Christine S. Autenrieth

Patterns of Multimorbidity in the Aged Population. Results from the KORA-Age Study.

Multimorbidity is a common problem in aged populations with a wide range of individual and societal consequences. The objective of the study was to explore patterns of comorbidity and multimorbidity in an elderly population using different analytical approaches. Data were gathered from the population-based KORA-Age project, which included 4,127 persons aged 65–94 years living in the city of Augsburg and its two surrounding counties in Southern Germany. Information on the presence of 13 chronic conditions was collected in a standardized telephone interview and a self-administered questionnaire. Patterns of comorbidity and multimorbidity were analyzed using prevalence figures, logistic regression models and exploratory tetrachoric factor analysis. The prevalence of multimorbidity (≥2 diseases) was 58.6% in the total sample. Hypertension and diabetes (Odds Ratio [OR] 2.95, 99.58% confidence interval [CI] [2.19–3.96]), as well as hypertension and stroke (OR 2.00, 99.58% CI [1.26–3.16]) most often occurred in combination. This association was independent of age, sex and the presence of other conditions. Using factor analysis, we identified four patterns of multimorbidity: the first pattern includes cardiovascular and metabolic diseases, the second includes joint, liver, lung and eye diseases, the third covers mental and neurologic diseases and the fourth pattern includes gastrointestinal diseases and cancer. 44% of the persons were assigned to at least one of the four multimorbidity patterns; 14% could be assigned to both the cardiovascular/metabolic and the joint/liver/lung/eye pattern. Further common pairs were the mental/neurologic pattern combined with the cardiovascular/metabolic pattern (7.2%) or the joint/liver/lung/eye pattern (5.3%), respectively. Our results confirmed the existence of co-occurrence of certain diseases in elderly persons, which is not caused by chance. Some of the identified patterns of multimorbidity and their overlap may indicate common underlying pathological mechanisms.

Association between different domains of physical activity and markers of inflammation.

PURPOSE Physical activity has recently been established as a potential modifier of the inflammatory process, suggesting that it mitigates inflammation and consequently reduces the incidence of several chronic diseases such as cardiovascular events. METHODS This study examined the association between different domains ofself-reported physical activity (work, transportation, household, and leisure time) and three inflammatory markers (fibrinogen, C-reactive protein (CRP), and interleukin 6 (IL-6)). Study subjects included 796 men and women aged 35-74 yr with complete data for the main study variables who participated in the 1989/1990 MONItoring trends and determinants in CArdiovascular disease (MONICA) Augsburg Survey. Data were collected using the MONICA Optional Study on Physical Activity (MOSPA) questionnaire, and activity levels were classified into low, moderate, and vigorous physical activities. RESULTS Fibrinogen showed an inverse relationship with higher levels of work (Ptrend = 0.038), transportation (Ptrend = 0.025), leisure time (Ptrend = 0.013), and summary physical activity (Ptrend< 0.001). This relationship was still observed after adjusting for age and sex and further correction for body mass index, waist-to-hip ratio, smoking status, hypertension, diabetes, total-to-HDL cholesterol ratio, education, and self-reported limited physical activity due to health problems. IL-6 showed significant results for transportation (Ptrend = 0.031), leisure time (Ptrend = 0.016), and summary physical activity (Ptrend < 0.001), whereas CRP was inversely related with the summary activity (Ptrend = 0.003) in the fully adjusted model. No statistically significant inverse association between household physical activity and any of the investigated markers was found. We observed interactions between summary physical activity and smoking (fibrinogen: P = 0.003) as well as ex-smoking (CRP: P < 0.001; IL-6: P = 0.049). CONCLUSION These data indicate that beyond leisure time, work and transportation physical activity may reduce inflammation.

Multimorbidität und erfolgreiches Altern

BACKGROUND The objective of the KORA-Age research consortium is to assess the determinants and consequences of multimorbidity in the elderly and to look into reasons for successful aging in the general public. PATIENTS AND METHODS In the KORA-Age cohort study 9,197 persons were included who where born in the year 1943 or before and participants of previous KORA cohort studies conducted between 1984 and 2001 (KORA: Cooperative Health Research in the Region of Augsburg). The randomized intervention study KORINNA (Coronary infarct follow-up treatment in the elderly) tested a nurse-based case management program with 338 patients with myocardial infarct and included an evaluation in health economics. RESULTS A total of 2,734 deaths were registered, 4,565 participants submitted a postal health status questionnaire and 4,127 participants were interviewed by telephone (response 76.2% and 68.9% respectively). A gender and age-stratified random sample of the cohort consisting of 1,079 persons took part in a physical examination (response 53.8%). CONCLUSION The KORA-Age consortium was able to collect data in a large population-based sample and is contributing to the understanding of multimorbidity and successful aging.

Physical activity is inversely associated with multimorbidity in elderly men : results from the KORA-Age Augsburg Study

OBJECTIVE Physical activity is suggested to play a key role in the prevention of several chronic diseases. However, data on the association between physical activity and multimorbidity are lacking. METHODS Using data from 1007 men and women aged 65-94 years who participated in the population-based KORA (Cooperative Health Research in the Region of Augsburg)-Age project conducted in Augsburg/Germany and two adjacent counties in 2008/09, 13 chronic conditions were identified, and physical activity scores were calculated based on the self-reported physical activity scale for the elderly (PASE). Multivariable sex-specific logistic regression was applied to determine the association of the continuous physical activity score with multimorbidity (≥ 2 out of 13 diseases). RESULTS Physical activity (mean PASE score±SD) was higher in men (125.1 ± 59.2) than in women (112.2 ± 49.2). Among men, the odds ratio (OR) for multimorbidity was 0.73 (95% CI: 0.60-0.90) for a 1 standard deviation increase of the PASE score. No significant results could be observed for women (OR: 1.05; 95% CI: 0.83-1.33). CONCLUSION We demonstrated an inverse association between physical activity and multimorbidity among men. Further prospective studies have to confirm the temporality of effects.

[Multimorbidity and successful aging: the population-based KORA-Age study].

BACKGROUND The objective of the KORA-Age research consortium is to assess the determinants and consequences of multimorbidity in the elderly and to look into reasons for successful aging in the general public. PATIENTS AND METHODS In the KORA-Age cohort study 9,197 persons were included who where born in the year 1943 or before and participants of previous KORA cohort studies conducted between 1984 and 2001 (KORA: Cooperative Health Research in the Region of Augsburg). The randomized intervention study KORINNA (Coronary infarct follow-up treatment in the elderly) tested a nurse-based case management program with 338 patients with myocardial infarct and included an evaluation in health economics. RESULTS A total of 2,734 deaths were registered, 4,565 participants submitted a postal health status questionnaire and 4,127 participants were interviewed by telephone (response 76.2% and 68.9% respectively). A gender and age-stratified random sample of the cohort consisting of 1,079 persons took part in a physical examination (response 53.8%). CONCLUSION The KORA-Age consortium was able to collect data in a large population-based sample and is contributing to the understanding of multimorbidity and successful aging.

Job strain associated CRP is mediated by leisure time physical activity: results from the MONICA/KORA study.

BACKGROUND Psychological stress at work is considered a cardiac risk factor, yet whether it acts directly through neuroimmune processes, or indirectly by increasing behavioral risk factors, is uncertain. Cross-sectional associations between job strain and serum biomarkers of inflammation and endothelial dysfunction were investigated. Secondary analyses explored the role of psychosocial/cardiometabolic risk factors as mediators of job stress associated inflammation in healthy workers. METHODS Information on risk factors was obtained in standardized personal interviews of a subcohort of working participants in the MONICA/KORA population (n = 951). Work stress was measured by the Karasek job strain index. Biomarkers were measured from non-fasting venous blood. Multivariate regression analyses were used to examine the association of job strain with inflammatory biomarkers. Mediation analysis (Sobel test) was used to determine the effect of psychosocial risk factors on the association between job strain and C-reactive protein (CRP). RESULTS High job strain was reported by half (n = 482, 50.7%) of the study participants. While workers with high job strain were more likely to have adverse workplace conditions (competition with coworkers, job dissatisfaction and insecurity), sleeping problems, depressive symptoms, a Type A personality, and be physically inactive, no differences in cardiometabolic risk factors were detected. A strong and robust association between job strain and CRP was observed in age and sex adjusted models, as well as models adjusted for classic coronary heart disease risk factors (β = 0.39, p = 0.006 and β = 0.27, p = 0.03, respectively). Adjustment for physical activity abrogated this effect (β = 0.23, p = 0.07), and a mediating effect of physical activity on stress-associated inflammation was demonstrated (p = 0.04). CONCLUSIONS The analyses provide evidence for both a direct and an indirect effect of job strain on inflammation.

Association between sleep disturbances and falls among the elderly : results from the German Cooperative Health Research in the Region of Augsburg-Age study

OBJECTIVE We aimed to examine the association between various sleep disturbances and falls among older individuals from the general population while considering the influence of age and dizziness. METHODS Data were derived from the population-based cross-sectional KORA (Cooperative Health Research in the Region of Augsburg)-Age study, whereby information was conducted in standardized telephone interviews with 4127 men and women aged ⩾65years in 2008 and 2009. Unstratified and stratified (by age and dizziness) multivariable logistic regression model analyses were performed. RESULTS The multivariable analysis showed a marginally significant association between trouble staying asleep and ⩾1 fall in the previous year (odds ratio [OR], 1.23 [95% confidence interval (CI), 1.01-1.50]). This association was more pronounced in participants older than the age of 75years (OR, 1.58 [95% CI, 1.16-2.16]) and in individuals without dizziness (OR, 1.35 [95% CI, 1.04-1.76]). There was no association between daytime sleepiness and falls in the fully-adjusted models, but the odds of falls in the previous year in individuals older than the age of 75years were significantly higher for individuals with difficulty falling asleep. Although sleep duration was not associated with falls in multivariable analyses when stratified by dizziness, sleep duration of 9h daily was significantly associated with higher odds of experiencing at least one fall in the previous year. CONCLUSIONS Our study suggested that the positive relationship between a trend towards longer sleep duration, trouble falling and staying asleep, and falls is strongest in older individuals and in individuals who did not experience dizziness in the previous year.

Validation of the long international physical activity questionnaire: Influence of age and language region

Objective Little is known about the influence of age, gender and language on the measurement properties of the long International Physical Activity Questionnaire (IPAQ). The aim was to validate the long IPAQ in adults aged 18–84 in the German-, French- and Italian-speaking parts of Switzerland, focusing on differences between gender, age groups and language regions. Methods This cross-sectional study was conducted in the frame of SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults) in 2011. 346 participants (54.6% women, mean age 54.6 years) wore an Actigraph GT3X accelerometer during 8 days and completed the IPAQ. IPAQ and accelerometer data on total physical activity and on different intensities as well as sitting time were compared using Spearman correlations and Bland–Altman plots. Results Correlations were highest for vigorous physical activity (r = 0.41) and sitting time (r = 0.42). Significant gender differences were apparent for leisure-time physical activity (men: r = 0.35 versus women: r = 0.57, p = 0.012) and for sitting time (men: r = 0.28 versus women: r = 0.53, p = 0.007). Differences between age groups were present for sitting time (youngest: r = 0.72 versus middle: r = 0.36, p < 0.001; youngest versus oldest: r = 0.34, p = 0.001). Differences between language regions were present for vigorous physical activity (German: r = 0.28 versus Italian: r = 0.53, p = 0.033). IPAQ overestimated physical activity but underestimated sitting time. Conclusion The long IPAQ showed moderate validity similar to other studies when compared to accelerometer data in a diverse sample of individuals. Some sex, age and regional differences were observed but do not seem to limit its applicability in population sub groups.

Decline in Gait Performance Detected by an Electronic Walkway System in 907 Older Adults of the Population-Based KORA-Age Study

Background: Gait changes at older ages are a strong predictor of a decline in lower extremity functions. However, large population-based studies assessing gait parameters in various gait tasks are lacking. Objective: We investigated the relationship of age, the use of mobility aids and being fitted with an endoprosthesis with selected gait parameters, assessed in different walking tasks. Methods: In the population-based KORA-Age study, data from 907 men and women aged 65-91 years were obtained using the validated electronic walkway system GAITRite, which quantifies spatiotemporal gait parameters in the measurement range of a 488 × 61 cm walkway mat. Participants completed three walking tasks at different speeds (normal, slow and fast) and a fourth walking task at normal speed with the additional task of counting backwards (dual-task walking). Additionally, the impact of endoprostheses (hip or knee) and mobility aids was assessed. Results: The highest relative age-related decline for velocity was observed during dual-task walking (26.1% for men and 23.4% for women) and for step length during fast walking (20.2 and 14.4%) when comparing participants aged <70 years with those aged ≥85 years. Weaker performances for velocity, cadence and step length were observed among women with knee or hip endoprostheses (fast walking speed) (p < 0.05). Across all walking tasks, significant differences between mobility aid users and nonusers were observed for velocity and step length among both men and women (p < 0.05). Conclusion: A decline in gait performance is most notable in fast speed and dual-task walking, in age-related endoprosthesis and mobility aid analyses. The marked relative decrease in gait parameters in these difficult gait tasks may be attributed to lacking resources for compensation among the elderly.

Long-term physical activity is associated with reduced arterial stiffness in older adults: longitudinal results of the SAPALDIA cohort study

BACKGROUND longitudinal analyses of physical activity (PA) and arterial stiffness in populations of older adults are scarce. We examined associations between long-term change of PA and arterial stiffness in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). METHODS we assessed PA in SAPALDIA 2 (2001-03) and SAPALDIA 3 (2010-11) using a short questionnaire with a cut-off of at least 150 min of moderate-to-vigorous PA per week for sufficient activity. Arterial stiffness was measured oscillometrically by means of the brachial-ankle pulse wave velocity (baPWV) in SAPALDIA 3. We used multivariable mixed linear regression models adjusted for several potential confounders in 2,605 persons aged 50-81. RESULTS adjusted means of baPWV were significantly lower in persons with sufficient moderate-to-vigorous PA (i) in SAPALDIA 2 but not in SAPALDIA 3 (P = 0.048) and (ii) in both surveys (P = 0.001) compared with persons with insufficient activity in both surveys. There was a significant interaction between sex and the level of change in PA concerning baPWV (P = 0.03). The triples of parameter estimates describing the association between level of PA change and baPWV were not significantly different between the two sex-specific models (P = 0.07). CONCLUSIONS keeping up or adopting a physically active lifestyle was associated with lower arterial stiffness in older adults after a follow-up of almost a decade. Increasing the proportion of older adults adhering to PA recommendations incorporating also vigorous PA may have a considerable impact on vascular health at older age and may contribute to healthy ageing in general.