Effect of education and multimorbidity on mortality among older adults: findings from the health, well-being and ageing cohort study (SABE).

OBJECTIVES: This study assessed the moderating role of education on the relationship between multimorbidity and mortality among older adults in Brazil. STUDY DESIGN: This was a cohort study. METHODS: This study used data from 1768 participants of the Health, Well-Being and Ageing Cohort Study (SABE) who were assessed between 2006 and 2015. The Cox Proportional Risks Model was used to evaluate the association between multimorbidity (two or more chronic diseases) and mortality. An interaction term between education and multimorbidity was included to test the moderating role of education in this association. RESULTS: The average follow-up time was 4.5 years, with a total of 589 deaths in the period. Multimorbidity increased the risk of mortality (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.27-1.91), and this association was not moderated by education (HR 1.06, 95% CI 1.00-1.13; P value = 0.07). CONCLUSIONS: The impact of education and multimorbidity on mortality emphasises the need for an integrated approach directed towards the social determinants of health to prevent multimorbidity and its burden among older adults.

Body Composition Changes and 10-Year Mortality Risk in Older Brazilian Adults: Analysis of Prospective Data from the SABE Study.

INTRODUCTION: Aging related alterations in body composition are associated with higher all-cause mortality risk. OBJECTIVE: To examine the associations between 10-year mortality risk with both BMI and body composition, as well as to establish whether these relationships are modified by age and gender, using data from community-dwelling older Brazilian adults. METHODS: We used data from two waves i.e., 2000 and 2010 of the SABE (Health, Well-being, and Aging) study conducted in São Paulo, Brazil, involving a probabilistic sample of community-dwelling older adults aged 60 years and older. The variables of the study were: mortality (in 10-year follow-up period), body mass index (BMI), body composition (waist circumference, waist hip ratio, triceps skinfold thickness, mid-upper arm circumference, calf circumference, and arm muscle area) and covariables (sociodemographic characteristics, life style, self-reported health conditions, number of chronic diseases, Mini mental state exam, and Geriatric depression scale). Poisson regression estimates with STATA statistical software were used for statistical analyses, considering all p-values < 0.05. RESULTS: Over the 10-year follow-up period, there were 769 deaths (40.2%). The mortality rate was 61.0 for men and 111.8 for the ≥80 age group. In the fully adjusted model, statistically significant hazard ratios were found for low muscle mass (IRR: 1.33), underweight (IRR: 1.29), and low fat mass (IRR: 1.31) with mortality. Men in extreme BMI categories (underweight - IRR: 1.47; obesity I - IRR: 1.66; and obesity II - IRR: 1.91) and women with low muscle and low fat mass were significantly associated with mortality risk. In the ≥80 age group it was observed that low muscle mass (IRR: 168.7), inadequate body reserves (IRR: 1.63), low fat mass (IRR: 140.7), and underweight (IRR: 142.9) were associated with mortality risk. Waist circumference demonstrated protection for mortality in the high-risk categorization for the ≥80 age group. CONCLUSION: Our results showed that underweight, low fat mass, and low muscle mass were associated with mortality risk, presenting different roles considering gender and age in older Brazilian adults over a 10-year follow-up period.

Dynapenic Abdominal Obesity Increases Mortality Risk among English and Brazilian Older Adults: A 10-Year Follow-Up of the ELSA and SABE Studies.

BACKGROUND/OBJECTIVE: There is little epidemiological evidence demonstrating that dynapenic abdominal obesity has higher mortality risk than dynapenia and abdominal obesity alone. Our main aim was to investigate whether dynapenia combined with abdominal obesity increases mortality risk among English and Brazilian older adults over ten-year follow-up. DESIGN: Cohort study. SETTING: United Kingdom and Brazil. PARTICIPANTS: Data came from 4,683 individuals from the English Longitudinal Study of Ageing (ELSA) and 1,490 from the Brazilian Health, Well-being and Aging study (SABE), hence the final sample of this study was 6,173 older adults. MEASUREMENTS: The study population was categorized into the following groups: non-dynapenic/non-abdominal obese, abdominal obese, dynapenic, and dynapenic abdominal obese according to their handgrip strength (< 26 kg for men and < 16 kg for women) and waist circumference (> 102 cm for men and > 88 cm for women). The outcome was all-cause mortality over a ten-year follow-up. Adjusted hazard ratios by sociodemographic, behavioural and clinical characteristics were estimated using Cox proportional hazards models. RESULTS: The fully adjusted model showed that dynapenic abdominal obesity has a higher mortality risk among the groups. The hazard ratios (HR) were 1.37 for dynapenic abdominal obesity (95% CI = 1.12 - 1.68), 1.15 for abdominal obesity (95% CI = 0.98 - 1.35), and 1.23 for dynapenia (95% CI = 1.04 - 1.45). CONCLUSIONS: Dynapenia is an important risk factor for mortality but dynapenic abdominal obesity has the highest mortality risk among English and Brazilian older adults.

The Relationship between Anemia, Hemoglobin Concentration and Frailty in Brazilian Older Adults.

OBJECTIVE: to explore the relationship between anemia, hemoglobin concentration and frailty syndrome in older adults. RESEARCH METHODS AND PROCEDURES: This was a cross-sectional population-based study, with adults ≥60 years (n=1,256) from the third wave of the SABE Cohort Study (Health, Well-being and Aging) conducted in 2010 in São Paulo, Brazil. Frailty syndrome was evaluated according to Fried´s phenotype. Anemia was defined using the WHO criteria (hemoglobin concentration <12 g/dL for women and <13 g/dL for men). Four approaches were used to verify the associations between anemia, hemoglobin concentration and frailty status or number of frailty criteria. We used logistic regression and Poisson regression in the analyses, and they were adjusted in three hierarchical models using three blocks of variables: basic characteristics; clinical characteristics; cognitive status. RESULTS: Mean hemoglobin concentration was significantly lower in frail elderly (13.3g/dL, versus 14.3g/dL in non-frail; p<0.001). Prevalence of anemia was also significantly higher in frail when compared to non-frail elderly (24.2% and 3.8%; p<0.001). Anemia was significantly associated to low physical activity, weakness and slowness. In the fully adjusted regression models, anemia was strongly associated to frailty (OR=3.27, 95%IC=1.89,5.65; p<0.001), and lower levels of hemoglobin were associated to higher number of frailty criteria. CONCLUSIONS: We found important associations between anemia, hemoglobin concentration and frailty; anemic older adults were more likely to be frail, and lower levels of hemoglobin were associated to higher number of frailty criteria showing a clear dose-response effect.

Sarcopenia according to the european working group on sarcopenia in older people (EWGSOP) versus Dynapenia as a risk factor for disability in the elderly.

BACKGROUND: Sarcopenia, defined as low muscle mass (LMM), and dynapenia have been associated with adverse outcomes in elderly. OBJECTIVE: Contrast the association of sarcopenia versus dynapenia with incidence of disability. DESIGN: A four-year prospective study (2006-2010). SETTING: São Paulo, Brazil. PARTICIPANTS: 478 individuals aged 60 and older from the Saúde, Bem-Estar e Envelhecimento (SABE) study who were non-disabled at baseline. MEASUREMENTS: Sarcopenia, measured according to the European Working Group on Sarcopenia in Older People (EWGSOP), includes: LMM assessed by skeletal muscle mass index ≤8.90kg/m2 (men) and ≤6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and <20kg (women); and low physical performance (LPP) assessed by gait speed ≤0.8m/s. Diagnosis of sarcopenia required LMM plus LMS or LPP. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, perception of vision, hearing and body mass index. OUTCOMES: Disability in mobility or instrumental activities of daily living (IADL) or disability in activities of daily living (ADL) and IADL. RESULTS: The incidence density of mobility or IADL disability was 43.4/1000 person/year and 22.6/1000 person/year for IADL and ADL disability. There was no significant difference in incidence density according sarcopenia or dynapenia status. After controlling for all covariates, sarcopenia was associated with mobility or IADL disability (relative risk ratio = 2.23, 95%Confidence Interval: 1.03-4.85). Dynapenia was not associated with disability. CONCLUSIONS: Sarcopenia according to the EWGSOP definition can be used in clinical practice as a screening tool for early functional decline (mobility or IADL disability).