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Ageing of the population, together with population growth, has brought along an ample increase in the number of older individuals living with dementia and disabilities. Dementia is the main cause of disability in old age, and promoting healthy brain ageing is considered as a key element in diminishing the burden of age‐related disabilities. The World Health Organization recently launched the first risk reduction guidelines for cognitive impairment and dementia. According to recent estimates, approximately 40% of dementia cases worldwide could be attributable to 12 modifiable risk factors: low education; midlife hypertension and obesity; diabetes, smoking, excessive alcohol use, physical inactivity, depression, low social contact, hearing loss, traumatic brain injury and air pollution indicating clear prevention potential. Dementia and physical disability are closely linked with shared risk factors and possible shared underlying mechanisms supporting the possibility of integrated preventive interventions. FINGER trial was the first large randomized controlled trial indicating that multidomain lifestyle‐based intervention can prevent cognitive and functional decline amongst at‐risk older adults from the general population. Within the World‐Wide FINGERS network, the multidomain FINGER concept is now tested and adapted worldwide proving evidence and tools for effective and easily implementable preventive strategies. Close collaboration between researchers, policymakers and healthcare practitioners, involvement of older adults and utilization of new technologies to support self‐management is needed to facilitate the implementation of the research findings. In this scoping review, we present the current scientific evidence in the field of dementia and disability prevention and discuss future directions in the field.

Background Walking forms a large portion of physical activity (PA) of older adults. We assessed free-living PA using acceleration corresponding to preferred walking speed as a relative cut-point and studied how it relates to age. We compared the relative cut-point to a common absolute cut-point of moderate-to-vigorous physical activity (MVPA). Method Four hundred forty-four community-dwelling adults aged 75, 80, and 85 years wore an accelerometer on the thigh during a PA surveillance period and a modified 6-minute walking test (6MWT) at preferred speed. Each individual’s mean acceleration (g) during the 6MWT was used as a cut-point for relative PA. Acceleration corresponding to three metabolic equivalents (METs) was used as the cut-point for absolute MVPA. Results When using the acceleration of preferred walking speed as a cut-point, 62 (SD 82) minutes a week of relative PA was detected, compared to 228 (163) minutes of absolute MVPA. For 96% of the participants, the acceleration generated by their preferred walking speed exceeded the common absolute cut-point for MVPA. Absolute MVPA was lower in the older age groups, and 6MWT speed explained 22% of its variation (p < .001), whereas relative PA was independent of walking speed and age. Conclusions Preferred walking speed was a significant contributor to absolute MVPA and those who walked the slowest accumulated the least MVPA. Assessing relative PA using the intensity of preferred walking speed as a cut-point eliminated the dependency of PA on age and walking speed, and may be a feasible scaling option to evaluate relative PA among older people.

Background The oldest old is the fastest growing age group worldwide and the most prone to severe disability, especially in relation to loss of cognitive function. Improving our understanding of the predictors of cognitive, physical and psychosocial wellbeing among the oldest old can result in substantial benefits for the individuals and for the society as a whole. The Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study investigated risk factors and determinants of cognitive impairment in a population-based longitudinal cohort, which was first examined between 1972 and 1992, when individuals were in their midlife, and re-assessed in 1998 and 2005–2009. Most of the study participants are currently aged 85 years or older. We aim to re-examine the cohort’s survivors and gain further insights on the mechanisms underlying both cognitive and overall healthy ageing at old age. Methods CAIDE85+ is the third follow-up of the CAIDE study participants. All individuals still alive and living in the Kuopio and Joensuu areas of Eastern Finland, from the original CAIDE cohort (two random samples, N = 2000 + ~ 900), will be invited to a re-examination. The assessment includes self-reported data related to basic demographics and lifestyle, as well as psychosocial and physical health status. Cognitive and physical evaluations are also conducted. Blood biomarkers relevant for dementia and ageing are assessed. Primary outcomes are the measurements related to cognition and daily life functioning (CERAD, Trail Making Test-A, Letter-Digit Substitution Test, Clinical Dementia Rating and Activities of Daily Living). Secondary endpoints of the study are outcomes related to physical health status, psychosocial wellbeing, as well as age-related health indicators. Discussion Through a follow-up of more than 40 years, CAIDE85+ will provide invaluable information on the risk and protective factors that contribute to cognitive and physical health, as well as ageing and longevity. Study registration The present study protocol has been registered at https://clinicaltrials.gov/ (registration nr NCT03938727 , date 03.05.2019).

BACKGROUND Both obesity and underweight are associated with impaired physical functioning, but related information on the oldest old population is scarce. Our purpose was to examine whether body mass index, waist circumference (WC), and their combination are associated with physical performance and activities of daily living (ADL) disability in 90-year-old women and men. METHODS Data are from the Vitality 90+ Study, which is a population-based study of persons with age ≥90 years living in the area of Tampere, Finland. Altogether 416 women and 153 men, aged 90-91 years, provided data on body mass index, WC, chair stand, and Barthel Index. Comorbidity, physical exercise, smoking history, living residence, and sample year were used as covariates in multinomial logistic and logistic regression models. RESULTS Women in the highest WC tertile had lower physical performance and were more likely unable to perform the chair stand than women in the lowest WC tertile. Women in the highest WC tertile were also more likely to have ADL disability, compared to the lowest WC tertile. In women, overweight and obesity were associated with ADL disability, but not when WC was included in the model. Men with body mass index ≥25 kg/m(2) and WC < sex-specific median were less likely to have ADL disability. Similarly classified women were less likely to have low performance or unable to perform chair stand (marginally significant). CONCLUSIONS High WC in the oldest old women, but not in men, is associated with both poor physical performance and ADL disability.

Increased proinflammatory status is associated with both increased adiposity and higher mortality risk. Thus, it is paradoxical that mild obesity does not predict increased mortality in older adults. We investigated the association of inflammatory markers with body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) in nonagenarians, and the combined effects of BMI, WC, WHR, and inflammatory status on mortality.This study was based on a prospective population-based study, Vitality 90+, carried out in Tampere, Finland. Altogether, 157 women and 53 men aged 90 years were subjected to anthropometric measurements, blood samples, and a 4-year mortality follow-up. Inflammatory status was based on sex-specific median levels of interleukin-1 receptor antagonist (IL-1RA), interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α).In the unadjusted linear regression analyses, IL-1RA, CRP, and TNF-α were positively associated with BMI and WC in women, whereas in men IL-1RA was positively associated with BMI and IL-6 positively with WC. In the models adjusted for diseases, functional status, and smoking, IL-1RA and CRP were positively associated with BMI and WC in women. Low WC and WHR combined with low inflammation protected from mortality in women and high BMI and WC regardless of inflammation protected from mortality in men in the adjusted Cox regression analysis.In the oldest old, the effect of adiposity in combination with inflammatory status on mortality differs between men and women. More research is needed to disentangle the role of adiposity among the oldest old.

Background Only scarce data exist on the association between obesity and disability in the oldest old. The purpose of this prospective study is to examine if body mass index and waist circumference (WC) are associated with incident mobility and activities of daily living (ADL) disability in nonagenarians. Methods We used longitudinal data from the Vitality 90+ Study, which is a population-based study conducted at the area of Tampere, Finland. Altogether 291 women and 134 men, aged 90-91 years, had measured data on body mass index and/or WC and did not have self-reported mobility or ADL disability at baseline. Incident mobility and ADL disability was followed-up on median 3.6 years (range 0.6-7.8 years). Mortality was also followed-up. Multinomial logistic regression models were used for the analyses, as death was treated as an alternative outcome. The follow-up time was taken into account in the analyses. Results Neither low or high body mass index, nor low or high WC, were associated with incident mobility disability. In women, the lowest WC tertile (

Background. The associations of body mass index (BMI) and abdominal obesity with mortality among very old people are poorly known. The purpose of this study was to investigate the association of BMI, waist circumference (WC), and waist-to-hip ratio with mortality in nonagenarians. Methods. This study is part of a prospective population-based study, Vitality 90+, including both community-dwelling and institutionalized persons from Tampere, Finland. Altogether 192 women and 65 men aged 90 years were subjected to anthropometric measurements, a baseline interview, and a 4-year mortality follow-up. Cox proportional hazards models were used in the statistical analyses. Results. In men, normal weight indicated a three times higher mortality risk (hazard ratio [HR] 3.09, 95% confidence interval [CI] 1.35–7.06) compared with overweight, and WC was inversely associated with mortality (HR 0.96, 95% CI 0.93–1.00) after adjustment for covariates. In women, the univariate waist-to-hip ratio (HR 1.43, 95% CI 1.06–1.92) and BMI-adjusted waist-to-hip ratio (HR 1.45, 95% CI 1.07–1.97) were positively associated with mortality. Also, overweight women whose WC was

Myostatin decreases muscle mass and this is accomplished, in part, by inhibiting muscle satellite cell proliferation and differentiation by regulating the expression of cell cycle-related proteins (e.g. p21 and cdk2) and myogenic regulatory factors (e.g. myogenin and MyoD). The purpose of this investigation was to determine whether protein ingestion before and after a resistance exercise (RE) bout affects myostatin and cell cycle-related gene expression. Strength-trained middle-aged to older men were divided into a protein group (61.4 +/- 4.3 years, n = 9) or a placebo group (62.1 +/- 4.2 years, n = 9). Muscle biopsies from the vastus lateralis muscle were taken at rest and 1 and 48 h after a 5 x 10 repetition leg press RE bout. Protein (15 g whey) or non-caloric placebo was taken immediately before and after the RE bout. mRNA expression levels of myostatin and related genes (AcvrIIb, FLRG, p21, p27, cdk2, myogenin and MyoD) were determined by Taqman probe-based real-time RT-PCR and normalized to GAPDH mRNA. Myostatin mRNA decreased after a RE bout, but only in the placebo group (P < or = 0.05). Conversely, myostatin-binding protein FLRG and cell-cycle kinase cdk2 mRNA increased only in the protein group (P < or = 0.05). p21 mRNA was increased at 1 h post-RE in placebo (P < or = 0.05) and tended to be increased in the protein group (P = 0.08). Myostatin, its binding protein and cell cycle-related gene expressions are affected by single RE bout and these responses are further modified by whey protein intake. Therefore, controlling nutrition intake is important when studying gene expression responses to exercise.

Data on how body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) are associated with body fat in the oldest-old people are scarce. The purpose of this study was to examine if BMI, WC or WHR are associated with leptin, a biological surrogate measure of body fat in 90-year-old people. The data comes from the Vitality 90+ Study, a prospective population-based study of people living in Tampere, Finland. BMI, WC, WHR and plasma concentration of leptin were available for 160 women and 54 men aged 90 years. BMI and WC had a strong significant positive association with leptin both in women and in men, but WHR was associated with leptin only in men. In conclusion, based on the circulating level of leptin, BMI and WC, and WHR in men, reflect body fat in 90-year-old people, but WHR seems to be a poor indicator of body fat in 90-year-old women.