Moses Wong

Inverse relationship between body mass index and mortality in older nursing home residents: A meta-analysis of 19,538 elderly subjects

Body mass index (BMI) and mortality in old adults from the general population have been related in a U‐shaped or J‐shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5–24.9, 25–29.9, ≥30 kg/m2), the most adjusted hazard ratios (HRs) according to a pre‐defined list of covariates were obtained from authors and pooled by random‐effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow‐up were meta‐analysed. Compared with normal weight, all‐cause mortality HRs were 1.41 (95% CI = 1.26–1.58) for underweight, 0.85 (95% CI = 0.73–0.99) for overweight and 0.74 (95% CI = 0.57–0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13–2.40]). RR results corroborated primary HR results, with additionally lower infection‐related mortality in overweight and obese than in normal‐weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.

Relative Contributions of Geographic, Socioeconomic, and Lifestyle Factors to Quality of Life, Frailty, and Mortality in Elderly

Background To date, few studies address disparities in older populations specifically using frailty as one of the health outcomes and examining the relative contributions of individual and environmental factors to health outcomes. Methodology/Principal Findings Using a data set from a health survey of 4,000 people aged 65 years and over living in all regions of Hong Kong, we examined regional variations in self-rated health, frailty, and four-year mortality, and analyzed the relative contributions of lifestyle, socioeconomic status, and geographical location of residence to these outcomes using path analysis. We hypothesize that lifestyle, socioeconomic status, and regional characteristics directly and indirectly through interactions contribute to self-rated physical and psychological health, frailty, and four-year mortality. District variations directly affect self-rated physical health, and also exert an effect through socioeconomic position as well as lifestyle factors. Socioeconomic position in turn directly affects self-rated physical health, as well as indirectly through lifestyle factors. A similar pattern of interaction is observed for self-rated mental health, frailty, and mortality, although there are differences in different lifestyle factors and district associations. Lifestyle factors also directly affect physical and mental components of health, frailty, and mortality. The magnitude of direct district effect is comparable to those of lifestyle and socioeconomic position. Conclusions/Significance We conclude that district variations in health outcomes exist in the Hong Kong elderly population, and these variations result directly from district factors, and are also indirectly mediated through socioeconomic position as well as lifestyle. Provision and accessibility to health services are unlikely to play a significant role. Future studies on these district factors would be important in reducing health disparities in the older population.

Incidence, reversibility, risk factors and the protective effect of high body mass index against sarcopenia in community-dwelling older Chinese adults

We examined the incidence and the reversibility of sarcopenia and their associated factors over a 4‐year period using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria.

Trends in hip fracture incidence and mortality in Chinese population from Hong Kong 2001–09

BACKGROUND there is a suggestion that while the age-adjusted incidence of hip fracture in the West may be declining, the incidence may be rising in Asia. OBJECTIVE this study examines the incidence and post-fracture mortality from 2001 to 2009 among the population aged 65 years and over. METHODS hip fracture incidence rates and case-fatality rates among Hong Kong population aged 65 and over for the period 2001-09 were obtained from the Hong Kong Hospital Authority (HA) database. Rates were adjusted for age. Poisson and logistic regressions were used to examine trends in incidence and post-fracture mortality, respectively. RESULTS the age-adjusted incidence rate of hip fracture among the population aged 65 and over in Hong Kong (per 100,000 population) decreased from 381.6 for men and 853.3 for women in 2001 to 341.7 and 703.1, respectively, in 2009. There were no significant changes in post-fracture mortality trends. CONCLUSIONS there is a downward trend in age-specific hip fracture incidence rates since 2001 among Hong Kong Chinese, but no change in post-fracture mortality trends.

Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis

Waist‐to‐height ratio (WHtR) is superior to body mass index and waist circumference for measuring adult cardio‐metabolic risk factors. However, there is no meta‐analysis to evaluate its discriminatory power in children and adolescents. A meta‐analysis was conducted using multiple databases, including Embase and Medline. Studies were included that utilized receiver‐operating characteristics curve analysis and published area under the receiver‐operating characteristics curves (AUC) for adiposity indicators with hyperglycaemia, elevated blood pressure, dyslipidemia, metabolic syndrome and other cardio‐metabolic outcomes. Thirty‐four studies met the inclusion criteria. AUC values were extracted and pooled using a random‐effects model and were weighted using the inverse variance method. The mean AUC values for each index were greater than 0.6 for most outcomes including hypertension. The values were the highest when screening for metabolic syndrome (AUC > 0.8). WHtR did not have significantly better screening power than other two indexes in most outcomes, except for elevated triglycerides when compared with body mass index and high metabolic risk score when compared with waist circumference. Although not being superior in discriminatory power, WHtR is convenient in terms of measurement and interpretation, which is advantageous in practice and allows for the quick identification of children with cardio‐metabolic risk factors at an early age.

Comparing the Age-Friendliness of Different Neighbourhoods Using District Surveys: An Example from Hong Kong

Background To address the age-friendliness of living environment in cities, the World Health Organization (WHO) launched the “Age-friendly cities” (AFC) initiative in 2005. To date, however, no universal standard tool for assessing age-friendliness of a community has been agreed. Methodology Two quantitative studies on AFC conducted in two Hong Kong districts—Sha Tin and Tuen Mun—were compared. A total of 801 residents aged ≥50 years were interviewed using structured questionnaires based on the WHO’s AFC criteria. District-wide differences in age-friendliness were compared on the basis of eight domain scores. Multiple linear regression was used to examine associations with demographic and socio-economic characteristics. The provision of services and amenities was also compared to help explain the difference in domain scores. Results Variations in mean domain scores were observed in both districts. Sha Tin showed significantly lower scores in outdoor spaces and buildings, transportation, social participation, respect and social inclusion, civic participation and employment, communication and information, as compared with Tuen Mun. Although a significantly higher score on the housing domain was observed in Sha Tin, differences in community and health services domains were insignificant. Socio-demographic factors, such as age group, gender, area of residence, type of housing, experience of elderly care, employment status, self-rated health and income, were associated with domain scores. However, variations in services and amenities provision appeared not to be strongly associated with district-wide difference in domain scores. Conclusions District differences in public opinions towards age-friendly characteristics were observed in this study. Except for two of the eight domains, Sha Tin had significantly lower scores than Tuen Mun. Some socio-demographic indicators seemed predictive to the differences. Paradoxically, Sha Tin had better services and infrastructure and higher socio-economic status, but lower age-friendliness. This warrants detailed research on psychosocial factors that may influence residents’ perceptions of local environments.

Ischemic Heart Disease Hospitalization among Older People in a Subtropical City — Hong Kong: Does Winter Have a Greater Impact than Summer?

Globally, excess winter morbidity from ischemic heart disease (IHD) is reported. In subtropical regions, there is a need to quantify the difference in the adverse effect of cold winters compared with hot summers, particularly among the older people. Our objectives were to: (i) compare the effect of winter on IHD hospitalizations with that of summer; (ii) examine temporal trends in the excess winter hospitalizations; and (iii) investigate the effect of age, gender, and meteorological factors on predicting such excess. Inpatient admissions due to IHD as principal cause during June 2000 to February 2009 in public hospitals of Hong Kong were extracted for the population aged ≥65. An Excess Hospitalization in Winter vs. Summer (EHWS) Index was used to contrast the adverse effect of weather on hospitalizations in winter vs. summer. Multiple linear regressions were used to investigate the trend and the predictors of such index. It was found that in a subtropical city, greater effect of winter on IHD hospitalizations than summer was observed, particularly among the oldest old (an index of 61.5% (95% CI: 49.5%–74.4%) for men aged ≥85 and 32.3% (95% CI: 25.5%–39.5%) for women aged ≥85). There was significant increasing trend in the index among those aged ≥85 but the age difference was less prominent among the women. Absolute level of coldness was not a significant factor, whereas the change in temperature was a significant factor, which implies that great fluctuation in temperature within a winter day had greater impact on occurrence of circulatory disease than an absolute temperature threshold.

Trends in activities of daily living disability in a large sample of community-dwelling Chinese older adults in Hong Kong: an age-period-cohort analysis

Background To examine the trends in activities of daily living (ADL) disability in older Chinese adults in Hong Kong between 2001 and 2012. Methods Using data from the Elderly Health Centres (EHCs) of the Department of Health comprising a total of 54 808 community-dwelling Chinese adults aged ≥65 years in 1 early cohort (1904–1917) and 10 3-year birth cohorts (1918–1920, 1921–1923, 1924–1926, 1927–1929, 1930–1932, 1933–1935, 1936–1938, 1939–1941, 1942–1944, 1945–1947), we examined trends in ADL disability by using age-period-cohort (APC) models. ADL disability was defined as being unable to perform at least 1 of 7 ADL activities (bathing, dressing, toileting, transferring, feeding, grooming, walking) independently. Cross-classified random-effects logistic regressions were performed for each of the APC trends with adjustment for age, period, cohort, sociodemographic, lifestyle, comorbidity and self-rated health. Results The mean age of the cohort was 70.9±4.7 (range 65–99) years. The prevalence rate of ADL disability was 1.6%. ADL disability increased with age (p<0.001) and the gradient of the increase was steeper in the older age groups. At the same age, women (1.7%) were more likely to report ADL disability than men (1.4%, p=0.001). For both genders, there was an increase in ADL disability between 2003 and 2012; adjustment for age, cohort and other covariates has diminished the trends observed among men. There was no cohort effect in ADL disability. Conclusions ADL disability in older adults has increased over the last decade. Further study is required to identify possible causes behind the disability trends.

Challenge to Long Term Care for the Elderly: Cold Weather Impacts Institutional Population More than Community-Dwelling Population

OBJECTIVES To examine whether cold weather affects the institutional population more than the community-dwelling population in terms of morbidity requiring hospital admission. METHODS Residence-based hospital discharge data were used to compile excess winter hospitalization (EWH) index for the older population (aged 65 years and above) living in institutions (residential care home for the elderly [RCHE] population) and the community-dwelling elderly population in Hong Kong. To separate the influence of influenza on the cold-related hospital admissions, episodes because of influenza were excluded from this study. RESULTS In 2009, the EWH index for the RCHE population was 22.93% (95% CI: 20.80%-25.09%), which was much higher than that for the community-dwelling population (14.09%, 95% CI: 13.11%-15.08%). The EWH index was higher among RCHE population compared with community-dwelling population across different age groups and sex (paired t-test one-tailed P= .014). CONCLUSION The institutional elderly population was more vulnerable to the risk of excess hospitalization in winter. There may be room for improvement in the living environment of institutions, in particular the ambient temperature and personal care, to reduce hospital admissions. Given the expanding institutional population, the limited hospital beds, and long waiting queue for accident and emergency services, prevention of cold-related hospitalization would help to reduce the medical care burden.

Effects of Perceived Neighbourhood Environments on Self-Rated Health among Community-Dwelling Older Chinese

In response to the growing number of older people living in cities, the World Health Organization (WHO) introduced the concept of “Age-Friendly Cities” (AFC) to guide the way in designing physical and social environments to encourage active ageing. Limited research has studied the effects of neighbourhood age-friendliness on elderly health outcomes. Using the example of a highly urbanized city in Asia, this study examined the effects of perceived age-friendliness of neighbourhood environments on self-rated health (SRH) among community-dwelling older Chinese. A multi-stage sampling method was used to collect views of community-dwelling older people from two local districts of Hong Kong. A structured questionnaire covering the WHO’s eight AFC domains was developed to collect information on the perceived neighbourhood environments, SRH and individual characteristics. Age-friendliness of neighbourhood was assessed by mean scores of AFC domains, which was used to predict SRH with adjustment for individual and objective neighbourhood characteristics. Furthermore, 719 respondents aged ≥60 years completed the questionnaire, of which 44.5% reported good SRH. Independent of individual and objective neighbourhood characteristics, multiple logistics regressions showed that higher satisfaction on outdoor spaces and buildings, transportation, housing, social participation, and respect and social inclusion was significantly associated with increased odds of reporting good SRH by more than 20% (p < 0.05). Individuals aged 70–79 years, being female, lower education and residents of public or subsidized housing were less likely to report good SRH, after controlling for individual and neighbourhood characteristics. In addition to age, gender, education and housing type, AFC environments have important contributive influence on SRH, after controlling for individual and objective neighbourhood characteristics.