Low vitamin B12 but not folate is associated with incident depressive symptoms in community-dwelling older adults: a 4-year longitudinal study.

This was a longitudinal study utilising the Irish Longitudinal Study on Ageing (n 3849 aged ≥ 50 years) and investigated the relationship between blood plasma folate and B12 levels at baseline (wave 1) and incident depressive symptoms at 2 and 4 years (waves 2 and 3). A score ≥ 9 on the Center for Epidemiological Studies Depression Scale-8 at wave 2 or 3 was indicative of incident depressive symptoms. B12 status profiles (pmol/l) were defined as < 185, deficient low; 185 to < 258, low normal; > 258-601, normal and > 601 high. Folate status profiles (nmol/l) were defined as ≤ 10·0, deficient low; > 10-23·0, low normal; > 23·0-45·0, normal; >45·0, high. Logistic regression models were used to analyse the longitudinal associations. Both B12 and folate plasma concentrations were lower in the group with incident depressive symptoms v. non-depressed (folate: 21·4 v. 25·1 nmol/l; P = 0·0003; B12:315·7 v. 335·9 pmol/l; P = 0·0148). Regression models demonstrated that participants with deficient-low B12 status at baseline had a significantly higher likelihood of incident depression 4 years later (OR 1·51, 95 % CI 1·01, 2·27, P = 0·043). This finding remained robust after controlling for relevant covariates. No associations of folate status with incident depression were observed. Older adults with deficient-low B12 status had a 51 % increased likelihood of developing depressive symptoms over 4 years. The findings highlight the need to further explore the low-cost benefits of optimising vitamin B12 status for depression in older adults.

The Role of Epigenetic Clocks in Explaining Educational Inequalities in Mortality: A Multicohort Study and Meta-analysis.

Educational inequalities in all-cause mortality have been observed for decades. However, the underlying biological mechanisms are not well known. We aimed to assess the role of DNA methylation changes in blood captured by epigenetic clocks in explaining these inequalities. Data were from 8 prospective population-based cohort studies, representing 13 021 participants. First, educational inequalities and their portion explained by Horvath DNAmAge, Hannum DNAmAge, DNAmPhenoAge, and DNAmGrimAge epigenetic clocks were assessed in each cohort via counterfactual-based mediation models, on both absolute (hazard difference) and relative (hazard ratio) scales, and by sex. Second, estimates from each cohort were pooled through a random effect meta-analysis model. Men with low education had excess mortality from all causes of 57 deaths per 10 000 person-years (95% confidence interval [CI]: 38, 76) compared with their more advantaged counterparts. For women, the excess mortality was 4 deaths per 10 000 person-years (95% CI: -11, 19). On the relative scale, educational inequalities corresponded to hazard ratios of 1.33 (95% CI: 1.12, 1.57) for men and 1.15 (95% CI: 0.96, 1.37) for women. DNAmGrimAge accounted for the largest proportion, approximately 50%, of the educational inequalities for men, while the proportion was negligible for women. Most of this mediation was explained by differential effects of unhealthy lifestyles and morbidities of the World Health Organization (WHO) risk factors for premature mortality. These results support DNA methylation-based epigenetic aging as a signature of educational inequalities in life expectancy emphasizing the need for policies to address the unequal social distribution of these WHO risk factors.

The effect of eye disease, cataract surgery and hearing aid use on multisensory integration in ageing.

Sensory impairment is common in ageing, as are approaches to treat it. However, the impact of age-related sensory impairment upon multisensory perception remains unexplored, despite the multisensory nature of our environment. Here, we used data from The Irish Longitudinal Study of Ageing (TILDA) to investigate whether common, age-related eye diseases (cataracts, glaucoma and Age-Related Macular Degeneration, ARMD) and clinical intervention to improve sensory function (cataract removal and hearing aids) influence multisensory integration in older adults. Integration was measured using the Sound-Induced Flash Illusion (SIFI), and the extent to which identifying two flashes was improved by accompanying auditory information ("visual gain"). Visual gain was not influenced by eye disease or treatment. For the SIFI, participants self-reporting cataracts, ARMD or glaucoma were as susceptible as healthy controls, even when controlling for age, sex, cognition, self-reported vision/hearing and visual acuity. In a second analysis using retinal photographs, glaucoma and ARMD (hard drusen) did not influence susceptibility relative to controls. However, participants with soft drusen ARMD were more susceptible to the illusion at long Stimulus-Onset Asynchronies (SOAs) compared with controls. Following this, we identified groups reporting bilateral cataract removal or hearing aid acquisition >4 years and <2 years prior to assessment, enabling comparison of longer- and shorter-term effects of interventions. Cataract removal groups did not differ from controls. Longer-term hearing aid users were less susceptible to the SIFI at short SOAs compared with controls. Our findings suggest that multisensory integration in ageing might be specifically influenced by ARMD (soft drusen) and hearing aid use.

Investigation of Surrogate Biomarkers Associated with Macular Pigment Status in a Group of Older Irish Adults.

SIGNIFICANCE: Macular pigment (MP) confers potent antioxidant and anti-inflammatory effects at the macula; however, its optical density in the eye is not routinely measured in clinical practice. PURPOSE: This study explored a range of surrogate biomarkers including anthropometric, clinical, and plasma measures that may be associated with lower MP optical density (MPOD). METHODS: Two thousand five hundred ninety-four subjects completed a full MP assessment as part of wave 1 of The Irish Longitudinal Study of Aging. Macular pigment optical density was measured using customized heterochromatic flicker photometry. Clinical (blood pressure), plasma (lipoproteins, inflammatory markers), and anthropometric (waist, hip, height, weight) biomarkers were measured for each participant. RESULTS: Mean (standard deviation) MPOD for the study group was 0.223 (0.161), with a range of 0 to 1.08. One-way ANOVA revealed that MPOD was significantly lower among participants with low plasma high-density lipoprotein (HDL; P = .04), raised plasma triglyceride-to-HDL ratio (P = .003), and raised total cholesterol-to-HDL ratio (P = .03). Subjects with an elevated waist circumference (WC) had a significantly lower MPOD (mean, 0.216 [0.159]) compared with those with an ideal WC (mean, 0.229 [0.162]; P = .03). Significant correlates of MPOD on mixed linear model analysis included education, smoking status, and WC. CONCLUSIONS: Higher abdominal fat is associated with lower MPOD in this representative sample of older Irish adults. Although altered lipoprotein profiles (low HDL, raised triglyceride-to-HDL ratio, raised total cholesterol-to-HDL ratio) may affect the transport, uptake, and stabilization of carotenoids in the retina, these plasma biomarkers were not predictive of low MPOD after adjustment for abdominal circumference. Although WC emerged as a viable anthropometric predictor of lower MPOD, its effect size seems to be small.

Dementia Research Fit for the Planet: Reflections on Population Studies of Dementia for Researchers and Policy Makers Alike.

In recent years, a rapidly increasing collection of investigative methods in addition to changes in diagnostic criteria for dementia have followed "high-tech" trends in medicine, with the aim to better define the dementia syndrome and its biological substrates, mainly in order to predict risk prior to clinical expression. These approaches are not without challenge. A set of guidelines have been developed by a group of European experts in population-based cohort research through a series of workshops, funded by the Joint Program for Neurodegenerative Disorders (JPND). The aims of the guidelines are to assist policy makers and researchers to understand (1) What population studies for ageing populations should encompass and (2) How to interpret the findings from population studies. Such studies are essential to provide evidence relevant to the understanding of healthy and frail brain ageing, including the dementia syndrome for contemporary and future societies by drawing on the past.

Age-related sensory decline mediates the Sound-Induced Flash Illusion: Evidence for reliability weighting models of multisensory perception.

Perception of our world is proposed to arise from combining multiple sensory inputs according to their relative reliability. We tested multisensory processes in a large sample of 2920 older adults to assess whether sensory ability mediates age-related changes in perception. Participants completed a test of audio-visual integration, the Sound Induced Flash Illusion (SIFI), alongside measures of visual (acuity, contrast sensitivity, self-reported vision and visual temporal discrimination (VTD)) and auditory (self-reported hearing and auditory temporal discrimination (ATD)) function. Structural equation modelling showed that SIFI susceptibility increased with age. This was mediated by visual acuity and self-reported hearing: better scores on these measures predicted reduced and stronger SIFI susceptibility, respectively. Unexpectedly, VTD improved with age and predicted increased SIFI susceptibility. Importantly, the relationship between age and SIFI susceptibility remained significant, even when considering mediators. A second model showed that, with age, visual 'gain' (the benefit of congruent auditory information on visual judgements) was predicted by ATD: better ATD predicted stronger visual gain. However, neither age nor SIFI susceptibility were directly associated with visual gain. Our findings illustrate, in the largest sample of older adults to date, how multisensory perception is influenced, but not fully accounted for, by age-related changes in unisensory abilities.

Socioeconomic position, lifestyle habits and biomarkers of epigenetic aging: a multi-cohort analysis.

Differences in health status by socioeconomic position (SEP) tend to be more evident at older ages, suggesting the involvement of a biological mechanism responsive to the accumulation of deleterious exposures across the lifespan. DNA methylation (DNAm) has been proposed as a biomarker of biological aging that conserves memory of endogenous and exogenous stress during life.We examined the association of education level, as an indicator of SEP, and lifestyle-related variables with four biomarkers of age-dependent DNAm dysregulation: the total number of stochastic epigenetic mutations (SEMs) and three epigenetic clocks (Horvath, Hannum and Levine), in 18 cohorts spanning 12 countries.The four biological aging biomarkers were associated with education and different sets of risk factors independently, and the magnitude of the effects differed depending on the biomarker and the predictor. On average, the effect of low education on epigenetic aging was comparable with those of other lifestyle-related risk factors (obesity, alcohol intake), with the exception of smoking, which had a significantly stronger effect.Our study shows that low education is an independent predictor of accelerated biological (epigenetic) aging and that epigenetic clocks appear to be good candidates for disentangling the biological pathways underlying social inequalities in healthy aging and longevity.

Voluntary fortification is ineffective to maintain the vitamin B12 and folate status of older Irish adults: evidence from the Irish Longitudinal Study on Ageing (TILDA).

Mandatory fortification of staple grains with folic acid and/or vitamin B12 (B12) is under debate in many countries including Ireland, which has a liberal, but voluntary, fortification policy. Older adults can be at risk of both deficiency and high folate status, although little is known on the actual prevalence and the major predictors. Population prevalence estimates from older adults (n 5290 ≥50 years) from the Irish Longitudinal Study on Ageing (TILDA) (Wave 1) are presented here. Measures included plasma total vitamin B12 and folate, whereas predictors included detailed demographic, socio-economic, geographic, seasonal and health/lifestyle data. The prevalence of deficient or low B12 status (45 nmol/l) was observed in 8·9 %, whereas high B12 status was observed in 3·1 % (>601 pmol/l). The largest positive predictor of B12 concentration was self-reported B12 injection and/or supplement use (coefficient 51·5 pmol/; 95 % CI 9·4, 93·6; P=0·016) followed by sex and geographic location. The largest negative predictor was metformin use (-33·6; 95 % CI -51·9, -15·4; P<0·0001). The largest positive predictor of folate concentration was folic acid supplement use (6·0; 95 % CI 3·0, 9·0 nmol/l; P<0·001) followed by being female and statin medications. The largest negative predictor was geographic location (-5·7; 95 % CI -6·7, -4·6; P<0·0001) followed by seasonality and smoking. B-vitamin status in older adults is affected by health and lifestyle, medication, sampling period and geographic location. We observed a high prevalence of low B12 and folate status, indicating that the current policy of voluntary fortification is ineffective for older adults.

High prevalence of frequent attendance in the over 65s.

INTRODUCTION: Characteristics of older frequent users of Emergency Departments (EDs) are poorly understood. Our aim was to examine the characteristics of the ED frequent attenders (FAs) by age (under 65 and over 65 years). METHODS: We examined the prevalence of FA attending the ED of an Urban Teaching Hospital in a cross-sectional study between 2009 and 2011. FA was defined as an individual who presented to the ED four or more times over a 12-month period. Randomly selected groups of FA and non-FA from two age groups (under 65 and over 65 years) were then examined to compare the characteristics between older FAs and non-FAs and older FAs and younger FAs. Logistic regression was used to calculate the odds ratio and 95% confidence intervals for 12-month mortality in FA compared with non-FA aged at least 65 years. RESULTS: Overall, 137 150 ED attendances were recorded between 2009 and 2011. A total of 21.6% were aged at least 65 years, 4.4% of whom were FAs, accounting for 18.4% of attendances by patients older than 65 years. There was a bimodal age distribution of FA (mean±SD; under 65 years 40±12.7; and over 65 years 76.9±7.4). Older FAs were five times more likely to present outside normal working hours and 5.5 times more likely to require admission. Cardiovascular emergencies were the most common complaint, in contrast with the younger FA group, where injury and psychosocial conditions dominated. The odds ratio for death at 12 months was 2.07 (95% confidence interval 0.93-4.63; P=0.07), adjusting for age and sex. CONCLUSION: One-in-five ED patients older than 65 years of age are FAs. Older FAs largely present with complex medical conditions. Enhanced access to expert gerontology assessment should be considered as part of effective intervention strategies for older ED users.

Disabilities moderate the association between neighbourhood urbanity and cognitive health: Results from the Irish longitudinal study on ageing.

BACKGROUND: Geographical variations in cognitive health have been extensively explored, but the evidence on adult individuals with disabilities is inconclusive. While urban living is suggested as more cognitively stimulating than rural dwelling in epidemiological research, both rurality and urbanity can present barriers that may negatively impact cognitive health, the former due to limited accessibility to stimulation, and the latter because presenting environmental stressors. OBJECTIVE: To bridge this gap in the literature, we investigated geographical variations in multiple cognitive skills in adult age based on neighbourhood urbanity and having disabilities. METHODS: Data on global cognition, memory, speed of processing and executive functions, as well as reported functional limitations, was taken from 4127 individuals aged 50 + participating in the first wave of The Irish Longitudinal Study on Ageing (TILDA). Neighbourhood urbanity was measured using Census data on population density. Multivariate regression analyses controlled for socio-demographic, health and lifestyle covariates. RESULTS: Residence in medium-high densely populated areas was significantly associated with better cognitive performance across all measures, after controlling for covariates. However, having disabilities was linked to worse global cognitive functioning (MoCA, p = .005), immediate recall (p = .022) and executive functions (CTT2, p = .009) in the least and most densely populated areas. CONCLUSIONS: Living in urbanised areas may provide more mental stimulation than rural places; however, functional limitations moderate this association, suggesting potential environmental challenges both in rural and urban areas. Considering both individual and environmental circumstances can enrich investigations of geographical variations in cognitive health.

Social adversity and epigenetic aging: a multi-cohort study on socioeconomic differences in peripheral blood DNA methylation.

Low socioeconomic status (SES) is associated with earlier onset of age-related chronic conditions and reduced life-expectancy, but the underlying biomolecular mechanisms remain unclear. Evidence of DNA-methylation differences by SES suggests a possible association of SES with epigenetic age acceleration (AA). We investigated the association of SES with AA in more than 5,000 individuals belonging to three independent prospective cohorts from Italy, Australia, and Ireland. Low SES was associated with greater AA (ß = 0.99 years; 95% CI 0.39,1.59; p = 0.002; comparing extreme categories). The results were consistent across different SES indicators. The associations were only partially modulated by the unhealthy lifestyle habits of individuals with lower SES. Individuals who experienced life-course SES improvement had intermediate AA compared to extreme SES categories, suggesting reversibility of the effect and supporting the relative importance of the early childhood social environment. Socioeconomic adversity is associated with accelerated epigenetic aging, implicating biomolecular mechanisms that may link SES to age-related diseases and longevity.

Disrupted Thalamus White Matter Anatomy and Posterior Default Mode Network Effective Connectivity in Amnestic Mild Cognitive Impairment.

Alzheimer's disease (AD) and its prodromal state amnestic mild cognitive impairment (aMCI) are characterized by widespread abnormalities in inter-areal white matter fiber pathways and parallel disruption of default mode network (DMN) resting state functional and effective connectivity. In healthy subjects, DMN and task positive network interaction are modulated by the thalamus suggesting that abnormal task-based DMN deactivation in aMCI may be a consequence of impaired thalamo-cortical white matter circuitry. Thus, this article uses a multimodal approach to assess white matter integrity between thalamus and DMN components and associated effective connectivity in healthy controls (HCs) relative to aMCI patients. Twenty-six HC and 20 older adults with aMCI underwent structural, functional and diffusion MRI scanning using the high angular resolution diffusion-weighted acquisition protocol. The DMN of each subject was identified using independent component analysis (ICA) and resting state effective connectivity was calculated between thalamus and DMN nodes. White matter integrity changes between thalamus and DMN were investigated with constrained spherical deconvolution (CSD) tractography. Significant structural deficits in thalamic white matter projection fibers to posterior DMN components posterior cingulate cortex (PCC) and lateral inferior parietal lobe (IPL) were identified together with significantly reduced effective connectivity from left thalamus to left IPL. Crucially, impaired thalamo-cortical white matter circuitry correlated with memory performance. Disrupted thalamo-cortical structure was accompanied by significant reductions in IPL and PCC cortico-cortical effective connectivity. No structural deficits were found between DMN nodes. Abnormal posterior DMN activity may be driven by changes in thalamic white matter connectivity; a view supported by the close anatomical and functional association of thalamic nuclei effected by AD pathology and the posterior DMN nodes. We conclude that dysfunctional posterior DMN activity in aMCI is consistent with disrupted cortico-thalamo-cortical processing and thalamic-based dissemination of hippocampal disease agents to cortical hubs.

Stability of daily home-based measures of postural control over an 8-week period in highly functioning older adults.

PURPOSE: The focus of this study was to monitor daily objective measures of standing postural control over an 8-week period, recorded in a person's home, in a population of healthy older adults. Establishing natural patterns of variation in the day-to-day signal, occurring in the relative absence of functional decline or disease, would enable us to determine thresholds for changes in postural control from baseline that could be considered clinically important. METHODS: Eighteen community-dwelling older adults (3 M, 15 F, 72 ± 6 years) participated in a home-based trial where each day they were asked to complete a technology-enabled routine consisting of a short questionnaire, as well as a quiet standing balance trial. Centre of pressure (COP) excursions were calculated over the course of each daily balance trial to generate variables such as postural sway length and mean sway frequency. RESULTS: The data demonstrated large differences between subjects in centre of pressure measures (coefficients of variation ranging 37-107 %, depending on the variable). Each participant also exhibited variations in their day-to-day trials (e.g. coefficients of variation across 8 weeks ranging ~17-56 %, within person for mean COP distance). Inter- and intra-subject differences were not strongly related to functional tests, suggesting that these variations were not necessarily aberrant movement patterns, but are seemingly representative of natural movement variability. CONCLUSIONS: The idea of applying a group-focused approach at an individual level may result in misclassifying important changes for a particular individual. Early detection of deterioration can only be achieved through the creation of individual trajectories for each person, that are inherently self referential.

Classification of frailty and falls history using a combination of sensor-based mobility assessments.

Frailty is an important geriatric syndrome strongly linked to falls risk as well as increased mortality and morbidity. Taken alone, falls are the most common cause of injury and hospitalization and one of the principal causes of death and disability in older adults worldwide. Reliable determination of older adults' frailty state in concert with their falls risk could lead to targeted intervention and improved quality of care. We report a mobile assessment platform employing inertial and pressure sensors to quantify the balance and mobility of older adults using three physical assessments (timed up and go (TUG), five times sit to stand (FTSS) and quiet standing balance). This study examines the utility of each individual assessment, and the novel combination of assessments, to screen for frailty and falls risk in older adults.Data were acquired from inertial and pressure sensors during TUG, FTSS and balance assessments using a touchscreen mobile device, from 124 community dwelling older adults (mean age 75.9 ± 6.6 years, 91 female). Participants were given a comprehensive geriatric assessment which included questions on falls and frailty. Methods based on support vector machines (SVM) were developed using sensor-derived features from each physical assessment to classify patients at risk of falls risk and frailty.In classifying falls history, combining sensor data from the TUG, Balance and FTSS tests to a single classifier model per gender yielded mean cross-validated classification accuracy of 87.58% (95% CI: 84.47-91.03%) for the male model and 78.11% (95% CI: 75.38-81.10%) for the female model. These results compared well or exceeded those for classifier models for each test taken individually. Similarly, when classifying frailty status, combining sensor data from the TUG, balance and FTSS tests to a single classifier model per gender, yielded mean cross-validated classification accuracy of 93.94% (95% CI: 91.16-96.51%) for the male model and 84.14% (95% CI: 82.11-86.33%) for the female model (mean 89.04%) which compared well or exceeded results for physical tests taken individually.Results suggest that the combination of these three tests, quantified using body-worn inertial sensors, could lead to improved methods for assessing frailty and falls risk.

Quantitative falls risk estimation through multi-sensor assessment of standing balance.

Falls are the most common cause of injury and hospitalization and one of the principal causes of death and disability in older adults worldwide. Measures of postural stability have been associated with the incidence of falls in older adults. The aim of this study was to develop a model that accurately classifies fallers and non-fallers using novel multi-sensor quantitative balance metrics that can be easily deployed into a home or clinic setting. We compared the classification accuracy of our model with an established method for falls risk assessment, the Berg balance scale. Data were acquired using two sensor modalities--a pressure sensitive platform sensor and a body-worn inertial sensor, mounted on the lower back--from 120 community dwelling older adults (65 with a history of falls, 55 without, mean age 73.7 ± 5.8 years, 63 female) while performing a number of standing balance tasks in a geriatric research clinic. Results obtained using a support vector machine yielded a mean classification accuracy of 71.52% (95% CI: 68.82-74.28) in classifying falls history, obtained using one model classifying all data points. Considering male and female participant data separately yielded classification accuracies of 72.80% (95% CI: 68.85-77.17) and 73.33% (95% CI: 69.88-76.81) respectively, leading to a mean classification accuracy of 73.07% in identifying participants with a history of falls. Results compare favourably to those obtained using the Berg balance scale (mean classification accuracy: 59.42% (95% CI: 56.96-61.88)). Results from the present study could lead to a robust method for assessing falls risk in both supervised and unsupervised environments.

Depression, anxiety and cardiovascular disease: which symptoms are associated with increased risk in community dwelling older adults?

BACKGROUND: Depression is a risk factor for Cardiovascular Disease (CVD). It has been reported that somatic symptoms of depression and not cognitive symptoms are associated with increased risk although findings have been inconsistent. Few studies have examined whether co-morbid anxiety confers additive risk. METHODS: We conducted a cross sectional analysis of 7872 community dwelling adults aged 50 years and over from The Irish LongituDinal Study on Ageing (TILDA). Depressive and anxiety symptoms were assessed with Center for Epidemiologic Studies Depression (CES-D) scale and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), respectively. We conducted logistic regression analyses to determine the relationship between depression, anxiety, individual depressive symptoms and CVD. We further determined whether co-morbid anxiety was associated with increased risk. RESULTS: Seven hundred and thirty eight (9.4%) study participants reported clinically significant depression. Depression was associated with 80% increased risk of CVD following adjustment for cardiovascular risk factors. Individual depressive symptoms most consistently associated with CVD included low mood, sadness, amotivation, fatigue, diminished appetite and concentration difficulties. Anxiety was associated with increased risk of CVD but did not confer additive risk in participants with depression. LIMITATIONS: Cross sectional design. CONCLUSION: Core symptoms of depression, which are both cognitive and somatic in nature, are associated with increased risk of CVD while co-morbid anxiety did not confer additive risk. It is important that clinicians give due regard both to both cognitive and somatic symptoms of depression when determining cardiovascular risk. Future longitudinal investigation should confirm these findings and explore potential pathological mechanisms.

Factors affecting continuous beat-to-beat orthostatic blood pressure response in community-dwelling older adults.

OBJECTIVE: To examine the effect of age, time of day, the timing of medication and food ingestion on orthostatic blood pressure response (OBP) in community-dwelling adults. METHODS: A nationally representative sample of 109 community-dwelling adults aged at least 50 years attended for health assessment in a pilot study of The Irish Longitudinal Study on Ageing. OBP was measured using continuous beat-to-beat plethysmography (Finometer) during active stand, and OBP with excessive artefacts were excluded. Nine outcome variables were supine systolic blood pressure (SBP), lowest standing SBP (nadir), standing SBP at 40, 60 and 120 s and the difference in supine SBP and nadir (delta SBP) and delta at 40, 60 and 120 s. Factors included for multiple linear regression analysis were age, time of assessment, interval from the last meal and whether regular medications were taken on the day. Subgroup analysis was performed on 103 respondents who were not on ß-blocker, fludrocortisone and Parkinson medications. RESULTS: There were 53 men, mean age 62.1 (SD=9.4) years. Older respondents (≥60 years) showed greater delta at 40 s by up to 12.9 mmHg. Delta SBP and delta 40, 60 and 120 were not significantly affected by the time of day or food ingestion. The effect of medications on delta 40 was no longer present in subgroup analysis. CONCLUSION: Age was the most significant determinant of OBP and was most strongly associated with greater delta at 40 s. This was independent of the time of day, food and medication ingestion. Continuous beat-to-beat plethysmography provides for a window into the pattern of OBP in community-dwelling adults aged 50 years and older.