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4. The Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers in Italy: Analyzing the Role of Individual and Workplace-Level Factors in the Reopening Phase After Lockdown

Author

Moro, M, Calamandrei, G, Poli, R, Di Mattei, V, Perra, A, Kurotschka, P, Restrepo, A, Romano, F, La Torre, G, Preti, E, Mascayano, F, Picardi, A, Chiarotti, F, Rapisarda, V, Urban, A, Alvarado, R, Susser, E, Carta, M, Moro M. F., Calamandrei G., Poli R., Di Mattei V., Perra A., Kurotschka P. K., Restrepo A., Romano F., La Torre G., Preti E., Mascayano F., Picardi A., Chiarotti F., Rapisarda V., Urban A., Alvarado R., Susser E., Carta M. G., Moro, M, Calamandrei, G, Poli, R, Di Mattei, V, Perra, A, Kurotschka, P, Restrepo, A, Romano, F, La Torre, G, Preti, E, Mascayano, F, Picardi, A, Chiarotti, F, Rapisarda, V, Urban, A, Alvarado, R, Susser, E, Carta, M, Moro M. F., Calamandrei G., Poli R., Di Mattei V., Perra A., Kurotschka P. K., Restrepo A., Romano F., La Torre G., Preti E., Mascayano F., Picardi A., Chiarotti F., Rapisarda V., Urban A., Alvarado R., Susser E., and Carta M. G.

Abstract

Introduction: Italy is one of the high-income countries hit hardest by Covid-19. During the first months of the pandemic, Italian healthcare workers were praised by media and the public for their efforts to face the emergency, although with limited knowledge and resources. However, healthcare workers soon had to face new challenges at a time when the national health system was working hard to recover. This study focuses on this difficult period to assess the impact of the COVID-19 pandemic on the mental health of Italian healthcare workers. Materials and Methods: Healthcare workers from all Italian regions [n = 5,502] completed an online questionnaire during the reopening phase after the first wave lockdown. We assessed a set of individual-level factors (e.g., stigma and violence against HCWs) and a set of workplace-level factors (e.g., trust in the workplace capacity to handle COVID-19) that were especially relevant in this context. The primary outcomes assessed were score ≥15 on the Patient Health Questionnaire-9 and score ≥4 on the General Health Questionnaire-12, indicators of clinically significant depressive symptoms and psychological distress, respectively. Logistic regression analyses were performed on depressive symptoms and psychological distress for each individual- and workplace-level factor adjusting for gender, age, and profession. Results: Clinically significant depressive symptoms were observed in 7.5% and psychological distress in 37.9% of HCWs. 30.5% of healthcare workers reported having felt stigmatized or discriminated, while 5.7% reported having experienced violence. Feeling stigmatized or discriminated and experiencing violence due to being a healthcare worker were strongly associated with clinically significant depressive symptoms [OR 2.98, 95%CI 2.36–3.77 and OR 4.72 95%CI 3.41–6.54] and psychological distress [OR 2.30, 95%CI 2.01–2.64 and OR 2.85 95%CI 2.16–3.75]. Numerous workplace-level factors, e.g., trust in the workplace capacity to han

Published
2022

6. The effect of depressive symptoms on disability-free survival in healthy older adults: A prospective cohort study

Author

Roebuck, G., Lotfaliany, M., Agustini, B., Forbes, M., Mohebbi, M., McNeil, J., Woods, R.L., Reid, Christopher, Nelson, M.R., Shah, R.C., Ryan, J., Newman, A.B., Owen, A., Freak-Poli, R., Stocks, N., Berk, M., Roebuck, G., Lotfaliany, M., Agustini, B., Forbes, M., Mohebbi, M., McNeil, J., Woods, R.L., Reid, Christopher, Nelson, M.R., Shah, R.C., Ryan, J., Newman, A.B., Owen, A., Freak-Poli, R., Stocks, N., and Berk, M.

Abstract

Background: Gerontology and ageing research are increasingly focussing on healthy life span (healthspan), the period of life lived free of serious disease and disability. Late-life depression (LLD) is believed to impact adversely on physical health. However, no studies have examined its effect on healthspan. This study investigated the effect of LLD and subthreshold depression on disability-free survival, a widely accepted measure of healthspan. Methods: This prospective cohort study used data from the ASPirin in Reducing Events in the Elderly study. Participants were aged ≥70 years (or ≥65 years for African-American and Hispanic participants) and free of dementia, physical disability and cardiovascular disease. Depressive symptoms were measured using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10). LLD and subthreshold depression were defined as CES-D-10 scores ≥8 and 3–7, respectively. Disability-free survival was defined as survival free of dementia and persistent physical disability. Results: A total of 19,110 participants were followed up for a maximum of 7.3 years. In female participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors, medical comorbidities, polypharmacy, physical function and antidepressant use (HR, 1.50; 95% CI, 1.23–1.82). In male participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors (HR, 1.30; 95% CI, 1.03–1.64). Subthreshold depression was also associated with lower disability-free survival in both sexes. Conclusions: LLD may be a common and important risk factor for shortened healthspan.

Published
2023

7. An eigen analysis of the GP community

Author

Langdon, W., Poli, R., and Banzhaf, W.

Abstract

Abstract: The coauthorship and coeditorship relations as recorded in the genetic programming bibliography provide a quantitative view of the GP community. Eigen analysis is used to find the principle components of the community. It shows the major eigenvalues and eigenvectors are responsible for 70% of the connection graph. Top eigen authors are given.

Published
2024
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9. The Halting Probability in Von Neumann Architectures

Author

Langdon, W. B., Poli, R., Hutchison, David, Series editor, Kanade, Takeo, Series editor, Kittler, Josef, Series editor, Kleinberg, Jon M., Series editor, Mattern, Friedemann, Series editor, Mitchell, John C., Series editor, Naor, Moni, Series editor, Nierstrasz, Oscar, Series editor, Pandu Rangan, C., Series editor, Steffen, Bernhard, Series editor, Sudan, Madhu, Series editor, Terzopoulos, Demetri, Series editor, Tygar, Dough, Series editor, Vardi, Moshe Y., Series editor, Weikum, Gerhard, Series editor, Collet, Pierre, editor, Tomassini, Marco, editor, Ebner, Marc, editor, Gustafson, Steven, editor, and Ekárt, Anikó, editor

Published
2006
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10. Trajectories of physical health-related quality of life and the risk of incident cardiovascular disease events and all-cause mortality in older people.

Author

Phyo, AZZ, Gonzalez-Chica, DA, Stocks, NP, Woods, RL, Tran, T, Reid, CM, Tonkin, AM, Nelson, MR, McNeil, JJ, Murray, AM, Gasevic, D, Freak-Poli, R, Ryan, J, ASPREE Study Group, Phyo, AZZ, Gonzalez-Chica, DA, Stocks, NP, Woods, RL, Tran, T, Reid, CM, Tonkin, AM, Nelson, MR, McNeil, JJ, Murray, AM, Gasevic, D, Freak-Poli, R, Ryan, J, and ASPREE Study Group

Abstract

STUDY OBJECTIVE: The aim of this study was to identify whether physical component score (PCS) of health-related quality of life trajectories over 4.7-years predicted subsequent risk of incident fatal and non-fatal CVD events, and all-cause mortality. METHODS: This study included 16,871 community-dwelling people aged ≥65 years enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) trial. PCS was assessed annually using the SF-12 (version-2) over a median 4.7-years (i.e. from baseline (2010-2014) till June 2017). Incident CVD events and all-cause mortality occurring after June 2017 until the second-year after the end of the trial were considered. Growth mixture and logistic regression modelling were used. RESULTS: Four PCS trajectories were identified: high (66.5%), intermediate (13.3%), decline (13.8%), and low (6.5%), and there was subsequently a total of 406 (2.50%) incident CVD events, 197 (1.17%) fatal CVD, and 751 (4.45%) deaths. The declining PCS trajectory group had the highest risk of incident CVD (adjusted OR, 1.51; 95% CI 1.14, 1.99), while the low PCS trajectory group had the greatest risk of fatal CVD (adjusted OR, 1.74; 95%CI 1.06, 2.85) and all-cause mortality (adjusted OR, 1.83; 95%CI 1.40, 2.40). After further adjustment for the baseline PCS score, only the association between declining PCS trajectory and incident CVD (adjusted OR, 1.51; 95%CI 1.11, 2.07) remained. CONCLUSION: Our study strengthens the importance of PCS as a predictive measure of CVD and all-cause mortality in older people and also highlights that a declining PCS trajectory could be considered an early predictor of future CVD events.

Published
2022

11. The Association of Weight Loss, Weight Status, and Abdominal Obesity with All-Cause Mortality in Older Adults

Author

Alharbi, TA, Ryan, J, Freak-Poli, R, Gasevic, D, Scali, J, Ritchie, K, Ancelin, M-L, Owen, AJ, Alharbi, TA, Ryan, J, Freak-Poli, R, Gasevic, D, Scali, J, Ritchie, K, Ancelin, M-L, and Owen, AJ

Abstract

OBJECTIVES: The objectives of this study were to examine whether weight loss, weight status (based on body mass index [BMI] categories), and abdominal obesity (based on waist circumference [WC]) were associated with a 17-year mortality risk in community-dwelling older adults. METHODS: Participants were 2,017 community-dwelling adults aged 65 years or above in the longitudinal Enquête de Santé Psychologique-Risques, Incidence et Traitement study. Self-reported weight loss was collected at baseline during face-to-face interviews. Bodyweight (kg), height (m), and WC (cm) were independently measured at the baseline. BMI was categorized as follows: underweight (BMI <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥30 kg/m2). Abdominal obesity was defined by a WC of ≥102 cm in men and ≥88 cm in women. Adjusted Cox proportional hazards models were used to examine associations of weight loss, weight status, and abdominal obesity with all-cause mortality. RESULTS: Over 17 years of follow-up (median 15.5 years), 812 participants died. Abdominal obesity compared to nonabdominal obesity was associated with a 49% increased mortality risk (95% confidence interval (CI): 1.22-1.83). However, being overweight (but not obese) was associated with a 20% decreased risk (95% CI: 0.66-0.97) compared to a normal BMI. Gender did not affect these associations. In the whole cohort, self-reported weight loss at baseline was not associated with an increased mortality risk after adjusting for health and lifestyle factors. However, in men, a baseline self-reported recent weight loss of >3 kg was associated with a 52% increase in mortality risk (95% CI: 1.05-2.18) in a fully adjusted model. CONCLUSION: In community-dwelling adults aged ≥65 years, abdominal obesity was strongly associated with increased mortality risk. Being overweight appeared, however, to be protective against mortality. Modest self-reported weight loss was not associated with all-cause mortal

Published
2022

12. Social Isolation, Social Support, and Loneliness Profiles Before and After Spousal Death and the Buffering Role of Financial Resources

Author

Kelley, J, Freak-Poli, R, Kung, CSJ, Ryan, J, Shields, MA, Kelley, J, Freak-Poli, R, Kung, CSJ, Ryan, J, and Shields, MA

Abstract

OBJECTIVES: We provide new evidence on the profiles of social isolation, social support, and loneliness before and after spousal death for older widows. We also examine the moderating effects of gender and financial resources on changes in social health before and after widowhood. METHODS: We use 19 waves of data from the Household, Income and Labour Dynamics in Australia Survey, including 749 widowed individuals and a comparison group of around 8,000 married individuals. We apply coarsened exact matching weights and control for age and time trends. Local polynomial smoothed plots show the profiles of social health from 3 years pre- to 3 years postspousal death. All analyses were stratified by gender. RESULTS: Spousal death was strongly associated with increased loneliness for women and men, but also an increase in interactions with friends and family not living with the bereaved. For men, financial resources (both income and asset wealth) provided some protection against loneliness. Spousal death was not associated with changes in social support or participation in community activities. DISCUSSION: We demonstrate that loneliness is a greater challenge of widowhood than social isolation or a lack of social support. Our findings suggest that interventions focusing only on increasing social interactions are unlikely to alleviate loneliness following spousal death. Moreover, policies that reduce the cost of formal social participation may have limited effectiveness in tackling loneliness, particularly for women. Alternative strategies, such as helping the bereaved form a new sense of identity and screening for loneliness around widowhood by health care workers, could be beneficial.

Published
2022

13. Objectively Assessed Weight Change and All-Cause Mortality among Community-Dwelling Older People

Author

Alharbi, T, Ryan, J, Freak-Poli, R, Gasevic, D, Scali, J, Ritchie, K, Ancelin, M-L, Owen, AJ, Alharbi, T, Ryan, J, Freak-Poli, R, Gasevic, D, Scali, J, Ritchie, K, Ancelin, M-L, and Owen, AJ

Abstract

Later life changes in body weight may be associated with an increased risk of mortality in older adults. The objective of this study was to examine whether weight change over four years was associated with a 17-year mortality risk in older adults. Participants were 1664 community-dwelling adults aged ≥65 years in the longitudinal Enquete de Sante’ Psychologique-Risques, Incidence et Traitement (ESPRIT) study. Outcomes were all-cause mortality, cardiovascular disease (CVD) and cancer mortality. Weight change was defined as difference between weight at baseline and 4 years, categorised into: weight stable (±<5% weight change), weight loss (≥5%) and weight gain (≥5%). Association between weight change and mortality risk was evaluated using Cox proportional hazards models. Over 17 years of follow-up (median 15 years), 565 participants died. Compared to stable weight participants, those with ≥ 5% weight loss had an increased risk of all-cause mortality (HR: 1.24, 95% CI: 1.00−1.56, p = 0.05) and CVD mortality (HR: 1.53, 95% CI: 1.10−2.14, p = 0.01), but not cancer mortality (HR: 0.83, 95% CI: 0.50−1.39, p = 0.49). Weight gain of ≥5% was not associated with increased mortality (HR: 1.05, 95% CI: 0.76−1.45, p = 0.74). Weight monitoring in older adults could help identify weight loss at its early stages to better target interventions to maintain nutritional reserve and prevent premature mortality.

Published
2022

15. Mutation in Genetic Programming: A Preliminary Study

Author

Page, J., Poli, R., Langdon, W. B., Goos, Gerhard, Series editor, Hartmanis, Juris, Series editor, van Leeuwen, Jan, Series editor, Poli, Riccardo, editor, Nordin, Peter, editor, Langdon, William B., editor, and Fogarty, Terence C., editor

Published
1999
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16. Boolean Functions Fitness Spaces

Author

Langdon, W. B., Poli, R., Goos, Gerhard, Series editor, Hartmanis, Juris, Series editor, van Leeuwen, Jan, Series editor, Poli, Riccardo, editor, Nordin, Peter, editor, Langdon, William B., editor, and Fogarty, Terence C., editor

Published
1999
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18. Fitness causes bloat: Mutation

Author

Langdon, W. B., Poli, R., Goos, Gerhard, editor, Hartmanis, Juris, editor, van Leeuwen, Jan, editor, Banzhaf, Wolfgang, editor, Poli, Riccardo, editor, Schoenauer, Marc, editor, and Fogarty, Terence C., editor

Published
1998
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28. Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality

Author

Freak-Poli, R, Ryan, J, Neumann, JT, Tonkin, A, Reid, CM, Woods, RL, Nelson, M, Stocks, N, Berk, Michael, McNeil, JJ, Britt, C, Owen, AJ, Freak-Poli, R, Ryan, J, Neumann, JT, Tonkin, A, Reid, CM, Woods, RL, Nelson, M, Stocks, N, Berk, Michael, McNeil, JJ, Britt, C, and Owen, AJ

Abstract

Abstract Background Poor social health is associated with increased risk of cardiovascular disease (CVD). Recent research suggests that different social health domains should be considered separately as the implications for health and possible interventions may differ. Aim To assess social isolation, low social support and loneliness as predictors of CVD. Methods Secondary analysis of 11,486 community-dwelling, Australians, aged 70 years and over, free of CVD, dementia, or significant physical disability, from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Social isolation, social support (Revised Lubben Social Network Scale), and loneliness were assessed as predictors of CVD using Cox proportional-hazard regression. CVD events included fatal CVD, heart failure hospitalization, myocardial infarction and stroke. Analyses were adjusted for established CVD risk factors. Results Individuals with poor social health were 42 % more likely to develop CVD (p = 0.01) and twice as likely to die from CVD (p = 0.02) over a median 4.5 years follow-up. Interaction effects indicated that poorer social health more strongly predicted CVD in smokers (HR 4.83, p = 0.001, p-interaction = 0.01), major city dwellers (HR 1.94, p < 0.001, p-interaction=0.03), and younger older adults (70-75 years; HR 2.12, p < 0.001, p-interaction = 0.01). Social isolation (HR 1.66, p = 0.04) and low social support (HR 2.05, p = 0.002), but not loneliness (HR 1.4, p = 0.1), predicted incident CVD. All measures of poor social health predicted ischemic stroke (HR 1.73 to 3.16). Conclusions Among healthy older adults, social isolation and low social support may be more im

Published
2021

29. The association of weight change and all-cause mortality in older adults: a systematic review and meta-analysis

Author

Alharbi, TA, Paudel, S, Gasevic, D, Ryan, J, Freak-Poli, R, Owen, AJ, Alharbi, TA, Paudel, S, Gasevic, D, Ryan, J, Freak-Poli, R, and Owen, AJ

Abstract

Abstract Objective there may be age-related differences in the impact of weight change on health. This study systematically reviewed the evidence on the relationship between weight change and all-cause mortality in adults aged 65 years and older. Methods MEDLINE, EMBASE and CINAHL were searched from inception to 11 June 2020, PROSPERO CRD 42019142268. We included observational studies reporting on the association between weight change and all-cause mortality in older community-dwelling adults. A random-effects meta-analysis was performed to calculate pooled hazard ratios and scored based on the Agency for Healthcare Research and Quality guidelines. Results a total of 30 studies, including 1,219,279 participants with 69,255 deaths, demonstrated that weight loss was associated with a 59% increase in mortality risk (hazard ratio (HR): 1.59; 95% confidence interval (CI): 1.45–1.74; P < 0.001). Twenty-seven studies that reported outcomes for weight gain (1,210,116 participants with 65,481 deaths) indicated that weight gain was associated with a 10% increase in all-cause mortality (HR: 1.10; 95%CI: 1.02, 1.17; P = 0.01). Four studies investigated weight fluctuation (2,283 events among 6,901 participants), which was associated with a 63% increased mortality risk (HR: 1.66; 95%CI: 1.28, 2.15). No evidence of publication bias was observed (all P > 0.05). Conclusion for community-dwelling older adults, weight changes (weight loss, gain or weight fluctuation) are associated with an increased risk of all-cause mortality risk relative to stable weight. Further research is needed to determine whether these associations vary depending upon initial weight, and whether or not the weight loss/gain was intention

Published
2021

30. Social Isolation, Social Support and Loneliness as independent interconnected concepts

Author

Freak-Poli, R, Ryan, J, Thach, T, Owen, A, Power, JM, Berk, Michael, Stocks, N, Gonzalez-Chica, D, Lowthian, JA, Fisher, J, Byles, J, Freak-Poli, R, Ryan, J, Thach, T, Owen, A, Power, JM, Berk, Michael, Stocks, N, Gonzalez-Chica, D, Lowthian, JA, Fisher, J, and Byles, J

Abstract

Abstract Background Social isolation, lack of social support and loneliness have historically been assessed as overlapping or even interchangeable terms. We aimed to assess whether these three social constructs are independently associated with health-related quality of life (HRQoL). Methods This analysis included 10,517 women aged 70-75 years from the Australian Longitudinal Study on Women's Health (ALSWH). Social isolation (Duke Social Support Index: DSSI), social support (DSSI), and loneliness (one-item) were investigated for their association with HRQoL (physical [PCS] and mental [MCS] component scores of the SF-36® questionnaire). Multivariable analyses adjusted for age, demographics, socio-economic position and medical conditions. Results Social isolation, social support and loneliness were not strongly correlated with one another. However, all were independently associated with HRQoL (PCS: isolation -0.97, low support -2.24, loneliness -2.70; MCS: isolation -1.96, low support -4.78, loneliness -10.31; p-value<0.001 for each). Compared to those with low social isolation, high social support and lack of loneliness, women highly isolated, with low social support and lonely reported the lowest HRQoL (MCS: -18 to -17; PCS: -8 to -6). Other combinations of isolation, support and loneliness varied in their associations with HRQoL. Conclusions Social isolation, social support and loneliness are distinct, yet interconnected concepts that may coexist and are each adversely associated with HRQoL. Key messages Ageing populations present the challenge of supporting older people to maintain a longer, healthy, meaningful and community-dwelling

Published
2021

31. Dispositional Optimism and All-Cause Mortality in Older Adults: A Cohort Study

Author

Craig, HJ, Ryan, J, Freak-Poli, R, Owen, A, McNeil, J, Woods, R, Ward, S, Britt, C, Gasevic, D, Craig, HJ, Ryan, J, Freak-Poli, R, Owen, A, McNeil, J, Woods, R, Ward, S, Britt, C, and Gasevic, D

Abstract

OBJECTIVE: Optimism is modifiable and may be associated with healthy aging. We aim to investigate whether dispositional optimism is associated with all-cause mortality in adults 70 years and older. METHODS: Between 2010 and 2014, older adults free of serious cardiovascular disease and dementia were recruited through primary care physicians and enrolled in the Aspirin Reducing Events in the Elderly (ASPREE) clinical trial. Australian ASPREE participants were invited to participate in the ASPREE Longitudinal Study of Older Persons (ALSOP) that was running in parallel to ASPREE. Optimism was assessed at baseline using the Life Orientation Test-Revised. The association between optimism, divided into quartiles, and all-cause mortality was assessed using Cox proportional hazards models. RESULTS: A total of 11,701 participants (mean [standard deviation] age = 75.1 [4.24] years; 46.6% men) returned the ALSOP Social questionnaire and completed the Life Orientation Test-Revised. During a median follow-up of 4.7 years, 469 deaths occurred. The fully adjusted model was not significant (hazard ratio = 0.78, 95% confidence interval = 0.58-1.06). There was evidence that age was an effect modifier of the association between optimism and longevity. Higher optimism was associated with lower mortality risk in the oldest individuals only (77+ years; hazard ratio = 0.61, 95% confidence interval = 0.39-0.96). CONCLUSIONS: We observed no independent relationship between optimism and all-cause mortality in the total sample, although optimism seemed to be associated with lower risk among the oldest old (adults 77 years and older).

Published
2021

32. Health-related quality of life and all-cause mortality among older healthy individuals in Australia and the United States: a prospective cohort study

Author

Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Woods, RL, Reid, CM, Nelson, MR, Murray, AM, Gasevic, D, Stocks, NP, Freak-Poli, R, Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Woods, RL, Reid, CM, Nelson, MR, Murray, AM, Gasevic, D, Stocks, NP, and Freak-Poli, R

Abstract

PURPOSE: Previous research has demonstrated that lower health-related quality of life (HRQoL) is associated with higher morbidity and mortality, especially in-patient groups. The association of HRQoL with all-cause mortality in community samples requires further investigation. This study aimed to examine whether HRQoL predicts all-cause mortality in older healthy community-dwelling people from Australia and the United States (U.S.) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial. We also explored whether this association varies by gender or country. METHOD: A prospective cohort of 19,106 individuals aged 65-98 years, who were without a dementia diagnosis or a known major life-limiting disease, and completed the 12-item short-form-HRQoL at recruitment (2010-2014). They were followed until June 2017. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours and clinical measures. Hazards ratios were estimated for every 10-unit increase in PCS or MCS. RESULTS: There were 1052 deaths over a median 4.7-years (interquartile range 3.6-5.7) of follow-up, with 11.9 events per 1000 person-years. Higher PCS was associated with lower all-cause mortality (HR 0.83, 95% CI 0.77, 0.89) in the entire sample, while higher MCS was associated with lower mortality among U.S. participants only (HR 0.78, 95% CI 0.63, 0.95). Gender differences in the association of either PCS or MCS with mortality were not observed. CONCLUSION: Our large study provides evidence that HRQoL is inversely associated with all-cause mortality among initially healthy older people.

Published
2021

33. The Utility of Assessing Health-Related Quality of Life to Predict Cognitive Decline and Dementia

Author

Phyo, AZZ, Gonzalez-Chica, DA, Stocks, NP, Storey, E, Woods, RL, Murray, AM, Orchard, SG, Shah, RC, Gasevic, D, Freak-Poli, R, Ryan, J, Phyo, AZZ, Gonzalez-Chica, DA, Stocks, NP, Storey, E, Woods, RL, Murray, AM, Orchard, SG, Shah, RC, Gasevic, D, Freak-Poli, R, and Ryan, J

Abstract

BACKGROUND: Health-related quality of life (HRQoL) has been shown to predict adverse health outcome in the general population. OBJECTIVE: We examined the cross-sectional association between HRQoL and cognitive performance at baseline. Next, we explored whether baseline HRQoL predicted 5-year incident cognitive decline and dementia and whether there were gender differences. METHODS: 19,106 community-dwelling participants from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, aged 65-98 years, free of major cognitive impairments, and completed the HRQoL 12-item short-form (SF-12) at baseline (2010-2014), were followed until June 2017. The physical (PCS) and mental component scores (MCS) of SF-12 were calculated. The cognitive tests were assessed at baseline, year 1, 3, 5, and 7 or close-out visit. Cognitive decline was defined as > 1.5 SD drop from baseline on any of the cognitive tests. Dementia was adjudicated according to DSM-IV criteria. Linear and Cox proportional-hazards regressions were used to examine the cross-sectional and longitudinal associations respectively. RESULTS: At baseline, higher PCS and MCS were associated with better cognition. Over a median 4.7-year follow-up, higher MCS was associated with a reduced risk of cognitive decline and dementia (12% and 15% respectively, per 10-unit increase) and a 10-unit higher PCS was associated with a 6% decreased risk of cognitive decline. PCS did not predict dementia incidence. Findings were not different by gender. CONCLUSION: Our study found that higher HRQoL, in particular MCS, predicted a reduced risk of cognitive decline and dementia over time in community-dwelling older people.

Published
2021

34. Using Health-Related Quality of Life to Identify the Incident Cardiovascular Disease Risk

Author

Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Stocks, NP, Reid, CM, Tonkin, AM, Woods, R, Freak-Poli, R, Phyo, AZZ, Ryan, J, Gonzalez-Chica, DA, Stocks, NP, Reid, CM, Tonkin, AM, Woods, R, and Freak-Poli, R

Abstract

Previous studies have revealed that poor health-related quality of life (HRQoL) is associated with a higher risk of hospital readmission and mortality in patients with cardiovascular disease (CVD). The association between HRQoL and incident CVD is still limited for general older people. This study explored the associations between baseline HRQoL and incident and fatal CVD in community-dwelling Australian and the United States older people enrolled in ASPREE clinical trial. A cohort of 19,106 individuals aged 65 to 98 years, who were initially free of CVD, dementia, or disability, were followed between March 2010 and June 2017. The SF-12 questionnaire was used to assess HRQoL, and the physical (PCS) and mental component scores (MCS) of SF-12 were derived using norm-based methods. Incident major adverse CVD events included fatal CVD (death due to atherothrombotic CVD), hospitalizations for heart failure, myocardial infarction or stroke. Analyses were performed using Cox proportional-hazard regression. Over a median 4.7 follow-up years, there were 922 incident CVD events, 203 fatal CVD events, 171 hospitalizations for heart failure, 355 fatal or nonfatal myocardial infarction and 403 fatal or nonfatal strokes. A 10-unit higher PCS, but not MCS, was associated with a lower risk of incident CVD (HR=0.86, 95%CI 0.79-0.92), hospitalization for heart failure (HR=0.72, 95%CI 0.60-0.85), and myocardial infarction (HR=0.85, 95%CI 0.75-0.96). Neither PCS nor MCS was associated with fatal CVD events or stroke. Physical HRQoL can be used in combination with clinical data to identify the incident CVD risk among community-dwelling older people.

Published
2021

35. Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality

Author

Freak-Poli, R., Ryan, J., Neumann, J.T., Tonkin, A., Reid, Christopher, Woods, R.L., Nelson, M., Stocks, N., Berk, M., McNeil, J.J., Britt, C., Owen, A.J., Freak-Poli, R., Ryan, J., Neumann, J.T., Tonkin, A., Reid, Christopher, Woods, R.L., Nelson, M., Stocks, N., Berk, M., McNeil, J.J., Britt, C., and Owen, A.J.

Abstract

Background: Poor social health is associated with increased risk of cardiovascular disease (CVD). Recent research suggests that different social health domains should be considered separately as the implications for health and possible interventions may differ. Aim: To assess social isolation, low social support and loneliness as predictors of CVD. Methods: Secondary analysis of 11,486 community-dwelling, Australians, aged 70 years and over, free of CVD, dementia, or significant physical disability, from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Social isolation, social support (Revised Lubben Social Network Scale), and loneliness were assessed as predictors of CVD using Cox proportional-hazard regression. CVD events included fatal CVD, heart failure hospitalization, myocardial infarction and stroke. Analyses were adjusted for established CVD risk factors. Results: Individuals with poor social health were 42 % more likely to develop CVD (p = 0.01) and twice as likely to die from CVD (p = 0.02) over a median 4.5 years follow-up. Interaction effects indicated that poorer social health more strongly predicted CVD in smokers (HR 4.83, p = 0.001, p-interaction = 0.01), major city dwellers (HR 1.94, p < 0.001, p-interaction=0.03), and younger older adults (70-75 years; HR 2.12, p < 0.001, p-interaction = 0.01). Social isolation (HR 1.66, p = 0.04) and low social support (HR 2.05, p = 0.002), but not loneliness (HR 1.4, p = 0.1), predicted incident CVD. All measures of poor social health predicted ischemic stroke (HR 1.73 to 3.16). Conclusions: Among healthy older adults, social isolation and low social support may be more important than loneliness as cardiovascular risk factors. Social health domains should be considered in future CVD risk prediction models.

Published
2021

37. Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes 11 Medical and Health Sciences 1103 Clinical Sciences

Author

Mirijello, A, Viazzi, F, Fioretto, P, Giorda, C, Ceriello, A, Russo, G, Guida, P, Pontremoli, R, De Cosmo, S, Cimino, A, Fava, D, Meloncelli, I, Nicolucci, A, Pellegrini, F, Rossi, M, Turco, S, Vespasiani, G, Graziano, G, Lucisano, G, Memmo, R, Pellicciotta, E, Paciotti, V, Pupillo, M, Armentano, G, Giovannini, C, Armentano, V, Laudato, M, Acquati, S, Ciardullo, A, Laffi, G, Felace, G, Taboga, C, Tortul, C, Santantonio, G, Suraci, C, Ghisoni, G, Raffa, M, Genovese, S, Lovagnini-Scher, C, Rampini, P, Rocca, A, Ruggeri, P, Tortato, E, Cotti, L, Cristofaro, M, Tagliaferri, M, Comoglio, M, Fornengo, R, Gentile, F, Gigante, A, Mastinu, F, Di Benedetto, A, Pata, P, Arcangeli, A, Orsini, P, Acler, P, De Blasi, G, Cicioni, G, Pocciati, S, Marangoni, A, Nogara, A, Lanero, M, Bertero, M, Damassino, R, Bergonzini, C, Schumtz, L, Seksich, L, Pipitone, A, Boaretto, M, Manfroi, I, Parmesan, L, Conte, B, Soccol, F, Pagano, A, Papini, E, Rinaldi, R, Petrucci, L, Graziano, F, Chianelli, M, Silvagni, S, 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L., Gallo A., Parlato P., Pecchielan W., Jacovacci J., Placentino G., Richini D., Molinari S., Strazzeri R., Fabbri T., Di Bartolo P., Garrapa G., D'Incau F., Lagomanzini P., Conte P., Todesco F., Foglini P., Pantanetti P., Bedetta C., Maricotti R., Tomasi F., Monesi M., Graziani R., Beretta F., Penna L., Guberti A., Dazzi D., Forte E., Gasbarrone A., Marrocco T., Moschetta R., Tuccinardi F., De Meo F., Coppola A., Pirolozzi P., Placitelli E., Vallefuoco R., Catone B., Ceschia S., Urban M., Fabbri F., Torresani M., Crovetto R., Battistini M., Carosia P., Viviani G. L., Durante A., Pais F., Lilliu V., Quieto C., D'Ugo E., Squadrone M., Amenduni T., Iovannisci M. M., Della Penna L., Potente F., Delle Donne T., Massa C., Ulisse M. A., De Berardinis S., Guarnieri I., Pace S., Splendiani M., Di Giuseppe R., Brunato B., Assaloni R., Muraro R., Loro R., Bucciol S., Lavacca C., Rossi M., Sabbatini G., Quadri F., Sambuco L., Santacroce C., Paola Caretta D., Marino C., Micheletti A., Petrelli A., Corda A., Pisano L., Guaita G., Deias C., Trevisan G., Coletti I., Iannarelli R., De Luca A., Minnucci A., Antenucci D., Di Florio C., Angelicola G., Bosco A., Fresco R., Di Marco G., Ugolotti D., Cadossi T., Di Caro P., Mazzocchetti M., Buzzetti R., Leto G., Gnessi C., Cipolloni L., Foffi C., Moretti C., Venditti C., Meniconi R., Bertoli S., Cosimi S., Di Cianni G., Turco A., Richini A., Marconi S., Sannino C., Lemmi P., Giuntoli S., Manfre N., Giannini F., Di Carlo A., Casadidio I., Melandri P., Maolo G., Polenta B., Piccinini N., Vincenti C., Pastore N., Mega P., Magurano E., Cananiello A., Francescutto C. A., Brussa Toi E., Gaspardo G., Angeli L., Ronchese L., Sciangula L., Ciucci A., Contartese A., Banfi E., Castelli E., Tatti P., Bloise D., Di Mauro P., Masselli L., Lo Presti A., Scarpitta A. M., Gambina F., Venezia A., Morea R., Lagonigro G., Copeta G., Iannucci V., Milano V., Trupo M., Lochmann A., Marchetto P. E., Incelli G., De Paola G., Steiger M. M., Gamper M. A., Breitenberger S., Holzner M., Frischmann J., Lambiase C., Di Vece T., D'Aniello M., Fezza M., Giordano C., Leo F., Saitta G., Cucinotta D., Di Vieste G., Pintaudi B., Mancuso T., Musacchio N., Giancaterini A., Pessina L., Salis G., Schivalocchi F., Testori G., Cerutti N., Morpugo P. S., Cavaletto M. L., Bonino G., Morreale F., Mariani G., Ragonesi P. D., Bollati P., Colapinto P., Falqui L., Bortolato L., Cosma A., Pistolato P., Centenaro B., Ceccato A., Campobasso G., Zaurino F., Mazzotta G., Manti R., Da Ros R., Carlucci S., Narduzzi L., Bortolotto D., D'Acunto L., Stanic L., Volpi A., Cospite A. M., Manicardi V., Michelini M., Finardi L., Borghi F., Manicardi E., Lombardi S., Tommasi C., Iaccarino M., Cozza S., Binotto M., Marini F., Mecenero I., Massignani S., Stecco P., Urbani E., Massariol W., Parolin R., Gatti A., Bonavita M., Creso E., Giannettino R., Gobbo M., Iovine C., Riccardi G., Iazzetta N., Giannattasio C., Egione O., Galdieri S., Velotti A., Azzolina A., Annicelli G., Sorrentino T., Gaeta I., Zenari L., Bertolini L., Sorgato C., Grippaldi F., Stroppiana M., Popolizio R., Carbone N., Grasso S., Abate S., Gaggero G. C., Strazzabosco M., Brun E., Carlesi G. P., Garrone S., Cicalo A. M., Clausi C., Cau R., Manconi A., Carboni A., Angius M. F., Pinna A. A., Caria S., Filigheddu G. D., Tonolo G., Carta I., Calebich S., Burlotti C., Saglietti G., Schellino A., Madau G., Cossu M., Mulas F., Zoccheddu S., Balsanelli M., Fetonti M., Rotolo A., Sambo P., Secchi E., Angotzi M. A., Loddoni S., Brundu I., Careddu F., Becciu A., Gabriella Piras G., Novara F., Cipro F., Torchio G., Palumbo P., Bianchi A., Colucci G., La Motta G., Tiengo A., Avogaro A., Bruttomesso D., Crepaldi C., Fadini G., Guarnieri G., Lavagnini M. T., Maran A., Vedovato M., De Kreutzenberg V., Fedele D., Lapolla A., Sartore G., Bax G., Cardone C., Dalfra M. G., Masin M., Toniato R., Piarulli F., Mattina G., Fulantelli M. A., Gioia D., Conti M., Ridola G., D'Agati F., Grossi G., Zavaroni I., Dei Cas A., Franzini L., Usberti E., Antonimi M., Anelli N., Poli R., Ridolfi V., Michela M., Haddoub S., Prampolini G., Muoio A., Filippi D., Bucci F., Tardio S. M., Calderini M. C., Magotti M. G., Quarantelli C., Vernazza M. A., Carolfi A., Saracca R., Picchio E., Del Sindaco P., Spalluto A., Maggiulli L., Torreggiani V., Rastelletti S., Ugolini C., Pucci N., Magi S., Muratori S., La Penna G., Consoli A., Galeone F., Magiar A. V., Gherardini V., Moretti L., Bientinesi M., Landi L., Bernardi A., Del Prato S., Miccoli R., Bianchi C., Penno G., Venditti F., Anichini R., De Bellis A., Bruschi T., Butelli L., Gioffredi M., Gori R., Picciafuochi R., Malagoli R., Bernini A., Gelisio R., Zanon M., Del Bianco A., Bamiston A., Signorato M., Citro G., Calabrese M., Ianni L., Lorenzetti M., Marsocci A., Guizzotti S., Memoli G., Cabasino F., Farci F., Atzori A., Sanna A., Ghiani M., Siotto I., Sedda M., Manis A., Loddo C., Loddo I., Seguro P., Cuomo A., Orlando L., Olanda G. B., Pucci A., Massenzo M., Sardu C., Perrone G., Corazziere F., La Puzza I., Tripodi P. F., Riggio S., Giampaolo A., Mannino D., Aleandri A. R., Guidi M. V., Battisti B., Faraglia M. R., Lilli V., Leotta S., Visalli N., Gagliardi A., Fontana L., Altomare M., Carletti S., Abbruzzese S., Chiaramonte F., Giordano R., Rossini M., Migneco G., Cappelloni D., Urbani A., Piergiovanni F., Simonetta A., Massimiani F., Bulzomi R., Giuliano M., Pennafina M. G., Di Perna P., D'Accinni M. P., Paolucci D., D'Ubaldi A., D'Angelo M. T., Masaro G., Pietrantoni M., Fratini M., La Rosa R., Poggi M., Piccirilli F., Pisano R., Saponara C., Conforti I., Penza A., Scalpone R., Lo Pinto S., Iacovella L., Caccamo C., Sposito S., Teodonio C., Restuccia M. G., Mirto G., Girardello R., Gennaro R., De Moliner L., Bettini E., Mattuzzi A., Speese K., Frisinghelli F., Locatelli F., Nicoletti M., Trojan N., Centis R., L Volsi P., Levis E., Zanette G., Comba G., Ballatore L., Cattaneo A., Aglialoro A., Guido R., Patrone M., Zecchini M., Clementi L., Galetta M., Marconi V., Bordin P., Perale L., Vinci C., Sira Zanon M., Geretto L., Toffolo C., Furlan M. G., Mazzanti G., Vinci M., Sica V., Armeni M., Derai R., Ennas O., Mamusa S., Pisano M. A., Carreras L., Rauseo A., Cervone S., Leggieri A., Pontonio M., Sturaro R., Quattrocchi F., Molinaro M., Trasatti M., Ferretti B., Labarile G., Baule G. M., Gentilini A., Spanu M. A., Fancellu A., Bianco P., Lione L., Massazza G., Bocchio G., Bosco E., Monachesi M., Carta G., Boschetti M., Ceresola E., Venier E., Calcaterra F., Cataldi F., Miola M., Manfrini S., Lai A., Locci B., Putzu D., Tanganelli I., Leonini M., Egger K., Marchiotto W., Vincis L., Orlandini V., Pilloni C., Farci R., Pelligra I., Renier G., Mameli M., Pala A., Devigus E., Fumagalli I., Lalli C., Leandri M., Agliani M., De Pascalis L., Malci F., De Ciocchis A., Diodati M. B., Macerola B., Davi S., Caccavale A., Brocato L., Pognant Gros M., Borla S., Lattanzi E., Piersanti C., Piersanti A., Spinelli I., Tuzzoli L., Tulini V., Quaranta G., Iorio V., Tirabovi M., De Terlizi C., Massarelli M. G., Venturi S., Travaglini A., Draghi P., Pomante P., Richiardi L., Clerico A., Bruno A., Cavallo Perin P., Ghigo E., Porta M., Scuntero P., Arcari R., Bertaina S., Bo S., Broglio F., Bruno G., Degiovanni M., Fornengo P., Grassi G., Inglese V., Maccario M., Maghenzani G., Marena S., Martina V., Passera P., Ruiu G., Tagliabue M., Zanone M., Monge M., Boffano G. M., Macri K., Maio P., Ozzello A., Pergolizzi E., Gaia D., Gennari P., Micali G., Rossetto E., Dalmazzo C., Oreglia M., Stefani T., Dossena C., Paglia P., Bosoni S., Romanelli T., Inchiostro S., Dauriz M., Bossi C. A., Meregalli G., Balini A., Berzi D., Filippini B., Crotto G., Paccagnella A., Orrasch M., Sambataro M., Citro T., Kiwanuka E., Bagolin E., Almoto B., Macchia A., Branca M. T., Filesi M., Candido R., Caroli E., Manca E., Petrucco A., Tommasi E., Jagodnik G., Baskar B., Daris N., Dal Col P., Pellegrini M. 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Abstract

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage ≥3 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage ≥3 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage ≥3 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 ± 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage ≥3 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage ≥3 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening.

Published
2018

39. Quality of life and mortality in the general population: a systematic review and meta-analysis

Author

Phyo, A.Z.Z., Freak-Poli, R, Craig, H., Gasevic, D., Stocks, N.P., Gonzalez-Chica, D.A., Ryan, J., Phyo, A.Z.Z., Freak-Poli, R, Craig, H., Gasevic, D., Stocks, N.P., Gonzalez-Chica, D.A., and Ryan, J.

Abstract

Background: Quality of life (QoL) is multi-dimensional concept of an individual’ general well-being status in relation to their value, environment, cultural and social context in which they live. This study aimed to quantitatively synthesise available evidence on the association between QoL and mortality in the general population. Methods: An electronic search was conducted using three bibliographic databases, MEDLINE, EMBASE and PsycINFO. Inclusion criteria were studies that assessed QoL using standardized tools and examined mortality risk in a non-patient population. Qualitative data synthesis and meta-analyses using a random-effects model were performed. Results: Of 4184 articles identified, 47 were eligible for inclusion, involving approximately 1,200,000 participants. Studies were highly heterogeneous in terms of QoL measures, population characteristics and data analysis. In total, 43 studies (91.5%) reported that better QoL was associated with lower mortality risk. The results of four metaanalyses indicated that higher health-re

Published
2020
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40. It's not age that prevents sexual activity later in life

Author

Freak-Poli, R. (Rosanne) and Freak-Poli, R. (Rosanne)

Abstract

Objective: To describe key factors that facilitate sexual behaviour in later life. Methods: Re-analysis of data from a study of 2,374 Dutch older adults. Results: Partner availability, gender and health are likely to be more important factors influencing sexual behaviour engagement than the factor of age in later life. Lack of partner availability, traditional gender roles and poor health are associated with older age. However, current generations of older adults will be more capable, less ashamed of their sexual desires and engage in more sexual behaviour than prior generations. Conclusion: This analysis observed that sexual activity is associated with partner availability and better health, rather than age, countering stereotypes of decline in sexual behaviour and normalising sexual activity and desire in later life.

Published
2020
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41. Quality of life and mortality in the general population: a systematic review and meta-analysis

Author

Phyo, AZZ, Freak-Poli, R, Craig, H, Gasevic, D, Stocks, NP, Gonzalez-Chica, DA, Ryan, J, Phyo, AZZ, Freak-Poli, R, Craig, H, Gasevic, D, Stocks, NP, Gonzalez-Chica, DA, and Ryan, J

Abstract

BACKGROUND: Quality of life (QoL) is multi-dimensional concept of an individual' general well-being status in relation to their value, environment, cultural and social context in which they live. This study aimed to quantitatively synthesise available evidence on the association between QoL and mortality in the general population. METHODS: An electronic search was conducted using three bibliographic databases, MEDLINE, EMBASE and PsycINFO. Inclusion criteria were studies that assessed QoL using standardized tools and examined mortality risk in a non-patient population. Qualitative data synthesis and meta-analyses using a random-effects model were performed. RESULTS: Of 4184 articles identified, 47 were eligible for inclusion, involving approximately 1,200,000 participants. Studies were highly heterogeneous in terms of QoL measures, population characteristics and data analysis. In total, 43 studies (91.5%) reported that better QoL was associated with lower mortality risk. The results of four meta-analyses indicated that higher health-related QoL (HRQoL) is associated with lower mortality risk, which was consistent for overall HRQoL (HR 0.633, 95% CI: 0.514 to 0.780), physical function (HR 0.987, 95% CI: 0.982 to 0.992), physical component score (OR 0.950, 95% CI: 0.935 to 0.965), and mental component score (OR 0.980, 95% CI: 0.969 to 0.992). CONCLUSION: These findings provide evidence that better QoL/HRQoL was associated with lower mortality risk. The utility of these measures in predicting mortality risk indicates that they should be considered further as potential screening tools in general clinical practice, beyond the traditional objective measures such as body mass index and the results of laboratory tests.

Published
2020

43. An overview of sexual behaviour research in later life-Quantitative and qualitative findings

Author

Freak-Poli, R, Malta, S, Freak-Poli, R, and Malta, S

Abstract

AIM: This article provides an overview of current sexual behaviour research in later life by describing associated factors, including the physical and psychological benefits. METHODS: Recent systematic reviews were interrogated for findings on sexual behaviour research in adults aged 60+. RESULTS: Regardless of research methods employed, all studies showed that there were a range of physical and psychological benefits to remaining sexually active in later life. While quantitative studies placed an emphasis on measuring penile-vaginal intercourse, they provided no definitive conclusion about the benefits due to 'inconsistent results' across studies. Qualitative studies described the myriad ways in which older adults redefine what constitutes sexual activity despite the onset of dysfunction and disability. CONCLUSION: While the different research methods show that engaging in sexual behaviour has physical and psychological benefits at all adult ages, there is limited conclusive evidence about what the overall benefits might be in later life.

Published
2020

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