Factors associated with mortality of elderly people due to COVID-19: Protocol for systematic review and meta-analysis.

INTRODUCTION: The COVID-19 pandemic has become a significant health crisis, marked by high mortality rates on a global scale, with mortality from the disease being notably concentrated among the elderly due to various factors. OBJECTIVE: This study aims to investigate the biological and non-biological factors associated with COVID-19 mortality rates among the elderly worldwide. METHODS: The following databases will be consulted: PubMed, Scopus, EMBASE, Web of Science and ScienceDirect. Longitudinal observational studies (cohort and case-control-risk factors) will be included. The risk of bias, defined as low, moderate, high, will be assessed using the National Heart, Lung and Blood Institute (NHLBI) Quality Assessment Tool for observational cohort and cross-sectional studies. Two independent authors will conduct the searches, and any possible disagreements will be resolved by a third author. Heterogeneity between study results will be assessed using a standard X2 test with a significance level of 0.05, and an I2 value will be calculated to further assess heterogeneity. The random effects model for meta-analyses will be adopted to distribute the weight between the studies and standardize their contributions. The meta-analyses will be conducted using RevMan software. DISCUSSION: Despite the numerous publications on COVID-19 mortality among the elderly, there is still a gap in knowledge, as there is no systematic review and meta-analysis that summarizes the main biological and non-biological associated factors globally. CONCLUSION: The results of this study will consolidate the latest evidence and address gaps in the overall understanding of biological or non-biological associated factors. This knowledge will facilitate the development of appropriate health strategies for this demographic group and pave the way for further research. TRIAL REGISTRATION: PROSPERO (CRD42023400873).

Vitamin D serum concentration is prospectively associated with depressive symptoms in the EpiFloripa Aging Cohort Study: a structural equation modeling approach.

OBJECTIVE: To evaluate the direct, indirect, and total prospective effects of serum concentrations of [25(OH)D, 25-hydroxycolecalciferol] on depressive symptoms in older adults. METHODS: Data from the second (2013-2015) and third (2017-2019) waves of the EpiFloripa Aging Cohort Study (≥ 60 years) were analyzed. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS-15). 25(OH)D levels were measured using the microparticle chemiluminescence method. A directed acyclic graph (DAG) was constructed to identify the minimum set of adjustments. Structural equation modeling (SEM) analysis was used to determine the effects of 25(OH)D on depressive symptoms. RESULTS: A total of 574 older adults' data were analyzed (63.1% female). In the follow-up (n=390), 16.2% of older adults presented high-severity of depressive symptoms (> or = 6 points). SEM analysis revealed a small direct and negative effect of 25(OH)D (ß=-0.11, P < 0.05), and a total negative effect (ß=-0.13; P < 0.05) on depressive symptoms on wave 3 (an increase of 25(OH)D led to a decrease on depressive symptoms). No direct effect on wave 2 and no indirect effect mediated by depressive symptoms in wave 2 were found. CONCLUSIONS: Findings indicate a prospective association between 25(OH)D and depressive symptoms, suggesting a long-term effect in older adults from southern Brazil.

Association Between Typologies of Sedentary Behavior and Muscle Strength, Gait Speed, and Balance in Community-Dwelling Older Adults.

Knowledge of how the different types of sedentary behaviors (SB) are associated with functional limitations can guide professionals who work with older adults on better recommendations about the amount of daily time that should be encouraged in each type of SB. The objective was to estimate the associations between two SB typologies (SB television [TV] and SB computer/internet) and the presence of handgrip strength, lower limb strength, gait speed, and balance limitations in Brazilian community-dwelling older adults. This is a cross-sectional study with 1,298 community-dwelling older adults (≥60 years). SB was assessed by self-reporting daily time spent watching TV or using computer/internet (categorized into <2, 3-4, and ≥5 hr/day). Outcomes were handgrip strength, lower limb strength, gait speed, and balance limitations considering referenced cutoff points. Older adults in SB TV ≥5 hr/day had 1.75 (95% confidence interval [CI] [1.07, 2.86]) and 1.88 (95% CI [1.02, 3.46]) times more chances of handgrip strength and gait speed limitations, respectively. On the other hand, those who spent 3-4 and ≥5 hr/day in SB computer/internet had 0.45 (95% CI [0.20, 0.99]) and 0.37 (95% CI [0.15, 0.93]) had less chances of lower limb strength and balance limitations, respectively. In conclusion, functional limitations would be associated differently depending on the type of SB in the older adults sampled.

Geocoding processes in cohort studies: methods applied in the EpiFloripa Aging.

OBJECTIVE: To describe the process and epidemiological implications of georeferencing in EpiFloripa Aging samples (2009-2019). METHOD: The EpiFloripa Aging Cohort Study sought to investigate and monitor the living and health conditions of the older adult population (≥ 60) of Florianópolis in three study waves (2009/2010, 2013/2014, 2017/2019). With an automatic geocoding tool, the residential addresses were spatialized, allowing to investigate the effect of the georeferencing sample losses regarding 19 variables, evaluated in the three waves. The influence of different neighborhood definitions (census tracts, Euclidean buffers, and buffers across the street network) was examined in the results of seven variables: area, income, residential density, mixed land use, connectivity, health unit count, and public open space count. Pearson's correlation coefficients were calculated to evaluate the differences between neighborhood definitions according to three variables: contextual income, residential density, and land use diversity. RESULT: The losses imposed by geocoding (6%, n = 240) caused no statistically significant difference between the total sample and the geocoded sample. The analysis of the study variables suggests that the geocoding process may have included a higher proportion of participants with better income, education, and living conditions. The correlation coefficients showed little correspondence between measures calculated by the three neighborhood definitions (r = 0.37-0.54). The statistical difference between the variables calculated by buffers and census tracts highlights limitations in their use in the description of geospatial attributes. CONCLUSION: Despite the challenges related to geocoding, such as inconsistencies in addresses, adequate correction and verification mechanisms provided a high rate of assignment of geographic coordinates, the findings suggest that adopting buffers, favored by geocoding, represents a potential for spatial epidemiological analyses by improving the representation of environmental attributes and the understanding of health outcomes.

Is Walk Score Associated With Physical Activity and Screen Time in Brazilian Older Adults?

This study aimed to examine the relationship between Walk Score index with walking to commuting, moderate-to-vigorous physical activity, and screen time in older adults. Georeferenced addresses were entered into the Walk Score platform. Walking to commute and moderate-to-vigorous physical activity were assessed using the International Physical Activity Questionnaire and categorized according to the World Health Organization recommendations. Screen time was analyzed through self-reported time watching television/being on the computer. We used binary logistic regression to estimate the association between variables. Older adults who lived in places with higher Walk Score had a higher prevalence of walking to commuting (odds ratio = 1.73; 95% confidence interval [1.18, 2.55]) and engaging in moderate-to-vigorous physical activity (odds ratio = 1.76; 95% confidence interval [1.05, 2.98]). A relationship also was observed between higher Walk Score and more time in screen time (odds ratio = 1.67; 95% confidence interval [1.19, 2.34]). The results showed that residing in a more walkable neighborhood increased the chances of the older adults spending 3 hr or more in front of a screen.

Self-reported hearing loss and cognitive impairment: a cross-sectional analysis of the EpiFloripa Aging study.

This study aimed to investigate the association between self-reported hearing loss and cognitive impairment in older adults in a city in Southern Brazil. In this cross-sectional, population-based cohort study of older adults, data were collected in the third wave of the EpiFloripa Aging study (2017/2019), which had been performed since 2009 in the city of Florianópolis, Santa Catarina State. Cognitive impairment was the dependent variable analyzed by the Mini-Mental State Examination (MMSE), and self-reported hearing loss, which was included in the cohort only in the last wave, was the main exposure variable. Logistic regression analyses were conducted, considering the study design and sample weights. Data from 1,335 older adults were evaluated. The prevalence was 20.5% for cognitive impairment and 10.7% for hearing loss. Older adults with hearing loss were 2.66 (95%CI: 1.08-6.54) times more likely to have cognitive impairment than older adults without hearing loss. The association between hearing loss and cognitive impairment highlights the need to integrate the early identification of these problems into primary care, as both are risk factors for healthy aging and potentially preventable and/or treatable conditions.

Negative self-perception of hearing and depression in older adults: a population-based study.

OBJECTIVE: To estimate the association between negative self-perception of hearing and depression in older adults in Southern Brazil. METHODS: This is a cross-sectional study conducted with data from the third wave of the EpiFloripa Idoso 2017/19 study, a population-based cohort of older adults (60+). A total of 1,335 older adults participated in this wave. The dependent variable was self-reported depression, and the main exposure was self-perception of hearing (negative; positive). For both the crude (bivariate) and adjusted analysis, the odds ratio (OR) was used as a measure of association and estimated by means of binary logistic regression analysis. The exposure variable was adjusted by sociodemographic and health covariates. A p value < 0.05 was adopted as statistically significant. RESULTS: The prevalence of negative self-perception of hearing and depression was 26.0% and 21.8%, respectively. In the adjusted analysis, the older adults with negative self-perception of hearing were 1.96 times more likely to report depression when compared to the ones with positive self-perception of hearing (p = 0.002). CONCLUSION: The association between negative self-perception of hearing and depression reflects the importance of reviewing health care actions for older adults, incorporating hearing-related issues, to ensure comprehensive care for this growing segment of the population.

Association between adiposity and emergent depressive symptoms in a 10-years prospective cohort of older adults: The EpiFloripa Aging study.

BACKGROUND: The association between obesity and depressive symptoms has been described in the literature, but there is a scarcity of longitudinal data. This study aimed to verify the association between body mass index (BMI) and waist circumference and the incidence of depressive symptoms over a 10-year follow-up in a cohort of older adults. METHODS: Data from the first (2009-2010), second (2013-2014), and third (2017-2019) waves of the EpiFloripa Aging Cohort Study were used. Depressive symptoms were assessed by the 15-item Geriatric Depression Scale (GDS-15) and classified in significant depressive symptoms for those with ≥6 points. The Generalized Estimating Equations model was used to estimate the longitudinal association between BMI and waist circumference and depressive symptoms across a 10-year follow-up. RESULTS: The incidence of depressive symptoms (N = 580) was 9.9 %. The relationship between BMI and the incidence of depressive symptoms in older adults followed a U-shaped curve. Older adults with obesity had an incidence relative ratio of 76 % (IRR = 1.24, p = 0.035) for increasing the score of depressive symptoms after 10 years, compared to those with overweight. The higher category of waist circumference (Male: ≥102; Female: ≥88 cm) was associated with depressive symptoms (IRR = 1.09, p = 0.033), only in a non-adjusted analysis. LIMITATIONS: Relatively high follow-up dropout rate; Few individuals in the underweight BMI category; BMI must be considered with caution because it does not measure only fat mass. CONCLUSIONS: Obesity was associated with the incidence of depressive symptoms when compared with overweight in older adults.

Adiposity and physical activity are among the main determinants of serum vitamin D concentrations in older adults: the EpiFloripa Aging Cohort Study.

The identification of factors associated with 25-hydroxycholecalciferol (25(OH)D) concentration can help suggest more specific interventions for older adults. In this cross-sectional study of older adults from southern Brazil, we hypothesized that some sociodemographic, behavioral, and health factors positively or negatively influence the 25(OH)D concentration in this population. This analysis was performed using data from the second wave of the EpiFloripa Aging Cohort Study (2013-2015). Serum 25(OH)D levels were classified according to the guidelines of the Endocrine Society. Multinomial logistic regression was performed to evaluate the relative risks of sociodemographic, behavioral, and health factors in each 25(OH)D category. A total of 574 older adults (aged 63-93 years) participated in this study. The prevalence of insufficiency (21-29 ng/mL) was 43.7% and that of deficiency (≤20 ng/mL) was 23.5%. In the adjusted analysis, female sex, higher levels of low-density lipoprotein cholesterol (LDL-C ≥160 mg/dL), obesity by adiposity (body fat percentage [%fat], male ≥31%; female ≥43%), and body mass index (BMI, >30 kg/m2) presented higher relative risks for insufficiency than for sufficiency. For those with deficiency, the associated factors were female sex, disability in 4 or more activities of daily living (ADLs), LDL-C ≥100 mg/dL, and obesity by %fat and BMI. A protective factor against insufficiency and deficiency was active leisure-time physical activity (PA, ≥150 min/week). Our results demonstrated that being female and having modifiable factors, such as high levels of LDL-C, obesity, and disability on ADLs, were negatively associated with hypovitaminosis D. On the other hand, leisure-time PA was positively associated with adequate serum vitamin D concentration.

The association between vitamin D and BDNF on cognition in older adults in Southern Brazil.

OBJECTIVE: To estimate the association between vitamin D and the cognitive decline of older adults and evaluate whether this association is mediated by brain-derived neurotrophic factor (BDNF) serum concentration. METHODS: Cross-sectional study nested in a population-based cohort. Of the 604 participants in the complementary examination of the EpiFloripa Study, 576 older adults (60 years or older) were eligible for the study. The outcome is cognitive decline evaluated by the Mini-Mental State Examination, the exposure is vitamin D, and BDNF is the mediator. The control variables are age, sex, per capita family income, and educational level. The direct effect of vitamin D and BDNF on cognitive decline and the indirect effect mediated by BDNF was evaluated using path analysis, with the estimation of standardized coefficients. RESULTS: Among the participants, we observed a direct and positive effect of vitamin D on cognitive function (Coef: 0.06; 95%CI: 0.02 to 0.11; p < 0.001) and serum BDNF concentration (Coef: 21.55; 95%CI: 9.92 to 33.17; p = 0.002), i.e., the higher the vitamin D, the higher the cognitive function and serum level of BDNF. CONCLUSION: There was an association between vitamin D on serum BDNF and on cognitive decline in older adults. Moreover, BDNF did not have an effect on cognitive decline, so BDNF was not a mediator of the vitamin D effect on cognitive decline.

Muscle Strength Assessed by Handgrip Strength Moderates the Relationship Between Overweight and Obesity With Cardiometabolic Risk Markers Among Adults and Older Adults.

Background and aims: Few population-based studies have studied whether muscle strength (MS) levels influence the relationship between cardiometabolic markers with excess body weight. We investigate the possible moderator role of MS in the relationship between overweight and obesity with cardiometabolic markers. Methods: Cross-sectional analysis using data from two studies in Florianópolis, Brazil (EpiFloripa Adult Cohort Study, n = 862, 39.3 ± 11.4 years; EpiFloripa Aging Cohort Study, n = 1,197, 69.7 ± 7.1 years). MS was assessed by handgrip strength. Body mass index (BMI) was classified as overweight or obesity (BMI 25.0-29.9 or ≥30.0 kg/m2, respectively). Cardiometabolic markers included systolic (SBP) and diastolic blood pressure (DBP), C-reactive protein (CRP), lipids, glucose markers, and carotid intima-media thickness (CIMT). Linear regression models stratified by age groups (adults: <60 years; older adults: ≥60 years) and adjusted for confounders were used. Results: Compared to those with a normal BMI, overweight and obesity were related to higher SBP, DBP, lnCRP, ln triglycerides, fasting glucose (FG), and glicated hemoglobin (HbA1c), and inversely associated with HDL-C among adults and older adults (p value < .05 for all). Additionally, BMI was positively associated with LDL-C and CIMT only among adults (p value < .05). Among adults and older adults, elevated MS attenuated the adverse relationship between excess body weight with FG and HbA1c. Conclusion: Higher MS might help adults and older adults with overweight or obesity reduce their cardiovascular risk by keeping their FG and HbA1c at the same levels of those with a normal BMI.

Does cognitive impairment precede self-reported poor hearing? Results from the English longitudinal study of ageing.

OBJECTIVE: To investigate whether cognitive impairment precedes self-reported poor hearing in adults aged 50 and older over a 14-year period. DESIGN: Biennial longitudinal study. STUDY SAMPLE: The data came from the English Longitudinal Study of Ageing carried out in England between 2002 and 2016, with 11,391 individuals aged 50 years and older. For this study, ELSA participants who had a positive perception of hearing at the beginning of the analysis in 2002 (n = 8,895) were eligible. The dependent variable was self-reported poor hearing, and the exposure measure was cognitive impairment. The analyses were performed using Generalised Estimation Equations and adjusted for gender, age, educational level, household wealth, smoking, alcohol consumption, depressive symptoms, ADL/IADL disability, physical activity level, diabetes, and cardiovascular disease. RESULTS: The results showed 33% increased odds of self-reported poor hearing in individuals with cognitive impairment. In the fully adjusted model, individuals who presented cognitive impairment in the previous wave had, over time, 10% increased odds (95% CI: 1.02; 1.19) of presenting self-reported poor hearing. CONCLUSIONS: The exposure to cognitive impairment was associated with a subsequent self-reported poor hearing. These data represent important tools for improving cognitive and hearing impairment diagnosis and treatment.

Neighbourhood walkability and mental health in older adults: A cross-sectional analysis from EpiFloripa Aging Study.

This study aims to analyse the association between walkability index and depressive symptoms and cognitive impairment and test the mediating role of moderate-vigorous physical activity (MVPA) in this relationship among older adults from Florianópolis, Brazil. This is cross-sectional research with data from the third wave of the EpiFloripa Aging cohort study, conducted in 2017-2019. Depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS), and cognitive impairment, using the Mini-Mental State Examination (MMSE) scales. The neighbourhood environment was assessed using a walkability index, which considered 500-m network buffers around the participants' homes. Binary logistic regression analysis the association between the walkability index (quartile) and mental health outcomes (yes vs. no). Structural equation modelling evaluated the mediation between the walkability index and cognitive impairment by MVPA with an estimator of dichotomous variables. 1,162 people participated in the study (61.5% women, average age = 73.1). Older adults residing in places with a high and highest walkability index were 38% and 44% less likely to have cognitive impairment, respective. There was no association between depressive symptoms and walkability index in crude nor adjusted analysis. Engaging in MVPA had a partial but not significant effect (14%; p = 0.087), showing a tendency for this relationship to be partially explained by the greater engagement in physical activities in places with greater walkability. Policy planning to prevent and reduce the risks of cognitive impairment should consider factors of the physical environment as determinants in older adults.

Association between the consumption of omega-3-rich fish and depressive symptoms in older adults living in a middle-income country: EpiFloripa Aging cohort study.

This study aimed to verify the association between the consumption of omega-3-rich (n-3) fish and depressive symptoms in older adults living in Southern Brazil. This is a cross-sectional analysis with data from the second wave of the EpiFloripa Aging cohort study (2013/2014) including 1,130 individuals aged 60 years or older. The presence of depressive symptoms was measured by the 15-items Geriatric Depression Scale (GDS-15), and the consumption of n-3-rich fish by a question of weekly frequency. The minimum set of variables for adjustment was defined using directed acyclic graph (DAG). Poisson regression with robust error variance was applied (adjusted by Model 1: demographic and socioeconomic variables, Model 2: added behavioral variables, Model 3: added health variables). We identified the prevalence of depressive symptoms in 19% of older adults and 51.8% reported eating n-3-rich fish once a week. Models 1 and 3 showed an inverse association between n-3-rich fish and depressive symptoms. However, the association was reduced when behavioral factors (leisure-time physical activity) were included in Model 2. These findings suggest that n-3-rich fish intake tends to be associated with depressive symptoms in older adults. However, other factors, such as physical exercise, are as pivotal as n-3 fatty acids in preventing the development of depressive symptoms.

How much time in sedentary behavior is associated with probable sarcopenia in older adults?

Sedentary activities, such as watching television and using the computer, are frequent conditions in older adults and can be associated with sarcopenia. The objectives of this study were: (a) to establish sedentary behavior (SB) cutoff values for screening probable sarcopenia in community-dwelling older adults and (b) to verify the association between SB and probable sarcopenia according to the established cutoff point. This was a cross-sectional study including 1,165 community residents in Florianopolis/SC. SB was assessed using the International Physical Activity Questionnaire. The outcome was probable sarcopenia (assessed by time ≥ 15 s in the Five times sit-to-stand test). The cut-off points found for SB were time > 120 min/day [AUC: 0.54 (95%CI: 0.51; 0.57)] watching TV or video/DVD and ≤ 20 min/day [AUC: 0.59 (95%CI: 0.56;0.62)] using computer/internet. Older adults with SB had 1.30 (95% CI: 1.01; 1.66) and 1.46 (95% CI: 1.08; 1.96) greater chances of having sarcopenia, respectively.

Metabolic syndrome and its association with changes in modifiable risk factors: Epifloripa aging study.

Purpose: To estimate the prevalence of Metabolic Syndrome (MetS) and its association with changes in modifiable risk factors in older adults from southern Brazil. Methods: A longitudinal study was performed with data from EpiFloripa Aging study. We defined MetS by the existence of three or more of the following risk factors for cardiovascular disease (CVD): waist circumference (WC) (≥ 92 cm in men and ≥ 87 cm in women); fasting glucose (≥100 mg/dl); decreased HDL cholesterol (<40 mg/dl in men and <50 mg/dl in women); hypertriglyceridemia (≥150 mg/dl) and blood pressure (≥130/85 mmHg). We evaluated the changes in modifiable risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity, and body mass index) between the two moments of the study (2009/10 and 2013/14). Directed acyclic graph and logistic regression models were used. Results: Among the 599 participants, the prevalence of MetS was 64.0% (95% CI, 58.7-68.9). In the adjusted analysis, those who remained or became persons who are overweight (OR = 4.59; 95% CI: 3.05-6.89) and those who remained or became insufficiently active (OR = 1.92; 95% CI: 1.23-2.98) were more likely to present MetS. Conclusion: Our findings suggest that being or becoming overweight and being or becoming insufficiently active are modifiable factors associated with MetS. These results highlight the need for developing preventive strategies for the observed risk indicators to mitigate the prevalence of MetS in older adults.

Is environment perception associated with change in leisure-time physical activity in Brazilian older adults? Results of EpiFloripa Idoso cohort study.

This study aims to analyze the association between perceived characteristics of the neighborhood environment and changes in leisure-time physical activity in Brazilian older adults. Longitudinal analysis was performed considering a population-based study carried out in 2009/2010 with follow-up in 2013/2014. Changes in leisure-time physical activity, obtained with the International Physical Activity Questionnaire during both waves, were associated with data of environment perception with the Neighborhood Environment Walkability Scale - Abbreviated (baseline only) performing multinomial logistic regression. In total, 1,162 older adults (65.2% women, mean age = 73.7 years) participated. Older adults who perceived flat streets, bicycle paths, and high flow of vehicles in the neighborhood were more likely to remain active in leisure time walking. Those who noticed the presence of flat streets also had a greater chance of becoming active than those who did not notice it. Older adults who perceived bicycle paths and sports events were more likely to maintain moderate and vigorous physical activity during leisure time. Furthermore, older adults who noticed parks and squares close to their residence were 0.49 times less likely to become insufficiently active. Brazilian older adults are more active in neighborhoods with more favorable attributes regarding leisure-time physical activity.

Association between physical activity and vitamin D is partially mediated by adiposity in older adults: EpiFloripa Aging Cohort Study.

Studies have found that physical activity (PA) could be a protective factor and adiposity a risk factor for low serum 25-hydroxycholecalciferol (25(OH)D) concentration. This cross-sectional study hypothesized that PA could have a direct effect on 25(OH)D, and adiposity could be a mediating factor. Data from the second wave of the EpiFloripa Aging longitudinal study, collected during 2013 and 2014 (n = 1197) in Florianopolis, Santa Catarina, Brazil, was used. PA was measured using an accelerometer and classified as light PA (LPA), moderate and vigorous PA (MVPA), and total PA (TPA); 25(OH)D levels were measured using the microparticle chemiluminescence method. Body fat composition (%fat) was assessed using dual-energy X-ray absorptiometry. Structural equation modeling was performed to analyze the total, direct, and indirect effects of PA on %fat and 25(OH)D levels, presented using the standardized coefficient (ß). Participants with complete data were included in the analysis (n = 574, 66.7% female). MVPA showed a direct (ß = 0.11; P < .05) and total positive effect on 25(OH)D (ß = 0.12; P < .05). All models of PA had a direct negative effect on %fat. Additionally, a direct negative effect of %fat on 25(OH)D was observed in all models. A marginal and partial effect of %fat as a mediator of the relationship between MVPA and 25(OH)D was noted (ß = 0.01, P = .09). Our results show that PA presents a direct effect on serum 25(OH)D. %fat has a small contribution as a mediator of this relationship. These data suggest that an increase in MVPA and a decrease in %fat could be strategies to increase 25(OH)D levels in older adults.