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Observed increases in retirement age are generally attributed to policies to extend working lives (PEW). In a quasi-experimental design, we examine to what extent increases in employment of older workers can be attributed to secular changes in individual characteristics as opposed to PEW. We compare two countries: one with clear PEW (the Netherlands) and one without PEW (Norway). Data come from the Dutch Longitudinal Aging Study Amsterdam and the NORwegian Longitudinal study on Aging and Generations. From each study, two same-age (55–64 years) samples are selected, one recruited in 2002–03, and one recruited after five (Norway) and ten years (Netherlands). In pooled regression analysis, paid work is the outcome variable, and time of measurement, the main independent variable. Individual characteristics include age, sex, educational level, self-perceived health, functional limitations, sense of mastery, and work status of partner. Employment rose in both countries, faster in the Netherlands than in Norway. Of the rise in employment, individual characteristics explained less in the Netherlands than in Norway. Accounting for these, the interaction country*time was significant, indicating an extra rise in employment of 5.2 and 7.5% points for Dutch men and women, net of individual characteristics and unobserved factors that are assumed to be similar in both countries. The extra rise in the Netherlands represents 57% of the total rise for both sexes. Thus, secular change in individual characteristics explains part of the rise in employment in both countries. In the Netherlands, other factors such as PEW may additionally explain the rise in employment. [ABSTRACT FROM AUTHOR]

Background Monitoring of trends in functioning of older adults provides indispensable information for health care policy. This study examined trends in multiple indicators of functioning among Dutch older adults across a period of 20 years. Methods Data from the Longitudinal Aging Study Amsterdam were used. We included 10 870 observations of 3803 respondents aged 64–84 years across seven waves (1992–12) and 931 observations of 603 respondents aged 85–94 years across four waves (2001–12). At each wave, 8 indicators of functioning were measured: multimorbidity, severe functional limitations, depression, anxiety, cognitive impairment, physical inactivity, loneliness and social isolation. In addition, a sum score (range: 0–8) of these indicators was calculated, with a score of ≥5 indicating 'multiple problems.' Trends in functioning over time were assessed using Generalized Estimating Equation analyses. Results In the 64-84-years-olds, the prevalence of multimorbidity increased over time [OR(year) = 1.06, 95% CI = 1.05–1.06], whereas the prevalence of the other indicators decreased [i.e. cognitive impairment, physical inactivity (in women) and loneliness (in women)] or remained stable [i.e. severe functional limitations, depression, anxiety, physical inactivity (in men), loneliness (in men) and social isolation]. In the 85-94-year-olds, the prevalence of severe functional limitations increased over time [OR(year) = 1.08, 95% CI = 1.02–1.13], whereas the prevalence of the other indicators remained stable. In both age groups, the prevalence of 'multiple problems' remained stable. Conclusion Unfavorable trends were observed in multimorbidity among 64-84-years-olds and in severe functional limitations among 85-94-year-olds. Favorable trends were found in cognitive impairment, physical inactivity (in women) and loneliness (in women) among 64–84-years-olds. [ABSTRACT FROM AUTHOR]

Women's physical functioning declines with age and the rate of decline increases with age, but substantial disparities exist in trajectories over time. To inform development of interventions to optimise physical functioning across the adult life span, the aim is to explore which lifestyle and socio-economic position (SEP) factors contribute to disparities in physical functioning across the adult life span in women. Younger (born 1973–1978, n = 14,247), middle-aged (born 1946–1951, n = 13,715) and older (born 1921–1926, n = 12,432) participants from the Australian Longitudinal Study on Women's Health completed six questionnaires between 1996 and 2012 at approximate 3-year intervals. Physical functioning was measured with a 10-item subscale of the Short-Form Health Survey (score 1–100). Relationships between age and physical functioning were modelled using spline regression, stratified by baseline categories of physical activity, alcohol intake, smoking status, level of education, managing on income and index of neighbourhood socio-economic disadvantage for area. Multivariable models excluding one of the six factors were compared with models including all six factors to examine the relative importance of each factor. Women with unhealthy lifestyles (inactive, smokers or risky alcohol intake) and lower SEP had lower levels of physical functioning and more rapid declines across the adult life span. The variables with the greatest relative contribution to the models for physical functioning differed by age cohort: i.e. education and physical activity in younger women, managing on income and physical activity in middle-aged women and physical activity in older women. For optimal physical functioning, socio-economic factors seemed particularly important in younger and middle-aged women, while physical activity seemed important at all ages. [ABSTRACT FROM AUTHOR]

Objectives. To examine 23-year trends in both physically and cognitively healthy life expectancy from age 65 years in the Netherlands. Methods. We used 8 waves between 1993 and 2016 from the nationally representative Longitudinal Aging Study Amsterdam (12 948 observations). We calculated physically and cognitively healthy life expectancies by using the Sullivan life table method and tested prevalence trends over time by using generalized estimating equations. Results. Total life expectancy at age 65 years rose from 14.7 to 18.7 years (men) and from 19.2 to 21.4 years (women). Life expectancy in poor physical health increased nonlinearly from 1.8 to 2.9 years for men; for women it fluctuated around 5.7 years. Meanwhile, life expectancy in good cognitive health increased linearly from 11.0 to 15.7 years (men) and from 13.4 to 18.0 years (women). The proportion of people with poor physical and poor cognitive health combined did not increase, averaging 5.9% (men) and 8.7% (women). Conclusions. This multiwave study shows that a negative trend in physically healthy life expectancy is accompanied by a positive trend in cognitively healthy life expectancy. [ABSTRACT FROM AUTHOR]

Background: Unhealthy lifestyle factors, such as obesity, smoking, excessive alcohol consumption and physical inactivity, are associated with increased morbidity and mortality risk, even in older age. We investigated trends in lifestyle among three cohorts of adults aged 55-64 years from the Netherlands. Methods: Data from the Longitudinal Aging Study Amsterdam were used. This study consisted of three randomly selected samples of men and women. Lifestyle data were collected in 1992/1993 (cohort 1, n = 988), in 2002/2003 (cohort 2, n = 1002) and in 2012/2013 (cohort 3, n = 1023). Trends in lifestyle across cohorts were tested using multivariable regression analyses. Results: Complete lifestyle data were available for 834 participants from cohort 1, 861 from cohort 2 and 845 from cohort 3. Among men, but not in women, mean BMI and prevalence of obesity increased over time. The mean minutes per day spent being physically active decreased among both men and women, from 130-107 and 230-122 (1992/1993) to 114-100 and 192-109 (2002/2003), and 126-98 and 187-112 (2012/ 2013), respectively. The percentage of men and women defined as excessive drinkers (>7 alcoholic consumptions per week) increased from 54.9%, 62.3% to 65.4% (men) and 22.7%, 36.1% to 37.4% (women), in 1992/1993, 2002/ 2003 and 2012/2013, respectively. The percentage of non-smoking men and women increased over time. Conclusion: The lifestyle of Dutch adults aged 55-64 years was less healthy in 2012/2013 compared with 2002/ 2003 and 1992/1993. Political attention regarding healthy ageing should target the prevention of overweight, physical inactivity and excessive alcohol consumption in middle-aged persons. [ABSTRACT FROM AUTHOR]

Objective To study time trends in the incidence of persistent cognitive decline (PCD), and whether an increase or decrease is explained by changes in well-known risk factors of dementia. Method Data from the Longitudinal Aging Study Amsterdam over a period of 20 years were used. Subsamples of 65–88 year-olds were selected at 7 waves, with numbers ranging from 1,800 to 1,165. Within-person change in cognitive functioning was used to determine PCD. In logistic generalized estimating equations (GEE), time (0, 3, 6, 9, 13, and 16 years) was the main predictor of 3-year PCD incidence. Explanatory variables were lagged one wave before incident PCD and included in separate models. Results PCD incidence was 2.5% at first, and 3.4% at last follow-up. GEE showed a positive time trend for PCD incidence [Exp(B)time = 1.042; p <.001]. None of the explanatory variables significantly changed the strength of the regression coefficient of linear time. Higher age, lower education, diabetes mellitus, smoking, lower body-mass index, and lower level of physical activity were associated with higher incidence of PCD. Conclusion An increase in PCD incidence over time was found. Although well-known risk factors were associated with incidence per se, they did not explain the increase in incidence of PCD. [ABSTRACT FROM AUTHOR]

Purpose of the Study: To determine the prevalence and extent of successful aging (SA) when various suggestions proposed in the previous literature for improving models of SA are incorporated into one holistic operational definition. These suggestions include defining and measuring SA as a developmental process, including subjective indicators alongside more objective ones, and expressing SA on a continuum. Design and Methods: Data were used from 2,241 respondents in the Longitudinal Aging Study Amsterdam, a multidisciplinary study in a nationally representative sample of older adults in the Netherlands. Latent class growth analysis was used to identify successful 16-year trajectories within nine indicators of physical, cognitive, emotional, and social functioning. SA was quantified as the number of indicators in which individual respondents showed successful trajectories (range 0-9). Results: Successful trajectories were characterized by stability, limited decline, or even improvement of functioning over time. Of the respondents, 39.6% of men and 29.3% of women were successful in at least seven indicators; 7% of men and 11% of women were successful in less than three indicators. Proportions of successful respondents were largest in life satisfaction (>85%) and smallest in social activity (<25%). Correlations of success between separate indicators were low to moderate (range r = .02-.37). Implications: Many older adults age relatively successfully, but the character of successful functioning over time varies between indicators, and the combinations of successful indicators vary between individuals. [ABSTRACT FROM AUTHOR]

Objectives: Building on social stress theory, this study has 2 aims. First, we aim to estimate the effects of stressful life events in childhood and adulthood on Successful Aging (SA). Second, we examine how unequal exposure to such life events between individuals with different socioeconomic position (SEP) contributes to socioeconomic inequalities in SA. Method: We used 16-year longitudinal data from 2,185 respondents aged 55-85 years in 1992 in the Dutch nationally representative Longitudinal Aging Study Amsterdam. Measurement of SA was based on earlier work, in which we integrated trajectories in 9 indicators of functioning into an index of SA. Using path analysis, we investigated direct and indirect effects of parental and adulthood SEP as well as of self-reported childhood and adulthood life events on SA. Results: Almost all included life events had negative direct effects on SA. Parental SEP had no direct effect on SA, whereas adulthood SEP had. Higher Parental SEP increased the likelihood of parental problems and parental death in childhood, resulting in negative indirect effects on SA. Higher adulthood SEP had both positive and negative indirect effects on SA, through increasing the likelihood of divorce and unemployment, but decreasing the likelihood of occupational disability. Discussion: SEP and particular stressful life events are largely, but not entirely independent predictors of SA. We found that high and low SEP may increase exposure to particular events that negatively affect SA. Findings suggest that low (childhood) SEP and stressful life events are interrelated factors that may limit individual opportunities to age successfully. [ABSTRACT FROM AUTHOR]

Objective To examine the role of comorbidity and pain in the associations of hand osteoarthritis (OA) with self-reported and performance-based physical function in a general population of elderly persons. Methods We studied data from 2,942 participants ages 65-85 years in the European Project on OSteoArthritis, a collaborative observational study of 6 European cohorts (from Germany, Italy, The Netherlands, Spain, Sweden, and the UK). Outcome measures included self-reported physical function of the hands measured by the AUStralian/CANadian Osteoarthritis Hand Index (AUSCAN) for hand OA physical function subscale and performance-based grip strength measured using a strain gauge dynamometer. Results Comorbidity was not a confounder in the association of hand OA with self-reported and performance-based functional limitations, while the role of pain as a mediator was confirmed. Anxiety, depression, stroke, and osteoporosis were associated with AUSCAN scores reflecting more impairment. Depression and osteoporosis were associated with less grip strength. Conclusion Although comorbidity was decidedly and independently associated with hand functional limitation, it had no effect on the relationship of hand OA with physical function. Hand OA was found to be associated with both self-reported and performance-based physical function impairment; the association was found to be partially mediated by pain, which reduced its impact. [ABSTRACT FROM AUTHOR]

Objectives To determine whether older people with advance directive for euthanasia ( ADEs) are stable in their advance desire for euthanasia in the last years of life, how frequently older people with an ADE eventually request euthanasia, and what factors determine this. Design Mortality follow-back study nested in a cohort study. Setting The Netherlands. Participants Proxies of deceased members of a cohort representative of Dutch older people (n = 168) and a cohort of people with advance directives (n = 154). Measurements Data from cohort members (possession of ADE) combined with after-death proxy information on cohort members' last 3 months of life. Multiple logistic regression analysis was performed on determinants of a euthanasia request in individuals with an ADE. Results Response rate was 65%. One hundred forty-two cohort members had an ADE at baseline. Three months before death, 87% remained stable in their desire for euthanasia; 47% eventually requested euthanasia (vs 6% without an ADE), and 16% died after euthanasia. People with an ADE were more likely to request euthanasia if they worried about loss of dignity. Conclusion The majority of older adults who complete an ADE will have a stable preference over time, but an advance desire for euthanasia does not necessarily result in a euthanasia request. Writing an ADE may reflect a person's need for reassurance that they can request euthanasia in the future. [ABSTRACT FROM AUTHOR]

As part of long-term care reforms, home-care organisations in the Netherlands are required to strengthen the linkage between formal and informal caregivers of home-dwelling older adults. Information on the variety in mixed care networks may help home-care organisations to develop network type-dependent strategies to connect with informal caregivers. This study first explores how structural (size, composition) and functional features (contact and task overlap between formal and informal caregivers) contribute to different types of mixed care networks. Second, it examines to what degree these network types are associated with the care recipients' characteristics. Through home-care organisations in Amsterdam, the Netherlands, we selected 74 frail home-dwelling clients who were receiving care in 2011-2012 from both informal and formal caregivers. The care networks of these older adults were identified by listing all persons providing help with five different types of tasks. This resulted in care networks comprising an average of 9.7 caregivers, of whom 67% were formal caregivers. On average, there was contact between caregivers within 34% of the formal-informal dyads, and both caregivers carried out at least one similar type of task in 29% of these dyads. A principal component analysis of size, composition, contact and task overlap showed two distinct network dimensions from which four network types were constructed: a small mixed care network, a small formal network, a large mixed network and a large formal network. Bivariate analyses showed that the care recipients' activities of daily living level, memory problems, social network, perceived control of care and level of mastery differed significantly between these four types. The results imply that different network types require different actions from formal home-care organisations, such as mobilising the social network in small formal networks, decreasing task differentiation in large formal networks and assigning co-ordination tasks to specific dyads in large mixed care networks. [ABSTRACT FROM AUTHOR]

Background: poor physical performance (PP) is known to be associated with disability, lower quality of life and higher mortality rates. Knee and hip osteoarthritis (OA) might be expected to contribute to poor PP, through joint pain and restricted range of movement. Both clinical and self-reported OA are often used for large-scale community and epidemiological studies.Objective: to examine the relationships between hip and knee OA and PP in a large data set comprising cohorts from six European countries.Methods: a total of 2,942 men and women aged 65–85 years from the Germany, Italy, Netherlands, Spain, Sweden and the UK were recruited. Assessment included an interview and clinical assessment for OA. PP was determined from walking speed, chair rises and balance (range 0–12); low PP was defined as a score of ≤9.Results: the mean (SD) age was 74.2 (5.1) years. Rates of self-reported OA were much higher than clinical OA. Advanced age, female gender, lower educational attainment, abstinence from alcohol and higher body mass index were independently associated with low PP. Clinical knee OA, hip OA or both were associated with a higher risk of low PP; OR (95% CI) 2.93 (2.36, 3.64), 3.79 (2.49, 5.76) and 7.22 (3.63, 14.38), respectively, with relationships robust to adjustment for the confounders above as well as pain.Conclusion: lower limb OA at the hip and knee is associated with low PP, and for clinical diagnosis relationships are robust to adjustment for pain. Those at highest risk have clinical OA at both sites. [ABSTRACT FROM AUTHOR]

Objective: This study investigates whether the rate of decline in older persons’ hearing status is associated with the rate of decrease in their psychosocial health and explores moderation by baseline hearing status, health-related factors, and sociodemographic factors. Method: Multilevel analyses were applied to data of 1,178 older participants from the Longitudinal Aging Study Amsterdam (LASA), covering 3 to 7 years of follow-up. Results: Faster decrease in speech-in-noise recognition was significantly associated with more increase in loneliness for persons with a moderate baseline speech-in-noise recognition (emotional and social loneliness) and for persons who recently lost their partner (emotional loneliness). No relationship was found with depression. Discussion: The results indicate that faster hearing decline results in more increase in loneliness in specific subgroups of older persons: in persons with an already impaired hearing and in widow(er)s. Monitoring older persons’ hearing seems important and may be a relevant starting point for targeted loneliness prevention efforts. [ABSTRACT FROM PUBLISHER]

Background: Whether middle-aged individuals are capable of employment continuation may be limited by poor memory. Subjective memory complaints may be used to identify those at risk of poor memory. Research questions, therefore, were (i) are prevalent memory complaints associated with relevantly poor memory performance and decline in 55 to 64-year-olds; (ii) are incident memory complaints associated with relevant memory decline; and (iii) do these associations differ between employed and not employed individuals? Methods: Participants of the Longitudinal Aging Study Amsterdam (LASA) were examined. Data were weighted by sex, age and region. To examine the association of prevalent memory complaints with relevantly poor learning ability (n = 903) and delayed recall (n = 897; both assessed with the Auditory Verbal Learning Test), subnormal (&leq; mean − 1 SD) and impaired (&leq; mean − 1.5 SD) memory performance were defined. To examine the association of prevalent and incident memory complaints with relevant decline after 3 years in learning ability (n = 774 and 611, respectively) and delayed recall (n = 768 and 603, respectively), above normal (&leq; mean − 1 SD) and clinically relevant (&leq; mean − 1.5 SD) memory decline were investigated. Logistic regression analyses were applied. Results: Adjusted for gender, education and age, individuals with memory complaints more often had impaired delayed recall and clinically relevant decline in learning ability. Incident memory complaints were borderline significantly associated with clinically relevant decline in learning in continuously employed individuals (paid job &geq;1 h weekly), but not in continuously not employed individuals. Conclusion: Memory complaints may identify 55 to 64-year-olds at risk of memory impairment and decline. Our results provide hypotheses about the association between memory complaints and decline in employed 55 to 64-year-olds. [ABSTRACT FROM AUTHOR]

Background: the STOPP criteria advise against the use of long-acting benzodiazepines (LBs).Objective: to study whether LBs are associated with a higher fall risk than short-acting benzodiazepines (SBs) (elimination half-life ≤10 h).Methods: we used base-line data and prospective fall follow-up from the Longitudinal Aging Study Amsterdam, a longitudinal cohort study including 1,509 community-dwelling older persons (Study 1) and from a separate fall prevention study with 564 older persons after a fall (Study 2). Time to the first fall after inclusion and number of falls in the first year after inclusion were the primary endpoints.Results: both in Study 1 and Study 2 the use of SBs was associated with time to the first fall, hazard ratio (HR) 1.62 (95% CI: 1.03–2.56) and HR 1.64 (95% CI: 1.19–2.26),respectively. LBs were not significantly associated with time to first fall, HR 1.40 (0.85–2.31) and HR 1.08 (0.72–1.62). In both studies, the use of SBs was also associated with number of falls, odds ratio (OR) 1.28 (95% CI: 1.01–1.61) and OR 1.37 (95% CI: 1.10–1.70). LBs were not significantly associated with number of falls, OR 1.23 (0.96–1.57) and 1.10 (0.82–1.48).Conclusions: the use of SBs is not associated with a lower fall risk compared with LBs. The use of both SBs and LBs by old persons should be strongly discouraged. [ABSTRACT FROM AUTHOR]

Objectives To compare actual treatments with preferences for starting or forgoing treatment of older adults at the end of life. Design Mortality follow-back study of relatives of deceased older adults. Preferences and actual treatment were studied for each of four treatments: starting or forgoing resuscitation (do not resuscitate), artificial nutrition and hydration ( ANH), antibiotics, and artificial respiration. Setting Older adults in the Netherlands. Participants Proxies of deceased members (in 2006-2009) of two cohorts representative of the older Dutch population (n = 168) and of people with an advance directive (n = 184). Measurements Relationship between preferred and actual treatment. Results In most individuals who preferred receiving treatment, this preference was followed (n = 2/2, resuscitation; 23/26, ANH; 33/38, antibiotics; 23/24, AR). In approximately half of the individuals who preferred that a treatment be forgone, the preference was followed (n = 6/13, resuscitation; 11/18, ANH; 3/5, antibiotics), except for artificial respiration (n = 1/8). The majority of people for whom no preference was known received treatment (n = 5/9, resuscitation; 19/33, ANH; 15/20, antibiotics; 8/13, artificial respiration). People with a known preference for receiving a specific treatment had a seven times higher chance of preference being followed than people with a known preference for forgoing that treatment. People with a known preference for forgoing a treatment had a six times higher chance of treatment being forgone than people having no known preference. Conclusion Although concordance between preferred and actual treatment is high in older adults who prefer treatment and lower in people who prefer no treatment, making preferences for forgoing treatment known is useful because it increases the chance of treatments being forgone in those who wish so. [ABSTRACT FROM AUTHOR]

Background: Studies on trends in the self-rated health (SRH) of older people have shown conflicting results, which might partly be explained by changing associations between SRH and indicators of other health dimensions over time. Therefore, this study investigates 17-year time trends in older adults’ poor SRH, in the context of trends in chronic diseases and disability, between 1992 and 2009. Methods: Data originate from six measurement waves of the Longitudinal Aging Study Amsterdam (N = 4009, ages 60–85 years). SRH was assessed with the question ‘How is your health in general?’ The presence of lung disease, cardiac disease, peripheral arterial disease, diabetes mellitus, stroke, arthritis and cancer was assessed by self-report. Two severity levels of disability were assessed with six questions on physical functioning. Generalized Estimating Equations (GEE) analysis was applied to assess statistical significance in each time trend. Results: There was a stable trend in the prevalence of poor SRH and severe disability, while the mean number of chronic diseases (1.3–1.8) and the prevalence of mild disability (20.5–32.1%) increased between 1992 and 2009. The association between poor SRH and chronic diseases became weaker, whereas the association between poor SRH and severe disability became stronger over time. Most unfavourable trends were observed in the older old and the lower educated. Conclusion: Our results suggest that the seeming stability of poor SRH hides underlying increases in chronic diseases and disability: over time, people may attach importance to different aspects of health when rating their overall health. [ABSTRACT FROM PUBLISHER]

Background: many instruments are available to identify frail older adults who may benefit from geriatric interventions. Most of those instruments are time-consuming and difficult to use in primary care.Objective: to select a valid instrument to identify frail older adults in primary care, five simple instruments were compared.Methods: instruments included clinical judgement of the general practitioner, prescription of multiple medications, the Groningen frailty indicator (GFI), PRISMA-7 and the self-rated health of the older adult. Fried's frailty criteria and a clinical judgement by a multidisciplinary expert panel were used as reference standards. Data were used from the cross-sectional Dutch Identification of Frail Elderly Study consisting of 102 people aged 65 and over from a primary care practice in Amsterdam. In this study, frail older adults were oversampled. We estimated the accuracy of each instrument by calculating the area under the ROC curve. The agreement between the instruments and the reference standards was determined by kappa.Results: frailty prevalence rates in this sample ranged from 11.6 to 36.4%. The accuracy of the instruments ranged from poor (AUC = 0.64) to good (AUC = 0.85).Conclusion: PRISMA-7 was the best of the five instruments with good accuracy. Further research is needed to establish the predictive validity and clinical utility of the simple instruments used in this study. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether gait speed predicts incident depressive symptoms and whether depressive symptoms predict incident gait speed impairment; to ascertain the presence of shared risk factors for these associations. Design The Longitudinal Aging Study Amsterdam, a prospective cohort study with five follow-up cycles over 16 years. Setting Population based. Participants One thousand nine hundred twenty-eight respondents for incident depressive symptoms (mean age 68.9 ± 8.5) and 1,855 respondents for incident gait speed impairment (mean age 68.0 ± 8.2). Measurements Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale; gait speed was measured, back and forth, during a 3-m walk as quickly as possible, with a 180° turn. Multivariate analyses were performed for both sexes using Cox regression. Results Incident depressive symptoms occurred in 24% of respondents. In univariate analyses, gait speed at baseline predicted incident depressive symptoms in men and women; after adjustment for covariates, this association persisted in men only. Examining the reverse association, 34% of respondents developed gait speed impairment. Depressive symptoms at baseline were univariately associated with incident gait speed impairment in women but not in men; this association did not persist after adjustment. The bidirectional associations did not share the same explanatory variables. Conclusion Gait speed predicts depressive symptoms in men. The geriatric giants of depressive symptoms and slowed gait speed in late life appear to result from different pathologies, both of which therefore require their own treatment strategies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to legal euthanasia under specific circumstances in the Netherlands, known as advance euthanasia directives (AEDs).

Objective To validate Kalache & Kickbusch's model: namely, that functional capacity peaks in early adulthood, then declines at a rate dependent on fitness level until a "disability threshold" is reached. Methods Data came from the Australian Longitudinal Study on Women's Health, which followed three cohorts from 1996 to 2011: a young, a mid-aged and an older cohort (born in 1973-78, 1946-51 and 1921-26, respectively). The Short Form (36) Health Survey was used to measure physical functioning (score 1-100). The disability threshold was the mean physical functioning score in older women requiring assistance with daily activities (62.8). The relationship between age and physical functioning was modelled using spline regression for the entire sample, and by baseline physical functioning quintile and physical activity level. Findings Physical decline quickened with age: 0.05 annual units (95% confidence interval, CI: -0.13 to 0.22) at ages 18-23 years (i.e. no decline); -2.43 (95% CI: -2.64 to -2.23) at ages 82-90 years. Decline was faster in quintiles with lower baseline physical functioning in the younger and mid-age cohorts and in quintiles with higher baseline physical functioning in the older cohort. The disability threshold was reached at a mean age of 79 years, but the range was 45-88 years, depending on baseline physical functioning and physical activity. Conclusion Age and physical decline are not linearly related, as traditionally believed; decline accelerates with age. However, baseline physical functioning, but not physical activity, influences the rate of decline. [ABSTRACT FROM AUTHOR]

Objectives Gerotranscendence is defined as a transition from a materialistic and rationalistic perspective to a more cosmic and transcendent view of life accompanying the aging process. Would gerotranscendence levels still increase in later life? The current prospective study investigates 10-year trajectories of cosmic transcendence (a core dimension of gerotranscendence). Methods Four interview cycles of the Longitudinal Aging Study Amsterdam with 3-year intervals from 1995 to 2006 provide data on cosmic transcendence, demographics (ages 57–85), religiousness, health, sense of mastery, and humor coping. Data are available for 2,257 respondents and 1,533 respondents in multivariate models. Results Latent Class Growth Analysis shows three course trajectories of cosmic transcendence: stable high, intermediate with a decrease, and stable low. Higher levels are predicted by age, importance of prayer, Roman Catholic affiliation, a low sense of mastery, higher cognitive ability, and humor coping. Similar results were obtained for the respondents who died during the study (N = 378). Discussion Although levels of cosmic transcendence do not show much change during 10 years of follow-up, the oldest respondents nonetheless attain the highest cosmic transcendence levels. An inclination toward relativism and contemplation may facilitate cosmic transcendence. However, lower cognitive ability probably impairs the development toward cosmic transcendence. [ABSTRACT FROM AUTHOR]

Age-related decline in processing speed has long been considered a key driver of cognitive aging. While the majority of empirical evidence for the processing speed hypothesis has been obtained from analyses of between-person age differences, longitudinal studies provide a direct test of within-person change. Using recent developments in longitudinal mediation analysis, we examine the speed-mediation hypothesis at both the within-and between-person levels in two longitudinal studies. Longitudinal Aging Study Amsterdam (LASA) and Origins of Variance in the Oldest-Old (OCTO-Twin). We found significant within-person indirect effects of change in age, such that increasing age was related to lower speed, which in turn relates to lower performance across repeated measures on other cognitive outcomes. Although between-person indirect effects were also significant in LASA, they were not in OCTO-Twin which is not unexpected given the age homogeneous nature of the OCTO-Twin data. A more in-depth examination through measures of effect size suggests that, for the LASA study, the within-person indirect effects were small and between-person indirect effects were consistently larger. These differing magnitudes of direct and indirect effects across levels demonstrate the importance of separating between- and within-person effects in evaluating theoretical models of age-related change. [ABSTRACT FROM AUTHOR]