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Objective To investigate associations of early and middle adulthood physical activity (PA) with symptoms of pelvic floor disorders (PFD), i.e., stress urinary incontinence (SUI), urge urinary incontinence (UUI), fecal incontinence (FI), constipation or defecation difficulties (CDD), and feeling of pelvic organ prolapse (POP) among middle-aged women. Design A cross-sectional, observational study with retrospective PA assessment. Setting University Research Laboratory. Sample A random population sample of 1098 47-to-55-year-old Finnish women. Methods Early adulthood PA, current PA, and demographical and gynaecological variables were assessed using self-report questionnaires. Logistic regression analyses were applied to study associations of PA variables with symptoms of PFDs. Potential confounding effects of demographical and gynaecological variables were controlled in multiple logistic regression models. Main outcome measures Structured questionnaire-assessed retrospective PA assessment at the age of 17–29, current PA at middle age, and prevalence of symptoms of SUI, UUI, FI, CDD and POP. Results Current PA was not independently associated with the occurrence of the symptoms of PFDs. Middle-aged women with early adulthood history of competitive sports were more likely to experience symptoms of UUI (OR 2.16, 95% CI 1.10–4.24, p=0.025) but not symptoms of SUI, FI, CDD, or POP, while women with history of regular PA were more likely to experience symptoms of FI (OR 4.41, 95% CI 1.05–18.49, p=0.043) but no other symptoms of PFDs. Conclusions Competitive sports during early adulthood may increase the risk of UUI at middle age. Regular PA during early adulthood may increase the risk of FI. peerReviewed

Objective To investigate associations of early and middle adulthood physical activity (PA) with symptoms of pelvic floor disorders (PFD), i.e. stress urinary incontinence (SUI), urge urinary incontinence (UUI), fecal incontinence (FI), constipation or defecation difficulties (CDD), and feeling of pelvic organ prolapse (POP) among middle-aged women. Design A cross-sectional, observational study with retrospective physical activity assessment. Setting University Research Laboratory. Sample A random population sample of 1098 47-to-55-year-old Finnish women. Methods PA history, current PA, and demographical and gynaecological variables were assessed using self-report questionnaires. Logistic regression analyses were applied to study associations of past and current PA with PFDs. Associations of demographical and gynaecological variables with PFDs were studied and their potential confounding effect was controlled in multiple logistic regression models. Main outcome measures Structured questionnaire-assessed retrospective physical activity history at the age of 17–29, current physical activity at middle age, and prevalence of SUI, UUI, FI, CDD and POP. Results Current PA was not independently associated with the occurrence of the PFDs. Middle-aged women with early adulthood history of competitive sports were more likely to experience UUI (OR 2.161, 95% CI 1.102–4.237, p=0.025) but not SUI, FI or POP, while women with history of regular PA were more likely to experience FI (OR 4.405, 95% CI 1.049–18.493, p=0.043) but not other PFDs. Conclusions Competitive sports during early adulthood may increase the risk of UUI at middle age. The history of regular PA may increase the risk of FI. Keywords Pelvic floor function, exercise, menopausal women

Purpose To study the prevalence and risk factors of myopia with data from a questionnaire study conducted in 1983 among Finnish school children. Methods School children (n = 4 961) from the 1st, 5th and 8th grades of school (7-, 11- and 15-year-olds) in Central Finland were screened for vision followed by a questionnaire, which was returned by 4 352 (87.7%) participants. Myopia was categorized based on the questionnaire. Items concerned daily time spent on near work and outdoor activities, excluding time spent at school, watching TV and parental myopia and the associations of myopia with these factors were studied. Results The prevalence of myopia was 3%, 15% and 27% among the 7-, 11- and 15-year-olds, and if daily near work at home was ≤1 hr, myopia prevalence was 0.5%, 3.3% and 17.6%, respectively. The adjusted risk of myopia for each daily near work hour was OR 1.476 (95% confidence interval 1.099–1.984, p = 0.010), OR 1.346 (1.170–1.584, p < 0.001) and OR 1.206 (1.076–1.352, p = 0.001), in the 3 age groups, respectively. The adjusted risk of myopia for each daily hour spent outdoors was OR 0.764 (0.648–0.900, p = 0.001) in the 11-year-olds and OR (0.840, 0.743–0.950, p = 0.005) in the 15-year-olds. Outdoors time prevented myopia at different levels of near work, although less at the highest levels, and near work increased risk of myopia with the level of outdoors time. If the ratio between near work and outdoors time was ≤0. 5 or >1.5, the prevalence of myopia was 1.4% versus 5.6%, 6.3% versus 24.7% and 15.9% versus 36.9%, among the 7-, 11- and 15-year-olds, respectively. The higher prevalence of myopia among the 11- and 15-year-old girls than boys was explained by more near work and less outdoor time among the girls. Having two myopic parents roughly doubled the risk of myopia compared to if one myopic parent in the 11- and 15-year-olds. Conclusions Myopic parents, greater near work time, less outdoors time, a higher near work/outdoors ratio, and being a girl increased the risk of myopia. Myopia was rare in the 7- and 11-year-olds if daily near work at home did not exceed one hour or if the near work/outdoors ratio was not higher than 0.5. Outdoors time was associated with the prevalence of myopia at all levels of near work, although the association was weaker at the highest level. peerReviewed

Purpose To compare 3-year myopic progression between Finnish and Singaporean children. Methods Myopic progression was compared between 9-year-old (mean age 9.7 ± 0.4 years, n = 92) and 11-year-old (mean age 11.7 ± 0.4 years, n = 144) Finnish (Finnish RCT) children and Singaporean children matched by age and refraction (SCORMMatched, n = 403) and 7- to 8-year-old Singaporean children matched only by refraction (SCORM Young, n = 186). Spherical equivalent (SE) was between −0.50 and −3.00 D. Refraction with cycloplegia was controlled annually for 3 years. Information on parental myopia, mother’s education, time spent on near-work and outdoor time was gathered by parental questionnaire. Results Three-year myopic progression was −2.08 ± 0.96 D and −1.30 ± 0.69 D in the Finnish RCT and Singaporean SCORM Matched 9-year-olds, respectively, and −1.34 ± 0.78 D, and −0.52 ± 0.44 D in the 11-year-olds, respectively (p

Background Social distancing, that is, avoiding places with other people and staying at home, was recommended to prevent viral transmission during the COVID-19 pandemic. Potentially, reduced out-of-home mobility and lower activity levels among older people may lower their quality of life (QOL). We studied cross-sectional and longitudinal associations of and changes in life-space mobility, active aging, and QOL during COVID-19 social distancing compared to 2 years before. Methods Altogether 809 community-living participants initially aged 75, 80, or 85 years of our active aging study (AGNES) conducted in 2017–2018 took part in the current AGNES-COVID-19 survey in May and June 2020. Outdoor mobility was assessed with the Life-Space Assessment (range 0–120). Active approach to life was assessed with the University of Jyväskylä Active Aging Scale (range 0–272), and QOL with the shortened Older People’s Quality of Life Questionnaire (range13–65; higher scores better for all). Data were analyzed with General Estimating Equations, General Linear Models, and One-way analysis of variance. Results Life-space mobility (B −10.8, SE 0.75, p < .001), the active aging score (B −24.1, SE 0.88, p < .001), and the QOL score (B −1.65, SE 0.21, p < .001) were lower during COVID-19 social distancing versus 2 years before. Concurrent life-space mobility and active aging scores, age, and sex explained 48% of QOL at the baseline and 42% during social distancing. Longitudinally, steeper declines in all 3 variables coincided. Conclusion The observed declines indicate compliance with social distancing recommendation, but underline the importance of participation in meaningful life situations as a factor underlying good QOL also during the COVID-19 pandemic.

PURPOSE To determine the effect of the definition of high myopia on its prevalence and risk factors for high myopia. METHODS A total of 240 myopic schoolchildren (119 boys and 121 girls) at the mean age of 10.9 years (range 8.8-12.8 years) were recruited to a randomized clinical trial of myopia treatment among children from 3rd- and 5th grades of school referred for an eye examination due to poor distant vision and having no previous spectacles. Clinical follow-ups, including refraction with cycloplegia, were conducted annually at 3 years [third follow-up here = clinical follow-up 1, (n = 237)], and thereafter twice at approximately 10-year intervals [clinical follow-ups 2 (n = 179) and 3, (n = 134)]. Additional refraction values between follow-ups 2 and 3 were received from ophthalmologists and opticians' prescriptions and records. The most recent adulthood refraction measure available was taken as the final refraction value for 204 (85%) of the original cohort [mean follow-up time (±standard deviation) 22.1 (±3.9) years]. Parental myopia, time spent on reading and close work, watching TV and outdoor activities were assessed with a questionnaire at the clinical follow-ups. The influence of different definitions of high myopia on its prevalence was analysed. The associations of different factors with high myopia were investigated. RESULTS Mean spherical equivalent (SE) at baseline was -1.43 (±0.60) D, ranging from -0.38 D to -3.00 D. At follow-up end, mean SE of the more myopic eye was -5.29 (±1.95) D, ranging from -1.00 D to -11.25 D. High myopia prevalence with the definitions SE

Background: Little is known about change in physical activity (PA) and its relationship to all-cause mortality among old people. There is even less information about the association between PA, fitness, and all-cause mortality among people aged 80 years and above. The objective is to investigate persistence and change in PA over 5 years as a predictor of all-cause mortality, and fitness as a mediator of this association, among people aged 80 and 85 years at the beginning of an 18-year mortality follow-up period. Methods: Using Evergreen Project data (started in 1989), 4 study groups were formed according to self-reported changes in PA level, over a 5-year period (starting in 1989–1990 and ending in 1994–1995): remained active (RA, control group), changed to inactive (CI), remained inactive (RI), and changed to active (CA). Mortality was followed up over the 18-year period (1994–2012). Cox models with different covariates such as age, sex, use of alcohol, smoking, chronic diseases, and a 10 m walking test were used to analyze the association between change in PA level and mortality. Results: Compared to RA, those who decreased their PA level (CI) between baseline and follow-up had higher all-cause mortality (hazard ratio (HR = 2.09; 95%CI: 1.63–2.69) when adjusted for age, gender, and chronic diseases. RI showed the highest all-cause mortality (HR = 2.16; 95%CI: 1.59–2.93). In CA, when compared against RA, the risk of all-cause mortality was not statistically significant (HR = 1.51; 95%CI: 0.95–2.38). In comparison with RA, when walking speed over 10 m was added as a covariate, all-cause mortality risk was almost statistically significant only in CI (HR = 1.37; 95%CI: 1.00–1.87). Conclusion: Persistence and change in PA level was associated with mortality. This association was largely explained by fitness status. Randomized controlled studies are needed to test whether maintaining or increasing PA level could lengthen the life of old people. Keywords: All-cause mortality, Fitness, Follow-up study, Functional ability, Old people, Physical activity

Purpose To study the associations of habitual reading posture, gaze angle in reading and reading distance with myopia and changes in myopia among myopic children. Methods A total of 240 myopic schoolchildren (mean age 10.9 years), with no previous spectacles, were recruited during 1983–1984 to a randomized 3-year clinical trial of bifocal treatment of myopia. Three annual examinations with subjective cycloplegic refraction were conducted for 237–238 subjects. A further examination was conducted at the mean age of 23.2 years for 178 subjects. Habitual reading posture was elicited by questionnaire at study outset. Reading distance was measured with a Clement Clark accommodometer and gaze angle with an angle scale at baseline and all three annual follow-ups. Height was measured by a school nurse. The connections between the variables were studied with the standard statistical methods. Results Higher myopia was connected with shorter reading distance among girls at follow-ups 2 and 3, but not at the other examinations. The correlation of spherical equivalent with height was non-significant at each follow-up. Myopic progression across the whole follow-up was highest among those who read sitting down at baseline (−3.58 ± 1.75 D) and lowest among those who read face up lying down (−2.35 ± 1.53 D) (p = 0.021). Reading with eyes at a more downward angle was slightly connected with greater myopic progression (r = −0.166, p = 0.028). Conclusions Reading in a sitting posture at myopia onset predicted the greatest myopic progression to adulthood and reading face up on one's back the lowest. Reading with eyes on turned more downwards was slightly connected with greater myopic progression.

Purpose To examine the prevalence of anisometropia of spherical refraction (AnisoSR), astigmatism (AnisoAST) and spherical equivalent (AnisoSE) and their associations with spherical refraction (SR), refractive astigmatism (AST), spherical equivalent (SE) and interocular differences of ocular biometric parameters among elderly female twins. Methods Refraction of 117 monozygotic (MZ) and 116 dizygotic (DZ) female twin subjects aged 66–79 years was assessed with an auto-refractor (Topcon AT) and controlled by subjective refraction. Corneal refraction, anterior chamber depth and axial length were measured with a Zeiss IOL Master. Participants with eyes operated for cataract or glaucoma were excluded, but the grade of nuclear opacity was not recorded. The associations between the absolute values of AnisoSR, AnisoAST and AnisoSE with SR, AST, SE, corneal refractive power (CR), corneal astigmatism (CAST), anterior chamber depth (ACD) and axial length (AL) and with their interocular differences were calculated. When calculating the interdependencies of the differences, the real and absolute differences between the right and left eye were used. Results Means ± standard deviations for AnisoSR, AnisoAST and AnisoSE were 0.67 ± 0.92 D, 0.42 ± 0.41 D and 0.65 ± 0.71 D, respectively. AnisoSR, AnisoAST and AnisoSE >1.0 D were present in 14.7%, 4.2% and 17.7% of cases, respectively. Anisometropia of spherical refraction (AnisoSR), AnisoAST and AnisoSE were higher the more negative the values of SR or SE. Hyperopic ametropia did not increase these anisometropia values. The correlations of AnisoSR and AnisoSE with the absolute values of interocular differences in CR and AL were non-significant. Using the real values of the interocular differences, the respective correlations were significant. The correlation between the real interocular differences in CR and AL was negative (r = −0.258, p

Background Our aim was to study the relationship between objectively measured physical activity and subsequent changes in life-space mobility over 2 years among older people. Life-space mobility refers to the area a person moves through in daily life, taking into account frequency, and need of assistance. Life-space mobility and physical activity correlate, but whether different intensities of objectively assessed physical activity predicts decline in life-space mobility is not known. Methods Prospective cohort study of the "Life-space Mobility in Old Age" (LISPE) project accelerometer substudy. Participants were community-dwelling older people aged 75-90 (n = 164). Life-space mobility was measured with the Life-Space Assessment at baseline face-to-face home interview and telephone follow-up interviews 1 and 2 years after baseline. Physical activity (step count and time spent in moderate activity, low activity, and sedentary behavior) was measured by a tri-axial accelerometer (Hookie "AM20 Activity Meter") for 7 days at baseline. Generalized estimating equations (GEE models) were used to compare changes in life-space mobility between participants categorized according to the baseline physical activity measures. Results Median age of the participants was 79.5 (IQR 6.7) and 64% were women. Over the 2 years, life-space mobility declined significantly among those with lower step counts and less time spent in moderate activity measured at baseline. Time spent in low activity and sedentary behavior did not predict changes in life-space mobility. Conclusions In old age, more time spent walking outdoors and accumulation of moderate-intensity physical activity may help to maintain higher life-space mobility, a correlate of good quality of life.

This paper gives an overview, how Automatic Meter Infrastructure (AMI) enable possibilities to participate flexibility markets. Paper introduces the current situation in Finnish electricity market and role of AMI for demand response. Flexibility market places available today in Finland are introduced with their technical specifications. Possibilities and development needs in AMI in respect to these requirements are discussed. These aspects need to be evaluated when planning new AMI projects. The paper proposes a novel AMI solution and business model based on requirements of flexibility market to realize large-scale demand response of small distributed energy resources. AMI-based demand response could be one of the solutions to activate customers and seems to be an interesting option to bring small scale resources in the flexibility market in cost-efficient manner.

Life-space assessment incorporates all movements in terms of the distance from home, the frequency of movement and the need of assistance for movement. Executive function (EF) is an important higher order cognitive ability that controls and guides people’s goal-directed actions. We examined the cross-sectional and longitudinal associations between EF and life-space mobility, and investigated if perceived walking difficulties, lower extremity performance, and transportation difficulties explain the association. Methods 157 community-dwelling persons aged 76–91 years participated in the study at the baseline, and 103 of them in 2-year follow-up study. Based on the distribution on the Trail Making Test participants were categorized into tertiles of EF. Life-space mobility was assessed using the Life-Space Assessment (range 0–120). Perceived walking difficulties and transportation difficulties were self-reported, and lower extremity performance was assessed with the short physical performance battery (SPPB). Adjustments were made for gender, age, number of chronic conditions, and years of education. Results Average age of participants at the baseline was 82.6 (SD 4.2) years and 61% were women. Individuals with poor EF had lower life-space mobility compared to those with good EF. SPPB and transportation difficulties explained the association. Over the 2-year follow-up, those with poor EF at the baseline showed steeper decline but the difference did not quite reach statistical significance (p = 0.068). Conclusions People with better executive function had higher life-space mobility. This was explained by better lower extremity performance and absence of transportation difficulties. Cognitive decline may hinder access to community amenities, which in turn may further accelerate cognitive decline. peerReviewed

Purpose Life-space mobility refers to the spatial area in which a person moves in daily life, taking into account distance, frequency and assistance needed. The aim was to examine how changes in life-space mobility are associated with changes in quality of life (QOL) over a 2-year period. Methods Community-dwelling people aged 75–90 years (n = 848) were interviewed face-to-face in their homes and followed up annually for 2 years. QOL was assessed with the short version of the World Health Organization QOL assessment (range 0–130, higher scores indicate better QOL). Life-space mobility was assessed with the Life-Space Assessment (range 0–120, higher scores indicate better life-space mobility). Lower extremity performance was objectively measured with the Short Physical Performance Battery (SPPB). Cognitive impairment was assessed using the Mini-Mental State Examination. Chronic conditions and years of education were self-reported. Data were analyzed with generalized estimation equation models. Results The mean life-space score at baseline was 63.9 ± SD 20.6 and mean QOL score 100.3 ± 11.8. Over the follow-up, the QOL score decreased to 95.0 ± 13.8 across the total study sample. The decrease in QOL score was somewhat higher among those whose life-space mobility score declined >10 points during the follow-up compared to those whose life-space remained stable or improved, even after adjustment for age, gender, number of chronic conditions, cognitive impairment, SPPB and education. Conclusions Decline in life-space mobility is associated with decline in QOL. The results highlight the importance of ensuring continuous possibilities for out-of-home mobility in maintaining QOL among older people. peerReviewed

Purpose To study the prevalence of and changes in astigmatism from the onset of myopia at school age. Methods Two hundred and forty myopic schoolchildren (mean age 10.9 years), with no previous spectacles, were recruited during 1983–1984 to a randomized 3-year clinical trial of bifocal treatment of myopia. Three annual examinations with subjective cycloplegic refraction were performed for 237–238 subjects. Subsequent examinations were performed at the mean ages of 23.2 and 33.9 years for 178 and 163 subjects, and the last examination, including data from prescriptions of different ophthalmologists, for 32 subjects. Corneal topography was studied at baseline, at the 3-year follow-up and at the two adulthood follow-ups. Prevalence and changes in refractive astigmatism (RA), in its polar values J0 and J45, and corneal astigmatism (CA) were studied. Results Mean RA of the right eye increased during follow-up from 0.26 D (SD) ± 0.30 to 0.79 D ± 0.74. Mean CA was 1.07 D ± 0.74 at study end. The prevalence of RA ≥0.25 or ≥1.00 D increased from 54.9 and 3.8% to 83.4 and 34.4%, respectively. The main direction of the axis of RA and its polar value J0 and CA changed mainly through sphericity, from against the rule (ATR) to with the rule during the follow-up. There was a negative correlation between RA and spherical refraction in the ATR group at end of follow-up. Changes in RA were associated with increase in myopia and with changes in CA. Conclusions The prevalence and mean amount of RA associated with CA increased, and the axis of astigmatism changed among myopics during the 23-year follow-up.

To explore associations between age, organizational justice, selection, optimization with compensation (SOC), and work ability.Data for this study were collected in 2011 among 605 employees (mean age = 43.7, SD = 10.7, 86% women) working at a university hospital in Finland.Age and work ability were negatively associated. Those who experienced high organizational justice and used SOC behaviors at work reported better work ability. The SOC behaviors mediated the relationship between justice and work ability. This meant that high experiences of organizational justice facilitated the use of SOC and thus helped employees maintain their work ability.Organizational justice can help promote work ability in two ways--directly by supporting employees' mental resources and indirectly by facilitating the use of individual resource allocation strategies in the form of SOC behaviors.

Purpose To examine myopic progression and factors connected with myopic progression. Methods Myopic schoolchildren, with no previous spectacles, 119 boys and 121 girls, were recruited during 1983–1984 to a randomized 3-year clinical trial of bifocal treatment of myopia with a subsequent 20-year follow-up. Participants' mean age at Baseline was 10.9, ranging from 8.7 to 12.8 years. An ophthalmological examination was carried out annually for 3 years and twice thereafter at ca. 10-year intervals. Additional refraction values were received from prescriptions issued by different ophthalmologists and opticians. Altogether, 1915 refraction values were available. Reading distance and accommodation were measured at each control visit. Data on parents' myopia, daily time spent on reading and close work, outdoor activities and watching television were gathered with a structured questionnaire. Results Using bifocals (+1.75 add) or reading without glasses or accommodation stimulus during the 3-year period in childhood did not correlate with adulthood refraction. Short reading distance in childhood predicted higher adulthood myopia among females. The factors predicting faster myopic progression were parents' myopia and less time spent on sports and outdoor activities at childhood. Time spent on reading and close work in childhood was related to myopic progression during the first 3 years but did not predict adulthood myopia. Myopia throughout follow-up was higher among those who watched television

Objective: To assess the effect of a comprehensive geriatric assessment and individually tailored intervention on mobility in older people. In addition, the effectiveness of the geriatric intervention was evaluated among a subgroup of persons with musculoskeletal pain. Design: Three-year geriatric development project with randomized assignment to intervention and control group. Setting: Research centre, community and assisted living facilities. Participants: Seven hundred and eighty-one Finnish persons aged 75–98 years were assigned to an intervention ( n = 404) or control ( n = 377) group. Intervention: A comprehensive geriatric assessment with a multifactorial intervention lasting two years. The intervention included individualized referrals, recommendations, physical activity counselling and supervised resistance training. Measurements: Perceived limitation in walking 400m was gathered annually during the intervention and at the one-year post-intervention follow-up. Results: The proportion of persons with mobility limitation at the beginning, at the two-year intervention and at the one-year post-intervention follow-up was 16%, 15%, 12% and 14%, respectively, in the intervention group. In the control group, the corresponding proportions were 19%, 18%, 23% and 26%. The treatment effect was significant at the end of the two-year intervention (odds ratio 0.82, 95% confidence interval 0.70–0.96, P = 0.013), and at the one-year post-intervention follow-up (0.84, 0.75–0.94, P = 0.002). The parallel positive effect of the intervention on mobility was even greater among persons with musculoskeletal pain. Conclusion: The comprehensive geriatric assessment and individually tailored multifactorial intervention had a positive effect on mobility, underlining their importance in health promotion and disability prevention in older people.

In this study self-reported ability to walk 2 km and six-minute walking test (6MWT) performance were examined as predictors of all-cause mortality in 434 women, aged 63-76 years. The primary outcome measure was all-cause mortality (follow-up: 8 years). Predictors were self-reported difficulties in walking 2 km and 6-min walking distance tertiles of ≤495, 496-560 and ≥561 m, and no test result due to refusal by the physician to grant permission to perform the test or participant's inability or unwillingness to perform the test. During the follow-up, 39 participants died. Participants reporting minor (age- and body mass index-adjusted hazard ratio 2.53, 95% confidence interval 1.12-5.69) or major (7.93, 3.49-18.05) difficulties in walking 2 km had increased risk of death compared with those reporting no difficulties. Participants with no 6MWT result (6.99, 2.46-19.86) were at an increased risk of death when compared with participants who walked ≥561 m. A similar trend (2.47, 0.81-7.56) was found for participants with walking distance of ≤495 m during the 6MWT. The trends remained similar after adjustments for other confounders. In conclusion, self-reported difficulties in walking 2 km are associated with an increased risk of death in older community-dwelling women. Objectively measured walking ability gives similar results.

OBJECTIVES: To examine the association between barriers in the outdoor environment and perceived quality of life (QoL) in old age and to assess whether fear of moving outdoors and unmet physical activity need contribute to this association. DESIGN: Cross-sectional. SETTING: Community and research center. PARTICIPANTS: Five hundred eighty-nine, community-dwelling people aged 75 to 81 took part in face-to-face home-interviews and examinations in the research center. MEASUREMENTS: QoL was assessed using the LEIPAD questionnaire. Environmental barriers were studied based on self-reports of lack of resting places or long distances (distances), noisy traffic or dangerous crossroads (traffic), and hilly terrain or poor street condition (terrain). Fear of moving outdoors and unmet physical activity need were self-reported, and maximal walking speed was measured over 10 m. A path analyses model using LISREL was used for the statistical analyses. RESULTS: QoL was worse among those who reported more barriers in their outdoor environment, experienced fear of moving outdoors or unmet physical activity need, and had slower walking speed and more chronic diseases. In the path model, in which 36% of the variation in QoL was explained, terrain, traffic and distances influenced QoL through fear of moving outdoors or unmet physical activity need, whereas distances had a direct association with QoL. CONCLUSION: An outdoor environment that encumbers outdoor mobility increases perceptions of fear of moving outdoors and unmet physical activity need and is associated with poor QoL in older people. More research is needed to confirm the temporal order and causality of these observations. J Am Geriatr Soc 58:2154-2159, 2010. (Less)

Purpose To examine the heritability of spherical equivalent (SE) in older women. Design Population-based twin study. Participants Ninety monozygotic (MZ) and 86 dizygotic (DZ) female twin pairs aged 63 to 76 years who were born from 1924 through 1937. Methods Ocular refraction was measured using an autorefractor and controlled by the subjective method. The contributions of genetic and environmental factors to individual differences in SE were estimated by applying an independent pathway model to twin data. Main Outcome Measures Contribution of genetic and environmental effects to the variation in SE. Results Mean SE of the study population was 1.68 (standard deviation, ±1.82) with no differences observed either between the MZ and the DZ individuals or between the left and the right eyes. The pairwise correlations were higher in the MZ sisters (intraclass correlation coefficient [ICC], 0.803 right eye and 0.807 left eye) than DZ sisters (ICC, 0.406 right eye and 0.435 left eye). Quantitative genetic modelling showed that 83% (95% confidence interval, 77%–87%) of the variance in SE could be explained by heritable factors. Conclusions Additive genetic influences explained most of the individual differences in SE among older Finnish women. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

The purpose of this study was to examine how resting electrocardiographic (ECG) and other clinical variables, which can be included in a routine clinical examination, predict walking ability in older women. Three hundred and twenty women (63–75 years) without overt cardiac diseases and apparent mobility limitations were studied. Measurements performed were clinical examination (standard 12-lead resting ECG, assessment of physical activity level, presence of chronic diseases, use of beta-blockers, body mass index (BMI), ability to squat, resting blood pressure) and six-minute walking test. Participants walked 533 ± 75 m in the six-minute walking test. The best electrocardiographic predictors of long walking distance were high TV5 and TII, but their explanation rates were small (4.5% and 3.8%, respectively). In hypertensive participants (systolic blood pressure = SBP ≥ 160 mmHg), the respective values were 9.3% and 5.8%. The best predictors of long walking distance were ability to squat without limitations and low BMI (15.5% and 13.6%, respectively). Altogether the studied variables explained 36% of the variation in walking distance. The data gathered in clinical examination give useful information for the assessment of walking ability in relatively healthy older women. Resting ECG does not give clinically significant additional information for the assessment in subjects without overt cardiac disease.

The purpose of this study was to estimate to what extent muscle cross-sectional area of the lower leg (mCSA) and tibial structural strength are influenced by common and trait-specific genetic and environmental factors. pQCT scans were obtained from both members of 102 monozygotic (MZ) and 113 dizygotic (DZ) 63- to 76-yr-old female twin pairs to estimate the mCSA of the lower leg, structural bending strength of the tibial shaft (BSIbend), and compressive strength of the distal tibia (BSIcomp). Quantitative genetic models were used to decompose the phenotypic variances into common and trait-specific additive genetic (A), shared environmental (C), and individual environmental (E) effects. The age-adjusted trivariate independent pathway model showed that the total relative contributions of A, C, and E were, respectively, 75%, 0%, and 25% for mCSA, 55%, 20%, and 25% for BSIbend, and 40%, 37%, and 23% for BSIcomp. In addition, the model showed that all three traits shared genetic and individual environmental factors. BSIbend and BSIcomp had common shared environmental factors and were also influenced by trait-specific genetic factors. In conclusion, the association between muscle cross-sectional area and structural bone strength has its origins in both genetic and environmental effects in older women. These results suggest that in older women the same genetic and environmental factors may predispose to or, conversely, protect from both sarcopenia and bone fragility.

BACKGROUND: The purpose of the present study was to examine, first, whether hearing acuity predicts falls and whether the potential association is explained by postural balance and, second, to examine whether shared genetic or environmental effects underlie these associations. METHODS: Hearing was measured using a clinical audiometer as a part of the Finnish Twin Study on Aging in 103 monozygotic and 114 dizygotic female twin pairs aged 63-76 years. Postural balance was indicated as a center of pressure (COP) movement in semitandem stance, and participants filled in a fall-calendar daily for an average of 345 days after the baseline. RESULTS: Mean hearing acuity (better ear hearing threshold level at 0.5-4 kHz) was 21 dB (standard deviation [SD] 12). Means of the COP velocity moment for the best to the poorest hearing quartiles increased linearly from 40.7 mm(2)/s (SD 24.4) to 52.8 mm(2)/s (SD 32.0) (p value for the trend = .003). Altogether 199 participants reported 437 falls. Age-adjusted incidence rate ratios (IRRs) for falls, with the best hearing quartile as a reference, were 1.2 (95% confidence interval [CI] = 0.4-3.8) in the second, 4.1 (95% CI = 1.1-15.6) in the third, and 3.4 (95% CI = 1.0-11.4) in the poorest hearing quartiles. Adjustment for COP velocity moment decreased IRRs markedly. Twin analyses showed that the association between hearing acuity and postural balance was not explained by genetic factors in common for these traits. CONCLUSION: People with poor hearing acuity have a higher risk for falls, which is partially explained by their poorer postural control. Auditory information about environment may be important for safe mobility. Language: en

Objectives:we studied visual acuity (VA) and co-existing hearing impairment and poor standing balance as predictors of falls. Design: prospective study with 1-year follow-up. Setting: research laboratory and residential environment. Participants: 428 women aged 63‐76 years from the Finnish Twin Study on Aging. Measurements: participants were followed up for incidence of falls over 1 year. VA, hearing ability and standing balance were assessed at the baseline. The incidence rate ratios (IRR) for falls were computed using the negative binomial regression model. Results: during the follow-up, 47% of participants experienced a fall. After adjusting for age and interdependence of twin sisters, participants with vision impairment (VA of

A bivariate genetic analysis among 217 older female twin pairs showed that, although the structural strength of tibia and radius are mainly regulated by same genetic and environmental factors, the tibia is more affected by environment. Introduction: The habitual loading environment of the bone may modulate the relative contribution of genetic and environmental factors to bone structure. The purpose of this study was to estimate the contribution of the common and site-specific genetic and environmental factors to interindividual variation in compressive structural strength of the weight-bearing tibia and non–weight-bearing radius. Materials and Methods: pQCT scans were obtained from both members of 103 monozygotic (MZ) and 114 dizygotic (DZ) 63- to 76-yr-old female twin pairs to estimate the compressive strength of the distal tibia and distal radius. Quantitative genetic models were used to decompose the phenotypic variance into additive genetic, shared environmental, and individual environmental effects at each bone site and to study whether these bone sites share genetic or environmental effects. Results: The MZ and DZ twins did not differ in mean age, height, weight, or bone structural strength. The age-adjusted Cholesky model showed that additive genetic factors accounted for 83% (95% CI, 77–88%) of the variance in radial strength and 61% (95% CI, 52–69%) of the variance in tibial strength, and these were fully correlated. A shared environmental factor accounted for 15% (95% CI, 10–20%) of tibial strength. An individual environmental factor accounted for 17% (95% CI, 12–23%) of the variance in radial strength and 10% (95% CI, 5–17%) of the variance in tibial strength. The relative contribution of an individual environmental factor specific to tibial strength was 14% (95% CI, 11–18%). Conclusions: The results suggest that, in older women, the majority of the individual differences in the compressive structural strength of the forearm and leg are regulated by genetic and environmental factors that are common to both bone sites. However, the relative importance of environmental factors was greater for the weight-bearing tibia than for the non–weight-bearing radius. Thus, the heritability of bone strength seems to vary between skeletal sites according to differences in the typical loading environment.

The purpose of the present study was to examine the relative contribution of genetic and environmental effects on the air-conducted hearing threshold levels at low (0.125-0.5 kHz), mid (1-2 kHz), and high (4-8 kHz) frequencies separately for the better and worse hearing ear in older women. We also examined the distribution of audiogram configurations. Data was analysed using quantitative genetic modelling. As part of the Finnish twin study on aging (FITSA), hearing was measured in 103 monozygotic and 114 dizygotic female twin pairs aged 63-76 years. Approximately every third subject had a flat type, and two-thirds a descending type of audiogram configuration. No significant difference was observed in the distribution of audiogram configurations between zygosity groups. In the better ear, additive genetic effects accounted for 64%-74% of the total variance at different frequencies. For the worse ear, environmental effects were larger. Although overall heritability is rather constant across the frequency spectrum, it is noteworthy that at low and high frequencies frequency-specific genetic and environmental effects together accounted for the majority of the total variance.

While predictors of survival in older people have been examined in depth in a large number of studies, a literature search revealed no cross-national comparative prospective cohort studies on this issue. This study investigated survival and its predictors from age 75 to 85 among three local Nordic populations using survival data on national cohorts as background information. The data were derived from national registers and from samples of 75-year old living in Denmark, Sweden, and Finland. The subjects were invited to take part in interviews and examinations focusing on different domains of health, functional capacity, and physical and social activities. The proportion of survivors to age 75 was markedly smaller among the Finnish men and women than Danish or Swedish subjects. In the local population no marked differences in survival from age 75 to 85 were observed between the groups of men, while women survived longer than men and longer in Goteborg than in Glostrup or Jyvaskyla. Univariate models revealed 12 predictors of survival. In the multivariate models, the significant predictors among men related to physical fitness, whereas among women they pertained to social activities and morbidity. Despite great differences in the proportions of survivors to age 75, and excepting the survival advantage of women, only minor differences were present in the subjects’ further survival to age 85. In the univariate analyses, many of the factors predictive of survival from age 75 to 85 were the same in the examined populations, whereas in the multivariate analyses differences between the sexes emerged.

This eight-year follow-up study examines the roles of physical and leisure activity as predictors of mental well-being among older adults born in 1904-1923. As part of the Evergreen project, 1224 (80%) persons aged 65-84 years were interviewed at baseline (1988), and 663 (90%) persons in the follow-up (1996). Mental well-being factors including depressive symptoms, anxiety, loneliness, self-rated mental vigour and meaning in life were constructed using factor analysis. The predictors of mental well-being included physical and leisure activity, mobility status and number of chronic illnesses. We used a path analysis model to examine the predictors of mental well-being. At baseline, low number of chronic illnesses, better mobility status and leisure activity were associated with mental well-being. Baseline mental well-being, better mobility status and younger age predicted mental well-being in the follow-up. Explanatory power of the path analysis model for the mental well-being factor at baseline was 19% and 35% in the follow-up. These findings suggest that mental well-being in later life is associated with activity, better health and mobility status, which should become targets for preventive measures.

All 75-year-olds born in 1914 and living in the city of Jyväskylä, central Finland (n=388) were invited to study the predictive value of exercise test for mortality. Subjects who entered the laboratory (n=295) were to have a standard pre-test evaluation and perform a cycle ergometer exercise test. Subjects with complete background, exercise-test status and mortality data (n=282) were divided into three groups according to exercise-test status: a non-exercise test group (n=79), an exercise-test termination group (n=95), and an exercise-test completion group (n=108). Mortality was followed up for 9 years. The multivariate hazard ratio (HR) for death among the non-exercise test group compared with exercise-test completion group was 1.87 (CI 1.19-2.94). The multivariate HR for death among the exercise-test termination group compared with the exercise-test completion group was 0.95 (CI 0.58-1.54). High cycling power (W/kg body weight) in the exercise-test completion group was associated with a decreased risk for death with a multivariate HR 0.14 (CI 0.05-0.38). Performing an exercise test serves information on the risk of death that is incremental to clinical data and traditional risk factors of death in elderly people.

Objective: Oral infections may increase the levels of cytokines in the blood which, in turn, are associated with early mortality in the elderly. We investigated the possible association between oral infections and mortality. Design: Prospective cohort study over a 5-year follow-up. Setting: Research laboratory. Participants: A cohort born in 1910 (n = 94) was examined in the year 1995. Five years later mortality data were obtained from the population register for 49 deceased subjects. Main outcome measures: Urgent need of dental treatment, lifetime, erythrocyte sedimentation rate (ESR). Results: The multivariate analysis adjusted for general health and lifestyle factors showed that the risk for death of subjects in urgent need of dental treatments was 3.9 times higher than that of the other subjects. Among men ESR correlated significantly with urgent need of dental treatment. Conclusions: Oral infections among frail elderly people may be a sign of early mortality.

The objectives of this study were to describe the changes occurring in depressive symptomatology over a 10-year period among 75-year-old residents of Jyväskylä, Finland. It also addressed the question of whether the mood disturbances detected were a permanent phenomenon or whether they had a more episodic nature. In addition, various associations with and predictors of low mood were studied. Depressive symptoms were screened with the Center for Epidemiologic Studies Depression Scale (CES-D).The cut-off point of 16 was used to distinguish depressed individuals from those classified as non-depressed. A baseline study was carried out in 1989 (n = 337). A 5-year follow-up was carried out with the same cohort in 1994 (n = 222) and a 10-year follow-up in 1999 (n = 131). The permanent versus episodic nature of depressed mood was studied by comparing the three-wave longitudinal depression score findings of different individuals. In the follow-up settings, multivariate logistic regression models adjusted for sex were used to find predictors of depressiveness. Looking at the prevalence of depressiveness we found a statistically significant increase in the figures for women particularly from age 80 to 85 years. The much lower mean scores recorded for men in earlier measurements reached the same level as for women at age 85 years. Loneliness, a large number of chronic diseases, poor self-rated health, poor functional capacity, poor vision and perceived negative changes in life predicted depressive symptomatology. It seemed that minor depression among the elderly was most typically an episodic phenomenon.

Identifying predictors of functional limitations among the elderly is essential for planning and implementing appropriate preventive services. The purpose of this prospective study was to examine baseline physical activity as a predictor of health and functional ability outcomes 5 years later in people age 75 and 80 years at baseline. A clear trend was observed: The more physically active subjects had better health and functional ability compared to their more sedentary counterparts. After controlling for the baseline status, the degree of physical activity did not predict future disability but still maintained its predictive role at the level of disease severity. It is suggested that the level of habitual physical activity is an important predictor of health and functional ability among elderly people. Presumably, however, there is a reciprocal causal relationship between physical activity and health in elderly people. Physical activity counseling should therefore be included in preventive health strategies for the elderly.

The aim of this cross-sectional and cross-national study was to describe and compare the ability to carry out physical activities of daily living (PADL) and examine factors that might explain variation in this ability in two Nordic populations. Seven hundred and six men and women aged 75 from two populations (Glostrup, Denmark, and Jyväskylä, Finland) were interviewed and given a laboratory examination in 1989-90. The ability to carry out the PADL activities was studied by interview. Tests were given to determine depressive symptoms, cognitive capacity, and selected physical and sensory performance domains. Four different regression models (men and women in Jyväskylä and Glostrup) were used to analyze a number of variables describing physical and psychological health and performance related to the PADL. Knee extension strength and stair mounting height in three models (men and women in Jyväskylä and women in Glostrup), and walking speed in one model (men in Glostrup) emerged as explanatory factors on the basis of the physical performance tests done. Sight, except in the women in Glostrup, hearing in the men in Jyväskylä, and balance in the women in Glostrup also explained PADL functioning. In addition, symptoms of depression in the men in Glostrup, and symptoms of illness, except in the men in Jyväskylä, and cognitive capacity in the men in Jyväskylä emerged as explanatory factors in the regression models. There were, however, no major differences in the determinants of PADL functioning in the two Nordic populations of elderly people. Physical, psychological and sensory tests provide useful information, complementary to self-reports regarding declining PADL functional capacity.

PURPOSE: To examine the heritability of refractive astigmatism in older women. METHODS: Astigmatism was measured with an autorefractor in 88 monozygotic and 82 dizygotic female twin pairs aged 63 to 75 years. The prevalence and distribution of astigmatism and polar values J0 and J45 were estimated by standard statistical methods. Bivariate maximum likelihood model fitting was used to estimate genetic and environmental variance components using information from both eyes. RESULTS: Mean astigmatism of the more astigmatic eye was 0.93 diopters (D; SD ±0.58). Astigmatism of at least 0.25 D, 0.5 D, 0.75 D, or 1.0 D in either eye was present in 99.7%, 88.5%, 66.5%, and 46.2% of cases, respectively. The main direction of astigmatism was against the rule. The age-adjusted quantitative genetic modeling revealed that additive genetic effects accounted for 33.3% (95% confidence interval [CI], 21.9%-43.8%) of the total variance of astigmatism and for 18% (95% CI, 4%-31%) of the total variance of polar value J45 of both eyes (bivariate model), with the remaining variances due to nongenetic effects. There were no significant correlations between the twin pairs for polar value J0. CONCLUSIONS: In elderly female twins, additive genetic effects accounted for one-third of the variance of the amount of astigmatism and only a small fraction of the total variance of polar value J45.

In this paper, examples of existing AMR systems and IT integration solutions are described. Use cases for LV neutral fault management is specially covered. In order to illustrate the capabilities of the current AMR meters for neutral fault indication some laboratory test results are presented. (4 pages)

Background A crucial issue for the sustainability of societies is how to maintain health and functioning in older people. With increasing age, losses in vision, hearing, balance, mobility and cognitive capacity render older people particularly exposed to environmental barriers. A central building block of human functioning is walking. Walking difficulties may start to develop in midlife and become increasingly prevalent with age. Life-space mobility reflects actual mobility performance by taking into account the balance between older adults internal physiologic capacity and the external challenges they encounter in daily life. The aim of the Life-Space Mobility in Old Age (LISPE) project is to examine how home and neighborhood characteristics influence people’s health, functioning, disability, quality of life and life-space mobility in the context of aging. In addition, examine whether a person’s health and function influence life-space mobility. Design This paper describes the study protocol of the LISPE project, which is a 2-year prospective cohort study of community-dwelling older people aged 75 to 90 (n = 848). The data consists of a baseline survey including face-to-face interviews, objective observation of the home environment and a physical performance test in the participant’s home. All the baseline participants will be interviewed over the phone one and two years after baseline to collect data on life-space mobility, disability and participation restriction. Additional home interviews and environmental evaluations will be conducted for those who relocate during the study period. Data on mortality and health service use will be collected from national registers. In a substudy on walking activity and life space, 358 participants kept a 7-day diary and, in addition, 176 participants also wore an accelerometer. Discussion Our study, which includes extensive data collection with a large sample, provides a unique opportunity to study topics of importance for aging societies. A novel approach is employed which enables us to study the interactions of environmental features and individual characteristics underlying the life-space of older people. Potentially, the results of this study will contribute to improvements in strategies to postpone or prevent progression to disability and loss of independence.

Purpose: To examine the heritability of corneal refraction power (CR) and corneal astigmatism (AST) in older women. Methods: Corneal refraction and AST were measured by IOL master in 52 monozygotic (MZ) and 47 dizygotic (DZ) female twin pairs aged 66–79 years. The relative contribution of genetic and environmental factors to individual differences in CR was estimated by applying an independent pathway model to the twin data and AST by intraclass correlations (ICC). Results: For the right eye, mean CR was 44.58 dioptres (D) (standard deviation (SD) ±1.28) When comparing CR of the right and left eye between MZ and DZ, no significant difference was found. Mean AST was 0.77 D (SD ±0.44) with no differences observed either between the MZ and the DZ individuals, or between the left and the right eyes. ICCs between the sisters for CR were, for the right eye, 0.882 and 0.378 for MZ and DZ, respectively, and for the left eye 0.855 and 0.358. For AST of the right eye, the ICCs were 0.533 and 0.096 for the MZ and DZ pairs, respectively, and for the left eye, the MZ and DZ correlations were 0.396 and 0.299. Quantitative genetic modelling showed that 81% of the variance in CR could be explained by genetic factors, additive genetic factors explaining 62% (95% confidence interval [CI] 44% -86%) and dominant genetic effect 19% (95% CI 7–49%) of the variance in CR. Different models were constructed to explain the heredity of AST. None of these models gave meaningful results, although the ICC values for MZ were higher than those for DZ. Conclusions: Most of the variance in CR among older Finnish women could be explained by genetic factors.

The study was based on an epidemiological model in which performing activities of daily living (ADL) was the dependent variable. Variation in performing was explained by physical and mental health, and by physical performance. The population consisted of all 80-year-old residents (N = 291) of the city of Jyväskylä in central Finland; 90% of them agreed to take part in the interviews at home, while 72% took part in the laboratory examinations to determine health status and functional capacity. Difficulties in at least some PADL (Physical Activities of Daily Living) tasks were reported by 86.5% of the men, and 87.2% of the women; none said they could perform all IADL (Instrumental Activities of Daily Living) tasks without difficulty. Physical performance (grip strength and stair mounting test in men, and stair mounting test, balance, and upper extremity function test in women) and visual acuity showed a significant association with ADL performance both in men and in women. In addition, depressive symptoms in women, and cognitive capacity in men were associated with both PADL and IADL, and ADL performance, respectively. In the search for pathways to reduced ADL performance, it is important to look not only at chronic diseases but also at the aging processes as well as the disabilities caused by inactivity. Tests of cognitive capacity, psychological well-being and physical performance provide valuable information on the factors that underlie the aged individual's reduced functional capacity.

This study analyzes the associations of socioeconomic status (SES), health, and physical activity with maximal isometric strength in 75-year-old men (n = 104) and women (n = 191). Maximal isometric strength was measured with dynamometers; the forces were adjusted using body weight. The maximal forces for women varied from 66% (trunk flexion) to 73% (knee extension) of those of the men. SES was not associated with muscle force. For men the trunk forces and elbow flexion force correlated negatively with the number of chronic diseases, index of musculoskeletal pain, and self-rated health. For women all the strength test results correlated with self-rated health; the other health indicators showed significant correlation with trunk extension force only. For both sexes the physically more active exhibited greater strength. The index of musculoskeletal symptoms explained the variance on trunk force factor in both sexes. It was concluded that a higher level of everyday physical activity and good values in the state-of-health indicators were the most important variables explaining greater strength among the elderly.

Background To cope at their homes, community-dwelling older people surviving a hip fracture need a sufficient amount of functional ability and mobility. There is a lack of evidence on the best practices supporting recovery after hip fracture. The purpose of this article is to describe the design, intervention and demographic baseline results of a study investigating the effects of a rehabilitation program aiming to restore mobility and functional capacity among community-dwelling participants after hip fracture. Methods/Design Population-based sample of over 60-year-old community-dwelling men and women operated for hip fracture (n = 81, mean age 79 years, 78% were women) participated in this study and were randomly allocated into control (Standard Care) and ProMo intervention groups on average 10 weeks post fracture and 6 weeks after discharged to home. Standard Care included written home exercise program with 5-7 exercises for lower limbs. Of all participants, 12 got a referral to physiotherapy. After discharged to home, only 50% adhered to Standard Care. None of the participants were followed-up for Standard Care or mobility recovery. ProMo-intervention included Standard Care and a year-long program including evaluation/modification of environmental hazards, guidance for safe walking, pain management, progressive home exercise program and physical activity counseling. Measurements included a comprehensive battery of laboratory tests and self-report on mobility limitation, disability, physical functional capacity and health as well as assessments for the key prerequisites for mobility, disability and functional capacity. All assessments were performed blinded at the research laboratory. No significant differences were observed between intervention and control groups in any of the demographic variables. Discussion Ten weeks post hip fracture only half of the participants were compliant to Standard Care. No follow-up for Standard Care or mobility recovery occurred. There is a need for rehabilitation and follow-up for mobility recovery after hip fracture. However, the effectiveness of the ProMo program can only be assessed at the end of the study. Trial registration Current Controlled Trials ISRCTN53680197

Functional ability is affected by a number of different factors, including biological ageing, illness, and living environment. This study was concerned with the connections of functional ability with mood and cognitive capacity in elderly individuals. It forms part of a cross-sectional study which was carried out in 1988, involving two random samples of 800 non-institutionalized persons born in 1904–1913 and 1914–1923. Functional ability tests included 18 questions; eight concerned coping with physical activities of daily living (PADL) and 10 instrumental activities of daily living (IADL). Depressive symptoms and cognitive capacity were examined by tests. In addition, there was a set of questions concerning health status and socioeconomic situation. Regression models (LISREL) were used to identify factors associated with PADL and IADL activities. In the younger age group, 68% of the men and 65% of the women had no difficulty in coping with PADL activities. The figures for the older group were 58% and 37%, respectively. Difficulties were reported more frequently with IADL activities. In the older age group 17% of the men and 10% of the women coped with no difficulty. In all activities difficulties tended to increase with age, and more so among women than men. The explanatory factors that emerged from the regression models as most significant were the number of chronic illnesses, the number of depressive symptoms and cognitive capacity.