Transitioning to home and beyond following stroke: a prospective cohort study of outcomes and needs.

INTRODUCTION: Understanding of the needs of people with stroke at hospital discharge and in the first six-months is limited. This study aim was to profile and document the needs of people with stroke at hospital discharge to home and thereafter. METHODS: A prospective cohort study recruiting individuals with stroke, from three hospitals, who transitioned home, either directly, through rehabilitation, or with early supported discharge teams. Their outcomes (global-health, cognition, function, quality of life, needs) were described using validated questionnaires and a needs survey, at 7-10 days, and at 3-, and 6-months, post-discharge. RESULTS: 72 patients were available at hospital discharge; mean age 70 (SD 13); 61% female; median NIHSS score of 4 (IQR 0-20). 62 (86%), 54 (75%), and 45 (63%) individuals were available respectively at each data collection time-point. Perceived disability was considerable at hospital discharge (51% with mRS ≥ 3), and while it improved at 3-months, it increased thereafter (35% with mRS ≥ 3 at 6-months). Mean physical health and social functioning were "fair" at hospital discharge and ongoing; while HR-QOL, although improved over time, remained impaired at 6-months (0.69+/-0.28). At 6-months cognitive impairment was present in 40%. Unmet needs included involvement in transition planning and care decisions, with ongoing rehabilitation, information, and support needs. The median number of unmet needs at discharge to home was four (range:1-9), and three (range:1-7) at 6-months. CONCLUSION: Stroke community reintegration is challenging for people with stroke and their families, with high levels of unmet need. Profiling outcomes and unmet needs for people with stroke at hospital-to-home transition and onwards are crucial for shaping the development of effective support interventions to be delivered at this juncture. ISRCTN REGISTRATION: 02/08/2022; ISRCTN44633579.

Time to Refocus Assessment of Vision in Older Adults? Contrast Sensitivity but Not Visual Acuity Is Associated With Gait in Older Adults.

BACKGROUND: The relationship between measures of visual function and gait related risk factors for falls is unclear. In this study, we examine the relationship between visual function (visual acuity [VA] and contrast sensitivity [CS] at multiple spatial frequencies) and quantitative spatiotemporal gait, using a large, nationally representative sample of community dwelling older adults. METHODS: Participants aged 50 and over were recruited as part of The Irish Longitudinal Study on Ageing (TILDA). VA was measured with the LogMAR chart according to the Early Treatment of Diabetic Retinopathy Study protocol. CS was measured at five spatial frequencies ranging 1.5 to 18 cycles per degree (cpd) using the Functional Acuity Contrast Test. Gait speed, cadence, and stride length were measured using the GAITRite system. Multivariate analysis examined associations between gait and visual performance parameters adjusting for socioeconomic, physical, cognitive, and mental health covariates. RESULTS: Data from 4,678 participants were analyzed (age 61.7 ± 8.3 years, 54.1% woman). Poorer CS at 1.5 cpd and 3.0 cpd (low spatial frequency) was independently associated with decreased stride length (CS at 1.5 cpd: ß = .031; p = .001 and CS at 3.0 cpd: ß = .020; p = .001) but not cadence or gait speed. There was no evidence of an association between VA and any of the gait variables considered (p > .05). CONCLUSION: Reduced CS, at low spatial frequencies, is independently associated with shorter stride length, while VA is not associated with any gait measures. This evidence suggests that it may be necessary to consider refocus of the assessment of vision to include the most appropriate measures.

Measurement Error, Reliability, and Minimum Detectable Change in the Mini-Mental State Examination, Montreal Cognitive Assessment, and Color Trails Test among Community Living Middle-Aged and Older Adults.

BACKGROUND: Knowing the reliability of cognitive tests, particularly those commonly used in clinical practice, is important in order to interpret the clinical significance of a change in performance or a low score on a single test. OBJECTIVE: To report the intra-class correlation (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) for the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Color Trails Test (CTT) among community dwelling older adults. METHODS: 130 participants aged 55 and older without severe cognitive impairment underwent two cognitive assessments between two and four months apart. Half the group changed rater between assessments and half changed time of day. RESULTS: Mean (standard deviation) MMSE was 28.1 (2.1) at baseline and 28.4 (2.1) at repeat. Mean (SD) MoCA increased from 24.8 (3.6) to 25.2 (3.6). There was a rater effect on CTT, but not on the MMSE or MoCA. The SEM of the MMSE was 1.0, leading to an MDC (based on a 95% confidence interval) of 3 points. The SEM of the MoCA was 1.5, implying an MDC95 of 4 points. MoCA (ICC = 0.81) was more reliable than MMSE (ICC = 0.75), but all tests examined showed substantial within-patient variation. CONCLUSION: An individual's score would have to change by greater than or equal to 3 points on the MMSE and 4 points on the MoCA for the rater to be confident that the change was not due to measurement error. This has important implications for epidemiologists and clinicians in dementia screening and diagnosis.

Prevalence of age-related macular degeneration in the Republic of Ireland.

BACKGROUND: Age-related macular degeneration (AMD) remains the most common cause of visual loss among subjects over 50 years of age in the developed world. The Irish Longitudinal study on Ageing (TILDA) is a population-based study of subjects aged 50 years or older, designed to investigate factors that influence ageing, and has enabled this investigation of the prevalence of AMD in the Republic of Ireland (ROI). METHODS: Data collected from a nationally representative sample of community-living older adults aged 50 years and over in ROI over the period November 2009 to July 2011. 5035 participants attended the TILDA health centre for assessment. Retinal photographs were obtained in 4859 of these participants. Retinal grading was performed in a masked fashion using a modified version of the International Classification and Grading System for AMD. RESULTS: Adjusting for lower response rates among older subjects, the estimated overall prevalence of any AMD was 7.2% (95% CI 6.5% to 7.9%) in the population aged 50 years or older. The estimated prevalence of early AMD was 6.6% (95% CI 5.9% to 7.3%), and the estimated prevalence of late AMD was 0.6% (95% CI 0.4% to 0.8%). Statistically significant associations with AMD included increasing age and family history of the condition. CONCLUSIONS: This is the first study to provide prevalence estimates of AMD in ROI and will inform eye care professionals and policymakers involved in the delivery and planning of care for those afflicted with this condition.

Age-related normative changes in phasic orthostatic blood pressure in a large population study: findings from The Irish Longitudinal Study on Ageing (TILDA).

BACKGROUND: In this report, we provide the first normative reference data and prevalence estimates of impaired orthostatic blood pressure (BP) stabilization, initial orthostatic hypotension, and orthostatic hypotension based on beat-to-beat blood pressure methods in a population-representative sample. METHODS AND RESULTS: Participants were recruited from a nationally representative cohort study (≥50 years). Beat-to-beat systolic BP, diastolic BP, and heart rate records were analyzed among those who underwent an active stand test (n=4475). Normograms were estimated by use of generalized additive models for location, shape, and scale with Box-Cox power exponential distribution. Prevalence estimates of impaired BP stabilization, initial orthostatic hypotension, and orthostatic hypotension are reported. Orthostatic BP responses in adults aged 50 to 59 years stabilized within 30 seconds of standing, with older groups taking 30 seconds or longer. The total prevalence of impaired BP stabilization was 15.6% (95% confidence interval [CI], 14.1%-17.1%), increasing with age to 41.2% (95% CI, 30.0%-52.4%) in people ≥80 years old. Initial orthostatic hypotension occurred in 32.9% (95% CI, 31.2%-34.6%) of the population aged ≥50 years, with no age gradient evident. The prevalence of orthostatic hypotension was 6.9% (95% CI, 5.9%-7.8%) in the total population, increasing to 18.5% (95% CI, 9.0%-28.0%) in those aged ≥80 years old. CONCLUSIONS: Significant age-related differences exist in the time course of postural BP responses, with abnormal responses taking longer than 30 seconds to stabilize. Impaired BP stabilization is more common as we age, affecting more than two-fifths of the population aged ≥80 years, and may play a future role in the management of falls and syncope.

Relative association of processing speed, short-term memory and sustained attention with task on gait speed: a study of community-dwelling people 50 years and older.

BACKGROUND: For single gait tasks, associations have been reported between gait speed and cognitive domains. However, few studies have evaluated if this association is altered in dual gait tasks given gait speed changes with complexity and nature of task. We evaluated relative contributions of specific elements of cognitive function (including sustained attention and processing speed) to dual task gait speed in a nationally representative population of community-dwelling adults over 50 years. METHODS: Gait speed was obtained using the GaitRite walkway during three gait tasks: single, cognitive (alternate letters), and motor (carrying a filled glass). Linear regression models, adjusted for covariates, were constructed to predict the relative contributions of seven neuropsychological tests to gait speed differences and to investigate gait task effects. RESULTS: The mean age and gait speed of the population (n = 4,431, 55% women) was 62.4 years (SD = 8.2) and 135.85 cm/s (SD = 20.20, single task), respectively. Poorer processing speed, short-term memory, and sustained attention were major cognitive contributors to slower gait speed for all gait tasks. Both dual gait tasks were robust to covariate adjustment and had a significant additional executive function element not found for the single gait task. CONCLUSIONS: For community-dwelling older adults processing speed, short-term memory and sustained attention were independently associated with gait speed for all gait tasks. Dual gait tasks were found to highlight specific executive function elements. This result forms a baseline value for dual task gait speed.

Using timed up and go and usual gait speed to predict incident disability in daily activities among community-dwelling adults aged 65 and older.

OBJECTIVES: To compare the ability of Timed Up and Go (TUG) and usual gait speed (UGS) to predict incident disability completing basic activities of daily living (ADL) and instrumental ADL (IADL) in older adults free of disability at baseline, and to provide estimates for the probability of incident disability at different levels of baseline mobility performance. DESIGN: Data from the first 2 waves of The Irish Longitudinal Study on Ageing, a study assessing health, economic, and social aspects of ageing in adults aged ≥50 years. SETTING: A nationally representative, population-based sample of community-dwelling adults. PARTICIPANTS: Participants aged ≥65 years who completed mobility tests during a health assessment, had no reported difficulty in ADL/IADL, and had a Mini-Mental State Examination score ≥24 were re-interviewed after 2 years (n=1664). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed the TUG and UGS at baseline and indicated difficulty in a number of basic ADL and IADL at follow-up. RESULTS: Receiver operating characteristic analysis indicated that TUG and UGS are acceptable tools to predict disability in ADL and IADL (area under the curve [AUC]=.65-.75) with no significant difference between them (P>.05). Both were excellent predictors of difficulty in higher-level functioning tasks such as preparing hot meals, taking medications, and managing money (AUC>.80). Predictive probabilities were obtained across a range of performance levels. CONCLUSIONS: TUG and UGS have similar predictive ability in relation to incident disability in basic ADL and IADL. Predictive probabilities can be used to identify those most at risk and in need of particular services. Since improving physical function can prevent or delay dependence in ADL/IADL, TUG and UGS can also provide performance goals and feedback during exercise interventions.

Validation of the self-reported hearing questions in the Irish Longitudinal Study on Ageing against the Whispered Voice Test.

BACKGROUND: Self report questions are often used in population studies to assess sensory efficacy and decline. These questions differ in their validity in assessing sensory impairment depending on the wording of the question and the characteristics of the population. We tested the validity of the self-report questions on hearing efficacy (self reported hearing, ability in following a conversation, use of a telephone and use of hearing aids) used in The Irish Longitudinal Study on Ageing (TILDA). METHODS: We tested sensitivity and specificity, positive and negative predictive values of each question against the Whispered Voice Test, a relatively easy to administer and cost effective alternative to the standard audiometric test. RESULTS: In this population the question 'Is your hearing (with or without a hearing appliance)/ Excellent/Very Good/Good/Fair/Poor?' showed the best diagnostic value in relation to the other questions (sensitivity 55.56% and specificity 94.67%). The question 'Can you use a normal telephone?' was deemed ineffective because of a very poor sensitivity (5.56%) and was proposed for exclusion from subsequent waves of TILDA. CONCLUSIONS: We showed that this validity check was useful to select the questions that most effectively assess hearing deficits and provided crucial information for the subsequent waves. We argue that longitudinal studies using self-reports of sensory efficacy would benefit from a similar check.

Relationship between fear of falling and mobility varies with visual function among older adults.

AIM: The present study examined the association between vision, fear of falling and fear-related activity restriction, and assessed the effect of vision on the relationship between fear of falling and mobility, using data from a nationally representative sample of community-dwelling adults aged ≥ 50 years. METHODS: Participants (n=5003) completed an interview and health assessment (including Timed Up-and-Go, vision and cognitive tests). Visual acuity and contrast sensitivity were assessed using an Early Treatment Diabetic Retinopathy Study logMAR chart and Functional Vision Analyzer, respectively. Participants self-reported their vision as excellent, very good, good, fair or poor. They were assigned to no fear of falling, fear without activity restriction and fear with activity restriction groups. Logistic regression models examined the relationship between vision, fear of falling and activity restriction. Linear regression models were used to examine the main and interaction effects of fear of falling, self-reported vision, visual acuity, and contrast sensitivity on mobility after adjusting for confounders. RESULTS: Poorer self-reported vision was independently associated with fear of falling and fear-related activity restriction (P<0.05), but visual acuity and contrast sensitivity were not. Participants with the lowest visual acuity and contrast sensitivity levels, combined with fear-related activity restriction, had slower Timed Up-and-Go than those in the highest visual performance quartiles (P<0.05). CONCLUSIONS: Participants' perceptions of visual function were related to fear of falling and activity restriction, but this was not explained by other visual factors measured here. However, poorer visual acuity and contrast sensitivity did moderate the relationship between fear-related activity restriction and mobility, highlighting the importance of a comprehensive vision assessment especially in individuals with fear of falling.

The impact of being the intermediate caring generation and intergenerational transfers on self-reported health of women in Ireland.

OBJECTIVES: To investigate the associations with being the "sandwich generation" in older women in Ireland and its impact on self-reported health. METHODS: Analysis of 3,196 women from wave 1 of the Irish Longitudinal Study on Ageing (TILDA) was undertaken. Poisson regression was used to determine whether intergenerational transfers, were associated with self-rated physical health and depression, when controlling for other socio-demographic variables. RESULTS: Multivariate analysis found that women in the sandwich generation who financially supported their children had better self-rated physical health (poor/fair health relative to excellent; RR 0.84, 95 % CI 0.72-0.97). Conversely, the women who provided other care for their children showed evidence of poorer mental health (case-level depression, RR 1.35, 95 %CI 1.05-1.73). Providing financial support for parents was associated with case-level depression (RR 2.21, 95 %CI 1.26-3.86). CONCLUSIONS: Supporting two generations was associated with both better self-rated health and poorer mental health, depending on the type and direction of the transfers. This generation of women have substantial caring responsibilities. Strategies to address the stresses associated with bi-directional intergenerational transfers are needed.

Variance between walking speed and neuropsychological test scores during three gait tasks across the Irish Longitudinal study on Aging (TiLDA) dataset.

This study investigated the relationship between neuropsychological test scores and gait speed in three gait tasks using baseline cross-sectional data from 4694 healthy adults (54% women, age (mean±sd) 62.4±8.2) from The Irish Longitudinal study on Aging (TiLDA). Global cognition, short term memory, speed of processing, executive function and sustained attention were measured by a detailed battery of neuropsychological tests. Gait speed was recorded from a GaitRite™ pressure sensing mat during a single walk and two dual walking tasks; dual cognitive walk (alternate letters) and dual motor walk (carrying a glass of water). Correlations between neuropsychological test scores and the three gait speed outcomes were investigated using univariate and multiple linear regressions models; firstly adjusting for age, gender, height, education and depression only and then including all neuropsychological test scores in the same regression model and adjusting as previously. It was found that short term memory, speed of processing and attention were significantly correlated with gait speed in all three gait conditions, with global cognition and executive function also significantly correlated with gait speed in the dual cognitive walk. The nature and complexity of the task performed affected gait speed with the addition of the cognitive task while walking causing a larger reduction in gait speed than the addition of the motor task. This indicates that for this healthy nationally representative population sample there is a link between neural processes involved in movement and cognition and this association differs depending on the gait task performed.

Oscillometric measure of blood pressure detects association between orthostatic hypotension and depression in population based study of older adults.

BACKGROUND: White matter hyperintensities may contribute to depression by disrupting neural connections among brain regions that regulate mood. Orthostatic hypotension (OH) may be a risk factor for white matter hyperintensities and accumulating evidence, although limited suggests it may play a role in the development of late-life depression. The aim of this study was to examine the relationship between an oscillometric measure of orthostatic hypotension and depression in population based sample of older adults. METHODS: We analysed data on adults aged 60 and over from the first wave of The Irish Longitudinal Study on Ageing (TILDA). Depression was assessed using the Center for Epidemiologic Studies--Depression (CES-D) scale and OH was assessed by a sit-to-stand orthostatic stress test; two seated blood pressure measurements were followed by a single standing blood pressure measurement. Participants self reported whether they felt dizzy, light-headed or unsteady on standing. RESULTS: Participants with symptomatic OH (SOH, n=20) had the highest mean CES-D score (mean 8.6, SE 1.6) when compared to participants with asymptomatic OH (AOH) (mean 5.6, SE .48) and participants with no OH (mean 5.2, SE .14) and this difference was significant for both comparisons (p<0.001). Linear regression analysis adjusted for socio-demographic and clinical characteristics showed that SOH was associated with higher CES-D scores (unstandardised B coefficient = 2.24; 95% CI .301 - 4.79; p =0.05) compared to participants without OH. AOH was not associated with higher CES-D scores (unstandardised B coefficient =.162; 95% CI -.681, 1.00; p= 0.70). CONCLUSIONS: Symptomatic orthostatic hypotension is associated with depression in older adults and needs to be considered in studies examining the relationship between vascular disease and depression in older adults.

Low macular pigment optical density is associated with lower cognitive performance in a large, population-based sample of older adults.

Macular pigment (MP) is comprised of the carotenoids lutein (L), zeaxanthin (Z), and meso-zeaxanthin (MZ), which selectively accumulate at the macula (central retina) of the eye and are neuroprotective. These carotenoids are also present in the brain, and evidence suggests a close correlation between retinal and brain concentrations. We investigated the relationship between MP and cognitive function in 4453 adults aged ≥ 50 years as part of The Irish Longitudinal Study on Aging. Macular pigment optical density (MPOD) was determined using customized heterochromatic flicker photometry-a quick and noninvasive way of measuring the concentration of the pigment. Lower MPOD was associated with poorer performance on the mini-mental state examination (p = 0.026) and on the Montreal cognitive assessment (p = 0.016). Individuals with lower MPOD also had poorer prospective memory (p = 0.011), took longer time to complete a trail-making task (p = 0.003), and had slower and more variable reaction times on a choice reaction time task (p = 0.000 and 0.001). These associations were only slightly attenuated following adjustment for physical and mental health. There was no significant association between MPOD and verbal fluency, word recall, visual reasoning, or picture memory. Overall, the findings support the theory that xanthophyll carotenoids impact on cognitive function, underscoring the need for exploration of novel, noninvasive biomarkers for cognitive vulnerability and preventive strategies.

Health and aging: development of the Irish Longitudinal Study on Ageing health assessment.

OBJECTIVES: To assist researchers planning studies similar to The Irish Longitudinal Study on Ageing (TILDA), concerning the development of the health assessment component, to promote use of the archived data set, to inform researchers of the methods employed, and to complement the accompanying article on normative values. DESIGN: Prospective, longitudinal study of older adults. SETTING: Republic of Ireland. PARTICIPANTS: Eight thousand five hundred four community-dwelling adults who participated in wave 1 of the TILDA study. MEASUREMENTS: The main areas of focus for the TILDA health assessments are neurocardiovascular instability, locomotion, and vision. RESULTS: The article describes the scientific rationale for the choice of assessments and seeks to determine the potential advantages of incorporating novel biomeasures and technologies in population-based studies to advance understanding of aging-related disorders. CONCLUSION: The detailed description of the physical measures will facilitate cross-national comparative research and put into context the normative values outlined in the subsequent article.

Normative values of cognitive and physical function in older adults: findings from the Irish Longitudinal Study on Ageing.

OBJECTIVES: To provide normative values of tests of cognitive and physical function based on a large sample representative of the population of Ireland aged 50 and older. DESIGN: Data were used from the first wave of The Irish Longitudinal Study on Ageing (TILDA), a prospective cohort study that includes a comprehensive health assessment. SETTING: Health assessment was undertaken at one of two dedicated health assessment centers or in the study participant's home if travel was not practicable. PARTICIPANTS: Five thousand eight hundred ninety-seven members of a nationally representative sample of the community-living population of Ireland aged 50 and older. Those with severe cognitive impairment, dementia, or Parkinson's disease were excluded. MEASUREMENTS: Measurements included height and weight, normal walking speed, Timed Up-and-Go, handgrip strength, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Color Trails Test, and bone mineral density. Normative values were estimated using generalized additive models for location shape and scale (GAMLSS) and are presented as percentiles, means, and standard deviations. RESULTS: Generalized additive models for location shape and scale fit the observed data well for each measure, leading to reliable estimates of normative values. Performance on all tasks decreased with age. Educational attainment was a strong determinant of performance on all cognitive tests. Tests of walking speed were dependent on height. Distribution of body mass index did not change with age, owing to simultaneous declines in weight and height. CONCLUSION: Normative values were found for tests of many aspects of cognitive and physical function based on a representative sample of the general older Irish population.

Age and sex differences in prevalence and clinical correlates of depression: first results from the Irish Longitudinal Study on Ageing.

OBJECTIVE: The risk of depression is increased by physical illness; however, the nature of this relationship is complex and unclear. Here, we explore the prevalence and clinical correlates of depression, with particular emphasis on factors representing consequences or physical manifestations of disease and identify age and gender differences in their effects. METHODS: A population-representative sample of 8175 community-dwelling adults aged 50 years and over participated in the first wave of The Irish Longitudinal Study on Ageing. The primary outcome measure was clinically significant depressive symptoms defined by a score of 16 or greater on the 20-item Centre for Epidemiologic Studies Depression scale. RESULTS: Overall, 10% (95% CI: 9-11%) of adults reported clinically significant depressive symptoms. Physical illness is associated with depressive symptoms only in adults 65 years and older; in adults aged 50-64 years, the association is mediated by medication use, and this age difference is statistically significant (p < 0.00). Irrespective of age, chronic pain and incontinence were stronger predictors of depression in men (interaction effects p < 0.00) CONCLUSIONS: Our findings identify age-specific and gender-specific clinical markers for depression risk among the older population, which may identify those more likely to present with depression in community settings.

Using timed up-and-go to identify frail members of the older population.

BACKGROUND: Fried's definition of frailty is widely used but its measurement is problematic. Timed up-and-go (TUG) is a simple measure of mobility that may be a useful proxy for frailty. Here, we describe the distribution of frailty and TUG in the older population of Ireland and discuss the extent to which TUG identifies the frail and prefrail populations. METHODS: A total of 1,814 participants of The Irish Longitudinal Study on Ageing aged 65 and older completed a comprehensive health assessment. Frailty was defined by having three or more of low gait speed, low grip strength, unintentional weight loss, self-reported exhaustion, and low physical activity. ROC curves were used to identify how well TUG discriminates the frail and prefrail populations and whether TUG improves on gait speed as a single objective measure of frailty. RESULTS: Among the Irish population aged 65 and older, 7.7% were frail and 44.0% were prefrail. TUG identifies frail members of the population well (AUC = 0.87) but is less able to discriminate the nonfrail from the prefrail or frail populations (AUC = 0.73). TUG captures the components of frailty that become more common with age but does not discriminate the components that do not, for example, unintended weight loss or exhaustion. There is no advantage in using TUG instead of gait speed with respect to identifying frailty. CONCLUSIONS: TUG is a sensitive and specific measure of frailty that offers advantages in its measurement where the full application or interpretation of Fried's criteria is impracticable; however, TUG cannot be used to reliably identify prefrail individuals.

Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults.

Fear of falling (FOF) is associated with poor physical and psychosocial health and can have debilitating consequences especially when it leads to activity restriction. This study examined whether normal and dual task gait disruptions were independently associated with FOF and activity restriction or if they were fully explained by impaired health status. Data was obtained from The Irish Longitudinal Study on Ageing (TILDA). Community dwelling adults ≥65 years, with a Mini-Mental State Examination score ≥18 and who completed a gait assessment (n=1307) were divided into three groups: no FOF, FOF but no activity restriction (FOF-NAR), FOF with activity restriction (FOF-AR). Physical, psychosocial and cognitive measures were obtained and gait characteristics were assessed using a GAITRite(®) mat during normal and dual task (cognitive) walking. After adjusting for sociodemographics, physical, mental and cognitive health, FOF was associated with reduced gait speed and stride length and increased double support phase and step width in normal and dual task conditions; these changes were most pronounced in those who restrict activities as a result of FOF. These gait changes may be associated with an increased fall risk, however some changes especially increased step width may also reflect positive, compensatory adaptations to FOF. The results also highlight the importance of treating underlying health impairments and preventing the transition from FOF to activity restriction.

Education is positively associated with macular pigment: the Irish Longitudinal Study on Ageing (TILDA).

PURPOSE: The three carotenoids lutein, zeaxanthin, and meso-zeaxanthin, are found at the macula and referred to as macular pigment (MP). This study was undertaken to investigate determinants of MP in a large randomly selected sample from the Republic of Ireland (as part of The Irish Longitudinal Study on Ageing [TILDA]). METHODS: MP optical density (MPOD) was measured using customized heterochromatic flicker photometry in 4373 participants. Sociodemographic and self reported health data was obtained using computer assisted personal interview (CAPI). RESULTS: Mean (SD) MPOD for the study group was 0.203 (0.156) with a range of 0 to 1.01. MPOD was higher for participants with secondary education (mean [SD] = 0.205 [0.148]) than for those with only primary education or no education (mean [SD] = 0.183 [0.113]; P < 0.001). MPOD was also higher for those with tertiary education (mean [SD] = 0.232 [0.231]) compared with primary/no education or secondary education (P < 0.001 for both comparisons). CONCLUSIONS: We report that MP is lower amongst those participants of a population-representative study who did not have secondary or third level education when compared with participants who had such education. Given the emerging evidence that MP is important for visual performance and comfort, and given the putative protection that this pigment confers against AMD (especially important in the context of increased risk of AMD in this social group), public health measures aimed at improving diet for this at-risk population need to be considered.

Association between timed up-and-go and memory, executive function, and processing speed.

OBJECTIVES: To determine which cognitive tests are independently associated with performance on the Timed Up-and-Go Test (TUG). DESIGN: Data were obtained from Wave 1 of The Irish Longitudinal Study on Ageing (TILDA), a population-based study assessing health, economic, and social aspects of aging. SETTING: Community-dwelling adults completed a home based interview and a health center-based assessment. PARTICIPANTS: TILDA participants aged 50 and older with a Mini-Mental State Examination (MMSE) score of 10 or greater (N = 4,998). MEASUREMENTS: Participants completed a battery of cognitive assessments including the Montreal Cognitive Assessment (MoCA), Color Trails Test, word and letter fluency, choice reaction time, sustained attention, prospective memory, word recall, and picture memory. Linear regression was used to determine univariate and multivariate associations between TUG and each cognitive test. RESULTS: Slower TUG time was associated with poorer performance on all cognitive tests in univariate analysis (P < .05). In multivariate analysis, poorer performance on the MoCA, letter fluency, Color Trail 1, cognitive reaction time, mean sustained attention response time, and prospective memory were independently associated with slower TUG time (P < .05). CONCLUSION: Slower TUG time is independently associated with poorer performance on global cognition, executive function, and memory tests and slower processing speed. This highlights that TUG is more than just a simple mobility task and suggests that a comprehensive cognitive assessment is important for individuals with mobility difficulties.