Objectives

To examine the prospective association between kidney function and three outcomes: survival to age 85 with functional independence, survival to age 85 with disability, and death before age 85.

Design

Prospective study.

Setting

Women's Health Initiative, conducted at 40 U.S. clinical centers.

Participants

Postmenopausal women enrolled between 1993 and 1998 with baseline biomarker assessments who had the potential to reach age 85 before September 2013 (N = 7,178).

Measurements

Kidney function was measured according to estimated glomerular filtration rate (eGFR) calculated from serum creatinine collected at baseline. Outcomes were survival to age 85 with functional independence, survival with disability, or death before age 85. Disability was defined as mobility or activity of daily living limitations measured by questionnaire.

Results

eGFR was greater than 90 mL/min per 1.73 m² in 22.7% of women, 60 to 89 mL/min per 1.73 m² in 66.5%, 45 to 59 mL/min per 1.73 m² in 8.7%, and less than 45 mL/min per 1.73 m² in 2.0%. Median follow-up was 15 years. Of 4,953 survivors, 3,155 reported no physical disability at age 85. Two thousand two hundred twenty-five participants died before age 85. Women with an eGFR of 90 mL/min per 1.73 m² or greater had 2.71 times greater odds of survival to age 85 with functional independence than of dying before 85 (95% confidence interval (CI) = 1.62-4.51) than those with an eGFR less than 45 mL/min per 1.73 m² , women with an eGFR of 60 to 89 mL/min per 1.73 m² had 3.04 times (95% CI = 1.85-5.00) greater odds, and women with an eGFR of 45 to 59 mL/min per 1.73 m² had 2.22 times (95% CI = 1.31-3.76) greater odds. Similar, but slightly weaker odds were seen for survival to age 85 with disability. Better kidney function was not significantly associated with greater likelihood of survival to age 85 with independent function than of surviving with disability.

Conclusion

Better kidney function was associated with greater likelihood of survival to age 85 with and without disability.

Background

Some accelerometer studies ask participants to document in a daily log when the device was worn. These logs are used to inform the window of consecutive days to extract from the accelerometer for analysis. Logs can be missing or inaccurate, which can introduce bias in the data. To mitigate this bias, we developed a simple computer algorithm that used data within the accelerometer to identify the window of consecutive wear days. To evaluate the algorithm's performance, we compared how well it agreed to the window of days identified by visual inspection and participant logs.

Findings

Participants were older women (mean age 79 years) in a cohort study that aimed to examine the relationship of objective physical activity on cardiovascular health. The study protocol requested that participants wear an accelerometer 24 h per day over nine calendar days (to capture seven consecutive wear days) and to complete daily logs. A stratified sample with (n = 75) and without (n = 100) participant logs were selected. The Objective Physical Activity and Cardiovascular Health (OPACH) algorithm was applied to the accelerometer data to identify a window of up to seven consecutive wear days. Participant logs documented dates the device was first put on, worn, and removed. Using pre-established guidelines, two independent raters visually reviewed the accelerometer data and characterized the dates representing up to seven consecutive days of 24-h wear. Average agreement level between the two raters was 90%. The percent agreement was compared between the three methods. The OPACH algorithm and visual inspection had 83% agreement in identifying a window with the same total number of days, if one or more shifts in calendar dates were allowed. For visual inspection vs. logs and algorithm vs. logs, this agreement was 81 and 74%, respectively.

Conclusion

The OPACH algorithm can be efficiently and readily applied in large-scale accelerometer studies for the identification of a window of consecutive days of accelerometer wear. This algorithm was comparable to visual inspection and participant logs and might provide a quicker and more cost-effective alternative to selecting which data to extract from the accelerometer for analysis.

Trial registration

clinicaltrials.gov identifier: NCT00000611.

Background

A better understanding of medically centered outcomes, such as physical function, for older women with multiple chronic conditions is a national public health priority.

Methods

The prevalence of multimorbidity (defined as having 2 chronic conditions from a list of 12) and comorbidity with coronary disease (CHD) were calculated for 33,386 women who were enrolled in the Women's Health Initiative since 1993-1998 and were ≥ 80 years old by mid-September 2012. Associations between multimorbidity and CHD comorbidity on RAND-36 physical function scores were estimated using linear regression models.

Results

The prevalence of multimorbidity in this sample was 59%. Women with 0-1 chronic condition had a mean physical function score of 74 (95% confidence interval [CI]: 73, 74). Relative decrements in physical function scores were -8 (95% CI: -8, -7), -13 (95% CI: -14, -12) and -19 (95% CI: -20, -18) in women with 2, 3, and ≥ 4 chronic conditions, respectively. Women with CHD in combination with hip fractures or cognitive impairment had the largest adjusted decreases in physical function scores compared to the scores for women with CHD only. The impact of select characteristics on physical function scores between multimorbid and non-multimorbid women were similar; however, overall mean physical functions scores were lower for women with multmorbidity.

Conclusions

Multimorbidity profoundly impacted physical functioning in women aged more than 80 years. Modifiable risk factors, such as obesity and physical activity, were similar in older women regardless of multimorbidity status and provide targets for health interventions aimed at preventing loss of late-age physical functioning.

Purpose of the study

To compare the number of chronic conditions among a list of 12 and their association with physical function among postmenopausal non-Veteran and Veteran women with diabetes.

Design and methods

Among women with diabetes from the Women's Health Initiative, we compared the average number of chronic conditions between non-Veterans and Veterans and the association between total number of chronic conditions on subsequent RAND-36 physical function. To examine associations between each condition and subsequent physical function, we compared women with diabetes plus one chronic condition to women with diabetes alone using linear regression in separate models for each condition and for non-Veterans and Veterans.

Results

Both non-Veterans (N = 23,542) and Veterans (N = 618) with diabetes had a median of 3 chronic conditions. Decreases in physical function for each additional condition were larger among Veterans than non-Veterans (-6.3 vs. -4.1 points). Decreases in physical function among women with diabetes plus one chronic condition were greater than that reported for diabetes alone for all combinations and were more pronounced among Veterans (non-Veterans: -11.1 to -24.2, Veterans: -16.6 to -40.4 points). Hip fracture, peripheral artery disease, cerebrovascular disease, and coronary disease in combination with diabetes were associated with the greatest decreases in physical function.

Implications

Chronic conditions were common among postmenopausal women with diabetes and were associated with large declines in physical function, particularly among Veterans. Interventions to prevent and reduce the impact of these conditions and facilitate coordination of care among women with diabetes may help them maintain physical function.

Background

the factors that moderate decline in physical functioning as death approaches are understudied. This study aimed to assess death-related decline in global quality of life (QoL) and physical functioning and to test whether baseline QoL moderates terminal decline in physical functioning.

Methods

four thousand six hundred and fifty-one decedents from the Women's Health Initiative Study (WHI) rated QoL and physical functioning each year throughout 5 years of follow-up.

Results

both QoL and physical functioning showed a steeper decline as a function of years to death than as a function of chronological age. Moreover, decedents with higher QoL at baseline showed a less steep decline in physical functioning as death approached than those with lower QoL at baseline.

Conclusion

although QoL strongly decreases across the terminal years, its beneficial influence on physical functioning is evident till the very end of life.

Purpose of the study

Postmenopausal osteoporosis can impact quality-of-life even prefracture. To determine whether osteoporosis should be a greater concern in women Veterans versus non-Veterans, we compared fracture rates and bone mineral density (BMD) for Veterans and non-Veterans using Women's Health Initiative data.

Design and methods

In this cohort study, participants were women aged 50-79 years. Outcomes were hip, central body, and limb fractures occurring during up to 19 years of follow-up and hip, spine, and whole body BMD collected three times over a 6-year period in a participant subsample. Covariates comprised risk factors for fracture, including fall history and other components of the World Health Organization Fracture Risk Assessment Tool (FRAX). Cox Proportional Hazards models were used to examine fracture rates for Veterans compared with non-Veterans.

Results

Of 161,808 women, 145,521 self-identified as Veteran (n = 3,719) or non-Veteran (n = 141,802). Baseline FRAX scores showed that Veterans had higher 10-year probabilities for any major fracture (13.3 vs 10.2; p < .01) and hip fracture (4.1 vs 2.2; p < .01) compared with non-Veterans. The age-adjusted rate of hip fracture per 1,000 person-years for Veterans was 3.3 versus 2.4 for non-Veterans (p < .01). After adjustment, the hazards ratio for hip fracture was 1.24 (95% confidence interval 1.03-1.49) for Veterans versus non-Veterans. Hazards ratios at other anatomic sites did not differ by Veteran status. Mean BMD at baseline and at Years 3 and 6 also did not differ by Veteran status at any site.

Implications

Women Veterans had an increased hip fracture rate not explained by differences in well-recognized fracture risk factors.

Background

Aspects of eudaimonic well-being, such as personal growth (PG) and purpose in life (PL), have been highlighted as important to older adults' health. We investigated the relationship of PG and PL with patterns of survival to the age of 85 years and older.

Methods

The sample included 8,880 women from the Women's Health Initiative cohort who reached 85 years of age by December 1, 2013, and for whom data on the PG and PL constructs were available. Women were classified into mutually exclusive outcomes: Healthy, Prevalent, Incident, Disabled, and Deceased. PG and PL were each assessed using a modified seven-item measure derived from the Psychological Well-Being scale.

Results

Women were most commonly classified as Healthy (38.2%, n = 3,395), followed by Incident (24.4%, n = 2,163), Disabled (19.0%, n = 1,685), Prevalent (14.3%, 1,273), and Deceased (4.1%, n = 364). Women with low PL and PG levels were more likely to have prevalent mobility disability and disease or incident death before the age of 85 years. Specifically, those who reported low levels of PG and PL had a 2.1- and 3.6-fold higher risk, respectively, of death.

Conclusions

These findings indicate that even among the oldest old, experience of purposeful life engagement and continuing PG may contribute to better health outcomes.

Background

Whether physical activity (PA) and sedentary behavior influence the odds of women living to age 85 years without chronic disease or disability is not well described.

Methods

Participants of the Women's Health Initiative (n = 49,612) were categorized based on health status by age 85 years: (i) lived without developing major chronic disease or mobility disability ("healthy"); (ii) lived and developed mobility disability with or without disease; (iii) lived and developed major chronic disease, but not mobility disability; and (iv) died before their 85th birth year. Multinomial logistic regression models that adjusted for covariates such as age, race/ethnicity, and body size estimated associations of self-reported PA and sitting time on developing major disease or mobility disability or dying before age 85 relative to being healthy.

Results

Mean ± SD baseline age was 70.2 ± 3.6 years. Distributions were: 22% healthy, 23% had mobility disability, 26% had major disease, and 29% died. Relative to those with high total PA, the adjusted odds ratios (OR) (confidence intervals [CI]) for mobility disability was 1.6 (1.4-1.7), 1.2 (1.1-1.3), and 1.1 (1.0-1.2) for women with no, low, and moderate total PA, respectively (p-trend < .001). The corresponding covariate-adjusted OR (CI) for mortality was 1.7 (1.5-1.8), 1.2 (1.1-1.3), and 1.0 (1.0-1.1) (p-trend < .001). Total PA was not associated with developing chronic disease before age 85 years. Sitting ≥10 relative to <5 hours per day increased the odds of mobility disability (1.1, CI: 1.0-1.3) and mortality (1.2, CI: 1.0-1.3) prior to age 85 years (p < .001).

Conclusions

Increasing PA to recommended levels and reducing sitting time are modifiable behaviors that may improve healthy aging in older women.

Objective

We conducted a laboratory-based calibration study to determine relevant cutpoints for a hip-worn accelerometer among women ≥60 years, considering both type and filtering of counts.

Methods

Two hundred women wore an ActiGraph GT3X+ accelerometer on their hip while performing eight laboratory-based activities. Oxygen uptake was measured using an Oxycon portable calorimeter. Accelerometer data were analyzed in 15-second epochs for both normal and low frequency extension (LFE) filters. Receiver operating characteristic (ROC) curve analyses were used to calculate cutpoints for sedentary, light (low and high), and moderate to vigorous physical activity (MVPA) using the vertical axis and vector magnitude (VM) counts.

Results

Mean age was 75.5 years (standard deviation 7.7). The Spearman correlation between oxygen uptake and accelerometry ranged from 0.77 to 0.85 for the normal and LFE filters and for both the vertical axis and VM. The area under the ROC curve was generally higher for VM compared to the vertical axis, and higher for cutpoints distinguishing MVPA compared to sedentary and light low activities. The VM better discriminated sedentary from light low activities compared to the vertical axis. The area under the ROC curves were better for the LFE filter compared to the normal filter for the vertical axis counts, but no meaningful differences were found by filter type for VM counts.

Conclusion

The cutpoints derived for this study among women ≥60 years can be applied to ongoing epidemiologic studies to define a range of physical activity intensities.

Background

We examined associations of sedentary time and sedentary accumulation patterns (ie, how sedentary time is accumulated) with prevalent diabetes in an ethnically diverse cohort of older women.

Methods

Community-dwelling women aged 63-99 (n = 6,116; median age = 79) wore ActiGraph GT3X+ accelerometers 24 h/day for up to 7 days from which we derived average daily sedentary time and three measures of sedentary accumulation patterns: breaks in sedentary time, usual sedentary bout duration, and alpha. Odds ratios (ORs) and 95% confidence intervals (CIs) for prevalent diabetes were estimated using multivariable logistic regression.

Results

Twenty-one percent (n = 1,282) of participants had diabetes. Women in the highest quartile of sedentary time (≥10.3 h/day) had higher odds of diabetes (OR = 2.18; 95% CI = 1.77-2.70) than women in the lowest quartile (≤8.3 h/day). Prolonged accumulation patterns (ie, accumulating sedentary time in longer sedentary bouts) was associated with higher odds of diabetes than regularly interrupted patterns (comparing quartiles with the most vs least prolonged patterns: usual bout duration OR = 1.57, 95% CI = 1.28-1.92; alpha OR = 1.61, 95% CI = 1.32-1.97); however, there was no significant association for breaks in sedentary time (OR = 1.00, 95% CI = 0.82-1.20).

Conclusions

High levels of sedentary time and accumulating it in prolonged patterns were associated with increased odds of diabetes among older women.