Aprille Sham

Social Determinants of Frailty

Background: Frailty represents a body-wide set of a linked deterioration that occurs with ageing, but is susceptible to active intervention and is reversible. The concept of frailty should include broader environmental factors. A quantitative measure of frailty, the frailty index (FI), developed for elderly Canadians and shown to be valid for an elderly Chinese population, was examined for its association with socioeconomic, lifestyle, and social support network factors in an elderly Chinese cohort. Objective: 2,032 people aged 70 years and over recruited by stratified random sampling of the population were surveyed in 1990–1991, and information obtained regarding physical and functional health, psychological factors, lifestyle, socioeconomic and social support factors. The FI was constructed from 62 variables covering cognitive, psychological and physical health, and tested for association with socioeconomic, lifestyle and social support factors using ANOVA and t test. Results: The mean FI for women was higher than for men (0.16 ± 0.08, n = 1,033 vs. 0.13 ± 0.08, n = 999, p < 0.001, t test). For men, increasing frailty was observed with non-white collar occupations, inadequate expenses, no or little exercise, abstinence from alcohol, few relatives or neighbours and no or infrequent participation in helping others. For women, little contact with relatives (rather than number of relatives), and absence of participation in community/religious activities were additional factors. Conclusion: FI is influenced by social and environmental factors in keeping with the concept of frailty being multi-dimensional. Such a quantitative measure may be a useful indicator of the health of elderly populations as well as for public health measures to combat frailty.

Impact of caregiving on health and quality of life : a comparative population-based study of caregivers for elderly persons and noncaregivers

This study aims to investigate the impact of caregiving on the health status and quality of life (QOL) of primary informal caregivers (PCGs) of elderly care recipients in Hong Kong. A total of 246 PCGs and 492 matched noncaregiver (NCG) controls were identified in a population-based cross-sectional study through random telephone dialing. Their health status and QOL were assessed based on structured questionnaires and Short Form 36 (SF-36) Health Survey. Multiple conditional logistic regression analysis showed that compared with NCGs, PCGs had significantly increased risks for reporting worse health, more doctor visits, anxiety and depression, and weight loss. Female PCGs were more likely to report chronic diseases, symptoms, and insomnia. PCGs, particularly women, had significantly lower scores in all eight domains of SF-36 Health Survey. High caregiver burden score (Zarit Burden Scale) was positively associated with adverse physical and psychological health and poorer QOL. The results indicate that PCGs, particularly women, had an adverse physical and psychological health profile and poorer QOL compared with NCGs.

Longitudinal Changes in Body Mass Index and Body Composition over 3 Years and Relationship to Health Outcomes in Hong Kong Chinese Age 70 and Older

OBJECTIVES: To determine longitudinal changes in body mass index (BMI) and body composition with age and the relationship between these changes with mortality, morbidity, functional capacity, and other health outcome measures.

Soy protein consumption and bone mass in early postmenopausal Chinese women

Recent interest has been shown in the potential beneficial effects of phytoestrogens on bone health. As the early years of menopause are a period of rapid bone loss, and the risk for osteoporosis increases substantially, the habitual intake of soy protein and isoflavones may play a role in the retardation of bone loss. This paper reports the results of the baseline cross-sectional analysis of the association between dietary soy protein intake and bone mineral density/content in a population-based study of Chinese women. The sample comprised 454 healthy Chinese women (mean age 55.1±3.57) within the first 12 years of postmenopause. We estimated the dietary intake of soy protein and isoflavones, and other key nutrients, including dietary protein and calcium, using the quantitative food frequency method. Bone mineral density (BMD) and content (BMC) at the spine, hip and total body were measured with a dual energy X-ray densitometer (Hologic 4500A). Soy protein consumption was categorized as quartiles of intake, and related to BMD values at the spine and hip, and BMC of total body. Stratified analyses were carried out among women within or at least 4 years postmenopausal. We observed few differences in BMD/BMC values among the intake quartiles in women within the first 4 years of menopause. However, among the later postmenopausal women, we noted a dose-response relationship with increasing higher BMD values at the trochanter, intertrochanter as well as the total hip and total body with increasing soy protein intake quartiles (P<0.05 from tests for trend). The BMD values differed by about 4–8% between the first and fourth soy protein intake quartiles. Though women from the fourth intake quartile had a 2.9% higher BMD value compared with those from the first intake quartile, the difference was not statistically significant. Stepwise multiple linear regression analyses showed the association between soy intake quartiles and hip BMD as well as total body BMC values remained after adjusting for body weight, which was retained in the final model. Analyses based on soy isoflavones content yielded similar results. This study demonstrated that, among women after the initial few years postmenopausal, soy protein/isoflavones intake had a modest but significant association with hip BMD as well as total body BMC. The effects of soy protein and soy isoflavones on bone health should be further explored in populations with habitual dietary soy intake.

Is waist circumference a useful measure in predicting health outcomes in the elderly

OBJECTIVE: To examine the effect of age on the relationship between body mass index (BMI) and waist circumference (WC), and the usefulness of BMI, WC and waist–hip ratio (WHR) in predicting mortality and cardiovascular risk in the elderly population.DESIGN: Longitudinal observational study of 36 months duration.SUBJECTS AND METHOD: A stratified random sample of 2032 Chinese subjects (990 male, 1033 female) mean age (s.d.) 80.1 (7.5), interviewed and examined at baseline and after 36 months. Deaths and presence of diabetes mellitus and hypertension were documented. A younger data set of 1010 subjects (500 male, 510 female), mean age (s.d.) 45.5 (11.6), was used for comparison of the BMI–WC relationship between younger and older subjects. In predicting outcomes using different values of BMI, WC and WHR, receiver operating characteristic curve analysis was used to derive cut-off values with optimal sensitivity and specificity, and the likelihood ratios for mortality, diabetes and hypertension for different anthropometric values were plotted.RESULTS: The waist circumference values corresponding to BMI values of 25 and 30 kg/m2 were higher in elderly (92 and 103 cm for men; 88 and 99 cm for women) compared with younger subjects (85 and 97 cm for men; 78 and 88 cm for women). BMI and WC are inversely associated with mortality, in both men and women, positively associated with diabetes in men but not in women. WC was positively associated with hypertension in men and women. WHR was not associated with any outcome measures. The anthropometric measurement at the point of intersection of the likelihood curves for mortality and diabetes may be considered the optimum value, being BMI=21 kg/m2 for men and 25 kg/m2 for women, WC between 80 and 85 cm, and WHR 0.88–0.90.CONCLUSION: Waist measurement values for predicting health outcomes in elderly people aged 70 y and over are different compared with younger subjects, and have similar predictive accuracy compared with body mass index. Waist–hip ratio is not a useful predictor.

Influence of educational level and marital status on dietary intake, obesity and other cardiovascular risk factors in a Hong Kong Chinese population

Objectives: To examine the influence of education and marital status on dietary intake, body mass index, waist hip ratio, blood pressure, fasting and 2 h glucose, and lipid profile in adult Hong Kong Chinese.Design: Randomized age and sex stratified surverySubjects: One thousand and ten subjects aged 25–74 y (500 men, 510 women) recruited for the 1995–96 Hong Kong Dietary and Cardiovascular Risk Prevalence Survey.Measurements: Dietary intake was estimated using a food frequency method. Information on education level and marital status was included in the questionnaire. Anthropometry and biochemical parameters were measured using standard methods.Results: After adjustment for age, higher levels of education are associated with higher percentage protein intake in men, higher percentage fat intake in women, higher nutrient density of fibre and calcium in both men and women, and higher nutrient density of protein, fat, niacin, vitamin D, and polyunsaturated fatty acid in women. Consumption of fruits was also higher in women, and that of dairy products higher in men. Body mass index and waist-hip ratio were lower with increasing levels of education in women, while lower mean systolic BP was observed in men. Single women had lower nutrient densities of vitamin D and iron, and lower consumption of vegetables and fish, compared with married women. Body mass index was lower in both single men and women. Single men had a better cardiovascular risk factor profile, in that diastolic BP, triglycerides and cholesterol/HDL ratio were lower, in addition to a lower body mass index.Conclusion: Higher education level is associated with a healthier diet and lower prevalence of overweight.Sponsorship: Hong Kong Health Services Research Grant.

Public health significance of the frailty index

Background. A quantifiable indicator of frailty would be very useful in assessing the health state of older populations, as well as enable the effect of interventions to be evaluated over time. Methods. A total of 2032 people aged 70 years and over recruited by stratified random sampling, and information obtained regarding physical and functional health, and psychological factors. The frailty index (FI) was constructed from 62 variables. Associations between the FI, and changes in ADL score, mental score, and hospitalization days over a 10-year period were evaluated. Results. For the baseline to 3-year changes, a 0.10 increase in baseline FI is accompanied by a 0.499-point faster drop in ADL score, a 0.223-point faster decline in mental score, and 4.57-day faster increase in hospital days. For 3 – 10-year changes, frailty was a significant predictor only of changes in mental score, with results indicating that, on average, each increase of 0.10 in the baseline frailty index was associated with 0.613-point drop in mental score during this period. Chronological age and frailty had differential associations with those changes. Conclusion. The FI is a valid indicator of morbidity and requirement for health and social services for ageing populations.

Dietary calcium intake, physical activity and the risk of vertebral fracture in Chinese

To study the relationship between dietary calcium intake, load-bearing activity, reproductive factors, anthropometric factors and vertebral fracture in Chinese, a case-control study was carried out on 481 women (aged 70–79 years) who lived in three housing blocks under the Geriatric Priority Housing Scheme in Shatin, Hong Kong. Lateral spine radiographs were taken from the T4 to L4 level. Definite and doubtful vertebral fractures were diagnosed when any of the three vertebral height (anterior to anterior, middle to posterior and posterior to posterior) ratios was 3 SD and 2–2.99 SD below the mean respectively. Women with one or more definite fractures were classified as definite cases, those with one or more doubtful fractures were classified as doubtful cases, and the rest as controls. The mean dietary calcium intake and load-bearing activities were obtained by interview, using a structured questionnaire. Detailed information on cigarette smoking, alcohol consumption and reproductive factors was also obtained. The grip strength, body weight and height were measured. Doubtful cases were found to differ little from the controls in their lifestyle and anthropometric factors. The odds ratio (OR) for being a definite case was 2.1 (95% CI=1.1−3.9) when the dietary calcium intake was in the lowest quartile. The OR was 1.8 (95% Ci=0.8−4.4) for subjects who walked or exercised outdoors for less than an hour a day. Giving birth to or breast-feeding three children or more was protective against definite fracture. The definite cases were significantly lighter and shorter than controls; they also had a weaker grip strength. It is concluded that a low dietary calcium intake was significantly associated with an elevated risk of vertebral fracture, while the effect of infrequent load-bearing activity was uncertain. Giving birth to or breast-feeding three or more children was protective against vertebral fracture in our population.

Effects of soy isoflavone supplementation on cognitive function in Chinese postmenopausal women : a double-blind, randomized, controlled trial

Objective:To investigate whether soy-derived isoflavone extract improves performance in cognitive function and quality of life in Chinese postmenopausal women. Design:The study was a 6-month double-blind, randomized, placebo-controlled, parallel group trial. Participants were community-dwelling women aged 55 to 76 years; 191 eligible women were randomly assigned to receive a daily oral intake of 80 mg soy-derived isoflavones or an identical-appearing placebo for 6 months. Standardized neuropsychological tests of memory, executive function, attention, motor control, language, and visual perception and a global cognitive function assessment were administered face-to-face individually at baseline and at 6-months posttreatment. The validated Chinese version of the Short Form-36 was used for quality of life measurements. Results:Of the participants, 88% (168 women: 80 among the supplementation group and 88 among the placebo group) completed the trial. Intention-to-treat analysis, conducted for 176 participants with 6-month assessment results, revealed no significant differences in outcome measures between treatment groups. Subgroup analysis among the good compliers only (consumed at least 80% of the supplements or placebo; n = 168) and among the age groups younger or older than 65 years also indicated no significant differences for any outcome measures. Types of complaints of adverse events were similar in both treatment groups and included mainly gastrointestinal and musculoskeletal problems. Conclusions:This 6-month trial indicates that 80-mg soy-derived isoflavone supplementation did not improve performance on standard neuropsychological tests and overall quality of life in generally healthy Chinese postmenopausal women.

Defining sarcopenia in terms of risk of physical limitations: a 5-year follow-up study of 3,153 chinese men and women.

OBJECTIVES: To examine the definition of sarcopenia in Chinese subjects by relating the value of appendicular skeletal muscle mass (ASM) divided by height squared to physical functional outcomes after 4 years.