Geeske Peeters

The World report on ageing and health: a policy framework for healthy ageing

Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report.

High Long-Term Cortisol Levels, Measured in Scalp Hair, Are Associated With a History of Cardiovascular Disease

BACKGROUND Stress is associated with an increased incidence of cardiovascular disease. The impact of chronic stress on cardiovascular risk has been studied by measuring cortisol in serum and saliva, which are measurements of only 1 time point. These studies yielded inconclusive results. The measurement of cortisol in scalp hair is a novel method that provides the opportunity to measure long-term cortisol exposure. Our aim was to study whether long-term cortisol levels, measured in scalp hair, are associated with cardiovascular diseases. METHODS A group of 283 community-dwelling elderly participants were randomly selected from a large population-based cohort study (median age, 75 y; range, 65-85 y). Cortisol was measured in 3-cm hair segments, corresponding roughly with a period of 3 months. Self-reported data concerning coronary heart disease, stroke, peripheral arterial disease, diabetes mellitus, and other chronic noncardiovascular diseases were collected. RESULTS Hair cortisol levels were significantly lower in women than in men (21.0 vs 26.3 pg/mg hair; P < .001). High hair cortisol levels were associated with an increased cardiovascular risk (odds ratio, 2.7; P = .01) and an increased risk of type 2 diabetes mellitus (odds ratio, 3.2; P = .04). There were no associations between hair cortisol levels and noncardiovascular diseases. CONCLUSIONS Elevated long-term cortisol levels are associated with a history of cardiovascular disease. The increased cardiovascular risk we found is equivalent to the effect of traditional cardiovascular risk factors, suggesting that long-term elevated cortisol may be an important cardiovascular risk factor.

Multifactorial Intervention to Reduce Falls in Older People at High Risk of Recurrent Falls: A Randomized Controlled Trial

BACKGROUND Falls occur frequently in older people and strongly affect quality of life. Guidelines recommend multifactorial, targeted fall prevention. We evaluated the effectiveness of a multifactorial intervention in older persons with a high risk of recurrent falls. METHODS A randomized controlled trial was conducted from April 3, 2005, to July 21, 2008, at the geriatric outpatient clinic of a university hospital and regional general practices in the Netherlands. Of 2015 persons identified, 217 persons aged 65 years or older were selected to participate. They had a high risk of recurrent falls and no cognitive impairment and had visited the emergency department or their family physician after a fall. The geriatric assessment and intervention were aimed at reduction of fall risk factors. Primary outcome measures were time to first and second falls after randomization. Secondary outcome measures were fractures, activities of daily living, quality of life, and physical performance. RESULTS Within 1 year, 55 (51.9%) of the 106 intervention participants and 62 (55.9%) of the 111 usual care (control) participants fell at least once. No significant treatment effect was demonstrated for the time to first fall (hazard ratio, 0.96; 95% confidence interval, 0.67-1.37) or the time to second fall (1.13; 0.71-1.80). Similar results were obtained for secondary outcome measures and for per-protocol analysis. One intervention participant died vs 7 in the control group (hazard ratio, 0.15; 95% confidence interval, 0.02-1.21). CONCLUSION This multifactorial fall-prevention program does not reduce falls in high-risk, cognitively intact older persons. Trial Registration isrctn.org Identifier: ISRCTN11546541.

ActiGraph GT3X+ cut-points for identifying sedentary behaviour in older adults in free-living environments

OBJECTIVES To determine the ActiGraph GT3X+ cut-points with the highest accuracy for estimating time spent in sedentary behaviour in older adults in free-living environments. ActivPAL(3)™ was used as the reference standard. DESIGN Cross-sectional study. METHODS 37 participants (13 males and 24 females, 73.5 ± 7.3 years old) wore an ActiGraph GT3X+ and an ActivPAL(3)™ for 7 consecutive days. For ActivPAL(3)™, variables were created based on posture. For ActiGraph GT3X+, sedentary behaviour was defined as (1) vector magnitude and (2) vertical axis counts for 1-s, 15-s and 1-min epochs, with cut-points for 1-s epochs of <1 to <10 counts, for 15-s epochs of <1 to <100 counts and for 1-min epochs of <1 to <400 counts. For each of the ActiGraph GT3X+ cut-points, area under the receiver operating characteristic curve (area under the curve), sensitivity, specificity, and percentage correctly classified were calculated. Bias and 95% limits of agreement were calculated using the Bland-Altman method. RESULTS The highest areas under the curve were obtained for the vector magnitude cut-points: <1 count/s, <70 counts/15-s, and <200 counts/min; and for the vertical axis cut-points: <1 count/s, <10 counts/15-s and <25 counts/min. Mean biases ranged from -4.29 to 124.28 min/day. The 95% limits of agreement for these cut-points were ± 2 h suggesting great inter-individual variation. CONCLUSIONS The results suggest that cut-points are dependent on unit of analyses (i.e. epoch length and axes); cut-points for a given epoch length and axis cannot simply be extrapolated to other epoch lengths. Limitations regarding inter-individual variability and misclassification of standing activity as sitting/lying must be considered.

Relationships between cortisol level, mortality and chronic diseases in older persons

Context  High cortisol level is known to be associated with osteoporosis, hypertension, diabetes mellitus (DM), susceptibility to infections and depression and may protect against chronic obstructive pulmonary disease.

Sitting-Time, Physical Activity, and Depressive Symptoms in Mid-Aged Women

BACKGROUND Associations of sitting-time and physical activity with depression are unclear. PURPOSE To examine concurrent and prospective associations between both sitting-time and physical activity with prevalent depressive symptoms in mid-aged Australian women. METHODS Data were from 8950 women, aged 50-55 years in 2001, who completed mail surveys in 2001, 2004, 2007, and 2010. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression questionnaire. Associations between sitting-time (≤ 4 hours/day, >4-7 hours/day, >7 hours/day) and physical activity (none, some, meeting guidelines) with depressive symptoms (symptoms/no symptoms) were examined in 2011 in concurrent and lagged mixed-effect logistic modeling. Both main effects and interaction models were developed. RESULTS In main effects modeling, women who sat >7 hours/day (OR=1.47, 95% CI=1.29, 1.67) and women who did no physical activity (OR=1.99, 95% CI=1.75, 2.27) were more likely to have depressive symptoms than women who sat ≤ 4 hours/day and who met physical activity guidelines, respectively. In interaction modeling, the likelihood of depressive symptoms in women who sat >7 hours/day and did no physical activity was triple that of women who sat ≤ 4 hours/day and met physical activity guidelines (OR 2.96, 95% CI=2.37, 3.69). In prospective main effects and interaction modeling, sitting-time was not associated with depressive symptoms, but women who did no physical activity were more likely than those who met physical activity guidelines to have future depressive symptoms (OR=1.26, 95% CI=1.08, 1.47). CONCLUSIONS Increasing physical activity to a level commensurate with guidelines can alleviate current depression symptoms and prevent future symptoms in mid-aged women. Reducing sitting-time may ameliorate current symptoms.

Fall risk: the clinical relevance of falls and how to integrate fall risk with fracture risk

In old age, 5-10% percent of all falls result in a fracture, and up to 90% of all fractures result from a fall. This article describes the link between fall risk and fracture risk in community-dwelling older persons. Which factors attribute to both the fall risk and the fracture risk? Which falls result in a fracture? Which tools are available to predict falls and fractures? Directions for the use of prediction tools in clinical practice are given. Challenges for future research include further validation of existing prediction tools and evaluation of the cost-effectiveness of treatment after screening.

The relationship between cortisol, muscle mass and muscle strength in older persons and the role of genetic variations in the glucocorticoid receptor.

Objective  Cortisol levels increase with age and hypercortisolism is associated with muscle weakness. This study examines the relationship between cortisol, muscle mass and muscle strength in community‐dwelling older persons and the role of genetic variations in the glucocorticoid receptor (GR).

The elimination half-life of benzodiazepines and fall risk: two prospective observational studies

BACKGROUND the STOPP criteria advise against the use of long-acting benzodiazepines (LBs). OBJECTIVE to study whether LBs are associated with a higher fall risk than short-acting benzodiazepines (SBs) (elimination half-life ≤ 10 h). METHODS we used base-line data and prospective fall follow-up from the Longitudinal Aging Study Amsterdam, a longitudinal cohort study including 1,509 community-dwelling older persons (Study 1) and from a separate fall prevention study with 564 older persons after a fall (Study 2). Time to the first fall after inclusion and number of falls in the first year after inclusion were the primary endpoints. RESULTS both in Study 1 and Study 2 the use of SBs was associated with time to the first fall, hazard ratio (HR) 1.62 (95% CI: 1.03-2.56) and HR 1.64 (95% CI: 1.19-2.26),respectively. LBs were not significantly associated with time to first fall, HR 1.40 (0.85-2.31) and HR 1.08 (0.72-1.62). In both studies, the use of SBs was also associated with number of falls, odds ratio (OR) 1.28 (95% CI: 1.01-1.61) and OR 1.37 (95% CI: 1.10-1.70). LBs were not significantly associated with number of falls, OR 1.23 (0.96-1.57) and 1.10 (0.82-1.48). CONCLUSIONS the use of SBs is not associated with a lower fall risk compared with LBs. The use of both SBs and LBs by old persons should be strongly discouraged.

Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care

BackgroundAnnually, about 30% of the persons of 65 years and older falls at least once and 15% falls at least twice. Falls often result in serious injuries, such as fractures. Therefore, the prevention of accidental falls is necessary. The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling.Methods/DesignThe study is designed as a randomised controlled trial (RCT) with an economic evaluation. Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a validated fall risk profile. Persons at low risk of recurrent falling are excluded from the RCT. Persons who have a high risk of recurrent falling are blindly randomised into an intervention (n = 100) or usual care (n = 100) group. The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors. The transmural multidisciplinary appraoch entails close cooperation between geriatrician, primary care physician, physical therapist and occupational therapist and can be extended with other specialists if relevant. A fall calendar is used to record falls during one year of follow-up. Primary outcomes are time to first and second falls. Three, six and twelve months after the home visit, questionnaires for economic evaluation are completed. After one year, during a second home visit, the secondary outcome measures are reassessed and the adherence to the interventions is evaluated. Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis will be performed.DiscussionStrengths of this study are the selection of persons at high risk of recurrent falling followed by a multidisciplinary intervention, its transmural character and the evaluation of adherence. If proven effective, implementation of our multidisciplinary assessment followed by treatment of fall risk factors will reduce the incidence of falls.Trial registrationCurrent Controlled Trials ISRCTN11546541.