DSpace Academic/Research Unit: Medical Gerontology

Obesity and Employment in Ireland: Moving Beyond BMI

2012-07-09T11:21:51Z

Title: Obesity and Employment in Ireland: Moving Beyond BMI Author: MOSCA, IRENE Abstract: I use data from the first wave of the Irish Longitudinal Study on Ageing (TILDA) to investigate the impact of obesity on the labour market status of older Irish individuals. I employ an anthropometric indicator of body composition (waist circumference) along with body mass index. I include a wide array of subjective and objective health indicators in the empirical model. I find that obese women are less likely to be at work. However, both the magnitude and statistical significance of this correlation are sensitive to the definition of obesity. Factors other than socioeconomic characteristics and health are also found to play a role in explaining why obese older women are less likely to be employed. Much weaker evidence is found for men. Description: PUBLISHED

Falls and falls efficacy: the role of sustained attention in older adults.

2013-03-06T17:11:55Z

Title: Falls and falls efficacy: the role of sustained attention in older adults. Author: O'HALLORAN, AISLING Abstract: Background Previous evidence indicates that older people allocate more of their attentional resources toward their gait and that the attention-related changes that occur during aging increase the risk of falls. The aim of this study was to investigate whether performance and variability in sustained attention is associated with falls and falls efficacy in older adults. Methods 458 community-dwelling adults aged ≥ 60 years underwent a comprehensive geriatric assessment. Mean and variability of reaction time (RT), commission errors and omission errors were recorded during a fixed version of the Sustained Attention to Response Task (SART). RT variability was decomposed using the Fast Fourier Transform (FFT) procedure, to help characterise variability associated with the arousal and vigilance aspects of sustained attention. The number of self-reported falls in the previous twelve months, and falls efficacy (Modified Falls Efficacy Scale) were also recorded. Results Significant increases in the mean and variability of reaction time on the SART were significantly associated with both falls (p < 0.01) and reduced falls efficacy (p < 0.05) in older adults. An increase in omission errors was also associated with falls (p < 0.01) and reduced falls efficacy (p < 0.05). Upon controlling for age and gender affects, logistic regression modelling revealed that increasing variability associated with the vigilance (top-down) aspect of sustained attention was a retrospective predictor of falling (p < 0.01, OR = 1.14, 95% CI: 1.03 – 1.26) in the previous year and was weakly correlated with reduced falls efficacy in non-fallers (p = 0.07). Conclusions Greater variability in sustained attention is strongly correlated with retrospective falls and to a lesser degree with reduced falls efficacy. This cognitive measure may provide a novel and valuable biomarker for falls in older adults, potentially allowing for early detection and the implementation of preventative intervention strategies. Description: PUBLISHED

The Long Term Health Effects of Education

2012-06-18T09:43:22Z

Title: The Long Term Health Effects of Education Author: O'SULLIVAN, VINCENT Abstract: Using data from The Irish Longitudinal Study on Ageing, I find that exogenous changes in the schooling of men born into lower social class families in Ireland during the late 1940s and 1950s had a statistically significant positive effect on their self-reported health in later life. I also find that the increased level of schooling had a statistically significant positive effect on physical exercise in later life as well as reducing the probability of an individual experiencing certain non-cardiovascular chronic conditions. However no statistically significant effect was found in relation to cardiovascular disease, self-rated mental health, smoking behaviour or self-reported and objectively measured memory although there is a high degree of imprecision in these estimates. Description: PUBLISHED

Hand-held dynamometry: tester strength is paramount, even in frail populations.

2012-04-02T10:39:33Z

Title: Hand-held dynamometry: tester strength is paramount, even in frail populations. Author: KENNY, ROSE ANNE Abstract: To determine test-retest and inter-rater reliability of hand-held dynamometry when used to measure knee--extensor strength in patients with advanced cancer. SUBJECTS: Adults with metastatic or locally advanced cancer recruited from palliative care services to a study of the risk factors for falls. METHODS: Consecutive recruits (n = 30) underwent repeat testing after an interval of 1 h, by the same researcher, to assess test-retest reliability. The subsequent 15 patients underwent retesting by a second researcher. The intra-class correlation coefficient and limits of agreement were calculated. RESULTS: The test-retest reliability difference between measurements increased with the magnitude of measurement, mean leg strength = 113 N (standard deviation 43.1), 95% ratio limits of agreement 0.81-1.5, intra-class correlation coefficient = 0.9. The inter-rater testing mean leg strength = 128.5 N (standard deviation 35.1), 95% limits of agreement = -57.24 to 36.06 N. Intra-class correlation coefficient = 0.83. CONCLUSION: Test-retesting and inter-rater testing yielded high intra-class correlation coefficients, but the limits of agreement were wide. In test-retesting, the difference between tests increased as the magnitude of measurement increased. It has been widely reported that hand-held dynamometry is reliable when used to measure knee-extensor strength in frail or elderly persons. However, our results show that, even in these populations, reliability may be compromised by inadequate tester strength. Description: PUBLISHED

Retirement and Labour Market Participation

2012-03-13T17:15:57Z

Title: Retirement and Labour Market Participation Author: BARRETT, ALAN Editor: Alan Barrett, George Savva, Virpi Timonen and Rose Anne Kenny Abstract: Labour market participation of older people is important from the perspective of the individual and the macroeconomy. At an individual level, participation in the labour market can be associated with increased resources and enhanced levels of life satisfaction if work is a source of positive social contact and engagement. Description: PUBLISHED

The Effect of Combined Sensory and Semantic Components on Audio Visual Speech Perception in Older Adults

2012-01-31T14:59:13Z

Title: The Effect of Combined Sensory and Semantic Components on Audio Visual Speech Perception in Older Adults Author: SETTI, ANNALISA; KENNY, ROSE ANNE; NEWELL, FIONA; MAGUINNESS, CORRINA Abstract: Previous studies have found that perception in older people benefits from multisensory over unisensory information. As normal speech recognition is affected by both the auditory input and the visual lip movements of the speaker, we investigated the efficiency of audio and visual integration in an older population by manipulating the relative reliability of the auditory and visual information in speech. We also investigated the role of the semantic context of the sentence to assess whether audio–visual integration is affected by top-down semantic processing. We presented participants with audio–visual sentences in which the visual component was either blurred or not blurred. We found that there was a greater cost in recall performance for semantically meaningless speech in the audio–visual ‘blur’ compared to audio–visual ‘no blur’ condition and this effect was specific to the older group. Our findings have implications for understanding how aging affects efficient multisensory integration for the perception of speech and suggests that multisensory inputs may benefit speech perception in older adults when the semantic content of the speech is unpredictable. Description: PUBLISHED

Alterations in the blood brain barrier in ageing cerebral cortex in relationship to Alzheimer-type pathology: a study in the MRC-CFAS population neuropathology cohort

2011-11-15T15:01:42Z

Title: Alterations in the blood brain barrier in ageing cerebral cortex in relationship to Alzheimer-type pathology: a study in the MRC-CFAS population neuropathology cohort Author: SAVVA, GEORGE Abstract: Impairment of the blood brain barrier (BBB) in human brain ageing and its relationship to Alzheimer-type pathology remains poorly defined. We have investigated the BBB in temporal cortex of brain donations from a population-representative sample of 92 participants from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS), a longitudinal study with a programme of brain donation. BBB alteration was investigated by immunohistochemistry to albumin and fibrinogen and to the tight junction proteins claudin-5, zonula occludens-1 (ZO-1) and occludin. BBB leakage showed wide population-variation and increased with progression of Alzheimer-type pathology, though with considerable overlap between different levels of Alzheimer-type pathology. This was accompanied by increased mean vascular density, but not by down-regulation of tight junction proteins. ZO-1 and occludin were also expressed in glia. Mechanisms leading to BBB leakage in brain ageing remain to be defined, but the population-variation in BBB changes and its early increase in relationship to Alzheimer-type pathology progression suggest that BBB dysfunction contributes to brain ageing. Description: PUBLISHED

Orthostatic haemodynamics may be impaired in frailty.

2011-08-24T15:31:04Z

Title: Orthostatic haemodynamics may be impaired in frailty. Author: LAWLOR, BRIAN; ROMERO-ORTUNO, ROMAN; KENNY, ROSE ANNE Abstract: Background: orthostatic hypotension (OH) is a physical sign that reflects a final common pathway of various forms of disordered physiology, which is the hallmark of geriatric frailty. Fried et al. recognise three increasing frailty phenotypes in older people, based on measurements of weight loss, exhaustion, grip strength, walking speed and physical activity. Orthostatic haemodynamics have not been considered as markers of frailty in older people. Objective: to classify a community sample of older people into three increasing frailty phenotypes and compare their orthostatic haemodynamics. Design: cross-sectional study. Setting: geriatric research clinic. Subjects: a total of 442 subjects (mean age 72, 72% females) without dementia or risk factors for autonomic neuropathy. Methods: the sample was classified according to modified Fried criteria. Orthostatic systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) responses were monitored during an active stand with Finometer®. Results: one hundred and ninety-eight subjects (44.8%) were classified as non-frail, 213 (48.2%) as pre-frail, and 31 (7.0%) as frail. Across groups, there was a significant increasing gradient in baseline HR (P = 0.008) and decreasing gradients in Delta HR (i.e. maximum HR within 30 s—baseline HR) (P < 0.001) and maximum HR by 30 s (P < 0.001). On average, by 30 s after stand, non-frail subjects had recovered 98% of their baseline SBP, while pre-frail and frail subjects had recovered 95 and 92%, respectively (P for trend = 0.064). Conclusions: the orthostatic HR response and, to a lesser extent, SBP recoverability, appear impaired in frailty. Orthostatic haemodynamics may be useful markers of frailty. Description: PUBLISHED

The Impact of Parental Earnings and Education on the Schooling of Children

2011-07-05T11:44:42Z

Title: The Impact of Parental Earnings and Education on the Schooling of Children Author: O'SULLIVAN, VINCENT Abstract: This paper addresses the intergenerational transmission of education and investigates the extent to which early school leaving (at age 16) may be due to variations in parental background. An important contribution of the paper is to distinguish between the causal effects of parental income and parental education levels. Least squares estimation reveals conventional results – weak effects of income (when the child is 16), stronger effects of maternal education than paternal, and stronger effects on sons than daughters. We find that the education effects remain significant even when household income is included. However, when we use instrumental variable methods to simultaneously account for the endogeneity of parental education and paternal income, only maternal education remains significant (for daughters only) and becomes stronger. These estimates are consistent across various sets of instruments. The impact of paternal income varies between specifications but becomes insignificant in our favored specifications. Our results provide only limited support for policies that alleviate income constraints at age 16 in order to alter schooling decisions. In contrast, our results do suggest that policies which increase permanent income would lead to increased participation (especially for daughters). Description: PUBLISHED

Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people.

2011-07-01T14:40:13Z

Title: Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people. Author: KENNY, ROSE ANNE; ROMERO-ORTUNO, ROMAN; FAN, CHIE WEI; FORAN, TIM Abstract: OBJECTIVES: To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypotension (OH) definitions: consensus (COH) and initial (IOH). DESIGN: Cross-sectional. SETTING: Geriatric research clinic. PARTICIPANTS: Four hundred forty-two participants (mean age 72, 72% female) without dementia or risk factors for autonomic neuropathy. MEASUREMENTS: Active lying-to-standing test monitored using a continuous noninvasive BP monitor. For the morphological classification, four orthostatic systolic BP variables were extracted (delta (baseline - nadir) and maximum percentage of baseline recovered by 30 seconds and 1 and 2 minutes) using the 5-second averages method and entered in K-means cluster analysis (three clusters). Main outcomes were OI, falls (≥1 in past 6 months), and frailty (modified Fried criteria). RESULTS: The morphological clusters were small drop, fast overrecovery (n=112); medium drop, slow recovery (n=238); and large drop, nonrecovery (n=92). Their characterization revealed an increasing OI gradient (17.9%, 27.5%, and 44.6% respectively, P<.001) but no significant gradients in falls or frailty. The COH definition failed to reveal clinical differences between COH+ (n=416) and COH- (n=26) participants. The IOH definition resulted in a clinically meaningful separation between IOH+ (n=85) and IOH- (n=357) subgroups, as assessed according to OI (100% vs 11.5%, P<.001), falls (24.7% vs 10.4%, P<.001), and frailty (14.1% vs 5.4%, P=.005). CONCLUSION: It is recommended that the IOH definition be applied when taking continuous noninvasive orthostatic BP measurements in older people. Description: PUBLISHED