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Background: Prevalence of dementia and cognitive impairment increase creating the need for identifying modifiable risk factors to reduce their burden. The aim of this study was to identify latent groups following similar trajectories in cognitive performance assessed with the verbal fluency test, as well as their determinants., Methods: Data from English Longitudinal Study of Aging (ELSA) were studied. Latent groups of similar course through a 6-year period in the outcome variable (verbal fluency) were investigated, along with their determinants, using Group Based Trajectory Modeling (GBTM)., Results: Four latent groups of verbal fluency trajectories were revealed. Education was the strongest predictor for a favorable trajectory, while cardiovascular disease and depression symptoms were associated with lower within each trajectory., Conclusion: Cardiovascular diseases and depressive symptoms are associated with a worse course of verbal fluency through aging, implying that they might serve as targets for interventions to prevent cognitive decline in the aging population. Contrarily, higher level of education is associated with a more favorable course through aging.

Background: Data on the survival status of older adults on antiretroviral treatment (ART) are scarce in sub-Saharan Africa. The objective of this study was to determine the survival status of people aged 50 years and older who were HIV-negative, HIV-positive not on ART, and HIV-positive on ART., Methods: We used three waves of data from the World Health Organisation Study on Global Ageing and adult health- Well Being of Older People Study cohort in Uganda, conducted in 2009, 2012-2013 and 2015-2016. The cohort included HIV-negative and HIV-positive persons aged 50 years and older recruited from multiple rural and peri-urban sites in Uganda. Data were collected using interviewer-administered questionnaire. Time-dependent ART data were collected from medical records using a data-abstraction form. This study was conducted before the universal test and treat policy came into effect. We fitted Cox survival models to estimate hazard ratios to compare the risk of death between groups, adjusted for age, sex, marital status and hypertension., Results: Of 623 participants, 517 (82.9%) of respondents had follow-up data and were included in this analysis. We observed 1571 person-years of follow-up from 274 people who were HIV-negative, and 1252 from 243 who were HIV-positive. The estimated mortality adjusted hazard ratio (aHR) was 1.89 (95% CI 1.0-3.4; p = 0.04) among people living with HIV compared to HIV-negative people. The aHR for mortality among people receiving ART compared with HIV-negative people was 1.75 (95% CI 0.9-3.5). People who were HIV-positive and not receiving ART had the greatest risk of death (aHR = 2.09, 95% CI 1.0-4.4 compared with HIV negative participants). The aHR for HIV-positive people not receiving ART, compared to those who were on treatment, was 1.19 (95% CI 0.6-2.5)., Conclusion: Older adults living with HIV on ART had a risk of mortality that was nearly twice as high as HIV-negative adults. Further analyses of longitudinal data should be done to understand factors that affect the survival of older adults on ART.

Background: Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents., Methods: We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors., Results: A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80)., Conclusions: Our results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese.

Background: Empirical evidence suggests that multimorbidity and disability are each significantly associated with out-of-pocket (OOP) health expenditures; however few efforts have been made to explore their joint association with OOP health expenditures., Objectives: To estimate the association of multimorbidity and disability with OOP health expenditures in households with older adults in Mexico, as well as the potential interaction effects of multimorbidity and disability on OOP health expenditures., Methods: Longitudinal study based on data collected as part of the Study on global AGEing and adult health Wave 1 (2009) and Wave 2 (2014), a nationally representative study in Mexico with a sample of older adults aged 50 and older. The dependent variable was OOP health expenditures, and main exposure variables were multimorbidity and disability. Two-Part regression models were used to analyze the relation between multimorbidity, disability and OOP health expenditures., Results: Multimorbidity was associated with the probability of incurring OOP health expenditures (OR = 1.28, CI 95% 1.11-1.48), and also the tertiles of disability (2nd tertile: OR = 1.45, CI 95% 1.23-1.70; 3rd tertile: OR = 2.19, CI 95% 1.81-2.66). The presence of multimorbidity was associated with an increase of 13% in average OOP health costs (β = 0.13, CI 95% 0.01-0.25), and 16% for the 3rd tertile of disability (β = 0.16, CI 95% 0.01-0.31). We did not find significant interaction effects of multimorbidity and disability., Conclusions: Multimorbidity and disability appear to be important determinants of OOP health expenditures. The economic implications for the households and the health system should be highlighted, particularly in low- and middle-income countries because of the rapid growth of their aging populations., (Copyright © 2019 Elsevier Inc. All rights reserved.)

BACKGROUND Studies on the effects of sociodemographic factors on health in aging now include the use of statistical models and machine learning. The aim of this study was to evaluate the determinants of health in aging using machine learning methods and to compare the accuracy with traditional methods. MATERIAL AND METHODS The health status of 6,209 adults, age <65 years (n=1,585), 65-79 years (n=3,267), and >80 years (n=1,357) were measured using an established health metric (0-100) that incorporated physical function and activities of daily living (ADL). Data from the English Longitudinal Study of Ageing (ELSA) included socio-economic and sociodemographic characteristics and history of falls. Health-trend and personal-fitted variables were generated as predictors of health metrics using three machine learning methods, random forest (RF), deep learning (DL) and the linear model (LM), with calculation of the percentage increase in mean square error (%IncMSE) as a measure of the importance of a given predictive variable, when the variable was removed from the model. RESULTS Health-trend, physical activity, and personal-fitted variables were the main predictors of health, with the%incMSE of 85.76%, 63.40%, and 46.71%, respectively. Age, employment status, alcohol consumption, and household income had the%incMSE of 20.40%, 20.10%, 16.94%, and 13.61%, respectively. Performance of the RF method was similar to the traditional LM (p=0.7), but RF significantly outperformed DL (p=0.006). CONCLUSIONS Machine learning methods can be used to evaluate multidimensional longitudinal health data and may provide accurate results with fewer requirements when compared with traditional statistical modeling.

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems., (© The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Four longitudinal studies were included in this rigorous harmonization process: the Study on global AGEing and adult health (SAGE); English Longitudinal Study on Ageing (ELSA); US Health and Retirement Study (HRS); and Survey of Health, Ageing and Retirement in Europe (SHARE). An ex-post harmonized process was applied to nine health-related thematic domains (socio-demographic and economic, health states, overall self-report of health and mental state, health examinations, physical and mental performance tests, risk factors, chronic conditions, social network and subjective well-being) for data from the 2004 wave of each study. Large samples of adults aged 50 years and older were available from each study: SAGE, n = 18 886; ELSA, n = 9181; HRS, n = 19 303; and SHARE, n = 29 917. The microdata, along with further details about the harmonization process and all metadata, are available through the World Health Organization (WHO) data archive at [http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog]. Further information and enquiries can be made to [sagesurvey@who.int] or the corresponding author. The data resource will continue to be updated with data across additional waves of these surveys and new waves., (© The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Purpose: To comprehensively identify the determinants of quality of life (QoL) in a population study sample of persons aged 18-50 and 50+., Methods: In this observational, cross-sectional study, QoL was measured with the WHOQOL-AGE, a brief instrument designed to measure QoL in older adults. Eight hierarchical regression models were performed to identify determinants of QoL. Variables were entered in the following order: Sociodemographic; Health Habits; Chronic Conditions; Health State description; Vision and Hearing; Social Networks; Built Environment. In the final model, significant variables were retained. The final model was re-run using data from the three countries separately., Results: Complete data were available for 5639 participants, mean age 46.3 (SD 18.4). The final model accounted for 45% of QoL variation and the most relevant contribution was given by sociodemographic data (particularly age, education level and living in Finland: 17.9% explained QoL variation), chronic conditions (particularly depression: 4.6%) and a wide and rich social network (4.6%). Other determinants were presence of disabling pain, learning difficulties and visual problems, and living in usable house that is perceived as non-risky. Some variables were specifically associated to QoL in single countries: age in Poland, alcohol consumption in Spain, angina in Finland, depression in Spain, and self-reported sadness both in Finland and Poland, but not in Spain. Other were commonly associated to QoL: smoking status, bodily aches, being emotionally affected by health problems, good social network and home characteristics., Conclusions: Our results highlight the importance of modifiable determinants of QoL, and provide public health indications that could support concrete actions at country level. In particular, smoking cessation, increasing the level of physical activity, improving social network ties and applying universal design approach to houses and environmental infrastructures could potentially increase QoL of ageing population.

Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report., (Copyright © 2016 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.)

Background: Population ageing challenges health care systems due to the high prevalence and impact of multimorbidity in older adults. However, little is known about how chronic conditions present in certain multimorbidity patterns, which could have great impact on public health at several levels. The aim of our study was to identify and describe multimorbidity patterns in low-, middle-, and high-income countries., Methods: We analyzed data from the Collaborative Research on Ageing in Europe project (Finland, Poland, and Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, and South Africa). These cross-sectional studies obtained data from 41,909 noninstitutionalized adults older than 50 years. Exploratory factor analysis was performed to detect multimorbidity patterns. Additional adjusted binary logistic regressions were performed to identify associations between sociodemographic factors and multimorbidity., Results: Overall multimorbidity prevalence was high across countries. Hypertension, cataract, and arthritis were the most prevalent comorbid conditions. Two or three multimorbidity patterns were found per country. Several patterns were identified across several countries: "cardio-respiratory" (angina, asthma, and chronic obstructive pulmonary disease), "metabolic" (diabetes, obesity, and hypertension), and "mental-articular" (arthritis and depression)., Conclusions: A high prevalence of multimorbidity occurs in older adults across countries, with low- and middle-income countries gradually approaching the figures of richer countries. Certain multimorbidity patterns are present in several countries, which suggest that common underlying etiopathogenic factors may play a role. Deeper understanding of these patterns may lead to the development of preventive actions to diminish their prevalence and also give rise to new, comprehensive approaches for the management of these co-occurring conditions., (© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The aim of this study was to evaluate the association of sarcopenia and sarcopenic obesity with disability among older adults (≥65years old) in nine high-, middle- and low-income countries from Asia, Africa, Europe, and Latin America., Methods: Data were available for 53,289 people aged ≥18years who participated in the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland, and Spain, and the WHO Study on global AGEing and adult health (SAGE) survey conducted in China, Ghana, India, Mexico, Russia, and South Africa, between 2007 and 2012. Skeletal muscle mass, skeletal muscle mass index, and percent body fat were calculated with specific population formulas. Sarcopenia and sarcopenic obesity were defined by specific cut-offs used in previous studies. Disability was assessed with the WHODAS 2.0 score (range 0-100) with higher scores corresponding to higher levels of disability. Multivariable linear regression analysis was conducted with disability as the outcome., Results: The analytical sample consisted of 18,363 people (males; n=8116, females; n=10247) aged ≥65years with mean (SD) age 72.9 (11.1) years. In the fully-adjusted overall analysis, sarcopenic obesity was associated with greater levels of disability [b-coefficient 3.01 (95% CI 1.14-4.88)]. In terms of country-wise analyses, sarcopenia was associated with higher WHODAS 2.0 scores in China [b-coefficient 4.56 (95% CI: 3.25-5.87)], Poland [b-coefficient 6.66 (95% CI: 2.17-11.14)], Russia [b-coefficient 5.60 (95% CI: 2.03-9.16)], and South Africa [b-coefficient 7.75 (95% CI: 1.56-13.94)]., Conclusions: Prevention of muscle mass decline may contribute to reducing the global burden of disability., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Chronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as 'multimorbidity'. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs., Methods: Data was obtained from the WHO's Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries., Results: The prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases., Conclusions: Findings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.

Background: Back pain is a common disabling chronic condition that burdens individuals, families and societies. Epidemiological evidence, mainly from high-income countries, shows positive association between back pain prevalence and older age. There is an urgent need for accurate epidemiological data on back pain in adult populations in low- and middle-income countries (LMICs) where populations are ageing rapidly. The objectives of this study are to: measure the prevalence of back pain; identify risk factors and determinants associated with back pain, and describe association between back pain and disability in adults aged 50 years and older, in six LMICs from different regions of the world. The findings provide insights into country-level differences in self-reported back pain and disability in a group of socially, culturally, economically and geographically diverse LMICs., Methods: Standardized national survey data collected from adults (50 years and older) participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analysed. The weighted sample (n = 30, 146) comprised respondents in China, Ghana, India, Mexico, South Africa and the Russian Federation. Multivariable regressions describe factors associated with back pain prevalence and intensity, and back pain as a determinant of disability., Results: Prevalence was highest in the Russian Federation (56%) and lowest in China (22%). In the pooled multi-country analyses, female sex, lower education, lower wealth and multiple chronic morbidities were significant in association with past-month back pain (p<0.01). About 8% of respondents reported that they experienced intense back pain in the previous month., Conclusions: Evidence on back pain and its impact on disability is needed in developing countries so that governments can invest in cost-effective education and rehabilitation to reduce the growing social and economic burden imposed by this disabling condition.

Background: The evidence suggesting that gait speed may represent a sensitive marker for cognitive decline in the elderly requires support from diverse racial groups., Objective: We investigated the relationship between gait speed and cognitive decline over 2 years in a community dwelling sample of elderly Africans., Methods: Data are from the Ibadan study of aging (ISA) conducted among a household multi-stage probability sample of 2149 Yoruba Nigerians aged 65 years or older. Gait speed was measured as the time taken to complete a 3 or 4m distance at normal walking speed. We assessed cognitive functions with a modified version of the 10-word learning list and delay recall test, and examined the relationship between baseline gait speed, as well as gait speed changes, and follow-up cognition using multiple linear regression and longitudinal analyses using random effects., Results: Approximately 71% of 1461 participants who were dementia free and who had their gait speed measured at baseline (2007) were successfully followed up in two waves (2008 and 2009). Along with increasing age, poor health and economic status, a slower baseline gait speed was independently associated with poorer follow-up cognition in both linear regression (1.2 words, 95% CI=0.48-2.0) and longitudinal analyses (0.8 words, 95% CI=0.44-1.2). Also, a greater change in gait speed between 2007 and 2009 was associated with the worst follow-up cognition (0.3 words, 95% CI=0.09-0.51)., Conclusion: The finding that a substantial change in gait speed was associated with reduced cognitive performance is of potential importance to efforts aimed at early identification of cognitive disorders in this population., (Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Continuous population aging has raised international policy interest in promoting active aging (AA). AA theoretical models have been defined from a biomedical or a psychosocial perspective. These models may be expanded including components suggested by lay individuals. This paper aims to study the correlates of AA in three European countries, namely, Spain, Poland, and Finland using four different definitions of AA., Methods: The EU COURAGE in Europe project was a cross-sectional general adult population survey conducted in a representative sample of the noninstitutionalized population of Finland, Poland, and Spain. Participants (10,800) lived in the community. This analysis focuses on individuals aged 50 years old and over (7,987). Four definitions (two biomedical, one psychosocial, and a complete definition including biomedical, psychosocial, and external variables) of AA were analyzed., Results: Differences in AA were found for country, age, education, and occupation. Finland scored consistently the highest in AA followed by Spain and Poland. Younger age was associated with higher AA. Higher education and occupation was associated with AA. Being married or cohabiting was associated with better AA compared to being widowed or separated in most definitions. Gender and urbanicity were not associated with AA, with few exceptions. Men scored higher in AA only in Spain, whereas there was no gender association in the other two countries. Being widowed was only associated with lower AA in Poland and not being married was associated with lower AA in Poland and Finland but not Spain., Conclusions: Associations with education, marital status, and occupation suggest that these factors are the most important components of AA. These association patterns, however, seem to vary across the three countries. Actions to promote AA in these countries may be addressed at reducing inequalities in occupation and education or directly tackling the components of AA lacking in each country.

Objectives: To determine the profile and determinants of successful aging in a developing country characterized by low life expectancy and where successful agers may represent a unique group., Design: Community-based cohort study., Setting: Eight contiguous states in the Yoruba-speaking region of Nigeria., Participants: A multistage clustered sampling of households was used to select a representative sample of individuals (N = 2,149) aged 65 and older at baseline. Nine hundred thirty were successfully followed for an average of 64 months between August 2003 and December 2009., Measurements: Lifestyle and behavioral factors were assessed at baseline. Successful aging, defined using each of three models (absence of chronic health conditions, functional independence, and satisfaction with life), was assessed at follow-up., Results: Between 16% and 75% of respondents could be classified as successful agers using one of the three models while 7.5% could be so classified using a combination of all the models. Correlations between the three models were small, ranging from 0.08 to 0.15. Different features predicted their outcomes, suggesting that they represent relatively independent trajectories of aging. Whichever model was used, more men than women tended to be classified as aging successfully. Men who aged successfully, using a combination of all the three models, were more likely never to have smoked (adjusted odds ratio (aOR) = 4.7, 95% confidence interval (CI) = 1.55-14.46) and to report, at baseline, having contacts with friends (aOR = 4.2, 95% CI = 1.0-18.76) or participating in community activities (aOR = 16.0, 95% CI = 1.23-204.40). In women, there was a nonlinear trend for younger age at baseline to predict this outcome., Conclusion: Modifiable social and lifestyle factors predicted successful aging in this population, suggesting that health promotion targeting behavior change may lead to tangible benefits for health and well-being in old age., (© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.)

Unlabelled: A tool to assess the built environment, which takes into account issues of disability, accessibility and the need for data comparable across countries and populations, is much needed. The Collaborative Research on Ageing in Europe (COURAGE) in Europe Built Environment Outdoor Checklist (CBE-OUT) helps us to understand when features of the neighbourhood environment have either a positive or negative impact on the accessibility of neighbourhoods for healthy ageing. The CBE-OUT is composed of 128 items that can be recorded when present in the evaluated environment. Audits were performed in households randomly selected from each cluster of the sample for Finland, Poland and Spain, following precise rules defined by experts. Global scores were computed both section by section and in the overall checklist, rescaling the resulting scores from 0 (negative environment) to 100 (positive). The total number of completed CBE-OUT checklists was 2452 (Finland, 245; Poland, 972; and Spain, 1235). Mean global score for our sample is 49.3, suggesting an environment composed both of facilitating and hindering features. Significant differences were observed in the built environment features of the three countries and in particular between Finland and the other two. The assessment of features of built environment is crucial when thinking about ageing and enhanced participation. The COURAGE in Europe project developed this tool to collect information on built environment in an objective evaluation of environmental features and is a recommended methodology for future studies., Key Practitioner Message: The CBE-OUT checklist is an objective evaluation of the built environment and is centred on technical measurement of features present in the environment and has its foundations in the concepts of disability and accessibility operating in the International Classification of Functioning, Disability and Health (ICF) model. The CBE-OUT checklist can be analysed using both the total score and the single section score, allowing an evaluation of the facilitating or hindering role of the environment and is usable for predictive analysis of ageing trends. The CBE-OUT checklist makes it possible to collect information about the built environment by means of an objective evaluation of environment features and is a recommended methodology for future studies about the built environment., (Copyright © 2013 John Wiley & Sons, Ltd.)

The collaborative research on ageing in Europe protocol was based on that of the World Health Organization Study on global AGEing and adult health (SAGE) project that investigated the relationship between health and well-being and provided a set of instruments that can be used across countries to monitor health and health-related outcomes of older populations as well as the strategies for addressing issues concerning the ageing process. To evaluate the degree to which SAGE protocol covered the spectrum of disability given the scope of the World Health Organization International Classification of Functioning, Disability and Health (ICF), a mapping exercise was performed with SAGE protocol. Results show that the SAGE protocol covers ICF domains in a non-uniform way, with environmental factors categories being underrepresented, whereas mental, cardiovascular, sensory functions and mobility were overrepresented. To overcome this partial coverage of ICF functioning categories, new assessment instruments have been developed. PRACTITIONER MESSAGE: Mapping exercises are valid procedures to understand the extent to which a survey protocol covers the spectrum of functioning. The mapping exercise with SAGE protocol shows that it provides only a partial representation of body functions and activities and participation domains, and the coverage of environmental factors is poor. New instruments are therefore needed for researchers to properly understand the health and disability of ageing populations., (Copyright © 2013 John Wiley & Sons, Ltd.)

Unlabelled: The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10,800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering., Key Practitioner Message: Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking. The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment. Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment., (Copyright © 2013 John Wiley & Sons, Ltd.)

Unlabelled: COURAGE in Europe was a 3-year project involving 12 partners from four European countries and the World Health Organization. It was inspired by the pressing need to integrate international studies on disability and ageing in light of an innovative perspective based on a validated data-collection protocol. COURAGE in Europe Project collected data on the determinants of health and disability in an ageing population, with specific tools for the evaluation of the role of the built environment and social networks on health, disability, quality of life and well-being. The main survey was conducted by partners in Finland, Poland and Spain where the survey has been administered to a sample of 10,800 persons, which was completed in March 2012. The newly developed and validated COURAGE Protocol for Ageing Studies has proven to be a valid tool for collecting comparable data in ageing population, and the COURAGE in Europe Project has created valid and reliable scientific evidence, demonstrating cross-country comparability, for disability and ageing research and policy development. It is therefore recommended that future studies exploring determinants of health and disability in ageing use the COURAGE-derived methodology., Key Practitioner Message: COURAGE in Europe Project collected data on the determinants of health and disability in an ageing population, with specific tools for the evaluation of the role of built environment and social networks on health, disability quality of life and well-being. The COURAGE Protocol for Ageing Studies has proven to be a valid tool for collecting comparable data in the ageing population. The COURAGE in Europe Consortium recommends that future studies exploring determinants of health and disability in ageing use COURAGE-derived methodology., (Copyright © 2013 John Wiley & Sons, Ltd.)

Unlabelled: The aim of the study was to create a simplified, easy implementable multidimensional instrument to assess all relevant elements of the structure and function of social network within individuals across different European countries and to provide the tool for health professionals and policy makers. The analysis was based on the sample of 10 446 non-institutionalized adult population from Finland, Poland and Spain. The Social Network Questionnaire Collaborative Research on Ageing in Europe Social Network Index (COURAGE-SNI) was part of the COURAGE questionnaire. The indicators of the functioning of social network ties (close relations), frequency of direct contact and general support were evaluated. Functions were assess within the main structural components as spouse, parents, children, grandchildren, other relatives, friends, coworkers and neighbours. The exploratory factor analysis revealed five main latent components of social network with one component composed of hierarchical part. The confirmatory factor analysis provided an acceptable fit for the model. The generalize partial credit model was used to calculate factor scores for five components of the COURAGE-SNI considering the social networks of 'spouse/partner', 'parents', 'other family members', 'neighbours' and 'friends and co-workers'. The scores for every component were recalculated so as to provide the social network saturation ranged from 0 (the lowest) to 100% (the highest possible). Finally, the COURAGE-SNI score was obtained as the sum of weighted information calculated by the item response theory procedure for every aforementioned component. In summary, the COURAGE-SNI showed good reliability and content validity and seems to be a promising tool for the assessment of the social network phenomenon across European countries., Key Practitioner Message: The Courage-SNI is a new tool to assess the construct of social network in population studies. The Courage-SNI is an instrument useful to identify high risk groups or populations whose social network is poorer., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: There is a need for short, specific instruments that assess quality of life (QOL) adequately in the older adult population. The aims of the present study were to obtain evidence on the validity of the inferences that could be drawn from an instrument to measure QOL in the aging population (people 50+ years old), and to test its psychometric properties., Methods: The instrument, WHOQOL-AGE, comprised 13 positive items, assessed on a five-point rating scale, and was administered to nationally representative samples (n = 9987) from Finland, Poland, and Spain. Cronbach's alpha was employed to assess internal consistency reliability, whereas the validity of the questionnaire was assessed by means of factor analysis, graded response model, Pearson's correlation coefficient and unpaired t-test. Normative values were calculated across countries and for different age groups., Results: The satisfactory goodness-of-fit indices confirmed that the factorial structure of WHOQOL-AGE comprises two first-order factors. Cronbach's alpha was 0.88 for factor 1, and 0.84 for factor 2. Evidence supporting a global score was found with a second-order factor model, according to the goodness-of-fit indices: CFI = 0.93, TLI = 0.91, RMSEA = 0.073. Convergent validity was estimated at r = 0.75 and adequate discriminant validity was also found. Significant differences were found between healthy individuals (74.19 ± 13.21) and individuals with at least one chronic condition (64.29 ± 16.29), supporting adequate known-groups validity., Conclusions: WHOQOL-AGE has shown good psychometric properties in Finland, Poland, and Spain. Therefore, considerable support is provided to using the WHOQOL-AGE to measure QOL in older adults in these countries, and to compare the QOL of older and younger adults.

Background: caregivers make substantial contributions to health and social systems, but many low-resource settings lack reliable data about the determinants and experiences of older adults who are caregivers., Objective: we identified socio-demographic determinants of caregiving among older adults of low- and middle-income countries, and compared determinants of specific categories of caregiving tasks., Subjects: a total of 34,289 adults aged 60 or older from a pooled sample of 48 low- and middle-income countries., Methods: prevalence values for caregiving and categories of caregiving tasks were calculated according to socio-demographic variables, for the overall sample and for each study country. Multivariate analyses assessed associations between caregiving variables and socio-demographic determinants, adjusting for health score and country of residence., Results: overall, 15% of older adults provided care, with varying prevalence according to study country. The prevalence of caregiving was significantly higher in women, and among adults aged 60-69, the college educated, the wealthy, those living in a household of two people and urban residents. No prevalence differences were reported for the employment status or health score. The odds of caregiving were greater for women, younger age groups and higher education levels, controlling for confounders. The likelihood of participating in specific categories of caregiving differed by sex, age, marital status, education, employment status and household size, but was not associated with household economic status, area of residence or health score.

Population ageing is rapidly becoming a global issue and will have a major impact on health policies and programmes. The World Health Organization's Study on global AGEing and adult health (SAGE) aims to address the gap in reliable data and scientific knowledge on ageing and health in low- and middle-income countries. SAGE is a longitudinal study with nationally representative samples of persons aged 50+ years in China, Ghana, India, Mexico, Russia and South Africa, with a smaller sample of adults aged 18-49 years in each country for comparisons. Instruments are compatible with other large high-income country longitudinal ageing studies. Wave 1 was conducted during 2007-2010 and included a total of 34 124 respondents aged 50+ and 8340 aged 18-49. In four countries, a subsample consisting of 8160 respondents participated in Wave 1 and the 2002/04 World Health Survey (referred to as SAGE Wave 0). Wave 2 data collection will start in 2012/13, following up all Wave 1 respondents. Wave 3 is planned for 2014/15. SAGE is committed to the public release of study instruments, protocols and meta- and micro-data: access is provided upon completion of a Users Agreement available through WHO's SAGE website (www.who.int/healthinfo/systems/sage) and WHO's archive using the National Data Archive application (http://apps.who.int/healthinfo/systems/surveydata).

Background: Research efforts to measure the concept of healthy ageing have been diverse and limited to specific populations. This diversity limits the potential to compare healthy ageing across countries and/or populations. In this study, we developed a novel measurement scale of healthy ageing using worldwide cohorts.Methods: In the Ageing Trajectories of Health-Longitudinal Opportunities and Synergies (ATHLOS) project, data from 16 international cohorts were harmonized. Using ATHLOS data, an item response theory (IRT) model was used to develop a scale with 41 items related to health and functioning. Measurement heterogeneity due to intra-dataset specificities was detected, applying differential item functioning via a logistic regression framework. The model accounted for specificities in model parameters by introducing cohort-specific parameters that rescaled scores to the main scale, using an equating procedure. Final scores were estimated for all individuals and converted to T-scores with a mean of 50 and a standard deviation of 10.Results: A common scale was created for 343 915 individuals above 18 years of age from 16 studies. The scale showed solid evidence of concurrent validity regarding various sociodemographic, life and health factors, and convergent validity with healthy life expectancy (r = 0.81) and gross domestic product (r = 0.58). Survival curves showed that the scale could also be predictive of mortality.Conclusions: The ATHLOS scale, due to its reliability and global representativeness, has the potential to contribute to worldwide research on healthy ageing. [ABSTRACT FROM AUTHOR]

Abstract Introduction Women represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women. Methods World Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into “disabled” vs. “not disabled”. We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the “explained” part that arises because of differences between males and females in terms of age and social and economic characteristics, and an “unexplained” part attributed to the differential effects of these characteristics. Results Prevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants. Conclusions There is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women.

Health system responsiveness is an indicator that can be used for evaluating how well healthcare systems respond to people's needs in non-clinical areas such as communication, autonomy and confidentiality. This study analyses health system responsiveness from the perspective of community-dwelling adults aged 50 and over in China, Ghana, India, the Russian Federation and South Africa using cross-sectional data from the World Health Organization Study on global AGEing and adult health. The aim is to assess and compare how individual, health condition and healthcare factors impact differently on outpatient and inpatient responsiveness. Poor responsiveness is measured according to participants' responses to questions on a five-point Likert scale. Five univariate and multiple logistic regression models test associations between individual, health condition and healthcare factors and poor responsiveness. The final model adjusts for country. Key results are that travel time is a major contributor to poor responsiveness across all countries. Similarly there are wealth inequalities in responsiveness. However no clear difference in responsiveness was observed in presentations for chronic versus other types of conditions. This study provides an interesting baseline on older patients' perceived treatment within outpatient and inpatient facilities in five diverse low- and middle-income countries. [ABSTRACT FROM AUTHOR]

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Background and Objectives We reviewed the literature on older adults (OAs) who are caring for persons living with HIV/AIDS in sub-Saharan Africa (SSA), with the goal of adapting models of caregiver stress and coping to include culturally relevant and contextually appropriate factors specific to SSA, drawing on both life course and cultural capital theories. Research Design and Methods A systematic literature search found 81 articles published between 1975 and 2016 which were reviewed using a narrative approach. Primary sources of articles included electronic databases and relevant WHO websites. Results The main challenge of caregiving in SSA reflects significant financial constraints, specifically the lack of necessities such as food security, clean water, and access to health care. Caregiving is further complicated in SSA by serial bouts of caring for multiple individuals, including adult children and grandchildren, in the context of high levels of stigma associated with HIV. Factors promoting caregiver resilience included spirituality, bidirectional (reciprocal) caregiving, and collective coping strategies. Discussion and Implications The creation of a theoretical model of caregiving which focuses more broadly on the sociocultural context of caregiving could lead to new ways of developing interventions in low-resources communities. [ABSTRACT FROM AUTHOR]

Background: Aging is a multidimensional process with a remarkable interindividual variability. This study is focused on identifying groups of population with similar aging patterns, and to define the health trajectories of these groups. Sociodemographic and health determinants of these trajectories are also identified.Methods: Data from the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) were used. A set of self-reported health items and measured tests were used to generate a latent health metric by means of a Bayesian multilevel IRT model, assessing the ability of the metric to predict mortality. Then, a Growth Mixture Model (GMM) was conducted in each study to identify latent classes and assess health trajectories. Kaplan-Meier survival curves were obtained for each class and a multinomial logistic regression was used to identify determinants of these trajectories.Results: The health score generated showed an adequate ability to predict mortality over 10 years in ELSA (AUC = 0.74; 95% CI: 0.72, 0.75) and HRS (AUC = 0.74; 95% CI: 0.73, 0.75). By means of GMM, four latent classes were identified in ELSA and five in HRS. Chronic conditions, no qualification and low level of household wealth were associated to the classes which showed a higher mortality in both studies.Conclusion: The method based on the creation of a common metric of health and the use of GMM to identify similar patterns of aging, allows for the comparison of trajectories of health across longitudinal surveys. Multimorbidity, educational level, and household wealth could be considered as determinants associated to these trajectories. [ABSTRACT FROM AUTHOR]

Purpose: Developing valid and reliable instruments that can be used across countries is necessary. The present study aimed to test the comparability of quality of life scores across three European countries (Finland, Poland, and Spain).Method: Data from 9987 participants interviewed between 2011 and 2012 were employed, using nationally representative samples from the Collaborative Research on Ageing in Europe project. The WHOQOL-AGE questionnaire is a 13-item test and was employed to assess the quality of life in the three considered countries. First of all, two models (a bifactor model and a two-correlated factor model) were proposed and tested in each country by means of confirmatory factor models. Second, measurement invariance across the three countries was tested using multi-group confirmatory factor analysis for that model which showed the best fit. Finally, differences in latent mean scores across countries were analyzed.Results: The results indicated that the bifactor model showed more satisfactory goodness-of-fit indices than the two-correlated factor model and that the WHOQOL-AGE questionnaire is a partially scalar invariant instrument (only two items do not meet scalar invariance). Quality of life scores were higher in Finland (considered as the reference category: mean = 0, SD = 1) than in Spain (mean = - 0.547, SD = 1.22) and Poland (mean = - 0.927, SD = 1.26).Conclusions: Respondents from Finland, Poland, and Spain attribute the same meaning to the latent construct studied, and differences across countries can be due to actual differences in quality of life. According to the results, the comparability across the different considered samples is supported and the WHOQOL-AGE showed an adequate validity in terms of cross-country validation. Caution should be exercised with the two items which did not meet scalar invariance, as potential indicator of differential item functioning. [ABSTRACT FROM AUTHOR]

Purpose: Gender-related differences in life expectancy, prevalence of chronic conditions and level of disability in the process of ageing have been broadly described. Less is known about social determinants, which may have different impacts on quality of life in men and women. The investigation aims to reveal gender-related differences in social determinants on quality of life assessed by a multi-pathway model including health, social, demographic and living place characteristics.Methods: The study group consisted of 5099 participants aged 50+ representing general populations of three different European regions (Finland, Poland, Spain) who participated in COURAGE in EUROPE Project. Standardized tools were used to measure quality of life (WHOQOL-AGE) and social determinants (COURAGE Social Network Index, OSLO-3 Social Support Scale, UCLA Loneliness Scale, participation scale and trust). A multipath model considering exogenous predictors (demographic, economic), mediators (social) and endogenous outcome (QOL) was created to reveal the role of determinants. Gender-related differences were investigated across three age categories: 50-64; 65-79 and 80+.Results: The model (RMSEA = 0.058; CFI = 0.939) showed the effects of all of the investigated determinants. Gender-related differences in the association between social constructs and QOL were observed for social networks in the group of 80+, for social support in the group of 50-64 and 65-79 years, and for social participation in the group of 65-79 years. Males benefited more (in QOL) from social networks and social support, and women from social participation.Conclusions: The research provides valuable knowledge about the role of social determinants in QOL considering complex relations between different social constructs. Additionally, the results showed gender-related differences in the associations between social networks, social support, social participation and QOL, suggesting that men might benefit more from the interventions in the first two. Although our research did not investigate the effects of interventions, the results show directions for future investigations, how to shape social interventions at the population level to improve quality of life of older adults, and thus help achieve successful ageing. [ABSTRACT FROM AUTHOR]

Ageing is a dynamic process, and trends in the health status of older adults aged at least 60 years vary over time because of several factors. We examined reported trends in morbidity and mortality in older adults during the past two decades to identify patterns of ageing across the world. We showed some evidence for compression of morbidity (ie, a reduced amount of time spent in worse health), in four types of studies: 1) of good quality based on assessment criteria scores; 2) those in which a disability-related or impairment-related measure of morbidity was used; 3) longitudinal studies; or 4) studies undertaken in the USA and other high-income countries. Many studies, however, reported contrasting evidence (ie, for an expansion of morbidity), but with different methods, these measures are not directly comparable. Expansion of morbidity was more common when trends in chronic disease prevalence were studied. Our secondary analysis of data from longitudinal ageing surveys presents similar results. However, patterns of limitations in functioning vary substantially between countries and within countries over time, with no discernible explanation. Data from low-income countries are very sparse, and efforts to obtain information about the health of older adults in less-developed regions of the world are urgently needed. We especially need studies that focus on refining measurements of health, functioning, and disability in older people, with a core set of domains of functioning, that investigate the effects of these evolving patterns on the health-care system and their economic implications. [ABSTRACT FROM AUTHOR]

Background: In Ghana, the older adult population is projected to increase from 5.3% of the total population in 2015 to 8.9% by 2050. National and local governments will need information about non-communicable diseases (NCDs) in this population in order to allocate health system resources and respond to the health needs of older adults. Design: The 2007/08 Study on global AGEing and adult health (SAGE) Wave 1 in Ghana used face-to-face interviews in a nationally representative sample of persons aged 50-plus years. Individual respondents were asked about their overall health, diagnosis of 10 chronic non-communicable conditions, and common health risk factors. A number of anthropometric and health measurements were also taken in all respondents, including height, weight, waist and hip circumferences, and blood pressure (BP). Results: This paper includes 4,724 adults aged 50-plus years. The highest prevalence of self-reported chronic conditions was for hypertension [14.2% (95% CI 12.815.6)] and osteoarthritis [13.8%, (95% CI 11.715.9)]. The figure for hypertension reached 51.1% (95% CI 48.953.4) when based on BP measurement. The prevalence of current smokers was 8.1% (95% CI 7.09.2), while 2.0 (95% CI 1.52.5) were infrequent/ frequent heavy drinkers, 67.9% (95% CI 65.270.5) consume insufficient fruits and vegetables, and 25.7% (95% CI 23.128.3) had a low level of physical activity. Almost 10% (95% CI 8.311.1) of adults were obese and 77.6% (95% CI 76.079.2) had a high-risk waist-to-hip ratio (WHR). Risks from tobacco and alcohol consumption continued into older age, while insufficient fruit and vegetable intake, low physical activity and obesity increased with increasing age. The patterns of risk factors varied by income quintile, with higher prevalence of obesity and low physical activity in wealthier respondents, and higher prevalence of insufficient fruit and vegetable intake and smoking in lower-income respondents. The multivariate analysis showed that only urban/rural residence and body mass index (BMI) were common determinates of both self-reported and measured hypertension, while all other determinants have differing patterns. Conclusions: The findings show a high burden of chronic diseases in the older Ghanaian population, as well as high rates of modifiable health risk factors. The government could consider targeting these health behaviors in conjunction with work to improve enrolment rates in the National Health Insurance Scheme. [ABSTRACT FROM AUTHOR]

Introduction: Women represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women. Methods: World Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into "disabled" vs. "not disabled". We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the "explained" part that arises because of differences between males and females in terms of age and social and economic characteristics, and an "unexplained" part attributed to the differential effects of these characteristics. Results: Prevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants. Conclusions: There is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify latent groups of similar trajectories in processing speed through aging, as well as factors that are associated with these trajectories. In the context of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project, data from the English Longitudinal Study of Aging (ELSA) (n = 12099) were analyzed. Latent groups of similar trajectories in the processing scores as well as their predictors and covariates were investigated, using group-based trajectory models (GBTM). The coefficient estimates for potential group predictors correspond to parameters of multinomial logit functions that are integrated in the model. Potential predictors included sex, level of education, marital status, level of household wealth, level of physical activity, and history of smoking, while time-varying covariates included incidence of cardiovascular disease (CVD), diabetes mellitus, depressive symptoms, and sleep disturbances. Four trajectories were identified and named after their baseline scores and shapes: High (4.4%), Middle/Stable (31.5%), Low/Stable (44.5%), and Low Decline (19.6%). Female sex, higher levels of education, mild level of physical activity, having been married, and higher level of wealth were associated with a higher probability of belonging to any of the higher groups compared to the Low/Decline that was set as reference, while presence of CVD, diabetes mellitus, and depressive symptoms were associated with lower processing speed scores within most trajectories. All the aforementioned factors might be valid targets for interventions to reduce the burden of age-related cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Low socio-economic status (SES) has been found to be associated with a higher prevalence of depression. However, studies that have investigated this association have been limited in their national scope, have analyzed different components of SES separately, and have not used standardized definitions or measurements across populations. The aim of the current study was to evaluate the association between SES and depression across three European countries that represent different regions across Europe, using standardized procedures and measurements and a composite score for SES.Method: Nationally-representative data on 10,800 individuals aged ≥18 from the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland and Spain were analyzed in this cross-sectional study. An adapted version of the Composite International Diagnostic Interview was used to identify the presence of depression, and SES was computed by using the combined scores of the total number of years educated (0-22) and the quintiles of the country-specific income level of the household (1-5). Multivariable logistic regression was used to assess the association between SES and depression.Results: Findings reveal a significant association between depression and SES across all countries (p ≤ 0.001). After adjusting for confounders, the odds of depression were significantly decreased for every unit increase in the SES index for Finland, Poland and Spain. Additionally, higher education significantly decreased the odds for depression in each country, but income did not.Conclusion: The SES index seems to predict depression symptomatology across European countries. Taking SES into account may be an important factor in the development of depression prevention strategies across Europe. [ABSTRACT FROM AUTHOR]

Abstract: We compared prevalence estimates of self-rated health (SRH) derived indirectly using four different small area estimation methods for the Vadu (small) area from the national Study on Global AGEing (SAGE) survey with estimates derived directly from the Vadu SAGE survey. The indirect synthetic estimate for Vadu was 24% whereas the model based estimates were 45.6% and 45.7% with smaller prediction errors and comparable to the direct survey estimate of 50%. The model based techniques were better suited to estimate the prevalence of SRH than the indirect synthetic method. We conclude that a simplified mixed effects regression model can produce valid small area estimates of SRH. [Copyright &y& Elsevier]