Holocaust survivors: Health and longevity 70 years later.

BACKGROUND: Holocaust survivors (HS) alive today form a unique and disappearing population, whose exposure to systematic genocide occurred over 70 years ago. Negative health outcomes were widely documented prior to age 70. We examine the hypothesis that the experience of remote trauma continues to negatively affect health, functional status, and survival between the ages of 85-95. METHODS: The Jerusalem Longitudinal Study (1990-2022) followed a representative sample of Jerusalem residents born 1920-1921, at ages 85, 90 and 95. Home assessment included medical, social, functional, and cognitive status, and mortality data. Subjects were classified: (1) HS-Camp (HS-C): survived slave-labor, concentration, or death camps; (2) HS-Exposed (HS-E): survived Nazi occupation of Europe; (3) Controls: European descent, outside Europe during WWII. We determined Hazards Ratios (HR), adjusting for gender, loneliness, financial difficulty, physical activity, ADL dependence, chronic ischemic heart disease, cancer, cognitive deficits, chronic joint pain, self-rated health. RESULTS: At ages 85 (n = 496), 90 (n = 524), and 95 (n = 383) the frequency of HS-C versus HS-E versus Controls was 28%/22%/50%, 19%/19%/62%, and 20%/22%/58%, respectively. No consistent significant morbidity differences were observed. Mortality between ages 85-90 and 90-95 years was 34.9% versus 38% versus 32.0%, and 43.4% versus 47.3% versus 43.7%, respectively, with no significant differences in survival rates (log rank p = 0.63, p = 0.81). Five-year mortality adjusted HRs were insignificant for HS-C and HS-E between ages 85-90 (HR 0.87, 95% CI 0.54-1.39; HR 1.14, 95% CI 0.73-1.78) and ages 90-95 (HR 0.72, 95% CI 0.39-1.32; HR 1.38, 95% CI 0.85-2.23). CONCLUSIONS: Seventy years following their trauma and suffering during the Holocaust, the significant impairments of health, function, morbidity, and mortality which have accompanied survivors throughout their entire adult life, were no longer observed. Indeed, it is likely that survivors living >85 years old represent a uniquely resilient population of people, whose adaptation to adversity has accompanied them throughout their lives.

Prolonged mechanical ventilation and caregiver strain: Home vs. long-term care facility.

OBJECTIVE: The number of patients treated with prolonged mechanical ventilation (PMV) is steadily rising. Traditionally treated within specialized long-term care facilities (LTCFs), healthcare providers are increasingly promoting homecare as a technologically safe, humane, and cheaper alternative. Little is known concerning their informal caregivers (ICGs), despite their crucial role in facilitating care. This study examines caregiver strain among the primary ICG of PMV patients treated at home vs. LTCF. METHOD: This study was an observational cross-sectional study. The study enrolled 120/123 PMV patients ≥18 years within the study region (46 treated with homecare/74 treated at the LTCF) and 106 ICGs (34 ICGs/46 homecare patients and 72 ICGs/74 LTCF patients). Caregiver assessment included the 13-item Modified Caregiver Strain Index (Mod CSI) (0-26 maximum); patient assessment included symptom burden (the revised Edmonton Symptom Assessment System). RESULTS: The mean age of ICGs was 58.9 years old; 60.4% were females; 82.1% were married; 29.2% were patient's spouses; and 40.6% were patient's children. The total Mod CSI was 13.58 (SD 6.52) and similar between home vs. LTCF (14.30 SD 7.50 vs. 13.26 SD 6.03, p = 0.50), or communicative vs. non-communicative patients (13.50 SD 7.12 vs. 13.64 SD 6.04, p = 0.93). Hierarchical analysis identified three clusters of caregiver strain, with ICGs at home vs. LTCF reporting significantly lower mood strain, higher burden, and similar levels of lifestyle disturbance. In adjusted models, homecare was significantly associated with reduced mood strain and increased burden, while increased patient symptomatology was significantly associated with total strain, mood, and burden strain clusters. SIGNIFICANCE OF RESULTS: Recognizing the different patterns of caregiver strain at home or LTCF is a prerequisite for addressing their palliative care needs and improving the wellbeing and resilience of informal caregivers, who often play a critical role in deciding whether to treat the PMV patient at home or LTCF.

Myocardial contraction fraction predicts mortality in the oldest old.

Background: People over the age of 85 are the world's most rapidly growing age group. Ejection fraction (EF) may be limited prognostically in this population and myocardial contraction fraction (MCF) may be more accurate. The objective of this longitudinal study was to assess the prognosis of MCF in an age-homogenous, community-dwelling population of subjects. Methods: Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed with a portable echocardiograph at the subjects place of residence. Standard echocardiographic assessment of cardiac structure and function including MCF was performed. Values of EF and MCF above and below the median for males and females were defined as normal and abnormal in categorical analysis. 5-year mortality was assessed via a centralized government database. Results: 418 subjects (199 males, 219 females) were enrolled in the study of whom 113 (27 %) died at the time of 5-year follow-up. Subjects who died had significantly lower MCF (32 ± 14 % vs 36 ± 12 %; p < 0.004) and EF (51.6 ± 11.6 % vs 56.3 ± 9.4 %; p < 0.0001) than survivors. The association between MCF and mortality remained significant on clinical multivariate analysis as both a categorical and continuous variable while EF was only significant as a continous variable. When both EF and MCF were added to the model only MCF as a categorical variable remained significant. Conclusions: MCF assessed by home echocardiography provides additional prognostic information to EF and may be a superior predictor of 5-year mortality in a community-dwelling population of the oldest old.

Optimism and Longevity Beyond Age 85.

BACKGROUND: Optimism is associated with health benefits and improved survival among adults older than 65 years. Whether or not optimism beyond age 85 continues to confer survival benefits is poorly documented. We examine the hypothesis that being optimistic at ages 85 and 90 is associated with improved survival. METHOD: The Jerusalem Longitudinal Study (1990-2020) assessed comorbidity, depression, cognition, social and functional status, and 5-year mortality among a representative community sample, born during 1920-1921, at age 85 (n = 1096) and age 90 (n = 533). Overall optimism (Op-Total) was measured using a validated 7-item score from the Scale of Subjective Wellbeing for Older Persons. The 4 questions concerning positive future expectations (Op-Future) and 3 questions concerning positive experiences (Op-Happy) were also analyzed separately. We determined unadjusted mortality hazards ratios and also adjusted for gender, financial difficulty, marital status, educational status, activities of daily living dependence, physical activity, diabetes mellitus, hypertension, ischemic heart disease, cognitive impairment, and depression. RESULTS: Between ages 85-90 and 90-95 years, 33.2% (364/1096) and 44.3% (236/533) people died, respectively. All mean optimism scores declined from age 85 to 90, with males significantly more optimistic than females throughout. All measures of optimism (Op-Total, Op-Future, and Op-Happy) at ages 85 and 90 were significantly associated with improved 5-year survival from age 85 to 90 and 90 to 95, respectively, in both unadjusted and adjusted models. Findings remained unchanged after separately excluding depressed subjects, cognitively impaired subjects, and subjects dying within 6 months from baseline. CONCLUSIONS: These finding support the hypothesis that being optimistic continues to confer a survival benefit irrespective of advancing age.

Prolonged Mechanical Ventilation: Symptomatology, Well-Being, and Attitudes to Life.

OBJECTIVE: Although prolonged mechanical ventilation (PMV) is increasingly common, little is known concerning patient symptom burden or attitudes toward PMV. This study aims to describe the mood, well-being, distressing symptoms, and attitudes toward prolonged ventilation among PMV patients treated either at home or long-term acute care (LTAC). DESIGN: An observational study. SETTING AND PARTICIPANTS: 62 communicative participants treated with PMV, aged ≥18 years, insurees of a single HMO, treated at home hospital or LTAC specializing in ventilation in Jerusalem. MEASURES: Sociodemographic characteristics; chronic conditions; functional status; symptom burden measured by revised Edmonton Symptomatic Assessment System (r-ESAS); attitudes toward PVM. RESULTS: Participants were aged 61.7 ± 20.7 years, commonly suffered progressive neuromuscular disease (43.5%) or chronic lung disease (29%), were functionally dependent, treated at home (64.5%) or LTAC (35.5%), and had a mean PMV duration of 36.6 months (interquartile range 10.8-114.1). The 5-item, short Geriatric Depression Scale identified depression among 38% of participants, and was less at home vs LTAC (34% vs 44%, P < .001). Mean revised Edmonton Symptom Assessment System score was 24.5 ± 14.8 (maximum severity = 100), and participants reported severe or distressing symptoms for tiredness (27%/20%), pain (10%/25%), anxiety (16%/14%), depression (9%/21%), drowsiness (12%/17%), shortness of breath (9%/15%), poor appetite (7%/9%), and nausea (0%/10%). Impaired general well-being was reported as severe, moderate, mild, or none among 15%, 40%, 30%, and 15%, respectively. Only 1 patient had advance directives concerning ventilation prior to intubation, and when asked if they had to choose again today, 85% of patients would again opt for ventilation. CONCLUSIONS AND IMPLICATIONS: Few PMV patients reported distressing symptoms, and 85% would choose ventilation if asked again. These findings might be useful in clinical practice to assist in decision making concerning prolonged ventilation.

Prolonged Mechanical Ventilation: A Comparison of Patients Treated at Home Compared With Hospital Long-Term Care.

OBJECTIVE: To compare the characteristics of patients treated with invasive prolonged mechanical ventilation (PMV) at home or in hospital long-term care (HLTC), specifically focusing on medical and functional status, caregiver strain, 6-month outcomes, and health maintenance organization (HMO) costs. DESIGN: Observational study. SETTING: A single HLTC and home hospital, serving a defined catchment area in the greater Jerusalem area, Israel. PARTICIPANTS: A total of 120 PMV patients aged ≥18 years, all insurees of the same HMO. All PMV patients in the local HMO were approached, of whom 46 of 47 home PMV and 74/76 HLTC patients were enrolled. MEASUREMENTS: Medical and sociodemographic factors, Barthel Index, Short Geriatric Depression Score, modified Caregiver Strain Index; 6-month follow-up for hospitalization, infections, pressure sores, and mortality; HMO costs. RESULTS: Home PMV was associated with younger age, improved functional status, financial difficulty, less comorbidity, and longer duration of PMV. Primary reasons for home PMV were degenerative neuromuscular disease and chronic lung disease, compared with acute illnesses with or without resuscitation among HLTC patients. Most home patients were alert and able to communicate (n = 40/46) versus HLTC (n = 22/74), and reported less depression. Caregiver strain was similar for home and HLTC. Among HLTC versus home patients, 6-month mortality (27% vs 7%, P = .012) and frequency of pressure sores (45% vs. 29%, P = .042) were higher in HLTC, with no differences for infection rates or hospitalization. In multivariate analyses, being treated at home with PMV was significantly associated with being able to communicate, lower age, financial difficulties, and improved functional status. HMO costs were one-third for home PMV versus HLTC. CONCLUSIONS AND IMPLICATIONS: Differing profiles were described for home and HLTC PMV patients, with lower rates of depression, pressure sores, mortality, and one-third the cost to HMO at home. Caregiver strain was similar irrespective of site of care. With appropriate targeting for eligible patients, home PMV is a viable and financially beneficial option.

[LONELINESS, FUNCTION AND LONGEVITY: THE JERUSALEM LONGITUDINAL COHORT STUDY].

AIMS: To assess the association between subjective loneliness among the elderly (whether an individual feels lonely) with functional status and longevity after adjustment for potential confounders. BACKGROUND: While objective measures of loneliness among older people have been found to be associated with functional decline and increased mortality, little is known concerning the relationship between subjective loneliness, function, morbidity and longevity. METHODS: Subjective loneliness, health variables, functional status and mortality were assessed through the Jerusalem Longitudinal Cohort Study (1990-2015), a prospective longitudinal study. Participants born between the years 1920-1921 were assessed at home at ages 70, 78, 85 and 90. Depressed participants were excluded from the statistical analyses. Participants were asked how often they felt lonely, with answers dichotomized to never versus rarely/often/very often. RESULTS: At age 70, 78, 80 and 90, overall prevalence of loneliness was 27.8% , 23.7% , 23.9% and 26.7% respectively. Male gender and not being married were consistently associated at all ages with increased likelihood of loneliness. After adjusting for baseline variables, we found no association between subjective loneliness and subsequent deterioration in functional status, cognitive function (decline in mini-mental score<24) or chronic pain in any age groups. Furthermore, loneliness was not associated with mortality among the participants between ages 70-78, 78-85, 85-90 and 90-95. We repeated all the analyses, this time including depressed subjects, with no significant change in the overall findings. CONCLUSIONS: Loneliness was not associated with subsequent poor health outcomes or decline in functional status up to the age of 95. Furthermore, no association was found between subjective loneliness and mortality at any age.

Longitudinal changes in cardiac function in the very elderly: the Jerusalem longitudinal cohort study.

BACKGROUND: People over the age of 85 are a rapidly growing age group with a high incidence of congestive heart failure (CHF), in particular heart failure with preserved ejection fraction (HFpEF). The diagnosis of CHF is challenging and longitudinal data assessing cardiac structure and function are necessary to distinguish physiologic from pathologic cardiac aging. The objective of the study was to determine longitudinal changes in cardiac struture and function from ages 85 to 94 years using home echocardiography. METHODS: Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Sixty three members of the initial cohort (32F, 31M) who underwent home echocardiography at age 85 were the subjects of the current study and underwent repeat home 2-D and Doppler echocardiographic assessment at age 94. RESULTS: There were no significant longitudinal changes in left ventricular mass index (LVMI), however LV end-diastolic volume significantly decreased from 113.4 ± 30 to 103.6 ± 35.5 mL (P < 0.02). Ejection fraction (EF) remained stable, however longitudinal systolic function significantly decreased with age from 7.9 ± 1.8 to 6.6 ± 1.4 cm/s2 (P < 0.0001). Diastolic function as assessed by increased E: e' (11.2 ± 3.4 to 16 ± 7.5, P < 0.0001) and increased left atrial volume index (34.1 ± 11.3 to 42.4 ± 13.7 mL/m2, P < 0.0001) was reduced with aging. CONCLUSIONS: This study demonstrated preserved EF with decreased longitudinal systolic function and diastolic function without significant change in LV mass. Changes in LV function in the very elderly may be independent of changes in LV geometry.

Frequency of Leaving the House and Mortality from Age 70 to 95.

OBJECTIVES: To determine the association between frequency of leaving the house and mortality. DESIGN: Prospective follow-up of an age-homogenous, representative, community-dwelling birth cohort (born 1920-21) from the Jerusalem Longitudinal Study (1990-2015). SETTING: Home. PARTICIPANTS: Individuals aged 70 (n = 593), 78 (n = 973), 85 (n = 1164), and 90 (n = 645), examined in 1990, 1998, 2005, and 2010, respectively. MEASUREMENTS: Frequency of leaving the house, defined as daily (6-7/week), often (2-5/week), and rarely (≤1/week); geriatric assessment; all-cause mortality (2010-15). Kaplan-Meier survival charts and proportional hazards models adjusted for social (sex, marital status, financial status, loneliness), functional (sex, self-rated health, fatigue, depression, physical activity, activity of daily living difficulty), and medical (sex, chronic pain, visual impairment, hearing impairment, diabetes mellitus, hypertension, ischemic heart disease, chronic kidney disease) covariates. RESULTS: At ages 70, 78, 85, and 90, frequency of going out daily was 87.0%, 80.6%, 65.6%, and 48.4%; often was 6.4%, 9.5%, 17.4%, and 11.3%; and rarely was 6.6%, 10.0%, 17.0%, and 40.3% respectively. Decreasing frequency of going out was associated with negative social, functional, and medical characteristics. Survival rates were lowest among those leaving rarely and highest among those going out daily throughout follow-up. Similarly, compared with rarely leaving the house, unadjusted mortality hazard ratios (HRs) were lowest among subjects leaving daily and remained significant after adjustment for social, functional and medical covariates. Among subjects leaving often, unadjusted HRs showed a similar effect of smaller magnitude, with attenuation of significance after adjustment in certain models. Findings were unchanged after excluding subjects dying within 6 months of follow-up. CONCLUSION: In community-dwelling elderly adults aged 70 to 90, leaving the house daily was associated with lower mortality risk, independent of social, functional, or medical status.

Cardiac structure and function predicts functional decline in the oldest old.

Background This study examined the association between cardiac structure and function and the deterioration in activities of daily living (ADLs) in an age-homogenous, community-dwelling population of patients born in 1920-1921 over a five-year follow-up period. Design Longitudinal cohort study. Methods Patients were recruited from the Jerusalem Longitudinal Cohort Study, which has followed an age-homogenous cohort of Jerusalem residents born in 1920-1921. Patients underwent home echocardiography and were followed up for five years. Dependence was defined as needing assistance with one or more basic ADL. Standard echocardiographic assessment of cardiac structure and function, including systolic and diastolic function, was performed. Reassessment of ADLs was performed at the five-year follow-up. Results A total of 459 patients were included in the study. Of these, 362 (79%) showed a deterioration in at least one ADL at follow-up. Patients with functional deterioration had a significantly higher left ventricular mass index and left atrial volume with a lower ejection fraction. There was no significant difference between the diastolic parameters the groups in examined. When the data were examined categorically, a significantly larger percentage of patients with functional decline had an abnormal left ventricular ejection fraction and left ventricular hypertrophy. The association between left ventricular mass index and functional decline remained significant in all multivariate models. Conclusions In this cohort of the oldest old, an elevated left ventricular mass index, higher left atrial volumes and systolic, but not diastolic dysfunction, were predictive of functional disability.

Left atrial function and mortality in the oldest old.

BACKGROUND: Previous studies demonstrated that left atrium (LA) size is associated with mortality in an elderly population. It remains unclear whether indices of LA function including reservoir, conduit, or booster elements of LA function provide incremental prognostic information. HYPOTHESIS: Echocardiographic measures of the various parameters of LA function would predict 5-year mortality in a community-dwelling population of 85 to 86 year olds independently of LA volume. METHODS: Subjects ages 85 to 86 years old underwent home echocardiography. LA volumes were assessed by the biplane Simpson's method from apical views using measurements of phasic volumes and functions of the LA, including LA expansion index. LA passive and active emptying fractions were assessed. Survival status at 5-year follow-up was assessed. RESULTS: Two hundred eighty-two subjects were included, of whom 87 (31%) had died at follow-up. Survival of the subjects in the lowest quartile of the LA expansion index as well as LA active filling index was significantly lower. When measurements of LA volume index were added to the model, the relationship between survival and indices of LA function remained significant. CONCLUSIONS: This study demonstrated that elderly subjects aged 85 to 86 years with significantly impaired LA function had increased 5-year mortality independently of indices of LA volume.

Hypertension and Its Treatment at Age 90 Years: Is There an Association with 5-Year Mortality?

OBJECTIVE: To determine the association between hypertension at age 90 years, treatment, and 5-year mortality. DESIGN: A prospective observational study of a representative community-dwelling birth cohort (born 1920-1921) by the Jerusalem Longitudinal Study (1990-2015). SETTING: Home-assessment. PARTICIPANTS: 480 subjects aged 90, examined 2010-2011. Measurements and Main Outcome: Hypertension was defined as treatment with antihypertensive medication, and/or sitting blood pressure (BP) > 140 mmHg systolic or >90 mmHg diastolic. Subjects were categorized as normotensive (NORMO), untreated hypertensive (NonTx-HTN), and treated hypertensive (Tx-HTN); assessment included activities of daily living (ADL), handgrip strength, and all-cause mortality (2010-2015). RESULTS: NORMO, NonTx-HTN, and Tx-HTN prevalence was 12.3% (59/480), 12.7% (61/480), and 75% (360/480). Tx-HTN had higher rates of low education, depression, low physical activity, chronic heart failure, ischemic heart disease, chronic kidney disease. Five-year survival was lowest among Tx-HTN and highest among NonTx-HTN versus NORMO among all subjects (51%, 72%, 61%; P = .01), and subgroups with ADL independence (64%, 91%, 74%; n = 265, P = .01), ADL dependence (37%, 55%, 48%; n = 194, P = .36), high grip strength (66%, 85%, 83%; n = 227, P = .04), low grip strength (38%, 60%, 61%; n = 149, P = .06), low comorbidity (64%, 84%, 70%; n = 219, P = .13), and high comorbidity (42%, 60%, 54%; n = 257, P = .12). Unadjusted mortality hazards ratios (HR) were higher for Tx-HTN [HR 1.38; 95% confidence interval (CI) 0.89-2.15] versus NonTx-HTN (HR 0.7; 95% CI 0.37-1.31) compared to NORMO (HR 1.0). After adjusting for medical and functional covariates, adjusted HRs were higher for Tx-HTN (HR 1.39; 95% CI 0.83-2.33) versus NonTx-HTN (HR 0.67; 95% CI 0.31-1.45) compared to NORMO (HR 1.0). Findings were consistent in subsets according to ADL status, grip strength, and comorbidity. CONCLUSIONS: Untreated hypertension at age 90 years was not associated with increased mortality risk among community-dwelling elderly, irrespective of comorbidity, functional status, or muscle strength.

Handgrip Strength in Old and Very Old Adults: Mood, Cognition, Function, and Mortality.

OBJECTIVES: To determine the trajectory of handgrip strength (HGS) from age 70 to 90 and its association with mood, cognition, functional status, and mortality. DESIGN: Prospective follow-up of an age-homogenous representative community-dwelling cohort (born 1920-21) in the Jerusalem Longitudinal Cohort Study (1990-2015). SETTING: Home-based assessment. PARTICIPANTS: Subjects aged 70 (n = 327), 78 (n = 384), 85 (n = 1187), and 90 (n = 406), examined in 1990, 1998, 2005, and 2010, respectively. MEASUREMENTS: Handgrip strength (kg) (dynamometer), low HGS defined as sex-specific lowest quartile grip; geriatric assessment; all-cause mortality (1990-2015). RESULTS: Mean HGS declined between age 70 and 90 from 21.3 ± 7.2 to 11.5 ± 5.6 kg in women and from 35.3 ± 8.4 to 19.5 ± 8.2 kg in men. Cross-sectional associations were observed between low HGS and poor functional measures (age 70-90), lower educational and financial status, smoking, and diabetes mellitus (ages 78-90). After adjustment for baseline education, self-rated health, physical activity, diabetes mellitus, depression, and cognition, low HGS predicted subsequent activity of daily living dependence from age 78 to 85 (odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.04-6.89) and 85 to 90 (OR = 2.31, 95% CI = 1.01-5.30), whereas the adjusted ORs for activities of daily living difficulty and depression failed to achieve significance. HGS did not predict subsequent cognitive decline. Survival rates were significantly lower in participants with low HGS (Quartile 1) than in those with normal HGS (Quartiles 2, 3, 4) throughout follow-up from ages 78 to 85, 85 to 90, and 90 to 95. Similarly, after adjusting for sex, education, self-rated health, body mass index, hypertension, diabetes mellitus, ischemic heart disease, and smoking, a low HGS was associated with significantly higher mortality. CONCLUSIONS: Mean HGS declined progressively with age, and participants in the lowest age-specific quartile of HGS had a higher risk of subsequent functional decline and mortality.

Cardiac Structure and Function and Frailty in Subjects Aged 85 and 86 Years.

Frailty is a biologic syndrome reflecting a state of decreased physiological reserve of increasing importance in cardiovascular disease given the aging of the population. The relation between frailty and indexes of cardiac structure and function remains unclear, particularly in the "oldest old." The objective of this study was to examine the association between cardiac function and frailty in an age-homogenous, community-dwelling population of subjects aged 85 and 86 years. Subjects were recruited at ages 85 to 86 from the Jerusalem Longitudinal Cohort Study that has followed an age-homogenous cohort of Jerusalem residents. Subjects underwent echocardiography at their place of residence with standard assessment of cardiac structure and function. Frailty was defined according to the "phenotype of frailty" including at least 3 of the following: weakness, slowness, low physical activity level, exhaustion, and weight loss; 405 subjects (193 men and 212 women) were enrolled in the study. Subjects defined as frail had significantly lower ejection fraction compared with the non-frail group (53.7 ± 0.09% vs 56.4 ± 0.09%; p <0.04). In addition, frail subjects had increased LV mass index (130.6 ± 36.2 g/m(2) vs 119.2 ± 31.1 g/m(2); p <0.03) and LA volume index (41.9 ± 14.7 cm(3)/m(2) vs 36.7 ± 13.1 cm(3)/m(2); p <0.001). Indexes of diastolic function (E/e)' were not significantly different in the 2 groups (11.5 vs 11.8; p = NS). In this age-homogenous cohort of the oldest old, structural changes and indexes of systolic but not diastolic function were associated with frailty.

Prevalence of orthostatic hypertension in the very elderly and its relationship to all-cause mortality.

OBJECTIVE: To investigate the association with mortality of orthostatic hypertension (OHYPER) amongst the oldest old. METHODS: Two waves of community-dwelling residents born in 1920-1921 were examined at age of 85 (n = 1004) and 90 (n = 437). OHYPER, orthostatic hypotension (OHYPO), or orthostatic normotension (ONORMO) were so classified when difference of standing-sitting SBP either increased or decreased by at least 20 mmHg or not. RESULTS: Prevalence of OHYPO, ONORMO, and OHYPER was 5% (n = 48), 91% (n = 915), and 4% (n = 41) at age 85, and 9% (n = 39), 88% (n = 385), and 3% (n = 13) at age 90. There was a tendency for fewer men among OHYPER, and significantly more participants with financial hardship, higher weight, loneliness, and anemia (P < 0.05 for all) among the 85-year-olds, fewer with poor self-rated health, and more with anemia among the 90-year-olds. Sitting blood pressure was 157 ±â€Š22/75 ±â€Š11, 147 ±â€Š21/74 ±â€Š11, and 140 ±â€Š16/74 ±â€Š10 mmHg among OHYPO, ONORMO, and OHYPER at age 85 (P < 0.0001), and 166 ±â€Š28/75 ±â€Š10, 145 ±â€Š23/69 ±â€Š11, and 138 ±â€Š23/74 ±â€Š9 mmHg at age 90 (P < 0.0001). Ten-year survival were 27, 30, and 27%, respectively, at age 85 (log-rank P = 0.34). Five-year survival were 57, 67, and 55%, respectively, at age 90 (log-rank P = 0.14). In an adjusted Cox proportional hazards ratio model, OHYPER at age 85 was not associated with mortality (hazards ratio = 0.95, 95% confidence interval 0.65-1.39). The few OHYPER among 90-year-olds precluded modeling. CONCLUSION: OHYPER is quite uncommon among community-dwelling 85 and 90-year-olds and is not associated with increased mortality.

Left Ventricular Mass as a Risk Factor in the Oldest Old.

In middle-aged and "young elderly" cohorts, higher left ventricular mass (LVM) is associated with worse outcomes. The authors examined LVM and 5-year mortality among community-dwelling 85-year-old patients. A representative sample (n=526, born 1920-1921) from the Jerusalem Longitudinal Cohort Study underwent echocardiography at age 85. LVM was indexed by body surface area (LVM-BSA) or height (LVM-Ht). Patients with higher LVM were less educated and sedentary and had poorer self-rated health, functional limitations, and increased comorbidity. Five-year mortality was 21.7% (n=114). Adjusted 5-year mortality rates were increased for the two upper quintiles of LVM-BSA (hazard ratio [HR], 1.8; 95% confidence interval [CI], 1.05-3.06) and LVM-Ht (HR, 2.2; 95% CI, 1.2-3.5). A step up in mortality occurred around the third quintile corresponding with LVM-BSA 110 g/m(2) or LVM-Ht 51 g/m(2.7). Among the oldest old, elevated LVM is significantly associated with mortality.

Prevalence of pain with advancing age brief report.

BACKGROUND: The epidemiology of chronic pain with advancing age remains poorly established. Although most studies have examined somatic (musculoskeletal and joint) pain, visceral pain (such as headache and abdominal pain) has warranted less attention. We present longitudinal data from age 70 to 90 years concerning chronic musculoskeletal/joint pain, abdominal pain, and headache. METHODS: Data was collected by the Jerusalem Longitudinal Study, which is a prospective study of a representative sample from the 1920-1921 birth-cohort living in West Jerusalem. Participants underwent comprehensive assessment at home in 1990, 1998, 2005, and 2010, at ages 70 (n = 460), 78 (n = 763), 85 (n = 1149), and 90 years (n = 394), respectively, and were directly questioned concerning the presence and location of pain. RESULTS: The overall prevalence of pain of any kind at ages 70, 78, 85, and 90 years was 73% (n = 336/460), 81.1% (n = 619/763), 56.3% (n = 647/1149), and 31.2% (n = 123/394), respectively. Pain at younger ages only was associated with female gender, lower educational status, functional dependence, physical inactivity, increased body mass index, loneliness, depression, and poor self-rated health. At ages 70, 78, 85, and 90 years, chronic neck/back pain was present among 41.5%, 58.9%, 30.1%, and 14.6% of participants, respectively; chronic joint pain was present among 43.0%, 60.6%, 45.2%, and 25.2%, respectively. In contrast abdominal pain was less common and disappeared among the oldest old: 14.7%, 13.9%, 1.7%, and 1.5%, respectively, with a similar pattern for headache: 43.3%, 33.5%, 2.1%, and 1.3%. While pain was reported at ≥2 sites by 42.3% and 54.6% at ages 70 and 78 years, respectively, by ages 85 and 90 years, pain was most frequently reported at only 1 site. CONCLUSIONS: Visceral pain (headache and abdominal pain) completely disappeared among the oldest old, in contrast to a far smaller decline in somatic (musculoskeletal and joint) pain.

Gender differences in survival in old age.

BACKGROUND: Although increased survival among females is observed throughout much of adult life, supporting evidence among the oldest old is lacking. OBJECTIVE: We examined the hypothesis that gender differences in survival diminish with advancing age. METHODS: The Jerusalem Longitudinal Study follows a representative cohort born 1920-1921, comprehensively assessed at ages 70, 78, 85, and 90 (n=463, 927, 1224, and 673, respectively). Mortality data were collected during 1990-2013. Kaplan-Meier survival curves and mortality hazards ratios (HRs) were determined, adjusting for gender, marital status, education, loneliness, self-rated health, physical activity, functional status, neoplasm, diabetes mellitus, hypertension, and ischemic heart disease. RESULTS: Survival between ages 70-78 was 77.3% (n=358/463), 78-85 was 68.9% (n=635/927), 85-90 years was 71.1% (n=870/1224), and 90-93 years was 80.5% (n=542/673). With advancing age, the survival advantage among females versus men declined-at ages 70-78 (85.6% vs. 71%, p<0.0001), 78-85 (74% vs. 63%, p=0.001), 85-90 (74% vs. 67.5%, p=0.06), and 90-93 (80% vs. 81%, p=0.92). Compared to females (HR=1.0), the adjusted HR for male mortality at ages 70-78 was 2.93 (95% confidence interval [CI] 1.75-4.91), ages 78-85 was 2.1 (95% CI 1.5-2.92), ages 85-90 was 1.6 (95% CI 1.2-2.2), and ages 90-93 was 1.1 (95% CI 0.7-1.8). CONCLUSIONS: Our findings confirm the hypothesis that the increased longevity observed among females at age 70 gradually diminishes with advancing age, and disappears beyond age 90.

Pulmonary artery systolic pressure and mortality in the oldest old.

OBJECTIVES: The objectives of the study were to assess pulmonary artery systolic pressure, its association with clinical and echocardiographic variables and its impact on 5-year mortality in a community-dwelling population of the oldest old. METHODS: Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at home, with standard measurements being taken including tricuspid regurgitation (TR) velocity (n = 300). Survival status at 5-year follow-up was assessed via the centralized population registry. RESULTS: The mean TR gradient in the study population as a whole was 30.5 ± 9.4 mm Hg. A significant relationship was noted between right-ventricular systolic pressure (RVSP) and left-atrial (LA) volume (r = 0.27, p < 0.0001), left-ventricular (LV) mass index (r = 0.26, p < 0.0001) and the ratio E/e (r = 0.19, p < 0.03). At the 5-year follow-up, 71 of the 300 subjects (23.7%) had died. TR gradient was significantly associated with mortality in both the unadjusted (HR 1.036, 95% CI 1.015-1.058; p < 0.007) and adjusted (HR 1.036, 95% CI 1.012-1.061; p < 0.0029) models. CONCLUSIONS: We demonstrate that RVSP is elevated and related to LV mass, LA volume and reduced diastolic function in the oldest old. An elevated RVSP is significantly associated with mortality in this population.