Association of Tai Chi exercise with physical and neurocognitive functions, frailty, quality of life and mortality in older adults: Singapore Longitudinal Ageing Study.

BACKGROUND: real-world observations on the long-term benefits of Tai Chi (TC) exercise, in terms of physical and cognitive functioning, frailty, quality of life (QOL) and mortality are lacking. METHODS: prospective cohort study participants were community-dwelling adults aged 55+, including 5,407 non-frequent TC participants (<1x/week) and 572 frequent TC participants (≥1x/week). Outcome measures at baseline and 3-5 years follow-up included physical performance (Knee Extension Strength, POMA Balance and Gait, Timed-up-and-go, Gait Speed) and neurocognitive performance (attention and working memory, visual-motor tracking and mental flexibility, verbal learning and memory, visual memory, spatial and constructional ability), Frailty Index ≥0.10, impaired QOL (SF12 physical and mental component) and all-cause mortality from mean 13 years follow-up. Effect estimates were adjusted for socio-demographics, other physical activities, nutritional risk and presence of cardiometabolic diseases. RESULTS: frequent TC participation was associated with 0.7-fold lower prevalence of impaired physical QOL [95% confidence interval (CI) = 0.57-0.91], decreased 0.4-fold odds of incident prefrailty/frailty among robust participants at baseline and 0.7-fold odds of impaired mental QOL at follow-up among participants with normal mental QOL at baseline. Lower odds of mortality risk (HR = 0.89, 95%CI = 0.72-1.09) were not significant after controlling for socioeconomic, behavioural and health factors. Composite indexes of physical functional and neurocognitive performance were maintained at high level or increased at follow-up among frequent TC participants. CONCLUSION: TC exercise practised among community-dwelling older adults is associated with better physical, cognitive and functional wellbeing.

Type of tea consumption and depressive symptoms in Chinese older adults.

BACKGROUND: Existing research indicates that tea drinking may exert beneficiary effects on mental health. However, associations between different types of tea intake and mental health such as depression have not been fully examined. The purpose of this study was to examine the associations of green tea, fermented tea, and floral tea consumption with depressive symptoms. METHODS: We used data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, a nationwide survey on older adults in mainland China. A total of 13,115 participants (mean age 83.7 years, 54.2% were women) with valid responses were included in the analysis. The type (green, fermented [black, Oolong, white, yellow, dark, and compressed teas], and floral) and the frequency of tea consumption were recorded, and depressive symptoms were assessed using 10-item of the Center for Epidemiologic Studies Depression Scale (CES-D-10). We examined the associations between the type and the frequency of tea intake and depression, controlling for a set of demographic, socioeconomic, psychosocial, behavioral, and health-related variables. RESULTS: Overall, intakes of green tea, fermented tea, and floral tea were all significantly associated with lower prevalence of depressive symptoms, independent of other risk factors. Compared with the group of no tea intake, the adjusted ORs of depressive symptoms for daily green tea, fermented tea, and floral tea intake were 0.85 (95% CI: 0.76-0.95), 0.87 (95% CI: 0.76-0.99), and 0.70 (95% CI: 0.59-0.82), respectively. Linear associations were observed between the frequencies of all three types of tea intake and depressive symptoms (P < 0.05 for trends for all three types). The associations of the type and the frequency of tea intake and depressive symptoms were robust in several sensitivity analyses. CONCLUSIONS: Among Chinese older adults, regularly consumed any type of tea (green, fermented, or floral) were less likely to show depressive symptoms, the associations seemed more pronounced among floral tea and green tea drinkers.

Tea Consumption and Risk of Chronic Obstructive Pulmonary Disease in Middle-Aged and Older Singaporean Adults.

Objective: The anti-oxidant and anti-inflammatory actions of phytochemicals and the smooth muscle relaxant actions of theophylline present in tea may confer pulmonary protection and reduce COPD risk. We investigated tea consumption (black, oolong, or green) association with COPD risks in a population-based cohort study of older adults aged ≥55. Methods: GOLD criteria was used to identify prevalent and incident cases of COPD (FEV1/FVC <0.70) among 4617 participants and 920 participants free of COPD at baseline who were assessed at follow-up 4.5 years later. Results: Prevalent cases of COPD consumed less tea than their non-COPD counterparts. Estimated odds ratio (OR) and 95% confidence intervals (95% CI) of association with prevalent COPD, adjusted for age, sex, ethnicity, housing type, smoking, alcohol, physical activity and BMI declined across tea consumption levels (p-trend=0.048), and was lowest for ≥3 cups/day (OR=0.77, 95% CI=0.61-0.96). The cumulated incidence of COPD declined across tea consumption categories (p-trend=0.012) and the lowest OR of association (OR=0.35, 95% CI=0.17-0.69) with consuming ≥3 cups/day after co-variate adjustment. Conclusion: Different kinds of tea showed similar non-significant trends of associations but appeared to be strongest for green tea. Tea consumption in this Asian population was associated with lowered COPD prevalence and incidence.

A single-arm feasibility study of community-delivered Baduanjin (Qigong practice of the eight Brocades) training for frail older adults.

BACKGROUND: Frailty is a common geriatric syndrome, characterized by reduced physiologic reserve and increased vulnerability to stressors, due to cumulative decline in multiple physiological systems. We studied the feasibility of a community-delivered Baduanjin (BDJ) training program among pre-frail/frail community-dwelling older people. We examined (1) safety (adverse events) and physical and psychological effects; and (2) feasibility of recruitment, retention, adherence; recruitment efforts, and any program challenges, so as to inform future studies. METHODS: Our study was a single arm pre-post study in a community setting. Sixteen-week group BDJ training (2×/week in the first 4 weeks and 3×/week thereafter) was co-designed and implemented by community-based providers in Singapore. Recruitment, attendance, and adverse events were recorded throughout the training. A participants' survey was also administered after the training program. Effects of the intervention on physical and functional outcomes (hand grip strength, knee extension strength, Time Up and Go (TUG), Physiological Profile Assessment (PPA), 30-s Sit-to-Stand test, 6-m fast gait speed test), frailty outcomes (frailty score and status), and other outcomes (Maastricht Questionnaire (MQ), Fall Efficacy Scale (FES), Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale (GDS), and EQ-5D-5L) were examined before and after the program. RESULTS: Of 31 older adults screened to be frail, 15 met inclusion criteria and 3 refused participation, resulting in 12 older adults (9 women) enrolled into the program. During the program, one participant was hospitalized (unrelated to BDJ training) and the other 11 (aged 77 ± 6 years; 2 frail, 9 prefrail at baseline) completed the program with average overall attendance of 89%. Most (89%) of the 44 training sessions had attendance > 80%. The program received positive feedback with no training-related adverse events. Participants either reversed (n = 2) or maintained (n = 9) their frailty statuses. There post-training outcomes in hand grip strength, knee extension strength, TUG, MQ, FES, MoCA, GDS, and EQ-5D-5L index score appeared to be better. The reduction of frailty and PPA fall risk scores was of moderate-to-large effect size. CONCLUSIONS: Community-delivered BDJ training program was safe and feasible for prefrail/frail older adults with the potential to improve physical and cognitive function, reduce fall risk, improve psychological well-being, and reverse frailty status.

Assessment of Sarcopenia Among Community-Dwelling At-Risk Frail Adults Aged 65 Years and Older Who Received Multidomain Lifestyle Interventions: A Secondary Analysis of a Randomized Clinical Trial.

Importance: There is little understanding of the outcomes associated with active lifestyle interventions for sarcopenia among older persons. Objective: To determine the association of 6-month multidomain lifestyle interventions (physical exercise, nutritional enhancement, cognitive training, combined treatment, and standard care) with change in sarcopenia status and physical function among adults 65 years and older. Design, Setting, and Participants: Post hoc secondary analysis of a parallel-group randomized clinical trial conducted from September 1, 2012, to September 1, 2014, at community centers providing services to elderly individuals in Singapore. Participants included a subsample of 92 community-dwelling prefrail or frail older persons with sarcopenia aged 65 years and older. Data were analyzed from June 1, 2017, to January 1, 2018. Interventions: The 5 intervention groups were a 6-month duration of physical exercise that included resistance and balance training, nutritional enhancement with a commercial oral nutrition supplement formula, cognitive training, a combination of the preceding 3 interventions, and standard care (control). Main Outcomes and Measures: Primary outcomes were changes in sarcopenia status and its components, appendicular skeletal muscle index (ASMI), knee extension strength (KES), and gait speed (GS) at 3 months and 6 months following the intervention. Sarcopenia was defined as the presence of both low ASMI and low KES and/or GS. Results: In 92 participants with sarcopenia, the mean (SD) age was 70.0 (4.7) years and 59 (64.1%) were female. Seventy-eight participants received active interventions and 14 received standard care. Of 92 total participants, the number who remained sarcopenic was reduced to 48 (of 73) after 3 months and 51 (of 75) after 6 months of intervention, indicating that 25 of 92 participants (27.2%) experienced sarcopenia reduction at 3 months and 24 of 92 (26.1%) had sarcopenia reduction at 6 months. Low KES was present in 88 of 92 patients (95.6%), and low GS in 30 of 92 patients (32.6%) at baseline. Among the components of sarcopenia, GS had the greatest change associated with active interventions, with 22 of 30 participants (73.3%) free of low GS at 6 months; in comparison, 17 of 88 participants (19.3%) were free of low KES at 6 months and 7 of 92 participants (7.6%) were free of low ASMI at 6 months. Men experienced greater reduction in sarcopenia than women (χ2 = 5.925; P = .02), as did those with younger age (t = -2.078; P = .04) or higher ASMI (mean [SD] ASMI, 5.74 [0.77] vs 5.14 [0.77] kg/m2; P = .002). Participants in the active intervention group experienced statistically significant decreases in sarcopenia score and its components at 3 months and 6 months from baseline (F = 14.138; P < .001), but the intervention was not associated with significant differences in ASMI, KES, and GS vs standard care. Conclusions and Relevance: This study suggests that older persons with sarcopenia are responsive to the effects of multidomain lifestyle interventions. Sarcopenia reduction was most pronounced through improved gait speed, and occurred more among those who were male, were younger, or had greater muscle mass.

Effectiveness of a Personalized Brain-Computer Interface System for Cognitive Training in Healthy Elderly: A Randomized Controlled Trial.

BACKGROUND: Cognitive training has been demonstrated to improve cognitive performance in older adults. To date, no study has explored personalized training that targets the brain activity of each individual. OBJECTIVE: This is the first large-scale trial that examines the usefulness of personalized neurofeedback cognitive training. METHODS: We conducted a randomized-controlled trial with participants who were 60-80 years old, with Clinical Dementia Rating (CDR) score of 0-0.5, Mini-Mental State Examination (MMSE) score of 24 and above, and with no neuropsychiatric diagnosis. Participants were randomly assigned to the Intervention or Waitlist-Control group. The training system, BRAINMEM, has attention, working memory, and delayed recall game components. The intervention schedule comprised 24 sessions over eight weeks and three monthly booster sessions. The primary outcome was the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) total score after the 24-session training. RESULTS: There were no significant between-subjects differences in overall cognitive performance post-intervention. However, a sex moderation effect (p = 0.014) was present. Men in the intervention group performed better than those in the waitlist group (mean difference, +4.03 (95% CI 0.1 to 8.0), p = 0.046. Among females, however, both waitlist-control and intervention participants improved from baseline, although the between-group difference in improvement did not reach significance. BRAINMEM also received positive appraisal and intervention adherence from the participants. CONCLUSION: A personalized neurofeedback intervention is potentially feasible for use in cognitive training for older males. The sex moderation effect warrants further investigation and highlights the importance of taking sex into account during cognitive training.

Cognitive Effects of Multi-Domain Interventions Among Pre-Frail and Frail Community-Living Older Persons: Randomized Controlled Trial.

Background: Cognitive, physical, and nutritional interventions may produce different cognitive effects for different groups of older persons. We investigated simultaneously the cognitive outcomes of cognitive, physical, and nutritional interventions singly and in combinations in older persons with the physical frailty phenotype at particular risk of cognitive decline. Method: Pre-frail and frail participants were randomly allocated to 24 weeks nutritional supplementation (N = 49), physical training (N = 48), cognitive training (N = 50), combination intervention (N = 49), or usual care control (N = 50). Cognitive domain and global functions were assessed at baseline (0M), 6 month (6M), and 12 month (12M). Results: The control group showed declines in z-scores (from -0.100 to -0.244) of all domains. The cognitive training compared to control group showed the greatest increase in global cognition at 6M (0.094 vs -0.174, p = .006) and 12M (0.099 vs -0.142, p = .002), immediate memory at 6M (0.164 vs -0.211, p = .010) and 12M (0.182 vs -0.142, p = .040), delayed memory at 6M (p = .010), and attention at 6M (p = .025). Nutritional intervention showed benefits at 6M for immediate memory (p = .028) and delayed memory (p = .024), but physical training showed no positive effects. The combination group showed the greatest increase for visuospatial construction at 6M (0.215 vs -0.141, p = .010) and 12M (0.166 vs -0.180, p = .016), and for global cognition at 12M (p = .016) and language at 12M (p = .023). Conclusion: Among frail older persons, cognitive training conferred the greatest cognitive benefits. Nutritional and physical interventions singly were associated with modest short-term or no cognitive benefits, but their combined effects on visuospatial construction should be further investigated.

The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty.

OBJECTIVE: To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. METHODS: An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. RECOMMENDATIONS: Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. CONCLUSIONS: The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.

Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial.

BACKGROUND: It is important to establish whether frailty among older individuals is reversible with nutritional, physical, or cognitive interventions, singly or in combination. We compared the effects of 6-month-duration interventions with nutritional supplementation, physical training, cognitive training, and combination treatment vs control in reducing frailty among community-dwelling prefrail and frail older persons. METHODS: We conducted a parallel group, randomized controlled trial in community-living prefrail and frail old adults in Singapore. The participants' mean age was 70.0 years, and 61.4% (n = 151) were female. Five different 6-month interventions included nutritional supplementation (n = 49), cognitive training (n = 50), physical training (n = 48), combination treatment (n = 49), and usual care control (n = 50). Frailty score, body mass index, knee extension strength, gait speed, energy/vitality, and physical activity levels and secondary outcomes (activities of daily living dependency, hospitalization, and falls) were assessed at 0 months, 3 months, 6 months, and 12 months. RESULTS: Frailty score and status over 12 months were reduced in all groups, including control (15%), but were significantly higher (35.6% to 47.8%) in the nutritional (odds ratio [OR] 2.98), cognition (OR 2.89), and physical (OR 4.05) and combination (OR 5.00) intervention groups. Beneficial effects were observed at 3 months and 6 months, and persisted at 12 months. Improvements in physical frailty domains (associated with interventions) were most evident for knee strength (physical, cognitive, and combination treatment), physical activity (nutritional intervention), gait speed (physical intervention), and energy (combination intervention). There were no major differences with respect to the small numbers of secondary outcomes. CONCLUSIONS: Physical, nutritional, and cognitive interventional approaches were effective in reversing frailty among community-living older persons.

Dietary and supplemental antioxidant and anti-inflammatory nutrient intakes and pulmonary function.

OBJECTIVE: A limited but growing body of evidence supports a significant role of antioxidant and anti-inflammatory micronutrients in pulmonary health. We investigated the associations of dietary and supplemental intakes of vitamins A, C, E and D, Se and n-3 PUFA with pulmonary function in a population-based study. DESIGN: Population-based, cross-sectional study and data analysis of fruits and vegetables, dairy products and fish, vitamins A, C, E and D, Se and n-3 PUFA supplemental intakes, pulmonary risk factors and spirometry. SUBJECTS: Chinese older adults (n 2478) aged 55 years and above in the Singapore Longitudinal Ageing Studies. RESULTS: In multiple regression models that controlled simultaneously for gender, age, height, smoking, occupational exposure and history of asthma/chronic obstructive pulmonary disease, BMI, physical activity, and in the presence of other nutrient variables, daily supplementary vitamins A/C/E (b = 0·044, SE = 0·022, P = 0·04), dietary fish intake at least thrice weekly (b = 0·058, SE = 0·016, P < 0·0001) and daily supplementary n-3 PUFA (b = 0·068, SE = 0·032, P = 0·034) were individually associated with forced expiratory volume in the first second. Supplemental n-3 PUFA was also positively associated with forced vital capacity (b = 0·091, SE = 0·045, P = 0·045). No significant association with daily dairy product intake, vitamin D or Se supplements was observed. CONCLUSIONS: The findings support the roles of antioxidant vitamins and n-3 PUFA in the pulmonary health of older persons.

Reliability and validity of a self-rated analogue scale for global measure of successful aging.

OBJECTIVE: Dimension-specific objective measures are criticized for their limited perspective and failure to endorse subjective perceptions by respondents, but the validity and correlates of a subjective global measure of successful aging (SA) are still not well established. We evaluated the reliability and validity of a self-rated analogue scale of global SA in an elderly Singaporean population. DESIGN: Cross-sectional data analysis using a comprehensive questionnaire survey. PARTICIPANTS AND SETTING: 489 community-dwelling Singaporeans aged 65 years and over. MEASUREMENTS: Self-rated SA on an analogue scale from 1 (least successful) to 10 (most successful) was analyzed for its relationship to criterion-based measures of five specific dimensions (physical health and function, mental well-being, social engagement, psychological well-being, and spirituality/religiosity), as well as outcome measures (life satisfaction and quality of life). RESULTS: Self-rated SA was significantly correlated to measures of specific dimensions (standardized ß from 0.11 to 0.39), most strongly with psychological functioning (ß = 0.391). The five dimension-specific measures together accounted for 16.7% of the variance in self-rated SA. Self-rated SA best predicted life satisfaction (R(2) = 0.26) more than any dimension-specific measure (R(2) from 0.05 to 0.17). Self-rated SA, vis-à-vis dimension-specific measures, was related to a different set of correlates, and was notably independent of chronological age, sex, education, socioeconomic status, and medical comorbidity, but was significantly related to ethnicity. CONCLUSION: The self-rated analogue scale is a sensitive global measure of SA encompassing a spectrum of underlying dimensions and subjective perspectives and its validity is well supported in this study.

Tea consumption and depressive symptoms in older people in rural China.

OBJECTIVES: To examine the association between tea consumption and depressive symptoms in Chinese older people and to explore the mediating role of cerebrovascular disease in the association. DESIGN: Population-based cross-sectional study. SETTING: A rural community near Qufu in Shandong, China. PARTICIPANTS: Community-dwelling individuals aged 60 and older (mean 68.6; 59.3% female) from the Confucius Hometown Aging Project (N = 1,368). MEASUREMENTS: Data were collected through interviews, clinical examinations, and psychological testing, following a standard procedure. Presence of high depressive symptoms was defined as a score of 5 or greater on the 15-item Geriatric Depression Scale. RESULTS: Of the 1,368 participants, 165 (12.1%) were weekly and 489 (35.7%) were daily tea consumers. Compared with no or irregular tea consumption, controlling for age, sex, education, leisure activities, number of comorbidities, and Mini-Mental State Examination score, the odds ratios of having high depressive symptoms were 0.86 (95% confidence interval (CI) = 0.56-1.32) for weekly and 0.59 (95% CI = 0.43-0.81) for daily tea consumption (P for linear trend = .001); the linear trend of the association remained statistically significant when further controlling for history of stroke, transient ischemic attacks, and presence of carotid plaques. CONCLUSIONS: Daily tea consumption is associated with a lower likelihood of depressive symptoms in Chinese older people living in a rural community. The association appears to be independent of cerebrovascular disease and atherosclerosis.

Tea consumption and mortality in the oldest-old Chinese.

OBJECTIVES: To investigate the association between tea consumption and mortality in the oldest-old Chinese. DESIGN: Population-based longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were analyzed using a Cox semiparametric proportional hazard model. SETTING: Six hundred thirty-one randomly selected counties and cities of China's 22 provinces. PARTICIPANTS: Individuals aged 80 and older (N = 9,093) who provided complete data in the baseline survey (1998). MEASUREMENTS: Self-reported current frequency of tea drinking and past frequency at approximately age 60 were ascertained at baseline survey; a follow-up survey was conducted 2000, 2002, and 2005. RESULTS: In the oldest-old Chinese, tea consumption was associated with lower risk of mortality after adjusting for demographic characteristics, socioeconomic status, health practices, and health status. Compared with non-tea drinkers, the adjusted hazard ratio (HR) was 0.90 (95% confidence interval (CI) = 0.84-0.96) for daily tea drinkers (at the baseline survey, 1998) and 1.00 (95% CI = 1.01-1.07) for occasional tea drinkers (P for linear trend .003). Similar results were found when tea drinking status at age 60 was used in the analysis. Further analysis showed that subjects who reported frequent tea drinking at age 60 and at the baseline survey had a 10% lower risk of mortality than subjects who reported infrequent tea drinking at age 60 and at the baseline survey (HR = 0.90, 95% CI = 0.84-0.97). CONCLUSION: Tea consumption is associated with lower risk of mortality in the oldest-old Chinese.

Omega-3 polyunsaturated fatty acid supplements and cognitive decline: Singapore Longitudinal Aging Studies.

OBJECTIVE: To determine the association between long chain omega-3 polyunsaturated fatty acid (n-3 PUFA) supplements intake and cognitive decline in an older Chinese population. DESIGN: Prospective cohort study. SETTING: The Singapore Longitudinal Aging Studies (SLAS), a community-based study in urban region of Singapore. PARTICIPANTS: 1,475 Chinese adults aged ≥ 55 years. MEASUREMENT: Omega-3 PUFA supplements intake and Mini-Mental State Examination (MMSE) were assessed at baseline. MMSE was re-assessed at a median of 1.5 years after baseline and cognitive decline was defined as at least 2-points drop in MMSE score from baseline to follow-up. Odds ratios (ORs) of association between n-3 PUFA supplements intake and cognitive decline were calculated in logistic regression models controlling for baseline confounding variables. RESULTS: Daily n-3 PUFA supplements intake was significantly (p=0.024) associated with lower risk of cognitive decline (OR=0.37, 95% C.I. 0.16-0.87) after controlling for age, gender, education, number of medical comorbidity, the presence of vascular risk factors/diseases, smoking, alcohol drinking, depression, APOE e4 allele carrier status, nutritional status, level of leisure activities, baseline MMSE and length of follow-up. The association remained significant (p=0.015) after excluding participants with baseline cognitive impairment (MMSE < 24), diabetes, stroke, and cardiac diseases (OR=0.23, 95% C.I. 0.07-0.75). No statistically significant association (OR=1.02, 95% C.I. 0.81-1.27) of fish consumption with cognitive decline was found. CONCLUSION: Daily n-3 PUFA supplements consumption was independently associated with less cognitive decline in elderly Chinese.

Religion, health beliefs and the use of mental health services by the elderly.

BACKGROUND: Few studies have investigated whether elderly people of particular religious affiliations were more or less likely to seek treatment for mental illness, and whether it was related to their health beliefs. METHOD: In the National Mental Survey of Elderly Singaporeans in 2004, data were collected on reported religious affiliations, and 1-year prevalence of mental disorders (DSM-IV diagnoses of psychiatric disorders) from diagnostic interviews using the Geriatric Mental State schedule, self-report of treatment for mental health problems, and health beliefs about the curability of mental illness, embarrassment and stigma, ease in discussing mental problems, effectiveness and safety of treatment, and trust in professionals. RESULTS: Compared to those with no religious affiliation, elderly people of all religious affiliations showed higher prevalence of mental health problems, yet reported less frequent treatment by healthcare professionals. In multivariate analyses, the adjusted odds ratio (95% confidence interval) of association with seeking treatment were for Christianity, 0.12 (0.02-0.57); Islam, 0.12 (0.01-1.31); Buddhism/Taoism, 0.59 (0.18-1.88); and Hinduism, 0.21 (0.02-2.56) versus no affiliation. Various religious affiliations differ from each other and from non-religious affiliation on some negative health beliefs, but they did not adequately explain why religious affiliates were less likely to seek treatment. CONCLUSION: Further studies should evaluate the lower tendency of elderly people with religious affiliations to seek treatment for mental health problems.

Use of complementary and alternative medicines and mental disorders in community-living Asian older adults.

The use of complementary and alternative medicines (CAMs) and its link with mental health is poorly understood. It is not clear whether mentally ill persons use CAM because conventional medical care does not meet their needs. In a nationally representative random sample of 1092 individuals aged 60 in Singapore, we determined CAM use and the prevalence of mental disorders using Geriatric Mental State (GMS) and found that overall CAM use, predominantly Chinese herbal medicines, was reported by an estimated 42.7% of the population. Depression (odds ratio=OR=1.94; 95% CI=1.26-2.98) and poor self-rated mental health (OR=2.44; 95% CI=1.25-4.80) were associated with CAM use, independently of other risks factors and correlates of CAM use. Although depressed Asians more frequently used CAM than conventional health care, we could find no evidence in this study to indicate that among individuals with depression, CAM users compared to nonusers, were less likely to seek treatment from general and mental health professionals or were more likely to have negative beliefs and attitudes about mental illnesses and its treatment. This is consistent with the common observation that the use of CAM complements rather than replaces conventional treatments.

Folate, vitamin B12, homocysteine, and depressive symptoms in a population sample of older Chinese adults.

OBJECTIVES: To investigate the independent associations between folate, B12, and homocysteine levels and depressive symptoms in older adults. DESIGN: Cross-sectional study. SETTING: Resident population in southeast Singapore. PARTICIPANTS: Six hundred sixty-nine community-living noninstitutionalized Chinese adults aged 55 and older. MEASUREMENTS: Laboratory values of folate, vitamin B12, and homocysteine were examined for their independent relationships with depressive symptoms (Geriatric Depression Scale (GDS) score > or =5). RESULTS: Respondents with depression (n=178) had lower mean serum folate concentrations (21.5 nmol/L) than those without (n=491, 24.0 nmol/L, P=.04). There was a linear relationship between descending quartiles of folate concentrations and increasing odds of association with depressive symptoms, independent of other risk factors (demographic, psychosocial, alcohol and smoking, chronic morbidity, functional status, nutritional risk, albumin, anemia, depression-inducing medications, use of antidepressants and vitamin supplements), including B12 and homocysteine (P for trend=.02). The odds ratio (OR) of association between low folate (lowest quartile: <14.6 nmol/L) and depressive symptoms independent of other risk factors, including homocysteine and B12, was 1.72 (95% confidence interval (CI)=1.11-2.66). Vitamin B12 across a range of values did not show a linear association, but B12 deficiency (<180 pmol/L) appeared to be significantly associated with depressive symptoms (OR=2.68, 95% CI=1.20-6.00), independent of folate and homocysteine. CONCLUSION: Decreasing and low levels of serum folate and deficient levels of B12 were associated with greater risk of depressive symptoms in older Chinese adults.

Tea consumption and cognitive impairment and decline in older Chinese adults.

BACKGROUND: Laboratory research suggests that tea has potential neurocognitive protective effects, but this is not established in humans. OBJECTIVE: We aimed to examine the relation between tea intake and cognitive impairment and decline. DESIGN: Among community-living Chinese adults aged > or = 55 y in the Singapore Longitudinal Ageing Studies cohort, we measured tea consumption at baseline and administered the Mini-Mental State Examination (MMSE) at baseline and 1-2 y later. Cognitive impairment was defined as an MMSE score < or = 23 and cognitive decline as a drop in MMSE score of > or = 1 point. We performed cross-sectional analysis of baseline data from 2501 participants and longitudinal analysis of data from 1438 cognitively intact participants. Odds ratios (ORs) of association were calculated in logistic regression models that adjusted for potential confounders. RESULTS: Total tea intake was significantly associated with a lower prevalence of cognitive impairment, independent of other risk factors. Compared with the ORs for rare or no tea intake, the ORs for low, medium, and high levels of tea intake were 0.56 (95% CI: 0.40, 0.78), 0.45 (95% CI: 0.27, 0.72), and 0.37 (95% CI: 0.14, 0.98), respectively (P for trend < 0.001). For cognitive decline, the corresponding ORs were 0.74 (95% CI: 0.54, 1.00), 0.78 (95% CI: 0.55, 1.11), and 0.57 (95% CI: 0.32, 1.03), respectively (P for trend = 0.042). These effects were most evident for black (fermented) and oolong (semi-fermented) teas, the predominant types consumed by this population. In contrast, no association between coffee intake and cognitive status was found. CONCLUSION: Regular tea consumption was associated with lower risks of cognitive impairment and decline.

Curry consumption and cognitive function in the elderly.

Curcumin, from the curry spice turmeric, has been shown to possess potent antioxidant and antiinflammatory properties and to reduce beta-amyloid and plaque burden in experimental studies, but epidemiologic evidence is lacking. The authors investigated the association between usual curry consumption level and cognitive function in elderly Asians. In a population-based cohort (n = 1,010) of nondemented elderly Asian subjects aged 60-93 years in 2003, the authors compared Mini-Mental State Examination (MMSE) scores for three categories of regular curry consumption, taking into account known sociodemographic, health, and behavioral correlates of MMSE performance. Those who consumed curry "occasionally" and "often or very often" had significantly better MMSE scores than did subjects who "never or rarely" consumed curry. The authors reported tentative evidence of better cognitive performance from curry consumption in nondemented elderly Asians, which should be confirmed in future studies.