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Background There is a complete lack of studies focusing on the association between care degree (reflecting the long-term care need) and loneliness or social isolation in Germany. Aims To investigate the association between care degree and loneliness as well as perceived social isolation during the COVID-19 pandemic. Methods We used data from the nationally representative German Ageing Survey, which covers community-dwelling middle-aged and older individuals aged 40 years or over. We used wave 8 of the German Ageing Survey (analytical sample: n = 4334 individuals, mean age was 68.9 years, SD: 10.2 years; range 46–100 years). To assess loneliness, the De Jong Gierveld instrument was used. To assess perceived social isolation, the Bude and Lantermann instrument was used. Moreover, the level of care was used as a key independent variable (absence of care degree (0); care degree 1–5). Results After adjusting for various covariates, regressions showed that there were no significant differences between individuals without a care degree and individuals with a care degree of 1 or 2 in terms of loneliness and perceived social isolation. In contrast, individuals with a care degree of 3 or 4 had higher loneliness (β = 0.23, p = 0.034) and higher perceived social isolation scores (β = 0.38, p Discussion/conclusions Care degrees of 3 or 4 are associated with higher levels of both loneliness and perceived social isolation. Longitudinal studies are required to confirm this association.

BackgroundSocial prescribing (SP) enables healthcare professionals to link patients with non-medical interventions available in the community to address underlying socioeconomic and behavioural determinants. We synthesised the evidence to understand the effectiveness of SP for chronic disease prevention.MethodsA systematic literature search was conducted using five databases and two registries. Eligible studies included randomised controlled trials of SP among community-dwelling adults recruited from primary care or community setting, investigating any chronic disease risk factors defined by the WHO (behavioural factors: smoking, physical inactivity, unhealthy diet and excessive alcohol consumption; metabolic factors: raised blood pressure, overweight/obesity, hyperlipidaemia and hyperglycaemia). Random effect meta-analyses were performed at two time points: completion of intervention and follow-up after trial.ResultsWe identified nine reports from eight trials totalling 4621 participants. All studies evaluated SP exercise interventions which were highly heterogeneous regarding the content, duration, frequency and length of follow-up. Majority of studies had some concerns for risk of bias. Meta-analysis revealed that SP likely increased physical activity (completion: mean difference (MD) 21 min/week, 95% CI 3 to 39, I2=0%; follow-up ≤12 months: MD 19 min/week, 95% CI 8 to 29, I2=0%). However, SP may not improve markers of adiposity, blood pressure, glucose and serum lipid. There were no eligible studies that primarily target unhealthy diet, smoking and excessive alcohol drinking behaviours.ConclusionsSP exercise interventions probably increased physical activity slightly; however, no benefits were observed for metabolic factors. Determining whether SP is effective in modifying the determinants of chronic diseases and promotes sustainable healthy behaviours is limited by the current evidence of quantification and uncertainty, warranting further rigorous studies.PROSPERO registration numberCRD42022346687.

Background: Psychological distress (stress) has been linked to an increased risk of chronic diseases and is exacerbated by a range of workplace factors. Physical activity has been shown to alleviate psychological distress. Previous pedometer-based intervention evaluations have tended to focus on physical health outcomes. This study aimed to investigate the immediate and long-term changes in psychological distress in employees based in Melbourne, Australia after their participation in a four-month pedometer-based program in sedentary workplaces. Methods: At baseline, 716 adults (aged 40 ± 10 years, 40% male) employed in primarily sedentary occupations, voluntarily enrolled in the Global Corporate Challenge© (GCC©), recruited from 10 Australian workplaces to participate in the GCC® Evaluation Study, completed the Kessler 10 Psychological Distress Scale (K10). Of these, 422 completed the K10 at baseline, 4 months and 12 months. Results: Psychological distress reduced after participation in a four-month workplace pedometer-based program, which was sustained eight months after the program ended. Participants achieving the program goal of 10,000 steps per day or with higher baseline psychological distress had the greatest immediate and sustained reductions in psychological distress. Demographic predictors of immediate reduced psychological distress (n = 489) was having an associate professional occupation, younger age, and being ‘widowed, separated or divorced’. Conclusions: Participation in a workplace pedometer-based program is associated with a sustained reduction in psychological distress. Low-impact physical health programs conducted in groups or teams that integrate a social component may be an avenue to improve both physical and psychological health in the workplace.

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.

An international systematic review concluded that individuals with poor social health (social isolation, lack of social support or loneliness) are 30% more likely to develop coronary heart disease (CHD) and stroke. Notably, the two included Australian papers reported no association between social health and CHD or stroke.We undertook a systematic review and meta-analysis to investigate the association between social isolation, lack of social support and loneliness and cardiovascular disease (CVD) incidence among people living in Australia and New Zealand.Four electronic databases were systematically searched for longitudinal studies published until June 2020. Two reviewers undertook title/abstract screen and one reviewer undertook full-text screen and data extraction. Quality was assessed using the Newcastle - Ottawa Quality Assessment Scale.Of the 725 unique records retrieved, five papers met our inclusion criteria. These papers reported data from three Australian longitudinal datasets, with a total of 2137 CHD and 590 stroke events recorded over follow-up periods ranging from 3 to 16 years. Reports of two CHD and two stroke outcomes were suitable for meta-analysis. The included papers reported no association between social health and incidence of CVD in all fully adjusted models and most unadjusted models.Our systematic review is inconclusive as it identified only a few studies, which relied heavily on self-reported CVD. Further studies using medical diagnosis of CVD, and assessing the potential influence of residential remoteness, are needed to better understand the relationship between social health and CVD incidence in Australia and New Zealand.

Background: Poor social health is likely associated with cognitive decline and risk of dementia; however, studies show inconsistent results. Additionally, few studies separate social health components or control for mental health. Objective: To investigate whether loneliness and social support are independently associated with cognitive decline and risk of dementia, and whether depressive symptoms confound the association. Methods: We included 4,514 participants from the population-based Rotterdam Study (RS; aged 71±7SD years) followed up to 14 years (median 10.8, interquartile range 7.4–11.6), and 2,112 participants from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; aged 72±10SD years) followed up to 10 years (mean 5.9±1.6SD). At baseline, participants were free of major depression and scored on the Mini-Mental State Examination (MMSE) ≥26 for RS and ≥25 for SNAC-K. We investigated loneliness, perceived social support, and structural social support (specifically marital status and number of children). In both cohorts, dementia was diagnosed and cognitive function was repeatedly assessed with MMSE and a global cognitive factor (g-factor). Results: Loneliness was prospectively associated with a decline in the MMSE in both cohorts. Consistently, persons who were lonely had an increased risk of developing dementia (RS: HR 1.34, 95%CI 1.08–1.67; SNAC-K: HR 2.16, 95%CI 1.12–4.17). Adjustment for depressive symptoms and exclusion of the first 5 years of follow-up did not alter results. Neither perceived or structural social support was associated with cognitive decline or dementia risk. Conclusion: Loneliness, not social support, predicted cognitive decline and incident dementia independently of depressive symptoms.

Background: Social health reflects one’s ability to form interpersonal relationships. Poor social health is a risk factor for cardiovascular disease (CVD), however an in-depth exploration of the link through CVD risk factors is lacking. Aim: To examine the relationship between social health (social isolation, social support, loneliness) and CVD risk factors among healthy older women and men. Methods: Data were from 11,498 healthy community-dwelling Australians aged ≥70 years from the ASPirin in Reducing Events in the Elderly (ASPREE) trial and the ASPREE Longitudinal Study of Older Persons sub-study. Ten-year CVD risk was estimated using the Atherosclerotic CVD Risk Scale (ASCVDRS) and the Framingham Risk Score (FRS). Results: Physical inactivity and experiencing depressive symptoms were the only CVD risk factors that consistently differed by all three social health constructs. Loneliness was associated with greater ASCVDRS (women: β = 0.01, p

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).

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.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.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.LLD may be a common and important risk factor for shortened healthspan.

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 0.05). 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 intentional.

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 allcause 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 1,052 deaths over a median 4.7-years (interquartile range: 3.6–5.7) of follow-up, with 11.9 events per 1,000 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

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.

Both cardiovascular disease (CVD) and social health carry high health and economic burdens. We undertook a systematic review to investigate the association between social isolation, low social support, and loneliness with health service utilisation and survival after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched for the period before June 2020. Two reviewers undertook the title/abstract screen. One reviewer undertook a full-text screen and data extraction. A second author checked data extraction. Of 756 records, 25 papers met our inclusion criteria. Included studies recruited 10–12,821 participants, aged 18–98 years, and the majority were males. Greater social support was consistently associated with better outcomes on four of the five themes (discharge destination, outpatient rehabilitation attendance, rehospitalisation and survival outcomes; no papers assessed the length of inpatient stay). Positive social health was consistently associated with better discharge designation to higher independent living. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies. Our systematic review demonstrates that social health is considered in cardiac care decisions and plays a role in how healthcare is being delivered (i.e., outpatient, rehabilitation, or nursing home). This likely contributes to our finding that lower social support is associated with high-intensity healthcare services, lower outpatient rehabilitation attendance, greater rehospitalisation and poorer survival. Given our evidence, the first step to improve cardiac outcomes is acknowledging that social health is part of the decision-making process. Incorporating a formal assessment of social support into healthcare management plans will likely improve cardiac outcomes and survival. Further research is required to assess if support person/s need to engage in the risk reduction behaviours themselves for outpatient rehabilitation to be effective. Further synthesis of the impact of social isolation and loneliness on health service utilisation and survival after a CVD event is required.

BACKGROUND: Optimism is a disposition characterised by positive future expectancies, while pessimism is characterised by expecting the worst. High optimism and low pessimism promote the health of older adults and may potentiate full engagement in life. We identified socioeconomic, behavioural, and social factors associated with optimism and pessimism in older adults.METHODS: Participants included 10,146 community-dwelling, apparently healthy Australian adults aged 70 years and over from the ASPREE Longitudinal Study of Older Persons (ALSOP). Optimism and pessimism were measured using the revised Life Orientation Test. Cross-sectional ordinal logistic regression was used to determine the socioeconomic, behavioural, and social health factors associated with optimism and pessimism.RESULTS: Higher education, greater physical activity, lower loneliness, and volunteering were associated with higher optimism and lower pessimism. Low social support was associated with higher pessimism. Higher socioeconomic advantage, greater income, and living alone were associated with lower pessimism. Women were more optimistic and less pessimistic than men. The association of age, smoking status, and alcohol consumption with optimism and pessimism differed for men and women.CONCLUSIONS: Factors associated with higher optimism and lower pessimism were also those demonstrated to support healthy ageing. Health-promotion action at the individual level (e.g., smoking cessation or regular physical activity), health professional level (e.g., social prescribing or improving access and quality of care for all older adults), and community level (e.g., opportunities for volunteer work or low-cost social activities for older adults) may improve optimism and reduce pessimism, possibly also promoting healthy ageing.

Objective: Positive psychosocial factors may protect against cardiovascular disease (CVD). We aimed to determine the association of optimism and pessimism with CVD events in community-dwelling older adults. Methods: 11,651 adults aged 70 years and over, participants of the ASPREE Longitudinal Study of Older Persons (ALSOP), were followed-up for 4.7 years (median). The association of optimism and pessimism (assessed as separate constructs by revised Life Orientation Test) and incident CVD events (composite and components) was assessed by Cox regression adjusted for demographic, socioeconomic and health factors. Results: No association was observed between optimism and pessimism with composite CVD events. Being more pessimistic was associated with a greater risk of fatal coronary heart disease, while being more optimistic was associated with a lower risk of non-fatal myocardial infarction. Conclusions: Optimism and pessimism may shape cardiovascular health of older adults; and we argue these psychosocial factors should be researched as separate constructs.

textabstractObjective: 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.

BACKGROUND: Poor social health is prevalent in older adults and may be associated with worse cognition, and increased dementia risk. The aim of this study was to determine whether social isolation, social support and loneliness are independently associated with cognitive function and incident dementia over 5 years in older adults, and to investigate potential gender differences. METHODS: Participants were 11,498 community-dwelling relatively healthy Australians aged 70–94, in the ASPREE Longitudinal Study of Older Persons (ALSOP). Social isolation, social support, loneliness and cognitive function were assessed through self-report. Outcomes examined were cognitive decline (>1.5 SD decline in cognitive performance since baseline) and incident dementia (adjudicated according to DSM-IV criteria). RESULTS: Most participants self-reported good social health (92%) with very few socially isolated (2%), with low social support (2%) or lonely (5%). Among women, social isolation and low social support were consistently associated with lower cognitive function (e.g., social support and cognition β = −1.17, p < 0.001). No consistent longitudinal associations were observed between baseline social health and cognitive decline (over median 3.1 years) or incident dementia (over median 4.4 years; social isolation: HR = 1.00, p = 0.99; low social support: HR = 1.79, p = 0.11; loneliness: HR = 0.72, p = 0.34 among women and men). CONCLUSION: Our study provides evidence that social isolation and a low social support are associated with worse cognitive function in women, but not men. Social health did not predict incident cognitive decline or dementia, but we lacked power to stratify dementia analyses by gender.

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 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 lives. Social isolation, low social support and loneliness have adverse associations with HRQoL.

Background Health-related quality of life (HRQoL) is a measure of an individual’s self-perceived health status. Few studies have examined HRQoL as a risk factor for mortality. This study examined whether HRQoL predicts all-cause mortality in older community-dwelling individuals from Australia and the United States enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial, and if this association varies across gender. Methods The 19,106 persons aged 65–98 years and free of known major life-limiting disease, who completed the 12-item short form (SF-12) HRQoL at ASPREE-baseline (2010–2014) were followed prospectively until 2017 for all-cause mortality. 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. Results There were 1,052 deaths over a median 4.7-year of follow-up, with 11.9 events per 1,000 person-years. A 10-unit increase in PCS was associated with a 17% decrease in all-cause mortality (95%CI: 0.77, 0.89). MCS was not associated with all-cause mortality. There was no evidence these associations were different between males and females (P-values for interaction: PCS 0.13 and MCS 0.44). Conclusions PCS, but not MCS, was inversely associated with all-cause mortality in this large cohort of healthy older individuals. Key messages Our findings support the decision of the Australian Commission on Safety and Quality in Health Care to incorporate the SF-12 into the routine collection of Patient Reported Outcome Measures as a policy goal for the Australian health system.

Background Lower health-related quality of life (HRQoL) has been shown to predict a higher risk of hospital readmission and mortality in patients with cardiovascular disease (CVD). Few studies have explored the associations between HRQoL and incident CVD. We explored the associations between baseline HRQoL and incident and fatal CVD in community-dwelling older people in Australia and the United States. Methods Longitudinal study using ASPirin in Reducing Events in the Elderly (ASPREE) trial data. This includes 19,106 individuals aged 65–98 years, initially free of CVD, dementia, or disability, and followed between March 2010 and June 2017. The physical (PCS) and mental component scores (MCS) of HRQoL were assessed using the SF-12 questionnaire. 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. Results 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. After adjustment for sociodemographic, health-related behaviours and clinical measures, a 10-unit higher PCS, but not MCS, was associated with a 14% lower risk of incident CVD, 28% lower risk of hospitalization for heart failure and 15% lower risk of myocardial infarction. Neither PCS nor MCS was associated with fatal CVD events or stroke. Conclusion Physical HRQoL can be used in combination with clinical data to identify the incident CVD risk among older individuals.

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 2), 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 mortality in community-dwelling older adults after adjusting for health and lifestyle factors. However, men reporting recent weight loss of more than 3 kg may be at increased risk. The findings of this study support the use of WC, rather than BMI, as a predictor of mortality risk in older adults.

To ascertain the trajectories of mental health among women in Australia assessed in repeat waves from their early 70 s to the end of their lives or their mid 80 s.Secondary analysis of data contributed by the 1921-26 cohort of the Australian Longitudinal Study of Women's Health Waves 1-6. Primary outcome was the 4-item SF-36 Vitality Subscale, which assesses mental health as life satisfaction, social participation, energy and enthusiasm. Structural, individual and intermediary factors were assessed using study-specific and standardised measures. Trajectories were identified using Growth Mixture Modelling and associations with baseline characteristics with Structural Equation Modelling.12,432 women completed Survey One. Three mental health trajectories: stable high (77%); stable low (18.2%) and declining from high to low (4.8%) were identified. Compared to the stable high group, women in the stable low group were significantly less physically active, had more nutritional risks, more recent adverse life events, fewer social interactions and less social support, reported more stress and were more likely to have a serious illness or disability at Survey One. The declining group had similar characteristics to the stable high group, but were significantly more likely to report at baseline that they had experienced recent financial, physical and emotional elder abuse. These interact, but not directly with socioeconomic position and marital status.Mental health among older women is related to social relationships, general health, access to physical activity and healthy nutrition, coincidental adverse life events and experiences of interpersonal violence, in particular elder abuse.

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.

Identification of factors which influence health after a cardiovascular disease (CVD) event will assist with reducing the high health and economic burden of CVD. We undertook a systematic review to investigate the association between social health (lower social isolation, higher social support and lower loneliness) and health and well-being after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched until June 2020. Two reviewers undertook title/abstract screen. One reviewer undertook full-text screen and data extraction. A second author either independently extracted or checked data. Narrative thematic analysis was undertaken. Of the 752 unique records retrieved, 39 papers from 29 studies met our inclusion criteria. Included studies recruited between 10 and 1,455 participants, aged 12-96 years, and the majority were male. Greater social health was consistently associated with better mental health outcomes (lower depressive symptoms, anxiety symptoms and psychological distress). Lower social isolation and higher social support were associated with the extent to which patient needs were being met. Living situation was not associated with mental health outcomes, and being married or living with someone was associated with greater medication adherence. Our systematic review demonstrates that greater social health is associated with better mental health outcomes and met patient needs among cardiac patients. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies when assessing health outcomes among CVD patients. Our review highlights the need for more research focused on women and the importance of gender-disaggregated reporting. Further assessment is required to evaluate whether loneliness is associated with health and well-being outcomes after a CVD event.

Research suggests that optimism and pessimism should be studied as two distinct constructs rather than as unidimensional, at opposing ends of a continuum. Optimism and pessimism have different associations with health-related behaviours, coping style, and a number of health outcomes. This study aimed to systematically review the evidence on the association of optimism and pessimism and all-cause mortality. A systematic search of MEDLINE, EMBASE and PsycINFO was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 6837 retrospective/prospective cohort studies identified, 25 were included, with a total of 217,256 participants. Eleven of the 18 studies assessing optimism reported that optimism was associated with lower risk of mortality, while seven of eight studies measuring pessimism and the two assessing unrealistic optimism reported that higher pessimism/unrealistic optimism was associated with an increased mortality risk. Results of a meta-analysis indicated that optimism measured categorically was associated with lower risk of mortality (pooled RR = 0.85, 95% CI: 0.79–0.91). We suggest optimism and pessimism be measured as separate constructs, as both of these have distinct effects on mortality risk. Future research is required to investigate whether psychological interventions to increase optimism or decrease pessimism can reduce risk of all-cause mortality.

International audience; Stress may be a risk factor for dementia, however it is unknown whether post-traumatic stress disorder (PTSD) symptoms are associated with incident dementia in community-dwelling older individuals. The aim was to determine whether lifetime major trauma with and without re-experiencing of PTSD symptoms is associated with later-life cognition and dementia risk. Participants were 1,700 community-dwelling older adults (65+) in the longitudinal ESPRIT study followed over 14 years. Lifetime major traumatic exposure and PTSD were assessed using Watson's PTSD Inventory. Cognitive tests assessed global cognition, visual memory, verbal fluency, psychomotor speed and executive function. Incident dementia was diagnosed according to DSM-IV criteria. Lifetime major trauma (versus no trauma) was associated with significantly increased executive function and increased global function in men, however women with lifetime trauma and re-experiencing symptoms had a significantly increased risk of low global cognition. Over 14 years, lifetime trauma without re-experiencing symptoms was associated with a significantly decreased risk of incident dementia, particularly for women. Lifetime major trauma without re-experiencing symptoms (but not with) may be protective for later life cognitive function. However, the mechanisms and moderating factors underlying these association requires further investigation.

To develop and pilot a tool that assesses the infrastructure and policy workplace environment characteristics that may influence employee healthy eating and physical activity behaviours. A checklist was developed with reference to prior tools and piloted at eight worksites. Piloting of the tool demonstrated that it was generally feasible to use, took 1–2 hours to complete and appeared sensitive to differences between workplace environment characteristics. Refinement of the tool occurred after piloting. The final 21-item checklist contains sub-scores capturing policy, infrastructure, healthy eating and physical activity characteristics. This new checklist overcomes some limitations of pre-existing tools as it explicitly considers policy and is short, inexpensive and can be used by workplaces for self-assessment and by health promotion professionals in evaluation studies or as an intervention tool.

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 4,184 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.

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Cardiovascular disease (CVD) risk factors, incidence and death increases from around the time of menopause comparing to women in reproductive age. A healthy lifestyle can prevent CVD, but it is unclear which lifestyle factors may help maintain and improve cardiovascular health for women after menopausal transition. We conducted a systematic review and meta-analysis of prospective cohort studies to evaluate the association between modifiable lifestyle factors (specifically smoking, physical activity, alcohol intake, and obesity), with CVD and mortality in middle-aged and elderly women. Pubmed, Embase, among other databases and reference lists were searched until February 29th, 2016. Study specific relative risks (RR) were meta-analyzed using random effect models. We included 59 studies involving 5,358,902 women. Comparing current versus never smokers, pooled RR were 3.12 (95% CI 2.15–4.52) for CHD incidence, 2.09 (95% CI 1.51–2.89) for stroke incidence, 2.76 (95% CI 1.62–4.71) for CVD mortality and 2.22 (95% CI 1.92–2.57) for all-cause mortality. Physical activity was associated with a decreased risk of 0.74 (95% CI 0.67–0.80) for overall CVD, 0.71 (95% CI 0.67–0.75) for CHD, 0.77 (95% CI 0.70–0.85) for stroke, 0.70 (95% CI 0.58–0.84) for CVD mortality and 0.71 (95% CI 0.65–0.78) for all-cause mortality. Comparing moderate drinkers versus non-drinkers, the RR was 0.72 (95% CI 0.56–0.91) for CHD, 0.63 (95% CI 0.57–0.71) for CVD mortality and 0.80 (95% CI 0.76–0.84) for all-cause mortality. For women with BMI 30–35 kg/m2 the risk was 1.67 (95% CI 1.24–2.25) for CHD and 2.3 (95% CI 1.56–3.40) for CVD mortality, compared to normal weight. Each 5 kg/m2 increase in BMI was associated with 24% (95% CI 16–33%) higher risk for all-cause mortality. This meta-analysis suggests that physical activity and moderate alcohol intake were associated with a reduced risk for CVD and mortality. Smoking and higher BMI were associated with an increased risk of these endpoints. Adherence to a healthy lifestyle may substantially lower the burden of CVD and reduce the risk of mortality among middle-aged and elderly women. However, this review highlights important gaps, as lack of standardized methods in assessing lifestyle factors and lack of accurate information on menopause status, which should be addressed by future studies in order to understand the role of menopause on the association between lifestyle factors and cardiovascular events.

Background: The ability to engage in sexual activity and better cognitive functioning are both associated with better health. However, the association between cognitive functioning and sexual activity is understudied. Objective: To examine the association between cognitive functioning with sexual activity and physical tenderness among community-dwelling older adults. Methods: From the Rotterdam Study, cognitive impairment and sexual activity were assessed in 4,201 community-dwelling, 60+ year olds between 2008 and 2014 in the Netherlands. Mild cognitive impairment (MCI) was based upon subjective complaints related to age and education-adjusted test scores. Mini-Mental State Examination (MMSE) impairment was defined by a score of < 26. Sexual activity and physical tenderness (e.g., fondling or kissing) in the last 6 months were assessed at an interview. Analyses were stratified by gender and partner status, with prevalence rates for the “no impairment” categories weighted based on age from the cognitive impairment categories. Inter-rater reliability was examined utilising 74 cohabiting couples of opposite gender. Results: It was found that 14% were categorised as having cognitive impairment, and < 1% as dementia (excluded from subsequent analyses). There was strong evidence that the odds of engaging in physical tenderness (observed through MMSE < 26, OR 2.14, 95% CI 1.32–3.48, p = 0.002) and sexual activity (MCI, OR 2.36, 95% CI 1.35–4.12, p = 0.003) among partnered females with no impairment was twice that observed among cognitively impaired partnered females. There was weak evidence that the odds of engaging in physical tenderness (MMSE < 26, OR 1.59, 95% CI 1.04–2.42, p = 0.03) and sexual activity (MMSE < 26, OR 1.51, 95% CI 1.02–2.24, p = 0.04) among partnered males with no impairment was 50% greater than observed among cognitively impaired partnered males. The associations between cognitive functioning and physical tenderness continued to remain after adjustment for physical function, diabetes, cardiovascular disease and cancer. There was no clear evidence of a difference between amnestic and non-amnestic MCI for sexual behaviour. There was moderate to substantial agreement among the coupled adults who had 1 partner categorised with MCI. Conclusion: Having no cognitive impairment was associated with more engagement in sexual activity and physical tenderness among community-dwelling older adults. Sexuality is an important aspect of active aging and our findings illustrate a potential barrier to maintaining or instigating intimate relationships as we age. Longitudinal analyses are required to explore the direction of effect.

Background Depression after a cardiovascular disease event (post-CVD) is associated with increased mortality. However, little is known about how pre-existing depression affects survival after CVD incidence. Aim To evaluate whether depressive symptoms preceding first incident CVD (pre-CVD) affects survival. Methods From the Rotterdam Study, 6,932 persons aged 55+ and free of dementia and CVD completed the Center for Epidemiological Studies Depression (CES-D) scale every 4 to 5 years from 1993. CES-D subdomains were positive affect, negative affect, somatic symptoms, and interpersonal affect. Persons were followed for mortality and CVD. Results During 15-year follow-up, 22% of participants suffered their first incident CVD. Pre-CVD depressive symptoms was not associated with mortality after adjustment for smoking status and physical function (HR per 10-point score: 1.05, 95%CI: 0.99-1.10). After first incident CVD, depressive symptoms increased. Higher post-CVD depressive symptoms was associated with increased mortality (HR: 1.13, 95%CI: 1.06, 1.22). The relation between post-CVD depressive symptoms and mortality was no longer statistically significant after adjustment for pre-CVD depressive symptoms. Pre-CVD and post-CVD measures of somatic symptoms and positive affect were associated with mortality. Conclusions During 15 years follow-up in community-dwelling older adults, the relation between higher depressive symptoms measured before first incident CVD and mortality was not independent of health status. Whereas, higher depressive symptoms measured after CVD was associated with increased mortality, was not independent of pre-CVD depressive symptoms. Given the associations observed between positive affect and mortality, positive affect may be the reason we observed a relation between depressive symptoms and mortality.