Julie Byles

Cohort profile: the 45 and up study.

In common with virtually all industrialized countries and many less developed nations, Australia is facing rapid population ageing. Historical patterns of fertility and migration, along with changes in life expectancy, mean that the over 65 age group is likely to increase by around 50% in the next 15–20 years. The further increase in the proportion of people in the very old age groups will result in the ‘ageing of the aged’. The challenges presented by the ageing of the population are far reaching. Discussions have tended to focus on its likely health and economic consequences; however, few aspects of society will remain unaffected by the issue. There is an urgent need for reliable evidence to inform policy to support healthy ageing. The concept of healthy ageing encompasses traditional ideas relating to freedom from disease, as well as broader considerations including independence, quality of life, management of disability, participation in society and the workforce and productivity. A wide range of factors are likely to affect health in later life, including socioeconomic, environmental and cultural variables, cigarette smoking, alcohol consumption, diet, physical activity, reproductive and hormonal factors, infections, availability of healthcare and use of pharmaceutical agents, as well as individuals’ susceptibility to disease. A comprehensive investigation of the determinants of healthy ageing must incorporate assessment of disease risk, quality of life and other indices, in relation to a very wide range of possible exposures, and with consideration of how these exposures might interact with one another. Research needs to be of a sufficient scale to provide specific information on the major diseases and health problems experienced in later life. This is because reliable assessments of risk factor–disease relationships require a substantial degree of pathological homogeneity of outcome and appropriate consideration of confounding. At the same time, research needs to be able to assess the broad risks and benefits of particular exposures, to allow meaningful conclusions to be reached about suitable public health interventions. Finally, it needs to be large and long term enough to track the impact of health interventions and policies at the population level. Australia has some unique characteristics that will impact on healthy ageing and provide particular challenges in delivering health care. For example, it has: a relatively heterogenous population with a large migrant community; an indigenous population with an average life expectancy 17 years less than for nonindigenous Australians; some remote and sparsely populated regions and a mixed health care system with responsibility shared between the national and state governments and delivery in both the public and private sectors. Excellent population-level databases relating to use of health services and medications, and registers of cancers and deaths, are available for statistical linkage with research data sets. There is therefore a need for research that addresses issues specific to the Australian population and makes use of the unique features of the Australian setting, giving the opportunity to provide insights of international relevance. The 45 and Up Study was conceived as a long-term collaborative resource to investigate healthy ageing, in response to the gaps in existing knowledge and the needs of researchers. Initial discussions among interested researchers resulted in the formation of a Scientific Steering Group in 2003 to oversee the development of the Study. The Study is auspiced by the Sax Institute, which also provided funding for its development. The Sax Institute is an independent organization with core funding from the state government of New South Wales, Australia’s most populous state. Its mission is to improve health through facilitating high-quality research and increasing the impact of this research on health policy and services; it has membership from y The Writing Committee is listed at the end of the report. For a list of the 45 and Up Study Collaborators please go to www.45andUp.org.au.

Association of Helicobacter pylori Infection With Gastric Carcinoma: A Meta-Analysis

OBJECTIVE:As conflicting studies have recently been published, we aimed to determine if Helicobacter pylori (H. pylori) infection is associated with gastric adenocarcinoma.METHODS:This was a meta-analysis of observational epidemiological studies.RESULTS:A total of 42 studies met the selection criteria and were categorized by the type of study design: eight cohort and 34 case-control studies. The pooled odds ratio for H. pylori in relation to gastric carcinoma was 2.04 (95% CI: 1.69–2.45). Both patient age (OR 0.77, 95% CI: 0.68–0.89) and intestinal type cancers (OR 1.14, 95% CI: 1.05–1.25) were independent effect modifiers. Analysis of other effect modifiers showed no relationship with female gender (OR 0.76, 95% CI: 0.64–0.89), stage of cancer (advanced %) (OR 1.12, 95% CI: 0.88–1.43), anatomical location (cardia %) (OR 1.54, 95% CI: 0.32–7.39) or cohort (nested case-control) studies (OR 1.72, 95% CI: 0.32–9.17). There was significant heterogeneity among the studies (τ2= 149; p < 0.001). The quality of the studies varied considerably, with the majority of excellent studies producing positive results and the very poor to moderate studies producing mixed results.CONCLUSIONS:H. pylori infection is associated with a 2-fold increased risk of developing gastric adenocarcinoma.

Health, functioning, and disability in older adults—present status and future implications

Ageing is a dynamic process, and trends in the health status of older adults aged at least 60 years vary over time because of several factors. We examined reported trends in morbidity and mortality in older adults during the past two decades to identify patterns of ageing across the world. We showed some evidence for compression of morbidity (ie, a reduced amount of time spent in worse health), in four types of studies: 1) of good quality based on assessment criteria scores; 2) those in which a disability-related or impairment-related measure of morbidity was used; 3) longitudinal studies; or 4) studies undertaken in the USA and other high-income countries. Many studies, however, reported contrasting evidence (ie, for an expansion of morbidity), but with different methods, these measures are not directly comparable. Expansion of morbidity was more common when trends in chronic disease prevalence were studied. Our secondary analysis of data from longitudinal ageing surveys presents similar results. However, patterns of limitations in functioning vary substantially between countries and within countries over time, with no discernible explanation. Data from low-income countries are very sparse, and efforts to obtain information about the health of older adults in less-developed regions of the world are urgently needed. We especially need studies that focus on refining measurements of health, functioning, and disability in older people, with a core set of domains of functioning, that investigate the effects of these evolving patterns on the health-care system and their economic implications.

Body mass index and survival in men and women aged 70 to 75

OBJECTIVES: To examine in an older population all‐cause and cause‐specific mortality associated with underweight (body mass index (BMI)<18.5), normal weight (BMI 18.5–24.9), overweight (BMI 25.0–29.9), and obesity (BMI≥30.0).

Perceptions of stroke in the general public and patients with stroke: a qualitative study

Abstract Objectives: To gain insight into peoples thoughts on stroke and to inform the development of educational strategies in the community. Design: Focus group discussions: two groups of people who had a stroke and their carers, and two groups of members of the general public. Setting: New South Wales, Australia. Participants: 35 people participated: 11 from the general public, 14 people who had had a stroke, and 10 carers or partners. Main outcome measures: Views on risk factors, symptoms, treatment, information resources, and prevention. Results: All groups reported similar knowledge of risk factors. People generally mentioned stress, diet, high blood pressure, age, and smoking as causes of stroke. Participants in the community group gave little attention to symptoms. Some participants who had had a stroke did not initially identify their experience as stroke because the symptoms were not the same as those they had read about. There were mixed feelings about the extent of involvement in management decisions during hospital admission. Some felt sufficiently involved, some wanted to be more involved, and others felt incapable of being actively involved. Conclusions: Symptoms of stroke are not easy to recognise because they vary so much. Presentation of information about stroke by hospital and community health services should be improved. Simple and understandable educational materials should be developed and their effectiveness monitored. What is already known on this topic Increasing the speed of presentation to hospital after the onset of stroke depends on the level of knowledge of stroke in the general population Among stroke patients and the general public the knowledge of stroke is poor What this study adds Focus group discussion showed that recognition of stroke was not easy for the general public because symptoms present in various ways None of the available written information about stroke successfully conveyed the importance of early presentation to hospital for anyone experiencing warning signs or symptoms

Health and Ageing

Australians experience very long life expectancy and healthy life expectancy; however, increases in longevity are currently greater than increases in healthy life expectancy. Multiple co-morbid chronic conditions are common among older people in Australia, with significant implications for their quality of life, independence, and need for health and aged care. Promotion of healthy ageing involves a life course approach to prevention of chronic conditions, comprehensive health care, and supportive environments. This chapter will provide an overview of the health profile of older people in Australia including analysis and discussion of epidemiological evidence of changes in the pattern of health-related issues and the challenges and opportunities these present.

Cohort Profile: The Hunter Community Study

In almost every country, the proportion of people aged 460 years is growing faster than any other age group and is expected to reach 2 billion worldwide by 2050. Internationally and nationally, considerable efforts are being made to promote active ageing. However, Australia lacks the kind of comprehensive longitudinal research underway in Europe and North America. Although Australia does have a number of longitudinal studies designed to address various issues of health and ageing among older adults, only a few of these studies include a broad and comprehensive range of physical and biological measures. The Hunter Community Study (HCS) is a collaborative study between the University of Newcastle’s School of Medicine and Public Health and the Hunter New England Area Health Service. It is a multi disciplinary initiative that was established to fill some existing gaps in ageing research in Australia and is unique in that it has collected detailed information across all six key policy themes as identified in the Framework for an Australian Ageing Research Agenda. What does the study cover?

Weighted multimorbidity indexes predicted mortality, health service use, and health-related quality of life in older women

OBJECTIVE To develop indexes of multimorbidity, based on self-reported data, to predict mortality, health service use, help with activities of daily living (ADL), and health-related quality of life (HRQOL) in older women. STUDY DESIGN AND SETTING Cross-sectional survey of 10,434 women, aged 73-78 years, in the Australian Longitudinal Study of Womens Health in 1999, with mortality follow-up to 2005. For analysis, the sample was equally split into a development and validation sample. Weighted and unweighted multimorbidity indexes were developed and tested. RESULTS Outcomes ranged from 14% for mortality to 47% for specialist doctor visits. Mortality was predicted by heart disease, stroke, low iron, diabetes, cancer (nonskin), bronchitis/emphysema, and Alzheimers disease. Different patterns of morbidities were associated with the other outcomes. Weighted and unweighted multimorbidity index scores were linearly related to increasing risk of each outcome. For each outcome, the weighted scores fitted the data better and had a wider range of possible values. CONCLUSION These multimorbidity indexes predict mortality, health service use, help with ADL, and HRQOL in older women. The indexes could be used as covariates in research with weighted scores having a better chance of discriminating between patient groups than unweighted scores.

Vegetable-rich food pattern is related to obesity in China

Objective:To investigate the association between a vegetable-rich food pattern and obesity among Chinese adults.Design:A food pattern rich in vegetables is associated with lower risk of obesity and non-communicable chronic disease in Western countries. A similar food pattern is found in the Chinese population but the cooking method is different. A cross-sectional household survey of 2849 men and women aged 20 years and over was undertaken in 2002 in Jiangsu Province (response rate, 89.0%). Food intake was assessed by food frequency questionnaire. Factor analysis was used to identify food patterns. Nutrient intake was measured by food weighing plus consecutive individual 3-day food records. Height, weight and waist circumference were measured.Results:The prevalence of general obesity (BMI ⩾28 kg m−2) was 8.0% in men and 12.7% in women, central obesity was 19.5% (⩾90 cm) and 38.2% (⩾80 cm), respectively. A four-factor solution explained 28.5% of the total variance in food frequency intake. The vegetable-rich food pattern (whole grains, fruits and vegetables) was positively associated with vegetable oil and energy intake. Prevalence of obesity/central obesity increased across the quartiles of vegetable-rich food pattern. After adjusting for sociodemographic factors and four distinct food patterns, the vegetable-rich pattern was independently associated with obesity. Compared with the lowest quartile of vegetable-rich pattern, the highest quartile had higher risk of general obesity (men, prevalence ratio (PR): 1.82, 95% confidence interval (CI): 1.05–3.14; women, PR: 2.25, 95% CI: 1.45–3.49).Conclusion:The vegetable-rich food pattern was associated with higher risk of obesity/central obesity in Chinese adults in both genders. This association can be linked to the high intake of energy due to generous use of oil for stir-frying the vegetables.

Assessment of a short scale to measure social support among older people

Background: Social support strongly influences health, but research has been limited by the paucity of brief, inexpensive, psychometrically sound scales suitable for use with older people.