Publications by authors named "Emiel O Hoogendijk"

78 Publications

The Accuracy of Four Frequently Used Frailty Instruments for the Prediction of Adverse Health Outcomes Among Older Adults at Two Dutch Emergency Departments: Findings of the AmsterGEM Study.

Ann Emerg Med 2021 Jul 23. Epub 2021 Jul 23.

Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands; Department of Internal Medicine and Vascular Medicine, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.

Study Objective: Older adults presenting to the emergency department (ED) are at high risk of adverse health outcomes. This study aimed to evaluate the accuracy of 4 frequently used screening instruments for the prediction of adverse health outcomes among older adults in the ED.

Methods: This was a prospective cohort study in patients ≥70 years of age presenting to the ED in 2 hospitals in the Netherlands. Screening instruments included the acutely presenting older patient screening program (APOP) (providing 2 risk scores-functional decline [APOP1] and mortality [APOP2]), the International Resident Assessment Instrument Emergendy Department screener (InterRAI ED), the Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP), and the safety management system (VMS). The primary outcome measure was a composite outcome encompassing functional decline, institutionalization, and mortality at 3 months after ED presentation. Other follow-up time points were 1 and 6 months. Analyses were performed to assess prognostic accuracy.

Results: In total, 889 patients were included. After 3 months, 267 (31%) patients experienced at least 1 adverse outcome. The positive likelihood ratio ranged from 1.67 (VMS) to 3.33 (APOP1), and the negative likelihood ratio ranged from 0.41 (ISAR-HP) to 0.88 (APOP2). Sensitivity ranged from 17% (APOP2) to 74% (ISAR-HP), and specificity ranged from 63% (ISAR-HP) to 94% (APOP2). The area under the curve ranged from 0.62 (APOP2) to 0.72 (APOP1 and ISAR-HP). Calibration was reasonable for APOP1 and VMS. The prognostic accuracy was comparable across all outcomes and at all follow-up time points.

Conclusion: The frailty screening instruments assessed in this study showed poor to moderate prognostic accuracy, which brings into question their usability in the prediction of adverse health outcomes among older adults who present to the ED.
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http://dx.doi.org/10.1016/j.annemergmed.2021.04.027DOI Listing
July 2021

Sarcopenia measurement in research and clinical practice.

Eur J Intern Med 2021 Jul 5. Epub 2021 Jul 5.

Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC - location VU University medical center, Amsterdam, the Netherlands. Electronic address:

Sarcopenia is a disease related to accelerated loss of skeletal muscle and subsequent decline in functional capacity. It affects approximately 13% of the world's population aged over 60 years. Sarcopenia is primarily managed and prevented through a combination of exercise prescription combined with appropriate nutritional strategies. This review outlines diagnostic and case finding/screening tools for age-related (primary) sarcopenia used in research and clinical practice. Diagnostic tools critically reviewed include those of the: European Workgroup for Sarcopenia (EWGSOP) versions 1 and 2; Asian Working Group for Sarcopenia (AWGS) versions 1 and 2; Foundation for the National Institutes of Health (FNIH); and the Sarcopenia Definition and Outcomes Consortium (SDOC). Criteria used by diagnostic tools (muscle mass, muscle strength and physical functioning/performance) are also detailed. Case-finding tools include the SARC-F questionnaire, Ishii's formula and Goodman's screening grid. Additionally, this review discusses the strengths and weaknesses of each diagnostic and case-finding tool, and examines their ability to reliably predict adverse clinical outcomes and patient responses to potential therapies.
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http://dx.doi.org/10.1016/j.ejim.2021.06.003DOI Listing
July 2021

Correction to: Multiple domains of functioning in older adults during the pandemic: design and basic characteristics of the Longitudinal Aging Study Amsterdam COVID-19 questionnaire.

Aging Clin Exp Res 2021 Jun 23. Epub 2021 Jun 23.

Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMCLocation VU University Medical Center, Amsterdam, The Netherlands.

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http://dx.doi.org/10.1007/s40520-021-01900-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219511PMC
June 2021

A 6-year prospective clinical cohort study on the bidirectional association between frailty and depressive disorder.

Int J Geriatr Psychiatry 2021 Jun 15. Epub 2021 Jun 15.

Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Introduction: Depressive disorder has been conceptualised as a condition of accelerated biological ageing. We operationalised a frailty index (FI) as marker for biological ageing aimed to explore the bidirectional, longitudinal association between frailty and either depressive symptoms or depressive disorder.

Methods: A cohort study with 6-year follow-up including 377 older (≥60 years) outpatients with a DSM-IV-defined depressive disorder and 132 never-depressed controls. Site visits at baseline, 2 and 6-year follow-up were conducted and included the CIDI 2.0 to assess depressive disorder and relevant covariates. Depressive symptom severity and mortality were assessed every 6 months by mail and telephone. A 41-item FI was operationalised and validated against the 6-year morality rate by Cox regression (HR  = 1.04 [95% CI: 1.02-1.06]).

Results: Cox regression showed that a higher FI was associated with a lower chance of remission among depressed patients (HR  = 0.98 [95% CI: 0.97-0.99]). Nonetheless, this latter effect disappeared after adjustment for baseline depressive symptom severity. Linear mixed models showed that the FI increased over time in the whole sample (B[SE] = 0.94 (0.12), p < .001) with a differential impact of depressive symptom severity and depressive disorder. Higher baseline depressive symptom severity was associated with an attenuated and depressive disorder with an accelerated increase of the FI over time.

Conclusions: The sum score of depression rating scales is likely confounded by frailty. Depressive disorder, according to DSM-IV criteria, is associated with accelerated biological ageing. This argues for the development of multidisciplinary geriatric care models incorporating frailty to improve the overall outcome of late-life depression.
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http://dx.doi.org/10.1002/gps.5588DOI Listing
June 2021

Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam.

Eur Geriatr Med 2021 May 28. Epub 2021 May 28.

Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands.

Purpose: Delay of routine medical care during the COVID-19 pandemic may have serious consequences for the health and functioning of older adults. The aim of this study was to investigate whether older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic, and to explore associations with health and socio-demographic characteristics.

Methods: Cross-sectional data of 880 older adults aged ≥ 62 years (mean age 73.4 years, 50.3% female) were used from the COVID-19 questionnaire of the Longitudinal Aging Study Amsterdam, a cohort study among community-dwelling older adults in the Netherlands. Cancellation and avoidance of care were assessed by self-report, and covered questions on cancellation of primary care (general practitioner), cancellation of hospital outpatient care, and postponed help-seeking. Respondent characteristics included age, sex, educational level, loneliness, depression, anxiety, frailty, multimorbidity and information on quarantine.

Results: 35% of the sample reported cancellations due to the COVID-19 situation, either initiated by the respondent (12%) or by healthcare professionals (29%). Postponed help-seeking was reported by 8% of the sample. Multimorbidity was associated with healthcare-initiated cancellations (primary care OR = 1.92, 95% CI = 1.09-3.50; hospital OR = 1.86, 95% CI = 1.28-2.74) and respondent-initiated hospital outpatient cancellations (OR = 2.02, 95% CI = 1.04-4.12). Depressive symptoms were associated with postponed help-seeking (OR = 1.15, 95% CI = 1.06-1.24).

Conclusion: About one third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. How this impacts outcomes in the long term should be investigated in future research.
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http://dx.doi.org/10.1007/s41999-021-00514-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159721PMC
May 2021

A narrative review of frailty assessment in older patients at the emergency department.

Eur J Emerg Med 2021 Aug;28(4):266-276

Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam, the Netherlands.

Optimizing emergency care for the aging population is an important future challenge, as the proportion of older patients at the emergency department (ED) rapidly increases. Older patients, particularly those who are frail, have a high risk of adverse outcomes after an ED visit, such as functional decline, institutionalization, and death. The ED can have a key position in identifying frail older patients who benefit most from comprehensive geriatric care [including delirium preventive measures, early evaluation of after-discharge care, and a comprehensive geriatric assessment (CGA)]. However, performing extensive frailty assessment is not suitable at the ED. Therefore, quick and easy-to-use instruments are needed to identify older patients at risk for adverse outcomes. This narrative review outlines the importance and complexity of frailty assessment at the ED. It aligns the available screening instruments, including clinical judgment as frailty assessment, and summarizes arguments for and against frailty assessment at the ED.
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http://dx.doi.org/10.1097/MEJ.0000000000000811DOI Listing
August 2021

Acceleration of health deficit accumulation in late-life: evidence of terminal decline in frailty index three years before death in the US Health and Retirement Study.

Ann Epidemiol 2021 06 1;58:156-161. Epub 2021 Apr 1.

Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria.

Background: Little is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life.

Material And Methods: A total of 23,393 observations from up to the last 21 years of life of 5713 deceased participants of the AHEAD cohort in the Health and Retirement Study were assessed. A FI with 32 health deficits was calculated for up to 10 successive biannual, self- and proxy-reported assessments (1995-2014), and FI changes according to time-to-death were analyzed with a piecewise linear mixed model with random change points.

Results: The average normal (preterminal) health deficit accumulation rate was 0.01 per year, which increased to 0.05 per year at approximately 3 years before death. Terminal decline began earlier in women and was steeper among men. The accelerated (terminal) rate of health deficit accumulation began at a FI-value of 0.29 in the total sample, 0.27 for men, and 0.30 for women.

Conclusion: We found evidence for an observable terminal health decline in the FI following declining physiological reserves and failing repair mechanisms. Our results suggest a conceptually meaningful cut-off value for the continuous FI around 0.30.
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http://dx.doi.org/10.1016/j.annepidem.2021.03.008DOI Listing
June 2021

Multiple domains of functioning in older adults during the pandemic: design and basic characteristics of the Longitudinal Aging Study Amsterdam COVID-19 questionnaire.

Aging Clin Exp Res 2021 May 15;33(5):1423-1428. Epub 2021 Mar 15.

Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, The Netherlands.

The Longitudinal Aging Study Amsterdam (LASA) is an ongoing cohort study among older adults in the Netherlands. Respondents are usually interviewed approximately every 3 years. Because of the exceptional situation of the COVID-19 pandemic, it was decided to add an extra assessment in between, consisting of a postal/digital questionnaire with measures assessing the impact of the COVID-19 situation, as well as a selection of measures from regular LASA measurement cycles covering the physical, social and mental domains. In total, 1128 LASA respondents aged 62-102 years provided data, just after the first wave of the pandemic in 2020. This paper describes the methods and design of the LASA COVID-19 questionnaire, as well as the basic characteristics of the sample, including an overview of impactful situations experienced by older adults during the first months of the pandemic. The data of the questionnaire may be used to study the impact of the COVID-19 pandemic on multiple domains of functioning in older adults.
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http://dx.doi.org/10.1007/s40520-021-01829-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957282PMC
May 2021

Serum 25-hydroxyvitamin D in relation to disability in activities of daily living, mobility, and objective physical functioning among Chinese older adults.

Exp Gerontol 2021 06 27;148:111290. Epub 2021 Feb 27.

Department of Big Data in Health Science and Center for Clinical Big Data and Analytics, Second Affiliated Hospital and School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. Electronic address:

Objectives: Vitamin D deficiency is common among older adults, but its association with physical function is not fully understood. The aim of this study was to investigate the associations between serum 25-hydroxyvitamin D and disability in activities of daily living (ADL), mobility, and objective physical functioning among Chinese older adults.

Methods: We used cross-sectional data of 2225 older adults (≥65 years) who participated in the 2011/2012 main survey of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the 2012 biomarker sub-study. Serum levels of 25-hydroxyvitamin D were measured by enzyme immunoassay. Outcomes included ADL disability, mobility disability, and disability in three objective physical examinations (standing-up from a chair, picking-up a book from the floor, and turning-around 360°).

Results: The multiple regression models suggested that participants in the serum 25-hydroxyvitamin D deficiency group had higher odds of ADL disability (OR: 4.08; 95% confidence interval (CI): 2.81, 5.92), mobility disability (OR: 1.59; 95% CI: 1.05, 2.41), and disability in standing-up from a chair (OR: 2.43; 95% CI: 1.60, 3.69), picking-up a book from the floor (OR: 3.09; 95% CI: 2.07, 4.60), and turning-around 360° (OR: 3.09; 95% CI: 2.07, 4.60). Subgroup analyses revealed that some of the above associations (particularly those with mobility disability and disability in turning-around 360°) were only statistically significant among the oldest-old.

Conclusions: Among the oldest-old in China, serum 25-hydroxyvitamin D deficiency was associated with disability in ADL, mobility, and objective physical functioning, highlighting the importance of managing the serum 25-hydroxyvitamin D level to promote healthy aging.
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http://dx.doi.org/10.1016/j.exger.2021.111290DOI Listing
June 2021

Inequalities in Frailty Among Older Turkish and Moroccan Immigrants and Native Dutch: Data from the Longitudinal Aging Study Amsterdam.

J Immigr Minor Health 2021 Feb 26. Epub 2021 Feb 26.

Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC-location VU University medical center, P.O. Box 7057, Amsterdam, 1007MB, the Netherlands.

Very few studies have investigated frailty among older immigrants in Europe. The aim of the current study was to investigate inequalities in frailty in young-olds related to gender, educational level and country of origin, as well as intersections between these characteristics. Cross-sectional data were used from older Turkish and Moroccan immigrants (n = 466) and native Dutch (n = 1,020), all aged 55-65 years and participating in the Longitudinal Aging Study Amsterdam. Frailty was assessed with a 30-item frailty index, based on the deficit accumulation approach. Frailty was higher among women, lower educated, and people with a migration background. Of all groups considered, frailty levels were the highest among Turkish immigrants. No statistically significant interaction effects between gender, educational level and country of origin were found. When targeting frailty interventions, special attention should be devoted to older immigrants, as they are the most vulnerable group with the highest frailty levels.
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http://dx.doi.org/10.1007/s10903-021-01169-9DOI Listing
February 2021

Trends in Frailty and Its Association With Mortality: Results From the Longitudinal Aging Study Amsterdam, 1995-2016.

Am J Epidemiol 2021 Jul;190(7):1316-1323

The aim of this study was to investigate trends in frailty and its relationship with mortality among older adults aged 64-84 years across a period of 21 years. We used data from 1995 to 2016 from the Longitudinal Aging Study Amsterdam. A total of 7,742 observations of 2,874 respondents in the same age range (64-84 years) across 6 measurement waves were included. Frailty was measured with a 32-item frailty index, with a cutpoint of ≥0.25 to indicate frailty. The outcome measure was 4-year mortality. Generalized estimating equation analyses showed that among older adults aged 64-84 years the 4-year mortality rate declined between 1995 and 2016, while the prevalence of frailty increased. Across all measurement waves, frailty was associated with 4-year mortality (odds ratio = 2.79, 95% confidence interval: 2.39, 3.26). There was no statistically significant interaction effect between frailty and time on 4-year mortality, indicating a stable association between frailty and mortality. In more recent generations of older adults, frailty prevalence rates were higher, while excess mortality rates of frailty remained the same. This is important information for health policy-makers and clinical practitioners, showing that continued efforts are needed to reduce frailty and its negative health consequences.
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http://dx.doi.org/10.1093/aje/kwab018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245891PMC
July 2021

The Functional Continuum Scale in Relation to Hospitalization Density in Older Adults: The FRADEA Study.

J Gerontol A Biol Sci Med Sci 2021 Jul;76(8):1512-1518

Geriatrics Department, Complejo Hospitalario Universitario de Albacete, Spain.

Background: There is a need to know the relationship between function and hospitalization risk in older adults. We aimed at investigating whether the Functional Continuum Scale (FCS), based on basic (BADL) and instrumental (IADL) activities of daily living and frailty, is associated with hospitalization density in older adults across 12 years of follow-up.

Methods: Cohort study, with a follow-up of 12 years. A total of 915 participants aged 70 years and older from the Frailty and Dependence in Albacete (FRADEA) study, a population-based study in Spain, were included. At baseline, the FCS, sociodemographic characteristics, comorbidity, number of medications, and place of residence were assessed. Associations with first hospitalization, number of hospitalizations, and 12-year density of hospitalizations were assessed using Kaplan-Meier curves, Poisson regression analyses, and density models.

Results: The median time until the first hospitalization was shorter toward the less functionally independent end of the FCS, from 3917 days (95% confidence interval [CI] 3701-3995) to 1056 days (95% CI 785-1645) (p < .001). The incidence rate ratio (IRR) for all hospitalizations increased from the robust category until the frail one (IRR 1.89), and thereafter it decreased until the worse functional category. Those who were BADL dependent presented an increased hospitalization density in the first 4 follow-up years (58%), those who were frail in the third-to-sixth follow-up years (55%), while in those prefrail or robust the hospitalization density was homogeneous during the complete follow-up.

Conclusions: The FCS is useful for stratifying the risk of hospitalization and for predicting the density of hospitalizations in older adults.
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http://dx.doi.org/10.1093/gerona/glab004DOI Listing
July 2021

Predictors of Frailty and Vitality in Older Adults Aged 75 years and Over: Results from the Longitudinal Aging Study Amsterdam.

Gerontology 2021 11;67(1):69-77. Epub 2021 Jan 11.

Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Introduction: Frailty can be seen as a continuum, from fit to frail. While many recent studies have focused on frailty, much less attention has been paid to the other end of the continuum: the group of older adults that remain (relatively) vital. Moreover, there is a lack of studies on frailty and vitality that investigate predictors from multiple domains of functioning simultaneously. The aim of this study was to identify predictors of frailty as well as vitality among older adults aged 75 years and over.

Methods: We used longitudinal data from 569 adults aged ≥75 years who participated in the Longitudinal Aging Study Amsterdam. Predictors from the sociodemographic, social, psychological, lifestyle, and physical domains of functioning were measured at T1 (2008-2009). We used the frailty index (FI) to identify frail (FI ≥ 0.25) and vital (FI ≤ 0.15) respondents at follow-up, 3 years later (T2: 2011-2012). We conducted logistic regression analyses with backward stepwise selection to develop and internally validate our prediction models.

Results: The prevalence of frailty in our sample at follow-up was 49.4% and the prevalence of vitality was 18.3%. Predictors of frailty and vitality partly overlapped and included age, depressive symptoms, number of chronic diseases, and self-rated health. We also found predictors that did not overlap. Male sex, moderate alcohol use, more emotional support received, and no hearing problems, were predictors of vitality. Lower cognitive functioning, polypharmacy, and pain were predictors of frailty. The final model for vitality explained 42% of the variance and the final model for frailty explained 48%. Both models had a good discriminative value (area under ROC-curve [AUC] vitality: 0.88; AUC frailty: 0.85).

Conclusion: Among older adults aged 75 years and over, predictors of frailty only partially overlap with predictors of vitality. The readily accessible predictors in our models may help to identify older adults who are likely to be vital, or who are at risk of frailty.
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http://dx.doi.org/10.1159/000512049DOI Listing
January 2021

Cognitive frailty in relation to adverse health outcomes independent of multimorbidity: results from the China health and retirement longitudinal study.

Aging (Albany NY) 2020 11 18;12(22):23129-23145. Epub 2020 Nov 18.

National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

Our objectives were to evaluate: 1) the associations of cognitive frailty with various health outcomes including disability, hospitalization, and death; 2) whether the associations differed by multimorbidity. We included data of 5113 Chinese older adults (aged 60+ years) who had baseline cognition and physical frailty assessments (2011 wave) and follow-up for 4 years. About 16.0% (n=820) had cognitive impairment; 6.7% (n=342) had physical frailty; and 1.6% (n=82) met criteria for cognitive frailty. Both cognitive impairment (odds ratios (ORs) range: 1.41 to 2.11) and physical frailty (ORs range: 1.51 to 2.43) were independently associated with basic activities of daily living (BADL), instrumental ADL (IADL), mobility disability, hospitalization, and death among participants without that corresponding outcome at baseline, even after accounting for covariates. Relative to participants who had normal cognition and were nonfrail, those with cognitive frailty had the highest risk for IADL disability (OR=3.40, 95% CI, 1.23-9.40) and death (OR=3.89, 95% CI, 2.25-6.47). We did not find significant interaction effects between cognitive frailty and multimorbidity (P>0.05). Overall, cognitive frailty was associated with disability and death, independent of multimorbidity. This highlights the importance of assessing cognitive frailty in the community to promote primary and secondary preventions for healthy aging.
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http://dx.doi.org/10.18632/aging.104078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746379PMC
November 2020

Frailty changes predict mortality in four longitudinal studies of aging.

J Gerontol A Biol Sci Med Sci 2020 Oct 26. Epub 2020 Oct 26.

Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria.

Background: Baseline frailty index (FI) values have been shown to predict mortality among older adults, but little is known about the effects of changes in FI on mortality.

Methods: In a coordinated approach, we analyzed data from four population-based cohorts: the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Survey of Ageing (ELSA) and the Longitudinal Aging Study Amsterdam (LASA), comprising a total of 24,961 respondents (65+), 95,897 observations, up to 9 repeated FI assessments, and up to 23 years of mortality follow-up. The effect of time-varying FI on mortality was modeled with joint regression models for longitudinal and time-to-event data.

Results: Differences (of 0.01) in current FI levels (HR=1.04, CI-95%=1.03-1.05) and baseline FI levels (HR=1.03, CI-95%=1.03-1.05) were consistently associated with mortality across studies. Importantly, individuals with steeper FI growth also had a higher mortality risk: an increase in annual FI growth by 0.01 was associated with an increased mortality risk of HRHRS=1.56 (CI-95%=1.49-1.63), HRSHARE=1.24 (CI-95%=1.13-1.35), HRELSA=1.40 (CI-95%=1.25-1.52), and HRLASA=1.71 (CI-95%=1.46-2.01).

Conclusion: FI changes predicted mortality independently of baseline FI differences. Repeated assessment of frailty and individual's frailty trajectory could provide a means to anticipate further health deterioration and mortality, and could thus support clinical decision making.
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http://dx.doi.org/10.1093/gerona/glaa266DOI Listing
October 2020

The Importance of Engaging in Physical Activity in Older Adulthood for Transitions between Cognitive Status Categories and Death: A Coordinated Analysis of Fourteen Longitudinal Studies.

J Gerontol A Biol Sci Med Sci 2020 Oct 25. Epub 2020 Oct 25.

Department of Psychology, University of Victoria, Victoria, BC, Canada.

Background: Given increasing incidence of cognitive impairment and dementia, further understanding of modifiable factors contributing to increased healthspan is crucial. Extensive literature provides evidence that physical activity (PA) delays the onset of cognitive impairment; however, it is unclear whether engaging in PA in older adulthood is sufficient to influence progression through cognitive status categories.

Methods: Applying a coordinated analysis approach, this project independently analyzed fourteen longitudinal studies (NTotal = 52,039; mean baseline age across studies= 69.9-81.73) from North America and Europe using multi-state survival models to estimate the impact of engaging in PA on cognitive status transitions (non-impaired, mildly impaired, severely impaired) and death. Multinomial regression models were fit to estimate life expectancy (LE) based on American PA recommendations. Meta-analyses provided the pooled effect sizes for the role of PA on each transition and estimated LEs.

Results: Controlling for baseline age, sex, education and chronic conditions, analyses revealed that more PA is significantly associated with decreased risk of transitioning from non-impaired to mildly impaired cognitive functioning and death, as well as substantially longer LE. Results also provided evidence for a protective effect of PA after onset of cognitive impairment (e.g., decreased risk of transitioning from mild to severe cognitive impairment; increased likelihood of transitioning backward from severe to mild cognitive impairment), though between-study heterogeneity suggests a less robust association.

Conclusions: These results yield evidence for the importance of engaging in PA in older adulthood for cognitive health, and a rationale for motivating older adults to engage consistently in PA.
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http://dx.doi.org/10.1093/gerona/glaa268DOI Listing
October 2020

Ferritin measurement IN Donors-Effectiveness of iron Monitoring to diminish iron deficiency and low haemoglobin in whole blood donors (FIND'EM): study protocol for a stepped wedge cluster randomised trial.

Trials 2020 Oct 1;21(1):823. Epub 2020 Oct 1.

Donor Studies, Sanquin Research, Amsterdam, The Netherlands.

Background: Blood donors are at risk for reduced iron stores, because of which donor iron monitoring received increased attention in the last decade. Despite the importance for donor health, international consensus on an appropriate policy for iron monitoring is lacking. Therefore, we conduct a trial to evaluate to what extent ferritin-guided donation intervals are effective in increasing haemoglobin and ferritin levels, decreasing low-haemoglobin deferral, increasing donor return and improving the health of whole blood donors in the Netherlands.

Methods: Sanquin Blood Bank is implementing ferritin-guided donation intervals to prevent donors from increasing iron loss at repeated donations. Using a stepped wedge cluster randomised trial approach, the design involves a random crossover of 29 clusters of blood collection centres from the existing policy without ferritin measurements to a ferritin-guided donation interval policy. This new policy includes ferritin measurements for all new donors and at every 5th whole blood donation, extending donation intervals to 6 months if ferritin is 15-≤ 30 ng/mL and to 12 months if ferritin is < 15 ng/mL. We measure ferritin levels of whole blood donors from stored plasma samples and collect haemoglobin levels and information on low-haemoglobin deferral and donor return from the donor database before, during and after the implementation period. We measure donor health during and after the implementation period using questionnaires, assessing physical and mental wellbeing and iron deficiency- and donation-related symptoms. We use multilevel analyses to investigate differences in ferritin and haemoglobin levels, low-haemoglobin deferral rates, donor return and donor health from whole blood donors, between blood collection centres that have versus those that have not yet implemented the ferritin-guided donation interval policy.

Discussion: This stepped wedge cluster randomised trial will provide insight into the effectiveness of ferritin-guided donation intervals in lowering iron deficiency, decreasing donor deferrals due to low haemoglobin and improving donor health. We will evaluate a policy that is implemented nationwide in a real-life setting. Our study is therefore not limited to a small experimental setting and the results will guide policymakers seeking an appropriate policy for iron monitoring.

Trial Registration: The Dutch trial registry NTR6738 . Registered on 29 September 2017. Retrospectively registered.
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http://dx.doi.org/10.1186/s13063-020-04648-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528293PMC
October 2020

Occupational Exposures Associated with Life Expectancy without and with Disability.

Int J Environ Res Public Health 2020 09 1;17(17). Epub 2020 Sep 1.

Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, 1081 Amsterdam, The Netherlands.

Policies to extend working lives often do not take into account potentially important health inequalities arising from differences in occupational exposures. Little is known about which occupational exposures are associated with these inequalities. This study aims to examine differences in life expectancy without and with disability by occupational exposures. Longitudinal data (1992-2016) on disability and physical and psychosocial work demands and resources of 2513 (former) workers aged ≥55 years participating in the Longitudinal Aging Study Amsterdam were used. Gender specific life expectancies without and with disability by occupational exposures were calculated using multistate survival models. Women aged 55 years with high physical work demands had a lower life expectancy without disability than those with low exposure (1.02-1.57 years), whereas there was no difference for men. Men and women with high psychosocial work demands and resources had a longer life expectancy without disability than those with low exposure (1.19-2.14 years). Life expectancy with disability did not significantly differ across occupational exposures. Workers with higher psychosocial demands and resources and lower physical demands can expect to live more disability-free years. Information on occupational exposure helps to identify workers at risk for lower life expectancy, especially without disability, who may need specific support regarding their work environment.
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http://dx.doi.org/10.3390/ijerph17176377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503628PMC
September 2020

Frailty Combined with Loneliness or Social Isolation: An Elevated Risk for Mortality in Later Life.

J Am Geriatr Soc 2020 11 23;68(11):2587-2593. Epub 2020 Jul 23.

Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Background/objectives: Frailty, loneliness, and social isolation are all associated with adverse outcomes in older adults, but little is known about their combined impact on mortality.

Design: Prospective cohort study.

Setting: The Longitudinal Aging Study Amsterdam.

Participants: Community-dwelling older adults aged 65 and older (n = 1,427).

Measurements: Frailty was measured with the frailty phenotype (Fried criteria). Loneliness was assessed with the De Jong Gierveld Loneliness Scale. Social isolation was operationalized using information on partner status, social support, and network size. Two categorical variables were created, for each possible combination regarding frailty and loneliness (FL) and frailty and social isolation (FS), respectively. Mortality was monitored over a period of 22 years (1995-2017). Survival curves and Cox proportional hazard models were used to study the effects of the FL and FS combinations on mortality. Analyses were adjusted for sociodemographic factors, depression, chronic diseases, and smoking.

Results: Frailty prevalence was 13%, and 5.9% of the sample were frail and lonely, and 6.2% frail and socially isolated. In fully adjusted models, older adults who were only frail had a higher risk of mortality compared with people without any of the conditions (hazard ratio [HR] range = 1.40-1.48; P < .01). However, the highest risk of mortality was observed in people with a combined presence of frailty and loneliness or social isolation (HR = 1.83; 95% confidence interval [CI] = 1.42-2.37; HR = 1.77; 95% CI = 1.36-2.30). Sensitivity analyses using a frailty index based on the deficit accumulation approach instead of the frailty phenotype showed similar results, confirming the robustness of our findings.

Conclusion: Frail older adults are at increased risk of mortality, but this risk is even higher for those who are also lonely or socially isolated. To optimize well-being and health outcomes in physically frail older adults, targeted interventions focusing on both subjective and objective social vulnerability are needed.
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http://dx.doi.org/10.1111/jgs.16716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689758PMC
November 2020

Ignoring competing events in the analysis of survival data may lead to biased results: a nonmathematical illustration of competing risk analysis.

J Clin Epidemiol 2020 06 9;122:42-48. Epub 2020 Mar 9.

Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, the Netherlands.

Objective: Competing events are often ignored in epidemiological studies. Conventional methods for the analysis of survival data assume independent or noninformative censoring, which is violated when subjects that experience a competing event are censored. Because many survival studies do not apply competing risk analysis, we explain and illustrate in a nonmathematical way how to analyze and interpret survival data in the presence of competing events.

Study Design And Setting: Using data from the Longitudinal Aging Study Amsterdam, both marginal analyses (Kaplan-Meier method and Cox proportional-hazards regression) and competing risk analyses (cumulative incidence function [CIF], cause-specific and subdistribution hazard regression) were performed. We analyzed the association between sex and depressive symptoms, in which death before the onset of depression was a competing event.

Results: The Kaplan-Meier method overestimated the cumulative incidence of depressive symptoms. Instead, the CIF should be used. As the subdistribution hazard model has a one-to-one relation with the CIF, it is recommended for prediction research, whereas the cause-specific hazard model is recommended for etiologic research.

Conclusion: When competing risks are present, the type of research question guides the choice of the analytical model to be used. In any case, results should be presented for all event types.
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http://dx.doi.org/10.1016/j.jclinepi.2020.03.004DOI Listing
June 2020

Frailty modifies the intervention effect of chair yoga on pain among older adults with lower extremity osteoarthritis: Secondary analysis of a nonpharmacological intervention trial.

Exp Gerontol 2020 Feb 20;134:110886. Epub 2020 Feb 20.

Department of Pathology, Yale School of Medicine, New Haven, CT, USA; Department of Precision Health and Data Science, School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address:

Objective: In an 8-week nonpharmacological pain intervention trial among older adults with lower extremity osteoarthritis (OA), we aimed to examine: a) the baseline frailty level of the participants; b) whether such intervention is more beneficial for baseline frailer older adults than for their counterparts with less frailty; and c) whether the intervention could also alter frailty.

Methods: Participants were randomly assigned to either chair yoga (CY) or health education program (HEP) groups and attended twice-weekly 45-minute CY or HEP sessions for 8 weeks. Following a standard procedure, 82 variables were used to construct a frailty index (FI, 0-1). Primary outcomes were: Western Ontario and McMaster Universities (WOMAC) pain and pain interference. Linear mixed-effects models were used to evaluate the modifying effect of baseline frailty on the intervention effect of CY on primary outcomes. Similar models were used to evaluate the effect of CY on frailty.

Results: A total of 112 participants (n = 63 CY, n = 49 HEP; 75.3 [SD = 7.5] years) with 85 females (75.9%) were included. The mean values of baseline FI for the CY and HEP groups were similar (0.428 [0.05] and 0.433 [0.05], P = 0.355). Each 0.01 increment in baseline FI was associated with higher WOMAC pain (beta = 0.28, P < 0.001) and pain interference (beta = 0.51, P < 0.001). There was a significant interaction effect between intervention, time, and baseline FI (P = 0.020 for WOMAC pain; P = 0.010 for pain interference), indicating that participants with higher level of baseline FI had greater declines in WOMAC pain and pain interference. There was no significantly greater decline in FI for the CY group compared to the HEP group (between-group difference - 0.01; P = 0.509) and there were no significant trend changes in FI (P for interaction = 0.605).

Conclusions: Frailty modifies the intervention effect of CY on pain among older adults with lower extremity OA, underscoring the importance of assessing frailty to improve the management of pain in this population.
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http://dx.doi.org/10.1016/j.exger.2020.110886DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438234PMC
February 2020

Operationalization of a frailty index among older adults in the InCHIANTI study: predictive ability for all-cause and cardiovascular disease mortality.

Aging Clin Exp Res 2020 Jun 31;32(6):1025-1034. Epub 2020 Jan 31.

Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background: The frailty index (FI) is a sensitive instrument to measure the degree of frailty in older adults, and is increasingly used in cohort studies on aging.

Aims: To operationalize an FI among older adults in the "Invecchiare in Chianti" (InCHIANTI) study, and to validate its predictive capacity for mortality.

Methods: Longitudinal data were used from 1129 InCHIANTI participants aged ≥ 65 years. A 42-item FI was operationalized following a standard procedure using baseline data (1998/2000). Associations of the FI with 3- and 6-year all-cause and cardiovascular disease (CVD) mortality were studied using Cox regression. Predictive accuracy was estimated by the area under the ROC curve (AUC), for a continuous FI score and for different cut-points.

Results: The median FI was 0.13 (IQR 0.08-0.21). Scores were higher in women, and at advanced age. The FI was associated with 3- and 6-year all-cause and CVD mortality (HR range per 0.01 FI increase = 1.03-1.07, all p < 0.001). The continuous FI score predicted the mortality outcomes with moderate-to-good accuracy (AUC range 0.72-0.83). When applying FI cut-offs between 0.15 and 0.35, the accuracy of this FI for predicting mortality was moderate (AUC range 0.61-0.76). Overall, the predictive accuracy of the FI was higher in women than in men.

Conclusions: The FI operationalized in the InCHIANTI study is a good instrument to grade the risk of all-cause mortality and CVD mortality. More measurement properties, such as the responsiveness of this FI when used as outcome measure, should be investigated in future research.
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http://dx.doi.org/10.1007/s40520-020-01478-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260260PMC
June 2020

Invited Commentary: Adult Child Migration and Parental Cognitive Decline-A New Perspective on Loneliness and Social Isolation.

Am J Epidemiol 2020 08;189(8):770-772

There is a growing body of research on the link between social isolation, loneliness, and health outcomes in later life, including cognitive decline and dementia. In the current issue of the Journal, Torres et al. (Am J Epidemiol. 2020;189(8):761-769) present findings from a study of the association between adult child migration status and cognitive performance among parents who stayed behind in Mexico, using longitudinal data (2001-2015) from the Mexican Health and Aging Study. This is an excellent example of the role that emotional and social factors may play in the development of cognitive impairment among older adults. In their study, having an adult child in the United States was associated with a steeper decline in verbal memory scores over time, but only among women. In the light of the increasing levels of immigration worldwide, this work is highly relevant, as it touches upon a less recognized socioemotional risk factor for cognitive decline: family-member migration status. Further research on this topic should be conducted in other countries and should include assessment of the social and emotional needs of those staying behind when a family member migrates. This will increase our understanding of how social isolation and loneliness relate to cognitive decline and may contribute to new directions for interventions.
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http://dx.doi.org/10.1093/aje/kwz278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407244PMC
August 2020

Gait speed as predictor of transition into cognitive impairment: Findings from three longitudinal studies on aging.

Exp Gerontol 2020 01 18;129:110783. Epub 2019 Nov 18.

Department of Psychology, University of Victoria, Victoria, BC, Canada; Centre for Dementia Prevention, The University of Edinburgh, Edinburgh, UK.

Objectives: Very few studies looking at slow gait speed as early marker of cognitive decline investigated the competing risk of death. The current study examines associations between slow gait speed and transitions between cognitive states and death in later life.

Methods: We performed a coordinated analysis of three longitudinal studies with 9 to 25 years of follow-up. Data were used from older adults participating in H70 (Sweden; n = 441; aged ≥70 years), InCHIANTI (Italy; n = 955; aged ≥65 years), and LASA (the Netherlands; n = 2824; aged ≥55 years). Cognitive states were distinguished using the Mini-Mental State Examination. Slow gait speed was defined as the lowest sex-specific quintile at baseline. Multistate models were performed, adjusted for age, sex and education.

Results: Most effect estimates pointed in the same direction, with slow gait speed predicting forward transitions. In two cohort studies, slow gait speed predicted transitioning from mild to severe cognitive impairment (InCHIANTI: HR = 2.08, 95%CI = 1.40-3.07; LASA: HR = 1.33, 95%CI = 1.01-1.75) and transitioning from a cognitively healthy state to death (H70: HR = 3.30, 95%CI = 1.74-6.28; LASA: HR = 1.70, 95%CI = 1.30-2.21).

Conclusions: Screening for slow gait speed may be useful for identifying older adults at risk of adverse outcomes such as cognitive decline and death. However, once in the stage of more advanced cognitive impairment, slow gait speed does not seem to predict transitioning to death anymore.
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http://dx.doi.org/10.1016/j.exger.2019.110783DOI Listing
January 2020

Frailty: implications for clinical practice and public health.

Lancet 2019 10;394(10206):1365-1375

Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA.

Frailty is an emerging global health burden, with major implications for clinical practice and public health. The prevalence of frailty is expected to rise alongside rapid growth in the ageing population. The course of frailty is characterised by a decline in functioning across multiple physiological systems, accompanied by an increased vulnerability to stressors. Having frailty places a person at increased risk of adverse outcomes, including falls, hospitalisation, and mortality. Studies have shown a clear pattern of increased health-care costs and use associated with frailty. All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Lifestyle and clinical risk factors are potentially modifiable by specific interventions and preventive actions. The concept of frailty is increasingly being used in primary, acute, and specialist care. However, despite efforts over the past three decades, agreement on a standard instrument to identify frailty has not yet been achieved. In this Series paper, we provide an overview of the global impact and burden of frailty, the usefulness of the frailty concept in clinical practice, potential targets for frailty prevention, and directions that need to be explored in the future.
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http://dx.doi.org/10.1016/S0140-6736(19)31786-6DOI Listing
October 2019

The Longitudinal Aging Study Amsterdam: cohort update 2019 and additional data collections.

Eur J Epidemiol 2020 Jan 25;35(1):61-74. Epub 2019 Jul 25.

Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.

The Longitudinal Aging Study Amsterdam (LASA) is a prospective cohort study of older adults in the Netherlands, initially based on a nationally representative sample of people aged 55-84 years. The study has been ongoing since 1992, and focuses on the determinants, trajectories and consequences of physical, cognitive, emotional and social functioning. Strengths of the LASA study include its multidisciplinary character, the availability of over 25 years of follow-up, and the cohort-sequential design that allows investigations of longitudinal changes, cohort differences and time trends in functioning. The findings from LASA have been reported in over 600 publications so far (see www.lasa-vu.nl). This article provides an update of the design of the LASA study and its methods, on the basis of recent developments. We describe additional data collections, such as additional nine-monthly measurements in-between the regular three-yearly waves that have been conducted among the oldest old during 2016-2019, and the inclusion of a cohort of older Turkish and Moroccan migrants.
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http://dx.doi.org/10.1007/s10654-019-00541-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058575PMC
January 2020

High dephospho-uncarboxylated matrix Gla protein concentrations, a plasma biomarker of vitamin K, in relation to frailty: the Longitudinal Aging Study Amsterdam.

Eur J Nutr 2020 Apr 8;59(3):1243-1251. Epub 2019 May 8.

Department of Epidemiology and Biostatistics, and the Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, The Netherlands.

Purpose: No previous study has evaluated the relationship between vitamin K and frailty. Thus, we assessed the relationship between vitamin K status and frailty over 13 years in the Longitudinal Aging Study Amsterdam (LASA).

Methods: Prospective cohort study with 644 community-dwelling adults ≥ 55 years from the LASA cohort. In 2002-2003, plasma desphospho-uncarboxylated matrix Gla protein (dp-ucMGP) was measured as marker of vitamin K status through a sandwich ELISA. Frailty was measured at baseline and in four follow-up examinations with the LASA Frailty Index (LASA-FI), which was used as both a continuous and a dichotomous measure (FI ≥ 0.25), as indicator of the degree of frailty and frailty risk, respectively. Statistical analyses were performed with multivariable generalized estimating equations using the lowest dp-ucMGP tertile, reflecting a high vitamin K status, as reference.

Results: The mean (SD) age was 59.9 (2.9) years, and 54% were female. Compared with the lowest tertile, the medium and highest dp-ucMGP tertile were associated with a higher degree of frailty [1.40, 95% confidence interval (0.01-2.81) and 1.62, (0.18-3.06), respectively. P trend: 0.03]. Additionally, the medium and highest dp-ucMGP tertile had a higher odds ratio of frailty [1.75 (1.11-2.77) and 1.63 (1.04-2.57), respectively]. The degree of frailty increased over time, but the differences by dp-ucMGP tertiles existed since baseline and remained stable during follow-up.

Conclusions: Baseline plasma low vitamin K status was associated with a greater degree of frailty and frailty risk in this cohort of older adults, which highlights the importance of ensuring an optimal nutritional status of this vitamin to prevent frailty in later life.
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http://dx.doi.org/10.1007/s00394-019-01984-9DOI Listing
April 2020

Neighbourhood characteristics and prevalence and severity of depression: pooled analysis of eight Dutch cohort studies.

Br J Psychiatry 2019 08 6;215(2):468-475. Epub 2019 May 6.

Professor,Amsterdam UMC, Vrije Universiteit Amsterdam,Department of Psychiatry,Amsterdam Public Health; andGGZ inGeest Specialized Mental Health Care, Research and Innovation, the Netherlands.

Background: Studies on neighbourhood characteristics and depression show equivocal results.AimsThis large-scale pooled analysis examines whether urbanisation, socioeconomic, physical and social neighbourhood characteristics are associated with the prevalence and severity of depression.

Method: Cross-sectional design including data are from eight Dutch cohort studies (n = 32 487). Prevalence of depression, either DSM-IV diagnosis of depressive disorder or scoring for moderately severe depression on symptom scales, and continuous depression severity scores were analysed. Neighbourhood characteristics were linked using postal codes and included (a) urbanisation grade, (b) socioeconomic characteristics: socioeconomic status, home value, social security beneficiaries and non-Dutch ancestry, (c) physical characteristics: air pollution, traffic noise and availability of green space and water, and (d) social characteristics: social cohesion and safety. Multilevel regression analyses were adjusted for the individual's age, gender, educational level and income. Cohort-specific estimates were pooled using random-effects analysis.

Results: The pooled analysis showed that higher urbanisation grade (odds ratio (OR) = 1.05, 95% CI 1.01-1.10), lower socioeconomic status (OR = 0.90, 95% CI 0.87-0.95), higher number of social security beneficiaries (OR = 1.12, 95% CI 1.06-1.19), higher percentage of non-Dutch residents (OR = 1.08, 95% CI 1.02-1.14), higher levels of air pollution (OR = 1.07, 95% CI 1.01-1.12), less green space (OR = 0.94, 95% CI 0.88-0.99) and less social safety (OR = 0.92, 95% CI 0.88-0.97) were associated with higher prevalence of depression. All four socioeconomic neighbourhood characteristics and social safety were also consistently associated with continuous depression severity scores.

Conclusions: This large-scale pooled analysis across eight Dutch cohort studies shows that urbanisation and various socioeconomic, physical and social neighbourhood characteristics are associated with depression, indicating that a wide range of environmental aspects may relate to poor mental health.Declaration of interestNone.
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http://dx.doi.org/10.1192/bjp.2019.100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872255PMC
August 2019

Trends across 20 years in multiple indicators of functioning among older adults in the Netherlands.

Eur J Public Health 2019 12;29(6):1096-1102

Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.

Background: Monitoring of trends in functioning of older adults provides indispensable information for health care policy. This study examined trends in multiple indicators of functioning among Dutch older adults across a period of 20 years.

Methods: Data from the Longitudinal Aging Study Amsterdam were used. We included 10 870 observations of 3803 respondents aged 64-84 years across seven waves (1992-12) and 931 observations of 603 respondents aged 85-94 years across four waves (2001-12). At each wave, 8 indicators of functioning were measured: multimorbidity, severe functional limitations, depression, anxiety, cognitive impairment, physical inactivity, loneliness and social isolation. In addition, a sum score (range: 0-8) of these indicators was calculated, with a score of ≥5 indicating 'multiple problems.' Trends in functioning over time were assessed using Generalized Estimating Equation analyses.

Results: In the 64-84-years-olds, the prevalence of multimorbidity increased over time [OR(year) = 1.06, 95% CI = 1.05-1.06], whereas the prevalence of the other indicators decreased [i.e. cognitive impairment, physical inactivity (in women) and loneliness (in women)] or remained stable [i.e. severe functional limitations, depression, anxiety, physical inactivity (in men), loneliness (in men) and social isolation]. In the 85-94-year-olds, the prevalence of severe functional limitations increased over time [OR(year) = 1.08, 95% CI = 1.02-1.13], whereas the prevalence of the other indicators remained stable. In both age groups, the prevalence of 'multiple problems' remained stable.

Conclusion: Unfavorable trends were observed in multimorbidity among 64-84-years-olds and in severe functional limitations among 85-94-year-olds. Favorable trends were found in cognitive impairment, physical inactivity (in women) and loneliness (in women) among 64-84-years-olds.
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http://dx.doi.org/10.1093/eurpub/ckz065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896978PMC
December 2019

The Social Support-Health Link Unraveled: Pathways Linking Social Support to Functional Capacity in Later Life.

J Aging Health 2020 Aug-Sep;32(7-8):616-626. Epub 2019 Apr 15.

Vrije Universiteit Amsterdam, The Netherlands.

Despite evidence that social support is strongly related to health, very little is known about the mechanisms underlying this association. This study investigates whether physical activity, depressive symptoms, and chronic diseases mediate the associations between social support and functional capacity. Data from the Longitudinal Aging Study Amsterdam on 954 participants, aged 75 and older, covering 9 years, are analyzed with latent growth mediation models. Only the indirect path from the initial level of emotional support to the initial level of functional capacity through the initial level of depressive symptoms was significant. All mediators however were significantly associated with the level of and changes in functional capacity. Models with reversed pathways were estimated, but model fit was worse. Because only initial levels of social support relate to functional capacity, and changes in social support do not, older adults likely receive the support they need.
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http://dx.doi.org/10.1177/0898264319841949DOI Listing
March 2021
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