BACKGROUND AND AIMS:While predictors of survival in older people have been examined in depth in a large number of studies, a literature search revealed no cross-national comparative prospective cohort studies on this issue. This study investigated survival and its predictors from age 75 to 85 among three local Nordic populations using survival data on national cohorts as background information.METHODS:The data were derived from national registers and from samples of 75-year old living in Denmark, Sweden, and Finland. The subjects were invited to take part in interviews and examinations focusing on different domains of health, functional capacity, and physical and social activities.RESULTS:The proportion of survivors to age 75 was markedly smaller among the Finnish men and women than Danish or Swedish subjects. In the local population no marked differences in survival from age 75 to 85 were observed between the groups of men, while women survived longer than men and longer in Göteborg than in Glostrup or Jyväskylä. Univariate models revealed 12 predictors of survival. In the multivariate models, the significant predictors among men related to physical fitness, whereas among women they pertained to social activities and morbidity.CONCLUSIONS:Despite great differences in the proportions of survivors to age 75, and excepting the survival advantage of women, only minor differences were present in the subjects' further survival to age 85. In the univariate analyses, many of the factors predictive of survival from age 75 to 85 were the same in the examined populations, whereas in the multivariate analyses differences between the sexes emerged.

Objective: The purpose of this study was to explore the association between body composition in the elderly and subsequent changes in muscle strength during aging.Methods: This was a longitudinal study with a 5-y follow-up. Eighty-seven men (n = 38) and women (it = 49) from a random sample of 75-y-old subjects in the Goteborg part of the Nordic Research on Aging study who were investigated at ages 75 and 80 y and were free from any major diseases at baseline were included. Body composition was estimated from bioelectrical impedance. The maximal isometric strengths of handgrip, ami flexion, and knee extension were measured on the side of the dominant hand while a subject was in a sitting position in an adjustable dynamometer chair.Results: Fat-free mass decreased significantly (P < 0.001) in both sexes, but more in men. Percentage of body fat increased only in men (P < 0.05). Body height decreased in both sexes, but more in women (P < 0.001). Declines in muscle strengths were evident for all muscle groups in both sexes but more prominent in men. It was observed that body composition status at baseline, measured as fat-free mass and fat-free mass index, was a statistically significant predictor for decline in muscle strength, particularly in the extremities.Conclusion: Fat-free mass at age 75 y was associated with lower 5-y decline in muscle strength. This finding underscores the potential importance of fat-free mass for maintaining functional ability during aging. (c) 2009 Published by Elsevier Inc.

Objective. The prevalence of caries and various risk factors was studied cross-sectionally in two cohorts of 72-year-olds over the course of 20 years. Incidence was also studied over a period of 6 years. Material and Methods. Samples of two dentate subjects from cohorts of 70 to 72-year-olds were included; cohort III (n=135), born 1911–12, and cohort VI (n=139), born 1930. Cohort III was also examined at 70 years of age and re-examined after 6 years. An interview and clinical examination, including DMFS, plaque and gingival bleeding indices, pocket depth, and secretion rate for stimulated whole saliva, were carried out. Results. The mean numbers of teeth in cohorts III and VI were 14 and 21, respectively. On average, 2.1 tooth surfaces were decayed (DS) in cohort III compared with 1.3 in cohort VI (p<0.05). 49% of the individuals in cohort III did not develop any new DS, while 19% developed ≥3 DS during the 6-year follow-up period. The prevalence of caries was related to plaque and gingival bleeding indices, as well as a pocket depth of ≥4 mm, at ages 70 and 72. Moreover, the incidence of caries was related to the same factors. Conclusions. The numbers of remaining teeth increased and the prevalence of caries decreased over the 20-year period. The incidence of caries over the follow-up period of 6 years was moderate. The results indicate that the prevalence of plaque, gingival bleeding, and a pocket depth of ≥4 mm are predictive factors for both prevalence and incidence of caries.

Background and Purpose - Depression may increase the risk for stroke. Few studies have examined whether depression increases the risk for stroke in the very old and among the demented. We examined the relation between depression in 85-year-olds and the 3-year incidence of first-ever stroke.Methods - A representative sample of 494 85-year-olds (147 demented, 347 nondemented) in Gothenburg, Sweden, was examined with psychiatric examinations and key informant interviews. Diagnoses of depression and dementia were made according to the Diagnostic and Statistical Manual of Mental Disorders, Third Revision. The sample was followed for 3 years regarding the incidence of stroke. Information on stroke was obtained from the Swedish Hospital Discharge Register, death certificates, self-reports, and key informants. Those with known stroke history at baseline (n = 93) were excluded from the incidence study.Results - The prevalence of depression at age 85 was 19%. Depression at baseline (hazard ratio, 2.7; 95% CI, 1.5 to 4.7; P = 0.0006) and systolic blood pressure (hazard ratio, 1.014 per 1 mm Hg; 95% CI, 1.00 to 1.03; P = 0.019) were related to increased incidence of first-ever stroke during follow-up. Depression increased stroke risk both among demented and nondemented individuals. Among the symptoms of depression, only depressed mood was an independent predictor of incidence first-ever stroke in multivariate analyses. Stroke history at age 85 was not associated with clinical depression.Conclusions - Depression and stroke are both common in elderly populations. The finding that depression increases risk for first-ever stroke indicates that detection and treatment of depression may have implications for stroke prevention.

Objective. Although associations between number of teeth and mortality have been found in some studies, the results have not been conclusive. The aim of this study was to determine whether dental status at age 75 is an independent predictor of survival in three Nordic populations. Material and Methods. The baseline study was conducted as part of a comparative Nordic investigation of systematic samples of 75-year-old men and women born in the period 1914 - 16 (n=1004) and living independently in three Nordic localities: Glostrup in Denmark, Jyvaskyla in Finland, and Goteborg in Sweden. Performed in 1989 - 91, the study included a home interview, a health questionnaire, and a laboratory examination. For the present study, the mortality data of all participants up to age 82 were collected from official registers in 1999. Results. Lower mortality during 7 years was associated with higher number of remaining teeth at age 75. In Jyvaskyla and Goteborg, but not in Glostrup, the association between number of teeth and mortality was statistically significant. For all three samples pooled and adjusted for sex and location, this association was significant (odds ratio 0.86; p < 0.001). Conclusions. Number of teeth is a significant predictor of 7-year mortality in 75-year-old women independently of a number of factors related to lifestyle, disease, and reduced functional capacity.

OBJECTIVE:The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes.DESIGN:Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg.PARTICIPANTS:A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden.METHODS:One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI).RESULTS:Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men.CONCLUSIONS:Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

Indicators of adiposity, such as body-mass index (BMI), may be markers for changes in energy metabolism that influence dementia risk, progression, and ultimately death. Cross-sectional studies show that people with dementia have a lower BMI than those without dementia, which is potentially due to a greater rate of BMI decline occurring during the years immediately preceding dementia onset. However, a high BMI can also increase the risk for dementia when measured before clinical dementia onset, which might be due to vascular disorders or bioactive hormonal compounds that are secreted by adipose tissue. In this personal view, I consider how dementia is associated with BMI by looking at the role of BMI and obesity syndromes, mechanisms associated with adiposity, and the potential for hypothalamic dysregulation during the life course. Understanding the life course of adiposity by use of common surrogate measures, such as BMI, among those who do and do not develop dementia is relevant for understanding the causes of dementia and for shaping possible treatment options.

OBJECTIVES: To measure relative fitness and frailty in older people without specific frailty instruments and to relate that measurement to long-term health outcomes.DESIGN: Retrospective cohort studies.SETTING: Two population-based studies of people aged approximately 70 at baseline and followed up to 10 years (in the Canadian Study of Health and Aging (CSHA)) or 26 years in the Gothenburg H-70 cohort study.PARTICIPANTS: Nine hundred sixty-two men and 1,178 women.MEASUREMENTS: Deficit accumulation (the exposure) was counted using self-reported (CSHA) or clinically designated (H-70) symptoms, signs, diseases, and disabilities. Relative fitness and frailty were measured in relation to the degree of deficit accumulation evaluated in four quartiles, representing those most fit to those most frail. The items that made up the frailty index were selected randomly without replacement in 1,000 iterations. The outcomes were risks of death or residential long-term care.RESULTS: Worse frailty, however measured, was associated with worse survival; the Kaplan-Meier curves of random iterations of the frailty definition showed virtually no interquartile overlap for mortality. For any given level of frailty, men died younger than women. Worse frailty was also associated with a higher risk of institutionalization.CONCLUSION: Frailty appears to be a robust concept that is readily operationalized, with the risk of adverse outcomes being largely established by age 70.

To develop a method for quantifying risks of death and dementia in relation to vascular risk factors the Gothenburg H-70 1901-02 birth cohort was studied (n = 380, was followed over 20 years, with 103 incident dementia cases). Separate vascular risk factor indices were calculated using 23 vascular risk factors to predict: (i) dementia-free-survival, and (ii) incident dementia derived from post hoc optimal separation of affected and unaffected cases. Classification of adverse outcomes (dementia/non-dementia; alive/dead) was assessed using receiver-operator characteristic (ROC) curves, and the area under the curve (AUC). Each index showed high separation between affected and unaffected cases. For dementia/non-dementia, the AUC was 0.74 +/- 0.02 for 10 year and 0.67 +/- 0.02 for 20 year; for death/survival, the AUC was 0.75 +/- 0.02 for 10 years and 0.79 +/- 0.03 for 20 years. Of note, few items were important in both indexes, and most showed reciprocal effects (e.g. decreased the risk of death but increased the risk of dementia). Our results suggest that vascular risk factor indexes can give robust estimates of dementia and life span prognoses in elderly people, but death and dementia have different risk profiles. This may be because of death being a competing risk for incident late-onset dementia.

The prevalence of the metabolic syndrome in different elderly European populations has not been well studied. The aim of this study was to measure the prevalence of metabolic syndrome, as well as its individual components, in an elderly Swedish cohort. A random sample of 778 individuals (372 men and 406 women) was selected from a 70-year-old cohort in the H70 study, a gerontological and geriatric population study carried out in Gothenburg, Sweden. The study included medical and treatment history assessments, laboratory procedures and physical examinations to determine the presence of each of the five components of the metabolic syndrome as defined by the National Cholesterol Education Program Adult Treatment Panel III. Of the 508 adults (243 men and 265 women) included in the study, 22.6% had metabolic syndrome. The prevalence was higher in men (26.3%) than in women (19.2%). One third of the total sample had at least one of the five risk factors for metabolic syndrome. High blood pressure (≥130/85 mmHg or use of antihypertensive/diuretic medication) was the most prevalent risk factor in both men (68.3%) and women (50.2%), while abdominal obesity was the overall second most common risk factor (27.2% of men and 42.7% of women). The prevalence of high fasting plasma glucose (≥110 mg/dl or use of antidiabetic medication) was 29.0% in men and 19.1% in women. Metabolic syndrome was prevalent in a significant proportion of this elderly Swedish population, highlighting the underdiagnosis of a condition that is important to treat.

OBJECTIVE The aims of this study, which are part of the gerontological and geriatric population studies in Göteborg, Sweden (H70), were to describe cohort differences and trends in dental status and utilization of dental care in 70-year-olds. The study is based on five cohorts examined in 1971/72, 1976/77, 1981/82, 1992/93 and 2000/01 (called cohort I, II, III, V and VI, respectively). The total number of participants was 2290 and varied between 386 and 583 in the different cohorts. The proportion of dentate 70-year-olds changed gradually from 49% in the first to 93% in the last cohort. The mean number of teeth in the dentate 70-year-olds was 14 in cohort I and 21 in cohort VI. The proportion of subjects with 20 or more teeth changed from 13% in cohort I, to 20% in cohort III, and to 65% in cohort VI. In cohort I, 76% of the 70-year-olds had some kind of removable denture; 37% in cohort III, but only 17% in cohort VI. About 20% of all 70-year-olds in cohort I reported regular yearly visits to a dentist. The corresponding figures in cohort III and cohort VI were 50% and 80%, respectively. Even though positive cohort trends were observed in all studied subgroups, factors such as low education, smoking, being un-married, having high waist circumference and being physically inactive were negatively associated with dental status at the end of the study period as well as at the beginning.

Objective: To examine the longitudinal association between plasma total cholesterol and triglyceride levels and incident dementia. Methods: Neuropsychiatric, anthropometric, laboratory, and other assessments were conducted for 392 participants of a 1901 to 1902 birth cohort first examined at age 70. Follow-up examinations were at ages 75, 79, 81, 83, 85, and 88. Information on those lost to follow-up was collected from case records, hospital linkage system, and death certificates. Cox proportional hazards regression examined lipid levels at ages 70, 75, and 79 and incident dementia between ages 70 and 88. Results: Increasing cholesterol levels (per mmol/L) at ages 70 (hazard ratio [HR] 0.77, 95% CI: 0.61 to 0.96, p = 0.02), 75 (HR 0.70, CI: 0.52 to 0.93, p = 0.01), and 79 (HR 0.73, CI: 0.55 to 0.98, p = 0.04) were associated with a reduced risk of dementia between ages 79 and 88. Examination of cholesterol levels in quartiles showed that the risk reduction was apparent only among the highest quartile at ages 70 (8.03 to 11.44 mmol/L [311 to 442 mg/dL]; HR 0.31, CI: 0.11 to 0.85, p = 0.03), 75 (7.03 to 9.29 mmol/L [272 to 359 mg/dL]; HR 0.20, CI: 0.05 to 0.75, p = 0.02), and 79 (6.82 to 9.10 mmol/L [264 to 352 mg/dL]; HR 0.45, CI: 0.17 to 1.23, p = 0.12). Triglyceride levels were not associated with dementia. Conclusions: High cholesterol in late life was associated with decreased dementia risk, which is in contrast to previous studies suggesting high cholesterol in mid-life is a risk factor for later dementia. The conflicting results may be explained by the timing of the cholesterol measurements in relationship to age and the clinical onset of dementia.

Objective: To assess the sensitivity, specificity and predictive validity of suggested cut-off scores in the SF-36 mental health (MH) and mental component summary (MCS) in screening for depressive and anxiety disorders in a population sample of older Swedish women. Method: The sample comprised 586 randomly selected females aged 70–84 years who took part in an in-depth psychiatric examination. This provided the ‘gold standard’ against which the usefulness of SF-36 recommended thresholds for screening for depressive and anxiety disorders in older Swedish women was examined. Results: Based on DSM-III-R criteria, 69 women (12) were diagnosed with depression (major depression, dysthymia and/or depression NOS) and 49 (8) with generalised anxiety and panic disorders. The previously recommended MH and MCS cut-offs (i.e. 52 and 42) gave a specificity for diagnosis of depression of 92 and 82 and sensitivity of 58 and 71, respectively. Both the MH and MCS were good predictors of depressive disorders but poor predictors of anxiety disorders. Conclusion: The study supports the predictive validity of suggested SF-36 MH and MCS cut-off scores in screening for depressive disorder but not for anxiety disorder in older women in Sweden.

BACKGROUND:Deficiencies of vitamin B-12, folic acid, and vitamin B-6-as defined by laboratory measures-occur in 10-20% of elderly subjects. The clinical significance remains unresolved.OBJECTIVE:The objective was to explore any association between vitamin status and vitamin treatment and movement and cognitive performance in elderly subjects.DESIGN:Community-dwelling subjects (n = 209) with a median age of 76 y were randomly assigned to daily oral treatment with 0.5 mg cyanocobalamin, 0.8 mg folic acid, and 3 mg vitamin B-6 or placebo (double blind) for 4 mo. Movement and cognitive performance tests were performed before and after treatment.RESULTS:A high plasma total homocysteine (tHcy) concentration (> or =16 micromol/L) was found in 64% of men and in 45% of women, and a high serum methylmalonic acid (MMA) concentration (> or =0.34 micromol/L) was found in 11% of both sexes. Movement time, digit symbol, and block design (adjusted for age, sex, smoking, and creatinine) correlated independently with plasma tHcy (P < 0.01, < 0.05, and < 0.01, respectively); the simultaneity index and block design correlated with serum MMA (P < 0.05 for both). Vitamin therapy significantly decreased plasma tHcy (32%) and serum MMA (14%). No improvements were found in the movement or cognitive tests compared with placebo. Neither vitamin therapy nor changes in plasma tHcy, serum MMA, serum vitamin B-12, plasma folate, or whole-blood folate correlated with changes in movement or cognitive performance.CONCLUSIONS:High plasma tHcy and serum MMA were prevalent and correlated inversely with movement and cognitive performance. Oral B vitamin treatment normalized plasma tHcy and serum MMA concentrations but did not affect movement or cognitive performance. This might have been due to irreversible or vitamin-independent neurocognitive decline or to an insufficient dose or duration of vitamins.

In 1987, the International Union of Nutritional Sciences (IUNS) subcommittee on Nutrition and Ageing, in conjunction with the World Health Organization (WHO) global program for the elderly, embarked on the 'Food Habits in Later Life' (FHILL): a cross-cultural study to determine to what extent health, social and lifestyle variables, especially food intake, collectively predict survival amongst long-lived cultures. A total of 818 participants aged 70 years and over were recruited from five IUNS centres. Mortality data were collected after five to seven years. The cohorts included Swedes in Sweden (SWD), Greeks in Greece (GRS) and in Melbourne, Australia (GRM), Anglo-Celts in Australia (ACS) and Japanese in Japan (JPN). Information was obtained on health, lifestyle and diet at baseline. A Cox Proportional Hazard model containing ten potential predictors of survival, adjusted to age at enrollment and ethnicity/locality, was developed to analyse the survival data. Based on up to seven years survival data, it was found that being an elderly Greek in Australia conferred the lowest mortality risk and being an elderly Greek in Greece conferred the highest mortality risk. When the ten potential predictors of survival were entered into the Cox model, the memory score, the Mediterranean diet score, Activities of Daily Living (ADL) and general health status scores showed the greatest effects in significantly reducing mortality hazard ratios by 22%, 13%, 4% and 4%, respectively. For diet score, a one-unit change predicted a significant 13% difference in survival. Of the lifestyle (modifiable) variables entered in the multivariate model, exercise and social activity were not significant predictors of survival suggesting that diet is a more important predictor of survival than these variables. Another lifestyle variable, smoking, significantly increased mortality hazard ratios by 67%, making it a more important predictor of survival than diet. Being male (non-modifiable) also increased risk of death by 63%. Diet, particularly the Mediterranean Diet, operates irrespective and together with other factors as an appreciable contributor to survival, with a strength comparable to or greater than all other measured variables. The independence and strength of the predictiveness of food pattern for survival, and for this to be cross-cultural from Europe to Asia is a novel and important observation for food and health policy.

In order to describe the different study populations and to allow a rough comparison between countries, some medical data were obtained from the subjects studied, together with demographic and psychosocial data described elsewhere in this publication. Such data can serve as valuable background factors for the description of the nutritional situation, which is the main purpose of this book. Some medical factors are discussed in other parts of the book such as the disease patterns of different countries. This chapter deals with blood pressure, some biochemical analyses and cutaneous microtopography.

Background: Within a larger study of social network and nutrition, we investigated measurements of nutritional status and health related quality of life. Objective: To relate a well-established questionnaire of nutritional status (MNA) to a likewise well-established questionnaire of health related quality of life (SF-36) in community dwelling, free-living and, healthy 70-75 years old persons. Design: Before an interview, the MNA and SF-36 questionnaires were filled in by 128 participants from a sample of 262 subjects. Results: The MNA worked well as a measurement in this sample. Many MNA aspects correlated with the SF-36 scales. The correlations between MNA total score and the eight SF-36 scales varied from .27 to .62. Discussion: This correlation was partly due to the fact that MNA has questions of health but also to the fact that there is an empirical relation between nutrition and health. Conclusion: The MNA measurement is applicable to a healthy, free-living elderly population and parts of the MNA can be interpreted as measurements of health related quality of life. Low values of SF-36 could also be used as predictors of risk of malnutrition, although further studies are required to confirm this result.