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Background: Falls cause 58% of injury-related Emergency Department (ED) attendances. Previous research has highlighted the potential role of cardiovascular risk factors for falls. This study investigated the impact of cardiovascular disease (CVD) risk on three-year incident falls, with presentation to the ED, and mortality. Methods: A matched cohort study design was employed using national registry data from 82,292 adults (33% male) aged ≥ 65 years living in Denmark who attended the ED in 2013. We compared age and gender matched ED attendees presenting with a fall versus another reason. The cohort was followed for three-year incident falls, with presentation to the ED, and mortality. The impact of falls-related CVDs was also examined. Results: Three-year incident falls was twofold higher among age and gender matched ED attendees aged ≥ 65 years presenting with a fall versus another reason at baseline. A presentation of falls with hip fracture had the highest percentage of incident falls in the 65–74 age group (22%) and the highest percentage mortality in all age groups (27–62%). CVD was not a significant factor in presenting with a fall at the ED, nor did it contribute significantly to the prediction of three-year incident falls. CVD was strongly associated with mortality risk among the ED fall group (RR = 1.81, 95% CI: 1.67–1.97) and showed interactions with both age and fall history. Conclusion: In this large study of adults aged ≥ 65 years attending the ED utilising data from national administrative registers in Denmark, we confirm that older adults attending the ED with a fall, including those with hip fracture, were at greatest risk for future falls. While CVD did not predict incident falls, it increased the risk of mortality in the three-year follow up with advancing age. This may be informative for the provision of care pathways for older adults attending the ED due to a fall. [ABSTRACT FROM AUTHOR]

Background Sarcopenia and orthostatic hypotension are growing age-related health burdens associated with adverse outcomes, including falls. Despite a possible pathophysiological link, the association between the 2 disorders is not well elucidated. We sought to investigate this relationship in The Irish Longitudinal Study on Ageing (TILDA). Methods Data from 2 858 participants at wave 3 of TILDA were analyzed. Probable sarcopenia was defined as per the European Working Group on Sarcopenia in Older People revised definition cutoffs (hand grip strength [HGS] <27 kg in men, <16 kg in women, and/or 5-chair stand test [5CST] time >15 seconds). Participants underwent an active stand orthostatic test with continuous blood pressure (BP) monitoring. Multilevel mixed-effects models, controlling for possible confounders, were used to assess the effect of probable sarcopenia by HGS and 5CST criteria on the change in BP after standing. Results HGS- and 5CST-defined probable sarcopenia were independently associated with an attenuated BP recovery at 10–20 seconds poststand (systolic BP: β −0.54, p <.001; β −0.25, p <.001). On average, those meeting HGS probable sarcopenia criteria had a significantly lower BP at 20, 30, and 40 seconds (differences in systolic BP: −5.01 mmHg, −3.68 mmHg, −2.32 mmHg, p <.05 for all). Those meeting 5CST probable sarcopenia criteria had a significant difference in systolic BP at 20 seconds (−1.94 mmHg, p =.002) but not at 30 or 40 seconds. Conclusion Probable sarcopenia had a significant association with delayed orthostatic BP recovery, with HGS-defined probable sarcopenia having a stronger association than 5CST-defined probable sarcopenia. Results support a modest but significant pathophysiological link between probable sarcopenia and orthostatic hypotension. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Older adults have both the highest risk of contracting SARS-CoV-2 and in many jurisdictions have had additional restrictions placed on the social interactions. As a result, the COVID-19 pandemic has led to increased depression and loneliness among older adults. Using data from an established cohort of older adults, the aims of this study was to describe changes in loneliness and depression and to examine the directionality of the association between depression and loneliness over a 5-year period that included the early months of the pandemic. Methods: Data were from The Irish Longitudinal Study on Ageing (TILDA), a large cohort of community-dwelling adults aged 54+. We applied an auto-regressive cross-lagged panel modelling approach to estimate the effect of depression on loneliness and vice versa over three time points. Results: Both depression and loneliness increased significantly in the early months of the pandemic. While the association between loneliness and depression was bidirectional, loneliness was a stronger predictor of depression. Conclusion: The strength and bi-directionality of the association between loneliness and depression suggests that interventions to alleviate loneliness may also help reduce depressive symptoms and vice versa. [ABSTRACT FROM AUTHOR]

Background: Frailty, expressed as accumulation of health deficits in older adults, could contribute to the risk of cognitive decline. We cross‐sectionally studied the brain connectivity signatures of frailty in The Irish Longitudinal Study on Ageing (TILDA). Method: We included participants from Wave 3 of TILDA who underwent resting‐state functional MRI. Connectivity maps were based on Shen's parcellation and connectome‐based predictive modeling was used to find associations between connectivity and frailty as measured by Frailty Index (FI) (Table 1). On each iteration of a 10‐fold cross‐validation the training folds were utilized to perform partial Spearman correlations (adjusted for age, sex, and mean framewise displacement) between each brain connection and FI scores. Connections with p<0.001 correlations were selected. Network strength was computed by summing the correlations across all connections selected and a linear model built using the network strength to predict FI score. After 10 folds are complete the performance was measured with linear R values between predicted and true FI scores. This process was repeated 1000 times (with random cross‐validation splits) and mean performance metrics obtained. A permutation test was employed in which the above procedure was repeated 1000 times, with FI scores shuffled each time. Significance of selected connections was calculated as the number of permutations scores that were equal to or greater than the proper mean score, divided by 1000. Result: 347 participants were included (mean age 67.7 (SD 7.3) and 51.6% men). We obtained a connectivity network that positively correlated with frailty ("frailty network") (R = 0.169, p = 0.006) and another that negatively correlated with frailty ("robustness network") (R = ‐0.193, p = 0.006); and are depicted in Figure 1. The "frailty network" was more widespread and showed higher connectivity from right occipital to both prefrontal cortices, subcortical and left temporal cortex, whereas the "robustness network" exhibited higher functional connectivity in subcortical to left parietal and bilateral temporal cortices. Conclusion: Functional brain connectivity could be influenced by frailty. Further research should study the relationship of brain connectivity and different tools for frailty and establish how different patterns of deficit accumulation affect brain health across lifespan. [ABSTRACT FROM AUTHOR]

Objective: To examine associations of plasma folate concentrations and risk of global and domain-specific cognitive decline in older people.Methods: Data of 3140 participants from The Irish Longitudinal Study on Ageing (TILDA), a nationally-representative cohort of adults aged ≥50 years were used over 8-year follow-up. Biannual cognitive assessments included the Mini-Mental State Examination (MMSE), verbal fluency and immediate and delayed word recall tests (Waves 1-5) and the Montreal Cognitive Assessment, (MoCA) (Waves 1 and 3). Plasma folate concentrations were measured in stored blood collected at baseline. Mixed effects Poisson and linear regression determined associations between baseline folate concentrations and cognition.Results: In multivariable-adjusted models of those aged ≥50 years at baseline, low folate at baseline (<11.2 nmol/L) was associated with higher proportions of MMSE errors (incidence rate ratio [IRR] = 1.10; 95% confidence interval [CI] (1.00, 1.21), lowest vs. highest quintile) over 8 years. Plasma folate <21.8 nmol/L predicted declines in episodic memory for immediate (beta [β] = -0.26; 95% CI (-0.48, -0.03), β = -0.29; 95% CI (-0.50, 0.08) and β = -0.29; (-0.50, -0.08), for lowest three vs. highest quintile) and delayed recall (β = -0.20; 95% CI (-0.38, -0.01), β = -0.18; 95% CI (-0.37, -0.01) and β = -0.19; (-0.36, -0.01) lowest three vs. highest quintile). There were no significant associations in a subsample aged ≥65 years.Conclusion: In those aged ≥50 years, lower concentrations of folate may have differential relationships with cognitive domains. Folate <11.2 nmol/L predicted a decline in global cognitive function, while <21.8 nmol/L predicted poorer episodic memory. Low folate was associated with accelerated decline in cognitive function and is an important marker for cognitive decline among older people. [ABSTRACT FROM AUTHOR]

Background: NT‐proB‐type Natriuretic Peptide (NTproBNP) is a hormone released in response to changes in pressure inside the heart often related to heart failure and other cardiac problems. Early evidence shows significant correlations between brain structure and markers of heart failure including ejection fraction and NTproBNP. We sought to investigate if levels of this biomarker are related to cognitive decline over 10 years in older adults participating in the Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of adults aged 50 years and older residing across Ireland. Method: Levels of NTproBNP were measured in 4,105 participants, mean age 61.5 years and 53.8% women, from blood drawn at baseline (Wave 1: 2009‐2011). Verbal memory (10‐word immediate and delayed recall) and verbal fluency/ executive function (animal naming) were measured every two‐years over a 10‐year follow‐up (Wave 1 – 6) and were used to create a composite score at each wave which served as a measure of global cognitive function. Linear mixed effect models with adjustment for covariates were performed. Model 1 included age, age^2, sex, education; Model 2 included Model 1 + cardiovascular diseases (heart failure, heart attack, stroke, tia, hypertension, diabetes), lifestyle factors (smoking, alcohol, physical activity, waist‐hip ratio) and depression. Result: NTproBNP was significantly and negatively associated with cognitive function at Wave 3 (B = ‐0.13, 95%CI = ‐0.20, ‐0.05), Wave 4 (B = ‐0.24, 95%CI = ‐0.31, ‐0.16), Wave 5 (B = ‐0.25, 95%CI = ‐0.32, ‐0.17) and Wave 6 (B = ‐0.26, 95%CI = ‐0.34, ‐0.17) (p<.001) (Figure 1). After further adjustment, the associations remained significant. Conclusion: These results suggest that NTproBNP may be useful as an early indicator of cognitive decline in older adults for those with and without current cardiovascular diseases. [ABSTRACT FROM AUTHOR]

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 B 12 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. B 12 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 B 12 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; B 12 :315·7 v. 335·9 pmol/l; P = 0·0148). Regression models demonstrated that participants with deficient-low B 12 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 B 12 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 B 12 status for depression in older adults.