Burden of chronic cough on social participation, healthcare resource utilisation and activities of daily living in the Canadian Longitudinal Study on Aging (CLSA).

BACKGROUND: Chronic cough is a common troublesome condition, but it is unclear whether dry or productive chronic cough and sex, impacts the burden of cough differently. METHODS: The Canadian Longitudinal Study on Aging is a nationally generalizable, stratified random sample of adults aged 45-85 years. Chronic cough was identified based on a self-reported daily cough in the last 12 months assessed at baseline (2011-2015) and follow-up (2015-2018). Odds ratios (95 % CI) for cough status and change in social participation activities (SPA), healthcare resource utilisation (HCRU), basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were estimated using a weighted generalised estimating equation (WGEE). Results were stratified by sex, and adjusted for age, sex, smoking, body mass index, education, respiratory diseases and retirement status. RESULTS: Overall, chronic cough was associated with less SPA, greater HCRU and impaired ADL/IADLs. Productive chronic cough in males was associated with SPA limited by health, ED visits and hospitalisation. Females with productive chronic cough was associated with reduced frequency of SPA and ED visit. Dry chronic cough in females was associated with SPA limited by health and ED visits. Both types of cough was associated with at least 1 impaired basic ADL, but only in females with productive chronic cough was there an association with any impairment in IADLs. CONCLUSION: Chronic cough is associated with a greater burden on social participation, healthcare use and personal care.

Sarcopenia Definition and Outcomes Consortium 2020 Definition: Association and Discriminatory Accuracy of Sarcopenia With Disability in the Canadian Longitudinal Study on Aging.

BACKGROUND: Previous sarcopenia definitions have poor discriminatory accuracy for identifying people with/without relevant health outcomes, and poor agreement between methods of operationalizing sarcopenia criterion. The 2020 Sarcopenia Definitions and Outcomes Consortium (SDOC) definition recommends grip strength (absolute, or standardized to body mass index, total body fat, lean arm mass, or weight), and gait speed. The agreement between methods of operationalizing grip strength and discriminatory accuracy of the SDOC definition for health outcomes such as activities of daily living (ADL) disability is unknown. METHODS: Cross-sectional analyses of 27 924 Canadian Longitudinal Study on Aging participants aged 45-85 at baseline (2012-2015) stratified by sex. The associations of the SDOC definitions with ADL disability were assessed using logistic regression. Area under the curve (AUC) analyses were conducted to assess discriminatory accuracy. Agreement between methods of operationalizing grip strength was measured using Cohen's kappa. RESULTS: Sarcopenia was associated with 1.60 (1.42-1.80) to 5.80 (4.89-6.88) greater odds of ADL disability with AUC values between 0.60 and 0.81. Agreement between methods of operationalizing grip strength was between 0.10-0.80 for grip strength alone and 0.45-0.91 when combined with gait speed. CONCLUSIONS: The SDOC-suggested criteria of grip strength and gait speed are significantly associated with ADL disability and have high discriminatory accuracy. However, the agreement between methods of operationalizing grip strength tended to be modest, and AUC, sensitivity, and specificity differed depending on the definition. We suggest a single measure of grip strength be considered and age-stratified cutoff values to improve AUC values.

Predictors of reported alcohol intake during the first and second waves of the COVID-19 pandemic in Canada among middle-aged and older adults: results from the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVE: To examine proportions and predictors of change in alcohol intake and binge drinking during the first 2 waves of the COVID-19 pandemic among middle-aged and older participants in the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study. METHODS: A total of 28,559 (67.2% of the potential sample) CLSA participants consented to the study with 24,114 completing the exit survey (fall 2020). Descriptive statistics and logistic regressions to examine predictors of change (increase or decrease) in alcohol intake and binge drinking were performed. RESULTS: Among alcohol users, 26.3% reported a change in alcohol consumption during the first 10 months of the pandemic. Similar percentages increased (13.0%) or decreased (13.3%) consumption. In our mutually adjusted logistic regression model, odds of change in alcohol intake were greater for younger age, higher income, current cannabis smoker, positive screen for depression, anxiety, and loneliness. The magnitude of all associations for decreased intake was less than that of increased intake, and the directions were opposite for male sex and age. Predictors of current binge drinking (27.9% of alcohol users) included male sex, younger age, higher education and income, cannabis use, depression, and anxiety. CONCLUSION: Factors predictive of potentially worrisome alcohol use (i.e. increased intake, binge drinking) included younger age, sex, greater education and income, living alone, cannabis use, and worse mental health. Some of these factors were also associated with decreased intake, but the magnitudes of associations were smaller. This information may help direct screening efforts and interventions towards individuals at risk for problematic alcohol intake during the pandemic.

RéSUMé: OBJECTIF: Examiner les proportions et les prédicteurs des changements dans la consommation d'alcool et l'hyperalcoolisation rapide au cours des deux premières vagues de la pandémie de COVID-19 chez les personnes âgées et d'âge moyen ayant participé à l'étude par questionnaire sur la COVID-19 de l'Étude longitudinale canadienne sur le vieillissement (ELCV). MéTHODE: Un total de 28 559 participants de l'ELCV (67,2 % de l'échantillon potentiel) ont consenti à l'étude sur la COVID-19, et 24 114 ont répondu à l'enquête à la sortie (automne 2020). Nous avons procédé par statistique descriptive et par régression logistique pour examiner les prédicteurs des changements (augmentation ou diminution) dans la consommation d'alcool et l'hyperalcoolisation rapide. RéSULTATS: Chez les consommateurs d'alcool, 26,3 % ont déclaré un changement de leur consommation d'alcool au cours des 10 premiers mois de la pandémie. Un pourcentage semblable de consommateurs d'alcool avaient accru (13 %) ou diminué (13,3 %) leur consommation. Dans notre modèle de régression logistique mutuellement ajusté, la probabilité de changement dans la consommation d'alcool était plus élevée chez les répondants plus jeunes, les répondants au revenu élevé, les fumeurs de cannabis actuels et les répondants ayant fait état de dépression, d'anxiété ou de solitude. Les associations avec la diminution de la consommation étaient moins significatives qu'avec l'augmentation de la consommation, et elles allaient dans le sens opposé pour ce qui est du sexe masculin et de l'âge. Les prédicteurs de l'hyperalcoolisation rapide actuelle (27,9 % des consommateurs d'alcool) étaient le sexe masculin, l'âge plus jeune, l'instruction et le revenu élevés, la consommation de cannabis, la dépression et l'anxiété. CONCLUSION: Les facteurs pouvant prédire une consommation d'alcool potentiellement inquiétante (c.-à-d. consommation accrue, hyperalcoolisation rapide) étaient l'âge plus jeune, le sexe, l'instruction et le revenu élevés, le fait de vivre seul, la consommation de cannabis et la moins bonne santé mentale. Certains de ces facteurs étaient aussi associés à une consommation réduite, mais ces associations étaient moins significatives. Ces informations pourraient orienter les efforts de dépistage et les interventions auprès des personnes à risque de consommation problématique d'alcool durant la pandémie.

Impact of mental health and personality traits on the incidence of chronic cough in the Canadian Longitudinal Study on Aging.

Background: Chronic cough is a common troublesome condition, but risk factors for developing chronic cough are poorly understood. The aim of this study was to understand the relationship between mental health disorders, personality traits and chronic cough. Methods: The Canadian Longitudinal Study on Aging is a prospective, nationally generalisable, random sample of adults aged 45-85 years at baseline recruited between 2011 and 2015, and followed-up 3 years later. Chronic cough was defined as a daily cough over the last 12 months. Incident chronic cough was defined as those participants who reported new-onset chronic cough between baseline and follow-up 1. Current depressive symptoms and psychological distress were assessed using the Center for Epidemiologic Study Short Depression Scale (CESD-10) and Kessler Psychological Distress Scale (K-10), respectively. The "Big Five" personality traits were assessed using the Ten-Item Personality Inventory. Relative risks are reported using a multivariate mutually adjusted model. Results: At follow-up 1, 2506 participants (11.1%) reported new-onset chronic cough during the ∼3-year interval. Depressive symptoms (CESD-10 ≥10: relative risk 1.22 (95% CI 1.03-1.44)) and psychological distress (K-10 ≥22: relative risk 1.20 (95% CI 1.07-1.36)) at baseline were both independent predictors of a higher risk of incident chronic cough. Prevalent and incident chronic cough were also independently associated with an increased risk of developing depressive symptoms and psychological distress. Personality traits did not influence the development of chronic cough but did increase the risk of depressive symptoms and psychological distress. Conclusions: This study shows that there is a bidirectional relationship between chronic cough, and depressive symptoms and psychological distress, and personality traits do not independently influence the development of chronic cough.

Mobility screening for fall prediction in the Canadian Longitudinal Study on Aging (CLSA): implications for fall prevention in the decade of healthy ageing.

BACKGROUND: Guidelines for fall prevention in older adults recommend mobility screening for fall risk assessment; however, there is no consensus on which test to use and at what cutoff. This study aimed to determine the accuracy and optimal cut-off values of commonly used mobility tests for predicting falls in the Canadian Longitudinal Study on Aging (CLSA). METHODS: Mobility tests at baseline included the Timed Up and Go (TUG), Single Leg Stance (SLS), chair-rise and gait speed. Inclusion criteria were: age ≥ 65 years and meeting first-level fall screening criteria (i.e. history of a fall or mobility problem) at baseline. Accuracy of fall prediction at 18-months for each test was measured by the area under the receiver operating curve (AUC). RESULTS: Of 1,121 participants that met inclusion criteria (mean age 75.2 ± 5.9 years; 66.6% women), 218 (19.4%) reported ≥one fall at 18 months. None of the tests achieved acceptable accuracy for identifying individuals with ≥one fall at follow-up. Among women 65-74 and 75-85 years, the TUG identified recurrent fallers (≥two falls) with optimal cut-off scores of 14.1 and 12.9 s (both AUCs 0.70), respectively. Among men 65-74 years, only the SLS showed acceptable accuracy (AUC 0.85) for identifying recurrent fallers with an optimal cutoff of 3.6 s. CONCLUSIONS: Our findings indicate that commonly used mobility tests do not have sufficient discriminability to identify fallers in a population-based sample of community-dwelling older adults. The TUG and SLS can identify recurrent fallers; however, their accuracy and cut-off values vary by age and sex.

Factors Associated With Willingness to Receive a COVID-19 Vaccine Among 23,819 Adults Aged 50 Years or Older: An Analysis of the Canadian Longitudinal Study on Aging.

Identifying persons who are least willing to receive a coronavirus disease 2019 (COVID-19) vaccine is critical for increasing uptake via targeted outreach. We conducted a survey of 23,819 Canadian Longitudinal Study on Aging participants from September 29 to December 29, 2020, to assess factors associated with COVID-19 vaccination willingness and reasons for willingness or lack thereof. Among adults aged 50-96 years, 84.1% (95% confidence interval (CI): 83.7, 84.6) were very or somewhat willing to receive a COVID-19 vaccine; 15.9% (95% CI: 15.4, 16.3) were uncertain or very or somewhat unwilling. Based on logistic regression, those who were younger, female, had lower education and income, were non-White, and lived in a rural area were less willing to receive a COVID-19 vaccine. After controlling for these factors, recent receipt of influenza vaccine (adjusted odds ratio = 14.3, 95% CI: 12.5, 16.2) or planning to receive influenza vaccine (adjusted odds ratio = 10.5, 95% CI: 9.5, 11.6), as compared with no receipt or planning, was most strongly associated with COVID-19 vaccination willingness. Willingness was also associated with believing one had never been infected with severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and experiencing negative pandemic consequences. Safety concerns were most common among those unwilling. Our comprehensive assessment of COVID-19 vaccination willingness among older adults in Canada, a prioritized group for vaccination due to their risk of severe COVID-19 outcomes, provides a road map for conducting outreach to increase uptake, which is urgently needed.

Language and geographical location influence the incidence of chronic cough in the Canadian Longitudinal Study on Aging.

French speakers have a 4% lower incidence of chronic cough than English speakers in the CLSA, but English speakers from Quebec, Newfoundland and Labrador, and Nova Scotia also have a lower risk of developing chronic cough https://bit.ly/3qAd3Mf.

Impact of productive and dry chronic cough on mortality in the Canadian Longitudinal Study on Aging (CLSA).

Background: Chronic cough is a common troublesome condition and accounts for a high burden on quality of life. Previous data investigating the mortality associated with chronic cough has been derived in patients with chronic bronchitis. No data exists on chronic dry cough. Therefore, we investigated if chronic dry and productive cough is independently associated with increased mortality. Methods: The Canadian Longitudinal Study on Ageing (CLSA) is a prospective, nationally generalizable, stratified random sample of adults aged 45-85 years at baseline recruited between 2011-2015 and followed up three years later. Chronic cough was identified based on a self-reported daily cough in the last 12 months. Deaths were confirmed by the Ministry of Health and/or completion of descendent questionnaire by a family member. Models were investigated for dry and productive chronic cough and was adjusted for age, sex, smoking, body mass index (BMI), and respiratory diseases. Results: Of the 30,016 participants, 4,783 (15.9%) reported chronic cough at baseline; 2,724 (57%) had a dry cough, and 2,059 (43%) had productive chronic cough. There was a total of 561 deaths between baseline and follow-up-1 (3 years later). There was a 49% higher risk of death in participants with chronic productive cough {adjusted odds ratio (aOR) 1.49 [95% confidence intervals (CI): 1.08-2.07]}, but not dry chronic cough [aOR 0.85 (0.60-1.20)]. The effects of chronic productive cough on mortality were persistent in those with no airflow obstruction [chronic productive cough aOR 1.90 (1.09-3.31)]. Conclusions: Chronic productive cough is associated with a higher risk of death, while chronic dry cough has no impact on mortality risk of death in middle-aged and older adults. This highlights the importance of careful evaluation of patients with chronic cough.

Impact of COVID-19 on mobility and participation of older adults living in Hamilton, Ontario, Canada: a multimethod cohort design protocol.

INTRODUCTION: The novel COVID-19 required many countries to impose public health measures that likely impacted the participation and mobility of community-dwelling older adults. This protocol details a multimethod cohort design undertaken to describe short-term and medium-term changes to the mobility and participation of older Canadians living in the community rather than retirement facilities during the COVID-19 pandemic. METHODS AND ANALYSIS: A longitudinal telephone (or online)-administered survey is being conducted with a random sample of older adults living within 20 km of McMaster University, Hamilton, Ontario, Canada, identified from census dissemination areas. Baseline data collection of community-dwelling older adults aged 65 years and over began in May 2020 with follow-ups at 3, 6, 9 and 12 months. The Late-Life Function and Disability Instrument and global rating of change anchors are the primary outcomes of interest. A subsample of respondents will participate in open-ended, semistructured interviews conducted over the telephone or through video-conference, to explore participants' lived experiences with respect to their mobility and participation during the pandemic. Descriptive statistics and quantitative approaches will be used to determine changes in mobility and social and personal participation, and associated personal and environmental factors. For the interviews, qualitative data will be analysed using descriptive phenomenology. ETHICS AND DISSEMINATION: Approval was obtained from the Hamilton Integrated Research Ethics Board of McMaster University (2020-10814-GRA). This study may inform the design of programmes that can support community-dwelling older adults during and after the COVID-19 pandemic. Findings will be disseminated through peer-reviewed publications and conferences focused on ageing.

Prevalence, incidence and characteristics of chronic cough among adults from the Canadian Longitudinal Study on Aging.

The global prevalence of chronic cough is highly variable, ranging from 2% to 18%. There is a lack of data on the prevalence and incidence of chronic cough in the general population. The objective of this study was to investigate the prevalence and incidence of chronic cough in a sample of Canadian adults, and how these are influenced by age, sex, smoking, respiratory symptoms, medical comorbidities and lung function. Participants with chronic cough were identified from the Canadian Longitudinal Study on Aging (CLSA) based on self-reported daily cough in the past 12 months. This is a prospective, nationally generalisable, stratified random sample of adults aged 45-85 years at baseline recruited between 2011 and 2015, and followed-up 3 years later. The prevalence and incidence per 100 person-years are described, with adjustments for age, sex and smoking. Of the 30 097 participants, 29 972 completed the chronic cough question at baseline and 26 701 did so at follow-up. The prevalence of chronic cough was 15.8% at baseline and 17.6% at follow-up with 10.4-17.1% variation across seven provinces included in the CLSA comprehensive sample. Prevalence increased with age and current smoking, and was higher in males (15.2%), Caucasians (14%) and those born in North America, Europe or Oceania (14%). The incidence of chronic cough adjusted for age, sex and smoking was higher in males and in underweight and obese subjects. Subjects with respiratory symptoms, airway diseases, lower forced expiratory volume in 1 s (% predicted), cardiovascular diseases, psychological disorders, diabetes and chronic pain had a higher incidence of chronic cough. The prevalence and incidence of chronic cough is high in the CLSA sample with geographic, ethnic and gender differences, influenced by a number of medical comorbidities.

Examining early and late onset of multimorbidity in the Canadian Longitudinal Study on Aging.

BACKGROUND/OBJECTIVES: The study objective was to understand characteristics and health outcomes of multimorbidity, distinguishing between multimorbidity onset in earlier and later phases of life among community-dwelling older adults in Canada. DESIGN: A cross-sectional analysis was conducted using baseline data from the Canadian Longitudinal Study on Aging (CLSA). SETTING AND PARTICIPANTS: This analysis included 11,161 older adults who were between the ages of 65 and 85 years at baseline and who were living in community-based settings. MEASUREMENTS: Multimorbidity was defined using two cutpoints: two or more chronic conditions (MM2+) and three or more chronic conditions (MM3+). After calculating the age of diagnosis for eligible participants, "early multimorbidity" was defined as multiple chronic conditions diagnosed before 45 years of age, while "late multimorbidity" was defined as multiple chronic conditions diagnosed at or after 45 years of age. The five health outcomes explored were physical disability, social limitation, frailty level, perceived general health status, and perceived mental health status. RESULTS: Overall, the prevalence of MM2+ was 75.3% (95% CI: 74.3, 76.1) and the prevalence of MM3+ was 47.0% (95% CI: 46.0, 48.0). The majority of participants (both females and males) living with multimorbidity were categorized with late multimorbidity. Participants with early multimorbidity or both early and late multimorbidity had increased odds of physical disability, social limitation, increased frailty level, and negative perceived general and mental health. These patterns were detected for both MM2+ and MM3+. CONCLUSION: This study examined the impact of the timing of multimorbidity onset on five health outcomes. Our findings highlight the importance of clinical and public health interventions to prevent and manage the causes and consequences of multimorbidity, with particular focus on age of onset. Future longitudinal research should be done to further articulate the relationships between multimorbidity and these health outcomes over time.

The association between primary ovarian insufficiency and osteoporosis in the Canadian Longitudinal Study on Aging.

OBJECTIVE: The objective of this study is to describe the association of premature ovarian insufficiency (POI) and early menopause on bone mineral density (BMD) and osteoporosis in a large cohort of women living in Canada. METHODS: Cross-sectional baseline data from a deeply characterized cohort (female participants) of the Canadian Longitudinal Study on Aging was used. Additional bio-psycho-social characteristics that may influence bone health and the development of osteoporosis were explored. RESULTS: The mean age of women at the time of baseline assessment was 65 years (N = 12,339). When comparing women with POI to those with early and normal age of menopause, there was no difference in hip BMD between groups, but women in the POI group were more likely to have a higher rate of self-reported osteoporosis (21.9% vs 16.7%) and have used osteoporosis drugs (11.39% vs 7.63%). After adjustment, POI was found to increase the odds of osteoporosis, as diagnosed using BMD. Current cigarette smoking was found to influence this association. Protective factors included obesity and current hormone therapy use, but not the duration of hormone therapy use. Women in the POI group were more likely to be obese, have decreased physical activity, and were more likely to be current smokers. CONCLUSION: These results confirm findings from smaller cohorts illustrating that POI is associated with osteoporosis. Increasing understanding of the sequelae associated with an earlier loss of ovarian function will aid in targeting earlier screening and intervention strategies for women in Canada and abroad.

Do Different Ascertainment Techniques Identify the Same Individuals as Sarcopenic in the Canadian Longitudinal Study on Aging?

BACKGROUND/OBJECTIVES: Sarcopenia is associated with poor health outcomes such as disability, institutionalization, and mortality. Efforts to manage sarcopenia clinically have been hindered by challenges in determining how to ascertain sarcopenia status correctly. The objective of this project was to assess the agreement between the different methods of ascertaining sarcopenia recommended by expert groups. DESIGN: Cross-sectional study of baseline data (2011-2015) from the Canadian Longitudinal Study on Aging. SETTING: Population-based multicenter study of community-dwelling participants. PARTICIPANTS: Eligible participants (n = 12,646) aged 65 to 85 living within 25 to 50 km of 11 data collection sites in Canada. The analyses included 10,820 participants with the data required to diagnose sarcopenia. MEASUREMENTS: Sarcopenia was operationalized as appendicular lean mass (ALM), ALM and grip strength, ALM and gait speed, and grip strength and gait speed. Within each combination, ALM was adjusted for height squared, weight, body mass index, and the residual of regressing lean mass on height and fat mass. The lowest 20th sex-specific percentile values were used as the cutoffs for low ALM. Low grip strength cutoffs of 35.5 kg for men and 20 kg for women and a gait speed cutoff of .8 m/s were used. RESULTS: The mean age was 73.0 ± 5.6 years, and 51.9% of the sample was male. The agreement (Cohen's κ) between the different combinations of variables used to ascertain sarcopenia status was below .50. Agreement for the different lean mass adjustment techniques ranged from .04 to .76. CONCLUSION: The combination of variables used to ascertain sarcopenia and many of the ALM adjustment techniques have insufficient agreement to be considered equivalent. This has important clinical implications for the management of sarcopenia because treatments may differ based on how sarcopenia is identified. To improve the clinical utility of sarcopenia, a unified definition of sarcopenia is required.

A longitudinal analysis of the impact of the COVID-19 pandemic on the mental health of middle-aged and older adults from the Canadian Longitudinal Study on Aging.

The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented challenge to public health, with over 233 million confirmed cases and over 4.6 million deaths globally as of September 20211. Although many studies have reported worse mental health outcomes during the early weeks of the pandemic, some sources suggest a gradual decrease in anxiety and depressive symptoms during the lockdown2. It remains to be explained whether mental health continued to deteriorate during the initial lockdown or whether there were signs of stabilization or improvement in the mental health of community-dwelling middle-aged and older adults. Our results showed that adults had twice the odds of depressive symptoms during the pandemic compared with the prepandemic period, with subgroups characterized by lower socioeconomic status and poor health-related factors experiencing a greater impact. Over 43% of adults showed a pattern of moderate or clinically high levels of depressive symptoms at baseline that increased over time. Loneliness and COVID-19 stressors were predictors of worsening depressive symptom trajectories. The disparities and patterns in the depressive symptom trajectories suggest that the negative mental health impacts of the pandemic persist and may worsen over time. Interventions that address the pandemic stressors and alleviate their impact on the mental health of adults are needed.

Gender, marital and educational inequalities in mid- to late-life depressive symptoms: cross-cohort variation and moderation by urbanicity degree.

BACKGROUND: Although ageing populations are increasingly residing in cities, it is unknown whether depression inequalities are moderated by urbanicity degree. We estimated gender, marital and educational inequalities in depressive symptoms among older European and Canadian adults, and examined whether higher levels of urbanicity, captured by population density, heightened these inequalities. METHODS: Harmonised cross-sectional data on 97 826 adults aged ≥50 years from eight cohorts were used. Prevalence ratios (PRs) were calculated for probable depression, depressed affect and depressive symptom severity by gender, marital status and education within each cohort, and combined using random-effects meta-analysis. Using a subsample of 73 123 adults from six cohorts with available data on population density, we tested moderating effects measured by the number of residents per square kilometre. RESULTS: The pooled PRs for probable depression by female gender, unmarried or non-cohabitating status and low education were 1.48 (95% CI 1.28 to 1.72), 1.44 (95% CI 1.29 to 1.61) and 1.29 (95% CI 1.18 to 1.41), respectively. PRs for depressed affect and high symptom severity were broadly similar. Except for one Dutch cohort with findings in an unexpected direction, there was no evidence that population density modified depressive symptom inequalities. CONCLUSIONS: Despite cross-cohort variation in gender, marital status and educational inequalities in depressive symptoms, there was weak evidence that these inequalities differed by levels of population density.

The impact of different diagnostic criteria on the association of sarcopenia with injurious falls in the CLSA.

BACKGROUND: Sarcopenia definitions recommend different combinations of variables (lean mass, strength, and physical function) and different methods of adjusting lean mass. The purpose of this paper was to address the gaps in the literature regarding how differences in the operationalization of sarcopenia impact the association between sarcopenia and injurious falls. METHODS: Participants included 9936 individuals from the Canadian Longitudinal Study on Aging aged ≥65 years at baseline (2012-2015), with complete data for sarcopenia-related variables, injurious falls, and covariates. Sarcopenia was defined using all combinations of muscle variables (lean mass, grip strength, chair rise test, and gait speed) and methods of adjusting lean mass (height2 , weight, body mass index (BMI), and regressing on height and fat mass) recommended by the expert group sarcopenia definitions. Multiple cut off values for the measures were explored. The association between sarcopenia and injurious falls (0, 1, or 2+ falls) measured 18 months after baseline data collection were assessed using proportional odds regression models. RESULTS: In men (n = 5162, 72.9 ± 5.6 years), the odds of having a higher level of injurious falls was between 1.43 and 2.14 greater when sarcopenia was defined as (i) lean mass adjusted for weight only; (ii) grip strength (<30 or <26 kg) only; (iii) lean mass adjusted for weight and grip strength (<30 or <26 kg); (iv) lean mass adjusted for BMI and grip strength (<26 kg); and (v) lean mass adjusted using the regression technique and grip strength (<30 or <26 kg). In women (n = 4774, 72.8 ± 5.6 years), only the combination of lean mass adjusted using regression with gait speed (<0.8 m/s) was associated with a significantly higher odds (1.46, 95% confidence interval: 1.01-2.10, P = 0.04) of having a higher level of injurious falls. CONCLUSIONS: Sarcopenia definitions based on different combinations of muscle variables and methods of adjusting lean mass are not equally associated with injurious falls. In men, definitions including grip strength but not gait speed or the chair rise test, and adjusting lean mass for weight, BMI, or using the residual technique but not height2 , tended to be associated with injurious falls. In women, sarcopenia was generally not associated with injurious falls regardless of the definition used.

Depression, hormone therapy, and the menopausal transition among women aged 45 to 64 years using Canadian Longitudinal Study on aging baseline data.

OBJECTIVE: To investigate the association between menopausal status, hormone therapy (HT) use and the presence of depressive symptoms among middle-aged women in Canada. METHODS: Cross-sectional baseline data from 13,216 women aged 45 to 64 years from the Canadian Longitudinal Study on Aging (CLSA) was used. The association between menopausal status (pre- vs postmenopausal) and self-reported symptoms of depression based on a score of 10 or more on the Center for Epidemiologic Studies Short Depression Scale-10 was assessed using logistic regression. Use and duration of use of HT, time since menopause, age at onset of menopause, and socioeconomic status and other contextual variables were explored for the association with depression. RESULTS: Overall, 18.4% of middle-aged women in the CLSA data were identified as depressed using the Center for Epidemiologic Studies Short Depression Scale-10. Based on the logistic regression models, women reporting premature menopause (before the age of 40 years) and postmenopausal women currently using HT had 1.45 (1.07-1.97) and 1.21 (1.02-1.44) greater odds of having depression. Chi-square analyses showed that women with depressive symptoms were more likely to have low education, low household incomes, live alone, be nulliparous, and have low social support. CONCLUSIONS: Our findings highlight the association between depression and premature menopause among midlife women. Current HT use may be a proxy for more severe menopausal vasomotor symptoms, a known risk factor for depressive symptoms. Identification of risk factors, including social determinants of health, age at menopause, and menopausal symptoms can help guide clinicians when assessing mental health. : Video Summary:http://links.lww.com/MENO/A576.

Video Summary:http://links.lww.com/MENO/A576.

Individual and population level impact of chronic conditions on functional disability in older adults.

BACKGROUND: It is unknown if the relationship between multimorbidity and disability differs by combinations of chronic conditions. The objective of our study was to elucidate how joint effect of different combinations of chronic conditions impact the five year risk of functional disability at the population level. METHODS: Participants ≥65 years from the Canadian Study of Health and Aging were assessed for functional disability measured using activities of daily living (ADL) and instrumental ADL (IADL), and the presence of conditions in five disease domains; cardiometabolic, neurological, sensory, musculoskeletal, and respiratory. Logistic regression was used to assess the relationship between each disease domain and incident ADL and IADL measured at five years of follow up and population attributable risk (PAR) was modeled for diseases domains that were significantly associated with disability. Results were stratified by sex and age (65-74 years, ≥75 years). RESULTS: There were 6272 participants free of ADL disability and 4571 participants free from IADL disability at baseline. For incident ADL, the greatest PAR values were 21.3 (9.8-32.8) for the cardiometabolic domain in males 65-74 years, 22.7 (4.7-40.8) for the musculoskeletal domain for females aged 65-74 years, and 11.2 (2.8-19.7) for the musculoskeletal domain in males ≥75 years. The PAR for the musculoskeletal, sensory, and neurological domains were similar in females ≥75 years(9.3-9.9). PAR values were lower but followed similar patterns for IADL disability. CONCLUSION: The chronic disease domains which most strongly predicted incident ADLs and IADLs did not account for the greatest amount of disability at the population level.

Latent variable models for harmonization of test scores: A case study on memory.

Combining data from different studies has a long tradition within the scientific community. It requires that the same information is collected from each study to be able to pool individual data. When studies have implemented different methods or used different instruments (e.g., questionnaires) for measuring the same characteristics or constructs, the observed variables need to be harmonized in some way to obtain equivalent content information across studies. This paper formulates the main concepts for harmonizing test scores from different observational studies in terms of latent variable models. The concepts are formulated in terms of calibration, invariance, and exchangeability. Although similar ideas are present in measurement reliability and test equating, harmonization is different from measurement invariance and generalizes test equating. In addition, if a test score needs to be transformed to another test score, harmonization of variables is only possible under specific conditions. Observed test scores that connect all of the different studies, are necessary to be able to test the underlying assumptions of harmonization. The concepts of harmonization are illustrated on multiple memory test scores from three different Canadian studies.