Jinhee Kim

Systematic review of health behavioral risks and cognitive health in older adults

BACKGROUNDnAn increasing body of evidence suggests that health behaviors may protect against cognitive impairment and dementia. The purpose of this study was to summarize the current evidence on health behavioral factors predicting cognitive health through a systematic review of the published literature.nnnMETHODSnPubMed, Embase, and PsycINFO databases were searched for studies on community representative samples aged 65 and older, with prospective cohort design and multivariate analysis. The outcome--cognitive health--was defined as a continuum of cognitive function ranging from cognitive decline to impairment and dementia, and health behaviors included physical activity, smoking, alcohol drinking, body mass index, and diet and nutrition.nnnRESULTSnOf 12,105 abstracts identified, 690 relevant full-texts were reviewed. The final yield amounted to 115 articles of which 37 studies were chosen that met the highest standards of quality. Leisure time physical activity, even of moderate level, showed protective effects against dementia, whereas smoking elevated the risk of Alzheimers disease. Moderate alcohol consumption tended to be protective against cognitive decline and dementia, but nondrinkers and frequent drinkers exhibited a higher risk for dementia and cognitive impairment. Midlife obesity had an adverse effect on cognitive function in later life. Analysis showed vegetable and fish consumption to be of benefit, whereas, persons consuming a diet high in saturated fat had an increased dementia risk.nnnCONCLUSIONnThe review demonstrates accumulating evidence supporting health behavioral effects in reducing the risk of cognitive decline and dementia. Results indicate potential benefits of healthy lifestyles in protecting cognitive health in later life.

The influence of multiple lifestyle behaviors on cognitive function in older persons living in the community

OBJECTIVEnThis study aimed to examine the influence of multiple lifestyle behaviors on cognitive function in older persons living in an urban community.nnnMETHODnA representative sample of 977 persons aged 65 and older in Suwon, Korea were interviewed in 2001, with follow-up interviews completed on 645 (2002) and 537 (2003). Lifestyle behaviors included physical activity, non-smoking, vegetable consumption, and social activity. Individual, as well as, the number and combination of health behavioral profiles were considered. Cognitive function was assessed by the Korean version of the Mini-Mental State Examination. Linear regression with generalized estimating equations was used in the analysis, controlling for sociodemographics and chronic conditions.nnnRESULTSnAll lifestyle behaviors showed independent association with cognitive ability, even after adjusting for the covariates. An incremental benefit of multiple lifestyle behaviors was evident, with those engaging in more positive behaviors exhibiting a tendency to have a higher cognitive score. A two- or three-factor combination of non-smoking, vegetable consumption, and social activity showed the strongest association with cognitive function.nnnCONCLUSIONnParticipation in healthy lifestyles may contribute to the maintenance of cognitive function in later life. It underlines the potential benefit of multiple behaviors in promoting cognitive health of older persons.

Association of cognitive impairment with frailty in community-dwelling older adults.

BACKGROUNDnFrailty is highly prevalent in older people, but its association with cognitive function is poorly understood. The aim of this study was to examine the association between cognitive function and frailty in community-dwelling older adults.nnnMETHODSnData were from the 2008 Living Profiles of Older People Survey, comprising 10,388 nationally representative sample aged 65 years and older living in the community in South Korea. Frailty criteria included unintentional weight loss, exhaustion, weakness, low physical activity, and slow walking speed. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. Multinomial logistic regression models were constructed with frailty status regressed on cognitive impairment and subdomains of cognitive function, adjusting for covariates.nnnRESULTSnThose who were frail showed a higher percentage of cognitive impairment (55.8% in men, 35.2% in women) than those who were not (22.1% in men, 15.6% in women). Cognitive impairment was associated with an increased risk of frailty in men (odds ratio (OR) = 1.81, 95% confidence interval (CI): 1.25-2.60) and women (OR = 1.69, 95% CI: 1.25-2.30) even after controlling for all covariates. Among the subdomains of cognitive function, time orientation, registration, attention, and judgment were associated with a lower likelihood of frailty in both men and women after adjusting for confounders. Among women higher scores on recall, language components, and visual construction were also significantly associated with lower odds of frailty.nnnCONCLUSIONSnCognitive impairment was associated with a higher likelihood of frailty in community-dwelling older men and women. Total scores and specific subdomains of cognitive function were inversely associated with frailty.

Association of vegetables and fruits consumption with sarcopenia in older adults: the Fourth Korea National Health and Nutrition Examination Survey

BACKGROUNDnseveral studies have found nutrients, including antioxidants, to be associated with sarcopenia. However, whether specific foods, such as vegetables and fruits, are associated with sarcopenia has not been studied.nnnOBJECTIVEnto examine the association of the frequency of vegetables and fruits consumption with sarcopenia in older people.nnnMETHODSnthis study used cross-sectional data from the Fourth Korea National Health and Nutrition Examination Survey in 2008-09. Subjects were community-dwelling 823 men and 1,089 women aged ≥65 years. Frequency of food group consumption was obtained by using the food frequency questionnaire. Body composition was measured with the dual-energy X-ray absorptiometry and sarcopenia was defined as appendicular lean mass adjusted for height and fat mass. Logistic regression was used to assess the association of the frequency of food group consumption with sarcopenia, controlling for sociodemographics and health-related variables.nnnRESULTSndietary intake of vegetables, fruits and both vegetables and fruits was associated with a significantly reduced risk of sarcopenia after controlling for covariates in men (P = 0.026 for trend, P = 0.012 for trend, P = 0.003 for trend, respectively). Men in the highest quintile, compared with those in the lowest quintile, of vegetables [odds ratio (OR) = 0.48; 95% confidence interval (CI): 0.24-0.95], fruits (OR = 0.30; 95% CI: 0.13-0.70) and vegetables and fruits consumption (OR = 0.32; 95% CI: 0.16-0.67) demonstrated a lower risk of sarcopenia. In women, high consumption of fruits demonstrated a lower risk of sarcopenia (OR = 0.39; 95% CI: 0.18-0.83).nnnCONCLUSIONnfrequent vegetables and fruits consumption was inversely associated with sarcopenia in older adults.

Participation in Physical, Social, and Religious Activity and Risk of Depression in the Elderly: A Community-Based Three-Year Longitudinal Study in Korea

Background We examined the longitudinal association between participation in individual or combinations of physical, social, and religious activity and risk of depression in the elderly. Methods Elderly subjects aged ≥60 years who completed the Living Profiles of Older People Survey in Korea (n = 6,647) were included. The baseline assessment, Wave 1, was conducted in 2008, and a follow-up assessment, Wave 2, was conducted in 2011. We defined participation in frequent physical activity as ≥3 times weekly (at least 30 minutes per activity). Frequent participation in social and religious activity was defined as ≥1 activity weekly. The primary outcome was depression at 3-year follow up. Results Multivariable logistic regression analysis showed that subjects who participated in frequent physical, social, and religious activity had an adjusted odds ratio of 0.81 (95% confidence interval [CI], 0.69–0.96), 0.87 (95% CI, 0.75–1.00), and 0.78 (95% CI, 0.67–0.90), respectively, compared with participants who did not participate in each activity. Participants who participated in only one type of activity frequently and participants who participated in two or three types of activities frequently had an adjusted odds ratio of 0.86 (95% CI, 0.75–0.98) and 0.64 (95% CI, 0.52–0.79), respectively, compared with participants who did not participate in any type of physical, social, and religious activity frequently. Conclusion Participation in physical, social, and religious activity was associated with decreased risk of depression in the elderly. In addition, risk of depression was much lower in the elderly people who participated in two or three of the above-mentioned types of activity than that in the elderly who did not.

Frailty and Body Mass Index as Predictors of 3-Year Mortality in Older Adults Living in the Community

Background: Frailty and body mass index (BMI) are known to be predictive of late life mortality, but little is known about the combined effects of frailty and BMI on mortality. Objective: This study investigated the influence of frailty status and BMI category on mortality in older adults. Methods: Data were from the Living Profiles of Older People Survey, a national survey of community-dwelling older people in Korea, with a baseline study of 11,844 Koreans aged 65 years and older in 2008 and a 3-year follow-up for mortality. Frailty was categorized as not frail, prefrail, and frail, based on five indicators (weight loss, exhaustion, physical activity, walking speed, and grip strength). BMI (kg/m2) was classified as underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), or obese (≥30.0). A Cox proportional model was used to analyze the association of the combined frailty and BMI categories with all-cause mortality, adjusting for sociodemographics and health-related factors. Results: Adjusting for covariates, compared with the normal-weight nonfrail counterpart, the underweight or normal-weight prefrail/frail status demonstrated significantly increased rates of death. The obese frail respondents showed a significantly higher mortality risk (hazard ratio, 3.89; 95% confidence interval, 1.14-13.28). The overweight prefrail/frail group, however, exhibited no significant association with mortality. Conclusion: Among older people who were of normal weight or underweight, greater frailty was associated with poorer survival. Whereas being overweight tended to be neutral of the influence of frailty on mortality, the obese frail exhibited a significantly elevated rate of death.

Multiple Socioeconomic Risks and Cognitive Impairment in Older Adults

Background/Aim: To investigate the multiple effects of socioeconomic factors on cognitive impairment in older persons. Methods: Subjects were a nationally representative sample (n = 4,155) aged ≧65 years of the Korean Longitudinal Study of Aging. Cognitive status was assessed by the Mini-Mental State Examination. Education, income, wealth and occupation were measured, with low levels on each factor combined to produce an aggregate risk score. Multiple logistic regression was used to analyze the combined effects of socioeconomic risks on cognitive impairment. Results: A socioeconomic risk gradient was evident, with the combined effect being stronger than any one of the risk factors acting alone. Compared with those with no risks, the odds ratios were 2.4 (for 2 socioeconomic risks), 3.4 (3 risks) and 7.7 (4 risks) for men, and 2.8 (2 risks), 3.5 (3 risks) and 5.4 (4 risks) for women. For individual socioeconomic risks, income and occupation were significant predictors of cognitive impairment in men, whereas in women, all 4 factors were independently associated. Conclusion: Multiple socioeconomic risks have a combined effect on cognitive impairment in older adults.

Dietary patterns and functional disability in older Korean adults

OBJECTIVESnThis study examined the relationship between dietary patterns and disability in the Korean elderly.nnnSTUDY DESIGNnWe used data from a cross-sectional study of 327 men and 460 women aged ≥65 years who completed the 2005 Korea National Health and Nutrition Examination Survey.nnnMAIN OUTCOME MEASURESnA single 24-h dietary recall method was used to assess dietary intake and dietary patterns were identified by cluster analysis. Functional disability was assessed by the activities of daily living (ADL) and instrumental ADL (IADL) scales. The association of dietary patterns with ADL and IADL disability was analyzed by logistic regression adjusting for age, marital status, education, household income, region, chronic conditions, body mass index, smoking, alcohol drinking, physical activity, and energy intake.nnnRESULTSnTwo dietary patterns were identified in both men and women: the modified traditional dietary pattern, characterized by a relatively lower consumption of white rice, but higher consumption of fruits, dairy products, and legumes, and the traditional dietary pattern, characterized by high consumption of white rice. After controlling for covariates, in men, those who engaged in modified traditional dietary pattern, compared with traditional dietary pattern, showed a lower likelihood of ADL disability (odds ratio [OR]=0.17, 95% confidence interval [CI]: 0.05-0.56). In women, the modified traditional dietary pattern compared with the traditional pattern was associated with a significantly decreased risk of ADL (OR=0.45, 95% CI: 0.23-0.90) and IADL disability (OR=0.45, 95% CI: 0.28-0.72).nnnCONCLUSIONSnThe modified traditional dietary pattern is associated with a decreased risk of functional disability in older Korean adults.

Changes in combined lifestyle risks and disability transition in older adults: Korean Longitudinal Study of Aging, 2006-2008.

OBJECTIVEnThis study examined associations between changes in lifestyle risks and disability in late life.nnnMETHODSnA national sample of Koreans aged ≥ 65 years was surveyed at baseline (2006) and 2-year follow-up (n=3511). Disability transition was categorized as disability-free, improved, maintained, and declined, based on activities of daily living (ADL) and instrumental ADL (IADL) scales. Lifestyle risk factors included current smoking, heavy alcohol consumption, low physical activity, and unhealthy weight. Changes in lifestyle risks were categorized as risk-free, positive (decreased risk), stable, and negative (increased risk). Multinomial logistic regression models examined the influence of changes in lifestyle risks on disability transition.nnnRESULTSnA higher percentage (82.9%) of respondents who were risk-free remained disability-free than those who exhibited positive (71.8%), stable (64.9%), or negative (63.8%) change (p<0.001). Sustaining no lifestyle risks, compared with negative change, was associated with a higher likelihood of remaining disability-free than decline (odds ratio=2.68, 95% confidence interval (CI): 1.32-5.42), adjusting for covariates. Among individual lifestyle factors, physical activity was predictive of not only functional independence but also improvement and maintenance.nnnCONCLUSIONSnOlder adults adopting more healthy lifestyles are more likely to maintain functional independence than decline. Making healthy lifestyle choices may delay disability progression in later life.

Clustering of multiple healthy lifestyles among older Korean adults living in the community.

Aim:u2003 Despite the predictive value of combined healthy lifestyles in maintaining physical and cognitive functioning in late life, little is known about the clustering patterns of healthy lifestyle behaviors in older people. The aim of the present study was to examine the prevalence, clustering and population characteristics of adherence to multiple health behaviors in community‐dwelling older Korean adults.