02865nas a2200409 4500008004100000022001400041245010800055210006900163260001300232300001100245490000700256520171400263653001601977653000901993653002202002653001002024653001902034653001502053653003102068653001102099653002502110653001802135653001102153653001402164653002502178653000902203653002702212653001502239653003702254653002002291653001602311653003102327100002402358700001702382700002002399856003602419 2010 eng d a1364-691500aPrevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study.0 aPrevalence incidence and persistence of major depressive symptom c2010 Mar a168-760 v143 a

PURPOSE: To explore the association of major depressive symptoms with advancing age, sex, and self-rated health among older adults.

DESIGN AND METHODS: We analyzed 10 years of annual assessments in a longitudinal cohort of 5888 Medicare recipients in the Cardiovascular Health Study. Self-rated health was assessed with a single question, and subjects categorized as healthy or sick. Major depressive symptoms were assessed using the Center for Epidemiologic Studies Short Depression Scale, with subjects categorized as nondepressed (score < 10) or depressed (> or =10). Age-, sex-, and health-specific prevalence of depression and the probabilities of transition between depressed and nondepressed states were estimated.

RESULTS: The prevalence of a major depressive state was higher in women, and increased with advancing age. The probability of becoming depressed increased with advancing age among the healthy but not the sick. Women showed a greater probability than men of becoming depressed, regardless of health status. Major depressive symptoms persisted over one-year intervals in about 60% of the healthy and 75% of the sick, with little difference between men and women.

IMPLICATIONS: Clinically significant depressive symptoms occur commonly in older adults, especially women, increase with advancing age, are associated with poor self-rated health, and are largely intransigent. In order to limit the deleterious consequences of depression among older adults, increased attention to prevention, screening, and treatment is warranted. A self-rated health item could be used in clinical settings to refine the prognosis of late-life depression.

10aAge Factors10aAged10aAged, 80 and over10aAging10aCohort Studies10aDepression10aDepressive Disorder, Major10aFemale10aGeriatric Assessment10aHealth Status10aHumans10aIncidence10aLongitudinal Studies10aMale10aPersonality Assessment10aPrevalence10aPsychiatric Status Rating Scales10aQuality of Life10aSex Factors10aSurveys and Questionnaires1 aThielke, Stephen, M1 aDiehr, Paula1 aUnutzer, Jurgen uhttps://chs-nhlbi.org/node/118002961nas a2200397 4500008004100000022001400041245013600055210006900191260001300260300001300273490000700286520180700293653000902100653002202109653002802131653001102159653001102170653000902181653002502190653002402215653003002239100002402269700002102293700001702314700001602331700002502347700002402372700001902396700001302415700002102428700002202449700002102471700001802492700001702510856003602527 2012 eng d a1532-541500aPersistence and remission of musculoskeletal pain in community-dwelling older adults: results from the cardiovascular health study.0 aPersistence and remission of musculoskeletal pain in communitydw c2012 Aug a1393-4000 v603 a

OBJECTIVES: To characterize longitudinal patterns of musculoskeletal pain in a community sample of older adults over a 6-year period and to identify factors associated with persistence of pain.

DESIGN: Secondary analysis of the Cardiovascular Health Study.

SETTING: Community-based cohort drawn from four U.S. counties.

PARTICIPANTS: Five thousand ninety-three men and women aged 65 and older.

MEASUREMENTS: Over a 6-year period, pain was assessed each year using a single question about the presence of pain in any bones or joints during the last year. If affirmative, participants were queried about pain in seven locations (hands, shoulders, neck, back, hips, knees, feet). Participants were categorized according to the percentage of time that pain was present and according to the intermittent or chronic pattern of pain. Factors associated with persistent pain during five remaining years of the study were identified.

RESULTS: Over 6 years, 32% of participants reported pain for three or more consecutive years, and 32% reported pain intermittently. Of those who reported pain the first year, 54% were pain free at least once during the follow-up period. Most of the pain at specific body locations was intermittent. Factors associated with remission of pain over 5 years included older age, male sex, better self-rated health, not being obese, taking fewer medications, and having fewer depressive symptoms. Approximately half of those with pain reported fewer pain locations the following year.

CONCLUSION: Musculoskeletal pain in older adults, despite high prevalence, is often intermittent. The findings refute the notion that pain is an inevitable, unremitting, or progressive consequence of aging.

10aAged10aAged, 80 and over10aCardiovascular Diseases10aFemale10aHumans10aMale10aMusculoskeletal Pain10aRemission Induction10aResidence Characteristics1 aThielke, Stephen, M1 aWhitson, Heather1 aDiehr, Paula1 aO'Hare, Ann1 aKearney, Patricia, M1 aChaudhry, Sarwat, I1 aZakai, Neil, A1 aKim, Dae1 aSekaran, Nishant1 aSale, Joanna, E M1 aArnold, Alice, M1 aChaves, Paulo1 aNewman, Anne uhttps://chs-nhlbi.org/node/140102943nas a2200385 4500008004100000022001400041245010000055210006900155260001300224300001200237490000700249520189000256653003102146653000902177653001002186653001902196653001102215653000902226653001802235653002902253653002002282653001102302653002502313653000902338653001802347653002002365653001602385653001802401100002002419700002402439700002002463700001902483700001902502856003602521 2013 eng d a1758-535X00aDecline in health for older adults: five-year change in 13 key measures of standardized health.0 aDecline in health for older adults fiveyear change in 13 key mea c2013 Sep a1059-670 v683 a

BACKGROUND: The health of older adults declines over time, but there are many ways of measuring health. It is unclear whether all health measures decline at the same rate or whether some aspects of health are less sensitive to aging than others.

METHODS: We compared the decline in 13 measures of physical, mental, and functional health from the Cardiovascular Health Study: hospitalization, bed days, cognition, extremity strength, feelings about life as a whole, satisfaction with the purpose of life, self-rated health, depression, digit symbol substitution test, grip strength, activities of daily living, instrumental activities of daily living, and gait speed. Each measure was standardized against self-rated health. We compared the 5-year change to see which of the 13 measures declined the fastest and the slowest.

RESULTS: The 5-year change in standardized health varied from a decline of 12 points (out of 100) for hospitalization to a decline of 17 points for gait speed. In most comparisons, standardized health from hospitalization and bed days declined the least, whereas health measured by activities of daily living, instrumental activities of daily living, and gait speed declined the most. These rankings were independent of age, sex, mortality patterns, and the method of standardization.

CONCLUSIONS: All of the health variables declined, on average, with advancing age, but at significantly different rates. Standardized measures of mental health, cognition, quality of life, and hospital utilization did not decline as fast as gait speed, activities of daily living, and instrumental activities of daily living. Public health interventions to address problems with gait speed, activities of daily living, and instrumental activities of daily living may help older adults to remain healthier in all dimensions.

10aActivities of Daily Living10aAged10aAging10aCohort Studies10aFemale10aGait10aHealth Status10aHealth Status Indicators10aHospitalization10aHumans10aLongitudinal Studies10aMale10aMental Health10aQuality of Life10aSelf Report10aUnited States1 aDiehr, Paula, H1 aThielke, Stephen, M1 aNewman, Anne, B1 aHirsch, Calvin1 aTracy, Russell uhttps://chs-nhlbi.org/node/599203162nas a2200529 4500008004100000022001400041245010700055210006900162260001300231300001000244490000700254520171700261653003101978653000902009653002202018653001002040653001502050653002702065653002802092653002102120653001102141653002202152653001802174653001802192653001102210653001402221653001102235653000902246653001502255653001402270653002602284653001802310100002402328700002102352700001802373700002402391700002002415700001802435700001902453700002102472700002202493700002402515700001902539700002002558700001802578856003602596 2014 eng d a1758-535X00aSerum carboxymethyl-lysine, disability, and frailty in older persons: the Cardiovascular Health Study.0 aSerum carboxymethyllysine disability and frailty in older person c2014 Jun a710-60 v693 a

BACKGROUND: Advanced glycation endproducts are biologically active compounds that accumulate in disordered metabolism and normal aging. Carboxymethyl-lysine (CML), a ubiquitous human advanced glycation endproduct, has been associated with age-related conditions and mortality. Our objective was to ascertain the relationship between CML and geriatric outcomes (disability and frailty) in a large cohort of older men and women.

METHODS: In 1996-1997, serum CML was measured in 3,373 Cardiovascular Health Study participants (mean age 78.1 ± 4.8 years). Disability, defined as difficulty in any of six activities of daily living, was assessed every 6-12 months for 14 years. Frailty was defined according to five standard criteria at the 1996-1997 visit. Cox proportional hazard models estimated the relationship between CML and incident disability (N = 2,643). Logistic regression models estimated the relationship between CML and prevalent frailty.

RESULTS: Adjusting for multiple potential confounders, higher CML was associated with incident disability (hazard ratio per standard deviation [225 ng/mL] increase: 1.05, 95% CI 1.01-1.11). In men, odds of frailty increased with higher CML values (odds ratio = 1.30 per standard deviation, 95% CI 1.14-1.48), but the relationship was attenuated by adjustment for cognitive status, kidney function, and arthritis. CML was not associated with frailty in women.

CONCLUSIONS: Higher serum CML levels in late life are associated with incident disability and prevalent frailty. Further work is needed to understand CML's value as a risk stratifier, biomarker, or target for interventions that promote healthy aging.

10aActivities of Daily Living10aAged10aAged, 80 and over10aAging10aBiomarkers10aCardiac Rehabilitation10aCardiovascular Diseases10aDisabled Persons10aFemale10aFollow-Up Studies10aFrail Elderly10aHealth Status10aHumans10aIncidence10aLysine10aMale10aPrevalence10aPrognosis10aRetrospective Studies10aUnited States1 aWhitson, Heather, E1 aArnold, Alice, M1 aYee, Laura, M1 aMukamal, Kenneth, J1 aKizer, Jorge, R1 aDjoussé, Luc1 aIx, Joachim, H1 aSiscovick, David1 aTracy, Russell, P1 aThielke, Stephen, M1 aHirsch, Calvin1 aNewman, Anne, B1 aZieman, Susan uhttps://chs-nhlbi.org/node/624302358nas a2200229 4500008004100000022001400041245014500055210006900200260000900269300001100278490000600289520162900295100002401924700002001948700001801968700002101986700002202007700002402029700001902053700002002072856003602092 2015 eng d a2075-442600aSex, Race, and Age Differences in Observed Years of Life, Healthy Life, and Able Life among Older Adults in The Cardiovascular Health Study.0 aSex Race and Age Differences in Observed Years of Life Healthy L c2015 a440-510 v53 a

OBJECTIVE: Longevity fails to account for health and functional status during aging. We sought to quantify differences in years of total life, years of healthy life, and years of able life among groups defined by age, sex, and race.

DESIGN: Primary analysis of a cohort study.

SETTING: 18 years of annual evaluations in four U.S. communities.

PARTICIPANTS: 5888 men and women aged 65 and older.

MEASUREMENTS: Years of life were calculated as the time from enrollment to death or 18 years. Years of total, healthy, and able life were determined from self-report during annual or semi-annual contacts. Cumulative years were summed across each of the age and sex groups.

RESULTS: White women had the best outcomes for all three measures, followed by white men, non-white women, and non-white men. For example, at the mean age of 73, a white female participant could expect 12.9 years of life, 8.9 of healthy life and 9.5 of able life, while a non-white female could expect 12.6, 7.0, and 8.0 years, respectively. A white male could expect 11.2, 8.1, and 8.9 years of life, healthy life, and able life, and a non-white male 10.3, 6.2, and 7.9 years. Regardless of starting age, individuals of the same race and sex groups spent similar amounts (not proportions) of time in an unhealthy or unable state.

CONCLUSION: Gender had a greater effect on longevity than did race, but race had a greater effect on years spent healthy or able. The mean number of years spent in an unable or sick state was surprisingly independent of the lifespan.

1 aThielke, Stephen, M1 aDiehr, Paula, H1 aYee, Laura, M1 aArnold, Alice, M1 aQuiñones, Ana, R1 aWhitson, Heather, E1 aJacob, Mini, E1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/693402587nas a2200253 4500008004100000022001400041245007400055210006900129260001300198300001400211490000700225520185900232100001902091700001802110700002002128700002102148700002402169700002302193700002102216700001902237700002102256700002002277856003602297 2016 eng d a1532-541500aCan a Healthy Lifestyle Compress the Disabled Period in Older Adults?0 aCan a Healthy Lifestyle Compress the Disabled Period in Older Ad c2016 Oct a1952-19610 v643 a

OBJECTIVES: To determine whether lifestyle factors, measured late in life, could compress the disabled period toward the end of life.

DESIGN: Community-based cohort study of older adults followed from 1989 to 2015.

SETTING: Four U.S. communities.

PARTICIPANTS: Community-living men and women aged 65 and older (N = 5,248, mean age 72.7 ± 5.5, 57% female, 15.2% minority) who were not wheelchair dependent and were able to give informed consent at baseline.

MEASUREMENTS: Multiple lifestyle factors, including smoking, alcohol consumption, physical activity, diet, body mass index (BMI), social networks, and social support, were measured at baseline. Activities of daily living (ADLs) were assessed at baseline and throughout follow-up. Years of life (YoL) was defined as years until death. Years of able life (YAL) was defined as years without any ADL difficulty. YAL/YoL%, the proportion of life lived able, was used to indicate the relative compression or expansion of the disabled period.

RESULTS: The average duration of disabled years was 4.5 (out of 15.4 mean YoL) for women and 2.9 (out of 12.4 mean YoL) for men. In a multivariable model, obesity was associated with 7.3 percentage points (95% confidence interval (CI) = 5.4-9.2) lower YAL/YoL% than normal weight. Scores in the lowest quintile of the Alternate Healthy Eating Index were associated with a 3.7% (95% CI = 1.6-5.9) lower YAL/YoL% than scores in the highest quintile. Every 25 blocks walked in a week was associated with 0.5 percentage points (95% CI = 0.3-0.8) higher YAL/YoL%.

CONCLUSION: The effects of healthy lifestyle factors on the proportion of future life lived free of disability indicate that the disabled period can be compressed, given the right combination of these factors.

1 aJacob, Mini, E1 aYee, Laura, M1 aDiehr, Paula, H1 aArnold, Alice, M1 aThielke, Stephen, M1 aChaves, Paulo, H M1 aDel Gobbo, Liana1 aHirsch, Calvin1 aSiscovick, David1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/724702603nas a2200265 4500008004100000022001400041245010000055210006900155260001300224300001100237490000700248520181100255100002202066700002102088700002202109700002402131700001302155700002402168700002002192700001902212700002202231700002802253700002002281856003602301 2016 eng d a1532-541500aEffects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults.0 aEffects of Disease Burden and Functional Adaptation on Morbidity c2016 Jun a1242-90 v643 a

OBJECTIVES: To ascertain whether older adults with extensive disease but relative vigor (adapters) shorten the period at the end of life in which they live with morbidity (compress morbidity).

DESIGN: Prospective, community-based cohort study in four U.S. cities.

SETTING: Cardiovascular Health Study.

PARTICIPANTS: Individuals aged 65 and older.

MEASUREMENTS: Participants were categorized into three groups according to extent of disease (assessed noninvasively), vigor, and frailty (expected agers (n = 3,528, extent of disease similar to vigor and frailty-reference group), adapters (n = 882, higher disease but vigorous), and prematurely frail (n = 855, lower disease but frail)) and compared according to years of able life (YAL), years of self-reported healthy life (YHL), and mortality using multivariable regression and survival analysis.

RESULTS: After adjustment, adapters had 0.97 (95% confidence interval (CI) = 0.60-1.33) more YAL and 0.54 (95% CI = 0.19-0.90) more YHL than expected agers, and those who were prematurely frail had -0.99 (95% CI = -1.36 to -0.62) fewer YAL and -0.53 (95% CI = -0.89 to -0.17) fewer YHL than expected agers. Adapters had 0.9 more and prematurely frail had 1.5 fewer years of total life than expected agers (P < .001). Adapters spent 55% of their remaining life able and healthy, those who were prematurely frail spent 37%, and of expected agers spent 47% (P < .001).

CONCLUSION: Despite similar levels of disease burden, older adults who were more vigorous appeared to compress morbidity and live longer. Older adults with higher frailty lengthened morbidity and had greater mortality. Adaptive factors may compress morbidity and decrease mortality.

1 aSanders, Jason, L1 aArnold, Alice, M1 aHirsch, Calvin, H1 aThielke, Stephen, M1 aKim, Dae1 aMukamal, Kenneth, J1 aKizer, Jorge, R1 aIx, Joachim, H1 aKaplan, Robert, C1 aKritchevsky, Stephen, B1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/713302788nas a2200325 4500008004100000022001400041245013300055210006900188260001300257300001200270490000700282520178400289100002402073700002302097700002402120700002002144700002002164700002302184700002002207700002102227700001902248700002402267700002202291700002402313700002202337700002602359700002002385700002102405856003602426 2018 eng d a1941-329700aLong-Term Cognitive Decline After Newly Diagnosed Heart Failure: Longitudinal Analysis in the CHS (Cardiovascular Health Study).0 aLongTerm Cognitive Decline After Newly Diagnosed Heart Failure L c2018 Mar ae0044760 v113 a

BACKGROUND: Heart failure (HF) is associated with cognitive impairment. However, we know little about the time course of cognitive change after HF diagnosis, the importance of comorbid atrial fibrillation, or the role of ejection fraction. We sought to determine the associations of incident HF with rates of cognitive decline and whether these differed by atrial fibrillation status or reduced versus preserved ejection fraction.

METHODS AND RESULTS: Participants were 4864 men and women aged ≥65 years without a history of HF and free of clinical stroke in the CHS (Cardiovascular Health Study)-a community-based prospective cohort study in the United States, with cognition assessed annually from 1989/1990 through 1998/1999. We identified 496 participants with incident HF by review of hospital discharge summaries and Medicare claims data, with adjudication according to standard criteria. Global cognitive ability was measured by the Modified Mini-Mental State Examination. In adjusted models, 5-year decline in model-predicted mean Modified Mini-Mental State Examination score was 10.2 points (95% confidence interval, 8.6-11.8) after incident HF diagnosed at 80 years of age, compared with a mean 5-year decline of 5.8 points (95% confidence interval, 5.3-6.2) from 80 to 85 years of age without HF. The association was stronger at older ages than at younger ages, did not vary significantly in the presence versus absence of atrial fibrillation (=0.084), and did not vary significantly by reduced versus preserved ejection fraction (=0.734).

CONCLUSIONS: Decline in global cognitive ability tends to be faster after HF diagnosis than without HF. Clinical and public health implications of this finding warrant further attention.

1 aHammond, Christa, A1 aBlades, Natalie, J1 aChaudhry, Sarwat, I1 aDodson, John, A1 aLongstreth, W T1 aHeckbert, Susan, R1 aPsaty, Bruce, M1 aArnold, Alice, M1 aDublin, Sascha1 aSitlani, Colleen, M1 aGardin, Julius, M1 aThielke, Stephen, M1 aNanna, Michael, G1 aGottesman, Rebecca, F1 aNewman, Anne, B1 aThacker, Evan, L uhttps://chs-nhlbi.org/node/768001807nas a2200193 4500008004100000022001400041245009000055210006900145260001600214520118500230100002201415700002401437700002401461700002501485700001801510700002101528700002801549856003601577 2021 eng d a1552-527900aOphthalmic conditions associated with dementia risk: The Cardiovascular Health Study.0 aOphthalmic conditions associated with dementia risk The Cardiova c2021 Mar 313 a

INTRODUCTION: Ophthalmic conditions and dementia appear to overlap and may share common pathways, but research has not differentiated dementia subtypes.

METHODS: Diagnoses of cataracts, age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma were based on medical histories and International Classification of Diseases, Ninth Revision (ICD-9) codes for 3375 participants from the Cardiovascular Health Study. Dementia, including Alzheimer's disease (AD) and vascular dementia (VaD), was classified using standardized research criteria.

RESULTS: Cataracts were associated with AD (hazard ratio [HR] = 1.34; 95% confidence interval [CI] = 1.01-1.80) and VaD/mixed dementia (HR = 1.41; 95% CI = 1.02-1.95). AMD was associated with AD only (HR = 1.87; 95% CI = 1.13-3.09), whereas DR was associated with VaD/mixed dementia only (HR = 2.63; 95% CI = 1.10-6.27).

DISCUSSION: Differential associations between specific ophthalmic conditions and dementia subtypes may elucidate pathophysiologic pathways. Lack of association between glaucoma and dementia was most surprising from these analyses.

1 aHwang, Phillip, H1 aLongstreth, Will, T1 aThielke, Stephen, M1 aFrancis, Courtney, E1 aCarone, Marco1 aKuller, Lewis, H1 aFitzpatrick, Annette, L uhttps://chs-nhlbi.org/node/870803468nas a2200361 4500008004100000022001400041245011800055210006900173260001500242300001300257490000600270520245000276653000902726653002202735653001902757653001102776653001202787653001702799653001102816653000902827653001302836653002402849653001802873653002102891100002202912700002002934700002402954700002502978700001803003700002103021700002803042856003603070 2022 eng d a2574-380500aLongitudinal Changes in Hearing and Visual Impairments and Risk of Dementia in Older Adults in the United States.0 aLongitudinal Changes in Hearing and Visual Impairments and Risk  c2022 05 02 ae22107340 v53 a

Importance: Hearing and vision problems are individually associated with increased dementia risk, but the impact of having concurrent hearing and vision deficits, ie, dual sensory impairment (DSI), on risk of dementia, including its major subtypes Alzheimer disease (AD) and vascular dementia (VaD), is not well known.

Objective: To evaluate whether DSI is associated with incident dementia in older adults.

Design, Setting, and Participants: This prospective cohort study from the Cardiovascular Health Study (CHS) was conducted between 1992 and 1999, with as many as 8 years of follow-up. The multicenter, population-based sample was recruited from Medicare eligibility files in 4 US communities with academic medical centers. Of 5888 participants aged 65 years and older in CHS, 3602 underwent cranial magnetic resonance imaging and completed the modified Mini-Mental State Examination in 1992 to 1994 as part of the CHS Cognition Study. A total of 227 participants were excluded due to prevalent dementia, leaving a total of 3375 participants without dementia at study baseline. The study hypothesis was that DSI would be associated with increased risk of dementia compared with no sensory impairment. The association between the duration of DSI with risk of dementia was also evaluated. Data analysis was conducted from November 2019 to February 2020.

Exposures: Hearing and vision impairments were collected via self-report at baseline and as many as 5 follow-up visits.

Main Outcomes and Measures: All-cause dementia, AD, and VaD, classified by a multidisciplinary committee using standardized criteria.

Results: A total of 2927 participants with information on hearing and vision at all available study visits were included in the analysis (mean [SD] age, 74.6 [4.8] years; 1704 [58.2%] women; 455 [15.5%] African American or Black; 2472 [85.5%] White). Compared with no sensory impairment, DSI was associated with increased risk of all-cause dementia (hazard ratio [HR], 2.60; 95% CI, 1.66-2.06; P < .001), AD (HR, 3.67; 95% CI, 2.04-6.60; P < .001) but not VaD (HR, 2.03; 95% CI, 1.00-4.09; P = .05).

Conclusions and Relevance: In this cohort study, DSI was associated with increased risk of dementia, particularly AD. Evaluation of hearing and vision in older adults may help to identify those at high risk of developing dementia.

10aAged10aAlzheimer Disease10aCohort Studies10aFemale10aHearing10aHearing Loss10aHumans10aMale10aMedicare10aProspective Studies10aUnited States10aVision Disorders1 aHwang, Phillip, H1 aLongstreth, W T1 aThielke, Stephen, M1 aFrancis, Courtney, E1 aCarone, Marco1 aKuller, Lewis, H1 aFitzpatrick, Annette, L uhttps://chs-nhlbi.org/node/9095