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2. Secular trends in frailty among community-dwelling 75–95-year-old cohorts over three decades in Helsinki, Finland.

Author

Pitkälä, Kaisu H, Aalto, Ulla L, Roitto, Hanna-Maria, Öhman, Hanna R, Lehti, Tuuli L, Knuutila, Mia T, Kautiainen, Hannu, Tilvis, Reijo, and Strandberg, Timo E

Subjects
CROSS-sectional method, INDEPENDENT living, FRAIL elderly, SEX distribution, QUESTIONNAIRES, AGE distribution, ANALYSIS of covariance, DESCRIPTIVE statistics, LONGITUDINAL method, GERIATRIC assessment, AGING, ANALYSIS of variance, COMPARATIVE studies, SOCIODEMOGRAPHIC factors, DATA analysis software, TIME, WELL-being, OLD age
Abstract

Background Frailty Index (FI) reflects health, functioning and well-being of older people. It is valuable to compare how frailty has changed over time in ageing cohorts. This study aims to examine trends in frailty among 75–95-year-old men and women over three decades. Methods The Helsinki Ageing Study started in 1989 and includes repeated cross-sectional postal surveys every 10 years examining community-dwelling cohorts of older people (75, 80, 85, 90 and 95 years). FI comprises the same 36 items in each cohort. Results The mean FI was 0.22 (SD 0.12), 0.25 (SD 0.15), 0.26 (SD 0.15) and 0.23 (SD 0.15) in 1989, 1999, 2009 and 2019, respectively (P for linearity for crude values.11). Adjusted for age and sex, the four cohorts differed in their frailty the 2019 cohort having the lowest FI. This sex-adjusted difference was seen among 75-, 80-, 85- and 90-year-olds but not among 95-year-olds. FI decreased more among men than women (P for cohort <.001, P for sex <.01, P for interaction =.19). Conclusions The prevalence of frailty among community-dwelling individuals aged 75, 80, 85 and 90 years—but not among those aged 95 years—has significantly decreased over the last decades. This positive trend may have important implications for health policies in societies with increasing longevity. [ABSTRACT FROM AUTHOR]

Published
2024
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23. Adult height and the risk of cause-specific death and vascular morbidity in 1 million people: individual participant meta-analysis

Author

Wormser, David, Angelantonio, Emanuele Di, Kaptoge, Stephen, Wood, Angela M, Gao, Pei, Sun, Qi, Walldius, Göran, Selmer, Randi, Verschuren, WM Monique, Bueno-de-Mesquita, H Bas, Engström, Gunnar, Ridker, Paul M, Njølstad, Inger, Iso, Hiroyasu, Holme, Ingar, Giampaoli, Simona, Tunstall-Pedoe, Hugh, Gaziano, J Michael, Brunner, Eric, Kee, Frank, Tosetto, Alberto, Meisinger, Christa, Brenner, Hermann, Ducimetiere, Pierre, Whincup, Peter H, Tipping, Robert W, Ford, Ian, Cremer, Peter, Hofman, Albert, Wilhelmsen, Lars, Clarke, Robert, Boer, Ian H de, Jukema, J Wouter, Ibañez, Alejandro Marín, Lawlor, Debbie A, DʼAgostino, Ralph B, Rodriguez, Beatriz, Casiglia, Edoardo, Stehouwer, Coen DA, Simons, Leon A, Nietert, Paul J, Barrett-Connor, Elizabeth, Panagiotakos, Demosthenes B, Björkelund, Cecilia, Strandberg, Timo E, Wassertheil-Smoller, Sylvia, Blazer, Dan G, Meade, Tom W, Welin, Lennart, Svärdsudd, Kurt, Woodward, Mark, Nissinen, Aulikki, Kromhout, Daan, Jørgensen, Torben, Tilvis, Reijo S, Guralnik, Jack M, Rosengren, Annika, Taylor, James O, Kiechl, Stefan, Dagenais, Gilles R, Gerry, F, Fowkes, R, Wallace, Robert B, Khaw, Kay-Tee, Shaffer, Jonathan A, Visser, Marjolein, Kauhanen, Jussi, Salonen, Jukka T, Gallacher, John, Ben-Shlomo, Yoav, Kitamura, Akihiko, Sundström, Johan, Wennberg, Patrik, Kiyohara, Yutaka, Daimon, Makoto, de la Cámara, Agustin Gómez, Cooper, Jackie A, Onat, Altan, Devereux, Richard, Mukamal, Kenneth J, Dankner, Rachel, Knuiman, Matthew W, Crespo, Carlos J, Gansevoort, Ron T, Goldbourt, Uri, Nordestgaard, Børge G, Shaw, Jonathan E, Mussolino, Michael, Nakagawa, Hidaeki, Fletcher, Astrid, Kuller, Lewis H, Gillum, Richard F, Gudnason, Vilmundur, Assmann, Gerd, Wald, Nicholas, Jousilahti, Pekka R, Greenland, Philip, Trevisan, Maurizio, Ulmer, Hanno, Butterworth, Adam S, Folsom, Aaron R, Davey-Smith, George, Hu, Frank B, Danesh, John, Tipping, Robert W, Ford, Charles E, Simpson, Lara M, Walldius, Göran, Jungner, Ingmar, Folsom, Aaron R, Demerath, Ellen W, Franceschini, Nora, Lutsey, Pamela L, Panagiotakos, Demosthenes B, Pitsavos, Christos, Chrysohoou, Christina, Stefanadis, Christodoulos, Shaw, Jonathan E, Atkins, Robert, Zimmet, Paul Z, Barr, Elizabeth LM, Knuiman, Matthew W, Whincup, Peter H, Wannamethee, S Goya, Morris, Richard W, Willeit, Johann, Kiechl, Stefan, Weger, Siegfried, Oberhollenzer, Friedrich, Wald, Nicholas, Ebrahim, Shah, Lawlor, Debbie A, Gallacher, John, Ben-Shlomo, Yoav, Yarnell, John WG, Casiglia, Edoardo, Tikhonoff, Valérie, Greenland, Philip, Shay, Christina M, Garside, Daniel B, Nietert, Paul J, Sutherland, Susan E, Bachman, David L, Keil, Julian E, de Boer, Ian H, Kizer, Jorge R, Psaty, Bruce M, Mukamal, Kenneth J, Nordestgaard, Børge G, Tybjærg-Hansen, Anne, Jensen, Gorm B, Schnohr, Peter, Giampaoli, Simona, Palmieri, Luigi, Panico, Salvatore, Pilotto, Lorenza, Vanuzzo, Diego, de la Cámara, Agustin Gómez, Simons, Leon A, Simons, Judith, McCallum, John, Friedlander, Yechiel, Gerry, F, Fowkes, R, Price, Jackie F, Lee, Amanda J, Taylor, James O, Guralnik, Jack M, Phillips, Caroline L, Wallace, Robert B, Kohout, Frank J, Cornoni-Huntley, Joan C, Guralnik, Jack M, Blazer, Dan G, Guralnik, Jack M, Phillips, Caroline L, Phillips, Caroline L, Guralnik, Jack M, Khaw, Kay-Tee, Wareham, Nicholas J, Brenner, Hermann, Schöttker, Ben, Müller, Heiko, Rothenbacher, Dietrich, Wennberg, Patrik, Jansson, Jan-Håkan, Nissinen, Aulikki, Donfrancesco, Chiara, Giampaoli, Simona, Woodward, Mark, Vartiainen, Erkki, Jousilahti, Pekka R, Harald, Kennet, Salomaa, Veikko, DʼAgostino, Ralph B, Vasan, Ramachandran S, Fox, Caroline S, Pencina, Michael J, Daimon, Makoto, Oizumi, Toshihide, Kayama, Takamasa, Kato, Takeo, Bladbjerg, Else-Marie, Jørgensen, Torben, Møller, Lars, Jespersen, Jørgen, Dankner, Rachel, Chetrit, Angela, Lubin, Flora, Svärdsudd, Kurt, Eriksson, Henry, Welin, Lennart, Lappas, Georgios, Rosengren, Annika, Lappas, Georgios, Welin, Lennart, Svärdsudd, Kurt, Eriksson, Henry, Lappas, Georgios, Bengtsson, Calle, Lissner, Lauren, Björkelund, Cecilia, Cremer, Peter, Nagel, Dorothea, Strandberg, Timo E, Salomaa, Veikko, Tilvis, Reijo S, Miettinen, Tatu A, Tilvis, Reijo S, Strandberg, Timo E, Kiyohara, Yutaka, Arima, Hisatomi, Doi, Yasufumi, Ninomiya, Toshiharu, Rodriguez, Beatriz, Dekker, Jacqueline M, Nijpels, Giel, Stehouwer, Coen DA, Hu, Frank B, Sun, Qi, Rimm, Eric B, Willett, Walter C, Iso, Hiroyasu, Kitamura, Akihiko, Yamagishi, Kazumasa, Noda, Hiroyuki, Goldbourt, Uri, Vartiainen, Erkki, Jousilahti, Pekka R, Harald, Kennet, Salomaa, Veikko, Kauhanen, Jussi, Salonen, Jukka T, Kurl, Sudhir, Tuomainen, Tomi-Pekka, Poppelaars, Jan L, Deeg, Dorly JH, Visser, Marjolein, Meade, Tom W, De Stavola, Bianca Lucia, Hedblad, Bo, Nilsson, Peter, Engström, Gunnar, Verschuren, WM Monique, Blokstra, Anneke, de Boer, Ian H, Shea, Steven J, Meisinger, Christa, Thorand, Barbara, Koenig, Wolfgang, Döring, Angela, Verschuren, WM Monique, Blokstra, Anneke, Bueno-de-Mesquita, H Bas, Wilhelmsen, Lars, Rosengren, Annika, Lappas, Georgios, Fletcher, Astrid, Nitsch, Dorothea, Kuller, Lewis H, Grandits, Greg, Tverdal, Aage, Selmer, Randi, Nystad, Wenche, Mussolino, Michael, Gillum, Richard F, Hu, Frank B, Sun, Qi, Manson, JoAnn E, Rimm, Eric B, Hankinson, Susan E, Meade, Tom W, De Stavola, Bianca Lucia, Cooper, Jackie A, Bauer, Kenneth A, Davidson, Karina W, Kirkland, Susan, Shaffer, Jonathan A, Shimbo, Daichi, Kitamura, Akihiko, Iso, Hiroyasu, Sato, Shinichi, Holme, Ingar, Selmer, Randi, Tverdal, Aage, Nystad, Wenche, Nakagawa, Hidaeki, Miura, Katsuyuki, Sakurai, Masaru, Ducimetiere, Pierre, Jouven, Xavier, Bakker, Stephan JL, Gansevoort, Ron T, van der Harst, Pim, Hillege, Hans L, Crespo, Carlos J, Garcia-Palmieri, Mario R, Kee, Frank, Amouyel, Philippe, Arveiler, Dominique, Ferrières, Jean, Schulte, Helmut, Assmann, Gerd, Jukema, J Wouter, de Craen, Anton JM, Sattar, Naveed, Stott, David J, Cantin, Bernard, Lamarche, Benoît, Després, Jean-Pierre, Dagenais, Gilles R, Barrett-Connor, Elizabeth, Bergstrom, Jaclyn, Bettencourt, Richele R, Buisson, Catherine, Gudnason, Vilmundur, Aspelund, Thor, Sigurdsson, Gunnar, Thorsson, Bolli, Trevisan, Maurizio, Hofman, Albert, Ikram, M Arfan, Tiemeier, Henning, Witteman, Jacqueline CM, Tunstall-Pedoe, Hugh, Tavendale, Roger, Lowe, Gordon DO, Woodward, Mark, Devereux, Richard, Yeh, Jeun-Liang, Ali, Tauqeer, Calhoun, Darren, Ben-Shlomo, Yoav, Davey-Smith, George, Onat, Altan, Can, Günay, Nakagawa, Hidaeki, Sakurai, Masaru, Nakamura, Koshi, Morikawa, Yuko, Njølstad, Inger, Mathiesen, Ellisiv B, Løchen, Maja-Lisa, Wilsgaard, Tom, Sundström, Johan, Ingelsson, Erik, Michaëlsson, Karl, Cederholm, Tommy, Gaziano, J Michael, Buring, Julie, Ridker, Paul M, Gaziano, J Michael, Ridker, Paul M, Ulmer, Hanno, Diem, Günter, Concin, Hans, Rodeghiero, Francesco, Tosetto, Alberto, Wassertheil-Smoller, Sylvia, Manson, JoAnn E, Marmot, Michael, Clarke, Robert, Fletcher, Astrid, Brunner, Eric, Shipley, Martin, Kivimaki, Mika, Ridker, Paul M, Buring, Julie, Ford, Ian, Robertson, Michele, Ibañez, Alejandro Marín, Feskens, Edith, Geleijnse, Johanna M, Kromhout, Daan, Walker, Matthew, Watson, Sarah, Alexander, Myriam, Butterworth, Adam S, Angelantonio, Emanuele Di, Franco, Oscar H, Gao, Pei, Gobin, Reeta, Haycock, Philip, Kaptoge, Stephen, Seshasai, Sreenivasa R Kondapally, Lewington, Sarah, Pennells, Lisa, Rapsomaniki, Eleni, Sarwar, Nadeem, Thompson, Alexander, Thompson, Simon G, Walker, Matthew, Watson, Sarah, White, Ian R, Wood, Angela M, Wormser, David, Zhao, Xiaohui, and Danesh, John

Published
2012
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30. Effects of psychosocial group rehabilitation on health, use of health care services, and mortality of older persons suffering from loneliness: a randomized, controlled trial

Author

Pitkala, Kaisu H., Routasalo, Pirkko, Kautiainen, Hannu, and Tilvis, Reijo S.

Subjects
Loneliness -- Health aspects, Group counseling -- Services, Group counseling -- Patient outcomes, Aged patients -- Care and treatment, Aged patients -- Psychological aspects, Mortality -- United States, Mortality -- Demographic aspects, Health, Seniors
Abstract

Background. Loneliness is a distressing feeling of a lack of satisfying human relationships. It is associated with poor quality of life. impaired health, and increased mortality among older individuals. The study aim was to determine the effects of new psychosocial group rehabilitation on the subjective health, use and costs of health services, and mortality of lonely older individuals. Methods. This randomized, controlled trial was performed in seven day care centers. A total of 235 older people (>74 years) suffering from loneliness participated. Intervention was implemented in 15 groups (each with 7-8 participants and 2 professional group leaders) meeting for 3 months altogether 12 times. Group intervention aimed to empower elderly people, and to promote their peer support and social integration. Intervention was based on the effects of closed-group dynamics. The groups had the following activities according to the participants' interests: (a) therapeutic writing and group psychotherapy, (b) group exercise and discussions, and (c) art activities. Group leaders received thorough training and tutoring. Subjective health, use and costs of health services, and mortality were measured. Results. At 2 years, survival was 97% in the intervention group (95% confidence interval [CI], 91-99) and 90% in the control group (95% CI, 85-95) (p = .047). The intervention group showed a significant improvement in subjective health, thus resulting in significantly lower health care costs during the follow-up: the difference between the groups was -943 [euro]/person per y (95% C1-1955 to -127:p = .039). Conclusions. Psychosocial group rehabilitation was associated with lower mortality and less use of health services. Key Words: Loneliness--Aged--Psychosocial rehabilitation--Randomized controlled trial.

Published
2009

33. Vitamin D supplementation has minor effects on parathyroid hormone and bone turnover markers in vitamin D-deficient bedridden older patients

Author

Bjorkman, Mikko, Sorva, Antti, Risteli, Juha, and Tilvis, Reijo

Subjects
Calcifediol -- Usage, Calcifediol -- Physiological aspects, Frail elderly -- Care and treatment, Frail elderly -- Health aspects, Alfacalcidol -- Usage, Alfacalcidol -- Physiological aspects, Vitamin D -- Usage, Vitamin D -- Physiological aspects, Bones -- Care and treatment, Health, Psychology and mental health, Seniors, Social sciences
Published
2008

34. Multicomponent geriatric intervention for elderly inpatients with delirium: effects on costs and health-related quality of life

Author

Pitkala, Kaisu H., Laurila, Jouko V., Strandberg, Timo E., Kautiainen, Hannu, Sintonen, Harri, and Tilvis, Reijo S.

Subjects
Delirium -- Diagnosis, Delirium -- Care and treatment, Medical care, Cost of -- Evaluation, Quality of life -- Evaluation, Health, Seniors
Abstract

Background. The detrimental effects of delirium on functioning and mortality are well known, but health-related quality of life (HRQoL) and costs of care have rarely been investigated among patients with delirium. We studied the effects of multicomponent geriatric treatment on costs of care and HRQoL in delirious inpatients. Methods. A randomized, controlled trial of 174 inpatients with delirium was performed in an acute geriatric hospital. The intervention was individually tailored geriatric treatment. The HRQoL was measured by the 15D instrument and subjective health by a four-level ordinal scale. Health care costs including intervention costs were calculated for 1 year after the delirium episode. Results. Mean age of the patients was 83 years; 31% had prior dementia. After the index hospitalization for delirium, a greater proportion in the intervention group than in the control group stated that they felt healthy (71% vs 49%, p = .050). HRQoL deteriorated in both groups as a consequence of delirium. Deterioration was, however, slower in the intervention group (-0.026, 95% confidence interval [CI], -0.051 to -.001) than in the control group (-0.065, 95% CI, -0.09 to -0.040; p = .034). Counting all costs of hospital care, long-term care, skilled home nursing visits, and costs related to intervention, the intervention group used, on average, 19,737 [euro] during the follow-up year, whereas the respective figure for the control group was 19,557 [euro]. The difference between the groups was nonsignificant (180 [euro] [95% CI, -5,006 to 5,064 [euro]]). Conclusions. Comprehensive geriatric intervention improved HRQoL without increasing overall costs of care. Key Words: Delirium--Multicomponent geriatric treatment--Quality of life--Cost of care.

Published
2008

37. Alcoholic beverage preference, 29-year mortality, and quality of life in men in old age

Author

Strandberg, Timo E., Strandberg, Arto Y., Salomaa, Veikko V., Pitkala, Kaisu, Tilvis, Reijo S., and Miettinen, Tatu A.

Subjects
Mortality -- Evaluation, Mortality -- Risk factors, Mortality -- United States, Quality of life -- Evaluation, Drinking of alcoholic beverages -- Physiological aspects, Drinking of alcoholic beverages -- Health aspects, Aged men -- Alcohol use, Aged men -- Physiological aspects, Aged men -- Health aspects, Alcoholic beverages -- Health aspects, Alcoholic beverages -- Physiological aspects, Cardiovascular diseases -- Risk factors, Health, Seniors
Abstract

Background. Harms of excessive alcohol consumption are obvious, but moderate wine consumption is frequently advocated for prevention of cardiovascular diseases. We compared 29-year mortality and quality of life in old age by alcoholic beverage preference (beer, wine, or spirits) in a cohort of men whose socioeconomic status was similar in their adult life. Methods. In 1974, cardiovascular risk factors and beverage preference were assessed in 2468 businessmen and executives aged 40-55 years. Of them, 131 did not use alcohol, 455 did not report a single preference, and 694, 251, and 937 preferred beer, wine, and spirits, respectively. Quality of life with a RAND-36 Short Form (SF)-36 instrument was surveyed in 2000 in survivors. Mortality was retrieved from registers during the 29-year follow-up. Results. Alcoholic beverage preference tracked well during the follow-up. Total alcohol consumption was not significantly different between preference groups. Men with wine preference had the lowest total mortality due to lower cardiovascular mortality. With the spirits group as the reference category and age, cardiovascular risk factors, and total alcohol consumption as covariates, wine drinkers had a 34% lower total mortality (relative risk 0.66; 95% confidence interval, 0.45-0.98); relative risk for beer preferers was 0.91 (95% confidence interval, 0.68-1.14). In 2000, wine preferers had the highest scores in all RAND-36 scales; general health (p = .007) and mental health (p = .01) were also significantly different. Conclusion. In this male cohort from the highest social class, wine preference was associated with lower mortality and better quality of life in old age. Mortality advantage was independent of overall alcohol consumption and cardiovascular risk factors, but contributing personal characteristics or early life differences cannot be excluded.

Published
2007

40. Multifactorial intervention to prevent recurrent cardiovascular events in patients 75 years or older: The Drugs and Evidence-Based Medicine in the Elderly (DEBATE) study: A randomized, controlled trial

Author

Strandberg, Timo E., Pitkala, Kaisu H., Berglind, Saila, Nieminen, Markku S., and Tilvis, Reijo S.

Subjects
Public health, Aged, Evidence-based medicine, Medical research, Medicine, Experimental, Cardiac patients, Health
Abstract

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2006.02.006 Byline: Timo E. Strandberg, Kaisu H. Pitkala, Saila Berglind, Markku S. Nieminen, Reijo S. Tilvis Abstract: We aimed to examine whether better use of preventive methods and treatments of cardiovascular disease would reduce recurrent events in home-dwelling patients 75 years or older. Author Affiliation: Department of Public Health Science and General Practice, University of Oulu, University Hospital, Oulu, Finland Department of Medicine, Geriatric Clinic and Division of Cardiology, University of Helsinki, Helsinki, Finland Article History: Received 13 October 2005; Accepted 5 February 2006 Article Note: (footnote) DEBATE was supported by the Academy of Finland (grant 48613), the Lions Organization (Punainen Sulka-Red Feather), the Ragnar Ekberg Foundation, the Finnish Foundation for Cardiovascular Research (Sydantutkimussaatio), and the Helsinki University Central Hospital. Dr Strandberg was a senior investigator of the Academy of Finland in 2000 to 2005. Conflict of interest: All authors have had various cooperation with companies marketing cardiovascular drugs.

Published
2006

41. Multicomponent geriatric intervention for elderly inpatients with delirium: a randomized, controlled trial

Author

Pitkala, Kaisu H., Laurila, Jouko V., Strandberg, Timo E., and Tilvis, Reijo S.

Subjects
Delirium -- Psychological aspects, Aged patients -- Psychological aspects, Aged patients -- Health aspects, Health, Seniors
Abstract

Background. Delirium is a common syndrome with poor prognosis affecting elderly inpatients. Treatment is mainly based on common sense with wide variations in practice. We investigated whether intensified, multicomponent geriatric treatment could improve the prognosis of delirious patients. Methods. We performed a randomized, controlled trial of 174 patients with delirium in six general medicine units from an acute hospital in Helsinki, Finland. The intervention group received individually tailored geriatric treatment. The primary endpoint was the sum of those deceased individuals and the patients permanently institutionalized. Secondary endpoints included the number of days in hospitals and other institutions, delirium intensity, and cognition. Results. The mean age of patients was 83 years, and 31% had previous dementia. The intervention group (N-87) received significantly more acetylcholinesterase inhibitors (58.6% vs 9.2%), atypical antipsychotics (69.8% vs 30.2%), specialist consultations (49.4% vs 28.7%), hip protectors (88.5% vs 3.4%). physiotherapy (87.4% vs 47.1%), and fewer conventional neuroleptics (8.0% vs 23.0%) than did the control group (N = 87). During the 1 year follow-up, 60.9% of the intervention group and 64.4% of controls were either deceased or permanently institutionalized (p = .638). The intervention group spent a mean of 126 days in institutions, and the control group 140 days (p = .688). Delirium was, however, alleviated more rapidly during hospitalization, and cognition improved significantly at 6 months in the intervention group. Conclusions. Faster alleviation of delirium and improved cognition justify good, comprehensive geriatric care for these patients although treatment produced no significant improvements in hard endpoints of prognosis.

Published
2006

44. Predictors of cognitive decline and mortality of aged people over a 10-year period

Author

Tilvis, Reijo S., Kahonen-Vare, Mervi H., Jolkkonen, Juha, Valvanne, Jaakko, Pitkala, Kaisu H., and Strandberg, Timo E.

Subjects
Health, Seniors
Abstract

Background. The search for preventable and remediable risk conditions of cognitive decline is ongoing, but results have thus far been inconsistent. According to the hypothesis of our 10-year prospective study, the predictive values of different risk indicators change over time in a general 75+ population. Methods. A population-based sample of 75-, 80-, and 85-year-old individuals (n = 650) underwent comprehensive clinical examinations in 1990 in Helsinki, Finland. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and/or Clinical Dementia Rating (CDR) at baseline and after 1, 5, and 10 years. Results. At baseline, a low MMSE score was associated with age, history of stroke, apolipoprotein E allele [epsilon]4 (APOE4), and intermittent claudication. After 1 year, cognitive decline was typical of participants suffering from vascular diseases, e.g., heart failure and intermittent claudication. Five-year decline was predicted by the presence of atrial fibrillation (RR [relative risk] 2.8), APOE4 (RR 2.4), elevated C-reactive protein (CRP) (RR 2.3). diabetes mellitus (RR 2.2), and heart failure (RR 1.8). They also tended to increase 5-year all-cause mortality. At 10 years, the decline associated with APOE4 (RR 3.3), slightly elevated serum ionized calcium (RR 3.3), and feelings of loneliness (RR 3.0). Conclusions. Long follow-up of a general aged population explains several inconsistencies of earlier reports. In 75+ individuals, general ill health is a strong associate of cognitive deficits. The strongest predictors of both cognitive decline and mortality are age, APOE4, manifest vascular diseases, and diabetes. The role of new potential predictors, feelings of loneliness and hypercalcemia, needs clinical testing.

Published
2004

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