: The average BMI among older Japanese adults was 22.3 at baseline, and decreased with an accelerating rate over time. Smoking was significantly associated with lower BMI over time, whereas smoking cessation was associated with higher BMI. Drinking and physical activity were not associated with BMI. We found significant interactions between age and smoking status, and between sex and physical activity, on BMI trajectory: the association between smoking and lower BMI was stronger in younger participants compared with older participants. The association between physical activity and higher BMI was more pronounced among men compared with women.

Conclusion: The present findings yield important new information regarding the complex dynamics underlying the linkage between lifestyles factors and BMI trajectory among older Japanese, and suggest that there might be cross-cultural differences in these linkages. Geriatr Gerontol Int 2017; 17: 2008-2016.
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http://dx.doi.org/10.1111/ggi.13008DOI Listing
November 2017

Dynapenia and Metabolic Health in Obese and Nonobese Adults Aged 70 Years and Older: The LIFE Study.

J Am Med Dir Assoc 2017 Apr 30;18(4):312-319. Epub 2016 Nov 30.

Department of Aging and Geriatric Research, University of Florida, Gainesville, FL.

Objective: The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and nonobese older adults.

Methods: A total of 1453 men and women (age ≥70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) nondynapenic/nonobese (NDYN-NO), (2) dynapenic/nonobese (DYN-NO), (3) nondynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (Foundation for the National Institute of Health criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least 3 metabolic syndrome (MetS) criteria, and other chronic conditions.

Results: A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared with DYN-NO groups (55.6 vs 45.1%, P ≤ .01) was observed. Waist circumference also was significantly higher in obese groups (DYN-O = 114.0 ± 12.9 and NDYN-O = 111.2 ± 13.1) than in nonobese (NDYN-NO = 93.1 ± 10.7 and DYN-NO = 92.2 ± 11.2, P ≤ .01); and higher in NDYN-O compared with DYN-O (P = .008). Additionally, NDYN-O demonstrated higher diastolic blood pressure compared with DYN-O (70.9 ± 10.1 vs 67.7 ± 9.7, P ≤ .001). No significant differences were found across dynapenia and obesity status for all other metabolic components (P > .05). The odds of having MetS or its individual components were similar in obese and nonobese, combined or not with dynapenia (nonsignificant odds ratio [95% confidence interval]).

Conclusion: Nonobese dynapenic older adults had fewer metabolic disease risk factors than nonobese and nondynapenic older adults. Moreover, among obese older adults, dynapenia was associated with lower risk of meeting MetS criteria for waist circumference and diastolic blood pressure. Additionally, the presence of dynapenia did not increase cardiometabolic disease risk in either obese or nonobese older adults.
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http://dx.doi.org/10.1016/j.jamda.2016.10.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366275PMC
April 2017

Sex Differences in Concomitant Trajectories of Self-Reported Disability and Measured Physical Capacity in Older Adults.

J Gerontol A Biol Sci Med Sci 2016 08 12;71(8):1056-62. Epub 2016 Apr 12.

Department of Internal Medicine/Geriatrics, Yale School of Medicine, New Haven, Connecticut.

Background: Despite documented age-related declines in self-reported functional status and measured physical capacity, it is unclear whether these functional indicators follow similar trajectories over time or whether the patterns of change differ by sex.

Methods: We used longitudinal data from 687 initially nondisabled adults, aged 70 or older, from the Precipitating Events Project, who were evaluated every 18 months for nearly 14 years. Self-reported disability was assessed with a 12-item disability scale. Physical capacity was measured using grip strength and a modified version of Short Physical Performance Battery. Hierarchical linear models estimated the intra-individual trajectory of each functional indicator and differences in trajectories' intercept and slope by sex.

Results: Self-reported disability, grip strength, and Short Physical Performance Battery score declined over 13.5 years following nonlinear trajectories. Women experienced faster accumulation of self-reported disability, but slower declines in measured physical capacity, compared with men. Trajectory intercepts revealed that women had significantly weaker grip strength and reported higher levels of disability compared with men, with no differences in starting Short Physical Performance Battery scores. These findings were robust to adjustments for differences in sociodemographic characteristics, length-of-survival, health risk factors, and chronic-disease status.

Conclusions: Despite the female disadvantage in self-reported disability, older women preserve measured physical capacity better than men over time. Self-reported and measured indicators should be viewed as complementary rather than interchangeable assessments of functional status for both clinical and research purposes, especially for sex-specific comparisons.
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http://dx.doi.org/10.1093/gerona/glw038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945890PMC
August 2016

Multimorbidity Combinations and Disability in Older Adults.

J Gerontol A Biol Sci Med Sci 2016 06 11;71(6):823-30. Epub 2016 Mar 11.

Department of Behavioral Sciences, Health Policy Studies, University of Michigan-Dearborn . Institute of Gerontology, University of Michigan, Ann Arbor.

Background: Multimorbidity (multiple co-occurring chronic diseases) is associated with greater likelihood of disability and mortality, above and beyond the risk attributable to individual diseases. This study identifies prevalent multimorbidity patterns and evaluates their association with disability among U.S. older adults.

Methods: Prospective cohort study using longitudinal Health and Retirement Study data (2010-2012). We included 8,782 participants aged 65 years and older and used negative binomial models to examine prospective disability, measured by the combined activities of daily living-instrumental activities of daily living index. Multimorbidity was defined as the co-occurring combination of at least two of the following chronic diseases: hypertension, cardiovascular disease, lung disease, diabetes, cancer, arthritis, stroke, cognitive impairment, or high depressive symptoms (CES-D score ≥ 4).

Results: We found 291 unique disease combinations with 1 to 1,167 older adults per disease combination. The three most prevalent combinations were: (a) hypertension and arthritis (n = 1,167); (b) hypertension, arthritis, and cardiovascular disease (n = 510); and (c) hypertension, arthritis, and diabetes (n = 430). Only one of the prevalent combinations included depressive symptoms (in combination with arthritis, hypertension; n = 129). This group showed the highest level of activities of daily living-instrumental activities of daily living disability compared to healthy participants or participants with a single disease (either included in the combination or different from diseases in the combination) even after adjusting for age, gender, education, race/ethnicity, and body mass index.

Conclusions: Clinicians stand to gain from a better understanding of which disease combinations are more and less disabling among older adults. Understanding how multimorbidity combinations relate to functional status is an important step towards reducing disability and sustaining independent living among older adults.
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http://dx.doi.org/10.1093/gerona/glw035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888400PMC
June 2016

Racial/Ethnic Differences in Trajectories of Cognitive Function in Older Adults.

J Aging Health 2016 12 8;28(8):1382-1402. Epub 2016 Jul 8.

1 University at Albany, School of Public Health, Rensselaer, NY, USA.

Objective: The objective of this study is to (a) examine racial/ethnic differences in trajectories of cognitive function and (b) evaluate the role of education and health behaviors (physical activity [PA] and smoking) as mediators of racial/ethnic differences in the rate of decline in cognitive function in older adults.

Method: Data for this study came from the Health and Retirement Study ( n = 3,424). Hierarchical linear models were used to define the trajectory of cognitive function between 2002 and 2008. Participants were classified based on PA as non-vigorously active, intermittent vigorously active, and consistently vigorously active.

Results: After adding education, the Hispanic's and Black's disparities in cognitive performance were slightly attenuated (Hispanics, β = -1.049, p < .001; Blacks, β = -3.397, p < .001) but were still different from Whites. Smoking was not associated with the cognition intercept or rate of decline.

Discussion: We found education had a partial mediating effect on racial differences in levels of cognition but not on the rate of change over time.
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http://dx.doi.org/10.1177/0898264315620589DOI Listing
December 2016

Trajectories of Body Mass Index and Their Associations With Mortality Among Older Japanese: Do They Differ From Those of Western Populations?

Am J Epidemiol 2015 Oct 12;182(7):597-605. Epub 2015 Sep 12.

Few studies have focused on the relationship between the trajectories of long-term changes in body mass index (BMI; weight (kg)/height (m)(2)) and all-cause mortality in old age, particularly in non-Western populations. We evaluated this association by applying group-based mixture models to data derived from the National Survey of the Japanese Elderly, which included 4,869 adults aged 60 or more years, with up to 7 repeated observations between 1987 and 2006. Four distinct BMI trajectories were identified: "low-normal weight, decreasing" (baseline BMI = 18.7; 23.8% of sample); "mid-normal weight, decreasing" (baseline BMI = 21.9; 44.6% of sample); "high-normal weight, decreasing" (baseline BMI = 24.8; 26.5% of sample); and "overweight, stable" (baseline BMI = 28.7; 5.2% of sample). Survival analysis with an average follow-up of 13.8 years showed that trajectories of higher BMI were associated with lower mortality. In particular, relative to those with a mid-normal weight, decreasing BMI trajectory, those with an overweight, stable BMI trajectory had the lowest mortality, and those with a low-normal, decreasing BMI trajectory had the highest mortality. In sharp contrast with prior observations from Western populations, BMI changes lie primarily within the normal-weight range, and virtually no older Japanese are obese. The association between BMI trajectories and mortality varies according to the distribution of BMI within the population.
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http://dx.doi.org/10.1093/aje/kwv107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4692978PMC
October 2015

Sedentary time is associated with the metabolic syndrome in older adults with mobility limitations--The LIFE Study.

Exp Gerontol 2015 Oct 28;70:32-6. Epub 2015 Jun 28.

Department of Aging and Geriatric Research, University of Florida, Gainesville, FL 32611, USA. Electronic address:

Background: Epidemiological and objective studies report an association between sedentary time and lower risk of the metabolic syndrome (MetS) and its risk factors in young and middle-age adults. To date, there is a lack of objective data on the association between sedentary time and MetS among older adults.

Methods: The association between objectively measured sedentary time (accelerometry) with MetS and MetS components was examined in a large sample of older adults with mobility limitations (N=1198; mean age=78.7 ± 5.3 years) enrolled in the Lifestyle Interventions and Independence for Elders (LIFE) study. Participants were divided into tertiles according to percentage of daily sedentary time, and the relation between sedentary time with MetS and MetS components was examined after adjusting for age, sex, ethnicity, and BMI.

Results: Participants in the highest sedentary time tertile had significantly higher odds of MetS (OR=1.54) (95% CI 1.13 to 2.11) in comparison with participants in the lowest tertile (p=0.03). Participants in the highest sedentary time tertile had larger waist circumference (p=0.0001) and lower HDL-C (p=0.0003) than participants in the lowest sedentary time tertile.

Conclusions: Sedentary time was strongly related to higher odds of MetS. These results, based on objectively measured sedentary time, suggest that sedentary time may represent an important risk factor for the development of MetS in older adults with high likelihood for disability.
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http://dx.doi.org/10.1016/j.exger.2015.06.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4600654PMC
October 2015

Cardiometabolic Risk, Socio-Psychological Factors, and Trajectory of Grip Strength Among Older Japanese Adults.

J Aging Health 2015 Oct 22;27(7):1123-46. Epub 2015 Apr 22.

University of Michigan-Dearborn, USA University of Michigan, Ann Arbor, USA.

Objective: To examine the association between cardiometabolic risk (percent body fat [BF%], triglycerides [TG], high-density lipoprotein [HDL]-cholesterol, hemoglobin A1c [HbA1c]), socio-psychological factors (education and self-rated health [SRH]), and trajectories of grip strength (GS) in older adults.

Method: Longitudinal 8-year data from 1,381 Japanese adults aged 65 years or above were analyzed using hierarchical linear models, stratified according to gender.

Results: GS declined following a linear trajectory. In both genders, higher BF% was associated with weaker GS, but not with the rate of decline. GS trajectory did not correlate with baseline TG, HDL-C, or HbA1c. Cardiometabolic factors mediated educational differences in GS intercept in both genders. In women, better SRH predicted stronger GS. The effect of SRH was robust to adjustments for cardiometabolic risk.

Discussion: In older adults, GS and its rate of decline are selectively associated with both cardiometabolic risk and socio-psychological characteristics. Cardiometabolic risk mediates educational disparities in GS but not differences in subjective assessments of health.
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http://dx.doi.org/10.1177/0898264315577587DOI Listing
October 2015

Light Intensity physical activity and sedentary behavior in relation to body mass index and grip strength in older adults: cross-sectional findings from the Lifestyle Interventions and Independence for Elders (LIFE) study.

PLoS One 2015 3;10(2):e0116058. Epub 2015 Feb 3.

Yale School of Medicine, New Haven, Connecticut, United States of America.

Background: Identifying modifiable determinants of fat mass and muscle strength in older adults is important given their impact on physical functioning and health. Light intensity physical activity and sedentary behavior are potential determinants, but their relations to these outcomes are poorly understood. We evaluated associations of light intensity physical activity and sedentary time-assessed both objectively and by self-report-with body mass index (BMI) and grip strength in a large sample of older adults.

Methods: We used cross-sectional baseline data from 1130 participants of the Lifestyle Interventions and Independence for Elders (LIFE) study, a community-dwelling sample of relatively sedentary older adults (70-89 years) at heightened risk of mobility disability. Time spent sedentary and in light intensity activity were assessed using an accelerometer worn for 3-7 days (Actigraph GT3X) and by self-report. Associations between these exposures and measured BMI and grip strength were evaluated using linear regression.

Results: Greater time spent in light intensity activity and lower sedentary times were both associated with lower BMI. This was evident using objective measures of lower-light intensity, and both objective and self-reported measures of higher-light intensity activity. Time spent watching television was positively associated with BMI, while reading and computer use were not. Greater time spent in higher but not lower intensities of light activity (assessed objectively) was associated with greater grip strength in men but not women, while neither objectively assessed nor self-reported sedentary time was associated with grip strength.

Conclusions: In this cross-sectional study, greater time spent in light intensity activity and lower sedentary times were associated with lower BMI. These results are consistent with the hypothesis that replacing sedentary activities with light intensity activities could lead to lower BMI levels and obesity prevalence among the population of older adults. However, longitudinal and experimental studies are needed to strengthen causal inferences.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116058PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315494PMC
January 2016

Prevalence of metabolic syndrome and its association with physical capacity, disability, and self-rated health in Lifestyle Interventions and Independence for Elders Study participants.

J Am Geriatr Soc 2015 Feb 30;63(2):222-32. Epub 2015 Jan 30.

Department of Health Policy Studies, University of Michigan, Ann Arbor, Dearborn, Michigan; Institute of Gerontology, University of Michigan, Ann Arbor, Dearborn, Michigan; Division of Geriatrics, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.

Objectives: To evaluate the prevalence of metabolic syndrome (MetS) and its association with physical capacity, disability, and self-rated health in older adults at high risk of mobility disability, including those with and without diabetes mellitus.

Design: Cross-sectional analysis.

Setting: Lifestyle Interventions and Independence for Elders (LIFE) Study.

Participants: Community-dwelling sedentary adults aged 70 to 89 at high risk of mobility disability (Short Physical Performance Battery (SPPB) score ≤9; mean 7.4 ± 1.6) (N = 1,535).

Measurements: Metabolic syndrome was defined according to the 2009 multiagency harmonized criteria; outcomes were physical capacity (400-m walk time, grip strength, SPPB score), disability (composite 19-item score), and self-rated health (5-point scale ranging from excellent to poor).

Results: The prevalence of MetS was 49.8% in the overall sample (83.2% of those with diabetes mellitus, 38.1% of those without). MetS was associated with stronger grip strength (mean difference (Δ) = 1.2 kg, P = .01) in the overall sample and in participants without diabetes mellitus and with poorer self-rated health (Δ = 0.1 kg, P < .001) in the overall sample only. No significant differences were found in 400-m walk time, SPPB score, or disability score between participants with and without MetS, in the overall sample or diabetes mellitus subgroups.

Conclusion: Metabolic dysfunction is highly prevalent in older adults at risk of mobility disability, yet consistent associations were not observed between MetS and walking speed, lower extremity function, or self-reported disability after adjusting for known and potential confounders. Longitudinal studies are needed to investigate whether MetS accelerates declines in functional status in high-risk older adults and to inform clinical and public health interventions aimed at preventing or delaying disability in this group.
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http://dx.doi.org/10.1111/jgs.13205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333053PMC
February 2015

Socioeconomic Status and the Trajectory of Body Mass Index Among Older Japanese: A Nationwide Cohort Study of 1987-2006.

J Gerontol B Psychol Sci Soc Sci 2016 Mar 10;71(2):378-88. Epub 2015 Jan 10.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan.

Objectives: This research analyzed the body mass index (BMI) level and rate of change, and their association with socioeconomic status among older Japanese adults.

Methods: Data came from a national sample of over 4,800 Japanese adults aged 60 and older at baseline, with up to 7 repeated observations over a period of 19 years (1987-2006). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in BMI.

Results: Average BMI among older Japanese was 22.26 at baseline and decreased with an accelerating rate over time. Relative to those with less education, BMI among older Japanese with more education was lower and it declined linearly at a faster rate over time. In contrast, higher household income at baseline was associated with a higher level of BMI but similar rates of decline over time. Furthermore, we found no evidence for age variations in the SES-BMI linkage as predicted by prior investigators.

Discussion: These findings provide new insights into the complex relationship between socioeconomic factors and BMI, and help to inform the design of health policies and interventions related to weight control among older adults with diverse socioeconomic backgrounds.
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http://dx.doi.org/10.1093/geronb/gbu183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926508PMC
March 2016

Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age.

J Gerontol B Psychol Sci Soc Sci 2015 Jul 26;70(4):661-71. Epub 2014 Aug 26.

Department of Internal Medicine, Yale University, New Haven, Connecticut.

Objectives: This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups.

Methods: We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups.

Results: We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3%, 23.5%, 24.5%, and 22.6% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age.

Discussion: Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.
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http://dx.doi.org/10.1093/geronb/gbu095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462671PMC
July 2015

Latent heterogeneity in long-term trajectories of body mass index in older adults.

J Aging Health 2013 Mar 21;25(2):342-63. Epub 2012 Dec 21.

Department of Internal Medicine/Geriatrics, Yale University, New Haven, CT 06510, USA.

Objective: To evaluate latent heterogeneity in long-term trajectories of body weight in older adults.

Methods: We analyzed 14-year longitudinal data on 10,314 older adults from the Health and Retirement Study. Semiparametric mixture models identified latent subgroups of similar trajectories of body mass index (BMI).

Results: Five distinct trajectory subgroups emerged: normal starting-BMI with accelerated increase over time (trajectory #1), overweight and increasing (trajectory #2), borderline-obese and increasing (trajectory #3), obese and increasing (trajectory #4), and morbidly obese with decelerating gain (trajectory #5). Blacks and Hispanics had greater risk of membership in ascending high-BMI trajectory groups. Females had approximately half the risk of following overweight and obese increasing BMI trajectories compared with males.

Discussion: Distinct latent subgroups of BMI trajectories and significant racial/ethnic and gender trajectory heterogeneity exist in the older adult population. The propensity of men and minorities to experience high-risk BMI trajectories may exacerbate existing disparities in morbidity/ mortality in older age.
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http://dx.doi.org/10.1177/0898264312468593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325276PMC
March 2013

Long-term trajectories of lower extremity function in older adults: estimating gender differences while accounting for potential mortality bias.

J Gerontol A Biol Sci Med Sci 2013 Jul 16;68(7):861-8. Epub 2012 Nov 16.

Yale University, Department of Internal Medicine/Geriatrics, 20 York Street, New Haven, Connecticut, USA.

Background: Gender-specific trajectories of lower extremity function (LEF) and the potential for bias in LEF estimation due to differences in survival have been understudied.

Methods: We evaluated longitudinal data from 690 initially nondisabled adults age 70 or older from the Precipitating Events Project. LEF was assessed every 18 months for 12 years using a modified Short Physical Performance Battery (mSPPB). Hierarchical linear models with adjustments for length-of-survival estimated the intraindividual trajectory of LEF and differences in trajectory intercept and slope between men and women.

Results: LEF declined following a nonlinear trajectory. In the full sample, and among participants with high (mSPPB 10-12) and intermediate (mSPPB 7-9) baseline LEF, the rate-of-decline in mSPPB was slower in women than in men, with no gender differences in baseline mSPPB scores. Among participants with low baseline LEF (mSPPB ≤6), men had a higher starting mSPPB score, whereas women experienced a deceleration in the rate-of-decline over time. In all groups, participants who survived longer had higher starting mSPPB scores and slower rates-of-decline compared with those who died sooner.

Conclusions: Over the course of 12 years, older women preserve LEF better than men. Nonadjustment for differences in survival results in overestimating the level and underestimating the rate-of-decline in LEF over time.
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http://dx.doi.org/10.1093/gerona/gls228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674712PMC
July 2013

The effect of stability and change in health behaviors on trajectories of body mass index in older Americans: a 14-year longitudinal study.

J Gerontol A Biol Sci Med Sci 2012 Oct 29;67(10):1075-84. Epub 2012 Mar 29.

Internal Medicine/Geriatrics Department, School of Medicine, Yale University, New Haven, CT 06510, USA.

Background: Obesity is increasingly prevalent among older adults, yet little is known about the impact of health behaviors on the trajectories of body weight in this age group.

Methods: We examined the effect of time-varying smoking, physical activity (PA), alcohol use, and changes thereof, on the 14-year (1992-2006) trajectory of body- mass index (BMI) in a cohort of 10,314 older adults from the Health and Retirements Study, aged 51-61 years at baseline. Hierarchical linear modeling (HLM) quantifies the effect of smoking, PA, and alcohol use (user status, initiation and cessation) on intercept and rate-of-change in BMI trajectory, and tests for variations in the strength of association between each behavior and BMI.

Results: Over 14 years (82,512 observations), BMI increased approximated by a quadratic function. Smoking and PA (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and PA resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased, while the strength of association between BMI trajectories and PA or alcohol use were constant over time. Socio-economic and health status differences explained the effects of alcohol use on BMI trajectory.

Conclusions: In older adults, smoking and PA, and changes thereof, vary in their long-term effect on trajectories of BMI. Barring increases in PA levels, older smokers who quit today are expected to gain significantly more weight than two decades ago. This knowledge is essential for the design of smoking cessation, physical activityPA, and weight-control interventions in older adults.
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http://dx.doi.org/10.1093/gerona/gls073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437967PMC
October 2012

The role of law in public health preparedness: opportunities and challenges.

J Health Polit Policy Law 2012 Apr 5;37(2):297-328. Epub 2011 Dec 5.

University of Michigan, USA.

We report the results of a study designed to assess and evaluate how the law shapes the public health system's preparedness activities. Based on 144 qualitative interviews conducted in nine states, we used a model that compared the objective legal environment with how practitioners perceived the laws. Most local public health and emergency management professionals relied on what they perceived the legal environment to be rather than on an adequate understanding of the objective legal requirements. Major reasons for the gap include the lack of legal training for local practitioners and the difficulty of obtaining clarification and consistent legal advice regarding public health preparedness. Narrowing the gap would most likely improve preparedness outcomes. We conclude that there are serious deficiencies in legal preparedness that can undermine effective responses to public health emergencies. Correcting the lack of legal knowledge, coupled with eliminating delays in resolving legal issues and questions during public health emergencies, could have measurable consequences on reducing morbidity and mortality.
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http://dx.doi.org/10.1215/03616878-1538629DOI Listing
April 2012

To test or not to test? The role of attitudes, knowledge, and religious involvement among U.S. adults on intent-to-obtain adult genetic testing.

Health Educ Behav 2011 Dec 11;38(6):617-28. Epub 2011 Apr 11.

University of Michigan, Ann Arbor, MI, USA.

Genetic testing can advance cancer prevention if current screening behaviors improve. Increased prevalence of high-risk genotypes within specific religious groups, use of religious venues for recruiting to genetic screening, and ethical-religious considerations argue for exploring the role of religiosity in forming genetic testing decisions. This study uses the theory of reasoned action and structural equation modeling to test the effects of religious involvement, attitudes, knowledge, and previous experience on intent-to-obtain genetic testing within a representative sample of 1,824 U.S. adults. A majority of respondents indicate willingness to test, especially for curable disorders. Attitudes, knowledge, and previous experience have significant direct effects, and religious involvement has an indirect effect, through its negative effect on attitudes, on intent-to-test. High religious involvement is associated with more negative attitudes toward genetic testing. The findings underscore the need to refine genetic testing outreach efforts to account for multiple influences on consumer intent-to-test.
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http://dx.doi.org/10.1177/1090198110389711DOI Listing
December 2011