To be happy and behave in a healthier way. A longitudinal study about gender differences in the older population.

INTRODUCTION: Subjective well-being plays a key role in health. The objectives of this study are to analyse the longitudinal associations between subjective well-being dimensions and healthy behaviours, and to examine gender differences. METHOD: A representative sample of 1,190 Spanish non-institutionalised adults aged 50+ were interviewed over a 6-year follow-up period. The Cantril scale was used to measure evaluative well-being. The Day Reconstruction Method measured experienced well-being. The Global Physical Activity Questionnaire was used, whereas fruit and vegetables, tobacco and alcohol consumption, and sleep quality were self-reported. The Generalised Estimating Equation was calculated. RESULTS: Women show significantly worse subjective well-being than men longitudinally. Higher scores in life satisfaction and positive affect were significantly related to a higher level of physical activity and better-quality sleep for both women and men. Associations between a higher life satisfaction and an adequate intake of fruits and vegetables and being a non-smoker was only found in women (OR = 1.05; 95% IC = 1.00, 1.10 and OR = 1.16; 95% IC = 1.09, 1.23, respectively). CONCLUSION: Subjective well-being levels and frequencies in healthy behaviours are different in women and men. Subjective well-being interventions should take into account these differences in the frequency of healthy-unhealthy behaviours.

Objectively measured secondhand tobacco smoke and cognitive impairment in disability-free older adults.

Previous studies have suggested that exposure to secondhand smoke (SHS) may be associated with greater risk of cognitive impairment. However, no longitudinal study has examined the association of serum cotinine (as objective measure of SHS exposure) and cognitive function in older adults. We used data from 2087 non-smoking adults aged≥65 years participating in the ENRICA-2 cohort and free from limitations in Instrumental Activities of Daily Living. Cognitive function was assessed through the Mini-Mental State Examination (MMSE), the Digit Span Backwards subtest (DSBT), the Luria's motor series subtest from the Frontal Assessment Battery, the Trail Making Test A (TMT-A), the Free and Cued Selective Reminding Test (FCSRT), and the Categorical Verbal Fluency Test (CFT) of the 7 min test. Cross-sectional analyses were performed using multivariable logistic and ordered logistic models, while analyses on changes in cognition over time used multivariable repeated-measures mixed-effects models. Compared to the unexposed, those in the highest exposure group (≥0.161 ng/ml) were more likely to have cognitive impairment (MMSE<24) (odds ratio [OR]:1.64; 95% confidence interval [CI]:1.04-2.60) and lower DSBT scores (OR:1.25; 95%CI:1.00-1.57), as well as a non-significant higher odds of a lower score in the Luria test (OR:1.23; 95%CI:0.92-1.64) or episodic memory impairment (FCSRT<12, OR:1.38; 95%CI:0.90-2.11). In longitudinal analyses, those with baseline cotinine ≥0.161 ng/ml showed an increased risk of cognitive impairment (MMSE<24,OR:2.23; 95%CI:1.14-4.33; p-trend across cotinine categories = 0.028) and decreased DSBT (OR:1.23; 95%CI:1.01-1.51; p-trend across cotinine categories = 0.046). Findings show an increased risk of global cognitive impairment and declines in working memory performance in older adults exposed to SHS. More efforts are needed to protect older adults from SHS in areas not covered by smoke-free legislation.

Late-life disability trajectories in Yoruba Nigerians and the Spanish population: a state space model in continuous time.

OBJECTIVES: We compared the trajectory of activities of daily living (ADL) in a nationally representative sample of older Nigerians with their Spanish peers and identified factors to explain country-specific growth models. METHODS: Data from two household multistage probability samples were used, comprising older adults from Spain (n = 2,011) and Nigeria (n = 1,704). All participants underwent assessment for ADL. Risk factors including sex, household income, urbanicity, years of education, depression, alcohol consumption and smoking were assessed using validated methods. State-space model in continuous time (SSM-CT) methods were used for trajectory comparison. RESULTS: Compared with Nigerians (µADL80=0.44, SE = 0.015, p < 0.001), Spanish older adults had higher disability scores (µADL80=1.23, SE = 0.021, p < 0.001). In SSM-CT models, the rate of increase in disability was faster in Nigerians (Nigeria: ß = 0.061, p<.01; Spain: ß = 0.028, p < 0.010). An increasing course of disability in the Spanish sample was predicted by female sex, lower education and depression diagnosis. CONCLUSION: The rate of increase in disability was faster in older Nigerians living in an economically disadvantaged context.

Changes in Health Behaviors, Mental and Physical Health among Older Adults under Severe Lockdown Restrictions during the COVID-19 Pandemic in Spain.

We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.

Exploring the effect of loneliness on all-cause mortality: Are there differences between older adults and younger and middle-aged adults?

OBJECTIVE: This study aims to investigate the association between loneliness and all-cause mortality over a six-year follow-up period using the overall sample and by age groups (18-59 years and 60+ years). METHOD: Data from a longitudinal, prospective study of a nationally-representative sample of the Spanish non-institutionalized adult population were analysed (n = 4467). Mortality was ascertained via linkage to the National Death Index or obtained during the household visits. The UCLA Loneliness Scale was used to measure loneliness. Sex, age, education, physical activity, tobacco consumption, body mass index, disability, depression, living situation, and social participation were also considered as covariates. Multivariable Cox proportional hazard models were carried out. RESULTS: A higher level of loneliness was not associated with mortality risk in fully covariate-adjusted models over the entire population (HR = 1.02; 95% CI = 0.94, 1.12). The interaction term between loneliness and age groups was significant, indicating that the rate for survival of loneliness varied by age (HR = 1.29; 95% CI = 1.02, 1.63 for young- and middle-aged individuals; HR = 0.96; 95% CI = 0.89, 1.04 for older adults). CONCLUSIONS: The development of interventions aimed at tackling loneliness among young- and middle-aged adults might contribute to a mortality risk reduction. Future research is warranted to test whether our results can be replicated.

Fruit and Vegetable Consumption and Potential Moderators Associated with All-Cause Mortality in a Representative Sample of Spanish Older Adults.

This study sought to determine the association between levels of fruit and vegetable consumption and time to death, and to explore potential moderators. We analyzed a nationally-representative sample of 1699 older adults aged 65+ who were followed up for a period of 6 years. Participants were classified into low (≤3 servings day), medium (4), or high (≥5) consumption using tertiles. Unadjusted and adjusted cox proportional hazard regression models (by age, gender, cohabiting, education, multimorbidity, smoking, physical activity, alcohol consumption, and obesity) were calculated. The majority of participants (65.7%) did not meet the recommendation of five servings per day. High fruit and vegetable intake increased by 27% the probability of surviving among older adults with two chronic conditions, compared to those who consumed ≤3 servings per day (HR = 0.38, 95%CI = 0.21-0.69). However, this beneficial effect was not found for people with none, one chronic condition or three or more, indicating that this protective effect might not be sufficient for more severe cases of multimorbidity. Given a common co-occurrence of two non-communicable diseases in the elderly and the low frequency of fruit and vegetable consumption in this population, interventions to promote consuming five or more servings per day could have a significant positive impact on reducing mortality.

Voice Habits and Behaviors: Voice Care Among Flamenco Singers.

PURPOSE: The purpose of this study is to analyze the vocal behavior of flamenco singers, as compared with classical music singers, to establish a differential vocal profile of voice habits and behaviors in flamenco music. METHOD: Bibliographic review was conducted, and the Singer's Vocal Habits Questionnaire, an experimental tool designed by the authors to gather data regarding hygiene behavior, drinking and smoking habits, type of practice, voice care, and symptomatology perceived in both the singing and the speaking voice, was administered. We interviewed 94 singers, divided into two groups: the flamenco experimental group (FEG, n = 48) and the classical control group (CCG, n = 46). Frequency analysis, a Likert scale, and discriminant and exploratory factor analysis were used to obtain a differential profile for each group. RESULTS: The FEG scored higher than the CCG in speaking voice symptomatology. The FEG scored significantly higher than the CCG in use of "inadequate vocal technique" when singing. Regarding voice habits, the FEG scored higher in "lack of practice and warm-up" and "environmental habits." A total of 92.6% of the subjects classified themselves correctly in each group. CONCLUSIONS: The Singer's Vocal Habits Questionnaire has proven effective in differentiating flamenco and classical singers. Flamenco singers are exposed to numerous vocal risk factors that make them more prone to vocal fatigue, mucosa dehydration, phonotrauma, and muscle stiffness than classical singers. Further research is needed in voice training in flamenco music, as a means to strengthen the voice and enable it to meet the requirements of this musical genre.