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Introduction: Dietary protein intake and serum amino acids (AAs) are factors controlling the rate of muscle protein synthesis and catabolism. This study examined the association between serum AAs patterns and incident sarcopenia in community-dwelling older adults. Methods: Chinese older adults in Hong Kong aged ≥65 years attended a health check at baseline and 4-year follow-up. At baseline, fasting blood was collected to measure 17 serum AAs. Serum AAs patterns were identified using principal component analysis. Dietary protein intake was assessed using a validated food frequency questionnaire. A composite score was computed by summing the principal component score and sex-standardized protein intake. Six composite scores representing each AAs pattern were available for each participant. Sarcopenia was defined using the updated version of the Asian Working Group for Sarcopenia. Crude and adjusted multiple logistic regressions were performed to examine the associations between each of the 6 composite scores and sarcopenia over 4 years. Results are presented as odds ratio (OR) and 95% confidence interval (CI). To address multiple testing, a Bonferroni correction was applied using a corrected significance level of p < 0.008 (α 0.05/6 patterns). Results: Data of 2,610 participants (mean age 71.6 years, 45.4% men) were available. In men, serum AAs patterns characterized by high branched-chain AAs (BCAAs) (OR 0.77, 95% CI 0.69–0.87, p < 0.001) and tyrosine, tryptophan, and phenylalanine (OR 0.79, 95% CI 0.71–0.89, p < 0.001) were significantly associated with a lower risk of sarcopenia over 4-year follow-up. After adjusting for confounders, the associations were no longer significant. In women, serum AAs patterns characterized by glutamine, glutamic acid, and methionine (OR 1.28, 95% CI 1.11–1.47, p = 0.001) and arginine, taurine, and serine (OR 1.20, 95% CI 1.06–1.35, p = 0.003) were associated with a higher risk of sarcopenia. After adjusting for confounders, serum AAs pattern characterized by high BCAAs (adjusted OR 1.52, 95% CI 1.25–1.86, p < 0.001) and arginine, taurine, and serine (adjusted OR 1.30, 95% CI 1.09–1.56, p = 0.004) were significantly associated with a higher risk of sarcopenia. No association between other AAs patterns with incident sarcopenia was found. Conclusions: In community-dwelling Chinese older adults, serum AAs patterns characterized by high BCAAs and nonessential AAs (arginine, taurine, and serine) were associated with a higher risk of sarcopenia in women. Findings may allow identifying new targets for interventions.

Background: Given findings that generally support the benefits of information and communication technology (ICT) for older adults’ psychosocial adjustment, one might surmise that lonely older adults, who have a stronger need for psychological support, would reap more psychosocial benefits from ICT use. However, scant research has examined this view, much less the likelihood that ICT use might worsen the psychological well-being of lonely older adults, as has been shown to be the case in younger adults. Objective: To examine whether the association between ICT use and psychological adjustment (i.e., psychological distress and sense of community [SOC]) among older adults depends on their loneliness levels. Methods: A representative sample of 738 Hong Kong SAR Chinese older adults aged 60 years or older (56% female) was interviewed in 2017 on loneliness, frequency of ICT use (i.e., Internet and smart devices), psychological distress (6-item Kessler scale; K6), and SOC. Results: Regression analyses showed that loneliness significantly moderated the relationship between ICT use frequency and psychological adjustment (psychological distress and SOC); more frequent ICT use was associated with more psychological distress and less SOC, with higher levels of loneliness. Conclusion: These findings suggest that ICT use may be a mixed blessing for older adults, i.e., using more ICT might predict worse psychological adjustment among lonelier older adults. Efforts that promote ICT use among older adults should take their loneliness levels into account.

Background: Few studies have examined the impact of sex across different age groups and over time on chronic diseases in Asia. The objective of this study was to explore the effect of sex across different age groups and over time on stroke incidence and 30-day case fatality in Hong Kong. Methods: Over 90% first hospitalizations for stroke in Hong Kong (from 2000 to 2007) were identified from the Clinical Management System of the Hospital Authority. Age-specific rate ratios (RRs; women to men) for incidence of first hospitalization and the 30-day case fatality were estimated based on Poisson regression models after adjustment for year of hospitalization. Results: Women below the age of 85 years had a lower incidence of first hospitalization than men, and the effect size varied with age [35–44 years: RR = 0.56, 95% confidence interval (CI) = 0.49–0.64; 45–54 years: 0.65, 0.53–0.79; 55–64 years: 0.58, 0.48–0.71; 65–74 years: 0.71, 0.58–0.85; 75–84 years: 0.83, 0.68–1.00)]. Women aged ≧85 years had a stroke incidence similar to men, but the adjusted 30-day case fatality was significantly higher than that of men aged ≧85 years (RR = 1.14, 95% CI = 1.05–1.23). Conclusions: Lower rates of incidence were observed in women than men aged 35–84 years in Hong Kong but short-term case fatality is greater in women aged ≧85 years.

Background: Physical function decline is associated with dementia, which might either be mediated by the coexisting sarcopenia or directly related to the impaired cognition. Our objectives are to examine the relationship between cognitive function and performance-based physical function and to test the hypothesis that cognitive function is related to poor physical function independent of muscle mass. Methods: We measured muscle strength, performance-based physical function and muscle mass using dual-energy X-ray absorptiometry and cognitive function using the cognitive part of the Community Screening Instrument of Dementia (CSI-D) in 4,000 community-dwelling Chinese elderly aged >65 years. A CSI-D cognitive score of >28.40 was considered as cognitively impaired. The effect of cognitive impairment on muscle strength and physical function was analyzed by multivariate analysis with adjustment for age, appendicular skeletal mass (ASM), the Physical Activity Scale for the Elderly (PASE) and other comorbidities. Results: In both genders, the cognitively impaired (CSI-D cognitive score >28.40) group had a weaker grip strength (–5.10 kg, p < 0.001 in men; –1.08 kg in women, p < 0.001) and performed worse in the two physical function tests (in men, 6-meter walk speed, –0.13 m/s, p < 0.001, chair stand test, 1.42 s, p < 0.001; in women, 6-meter walk speed, –0.08 m/s, p < 0.001, chair stand test, 1.48 s, p < 0.001). After adjustment for age, ASM, PASE and other comorbidities, significant differences in grip strength (–2.60 kg, p < 0.001 in men; –0.49 kg, p = 0.011 in women) and the two physical function tests persisted between the cognitively impaired and nonimpaired group (in men, 6-meter walk speed, –0.072 m/s, p < 0.001, chair stand test, 0.80 s, p = 0.045; in women, 6-meter walk speed, –0.049 m/s, p < 0.001, chair stand test, 0.98 s, p < 0.001). Conclusions: Poor physical function and muscle strength coexisted with cognitive impairment. This relationship was independent of muscle mass. It is likely therefore that the functional decline in dementia might be related directly to factors resulting in cognitive impairment independently of the coexisting sarcopenia.

Background: Sarcopenia is increasingly being recognized as a feature of frailty in old age and is associated with unfavorable health outcomes in Western populations. Little is known about sarcopenia among Asian elderly populations. Objectives: The study was undertaken to study the association between sarcopenia and common chronic illnesses, lifestyle factors, psychosocial well-being and physical performance. Methods: 4,000 community-dwelling Chinese elderly ≧65 years were recruited. Medical illnesses, cigarette smoking, alcohol consumption, physical activity level and psychosocial well-being scores were recorded. Physical performance measured included grip strength, timed chair-stands, stride length and a timed 6-meter walk. Muscle mass was measured using dual-energy X-ray absorptiometry. Relationships between appendicular skeletal muscle mass (ASM/ht2) and multiple variables were analyzed using uni- and multivariate analyses. Results: Mean ASM/ht2 was 7.19 and 6.05 kg/m2 in men and women respectively. Older age, cigarette smoking, chronic lung disease, atherosclerosis, underweight, and physical inactivity were associated with low adjusted ASM, which was in turn associated with poorer physical well-being in men. After adjustment to age, lower appendicular muscle mass was associated with weaker grip strength in both sexes. In men, lower limb tests (chair-stands, walking speed and step length) were not related to ASM, while in women, lower muscle mass was not associated with poorer lower limb muscle performance. Conclusions: Sarcopenia in community-dwelling older Chinese men and women was associated with cigarette smoking, chronic illnesses, underweight, physical inactivity, poorer well-being and upper limb physical performance.

Background: Effective management of heart failure relies on optimal use of non-pharmacological therapy alongside medical treatment. Yet, there is an inadequate use of non-pharmacological therapy in caring for older people with heart failure. Objective: To examine the effects of relaxation therapy and exercise training on psychological outcomes and disease-specific quality of life of older heart failure patients. Methods: Subjects undertook relaxation (n = 59), exercise training (n = 32) or received attention placebo (n = 62) for 12 weeks. The relaxation group attended two training sessions, one revision workshop, and continued with twice-daily taped-directed home relaxation practice, with support from the intervener through bi-weekly telephone contact, for 12 weeks. The exercise group undertook 12 weekly sessions of resistance training and aerobic exercise and thrice weekly home exercise. The control group received regular telephone calls for general ‘greetings’. Results: The relaxation and exercise groups reported a significantly greater improvement in psychological [F(2, 149) = 6.69, p = 0.002] and various disease-specific quality of life outcomes [dyspnea: F(2, 149) = 5.72, p = 0.004; fatigue: F(2, 149) = 3.78, p = 0.25; emotion: F(2, 149) = 6.68, p = 0.001], compared with those who received the attention placebo. While relaxation therapy was more effective to reduce psychological distress, with depression in particular (p < 0.001), exercise therapy worked better to control fatigue symptoms (p = 0.03). Conclusion: Relaxation therapy and exercise training are effective to improve the psychological and physical health of older heart failure patients. They should be used as an individual treatment modality, or as care components of a disease management program.

Objectives of this study were to determine the prevalence of positive tuberculin reactivity and associated factors among elderly nursing home residents in a population with a relatively high tuberculosis notification rate, to estimate the prevalence of active tuberculosis, and to assess tuberculin reactivity as a screening tool. A stratified, disproportional, randomized cluster sample of residents was selected and the Mantoux test (using 0.1 ml of 5 tuberculin units of purified protein derivative of tuberculin) carried out. All subjects with a positive test had a chest X-ray followed by sputum smear and culture if the X-ray was abnormal. Sputum examination was also carried out in a random sample of controls, matched for age and gender, drawn from subjects with a negative Mantoux test. Information regarding medical history, tobacco smoking habits, symptoms related to tuberculosis, and communal eating habits were gathered. Also anthropometric data were collected. Sixteen nursing homes in the catchment area of a major district hospital in Hong Kong comprising 587 residents (136 men, 451 women, mean age 80 +/- 8 years) participated in this study. The weighted prevalence of tuberculin reactivity was 43.8%. It was higher in men, among those who took their meals in a common area, in the younger age group, and in those with no previous history of hospitalization. No association was found between prevalence and duration of residence, smoking, skinfold thickness, past medical history, or any relevant symptoms. Following radiological and sputum examination, the estimated prevalence of active tuberculosis ranged from 1.2 to 2.6%. The sensitivity of the tuberculin test was 86, the specificity 30%. The prevalence of active tuberculosis in nursing homes in Hong Kong is high, but it is unclear whether cross-infection or poor health of the residents is the major contributing factor. Tuberculin skin testing does not appear to be a useful screening method in this population.

To determine the influence of age, disease and other factors on anthropometric indices in elderly subjects aged 70 years and above, body mass index (BMI), arm muscle circumference (AMC), corrected arm muscle area (CAMA), fat-free mass (FFM) and total body fat (TBF) were determined in a random sample of 990 Chinese men and 1,021 women aged 70 years and over stratified by age and sex. Old age, presence of disease, poor self-perceived health, poor functional ability, lower level of physical activity, lack of dentures, depression and cognitive impairment were all factors associated with lower anthropometric values. Haemoglobin, total cholesterol and walking speed were also associated factors, although the latter two factors became insignificant after adjusting for age. When subjects with a history of disease or cognitive impairment were excluded, an age-related decline in BMI, AMC, CAMA and TBF was still observed in men although FFM remained unchanged. However, in women, only TBF showed an age-related decline. It is concluded that in the old-old population, both age and disease affect anthropometric indices, the change being more marked in men.

To examine the role of disease-related factors and age-related physiological changes in affecting gait speed and stride length in the elderly.925 men and 890 women aged 70 years and above who were ambulant, recruited by random sampling stratified according to age and sex, from all recipients of Old Age and Disability Allowance in Hong Kong.Gait was assessed by measuring the time taken and the number of steps required to complete a 16-foot walk. Information on health and functional status, cognitive function, and depressive symptoms was collected, and anthropometric indices obtained. Factors affecting walking speed and stride were examined in the overall population and also after excluding those with physical disability or diseases.Results were analyzed separately for men and women since mean walking speed was slower in women, who also took a larger number of steps. Age, coexisting disease, leg or back pain, poor vision, low level of physical activity, functional and cognitive impairment, high depressive symptom score, and anthropometric indices were all negatively associated with walking speed. Fallers also had slower speed. After excluding those with diseases or physical impairment, multivariate analysis showed that the only factors affecting speed were age in men, and age, height, and level of physical activity in women. Age and height were factors associated with stride length in men, and height only for women.Both disease-related factors as well as age-related physiological changes contribute to the decline in walking speed and stride length.

In a health survey of 2,032 elderly Hong Kong Chinese aged 70 years and over selected by stratified random sampling, a subset of 199 subjects (96 M, 103 F) were selected for a study of their lipid profile. No age and sex differences were observed in mean total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride concentrations in this subgroup. Compared with values from younger Chinese subjects from a previous survey, TC and LDL-C showed an age-related rise up till about 60 years, followed by a gradual decline. HDL-C concentrations showed little variation with age. Nonagenarians had a LDL/HDL ratio similar to subjects in the24 age group and lower than male subjects in the age 35-64 age group. HDL-C was lower in those with heart disease or hypertension. Other lipid parameters were not influenced by the presence of other chronic diseases, self-perceived health status, or cognitive impairment. TC was positively associated with the Barthel Index, a measure of functional ability. Positive associations between obesity indices and diastolic blood pressure, and TC, LDL-C, and triglycerides were present.(ABSTRACT TRUNCATED AT 250 WORDS)

216 survivors of acute stroke were studied 3 months postictus to determine predictors of long-term survival and disability 20 months after the initial stroke. Factors predicting mortality were, in order of importance, old age, a history of ischaemic heart disease, low mental-test score, low serum cholesterol concentration, low Glasgow Coma Score on admission, and the presence of left ventricular hypertrophy. 73% of subjects were correctly classified by discriminant function analysis using these variables. Factors predicting poor functional outcome (Barthel Index 15) were a low Barthel Index at 3 months, old age, low mental-test score at 3 months and a low Glasgow Coma Score on admission. 70% of subjects were correctly classified into 3 functional-outcome groups using these variables. Stroke subtype and size, position, and the territory of the lesion on brain CT did not influence long-term outcome. We conclude that factors affecting long-term survival and disability are different from those affecting outcome immediately after stroke.

The effect of environmental temperature on stroke occurrence in a subtropical climate was studied over a 1-year period by documenting the number of strokes (subdivided into cerebral infarct and intracerebral hemorrhage) admitted into a district hospital in Hong Kong at different temperatures. There was no significant correlation between the number of strokes (or its subtypes) per day per temperature category and the environmental minimum or maximum temperature. However, an association was present between the occurrence of cerebral infarcts and maximum temperature on the day of onset in elderly patients aged 70 years and above. Environmental temperature is not a strong risk factor for the occurrence of stroke in a subtropical climate.

In a longitudinal study of 283 elderly subjects aged 60 years or over living in the community, 9 subjects (7 women and 2 men) developed osteoporosis-related fractures in 30 months. These subjects initially had higher random urinary hydroxyproline/creatinine and calcium/creatinine ratios, and lower plasma 25-hydroxyvitamin D concentrations. These biochemical variables may be useful predictors of osteoporosis-related fractures and may provide a suitable community screening method to identify those most at risk.