Evaluation of the Late-Life Disability Instrument (LLDI) in low-income older populations.

OBJECTIVE: To assess the construct and convergent validity of the 16 items of the Late-Life Disability Instrument (LLDI) in Latin American seniors. METHOD: Exploratory and confirmatory factor analyses were performed to assess the factor structure of frequency and limitation sub-scales of the LLDI. ANOVA and t test were used to determine the convergent and construct validity of the LLDI by exploring associations with physical performance tests, mobility limitations, depression, cognition, self-reported health, as well as with sex, education, and income. RESULTS: Factor analysis resulted in one-factor solution and acceptable model fit. Participants with better physical function, less mobility limitations, better self-reported health, and intact cognition reported more frequent activities and fewer limitations, indicating good convergent and construct validity of our measure. CONCLUSION: LLDI is a good instrument to assess disability in low-income populations. Further research is needed to include culturally acceptable activities for the frequency sub-scale.

Asociación entre presión arterial y mortalidad en una cohorte de individuos de edad igual o superior a 65 años de España: un modelo dinámico / Association between blood pressure and mortality in a Spanish cohort of persons aged 65 years or over: a dynamic model

Introducción y objetivos. Son pocos los estudios que han utilizado una corrección dependiente del tiempo para analizar la relación entre presión arterial y mortalidad por cualquier causa, y hasta donde sabemos no se ha realizado ninguno en ancianos del área mediterránea. El objetivo de este estudio es estimar la relación que la presión arterial basal y la presión arterial como variable dependiente del tiempo tienen con el riesgo de mortalidad por cualquier causa en una cohorte poblacional en España de personas de 65 o más años. Métodos. Los datos se obtuvieron del estudio de base poblacional «Envejecer en Leganés», con un seguimiento de 17 años, que se puso en marcha en 1993 en una muestra aleatoria (n = 1.560) de personas de 65 o más años. Se evaluó la mortalidad en 2010. Se ajustaron modelos de riesgos proporcionales de Cox para analizar los efectos de la presión arterial basal y la presión arterial como covariable dependiente del tiempo en la mortalidad. Resultados. El valor mínimo de mortalidad se observó con una presión arterial sistólica basal de 136 mmHg y un valor de presión arterial sistólica como covariable dependiente del tiempo de 147 mmHg. El riesgo de mortalidad más alto para la presión arterial sistólica como covariable dependiente del tiempo se produjo con valores de presión arterial sistólica < 115 y > 193 mmHg y presión arterial diastólica < 80 mmHg. Valores de presión arterial diastólica > 85 mmHg no aumentaron el riesgo de muerte. Conclusiones. Teniendo en cuenta la relación dinámica entre la presión arterial y la mortalidad, nuestros datos muestran una relación en forma de U para la presión arterial sistólica y una relación negativa para la presión arterial diastólica y mortalidad por todas las causas. La menor mortalidad correspondió a un valor de presión arterial sistólica ligeramente superior al valor diagnóstico de hipertensión, lo que indica que 140 mmHg podría no ser adecuado como valor diagnóstico y objetivo terapéutico en la población anciana (AU)

Introduction and objectives. Few studies have used time-dependent correction to analyze the relationship between blood pressure and all-cause mortality, and to our knowledge none has been performed in older people from the Mediterranean area. This study aimed to estimate the relationship between baseline blood pressure and blood pressure as a time-dependent covariate with the risk of all-cause mortality in a population cohort of persons aged 65 or older in Spain. Methods. Data were taken from the population-based study “Aging in Leganés” with 17 years of follow-up, launched in 1993 in a random sample (n=1560) of persons aged >=65 years. Mortality was assessed in 2010. Cox proportional hazards models were fitted to examine the effects on mortality of blood pressure at baseline and of blood pressure as a time-dependent covariate. Results. The lowest mortality was observed at baseline systolic blood pressure of 136mmHg and time-dependent covariate value of 147mmHg. The highest risk of mortality for time-dependent covariates occurred with systolic blood pressure<115 mmHg and >93mmHg and diastolic blood pressure<80mmHg. Diastolic blood pressure over 85mmHg did not increase the risk of death. Conclusions. Based on the dynamic association between blood pressure and mortality, a U-shaped relationship was found for systolic blood pressure and a negative relationship for diastolic blood pressure and all-cause mortality. The lowest mortality corresponded to a systolic blood pressure level slightly over the diagnostic hypertension value and suggests that a value of 140mmHg is not adequate as a diagnostic and therapeutic threshold in an elderly population(AU)

Association between blood pressure and mortality in a Spanish cohort of persons aged 65 years or over: a dynamic model.

INTRODUCTION AND OBJECTIVES: Few studies have used time-dependent correction to analyze the relationship between blood pressure and all-cause mortality, and to our knowledge none has been performed in older people from the Mediterranean area. This study aimed to estimate the relationship between baseline blood pressure and blood pressure as a time-dependent covariate with the risk of all-cause mortality in a population cohort of persons aged 65 or older in Spain. METHODS: Data were taken from the population-based study "Aging in Leganés" with 17 years of follow-up, launched in 1993 in a random sample (n=1560) of persons aged ≥65 years. Mortality was assessed in 2010. Cox proportional hazards models were fitted to examine the effects on mortality of blood pressure at baseline and of blood pressure as a time-dependent covariate. RESULTS: The lowest mortality was observed at baseline systolic blood pressure of 136 mmHg and time-dependent covariate value of 147 mmHg. The highest risk of mortality for time-dependent covariates occurred with systolic blood pressure <115 mmHg and >93 mmHg and diastolic blood pressure <80 mmHg. Diastolic blood pressure over 85 mmHg did not increase the risk of death. CONCLUSIONS: Based on the dynamic association between blood pressure and mortality, a U-shaped relationship was found for systolic blood pressure and a negative relationship for diastolic blood pressure and all-cause mortality. The lowest mortality corresponded to a systolic blood pressure level slightly over the diagnostic hypertension value and suggests that a value of 140 mmHg is not adequate as a diagnostic and therapeutic threshold in an elderly population.

Prevalence and incidence of hypertension in a population cohort of people aged 65 years or older in Spain.

OBJECTIVE: To estimate the prevalence and incidence of hypertension in a Spanish cohort of people aged at least 65 years with 13 years' follow-up. This is the first study to provide age-adjusted and sex-adjusted incidence rates of hypertension in a Mediterranean-based population aged 65 years or older. METHODS: Population-based longitudinal study set in the city of Leganes, Spain. The cross-sectional prevalence of hypertension was estimated using data available for the 1993, 1995, 1999, and 2006 cohorts. The incidence density (incident cases of hypertension/person-years) was calculated for 522 individuals without hypertension at baseline. Individuals were classified as hypertensive if they were taking physician-prescribed medication for hypertension or if their blood pressure was equal to or greater than 140/90 mmHg. RESULTS: Hypertension prevalence increased progressively with time, from 53.5% in 1993 to 86.2% in 2006. In all four waves, women had a higher prevalence of hypertension than men (P < 0.05). The total incidence density of hypertension was 7.6 [95% confidence interval (CI) 6.6-8.7] cases per 100 person-years of follow-up: 9.0 (95% CI 7.2-11.2) in women and 6.9 (95% CI 5.8-8.3) in men. In all age groups, the incidence density was nonsignificantly higher in women than in men (P > 0.05). CONCLUSION: Both the incidence and prevalence of hypertension in this population of people aged at least 65 years were high, and the prevalence increased dramatically over time, especially among women.

Cross-national determinants of quality of life from six longitudinal studies on aging: the CLESA project.

BACKGROUND AND AIMS: The Comparison of Longitudinal European Studies on Aging (CLESA) Project, here presented for the first time, is a collaborative study involving five European and one Israeli longitudinal study on aging. The aim of this paper is to describe the methodology developed for the harmonization of data and the creation of a Common Data Base (CDB), and to investigate the distribution of some selected common variables among the six countries. The design of each study is briefly introduced and the methodology leading to the harmonization of the common variables is described. METHODS: The study base includes data from five European countries (Finland, Italy, the Netherlands, Spain, Sweden) and Israel, for older people aged 65-89 living both in the community and in institutions (total, 11557 subjects). For two age classes (65-74 and 75-84), the prevalence ratios or the mean values of the following selected variables are provided: a) sociodemographic variables; b) health habits; c) health status; d) physical functioning; e) social networks and support; and f) health and social services utilization. RESULTS: Statistically significant differences were found between most of the investigated characteristics across the CLESA countries, with very few exceptions. While some of the differences found may be due to cultural variations, others require further investigation and should be encompassed in the main framework of the Project, which is to identify predictors of hospitalization, mortality, institutionalization and functional decline. CONCLUSIONS: A common data base is available for the study of the aging process in five European and one Israeli population. These data provide a unique opportunity to identify common risk factors for mortality and functional decline and increase our understanding of country-specific exposures and vulnerability.