Cross-Regional Data Initiative for the Assessment and Development of Treatment for Neurological and Mental Disorders.

Purpose: To describe and categorize detailed components of databases in the Neurological and Mental Health Global Epidemiology Network (NeuroGEN). Methods: An online 132-item questionnaire was sent to key researchers and data custodians of NeuroGEN in North America, Europe, Asia and Oceania. From the responses, we assessed data characteristics including population coverage, data follow-up, clinical information, validity of diagnoses, medication use and data latency. We also evaluated the possibility of conversion into a common data model (CDM) to implement a federated network approach. Moreover, we used radar charts to visualize the data capacity assessments, based on different perspectives. Results: The results indicated that the 15 databases covered approximately 320 million individuals, included in 7 nationwide claims databases from Australia, Finland, South Korea, Taiwan and the US, 6 population-based electronic health record databases from Hong Kong, Scotland, Taiwan, the Netherlands and the UK, and 2 biomedical databases from Taiwan and the UK. Conclusion: The 15 databases showed good potential for a federated network approach using a common data model. Our study provided publicly accessible information on these databases for those seeking to employ real-world data to facilitate current assessment and future development of treatments for neurological and mental disorders.

Validity of the Finnish Care Register for Social Welfare in a nationwide cohort of people with Alzheimer's disease.

AIMS: To assess the validity and completeness of the Care Register for Social Welfare among community-dwelling people with Alzheimer's disease in Finland. METHODS: The study was carried out in the Medication Use and Alzheimer's disease (MEDALZ) study population, which includes 70,719 people who received a clinically verified diagnosis of Alzheimer's disease between 2005 and 2011 and the people matched with them for comparison (n=282,862). The data were linked to the Care Register for Social Welfare, which contains data on care periods for nursing homes and sheltered housing with 24-h assistance during the time period 1994-2015. The validity of the Care Register for Social Welfare was analysed in relation to the Prescription Register among people with Alzheimer's disease aged >65 years (n=25,640) who fulfilled the definitions of long-term care in certain inpatient care units (nursing homes, institutional care for people with dementia and rehabilitation institutions), although, in Finland, drug purchases should not be recorded in the register during long-term care. RESULTS: The required level of assistance at discharge was recorded for 99.7% of people, diagnoses for 5.1% of the care periods and the discharge date for 100% of the completed care periods. Depending on the definition of long-term care, 6-10% of all long-term care periods included drug purchases during the study period. CONCLUSIONS: The validity of the Care Register for Social Welfare is high, but some limitations should be considered when using the data. Combining health and social care registers provides a potentially more comprehensive database on the utilisation and costs of services.

Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people: a European survey.

PURPOSE: Fall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitators to CDSS use and explored differences in their perceptions. METHODS: We examined and compared the relative importance and the occurrence of regional differences of a literature-based list of barriers and facilitators for CDSS usage among physicians treating older fallers from 11 European countries. RESULTS: We surveyed 581 physicians (mean age 44.9 years, 64.5% female, 71.3% geriatricians). The main barriers were technical issues (66%) and indicating a reason before overriding an alert (58%). The main facilitators were a CDSS that is beneficial for patient care (68%) and easy-to-use (64%). We identified regional differences, e.g., expense and legal issues were barriers for significantly more Eastern-European physicians compared to other regions, while training was selected less often as a facilitator by West-European physicians. Some physicians believed that due to the medical complexity of their patients, their own clinical judgement is better than advice from the CDSS. CONCLUSION: When designing a CDSS for Geriatric Medicine, the patient's medical complexity must be addressed whilst maintaining the doctor's decision-making autonomy. For a successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Equipping a CDSS with prediction models has the potential to provide individualized recommendations for deprescribing FRIDs in older falls patients.

Factors associated with daily opioid use among aged home care clients: a cross-sectional analysis of Resident Assessment Instrument data.

PURPOSE: To examine which client characteristics and other factors, including possible adverse effects, identified in the Resident Assessment Instrument-Home Care (RAI-HC) are associated with daily opioid use among aged home care clients. METHODS: The study sample comprised 2584 home care clients aged ≥ 65 years, of which 282 persons used opioids daily. Clients using opioids less than once daily were excluded. The cross-sectional data were gathered from each client's first assessment with the RAI-HC during 2014. Multivariable logistic regression was used to study associations of daily opioid use with the clients' characteristics and symptoms. RESULTS: Cognitive impairment was associated with less frequent opioid use after adjusting for pain-related diseases, disabilities and depressive symptoms (OR 0.43, 95% CI 0.32-0.58). The association was not explained by the estimated severity of pain. Osteoporosis, cancer within previous 5 years and greater disabilities in Instrumental Activities of Daily Living (IADL) were associated with daily opioid use regardless of the estimated severity of pain. Depressive symptoms and Parkinson's disease were associated with daily opioid use only among clients with cognitive impairment, and disabilities in Activities of Daily Living, cancer, arthritis, fractures and pressure ulcers only among clients without cognitive impairment. Constipation was the only adverse effect associated with daily opioid use. CONCLUSION: The pain of home care clients with cognitive impairment may not be treated optimally, whereas there might be prolonged opioid use without a sufficient evaluation of current pain among clients with osteoporosis, cancer within previous 5 years and disabilities in IADLs.

Medication Management in Frail Older People: Consensus Principles for Clinical Practice, Research, and Education.

Frailty is a geriatric condition associated with increased vulnerability to adverse drug events and medication-related harm. Existing clinical practice guidelines rarely provide medication management recommendations specific to frail older people. This report presents international consensus principles, generated by the Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network, related to medication management in frail older people. This consensus comprises 7 principles for clinical practice, 6 principles for research, and 4 principles for education. Principles for clinical practice include (1) perform medication reconciliation and maintain an up-to-date medication list; (2) assess and plan based on individual's capacity to self-manage medications; (3) ensure appropriate prescribing and deprescribing; (4) simplify medication regimens when appropriate to reduce unnecessary burden; (5) be alert to the contribution of medications to geriatric syndromes; (6) regularly review medication regimens to align with changing goals of care; and (7) facilitate multidisciplinary communication among patients, caregivers, and healthcare teams. Principles for research include (1) include frail older people in randomized controlled trials; (2) consider frailty status as an effect modifier; (3) ensure collection and reporting of outcome measures important in frailty; (4) assess impact of frailty on pharmacokinetics and pharmacodynamics; (5) encourage frailty research in under-researched settings; and (6) utilize routinely collected linked health data. Principles for education include (1) provide undergraduate and postgraduate education on frailty; (2) minimize low-value care related to medication management; (3) improve health and medication literacy; and (4) incorporate evidence in relation to frailty into clinical practice guidelines. These principles for clinical practice, research and education highlight different considerations for optimizing medication management in frail older people. These principles can be used in conjunction with existing best practice guidelines to help achieve optimal health outcomes for this vulnerable population. Implementation of the principles will require multidisciplinary collaboration between healthcare professionals, researchers, educators, organizational leaders, and policymakers.

Application of Healthcare 'Big Data' in CNS Drug Research: The Example of the Neurological and mental health Global Epidemiology Network (NeuroGEN).

Neurological and psychiatric (mental health) disorders have a large impact on health burden globally. Cognitive disorders (including dementia) and stroke are leading causes of disability. Mental health disorders, including depression, contribute up to one-third of total years lived with disability. The Neurological and mental health Global Epidemiology Network (NeuroGEN) is an international multi-database network that harnesses administrative and electronic medical records from Australia, Asia, Europe and North America. Using these databases NeuroGEN will investigate medication use and health outcomes in neurological and mental health disorders. A key objective of NeuroGEN is to facilitate high-quality observational studies to address evidence-practice gaps where randomized controlled trials do not provide sufficient information on medication benefits and risks that is specific to vulnerable population groups. International multi-database research facilitates comparisons across geographical areas and jurisdictions, increases statistical power to investigate small subpopulations or rare outcomes, permits early post-approval assessment of safety and effectiveness, and increases generalisability of results. Through bringing together international researchers in pharmacoepidemiology, NeuroGEN has the potential to be paradigm-changing for observational research to inform evidence-based prescribing. The first focus of NeuroGEN will be to address evidence-gaps in the treatment of chronic comorbidities in people with dementia.

Incidence of muscle relaxant use in relation to diagnosis of Parkinson's disease.

Background Parkinson's disease is the second most common neurodegenerative disorder. Motor and non-motor symptoms seem to precede the diagnosis of Parkinson's disease. Objective To evaluate the incidence of muscle relaxant use in community-dwelling persons with and without Parkinson's disease from 4 years before to 4 years after the diagnosis of Parkinson's disease. Method Nationwide register-based cohort included all community-dwelling Finnish persons who received reimbursement of Parkinson's disease drugs between 2000 and 2015 (N = 17,450) and comparison persons without Parkinson's disease who were matched for age, gender and region of residence (N = 122,694). Data on muscle relaxant use during 1995-2016 were collected from the Prescription Register. Results The incidence of muscle relaxant use was higher among persons with Parkinson's disease in comparison to persons without Parkinson's disease from 3 years before the diagnosis until 6 months after the diagnosis. The largest difference in incidence rates was observed at the time of the diagnosis (incidence rate ratio = 2.04, 95% confidence interval = 1.81-2.30). Tizanidine was the most frequently initiated muscle relaxant. Conclusions The incidence of muscle relaxant use starts increasing years before the diagnosis of Parkinson's disease but declines after that. It is important to identify the causes of muscle symptoms to avoid unnecessary muscle relaxant use and consequent adverse effects and events.

Predictors of high hospital care and medication costs and cost trajectories in community-dwellers with Alzheimer's disease.

Objectives: We studied the determinants of high healthcare costs (highest decile of hospital care and medication costs) and cost trajectories among all community-dwellers with clinically verified Alzheimer's disease (AD), diagnosed during 2005-2011 in Finland (N = 70,531). Methods: The analyses were done separately for hospital care costs, medication costs and total healthcare costs that were calculated for each 6-month period from 5 years before to 3 years after AD diagnosis. Results: Total healthcare costs were driven mainly by hospital care costs. The definition of "high-cost person" was time-dependent as 63% belonged to the highest 10% at some timepoint during the study period and six distinct cost trajectories were identified. Strokes, cardiovascular diseases, fractures and mental and behavioural disorders were most strongly associated with high hospital care costs. Conclusions: Although persons with AD are often collectively considered as expensive patient group, there is large temporal and inter-individual variation in belonging to the highest decile of hospitalization and/or medication costs. It would be important to assess whether hospitalization rate could be decreased by, e.g., comprehensive outpatient care with more efficient management of comorbidities. In addition, other interventions that could decrease hospitalization rate in persons with dementia should be studied further in this context. Key messages Persons with AD had large individual fluctuation in hospital care costs and medication costs over time. Hospital care costs were considerably larger than medication costs, with fractures, cardiovascular diseases and mental and behavioural disorders being the key predictors. Antidementia medication was associated with lower hospital care costs.

Use of Antiepileptic Drugs and Dementia Risk-an Analysis of Finnish Health Register and German Health Insurance Data.

OBJECTIVES: To evaluate the association between regular antiepileptic drug (AED) use and incident dementia. DESIGN: Case-control analysis. SETTING: Finnish public health register and German health insurance data. PARTICIPANTS: Individuals with dementia of any type (German data, N=20,325) and Alzheimer's disease (AD; Finnish data, N=70,718) were matched with up to four control persons without dementia. MEASUREMENTS: We analyzed the association between regular AED use and dementia. To address potential protopathic bias, a lag time of 2 years between AED use and dementia diagnosis was introduced. Odds ratios (ORs) were calculated by applying conditional logistic regression, adjusted for potential confounding factors such as comorbidities and polypharmacy. RESULTS: Regular AED use was more frequent in individuals with dementia than controls. Regular use of AEDs was associated with a significantly greater risk of incident dementia (adjusted OR=1.28, 95% confidence interval (CI)=1.14-1.44) and AD (adjusted OR=1.15, 95% CI=1.09-1.22) than no AED use. We also detected a trend toward greater risk of dementia with higher exposure. When AEDs with and without known cognitive adverse effects (CAEs) were compared, a significantly greater risk of dementia was observed for substances with known CAEs (dementia: OR=1.59, 95% CI=1.36-1.86; AD: OR=1.19, 95% CI=1.11-1.27). CONCLUSION: AEDs, especially those with known CAEs, may contribute to incident dementia and AD in older persons.

The effect of comprehensive geriatric assessment on anticholinergic exposure assessed by four ranked anticholinergic lists.

BACKGROUND: Older people often use multiple drugs, and some of them have anticholinergic activity. Anticholinergic drugs may cause adverse reactions, and therefore their use should be limited. To identify anticholinergic load, several ranked lists with different drugs and scoring systems have been developed and used widely in research. We investigated, if a comprehensive geriatric assessment (CGA) decreased the anticholinergic drug score in a 4-year period. We used four different anticholinergic ranked lists to determine the anticholinergic score and to describe how the results differ depending on the list used. METHODS: We analyzed data from population-based intervention study, in which a random sample of 1000 persons aged ≥75 years were randomized to either an intervention group or a control group. Those in the intervention group underwent CGA including medication assessment annually between 2004 and 2007. Current medication use was assessed annually. The anticholinergic load was calculated by using four ranked lists of anticholinergic drugs (Boustani's, Carnahan's, Chew's and Rudolph's) for each person and for each year. RESULTS: CGA had no statistically significant effect on anticholinergic exposure during the 4-year follow-up, but improvements towards more appropriate medication use were observed especially in the intervention group. However, age, gender and functional comorbidity index were associated to higher anticholinergic exposure, depending on the list used. CONCLUSIONS: Repeated CGAs may result as more appropriate anticholinergic medication use. The selection of the list may affect the results and therefore the selection of the list is important.

Hospital care and drug costs from five years before until two years after the diagnosis of Alzheimer's disease in a Finnish nationwide cohort.

AIMS: The aim of our study was to investigate costs related to hospital care and drugs utilizing register-based data from five years before until two years after the diagnosis of Alzheimer's disease (AD) in a nationwide cohort. METHODS: Finnish nationwide MEDALZ cohort includes all incident cases with clinically verified diagnosis of AD diagnosed during 2005-2011. The study population included 70,718 persons with AD and age-, gender- and region-of-residence-matched control persons. Data of medical care costs was derived from the prescription register and hospital discharge register. Costs of hospital care were calculated according to Finnish healthcare system unit costs. Costs in six month periods before and after the diagnosis per person-years were analyzed. RESULTS: Persons with AD had higher mean total medical care costs per person-years starting from 0.5-1 years before the diagnosis of AD and remained at a higher level until two years after the diagnosis. The difference in mean total medical care costs was at its highest at six months after the diagnosis (cost difference €5088). After that, persons with AD had costs that reached approximately double those without AD. Hospital care costs constituted the major share (78-84%) of the total medical care costs in both persons with and without AD, whereas drug costs had a minor role. Increase in drug costs was caused by anti-dementia drugs. CONCLUSIONS: Costs of hospital stays constituted the most significant portion of medical care costs for persons with AD. Further research should be focused on the causes of hospitalization periods.

Health condition and physical function as predictors of adherence in long-term strength and balance training among community-dwelling older adults.

AIM: Strength and balance training (SBT) has remarkable health benefits, but little is known regarding exercise adherence in older adults. We examined the adherence to strength and balance training and determinants of adherence among ≥75 year old adults. METHODS: 182 community-dwelling individuals (aged 75-98 years, 71% female) began group-based SBT as part of a population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly study. Training was offered once a week for 2.3 years. Adherence was defined as the proportion of attended sessions relative to offered sessions. Participants were classified based on their adherence level into low (≤33.3%), moderate (33.4-66.5%) and high (≥66.6%) adherers. RESULTS: The mean length of training was 19 ± 9 months, and 68% continued participation for at least two years. The mean training adherence was 55 ± 29% for all participants and 18%, 53% and 82% for low, moderate and high adherers, respectively. High adherence was predicted by female sex; younger age; better cognition; independence in Instrumental Activities of Daily Living; higher knee extension strength; faster walking speed; and better performance on the Berg Balance Scale and Timed Up and Go tests. Poorer self-perceived health and the use of a walking aid were related to low adherence. CONCLUSIONS: Long-term continuation of training is possible for older community-dwelling adults, although poorer health and functional limitations affect training adherence. Our findings have implications for tailoring interventions and support for older adults to optimize their exercise adherence.

Associations across spatial patterns of disease incidences, socio-demographics, and land use in Finland 1991-2010.

AIMS: The epidemiological aim was to draw a general picture of spatial patterns of diseases, socio-demographics, and land use in Finland to detect possible under-recognized associations between the patterns. The methodological purpose was to compare and combine two statistical techniques to approach the data from different viewpoints. METHODS: Two different statistical methods, the self-organizing map and principal coordinates of neighbor matrices with variation partitioning, were used to search for spatial patterns of 15 non-infectious diseases and 17 direct or indirect risk factors. The dataset was gathered from five Finnish registries and pooled over the years 1991-2010. The statistical unit in the analyses was a municipality (n=303). RESULTS: Variables referring to urban living were related to low incidences of all other diseases but cancer, whereas variables referring to rural living were related to low incidences of cancer and high incidences of other diseases, especially coronary heart disease (CHD), hypertension, diabetes, asthma/chronic obstructive pulmonary disease, and serious mental illnesses at the municipal level. The relationships between diseases other than cancer and risk factors related to socio-demographics and land use variables were stronger than those between cancer and risk factors. CONCLUSIONS: The structuration of spatial patterns was dominated by CHD together with land use features and unemployment rate. The relationship between unemployment and spatial health inequalities was emphasized. On the basis of the present study, it is suggested that large heterogeneous datasets are clustered and analyzed simultaneously with more than one statistical method to recognize the most significant and generalizable results.

Effects of comprehensive geriatric assessment-based individually targeted interventions on mobility of pre-frail and frail community-dwelling older people.

AIM: To assess the effects of comprehensive geriatric assessment (CGA)-based individually targeted interventions on the ability to walk 400 m in pre-frail or frail and non-frail community-dwelling older people. METHODS: A subgroups analysis of a population-based comparative study, the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) was carried out in the city of Kuopio, Finland, from 2004 to 2007. This study was based on data from 2005 to 2007. The present analysis included 605 community-dwelling older adults aged ≥ 76 years (mean age 80.9, 70% women), 314 in the intervention and 291 in the control group. Frailty status was assessed in 2005. Mobility was assessed by self-reported ability to walk 400 m. The generalized estimating equation model with binary logistic regression was used to assess the treatment effect of the interventions on the ability to walk 400 m between 2005 and 2007. RESULTS: In 2005, 55% (n = 173) of the participants in the intervention group and 64% (n = 187) in the control group were pre-frail or frail. The intervention prevented the loss of ability to walk 400 m among pre-frail and frail persons (OR 0.74, 95% CI 0.59-0.93, P = 0.01). The treatment effect was not statistically significant among non-frail participants (OR 0.99, 95% CI 0.68-1.42, P = 0.94). CONCLUSIONS: CGA-based individually targeted interventions were effective in preventing mobility limitations among pre-frail and frail older people.

Cost-related barriers to use of health services and prescription medicines in Finland: a cross-sectional survey.

BACKGROUND: The objective was to examine cost-related barriers to using health services and prescription medicines in Finland. METHODS: A survey that examined adults' experiences of and opinions about the social security system was mailed to a random population-based sample of 5000 Finns aged 18-74 years. The survey assessed households' cost-related barriers to use of health services, prescription medicines and social assistance in the past year. The responses were adjusted for sociodemographic and health predictors by weighting and logistic regression. RESULTS: Responses were received from 1770 households. In total, 18% had experienced at least one cost-related barrier; 11% did not fill a prescription, 8% did not go to hospital and 13% went without another form of treatment. Of respondents diagnosed with a disabling illness or impairment, 32% reported at least one cost-related barrier. Households with below-average income reported barriers twice as often as above-average income households, after adjusting for age and health. Lower income [lowest tertile, odds ratio (OR) 5.0 compared with highest tertile], fair/poor self-assessed health (fair/poor OR 7.1 compared with very good/good), younger age (18-34 years OR 3.8 compared with 65-74 years), lower education (primary OR 1.6 compared with tertiary) and female gender (OR 1.4) were significantly associated with more frequent cost-related barriers. Overall, 34% of households who encountered cost-related barriers had applied for and 17% had received social assistance. CONCLUSIONS: Cost-related barriers were common among respondents with low income and/or poor health. These barriers may thus have a role in creating inequities in access to health care in Finland.

Hospital admissions, outpatient visits and healthcare costs of community-dwellers with Alzheimer's disease.

BACKGROUND: Detailed data on the health care service use of people with Alzheimer's disease (AD) are scarce. METHODS: We assessed the health care service use of all community-dwelling persons with clinically verified AD diagnosis, residing in Finland on December 31, 2005 (n = 27,948) in comparison to matched cohort without AD. Hospitalization data during 2006-2009 were extracted from the National Hospital Discharge Register. RESULTS: Comorbidity-adjusted incidence rate ratios; IRR (95% CI) were 1.25 (1.22-1.28) for inpatient admissions and 0.72 (0.68-0.77) for outpatient visits. People with AD had more general health care admissions (IRR, 95%CI 1.73, 1.67-1.80) but less admissions to specialty units 0.82 (0.79-0.85) than the non-AD group, with psychiatry being the only specialty with more admissions in the AD group. People with AD had 16 more hospital days/person-year. CONCLUSIONS: It would be important to assess whether inpatient hospitalizations of AD patients could be decreased by better targeting of outpatient services and whether other conditions are underdiagnosed or undertreated among persons with AD.

Antidementia drug use among community-dwelling individuals with Alzheimer's disease in Finland: a nationwide register-based study.

The objective of this study was to investigate the prevalence of acetylcholinesterase inhibitor (AChEI) and memantine use, duration of treatment, concomitant use of these drugs, and factors associated with the discontinuation of AChEI therapy during 2006-2009. We utilized data from a nationwide sample of community-dwelling individuals with a clinically verified Alzheimer's disease diagnosed during the year 2005 (n=6858) as a part of the MEDALZ-2005 study. During the 4-year follow-up, 84% used AChEI and 47% used memantine. Altogether, 22% of the sample used both drugs concomitantly. The median duration of the first AChEI use period was 860 (interquartile range 295-1458) days and 1103 (interquartile range 489-1487) days for the total duration of AChEI use. Although 20% of the AChEI users discontinued the use during the first year, over half of them restarted later. The risk of discontinuation was higher for rivastigmine [hazard ratio 1.34 (confidence interval 1.22-1.48)] and galantamine users [hazard ratio 1.23 (confidence interval 1.15-1.37)] compared with donepezil users in the adjusted model. In conclusion, median time for AChEI use was over 3 years and every fifth Alzheimer's disease patient used AChEI and memantine concomitantly during the follow-up. The low rate of discontinuation is consistent with the Finnish Care Guideline but in contrast to the results reported from many other countries.

Depressive symptoms and cardiovascular burden-related mortality among the aged.

BACKGROUND: Depressive symptoms have been linked to increased cardiovascular mortality among the elderly. This study was aimed to test the independent and additive predictive value of depressive symptoms and B-type natriuretic peptide (BNP), a marker of direct cardiovascular stress and a strong predictor of mortality, together with traditional cardiovascular risk markers on total and cardiovascular mortalities in a general elderly population. METHODS: A total of 508 subjects aged 75 or older participated in the study. The prognostic capacity of depressive symptoms and BNP in regard to total and cardiovascular mortalities was assessed with Cox regression analyses. Depressive symptoms were handled as a dichotomous variable based on the Zung self-rated depression scale score with a cut-off point of 40. RESULTS: The median follow-up time was 84 months with an interquartile range of 36-99 months. Depressive symptoms reflected susceptibility to all-cause (HR 1·60; 95% CI 1·26-2·04) and cardiovascular mortalities (HR 1·81; 95% CI 1·30-2·52) only in univariable analyses. When cardiovascular illnesses and risk markers were taken into account, depressive symptoms lost their significance as an independent predictor of mortality. BNP as a continuous variable was a significant predictor of both all-cause (HR 1·44; 95% CI 1·22-1·69) and cardiovascular mortalities (HR 1·79; 95% CI 1·44-2·22) in fully adjusted models including depressive symptoms as a covariate. CONCLUSIONS: The prognostic capacity of depressive symptoms is closely linked to cardiovascular morbidity and has no independent power in an elderly general population. BNP remains a strong harbinger of death regardless of depressive symptoms status.

Health and physical function predicting strength and balance training adoption: a community-based study among individuals aged 75 and older.

This study was conducted to determine the characteristics of health and physical function that are associated with not starting strength and balance training (SBT). The study population consisted of 339 community-dwelling individuals (75-98 years, 72% female). As part of a population-based intervention study they received comprehensive geriatric assessment, physical activity counseling, and had the opportunity to take part in SBT at the gym once a week. Compared with the SBT-adopters, the nonadopters (n = 157, 46%) were older and less physically active, had more comorbidities and lower cognitive abilities, more often had sedative load of drugs or were at the risk of malnutrition, had lower grip strength and more instrumental activities of daily living (IADL) difficulties, and displayed weaker performance in Berg Balance Scale and Timed Up and Go assessments. In multivariate models, higher age, impaired cognition, and lower grip strength were independently associated with nonadoption. In the future, more individually-tailored interventions are needed to overcome the factors that prevent exercise initiation.